Category: Nevin Manimala

PLoS One. 2022 Nov 29;17(11):e0278019. doi: 10.1371/journal.pone.0278019. eCollection 2022.

ABSTRACT

INTRODUCTION: Despite the availability of various pressure injury (PI) prevention strategies (e.g., risk identification, use of pressure re-distribution surfaces, frequent repositioning), they persist as a significant issue for healthcare systems worldwide. Continuous pressure imaging (CPI) is a novel technology that could be integrated within a comprehensive approach to the prevention of PIs. We studied the perceptions of healthcare providers and patients/families to identify facilitators and barriers to the use of this technology.

METHODS: Hospitalized patients/family members from a randomized controlled trial assessing the efficacy of CPI in preventing PIs completed a survey after 72 hours (or upon discharge from hospital) of CPI monitoring. They were asked questions about prior and current experience with CPI technology. For healthcare providers, perceptions on the use of the device and its impact on care were explored through a survey distributed by email or hard copies.

RESULTS: A total of 125 healthcare providers and 525 patients/family members completed the surveys. Of the healthcare providers, 95% either agreed/strongly agreed that the CPI technology was easy to use and 65% stated that the device improved how they provided pressure relief for patients. Identified issues with the device were cost, the fitting of the mattress cover, and the fixation of the patients/families on the device. Over a quarter of the patient/family respondents agreed/strongly agreed that the device influenced how pressure relief was provided. This response was statistically associated with whether the monitor was turned on (intervention arm; 52.7%) or off (control arm; 4.2%).

DISCUSSION AND CONCLUSION: CPI technology was positively perceived by healthcare providers. Most patients/families felt it influenced care when the CPI monitor was turned on. Concerns raised around cost and the ease of use of these devices by healthcare providers may affect the decisions of healthcare system administrators to adopt and implement this technology.

PMID:36445905 | DOI:10.1371/journal.pone.0278019

PLoS One. 2022 Nov 29;17(11):e0277460. doi: 10.1371/journal.pone.0277460. eCollection 2022.

ABSTRACT

BACKGROUND: There is uncertainty in the treatment options for resectable hypopharyngeal squamous cell carcinoma.

METHODS: A systematic review of randomised controlled trials (RCTs) was performed. Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, Science Citation Index, and Conference Proceedings databases and trial registries were searched until November 2020 for randomized controlled trials performed on resectable hypopharyngeal squamous cell carcinoma. Two systematic review authors independently identified studies and extracted data. The primary outcomes evaluated were overall survival, disease-free survival, any recurrence, local recurrence, loco-regional recurrence, distal recurrence and laryngectomy-free survival. The secondary outcomes were response rates following neoadjuvant treatment and comparison of treatment-related toxicity. Assessment of risk of bias was performed for the selected studies using Cochrane’s tool for assessing risk of bias. The studies were evaluated for the quality of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Risk ratios (RR), rate ratios, and hazard ratios (HR) were calculated along with 95% confidence intervals (95% CI). The Meta-analysis was performed using a random-effects model.

RESULTS: Five RCTs met the inclusion criteria for this review. The risk of bias was unclear or high for the trials. Non-organ preservation(n = 140) versus organ preservation (n = 144) (two trials): no statistically significant difference could be identified for any of the primary outcomes. Concurrent chemoradiotherapy (n = 37) versus sequential chemotherapy followed by radiotherapy (n = 34) (one trial): no statistically significant difference was noted between the two treatment arms for overall survival, disease-free survival and loco-regional recurrence. Laryngectomy-free survival was found to be superior in concurrent chemoradiotherapy arm (HR:0.28, 95% CI 0.13, 0.57). Induction chemotherapy followed by concurrent chemoradiotherapy (n = 53) versus induction chemotherapy followed by radiotherapy (n = 60) (one trial): no statistically significant difference was noted between the treatment arms for overall survival, disease-free survival and laryngectomy-free survival. Preoperative radiotherapy (n = 24) versus postoperative radiotherapy (n = 23) (one trial): overall survival was found to be better in the postoperative radiotherapy arm (HR:2.44, 95% CI1.18, 5.03). No statistically significant difference was noted in terms of treatment-related toxicity.

CONCLUSIONS: There are considerable uncertainties in the management of resectable hypopharyngeal cancer.

TRAIL REGISTRATION: PROSPERO registration: CRD42019155613.

PMID:36445884 | DOI:10.1371/journal.pone.0277460

PLoS One. 2022 Nov 29;17(11):e0277921. doi: 10.1371/journal.pone.0277921. eCollection 2022.

ABSTRACT

Among non-dialysis-dependent chronic kidney disease (ND-CKD) patients, a low hematopoietic response to erythropoiesis-stimulating agents (ESAs) is a predictor for poor renal and cardiovascular outcome. To assess the method for evaluating hyporesponsiveness to ESA in patients with ND-CKD, a multicenter, prospective, observational study of 1,980 adult patients with ND-CKD with renal anemia was conducted. Darbepoetin alfa (DA) and iron supplement administrations were provided according to the recommendation of the attached document and the guidelines of JSDT (Japanese Society of Dialysis and Transplantation). The primary outcomes were progression of renal dysfunction and major adverse cardiovascular events. ESA responsiveness was assessed using pre-defined candidate formulae. During the mean follow-up period of 96 weeks, renal and cardiovascular disease (CVD) events occurred in 683 (39.6%) and 174 (10.1%) of 1,724 patients, respectively. Among pre-set candidate formulae, the one expressed by dividing the dose of DA by Hb level at the 12-week DA treatment was statistically significant in predicting renal (hazard ratio [HR], 1.449; 95% confidence interval [CI], 1.231-1.705; P<0.0001) and CVD events (HR, 1.719; 95% CI, 1.239-2.386; P = 0.0010). The optimum cut-off values for both events were close to 5.2. In conclusion, hyporesponsiveness to ESA in ND-CKD cases, which is associated with a risk for renal and CVD events, may be evaluated practicably as the dose of DA divided by the Hb level at the 12-week DA treatment, and the cut-off value of this index is 5.2. A search for the causes of poor response and measures for them should be recommended in such patients. Trial registration: ClinicalTrials. gov Identifier: NCT02136563; UMIN Clinical Trial Registry Identifier: UMIN000013464.

PMID:36445882 | DOI:10.1371/journal.pone.0277921

PLoS One. 2022 Nov 29;17(11):e0277497. doi: 10.1371/journal.pone.0277497. eCollection 2022.

ABSTRACT

In this paper, we propose a partial randomized response technique to collect reliable sensitive data for estimation of population proportion in ranked set sampling (RSS) scheme using auxiliary information. The idea is to increase confidence and (or) co-operation of the respondents by providing them the option of both ‘direct’ and ‘randomized’ response for the inquired sensitive question. This option is quite logical because perception of sensitive (insensitive) inquiry can vary among respondents. The properties of the proposed method are discussed and compared with existing randomized response techniques. Cost analysis is also carried out to prove supremacy of the suggested method. Finally, an application to clinical trial on AIDS is included.

PMID:36445862 | DOI:10.1371/journal.pone.0277497

Quintessence Int. 2022 Nov 29;0(0):1-33. doi: 10.3290/j.qi.b3631841. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the clinical performance of two methacrylate-based flowable composites and an Ormocer-based flowable composite in non-carious cervical lesions (NCCLs) in adult participants.

METHOD AND MATERIALS: One hundred eighty-three restorations were performed on NCCLs. All cavities were restored using a universal adhesive system (Futurabond U, Voco GmbH) with selective enamel etching and with one of the three evaluated flowable composites (n = 61): low-viscosity methacrylate-based composite (GrandioSO Flow, LV), high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV), and an Ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 24 months. Kruskall Wallis analysis of variance rank (α = 0.05) was used for statistical analysis.

RESULTS: After 24 months of clinical evaluation, sixteen restorations were lost (LV = 3, HV = 10, ORM = 3) and the retention rates (95% confidence interval) were 95.0% for LV, 82.2% for HV and 95.0% for ORM, with statistical differences observed between HV and LV as well as HV and ORM (p < 0.05). When secondary parameters were evaluated, no significant difference between groups were observed (p > 0.05). Thirty-three restorations (LV = 8, HV = 13, ORM = 12) showed minor marginal staining, seventy-one restorations (LV = 26, HV = 20, ORM = 25) presented small marginal adaptation defects and one restoration for HV presented recurrence of caries.

CONCLUSION: The universal adhesive associated with the Ormocer-based and methacrylate-based flowable composite showed promising clinical performance after 24 months. However, the heavy-flow restorations showed significantly more failures.

PMID:36445776 | DOI:10.3290/j.qi.b3631841

Games Health J. 2022 Nov 23. doi: 10.1089/g4h.2022.0134. Online ahead of print.

ABSTRACT

Active exergaming for improving cognitive function is a relatively novel concept as it has certain unique features that could prove advantageous in improving patient outcomes, particularly in patients with neurological disabilities. Hence, we have conducted this review to obtain a comprehensive estimate of effectiveness of active exergames for improving cognitive functioning in patients with neurological disabilities. Literature search was done in PubMed Central, SCOPUS, MEDLINE, and Cochrane Library, ScienceDirect, and Google Scholar until February 2022. We carried out a meta-analysis with a random-effects model and reported pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs). In total, we analyzed 21 studies and half of them had a high risk of bias and were conducted in Korea and the United States. The pooled SMD for global cognition was 0.46 (95% CI: -0.01 to 0.94; I² = 81.2%), pooled SMD for attention function was 0.49 (95% CI: -0.12 to 0.10; I² = 81%), pooled SMD for perception function was 0.31 (95% CI: -0.02 to 0.65; I² = 0%), and pooled SMD for executive function was -0.26 (95% CI: -0.86 to 0.33; I² = 86.7%). Active exergames can have a beneficial effect on most cognitive outcomes, although not statistically significant for managing patients with neurological disabilities.

PMID:36445748 | DOI:10.1089/g4h.2022.0134

Arch Pathol Lab Med. 2022 Nov 29. doi: 10.5858/arpa.2022-0193-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: Evidence of T-cell clonality is often critical in supporting a T-cell lymphoma.

OBJECTIVES.—: To retrospectively explore the significance of copy number losses at the 14q11.2 T-cell receptor α locus in relation to the presence of a T-cell neoplasm and proportion of T cells by targeted next-generation sequencing.

DESIGN.—: Targeted next-generation sequencing data from 139 tissue biopsies including T-cell lymphomas, B-cell lymphomas, classic Hodgkin lymphomas, nonhematopoietic malignancies, and normal samples were reviewed for copy number losses involving the T-cell receptor α gene segments at chr14q11.2.

RESULTS.—: We found that biallelic or homozygous deletion of 14q11.2 was found in most (28 of 33, 84.8%) T-cell lymphomas. The magnitude of 14q11.2 loss showed a statistically significant correlation with the proportion of T cells in lymphoma tissue samples. Copy number losses could also be detected in other lymphomas with high number of T cells (8 of 32, 25% of B-cell lymphomas, 4 of 4 classical Hodgkin lymphomas), though biallelic/homozygous deletion of 14q11.2 was not significantly observed outside of T-cell lymphomas. Most nonhematopoietic neoplasms and normal tissues (59 of 64, 92.2%) showed no significant copy number losses involving the T-cell receptor α locus at chr14q11.2.

CONCLUSIONS.—: Analysis of copy number losses at the T-cell receptor α locus chr14q11.2 with targeted next-generation sequencing can potentially be used to estimate the proportion of T cells and detect T-cell neoplasms.

PMID:36445717 | DOI:10.5858/arpa.2022-0193-OA

JAMA Netw Open. 2022 Nov 1;5(11):e2243388. doi: 10.1001/jamanetworkopen.2022.43388.

ABSTRACT

IMPORTANCE: Individuals with systemic lupus erythematosus (SLE) have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited.

OBJECTIVE: To investigate whether SLE is associated with an increased risk of acute peripartum cardiovascular complications during delivery hospitalization among individuals giving birth.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study was conducted with data from the National Inpatient Sample (2004-2019) by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify delivery hospitalizations among birthing individuals with a diagnosis of SLE. A multivariable logistic regression model was developed to report an adjusted odds ratio (OR) for the association between SLE and acute peripartum cardiovascular complications. Data were analyzed from May 1 through September 1, 2022.

EXPOSURE: Diagnosed SLE.

MAIN OUTCOMES AND MEASURES: Primary study end points were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary end points included ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury (AKI), venous thromboembolism (VTE), length of stay, and cost of hospitalization.

RESULTS: A total of 63 115 002 weighted delivery hospitalizations (median [IQR] age, 28 [24-32] years; all were female patients) were identified, of which 77 560 hospitalizations (0.1%) were among individuals with SLE and 63 037 442 hospitalizations (99.9%) were among those without SLE. After adjustment for age, race and ethnicity, comorbidities, insurance, and income level, SLE remained an independent risk factor associated with peripartum cardiovascular complications, including preeclampsia (adjusted OR [aOR], 2.12; 95% CI, 2.07-2.17), peripartum cardiomyopathy (aOR, 4.42; 95% CI, 3.79-5.13), heart failure (aOR, 4.06; 95% CI, 3.61-4.57), cardiac arrhythmias (aOR, 2.06; 95% CI, 1.94-2.21), AKI (aOR, 7.66; 95% CI, 7.06-8.32), stroke (aOR, 4.83; 95% CI, 4.18-5.57), and VTE (aOR, 6.90; 95% CI, 6.11-7.80). For resource use, median (IQR) length of stay (3 [2-4] days vs 2 [2-3] days; P < .001) and cost of hospitalization ($4953 [$3305-$7517] vs $3722 [$2606-$5400]; P < .001) were higher for deliveries among individuals with SLE.

CONCLUSIONS AND RELEVANCE: This study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization.

PMID:36445710 | DOI:10.1001/jamanetworkopen.2022.43388

Int J Cardiovasc Imaging. 2022 Dec;38(12):2811-2818. doi: 10.1007/s10554-022-02699-5. Epub 2022 Aug 28.

ABSTRACT

PURPOSE: Fractional flow reserve (FFR) has been demonstrated in some studies to predict long-term coronary artery bypass graft (CABG) patency. Quantitative flow ratio (QFR) is an emerging technology which may predict FFR. In this study, we hypothesised that QFR would predict long-term CABG patency and that QFR would offer superior diagnostic performance to quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).

METHODS: A prospective study was performed on patients with left main coronary artery disease who were undergoing CABG. QFR, QCA and IVUS assessment was performed. Follow-up computed tomography coronary angiography and invasive coronary angiography was undertaken to assess graft patency.

RESULTS: A total of 22 patients, comprising of 65 vessels were included in the analysis. At a median follow-up of 3.6 years post CABG (interquartile range, 2.3 to 4.8 years), 12 grafts (18.4%) were occluded. QFR was not statistically significantly higher in occluded grafts (0.81 ± 0.19 vs. 0.69 ± 0.21; P = 0.08). QFR demonstrated a discriminatory power to predict graft occlusion (area under the receiver operating characteristic curve, 0.70; 95% confidence interval [CI], 0.52 to 0.88; P = 0.03). At long-term follow-up, the risk of graft occlusion was higher in vessels with a QFR > 0.80 (58.6% vs. 17.0%; hazard ratio, 3.89; 95% CI, 1.05 to 14.42; P = 0.03 by log-rank test). QCA (minimum lumen diameter, lesion length, diameter stenosis) and IVUS (minimum lumen area, minimum lumen diameter, diameter stenosis) parameters were not predictive of long-term graft patency.

CONCLUSIONS: QFR may predict long-term graft patency in patients undergoing CABG.

PMID:36445675 | DOI:10.1007/s10554-022-02699-5

Int J Cardiovasc Imaging. 2022 Dec;38(12):2733-2741. doi: 10.1007/s10554-022-02642-8. Epub 2022 Jul 19.

ABSTRACT

PURPOSE: Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to evaluate the relation between AF and left ventricular (LV) late gadolinium enhancement (LGE).

METHODS: 55 patients with HCM were retrospectively included. Patients were divided in HCM with AF and HCM without AF. Baseline clinical, echocardiographic and cardiovascular magnetic resonance (CMR) characteristics were collected and compared between groups.

RESULTS: In univariable analysis, the factors related to AF development were HCM risk score for sudden cardiac death (SCD) > 2.29% (p = 0.002), left atrium (LA) diameter > 42.5 mm (p = 0.014) and LGE in the mid anterior interventricular septum (IVS) (p = 0.021), basal inferior IVS (p = 0.012) and mid inferior IVS (p = 0.012). There were no differences in LV diastolic function and LA strain between groups. Independent predictors of AF were LA diameter (p = 0.022, HR 5.933) and LGE in mid inferior IVS (p = 0.45, HR 3.280). Combining LA diameter (> 42.5 mm or < 42.5 mm) and LGE in mid inferior IVS (present or absent) in a model with four groups showed a statistically significant difference between groups (p = 0.013 for the model).

CONCLUSIONS: LGE in mid inferior IVS is an independent predictor for AF occurrence in patients with HCM. Combining both LGE in mid inferior IVS and enlarged LA improves prediction of AF and may be preferred for risk stratification.

PMID:36445662 | DOI:10.1007/s10554-022-02642-8