Category: Nevin Manimala

Eur J Cardiothorac Surg. 2022 May 28:ezac324. doi: 10.1093/ejcts/ezac324. Online ahead of print.

ABSTRACT

OBJECTIVES: There is increasing evidence that performing superior cavopulmonary connection at 3 months reduces mortality: reducing the risky ‘interstage’ period, volume off-loading the ventricle and reducing coronary steal, hopefully preserving ventricular function. Our objective was to describe our experience of early superior cavopulmonary connection with preoperative CT assessment compared to later connection at 6 months.

METHODS: Patients undergoing Norwood procedure from 2005 to 2020 were divided into Two eras were described and compared. Era 1 from 2005-2016 when superior cavopulmonary connection was undertaken at 6 months: and era 2 (2017-2020) when an earlier operation was performed. Demographics, mortality (interstage, early and late following superior cavopulmonary connection) and data on post-operative course and complications were recorded.

RESULTS: In era 1, 191 patients underwent Norwood (120 survivors to superior cavopulmonary connection) and 28 patients (23 survivors) in era 2. There were no significant differences in the demographics. Interstage mortality was 17.8% in era 1 and 8.0% in era 2 but not significantly significant (p = 0.22). The median (IQR) age at pre-imaging and superior cavopulmonary connection was significantly lower: 99 (81-120) vs 77 (47-102) days and 175 (117-208) vs 106 (102-122) day in era 1 vs era 2 (P < 0.005). Weight was lower at superior cavopulmonary connection in era 2 (mean (SD) 6.2 kg (1.2) vs 5.1 kg (0.8), p < 0.05). Intubation time and total length of stay were not statistically different. Median Intensive care unit stay was statistically significantly longer, but not clinically significant): 2.5 (2-4) vs 3 (3-5) days respectively (p < 0.05). There was no significant difference in early or late mortality, rates of diagnostic or interventional catheter, post-operative MRI/CT or stroke. Logistic regression analysis demonstrates increasing age at superior cavopulmonary connection was associated with increased chance of stroke or early death (p = 0.043).

CONCLUSIONS: Early superior cavopulmonary connection with CT assessment is feasible and although intensive care unit length of stay was slightly longer there was no change in the overall length of stay and no change in post-operative mortality or complications.

PMID:35640135 | DOI:10.1093/ejcts/ezac324

Rheumatology (Oxford). 2022 May 28:keac320. doi: 10.1093/rheumatology/keac320. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify barriers to the use of nailfold capillaroscopy as a diagnostic tool for patients presenting with Raynaud’s phenomenon in UK rheumatology centres, and to obtain rheumatologists’ views on a proposed internet-based standardised system for clinical reporting of nailfold capillaroscopy images.

METHODS: An online survey was developed using expert opinion from clinicians, scientists and health service researchers. The survey was piloted and sent to UK-based rheumatologists using established electronic mailing lists between October 2020 and March 2021. Survey data were analysed using descriptive statistics.

RESULTS: 104 rheumatologists representing rheumatology centres across the UK responded to the survey. Wide variations in terms of workloads and practices were described. 34 (33%) respondents reported using nailfold capillaroscopy only at their own centre, 33 (32%) referred to other centres, 9 (9%) did both and 28 (27%) did not use capillaroscopy at all. Of the 43 respondents using capillaroscopy on site, 25 (58%) used either a dermatoscope or USB microscope, and 9 (21%) used videocapillaroscopy. Amongst the 61 respondents not undertaking capillaroscopy on site, barriers included lack of equipment (85%), lack of experience in acquiring images (69%) and lack of expertise in interpreting images (67%). Sixty-six respondents (63%) expressed interest in an internet-based, standardised automated system for reporting images.

CONCLUSION: Most UK rheumatologists currently do not perform nailfold capillaroscopy on site. An internet-based nailfold capillaroscopy system, for use with low cost microscopes as well as with videocapillaroscopy, could help increase uptake of capillaroscopy and thereby facilitate early diagnosis of systemic sclerosis across the UK.

PMID:35640131 | DOI:10.1093/rheumatology/keac320

Eur J Cardiothorac Surg. 2022 May 28:ezac310. doi: 10.1093/ejcts/ezac310. Online ahead of print.

NO ABSTRACT

PMID:35640126 | DOI:10.1093/ejcts/ezac310

Eur J Cardiothorac Surg. 2022 May 28:ezac328. doi: 10.1093/ejcts/ezac328. Online ahead of print.

ABSTRACT

OBJECTIVES: Concerns exist about higher rates of pacemaker implantation using the extended superior transseptal approach for mitral valve surgery. This study aims to compare the extended superior transseptal and the left-atrial approach regarding the need for pacemaker implantation after mitral valve surgery.

METHODS: We performed a retrospective analysis of the data of patients undergoing mitral valve surgery through either a sternotomy and transseptal approach or a mini-thoracotomy and left-atrial approach in a single center in the period 01/2010-05/2021. The primary outcome was the evaluation of the postoperative pacemaker implantation rate.

RESULTS: Overall, 677 patients were included, 333 with transseptal and 344 with left-atrial approach, and 58 (8.6%) patients underwent pacemaker implantation postoperatively. There was no significant difference in the rate of pacemaker implantation between the two groups [overall: 34(10.2%) vs 24(7%), p = 0.133; for sinus node dysfunction: 12(3.6%) vs 9(2.6%), p = 0.459; for high-degree atrioventricular block: 22(6.6%) vs 15(4.4%), p = 0.199; transseptal vs left-atrial approach respectively]. A subgroup analysis of the relative effect of transseptal vs left atrial approach on the rate of postoperative pacemaker implantation revealed mitral replacement as a statistically significant confounder (p = 0.019). The exclusion of patients undergoing concomitant cardiac procedures did not lead to a statistically significant difference in the pacemaker implantation rate between the two approaches.

CONCLUSIONS: The analysis of the data of these patients shows no significant difference in the rate of permanent pacemaker implantation between the extended superior transseptal and the left-atrial approach for mitral valve surgery.

PMID:35640119 | DOI:10.1093/ejcts/ezac328

Stat Methods Med Res. 2022 May 29:9622802221102624. doi: 10.1177/09622802221102624. Online ahead of print.

ABSTRACT

Precision medicine is a medical paradigm that focuses on making effective treatment decision based on individual patient characteristics. When there are a large amount of patient information, such as patient’s genetic information, medical records and clinical measurements, available, it is of interest to select the covariates which have interactions with the treatment, for example, in determining the individualized treatment regime where only a subset of covariates with treatment interactions involves in decision making. We propose a marginal feature ranking and screening procedure for measuring interactions between the treatment and covariates. The method does not require imposing a specific model structure on the regression model and is applicable in a high dimensional setting. Theoretical properties in terms of consistency in ranking and selection are established. We demonstrate the finite sample performance of the proposed method by simulation and illustrate the applications with two real data examples from clinical trials.

PMID:35635269 | DOI:10.1177/09622802221102624

Stat Methods Med Res. 2022 May 29:9622802221104239. doi: 10.1177/09622802221104239. Online ahead of print.

ABSTRACT

Causal multimediation analysis (i.e. the causal mediation analysis with multiple mediators) is critical for understanding the effectiveness of interventions, especially in medical research. Deriving the path-specific effects of exposure on the outcome through a set of mediators can provide detail about the causal mechanism of interest However, existing models are usually restricted to partial decomposition, which can only be used to evaluate the cumulative effect of several paths. In genetics studies, partial decomposition fails to reflect the real causal effects mediated by genes, especially in complex gene regulatory networks. Moreover, because of the lack of a generalized identification procedure, the current multimediation analysis cannot be applied to the estimation of path-specific effects for any number of mediators. In this study, we derive the interventional analogs of path-specific effect for complete decomposition to address the difficulty of nonidentifiability. On the basis of two survival models of the outcome, we derive the generalized analytic forms for interventional analogs of path-specific effects by assuming the normal distributions of mediators. We apply the new methodology to investigate the causal mechanism of signature genes in lung cancer based on the cell cycle pathway, and the results clarify the gene pathway in cancer.

PMID:35635267 | DOI:10.1177/09622802221104239

J Med Econ. 2022 May 28:1-40. doi: 10.1080/13696998.2022.2084234. Online ahead of print.

ABSTRACT

AIMS: Provide the first national description across the US of variations in healthcare measures in 2018 among Medicaid beneficiaries with schizophrenia.

MATERIALS AND METHODS: Adult beneficiaries with ≥2 diagnoses for schizophrenia, and continuous enrollment with consistent geographical data in all of 2018 were identified from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) data for 45 of 50 states. Antipsychotic (AP) utilization rates, including long-acting injectable APs (LAIs), quality metrics, and all-cause healthcare resource utilization and costs for claims submitted to Medicaid were reported nationally and by state. Pearson correlation evaluated associations between LAI utilization and total healthcare costs at state and county levels.

RESULTS: Across the US 688,437 patients with schizophrenia were identified. The AP utilization rate was 51% (state range: 24%-77%), while the LAI utilization rate was 13% (range: 4%-26%). The proportion of patients adherent to any AP was 56% (range: 19%-73%). Within 30 days post-discharge from an inpatient admission, 22% (range: 8%-58%) of patients had an outpatient visit, and 12% (range: 4%-48%) had a readmission. The proportion of patients with ≥1 inpatient admission and ≥1 emergency room visit was 34% (range: 19%-82%) and 45% (range: 20%-70%). Per-patient-per-year total healthcare costs averaged $32,920 (range: $717-$93,972). At the county level, a weak negative correlation was observed between LAI utilization and total healthcare costs.

LIMITATIONS: This study included Medicaid beneficiaries enrolled with pharmacy and medical benefits, including beneficiaries dually eligible for Medicare; results cannot be generalized to the overall schizophrenia population or those with other payer coverage.

CONCLUSIONS: In 2018, half of beneficiaries with schizophrenia did not submit any claims for APs to Medicaid, nearly half had an emergency room visit, and one-third had an inpatient admission. Moreover, healthcare measures varied considerably across states. These findings may indicate unmet treatment needs for Medicaid beneficiaries with schizophrenia.

PMID:35635250 | DOI:10.1080/13696998.2022.2084234

Nurs Crit Care. 2022 May 30. doi: 10.1111/nicc.12782. Online ahead of print.

ABSTRACT

BACKGROUND: Intensive care professionals (ICPs) have a key role in counselling adult intensive care unit (ICU) patients and their family members. The counselling provided to ICU patients and their family members can be described based on the content, implementation, benefits, and resources.

AIMS: The study had two specific aims: first, to assess ICPs’ perceptions of the quality of counselling provided to ICU patients and their family members; and second, to explore which factors ICPs feel is associated with the quality of counselling.

DESIGN AND METHODS: A cross-sectional survey of ICPs working in adult ICUs in Finnish university hospitals. Data were collected using the Counselling Quality Instrument. The data were analysed by descriptive statistics and chi-square and t-test statistical methods.

RESULTS: A total of 182 ICPs returned the questionnaire, reflecting a response rate of 18.6%. Most of the respondents were nurses (97%) and the mean age was 42 years. The ICPs reported having adequate time for patient- (77%) and family-centered (73%) counselling, but only 47% felt that their units had the appropriate facilities. There were statistically significant differences between patient- and family-centered counselling and the ICP’s self-assessed competence (p < .001), goal-oriented counselling (p < .001), and atmosphere during counselling (p < .001). ICPs’ attitudes towards counselling impacted how these professionals assessed patients’ and family members’ confidence, along with patient recovery (p < .001).

CONCLUSIONS: This study confirms that the provision of high-quality counselling has beneficial effects; however, it also indicates that there is a need for training that considers each ICP’s professional experience and patient- and family-centered factors, which may differ from one another.

RELEVANCE TO CLINICAL PRACTICE: According to ICPs, the quality of counselling can be enhanced by empowering ICPs to improve counselling and providing appropriate ICU facilities for counselling, such as a private room for family members.

PMID:35635243 | DOI:10.1111/nicc.12782

J Med Screen. 2022 May 29:9691413221102212. doi: 10.1177/09691413221102212. Online ahead of print.

ABSTRACT

OBJECTIVE: Evidence of reduction in colorectal cancer (CRC) mortality following CRC screening based on the faecal immunochemical test (FIT) is insufficient. This study aimed to analyse if CRC mortality was reduced after implementing FIT-based screening.

SETTING: The Danish national CRC screening programme.

METHODS: This nationwide cohort study included residents aged 50-71 years invited to the prevalence round of the screening programme. Invitation order was decided by randomising on birth month; the first two birth months to be invited were classified as invited and the five last were classified as not-yet-invited and given a pseudo invitation data. Follow-up was from (pseudo)invitation date until 31 December 2017, emigration or death. Relative risk (RR) of CRC death was calculated with 95% confidence intervals (CIs).

RESULTS: A total of 897,812 residents were included (29% invited and 71% not-yet-invited). The median follow-up was 3.3 years. The RR of CRC death at end of follow-up was 0.83 (95% CI 0.66; 1.03) among those invited to screening compared with those not yet invited. For men aged 60-71 years, this RR was 0.68 (95% CI 0.49; 0.94). For those participating in screening compared with a similar group of not-yet-invited residents, the RR was 0.71 (95% CI 0.46-1.08). For male participants aged 60-71 years, this RR was 0.49 (95% CI 0.27-0.89). For women and men aged 50-59 years, RRs were small and statistically non-significant.

CONCLUSION: This nationwide study showed that even within a median follow-up of only 3.3 years, implementing FIT-based CRC screening reduced CRC mortality among older men.

PMID:35635233 | DOI:10.1177/09691413221102212

J Psychoactive Drugs. 2022 May 28:1-13. doi: 10.1080/02791072.2022.2073300. Online ahead of print.

ABSTRACT

Alcohol use disorder (AUD) is a serious public health problem. Over 3.3 million people worldwide die each year due to alcohol-related causes, which is almost 5.3% of all deaths. This systematic review examines the effectiveness of injectable naltrexone treatment for people with AUD based on randomized clinical trial studies conducted between January 2004 and December 2019. Following PRISMA-P, this review searched PubMed, PsycINFO, CINAHL, Cochrane Library, and Web of Science for relevant studies. The inclusion criteria were AUD treatment, injectable naltrexone, and randomized clinical trials. Only articles written in English, involving human participants, and published in peer-reviewed journals were considered for this review. A total of 11 studies met the inclusion criteria. Ten out of the 11 studies assessed the impact of injectable naltrexone in a 3- to 6-month follow-up period, with one study having a year follow-up. This systematic review indicates that overall, injectable naltrexone therapy produced positive AUD treatment outcomes, including reduced mean time to first drinking day and/or heavy drinking day, decreased number of drinking and/or heavy drinking days, and increased abstinence, frequently at a statistically significant level in the larger studies. However, in all studies, less than half of the participants were completely abstinent after receiving injectable naltrexone. Injectable naltrexone treatment along with psychosocial therapy holds promise for addressing AUD.

PMID:35635191 | DOI:10.1080/02791072.2022.2073300