Category: Nevin Manimala

J Health Serv Res Policy. 2021 Dec 31:13558196211058974. doi: 10.1177/13558196211058974. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether there are significant differences in costs of treatment and readmission rates for hospital consultations undertaken by female versus male physicians in China.

METHODS: Using data from the Urban Employee Basic Medical Insurance program from January 2018 through October 2019, we investigated spending patterns and clinical outcomes for patients at tertiary hospitals in one of the largest cities in China by the gender of the attending physician. Our sample included 79,085 hospitalizations treated by 3993 physicians in internal medicine departments. We examined the association between physician gender and visit cost using a multivariable linear model. We examined the association between physician gender and 30-days readmission rates using a multivariable probability model. We adjusted for a rich set of patient characteristics, primary diagnosis fixed effects, and hospital fixed effects. In addition, we used patient fixed effects in a robustness analysis.

RESULTS: Adjusting for primary diagnosis fixed effects, spending per visit was 4.1% higher for patients treated by male physicians than for those treated by female physicians, a statistically significant difference (95% CI [1.5%, 6.7%]). This pattern persisted after further adjusting for hospital fixed effects (3.2% [1.2%, 5.2%]), patient characteristics (3.2% [1.2%, 5.1%]), and patient fixed effects (4.2% [1.8%, 6.7%]). The difference is mainly driven by higher spending on drugs (8.7% [3.9%, 13.6%]) and out-of-pocket costs (3.9% [1.7%, 6.0%]). No statistically significant differences were observed in the readmission rates of patients treated by male and female physicians in any of our three model specifications.

CONCLUSIONS: Spending per visit was significantly higher among patients treated by male physicians than among those treated by female physicians, with the difference mainly driven by spending on drugs and out-of-pocket costs. No significant difference was observed in the hospital readmission rates of patients treated by male and female physicians. These findings have important implications for gender equality in medicine and health care quality and efficiency in developing countries.

PMID:34971520 | DOI:10.1177/13558196211058974

IEEE Trans Med Imaging. 2021 Dec 31;PP. doi: 10.1109/TMI.2021.3139999. Online ahead of print.

ABSTRACT

Prostate segmentation in transrectal ultrasound (TRUS) image is an essential prerequisite for many prostate-related clinical procedures, which, however, is also a long-standing problem due to the challenges caused by the low image quality and shadow artifacts. In this paper, we propose a Shadow-consistent Semi-supervised Learning (SCO-SSL) method with two novel mechanisms, namely shadow augmentation (Shadow-AUG) and shadow dropout (Shadow-DROP), to tackle this challenging problem. Specifically, Shadow-AUG enriches training samples by adding simulated shadow artifacts to the images to make the network robust to the shadow patterns. Shadow-DROP enforces the segmentation network to infer the prostate boundary using the neighboring shadow-free pixels. Extensive experiments are conducted on two large clinical datasets (a public dataset containing 1,761 TRUS volumes and an in-house dataset containing 662 TRUS volumes). In the fully-supervised setting, a vanilla U-Net equipped with our Shadow-AUG&Shadow-DROP outperforms the state-of-the-arts with statistical significance. In the semi-supervised setting, even with only 20% labeled training data, our SCO-SSL method still achieves highly competitive performance, suggesting great clinical value in relieving the labor of data annotation. Source code is released at https://github.com/DIAL-RPI/SCO-SSL.

PMID:34971530 | DOI:10.1109/TMI.2021.3139999

Vet Ital. 2021 Jul 27;57(2). doi: 10.12834/VetIt.2341.14461.1.

ABSTRACT

The purpose of the present study was to investigate pigs in Northern Bulgaria for serological evidence of hepatitis E virus (HEV). Sera from 225 individuals from three industrial farms were tested for anti‑HEV IgG antibodies. The overall HEV seroprevalence was 36% (81/225); weaners 6.8% (5/74); fattening pigs 38.7% (29/75) and in sows 61.8% (47/76). Compared to weaners, HEV positivity was higher in fattening pigs and sows: OR = 8.70 (95% CI: 3.14‑24.12) and OR = 22.37 (95% CI: 8.07‑61.96), respectively. These data confirm that HEV is endemic in pigs throughout Bulgaria, and can be a Public Health problem due to the transmission of HЕV to humans through the consumption of pork meat and pork products.

PMID:34971505 | DOI:10.12834/VetIt.2341.14461.1

Cell Mol Life Sci. 2021 Dec 31;79(1):19. doi: 10.1007/s00018-021-04078-0.

ABSTRACT

Secondary necrosis has long been perceived as an uncontrolled process resulting in total lysis of the apoptotic cell. Recently, it was shown that progression of apoptosis to secondary necrosis is regulated by Gasdermin E (GSDME), which requires activation by caspase-3. Although the contribution of GSDME in this context has been attributed to its pore-forming capacity, little is known about the kinetics and size characteristics of this. Here we report on the membrane permeabilizing features of GSDME by monitoring the influx and efflux of dextrans of different sizes into/from anti-Fas-treated L929sAhFas cells undergoing apoptosis-driven secondary necrosis. We found that GSDME accelerates cell lysis measured by SYTOX Blue staining but does not affect the exposure of phosphatidylserine on the plasma membrane. Furthermore, loss of GSDME expression clearly hampered the influx of fluorescently labeled dextrans while the efflux happened independently of the presence or absence of GSDME expression. Importantly, both in- and efflux of dextrans were dependent on their molecular weight. Altogether, our results demonstrate that GSDME regulates the passage of compounds together with other plasma membrane destabilizing subroutines.

PMID:34971436 | DOI:10.1007/s00018-021-04078-0

Neuropsychopharmacol Hung. 2021 Dec 1;23(4):363-373.

ABSTRACT

Findings of three articles reporting results in 1372 stabilized outpatients taking 2454 medications in Spain, Argentina, and Venezuela were combined. Prevalence of good adherence was not obviously different across diagnoses: 69.5% (N=212) for schizophrenia, 66.3% (N=142) for bipolar disorder, and 69.8% (N=521) for depression. Besides the focus on stabilized outpatients, other study biases included use of a research sample; limited to oral medications, ignoring long-acting injectable antipsychotics; and lack of data on active substance abuse, clinical severity, and insight. Logistic regression models explored predictors of good vs. poor adherence. The six self-reported variables studied were pharmacophobia, pharmacophilia, high psychological reactance, high internal health locus of control (LOC), high doctor LOC, and skepticism concerning specific medications. ORs were significant in 56% (47/84) of the statistical tests vs. 24% (23/98) of ORs significant in case of 7 demographic/clinical variables (p=0.001). At least 2/3 of the ORs for pharmacophobia, pharmacophilia and skepticism were significantly associated with adherence in cases and controls, indicating their independence from diagnoses. In need of replication, three other self-reported measures had differential effects on adherence across diagnoses. High psychological reactance was associated with decreased adherence to antidepressant medications in general, or for patients with mood disorders. High internal LOC as associated with poor adherence may reflect the distrust patients with schizophrenia or severe bipolar disorder have of other people. High doctor LOC was significantly associated with increased adherence only in patients with bipolar disorder, but was significant for all medications, mood stabilizers and antipsychotics, indicating the relevance of the patient-psychiatrist relationship in these patients. (Neuropsychopharmacol Hung 2021; 23(4): 363-373).

PMID:34971494

Eur J Trauma Emerg Surg. 2021 Dec 31. doi: 10.1007/s00068-021-01847-1. Online ahead of print.

ABSTRACT

INTRODUCTION: The humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage.

METHODS: In this retrospective study, 109 patients were evaluated, who, during a period of 6 years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS.

RESULTS AND CONCLUSION: The healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.

PMID:34971422 | DOI:10.1007/s00068-021-01847-1

J Diabetes Sci Technol. 2021 Dec 31:19322968211067511. doi: 10.1177/19322968211067511. Online ahead of print.

ABSTRACT

On March 23, 2020, all insulin products were reclassified as biologics instead of drugs under the Biological Price Competition and Innovation (BPCI) Act of 2009. This allows biosimilar insulin products to be manufactured when the patent expires for the reference biologic, sometimes called the originator or brand name product. A biosimilar product may not be substituted for the reference biologic at the pharmacy counter unless the biosimilar undergoes further switch trials to earn the designation as an interchangeable biosimilar. Insulin glargine-yfgn 100 units/mL is the first biosimilar insulin to attain interchangeable status with the reference insulin glargine. In the INSTRIDE 1 and INSTRIDE 2 trials, insulin glargine-yfgn has proven noninferiority regarding blood glucose reduction and adverse effect profile versus reference insulin glargine; even in the INSTRIDE 3 trial in which treatment of diabetes was switched between insulin glargine-yfgn and reference insulin glargine throughout the trial without statistically significant changes to glucose levels or adverse effects. Insulin glargine-yfgn may be substituted at the pharmacy counter without consultation with the prescriber, in accordance with state laws. In suit with other biosimilars, insulin glargine-yfgn’s list price is significantly lower than other insulin glargine products. This increases market competition leading to decreases in costs of other insulin glargine products. Many patients who could not previously afford insulin therapy may now have significantly improved access to treatment. Providers will need education to increase awareness of these new biosimilars and interchangeable biosimilar insulin products, cost benefits, and substitution allowances.

PMID:34971335 | DOI:10.1177/19322968211067511

Mod Rheumatol. 2021 Dec 31:roab119. doi: 10.1093/mr/roab119. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the safety and efficacy of tocilizumab (TCZ) on refractory macrophage activation syndrome (rMAS) associated with systemic juvenile idiopathic arthritis (sJIA-rMAS).

METHODS: We retrospectively reviewed the charts of 14 patients diagnosed with sJIA-rMAS, who were treated with TCZ after failing conventional therapies at three hospital centers from Jan 2016 to Dec 2020. Demographic, clinical, and laboratory characteristics were recorded at the onset of MAS, before TCZ (pre-TCZ) and 14 days after TCZ (post-TCZ).

RESULTS: The clinical manifestation of sJIA-rMAS included fever (100%), skin rashes (35.7%), lymphadenomegaly (42.9%), hepatomegaly (57.1%), splenomegaly (7.1%), gastrointestinal symptoms (28.6%), arthritis (14.3%), myalgia (28.6%) and polyserositis (14.3%). After TCZ treatment, fever (100%, 14/14), gastrointestinal symptoms (100%, 4/4) and myalgia (100%, 4/4) were significantly improved after one week (p< 0.05). Skin rashes, lymphadenomegaly and arthritis also improved in many patients but these parameters did not reach statistical significance. In post-TCZ group, decreases in levels of c-reactive protein, erythrocyte sedimentation rate and serum ferritin of sJIA-rMAS were observed compared with pre-TCZ (p< 0.05). Although not statistically significant, post-TCZ group showed normalization of white blood cell, platelet count, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase and triglyceride levels compared with pre-TCZ. No disease relapse or fatality was recorded during the follow-up (25 months, range 3-60 months).

CONCLUSIONS: TCZ is safe and effective for the treatment of sJIA-rMAS after failure of conventional therapies.

PMID:34971386 | DOI:10.1093/mr/roab119

OTJR (Thorofare N J). 2021 Dec 31:15394492211060877. doi: 10.1177/15394492211060877. Online ahead of print.

ABSTRACT

This study evaluated the psychometric properties of the Relative Mastery Scale (RMS). Valid and reliable client-centered instruments support practice in value-based health care and community-based settings. Participants were 368 community-dwelling adults aged 18 to 95 years. Researchers conducted validity and reliability examinations of the RMS using classical test theory and Rasch measurement model. A partial credit model allowed exploration of individual scale properties. Spearman’s correlation coefficients between items were statistically significant at the .01 level. Cronbach’s alpha coefficient was .94 showing strong internal consistency. In exploratory factor analysis, Factor 1 accounted for 71% of variance with an eigenvalue of 4.26. In Rasch analysis, the 5-point rating scale demonstrated adequate functioning, confirmed unidimensionality, and person/item separation. The RMS instrument demonstrates sound psychometric characteristics. A valid and reliable measure of internal occupational adaptation supports application to monitor progress of internal occupational adaptation across a variety of individuals.

PMID:34971325 | DOI:10.1177/15394492211060877

Alzheimers Dement. 2021 Dec;17 Suppl 8:e057766. doi: 10.1002/alz.057766.

ABSTRACT

BACKGROUND: Hallucinations and delusions associated with dementia-related psychosis (DRP) can occur in persons with dementia-however, quickly screening for these symptoms in busy clinical settings can be challenging. We developed the DRP3 Screen, a novel tool to screen for psychosis in clinical settings; performed an Alignment Exercise to determine association of the DRP3 Screen with established psychosis/DRP reference assessments; and retrospectively assessed the ability of the DRP3 Screen to detect patients with DRP enrolled in a clinical trial (HARMONY, NCT03325556).

METHODS: The DRP3 Screen comprises 3 yes/no questions and was developed by Acadia Pharmaceuticals Inc. in collaboration with an international team of six subject matter experts (SMEs). Through facilitated discussions, the panel developed questions addressing key aspects of psychosis in dementia. SMEs independently rated level of alignment (Table) of the questions with current reference assessments (SAPS-H+D, NPI-Q, IPA Criteria) to determine if the symptoms itemized in those assessments would be captured by ≥1 DRP3 Screen question. Criteria for association with a reference assessment item was mean rating ≥2.0 for at least one DRP3 Screen question (95% CI, lower limit ≥1.3). Inter-rater reliability of the Alignment Exercise for individual reference assessments was assessed using Fleiss’ kappa statistic. For retrospective application of the DRP3 Screen to HARMONY, patients were considered likely to have been identified by the DRP3 Screen if they were positive (score ≥2) on ≥1 SAPS-H+D items that were positively associated with the DRP3 Screen.

RESULTS: All items across 3 reference assessments (except SAPS-H+D D6, somatic delusions) were associated with the DRP3 Screen. Mean level of alignment segregated to none/some (0.3-1.8) and most/all (2.3-3.0) with significant inter-rater agreement of the DRP3 Screen with the SAPS-H+D, NPI-Q and IPA Criteria, (kappa values: 0.37, 0.26, and 0.45, respectively; p<.0001). Retrospective application of the DRP3 Screen to HARMONY identified all trial enrollees.

CONCLUSIONS: The novel DRP3 Screen is a brief tool designed to assess the presence of hallucinations and delusions in persons with dementia. Potential for its clinical application has been established through association with current reference assessments, with significant agreement among raters; and through successful retrospective application to an existing trial population.

PMID:34971295 | DOI:10.1002/alz.057766