Category: Nevin Manimala

Health Inf Manag. 2023 Jan 21:18333583221144662. doi: 10.1177/18333583221144662. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare data frequently lack the specificity level needed to achieve clinical and operational objectives such as optimising bed management. Pneumonia is a disease of importance as it accounts for more bed days than any other lung disease and has a varied aetiology. The condition has a range of SNOMED CT concepts with different levels of specificity.

OBJECTIVE: This study aimed to quantify the importance of the specificity of an SNOMED CT concept, against well-established predictors, for forecasting length of stay for pneumonia patients.

METHOD: A retrospective data analysis was conducted of pneumonia admissions to a tertiary hospital between 2011 and 2021. For inclusion, the primary diagnosis was a subtype of bacterial or viral pneumonia, as identified by SNOMED CT concepts. Three linear mixed models were constructed. Model One included known predictors of length of stay. Model Two included the predictors in Model One and SNOMED CT concepts of lower specificity. Model Three included the Model Two predictors and the concepts with higher specificity. Model performances were compared.

RESULTS: Sex, ethnicity, deprivation rank and Charlson Comorbidity Index scores (age-adjusted) were meaningful predictors of length of stay in all models. Inclusion of lower specificity SNOMED CT concepts did not significantly improve performance (ΔR² = 0.41%, p = .058). SNOMED CT concepts with higher specificity explained more variance than each of the individual predictors (ΔR² = 4.31%, p < .001).

CONCLUSION: SNOMED CT concepts with higher specificity explained more variance in length of stay than a range of well-studied predictors.

IMPLICATIONS: Accurate and specific clinical documentation using SNOMED CT can improve predictive modelling and the generation of actionable insights. Resources should be dedicated to optimising and assuring clinical documentation quality at the point of recording.

PMID:36680531 | DOI:10.1177/18333583221144662

Pediatr Int. 2023 Jan;65(1):e15359. doi: 10.1111/ped.15359.

ABSTRACT

BACKGROUND: This non-randomized intervention study aimed to evaluate the effect of supplementing infant formula with biotin on biotin metabolism and on development.

METHODS: We enrolled healthy Japanese infants (n = 84) and assigned them to groups offered Formula A (total biotin, 0.5 μg/100 kcal) or Formula B (total biotin, 2.4 μg/100 kcal) until they were 6 months of age, and completed an additional follow up to age 36 months. Urinary biotin concentrations were measured at 1 and 6 months, and were compared among breast-fed, Formula A-fed, and Formula B-fed infants at each age. In a follow-up subgroup analysis, we compared scores on the Ages and Stages Questionnaire, version 3 (ASQ-3), from 9 to 36 months among infants continuously fed Formula A, Formula B, or breastmilk.

RESULTS: No adverse events occurred during the intervention period. At 1 month, urinary biotin concentrations were highest in Formula B-fed infants and lowest in Formula A-fed infants. At 6 months, Formula B-fed infants retained higher biotin levels than Formula A-fed and breast-fed infants. Both differences were statistically significant (P < 0.05). The breast-fed, Formula A-fed, and Formula B-fed groups had similar ASQ scores at 9-36 months.

CONCLUSIONS: Biotin supplementation of infant formula contributed to improving biotin status in formula-fed infants. The results support the official approval of the use of biotin in infant formula by the government of Japan in 2014.

PMID:36680523 | DOI:10.1111/ped.15359

Med Phys. 2023 Jan 21. doi: 10.1002/mp.16232. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) detection with B-mode and contrast-enhanced ultrasound (CUS) imaging often varies between subjects, especially in patients with background cirrhosis. Various factors contribute to this variability, including the tumor blood flow, tumor size, internal echoes, and its location in livers with diffuse fibro-cirrhotic changes OBJECTIVE: Towards improving lesion detection, this study evaluates a vasodilator, hydralazine, to enhance the visibility of HCC by reducing its blood flow relative to the surrounding liver tissue.

METHODS: HCC were analyzed for tumor visibility measured for B-mode, CUS, and hydralazine-augmented-contrast ultrasound (HyCUS) in an autochthonous HCC rat model. 21 tumors from 12 rats were studied. B-mode and CUS images were acquired before hydralazine injection. Rats received an intravenous hydralazine injection of 5 mg/kg, then images were acquired 20 min later. Four rats were used as controls. The difference in echo intensity of the lesion and the surrounding tissue was used to determine the visibility index (VI).

RESULTS: The visibility index for HCC was found to be significantly improved with the use of HyCUS imaging compared to traditional B-mode and CUS imaging. The visibility index for HCC was 16.5 ± 2.8 for HyCUS, compared to 5.3 ± 4.8 for B-mode and 4.1 ± 3.8 for CUS. The differences between HyCUS and the other imaging modalities were statistically significant, with p-values of 0.001 and 0.02, respectively. Additionally, when compared to control cases, HyCUS showed higher discrimination of HCC (VI = 6.4 ± 1.2) with a p-value of 0.003, while B-mode (VI = 6.7 ± 1.4, p = 0.5) and CUS (VI = 6.4 ± 1.2, p = 0.3) showed lower discrimination.

CONCLUSION: Vascular blood flow modulation by hydralazine enhances the visibility of HCC. HyCUS offers a potential problem-solving method for detecting HCC when B-mode and CUS are unsuccessful, especially with background fibro-cirrhotic liver disease. Future evaluation of the approach in humans will determine its translatability for clinical applications. This article is protected by copyright. All rights reserved.

PMID:36680519 | DOI:10.1002/mp.16232

Health Inf Manag. 2023 Jan 21:18333583221144665. doi: 10.1177/18333583221144665. Online ahead of print.

ABSTRACT

BACKGROUND: Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information.

OBJECTIVE: To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020).

METHOD: A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded.

RESULTS: A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors.

CONCLUSION: A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control.

IMPLICATIONS: This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors.

PMID:36680503 | DOI:10.1177/18333583221144665

Cell J. 2023 Jan 1;25(1):45-50. doi: 10.22074/cellj.2022.557259.1041.

ABSTRACT

OBJECTIVE: Preeclampsia (PE) is a pregnancy related disorder with prevalence of 6-7%. Insufficient trophoblastic invasion leads to incomplete remodeling of spiral arteries and consequent decrease in feto-placental perfusion. Altered placental expression of tissue inhibitors of matrix metalloproteinase (TIMPs) is considered to be involved in this process while the balance between matrix metalloproteinases (MMPs) and TIMPs contributes to remodeling of the placenta and uterine arteries by degradation and refurbishing of extracellular matrix (ECM). Therefore, TIMPs, fetal expression pattern was evaluated with the aim of its potential to be used as a determinant for the (early) detection of PE.

MATERIALS AND METHODS: In this case-control study, cell free fetal RNA (cffRNA) released by placenta into the maternal blood was used to determine expression patterns of TIMP1, 2, 3 and 4 in the severe preeclamptic women in comparison with the normal pregnant women. Whole blood from 20 preeclamptic and 20 normal pregnant women in their 28-32 weeks of gestational age was collected. The second control group consisted of 20 normal pregnant women in either 14 or 28 weeks of gestation (each 10). cffRNA was extracted from plasma and real-time polymerase chain reaction (PCR) was done to determine the expression levels of TIMP1, 2, 3 and 4 genes.

RESULTS: Statistical analysis of the results showed significant higher expression of TIMP1-4 in the preeclamptic women in comparison with the control group (P=0.029, 0.037, 0.037 and 0.049, respectively). Also, an increased level of TIMPs expression was observed by comparing 14 to 28 weeks of gestational age in the normal pregnant women in the second control group.

CONCLUSION: An increased cffRNA expression level of TIMPs may be correlated with the intensity of placental vascular defect and may be used as a determinant of complicated pregnancies with severe preeclampsia.

PMID:36680483 | DOI:10.22074/cellj.2022.557259.1041

Early Interv Psychiatry. 2023 Jan 21. doi: 10.1111/eip.13400. Online ahead of print.

ABSTRACT

AIM: The study aimed to assess changes in adolescent visits due to eating disorders (EDs) during the pandemic.

METHOD: A retrospective evaluation of adolescents diagnosed with an ED during two periods: June 2019-February 2020 (pre-pandemic) and June 2021-February 2022 (during the pandemic) at an adolescent medicine clinic in Tukey was conducted. The number of patients diagnosed with an ED between these dates was compared with the number of overall attended outpatient appointments. Baseline data for patients with Anorexia Nervosa (AN) and the requirement of hospitalization for all cases were compared.

RESULTS: Of the 3708 visits in the pre-pandemic period 46 (1.2%) were diagnosed with an ED. This was 69 (2.2%) of 3149 visits during the pandemic which was statistically significant (p = 0.003). The percentage of males to females changed from 2.2% to 11.6% (p = 0.065). Distribution of the type of ED did not change (p = 0.280), although the percentage of atypical AN increased from 6.5% to 17.4%. Mean age, BMI, calorie intake and hospital admissions did not significantly change.

CONCLUSION: Our findings support the increase in adolescent EDs during COVID-19. Particular attention should be given to males and Atypical AN cases.

PMID:36680467 | DOI:10.1111/eip.13400

Assessment. 2023 Jan 21:10731911221147038. doi: 10.1177/10731911221147038. Online ahead of print.

ABSTRACT

The Structured Clinical Interview for Gambling Disorder (SCI-GD) has the potential to bridge a diagnostic clinical gap, but psychometric evaluations have been scarce, in particular in relation to self-reported diagnostic criteria. This study analyzed existing data, including Swedish gamblers (N = 204) from treatment- and help-seeking contexts, self-help groups, and the general population, who were interviewed with the SCI-GD and completed self-report measures. The results indicated that fewer individuals fulfilled the diagnostic criteria for gambling disorder (GD) with the SCI-GD (n = 110, 54%), compared to a self-report Diagnostic and Statistical Manual of Mental Disorders:5th Edition (DSM-5) questionnaire on GD (n = 145, 71%; p < .001). Agreement between interviews and self-reported criteria was generally low (Fleiss kappa range: 0.31-0.52; r range: 0.35-0.55). A Rasch analysis showed that specific diagnostic criteria varied in difficulty, indicating a general pattern of higher item difficulty for the SCI-GD compared to self-reported DSM-5 criteria. Both the SCI-GD and the self-reported DSM-5 criteria performed well in terms of internal consistency, convergent, and discriminant validity. We conclude that the SCI-GD is a reliable and valid diagnostic tool to assess GD among individuals with various gambling behavior patterns. Further research-related and clinical implications are discussed.

PMID:36680458 | DOI:10.1177/10731911221147038

Anatol J Cardiol. 2023 Jan;27(1):41-46. doi: 10.14744/AnatolJCardiol.2022.2050.

ABSTRACT

OBJECTIVE: Malignant pericardial effusion may affect almost 15 of the patients with underlying malignancies which deteriorates the prognosis. The prognostic significance of pericardial fluid cytology is under-represented in previous studies.

METHODS: A total of 73 patients with symptomatic pericardial effusion treated with pericardiocentesis were included in this retrospective analysis. Macroscopic appearance, biochemical features, and cytological findings were obtained. Patients were divided into 3 groups: (i) without malignancy, (ii) with malignancy and negative cytology, and (iii) with malignancy and positive cytology. Survival data were searched via governmental death notification system.

RESULTS: Mean age of the study group was 62 ± 15, and 54% (40) of the patients were female. On the cytological evaluation, 17 patients (23.3%) revealed positive cancer cytology, whereas 56 patients (76.7%) revealed negative cancer cytology. The median follow-up period was 840 days, and 34 patients (46.5%) died during follow-up. The survival rate of Group 3 was found to be significantly worse compared to Groups 1 and 2, no statistical difference was found between Groups 1 and 2 in terms of survival (Group 1 vs. Group 2 P =.078; Group 1 vs. Group 3 P <.001; Group 2 vs. Group 3 P =.041).

CONCLUSION: Cytological evaluation is an important step in patients with malignant pericardial effusion. Positive pericardial fluid cytology indicates a poorer prognosis.

PMID:36680446 | DOI:10.14744/AnatolJCardiol.2022.2050

J Med Virol. 2023 Jan 21. doi: 10.1002/jmv.28517. Online ahead of print.

ABSTRACT

This study investigated outcomes of children born to women who seroconverted to rubella immune during pregnancy. In a prior 2012-2013 study of 296 women who were rubella non-immune, 26 (8.8%) seroconverted to rubella immune during pregnancy. These same women and their now 8-9 years-old children were queried as to the children’s developmental health. After removing exclusions and those lost to follow-up, the total response rate was 115/204 (56.4%). Three sets of twins in the non-immune group increased the total to 118. The seroconversion group had more autism (12.5% versus 3.9%, P=.19), ADHD (37.5% versus 18.6%, P=.10), and any developmental disability (43.8% versus 31.4%, P=.39) but none showed a statistical difference between the two groups. Compared to Autism and Developmental Disabilities Monitoring data, the seroconversion group had a greater prevalence of autism (OR 6.07, P=0.051, nonsignificant); and to data derived from the National Health Interview Survey, a nonsignificant higher odds of autism (OR 5.57, P=0.060), higher odds of ADHD (OR 5.65, P=0.0027) and of any developmental disability (OR 3.59, P=0.014).The non-immune group also demonstrated a statistically significant increase for both ADHD and any developmental disability, but not for autism. This article is protected by copyright. All rights reserved.

PMID:36680415 | DOI:10.1002/jmv.28517

Scand J Med Sci Sports. 2023 Jan 21. doi: 10.1111/sms.14319. Online ahead of print.

ABSTRACT

BACKGROUND: Markerless motion capture based on low-cost 2-D video analysis in combination with computer vision techniques has the potential to provide accurate analysis of running technique in both a research and clinical setting. However, the accuracy of markerless motion capture for assessing running kinematics compared to a gold-standard approach remains largely unexplored.

OBJECTIVE: Here we investigate the accuracy of custom-trained (DeepLabCut) and existing (OpenPose) computer vision techniques for assessing sagittal-plane hip, knee, and ankle running kinematics at speeds of 2.78 and 3.33 m∙s^-1 as compared to gold-standard marker-based motion capture.

METHODS: Differences between the markerless and marker-based approaches were assessed using statistical parameter mapping and expressed as root mean squared errors (RMSEs).

RESULTS: After temporal alignment and offset removal, both DeepLabCut and OpenPose showed no significant differences with the marker-based approach at 2.78 m∙s^-1 , but some significant differences remained at 3.33 m∙s^-1 . At 2.78 m∙s^-1 , RMSEs were 5.07, 7.91, and 5.60, and 5.92, 7.81, and 5.66 degrees for the hip, knee, and ankle for DeepLabCut and OpenPose, respectively. At 3.33 m∙s^-1 , RMSEs were 7.40, 10.9, 8.01, and 4.95, 7.45, and 5.76 for the hip, knee, and ankle for DeepLabCut and OpenPose, respectively.

CONCLUSION: The differences between OpenPose and the marker-based method were in line with or smaller than reported between other kinematic analysis methods and marker-based methods, while these differences were larger for DeepLabCut. Since the accuracy differed between individuals, OpenPose may be most useful to facilitate large-scale in-field data collection and investigation of group effects rather than individual-level analyses.

PMID:36680411 | DOI:10.1111/sms.14319