Category: Nevin Manimala

Adv Skin Wound Care. 2023 Apr 1;36(4):201-204. doi: 10.1097/01.ASW.0000919480.14665.e7.

ABSTRACT

OBJECTIVE: To determine (1) if offloading with a felt foot plate heals a diabetic foot ulcer, (2) the rate of healing with the felt foot plate, and (3) the impact on rate of healing from the confounding factors of patient weight and growth factors on healing times.

METHODS: The researchers conducted a retrospective chart cohort review over 3 years.

RESULTS: Using a multivariable linear and logistic regression model, the data showed a statistically significant reduction in the diabetic foot ulcer area over time. Confounding factors of patient weight and growth factors did not impact healing times.

CONCLUSIONS: Offloading a diabetic foot ulcer with a felt foot plate is adequate for healing.

PMID:36940376 | DOI:10.1097/01.ASW.0000919480.14665.e7

J Clin Ethics. 2023 Spring;34(1):103-109. doi: 10.1086/723321.

ABSTRACT

AbstractPurpose: Tolerance for ambiguity (TFA) is a character trait that is associated with a multitude of benefits for physicians, including increased empathy, greater desire to work in underserved areas, fewer medical errors, enhanced psychological well-being, and lower rates of burnout. Furthermore, it has been shown that TFA is a malleable trait that can be enhanced with interventions such as art courses and group reflection. This study describes the utility of a six-week medical ethics elective course in increasing TFA in first- and second-year medical students.Methods: First- and second-year medical students were enrolled in an elective medical ethics course at Cooper Medical School of Rowan University that guided students in critical thinking, group discussion, and respectful debate regarding various ethical dilemmas in medicine. Students took a validated survey before and after course completion to measure TFA. The average pre- and post-course scores for each semester, as well as the total cohort of 119 students, were compared using paired t-tests.Results: A statistically significant improvement in TFA scores was observed in the overall cohort, as well as in each individual semester of the medical ethics elective course offering.Conclusion: A six-week elective course in medical ethics can significantly improve medical students’ TFA.

PMID:36940358 | DOI:10.1086/723321

Proc Natl Acad Sci U S A. 2023 Mar 28;120(13):e2214382120. doi: 10.1073/pnas.2214382120. Epub 2023 Mar 20.

ABSTRACT

The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) matter for older people in taking on precautionary behaviors (e.g., wearing a mask) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June to September 2020 and June to August 2021) with pre-COVID information (October 2019 to March 2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance and to accounting for coresidence with kin. Our findings suggest that policymakers and practitioners may differently address kinless individuals when promoting public policy measures.

PMID:36940329 | DOI:10.1073/pnas.2214382120

Proc Natl Acad Sci U S A. 2023 Mar 28;120(13):e2221311120. doi: 10.1073/pnas.2221311120. Epub 2023 Mar 20.

ABSTRACT

Leveraging a scientific infrastructure for exploring how students learn, we have developed cognitive and statistical models of skill acquisition and used them to understand fundamental similarities and differences across learners. Our primary question was why do some students learn faster than others? Or, do they? We model data from student performance on groups of tasks that assess the same skill component and that provide follow-up instruction on student errors. Our models estimate, for both students and skills, initial correctness and learning rate, that is, the increase in correctness after each practice opportunity. We applied our models to 1.3 million observations across 27 datasets of student interactions with online practice systems in the context of elementary to college courses in math, science, and language. Despite the availability of up-front verbal instruction, like lectures and readings, students demonstrate modest initial prepractice performance, at about 65% accuracy. Despite being in the same course, students’ initial performance varies substantially from about 55% correct for those in the lower half to 75% for those in the upper half. In contrast, and much to our surprise, we found students to be astonishingly similar in estimated learning rate, typically increasing by about 0.1 log odds or 2.5% in accuracy per opportunity. These findings pose a challenge for theories of learning to explain the odd combination of large variation in student initial performance and striking regularity in student learning rate.

PMID:36940328 | DOI:10.1073/pnas.2221311120

Telemed J E Health. 2023 Mar 20. doi: 10.1089/tmj.2022.0483. Online ahead of print.

ABSTRACT

Purpose: To understand provider preferences regarding telemedicine across clinical departments and provider demographic groups. Methods: A cross-sectional online survey was distributed to providers at Johns Hopkins Medicine who had completed at least one outpatient telemedicine encounter. The survey included questions about clinical appropriateness and preferred use of telemedicine. Demographic data were obtained from institutional records. Descriptive statistics provided a profile of provider responses. Wilcoxon rank sum tests evaluated departmental and demographic differences. Results: A total of 1,342 of 3,576 providers responded (37.5%). Providers indicated that telemedicine was clinically appropriate for new patients a median of 31.5% of the time (Range: 20% in pediatrics, 80% in psychiatry/behavioral sciences). For existing patients, providers indicated that telemedicine was clinically appropriate a median of 70% of the time (Range: 50% in physical medicine, 90% in psychiatry/behavioral sciences). Providers desired a median of 30% of their schedule template be dedicated to telemedicine (Range: 20% in family medicine, 70% in psychiatry/behavioral sciences). Providers who were female, had fewer than 15 years in practice, or were psychiatrists/psychologists tended to find telemedicine more clinically appropriate (p < 0.05). Conclusions: A majority of providers across clinical departments felt that high-quality care could be delivered through telemedicine, although the amount of care varied widely based on department and patient type. Preferences for future telemedicine similarly showed wide variety across and within departments. These findings indicate that in this early adoption phase of widespread telemedicine integration, there is lack of consensus among providers about the amount of telemedicine appropriate for everyday practice.

PMID:36940314 | DOI:10.1089/tmj.2022.0483

J Agric Food Chem. 2023 Mar 20. doi: 10.1021/acs.jafc.2c08654. Online ahead of print.

ABSTRACT

In this study, the soil effect on the micro-component composition of Nero d’Avola wines obtained from different locations was investigated through ¹H NMR-based metabolomics. Two different approaches were applied: the targeted (TA) and the non-targeted one (NTA). The former differentiated the wines by profiling (i.e., by identifying and quantifying) a number of different metabolites. The latter provided wine fingerprinting by processing the entire spectra with multivariate statistical analysis. NTA also allowed investigation of the hydrogen bond network inside wines via the analysis of ¹H NMR chemical shift dispersions. Results showed that the differences among wines were due not only to the concentrations of various analytes but also to the characteristics of the H-bond network where different solutes were involved. The H-bond network affects both gustatory and olfactory perceptions by modulating the way how solutes interact with the human sensorial receptors. Moreover, the aforementioned H-bond network is also related to the soil properties from which the grapes were taken. Therefore, the present study can be considered a good attempt to investigate terroir, i.e., the relationship between wine quality and soil characteristics.

PMID:36940311 | DOI:10.1021/acs.jafc.2c08654

Spine (Phila Pa 1976). 2023 Mar 20. doi: 10.1097/BRS.0000000000004633. Online ahead of print.

ABSTRACT

STUDY DESIGN: Descriptive.

OBJECTIVE: To analyze trends in racial, ethnic, and gender diversity in orthopaedic spine surgery fellowship trainees.

SUMMARY OF BACKGROUND DATA: Orthopaedic surgery has consistently been labeled as one of the least diverse fields in Medicine. While some effort has been made to combat this in recent years at the residency level, it is uncertain if spine fellowships have had any changes in fellow demographics.

METHODS: Fellowship demographic data was collected through the Accreditation Council for Graduate Medical Education (ACGME). Data collected included gender (Male, Female, Not reported), and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007-2008 to 2020-2021. A χ2 test for trend (Cochran-Armitage test) was done to determine if there was a significant change in percentages of each race and gender during the study period. Results were considered statistically significant at P<0.05.

RESULTS: White, Non-Hispanic males represent the largest proportion of orthopaedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in representation of any race or gender of orthopaedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be underrepresented in orthopaedic spine fellowship.

CONCLUSION: Orthopaedics spine surgery fellowship programs have not made substantial progress in diversifying its population. To see progression of diversity, more attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field.

LEVEL OF EVIDENCE: 1.

PMID:36940267 | DOI:10.1097/BRS.0000000000004633

Arthritis Rheumatol. 2023 Mar 20. doi: 10.1002/art.42504. Online ahead of print.

ABSTRACT

OBJECTIVES: Gout is associated with a higher risk of fracture; however, the associations of hyperuricemia and urate-lowering therapy (ULT) with the risk of fracture have been inconsistent. We examined whether lowering serum urate (SU) levels with ULT to a target level (i.e., <360 μmol/L) reduces risk of fracture among people with gout.

METHOD: We emulated analyses of a hypothetical target trial using a “cloning, censoring, and weighting” approach to examine the association between lowering SU with ULT to the target levels and the risk of fracture using data from The Health Improvement Network, a United Kingdom primary care database. Individuals with gout who were 40 years or older and initiated ULT were included in the study.

RESULTS: Among 28,554 people with gout, the 5-year risk of hip fracture was 0.5% for the “achieving the target SU level” arm and 0.8% for “not achieving the target SU level” arm, respectively. The risk difference and hazard ratio for “achieving the target SU level” arm was -0.3% (95% confidence interval [CI]: -0.5% to -0.1%) and 0.66 (95% CI: 0.46 to 0.93), respectively, compared with “not achieving the target SU level”. Similar results were observed when the associations of lowering SU level with ULT to the target levels with the risk of composite fracture, major osteoporotic fracture, vertebral fracture, and non-vertebral fracture were assessed.

CONCLUSIONS: In this population-based study, lowering the SU level with ULT to the guideline-based target level is associated with a lower risk of incident fracture in people with gout.

PMID:36940260 | DOI:10.1002/art.42504

Spine (Phila Pa 1976). 2023 Mar 13. doi: 10.1097/BRS.0000000000004581. Online ahead of print.

ABSTRACT

STUDY DESIGN: Matched cohort comparison.

OBJECTIVE: To determine perioperative outcomes of ESP block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

SUMMARY OF BACKGROUND DATA: There is a paucity of data on the impact of lumbar erector spinae plane (ESP) block on perioperative outcomes and its safety in MI-TLIF.

METHODS: Patients who underwent 1-level MI-TLIF and received the ESP block (Group E) were included. An age- and gender-matched control group was selected from a historical cohort that received the standard of care (Group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milliequivalents (MME). Secondary outcomes were pain severity measured by numeric rating scale (NRS), opioid related side effects, and hospital length of stay (LOS). Outcomes were compared between the two groups.

RESULTS: 98 and 55 patients were included in the E and NE groups respectively. There were no significant differences amongst the two cohorts in patient demographics. Group E had lower 24hr postoperative opioid consumption (P=0.117, not significant), reduced opioid consumption on POD 0 (P=0.016), and lower first pain scores post-surgery (P<0.001). Group E had lower intraoperative opioid requirements (P<0.001), and significantly lower average NRS pain scores on postoperative day 0 (P=0.034). Group E reported fewer opioid related side effects as compared with Group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours post-procedurally were 6.9 and 7.7 in the E and NE cohorts, respectively (P=0.029). The median LOS was comparable between groups with the majority of patients in both groups being discharged on postoperative day 1.

CONCLUSIONS: In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD0 in patients undergoing MI-TLIF.

LEVEL OF EVIDENCE: III.

PMID:36940258 | DOI:10.1097/BRS.0000000000004581

Spine (Phila Pa 1976). 2023 Mar 13. doi: 10.1097/BRS.0000000000004619. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective review of prospectively collected multi-surgeon data.

OBJECTIVE: Examine the rate, clinical impact, predictors of subsidence after expandable MI-TLIF cage.

SUMMARY OF BACKGROUND DATA: Expandable cage technology has been adopted in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence.

METHODS: Patients who underwent 1 or 2 level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of>1 year were included. Preop and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by>25% compared to the immediate postoperative value. Patient reported outcomes were collected and analyzed for differences at the early (<6 mo) and late (>6 mo) timepoints. Fusion was assessed by 1-year postop CT.

RESULTS: 148 patients were included (mean age 61 y, 86% 1-level, 14% 2-level). 22 (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, lower bone mineral density, and had higher BMI and comorbidity burden. Operative time was significantly higher (P=0.02) and implant width was lower (P<0.01) for subsided patients. VAS-Leg was significantly lower for subsided patients compared to non-subsided patients at a>6 m time point. Long-term (> 6m) patient acceptable symptom state (PASS) achievement rate was lower for subsided patients (53% vs. 77%), although statistically not significant (P=0.065). No differences existed in complication, reoperation, or fusion rates.

CONCLUSIONS: 14.9% of patients experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most PROMs and complication, reoperation, or fusion rates, patients had lower VAS-Leg and PASS achievement rate at the>6-month timepoint.

LEVEL OF EVIDENCE: 4.

PMID:36940252 | DOI:10.1097/BRS.0000000000004619