Category: Nevin Manimala

Eur Arch Otorhinolaryngol. 2023 Apr 19. doi: 10.1007/s00405-023-07946-6. Online ahead of print.

ABSTRACT

BACKGROUND: At present, it is still controversial whether lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC) patients should be dissected. Failure to dissect metastatic lymph nodes results in continued metastasis from the positive lymph nodes to other regions. Our study aimed to establish a predictive model and predict the probability of metastasis of the lymph nodes posterior to the right recurrent laryngeal nerve (LNM-prRLN) in patients.

METHODS: A total of 309 patients underwent surgery for thyroid cancer between May 2019 and September 2022. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic (ROC) curve to verify the accuracy of the prediction model.

RESULTS: Multivariate analysis showed that irregular tumor margins (OR: 3.549, 95% CI 1.294-9.733, P = 0.014), extrathyroidal extension (OR: 4.507, 95% CI 1.694-11.993, P = 0.003), maximum tumor diameter > 1 cm (OR: 5.729, 95% CI 2.617-12.542, P < 0.001), overweight status (OR: 2.296, 95% CI 1.057-4.987, P = 0.036), high total cholesterol level (OR: 5.238, 95% CI 2.304-11.909, P < 0.001), and multifocality (OR: 11.954, 95% CI 5.233-27.305, P < 0.001) were independent risk factors for LNM-prRLN. The area under the ROC curve was 0.927. The calibration curve showed good agreement between the predicted and observed rates of LNM-prRLN.

CONCLUSION: The probability of LNM-prRLN could be predicted by a nomogram based on the statistically significant risk factors identified in the multivariate analysis. This nomogram can guide clinicians when preoperatively evaluating the status of the LN-prRLN with regard to LNM-prRLN in PTC patients. For patients at high risk for LNM-prRLN, the preventive dissection of LN-prRLNs can be considered.

PMID:37072557 | DOI:10.1007/s00405-023-07946-6

BMJ Open. 2023 Apr 18;13(4):e063614. doi: 10.1136/bmjopen-2022-063614.

ABSTRACT

OBJECTIVE: To assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA.

DESIGN: Cost-effectiveness analysis using a Markov cohort state-transition model.

SETTING: Policy intervention.

PARTICIPANTS: A modelled population of 235 million adults aged ≥20 years in 2015-2016.

INTERVENTIONS: The impact of menu calorie labelling on reducing 13 obesity-associated cancers among US adults over a lifetime was evaluated for: (1) effects on consumer behaviours; and (2) additional effects on industry reformulation. The model integrated nationally representative demographics, calorie intake from restaurants, cancer statistics and estimates on associations of policy with calorie intake, dietary change with body mass index (BMI) change, BMI with cancer rates, and policy and healthcare costs from published literature.

MAIN OUTCOME MEASURES: Averted new cancer cases and cancer deaths and net costs (in 2015 US$) among the total population and demographic subgroups were determined. Incremental cost-effectiveness ratios from societal and healthcare perspectives were assessed and compared with the threshold of US$150 000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs).

RESULTS: Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals.

CONCLUSIONS: Study findings suggest that menu calorie labelling is associated with lower obesity-related cancer burdens and reduced healthcare costs. Policymakers may prioritise nutrition policies for cancer prevention in the USA.

PMID:37072239 | DOI:10.1136/bmjopen-2022-063614

Can Fam Physician. 2023 Apr;69(4):271-277. doi: 10.46747/cfp.6904271.

ABSTRACT

OBJECTIVE: To identify how graduating and incoming family medicine residents (FMR) experienced changes to their education during the early waves of the COVID-19 pandemic.

DESIGN: The Family Medicine Longitudinal Survey was modified with questions related to the impact of COVID-19 on FMR and their training. Short-answer responses underwent thematic analysis. Responses to Likert scale and multiple-choice questions were reported as summary statistics.

SETTING: Department of Family and Community Medicine at the University of Toronto in Ontario.

PARTICIPANTS: Graduating FMR in spring 2020 and incoming FMR in fall 2020.

MAIN OUTCOME MEASURES: Residents’ perceptions of the impact of COVID-19 on clinical skills acquisition and preparedness for practice.

RESULTS: Surveys response rates were 124 of 167 (74%) and 142 of 162 (88%) for graduating and incoming residents, respectively. Important themes for both cohorts included reduced access to clinical environments, reduced patient volumes, and lack of exposure to procedural skills. While the graduating cohort indicated they felt confident to begin practising family medicine, they described being impacted by the loss of a tailored learning environment, including canceled or altered electives. In contrast, incoming residents reported the loss of core skills, such as physical examination competency, as well as the loss of face-to-face communication, rapport, and relationship-building opportunities. However, both cohorts endorsed gaining new skills during the pandemic, including conducting telemedicine appointments, pandemic planning, and interfacing with public health.

CONCLUSION: Based on these results, residency programs can specifically tailor solutions and modifications to address common themes across cohorts to facilitate optimal learning environments in pandemic times.

PMID:37072215 | DOI:10.46747/cfp.6904271

BMJ. 2023 Apr 18;381:e073435. doi: 10.1136/bmj-2022-073435.

ABSTRACT

OBJECTIVE: To estimate the effect of denosumab compared with oral bisphosphonates on reducing the risk of type 2 diabetes in adults with osteoporosis.

DESIGN: Population based study involving emulation of a randomized target trial using electronic health records.

SETTING: IQVIA Medical Research Data primary care database in the United Kingdom, 1995-2021.

PARTICIPANTS: Adults aged 45 years or older who used denosumab or an oral bisphosphonate for osteoporosis.

MAIN OUTCOME MEASURES: The primary outcome was incident type 2 diabetes, as defined by diagnostic codes. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals, comparing denosumab with oral bisphosphonates using an as treated approach.

RESULTS: 4301 new users of denosumab were matched on propensity score to 21 038 users of an oral bisphosphonate and followed for a mean of 2.2 years. The incidence rate of type 2 diabetes in denosumab users was 5.7 (95% confidence interval 4.3 to 7.3) per 1000 person years and in oral bisphosphonate users was 8.3 (7.4 to 9.2) per 1000 person years. Initiation of denosumab was associated with a reduced risk of type 2 diabetes (hazard ratio 0.68, 95% confidence interval 0.52 to 0.89). Participants with prediabetes appeared to benefit more from denosumab compared with an oral bisphosphonate (hazard ratio 0.54, 0.35 to 0.82), as did those with a body mass index ≥30 (0.65, 0.40 to 1.06).

CONCLUSIONS: In this population based study, denosumab use was associated with a lower risk of incident type 2 diabetes compared with oral bisphosphonate use in adults with osteoporosis. This study provides evidence at a population level that denosumab may have added benefits for glucose metabolism compared with oral bisphosphonates.

PMID:37072150 | DOI:10.1136/bmj-2022-073435

Eur Heart J. 2023 Apr 18:ehad188. doi: 10.1093/eurheartj/ehad188. Online ahead of print.

ABSTRACT

AIMS: People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD.

METHODS AND RESULTS: A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES-ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses.

CONCLUSION: Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.

PMID:37072130 | DOI:10.1093/eurheartj/ehad188

Br J Nutr. 2023 Apr 18:1-31. doi: 10.1017/S0007114523000910. Online ahead of print.

ABSTRACT

To date, several systematic reviews and meta-analyses (SRMAs) have investigated the effects of probiotics, but the certainty of the evidence for an effect on chemotherapy and radiotherapy-related diarrhea has not been assessed. We conducted an overview of SRMAs, searching MEDLINE, Scopus, and ISI Web of Science from inception up to February 2022. We summarized the findings of eligible SRMAs. Subsequently, we included RCTs from the SRMAs in meta-analyses, using a quality effects model to calculate the Odds ratio (ORs) and 95% confidence intervals (95%CIs) for each outcome. We used ‘A Measurement Tool to Assess Systematic Reviews’ (AMSTAR 2) and the Cochrane risk of bias (RoB) tool to assess the methodological quality of the SRMAs and their RCTs, respectively. We used the ‘Grading of Recommendations Assessment, Development, and Evaluation’ (GRADE).We included 13 SRMAs, which reported pooled effect sizes for chemotherapy and radiotherapy-related diarrhea based on a total of 18 RCTs. Our meta-analyses demonstrated statistically significant beneficial effects from probiotics on all outcomes, except stool consistency; diarrhea (any grade) OR 0.35 (95%CI 0.22, 0.54), grade ≥2 diarrhea 0.43 (0.25, 0.74), grade ≥3 diarrhea 0.30 (0.15, 0.59), use of medication 0.49 (0.27, 0.88), soft stool 1.10 (0.44, 2.76) and watery stool 0.52 (0.29, 1.29). Probiotics use can reduce the incidence of diarrhea in cancer patients in chemotherapy and radiotherapy, but the certainty of evidence for significant outcomes were very low and low.

PMID:37072129 | DOI:10.1017/S0007114523000910

J Appl Gerontol. 2023 Apr 18:7334648231168446. doi: 10.1177/07334648231168446. Online ahead of print.

ABSTRACT

This study examined the associations between cognition and depressive symptoms, function, and pain among hospitalized older patients with dementia. We utilized baseline data of 461 hospitalized older patients with dementia who participated in an intervention study implementing Family-centered Function-focused Care (Fam-FFC) and conducted stepwise linear regression. On average, the participants (males = 189; 41% and females = 272; 59%) were 81.64 years old (Standard Deviation, SD = 8.38). There was a statistically significant association of cognition with depressive symptoms (b = -0.184, p < .001), functional status (b = 1.324, p < .001), and pain (b = -0.045, p < .001) when controlling for covariates. This study utilized a large sample of a relatively underrepresented population, hospitalized older adults with dementia, and addressed a topic with great clinical significance. Specific focus on testing and implementing best practices or interventions to support the clinical outcomes, and the cognitive function of hospitalized older adults with dementia is warranted in both practice and research.

PMID:37072127 | DOI:10.1177/07334648231168446

J Am Vet Med Assoc. 2023 Apr 18:1-7. doi: 10.2460/javma.23.01.0027. Online ahead of print.

ABSTRACT

OBJECTIVE: Assess efficacy of ropinirole versus apomorphine in inducing vomiting in dogs.

ANIMALS: 279 client-owned dogs with known or suspected ingestion of a foreign material (n = 129) or toxin (150) between August 2021 and February 2022.

PROCEDURES: In this non-randomized non-controlled clinical trial, ropinirole topical ophthalmic solution was applied to dogs’ eyes, with a target dose of 3.75 mg/m2. A second dose was administered after 15 minutes based on clinician discretion. Reversal with metoclopramide was provided based on clinician discretion. Results of ropinirole’s efficacy were compared to previous literature assessing the efficacy of apomorphine.

RESULTS: Of 279 dogs, 255 (91.4%) vomited after ropinirole administration, including 116 of the 129 dogs (89.9%) dogs that ingested foreign material and 139 of the 150 dogs (92.7%) that ingested toxins. Success of emesis did not differ between groups. With a single dose of ropinirole, 78.9% produced vomit. Fifty-nine dogs received 2 doses of ropinirole, resulting in 79.7% that produced vomit. Overall, 74.2% of the dogs vomited all the expected ingested material. Average time to emesis was 11.0 minutes with 50% of dogs vomiting within 7 to 18 minutes. Adverse effects were observed for 17.0% of dog and were self-limiting. Ropinirole was less effective than apomorphine in inducing vomiting (91.4% ropinirole, 95.6% apomorphine [P < .0001]) and equally effective at evacuating all ingested material (74.2% ropinirole, 75.6% apomorphine [P = .245]).

CLINICAL RELEVANCE: Ropinirole ophthalmic solution is a safe and effective emetic for use in dogs. It has a small but statistically significant decrease in efficacy compared to IV apomorphine.

PMID:37072118 | DOI:10.2460/javma.23.01.0027

J Card Fail. 2023 Apr 16:S1071-9164(23)00142-2. doi: 10.1016/j.cardfail.2023.04.003. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammation is a key driver of heart failure (HF) with preserved left ventricular ejection fraction (LVEF). AZD4831 inhibits extracellular myeloperoxidase, reduces inflammation and improves microvascular function in preclinical disease models.

METHODS: In this double-blind phase 2a study (SATELLITE; NCT03756285), patients with symptomatic HF, LVEF ≥40%, and elevated B-type natriuretic peptides were randomized 2:1 to once-daily oral AZD4831 5 mg or placebo for 90 days. We aimed to assess target engagement (primary endpoint: myeloperoxidase specific activity) and safety of AZD4831.

RESULTS: Due to COVID-19, the study was terminated early after randomizing 41 patients (median age, 74.0 years; 53.7% male). Myeloperoxidase activity was reduced by >50% from baseline to day 30 and 90 in the AZD4831 group, with a placebo-adjusted reduction of 75% (95% confidence interval: 48, 88; nominal P <0.001). No improvements were noted in secondary/exploratory endpoints, apart from a trend in Kansas City Cardiomyopathy Questionnaire overall summary score. No deaths or treatment-related serious adverse events occurred. AZD4831 treatment-related adverse events were generalized maculopapular rash, pruritus and diarrhoea (all n=1).

CONCLUSIONS: AZD4831 inhibited myeloperoxidase and was well tolerated in patients with HF and LVEF ≥40%. Efficacy findings were exploratory due to early termination but warrant further clinical investigation of AZD4831.

LAY SUMMARY: Few treatments are available for patients with the forms of heart failure known as ‘heart failure with preserved or mildly reduced ejection fraction’. Current treatments do not target inflammation, which may play an important role in this condition. We tested a new drug called AZD4831 (mitiperstat), which reduces inflammation by inhibiting the enzyme myeloperoxidase. Among the 41 patients in our clinical trial, AZD4831 had a good safety profile and inhibited myeloperoxidase by the expected amount. Results mean we can conduct further trials to see whether AZD4831 reduces the symptoms of heart failure and improves patients’ ability to take physical exercise.

PMID:37072105 | DOI:10.1016/j.cardfail.2023.04.003

Pediatr Phys Ther. 2023 Apr 19. doi: 10.1097/PEP.0000000000001014. Online ahead of print.

ABSTRACT

PURPOSE: Physical therapists at an outpatient pediatric facility developed and implemented an Intensity Program for children with movement challenges. The program was initiated on the basis of best evidence, parent advocacy, and clinician expertise. The purpose of this investigation is to analyze outcome data gathered from the program since 2012 to determine the effect of the program along with any specific child characteristics that were more likely to lead to positive outcomes.

METHODS: A variety of outcome data were analyzed to compare preprogram performance with postprogram performance.

RESULTS: Program participants made statistically significant and clinically important improvement in most outcome measures. Parents were highly satisfied with the program, including 98% of respondents who indicated that they would like to repeat their participation in the program.

CONCLUSIONS: The results of this investigation suggest that many children with movement challenges are likely to benefit from participation in an Intensity Program.

PMID:37071878 | DOI:10.1097/PEP.0000000000001014