Category: Nevin Manimala

Physiother Theory Pract. 2022 Oct 19:1-12. doi: 10.1080/09593985.2022.2135979. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal ultrasound (MSK-US) use for diagnostic purposes is expanding in physical therapy practice. Identifying and describing physical therapy-specific approaches to incorporating MSK-US into the evaluation process is needed. Musculoskeletal ultrasound extends the physical exam to allow clinicians to visualize anatomy and pathophysiology both statically and dynamically. Purpose: To document 1) weekly use of diagnostic MSK-US; and 2) clinical reasoning approach used in challenging patient cases by physical therapists (PTs) registered by Inteleos in musculoskeletal sonography (RMSK-certified).

METHODS: Longitudinal, observational, cohort study using mixed methods for data collection and analysis. All 23 currently RMSK-certified PTs using MSK-US in clinical practice across the United States were contacted, and 16 participated. Data were collected using an online survey created with the Research Electronic Data Capture System. Participants documented MSK-US clinical use and significant cases using weekly, reflective, online journals for three months. Demographic data were summarized using descriptive statistics. Case data were analyzed thematically.

RESULTS: Participating RMSK-certified PTs performed 1110 MSK-US examinations over 110 weeks. Clinicians averaged 7 (range 1-25) MSK-US examinations weekly, representing 28% of an average caseload. Examinations contributed significant anatomical/ pathological information 100% of the time. The most common joints scanned were the knee (n = 281), shoulder (n = 254), and wrist (n = 228). Case data revealed three themes: 1) augmenting the clinical evaluation to extend or narrow a diagnosis; 2) outcomes guiding action; and 3) lessons learned from clinical findings.

CONCLUSION: RMSK-certified PTs regularly used MSK-US to validate and refine their clinical diagnoses and treatment. Ultrasound imaging directly influenced patient care by informing the diagnostic process, guiding treatment, and appropriately identifying referrals.

PMID:36259351 | DOI:10.1080/09593985.2022.2135979

J Magn Reson Imaging. 2022 Oct 19. doi: 10.1002/jmri.28488. Online ahead of print.

ABSTRACT

BACKGROUND: Vessels encapsulating tumor clusters (VETC) pattern is a novel microvascular pattern associated with poor outcomes of hepatocellular carcinoma (HCC). Preoperative estimation of VETC has potential to improve treatment decisions.

PURPOSE: To develop and validate a nomogram based on gadoxetate disodium-enhanced MRI for estimating VETC in HCC and to evaluate whether the estimations are associated with recurrence after hepatic resection.

STUDY TYPE: Retrospective.

POPULATION: A total of 320 patients with HCC and histopathologic VETC pattern assessment from three centers (development cohort:validation cohort = 173:147).

FIELD STRENGTH/SEQUENCE: A3.0 T/turbo spin-echo T2-weighted, spin-echo echo-planar diffusion-weighted, and 3D T1-weighted gradient-echo sequences.

ASSESSMENT: A set of previously reported VETC- and/or prognosis-correlated qualitative and quantitative imaging features were assessed. Clinical and imaging variables were compared based on histopathologic VETC status to investigate factors indicating VETC pattern. A regression-based nomogram was then constructed using the significant factors for VETC pattern. The nomogram-estimated VETC stratification was assessed for its association with recurrence.

STATISTICAL TESTS: Fisher exact test, t-test or Mann-Whitney test, logistic regression analyses, Harrell’s concordance index (C-index), nomogram, Kaplan-Meier curves and log-rank tests. P value < 0.05 was considered statistically significant.

RESULTS: Pathological VETC pattern presence was identified in 156 patients (development cohort:validation cohort = 83:73). Tumor size, presence of heterogeneous enhancement with septations or with irregular ring-like structures, and necrosis were significant factors for estimating VETC pattern. The nomogram incorporating these indicators showed good discrimination with a C-index of 0.870 (development cohort) and 0.862 (validation cohort). Significant differences in recurrence rates between the nomogram-estimated high-risk VETC group and low-risk VETC group were found (2-year recurrence rates, 50.7% vs. 30.3% and 49.6% vs. 31.8% in the development and validation cohorts, respectively).

DATA CONCLUSION: The nomogram integrating gadoxetate disodium-enhanced MRI features was associated with VETC pattern preoperatively and with postoperative recurrence in patients with HCC.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

PMID:36259347 | DOI:10.1002/jmri.28488

Ann Med. 2022 Dec;54(1):2816-2827. doi: 10.1080/07853890.2022.2131326.

ABSTRACT

BACKGROUND/OBJECTIVE(S)/INTRODUCTION: In clinical practice, treatment goals are often set up without exploring what patients really want. We, therefore, collected individualised treatment goals of patients with osteoarthritis (OA), categorised and mapped them to the World Health Organisation International Classification for Functioning, Disability and Health (ICF).

PATIENTS/MATERIALS AND METHODS: A longitudinal prospective cohort study was conducted (2019-2021). We used descriptive statistics and Chi²/Fisher’s Exact Tests, where appropriate, as well as Kruskal-Wallis-Tests for the mean score ranks of the patients’ goals.

RESULTS: In total, 305 goals reported by 132 participants were analysed (267 women vs. 38 men). The top 3 ICF categories were sensation of pain (ICF:b280), mobility of joint (ICF:b710) and muscle power functions (ICF:b730). Overall, 51% of all individually reported functional goals were achieved after 3 months. Men were more likely to achieve their goals than women (p = 0.009). The majority of the “very important” goals (51%) and “very difficult” goals (57%) was not improved. Goals’ mean score ranks significantly differed between baseline and follow-up.

CONCLUSION(S): As the human lifespan as well as the number of people affected by OA worldwide increase, there is a growing need to identify and evaluate rehabilitation outcomes that are relevant to people with OA.Key MessagesTreat-to-target agreements between patients and health care providers present a step towards more personalised precision medicine, which will eventually lead to better reported functional and health outcomes.In patients with osteoarthritis, the Goal Attainment Scale instrument can be used to measure health outcomes at different time points and its content may be linked to ICF providing a unified language and conceptual scientific basis.

PMID:36259346 | DOI:10.1080/07853890.2022.2131326

Epidemiol Prev. 2022 Jul-Aug;46(4):268-272. doi: 10.19191/EP22.4.A372.075.

ABSTRACT

OBJECTIVES: to assess the occurrence of potentially inappropriate prescribing (PIP) in residents of Tuscany nursing homes (NHs) and its variation before and after NH entry.

DESIGN: retrospective observational study using data from the Regional Administrative Database of Tuscany.

SETTING AND PARTICIPANTS: the study involved residents of 67 Tuscan NHs identified between 2011 and 2012. To estimate PIP prevalence before and after NH, a subset of 10 indicators of the Screening Tool of Older Person’s Prescriptions (STOPP) criteria were selected.

MAIN OUTCOME MEASURES: prevalence of PIP. RESULTS: considering 2,801 NH residents, the proportion of PIP ranged from 0.0% to 55.2% and from 0.0% to 33.9% before and after the NH admission, respectively. Overall, this study showed a decrease in the occurrence of PIP after the NH admission for most of the indicators, reaching statistical significance for indicator 3 (tricyclic antidepressants in combination with an opiate or calcium channel blockers), 7 (prescription of NSAIDs in heart failure patients), and 9 (warfarin in combination with NSAIDs).

CONCLUSIONS: although the reduction of PIP after NH admission may suggest greater awareness about the appropriateness of drug use, more efforts still need to be made.

PMID:36259343 | DOI:10.19191/EP22.4.A372.075

Epidemiol Prev. 2022 Jul-Aug;46(4):259-267. doi: 10.19191/EP22.4.A372.074.

ABSTRACT

BACKGROUND: immigrant women diagnosed with gestational diabetes mellitus (GDM) have additional language and cultural obstacles in following lifestyle and dietary recommendations within a Western health care setting.

OBJECTIVES: to describe: • sociodemographic characteristics and dietary and lifestyle behaviours in Italian and immigrant pregnant women who underwent a GDM screening; • any differences in these aspects among GDM Italian and immigrant women; • any differences in terms of primary maternal-neonatal outcomes among GDM and normal glucose tolerance (NGT) cohorts.

DESIGN: survey.

SETTING AND PARTICIPANTS: this survey was conducted in three hospitals located in Tuscany Region (Central Italy). According to a convenience sampling, an ad hoc questionnaire was administered both to Italian and immigrant women who underwent an oral glucose tolerance test.

MAIN OUTCOME MEASURES: information about nutrition and lifestyle, medical and obstetric history, clinical and therapy data, maternal and neonatal primary outcomes was analysed. Eating habits have been investigated referring to the prudent diet, in order to also include those foods specifically consumed by the immigrant women, in addition to the Mediterranean Diet which is more widespread among Italians.

RESULTS: a total of 117 Italian women (42 diagnosed with GDM) and 95 immigrant women (36 with GDM) were enrolled. Immigrant women showed lower adherence to the prudent diet compared to Italian women (p<0.05) and a broader use of unhealthy food preparation (e.g., frying; p<0.05). Primary maternal and neonatal outcomes (preterm birth, caesarean section, macrosomia) showed no statistical differences among GDM and NGT cohorts.

CONCLUSIONS: even if immigrant and Italian women gained similar pregnancy outcomes, immigrant women showed lower adherence to the prudent diet at the time of GDM screening. An ethnic and tailored meal plan is needed to overcome cultural barriers in dietary recommendations during pregnancy in immigrant women.

PMID:36259342 | DOI:10.19191/EP22.4.A372.074

BJPsych Open. 2022 Oct 18;8(6):e186. doi: 10.1192/bjo.2022.588.

ABSTRACT

BACKGROUND: There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology.

AIMS: To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder.

METHOD: This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ).

RESULTS: Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was ‘difficult to relax’ in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. ‘Worry a lot more’ (preoccupation) and ‘difficult to adapt to life’ (failure to adapt) at T1 significantly predicted this diagnosis at T2.

CONCLUSIONS: Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic.

PMID:36254808 | DOI:10.1192/bjo.2022.588

Health Informatics J. 2022 Oct-Dec;28(4):14604582221135439. doi: 10.1177/14604582221135439.

ABSTRACT

BACKGROUND: Sound and reliable health information is needed to promote culture of evidence based decision making. The aim of this study was to assess knowledge and attitudes of healthcare providers to use District health information system among public health facilities in South-West Ethiopia.

METHOD: Cross sectional quantitative study was conducted. A total of 264 participants were approached. Descriptive and analytical statistics was done.

RESULT: Overall 130 (49.2%) of respondents had good knowledge to use DHIS (95% CI: [43, 55.3]). 149 (56.4%) of respondents had favourable attitudes (95% CI: [53.2, 59.8]). Sufficient skills [AOR = 2.20, 95% CI: (1.16, 4.19)], older age [AOR = 1.92, 95% CI: (1.03, 3.59)] , resources [AOR = 2.56, 95% CI: (1.35, 4.86)], staffing [AOR = 2.85, 95% CI: (1.49, 5.48)] and high experiences [AOR = 4.66, 95% CI: (1.94, 5.78)] were variables associated with knowledge. Being trained [AOR = 3.59, 95% CI: (2.48, 5.42)], provision of feedback [AOR = 4.08, 95% CI: (1.87, 8.91)], motivation [AOR = 2.87, 95% CI: (1.36, 6.06)] and health need [AOR = 2.32, 95% CI: (1.10, 4.92)] were variables associated with attitudes.

CONCLUSION: Thus, Knowledge and attitudes of healthcare providers to use DHIS working in public health facilities in this setting is relatively low. The results highlight the need to improve knowledge and attitudes to use DHIS among healthcare providers focusing on the identified gaps.

PMID:36254781 | DOI:10.1177/14604582221135439

Ann Ital Chir. 2022;93:510-516.

ABSTRACT

INTRODUCTION: Mammographic breast density (MBD) has been investigated as a risk factor for many years and has been determined to increase the risk of breast cancer in many studies. Research has shown that the correlation between MBD with breast cancer as both a risk factor and a prognostic factor is not limited to difficulty in diagnosis and patient age. This study was aimed to investigate the effect of MBD on the surgical effectiveness of different techniques applied for breast-conserving surgery (BCS).

METHODS: We investigated the data of 460 patients who were prospectively registered in the database of the center between 2007-2017 and who were treated with level II Oncoplastic surgery (OPS) and conventional lumpectomy due to invasive breast cancer.

RESULTS: BCS was applied to 223 (48.5%) patients, and OPS was applied to 237 (51.5%) patients. 213 (46.3%) patients had fatty breast density, and 247 (53.7%) had dense breasts. Mean surgical margin was 11.01 mm in the OPS group and 9.17 mm in the BCS group, with a statistically larger surgical margin in the OPS group (p=0.011). Regarding the surgical margin, mean distances were 10.59 mm infatty breasts and 9.70 mm in dense breasts.

DISCUSSION AND CONCLUSIONS: In the present study, increased MBD was found to be associated with closer surgical margins and increased reoperation rates, albeit with a reduced risk for late complications. We think that level II OPS can eliminate this handicap in terms of surgical margin and reoperation in dense breasts.

KEY WORDS: Breast Cancer, Breast Conserving Surgery, Breast Density, Oncoplastic Surgery.

PMID:36254778

Ann Ital Chir. 2022;93:584-591.

ABSTRACT

AIM: The traditional treatment for appendiceal cancer with peritoneal spread is cytoreductive surgery (CRS) but added HİPEC chemotherapy to cytoreductive surgery and has shown that it improves overall survival. The aim of this study was to report the results of CRS and HIPEC treated patients with appendiceal cancers which is based on the experience of at Surgical oncology department.

MATERIAL-METHOD: Ankara University School of Medicine, Deparment of Surgical Oncology. The data of patients who underwent CRS + HIPEC for appendiceal cancer between January 2008 – January 2019 was retrospectively analysed. 40 patients who underwent CRS + HIPEC were evaluated retrospectively. Patients with unresectable liver metastasis, large retroperitoneal tumor, tumoral infiltration in the intestinal mesentery and liver hilum were excluded from the study.

RESULTS: The mean (±sd) PCI was 17.98 (±8.21). Twenty six patients’s completeness of cytoreduction score was 0(65.0%), 10(25.0%) CCS-1, 3(7.5%) CCS-2 and 1(2.5%) CCS-3. There was statistically significant difference with prognosis between ccr score, ASA, lymphovascular invasion, PCI score, albumin categories.

CONCLUSIONS: In selected patients survival can be increased. However, it is thought that cytoreductive surgery should be performed even if completeness of cytoreduction score is two. In our study we represent that >17PCI patients could be managed by CRS/HIPEC if the CC score ≤2 can be reached. Our results suggest that the CRS/HIPEC procedure can improve the benefits of larger patient group and provides longer survival.

KEY WORDS: Appendiceal Neoplasms, Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy.

PMID:36254768

Multivariate Behav Res. 2022 Oct 18:1-17. doi: 10.1080/00273171.2022.2115965. Online ahead of print.

ABSTRACT

Network meta-analysis is an extension of standard meta-analysis. It allows researchers to build a network of evidence to compare multiple interventions that may have not been compared directly in existing publications. With a Bayesian approach, network meta-analysis can be used to obtain a posterior probability distribution of all the relative treatment effects, which allows for the estimation of relative treatment effects to quantify the uncertainty of parameter estimates, and to rank all the treatments in the network. Ranking treatments using both direct and indirect evidence can provide guidance to policy makers and clinicians for making decisions. The purpose of this paper is to introduce fundamental concepts of Bayesian network meta-analysis (BNMA) to researchers in psychology and social sciences. We discuss several essential concepts of BNMA, including the assumptions of homogeneity and consistency, the fixed and random effects models, prior specification, and model fit evaluation strategies, while pointing out some issues and areas where researchers should use caution in the application of BNMA. Additionally, using an automated R package, we provide a step-by-step demonstration on how to conduct and report the findings of BNMA with a real dataset of psychological interventions extracted from PubMed.

PMID:36254763 | DOI:10.1080/00273171.2022.2115965