Category: Nevin Manimala

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220395. Online ahead of print.

ABSTRACT

BACKGROUND: The continuous decrease of healthcare resources requires hospitals to improve efficiency while striving to improve quality standards that deliver better patient outcomes.

OBJECTIVE: The objective of this study was to analyze whether the implementation of digital support systems during orthopedic surgery positively affected clinical processes and quality ratios.

METHODS: A retrospective case-control study of 297 knee joint replacement procedures was conducted between 2015 and 2020. Thirty-five patients were allocated to the treatment and control groups after they were identified with exact matching and estimation of the propensity score. Both groups were balanced regarding the selected covariates. The effect of the surgical procedure manager (SPM) on the incidence of acute haemorrhagic anaemia between the two groups was evaluated with a t-test, and the odds ratio was calculated.

RESULTS: SPM-supported surgery has no significant influence on the incidence of acute haemorrhagic anaemia but leads to significantly shorter hospital stay (1.93 days), changeover (4.14 minutes) and recovery room time (20.20 minutes). In addition, it reduces the standard deviation of operation room times.

CONCLUSIONS: The study concludes that SPM enhances surgical efficiency and maintains quality outcomes. To overcome their increasing financial pressure hospital management should commercially evaluate the implementation of digital support systems.

PMID:36442162 | DOI:10.3233/THC-220395

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220361. Online ahead of print.

ABSTRACT

BACKGROUND: At present, the clinical diagnosis of white matter change (WMC) patients depends on cranial magnetic resonance imaging (MRI) technology. This diagnostic method is costly and does not allow for large-scale screening, leading to delays in the patient’s condition due to inability to receive timely diagnosis.

OBJECTIVE: To evaluate whether the burden of WMC is associated with the degree of invisible hand tremor in humans.

METHODS: Previous studies have shown that tremor is associated with WMC, however, tremor does not always have imaging of WMC. Therefore, to confirm that the appearance of WMC causes tremor, which are sometimes invisible to the naked eye, we achieved an optical-based computer-aided diagnostic device by detecting the invisible hand tremor, and we proposed a calculation method of WMC volume by using the characteristics of MRI images.

RESULTS: Statistical analysis results further clarified the relationship between WMC and tremor, and our devices are validated for the detection of tremors with WMC.

CONCLUSIONS: The burden of WMC volume is positive factor for degree of invisible hand tremor in the participants without visible hand tremor. Detection technology provides a more convenient and low-cost evaluating method before MRI for tremor diseases.

PMID:36442160 | DOI:10.3233/THC-220361

J Dtsch Dermatol Ges. 2022 Nov 28. doi: 10.1111/ddg.14911. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: In recent years, considerable insight has been gained into the pathogenesis, diagnosis and treatment of cutaneous sarcomas, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). Both entities have shown increasing incidence rates in the last decade. This study was initiated to evaluate how these new insights impact the number of diagnoses of AFX/PDS compared to other cutaneous sarcoma entities.

PATIENTS AND METHODS: In a retrospective study of four German skin cancer centers, all histopathological reports of cutaneous sarcomas (AFX, PDS, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, angiosarcoma, and Kaposi sarcoma) confirmed by board-certified dermatopathologists were analyzed during a time-period of seven years (2013-2019). Additionally, utilization of immunohistochemical markers (including pan-cytokeratin, S100, desmin, CD34, CD10, procollagen-1, CD99, CD14, and CD68) as an adjunct to diagnose AFX/PDS was recorded.

RESULTS: Overall, 255 cutaneous sarcomas were included in the present study. The diagnosis of a cutaneous sarcoma has consequently risen from 2013 to 2019 (from 16 to 52 annual cases). The results of AFX/PDS revealed 4.6 times more diagnoses in 2019 than in 2013. Atypical fibroxanthoma represented the most common subtype, displaying 49.3 % of all diagnosed cutaneous sarcomas. Additionally, the increase of AFX/PDS was linked to the use of immunohistochemistry, with specific immunohistochemical markers used in 57.1 % of cases in 2013 compared to 100 % in 2019.

CONCLUSIONS: This retrospective study of four German skin cancer centers demonstrates a substantial rise of AFX/PDS, possibly due to recently established diagnostic and terminology standards. This rise is probably linked to increased utilization of specific immunohistochemical markers. Atypical fibroxanthoma/PDS may be more common than previously thought and seems to represent the most frequent cutaneous sarcoma subtype.

PMID:36442137 | DOI:10.1111/ddg.14911

Proc Natl Acad Sci U S A. 2022 Dec 6;119(49):e2215352119. doi: 10.1073/pnas.2215352119. Epub 2022 Nov 28.

ABSTRACT

Problem-solving and reasoning involve mental exploration and navigation in sparse relational spaces. A physical analogue is spatial navigation in structured environments such as a network of burrows. Recent experiments with mice navigating a labyrinth show a sharp discontinuity during learning, corresponding to a distinct moment of “sudden insight” when mice figure out long, direct paths to the goal. This discontinuity is seemingly at odds with reinforcement learning (RL), which involves a gradual build-up of a value signal during learning. Here, we show that biologically plausible RL rules combined with persistent exploration generically exhibit discontinuous learning. In tree-like structured environments, positive feedback from learning on behavior generates a “reinforcement wave” with a steep profile. The discontinuity occurs when the wave reaches the starting point. By examining the nonlinear dynamics of reinforcement propagation, we establish a quantitative relationship between the learning rule, the agent’s exploration biases, and learning speed. Predictions explain existing data and motivate specific experiments to isolate the phenomenon. Additionally, we characterize the exact learning dynamics of various RL rules for a complex sequential task.

PMID:36442113 | DOI:10.1073/pnas.2215352119

Proc Natl Acad Sci U S A. 2022 Dec 6;119(49):e2209490119. doi: 10.1073/pnas.2209490119. Epub 2022 Nov 28.

ABSTRACT

Emissions of fine particulate matter (PM_2.5) from human activities have been linked to substantial disease burdens, but evidence regarding how reducing PM_2.5 at its sources would improve public health is sparse. We followed a population-based cohort of 2.7 million adults across Canada from 2007 through 2016. For each participant, we estimated annual mean concentrations of PM_2.5 and the fractional contributions to PM_2.5 from the five leading anthropogenic sources at their residential address using satellite observations in combination with a global atmospheric chemistry transport model. For each source, we estimated the causal effects of six hypothetical interventions on 10-y nonaccidental mortality risk using the parametric g-formula, a structural causal model. We conducted stratified analyses by age, sex, and income. This cohort would have experienced tangible health gains had contributions to PM_2.5 from any of the five sources been reduced. Compared with no intervention, a 10% annual reduction in PM_2.5 contributions from transportation and power generation, Canada’s largest and fifth-largest anthropogenic sources, would have prevented approximately 175 (95%CI: 123-226) and 90 (95%CI: 63-117) deaths per million by 2016, respectively. A more intensive 50% reduction per year in PM_2.5 contributions from the two sources would have averted 360 and 185 deaths per million, respectively, by 2016. The potential health benefits were greater among men, older adults, and low-income earners. In Canada, where PM_2.5 levels are among the lowest worldwide, reducing PM_2.5 contributions from anthropogenic sources by as little as 10% annually would yield meaningful health gains.

PMID:36442082 | DOI:10.1073/pnas.2209490119

J Public Health Manag Pract. 2022 Nov 23. doi: 10.1097/PHH.0000000000001664. Online ahead of print.

ABSTRACT

CONTEXT: Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing primary prevention strategy from 1991 to 2015; and implementation of large-scale proven interventions since then.

PROGRAM: Childhood Lead Poisoning Prevention & Healthy Housing.

METHODS: Historic and recent health and housing data from the National Health and Nutrition Examination Survey (NHANES) and the American Healthy Homes Survey (AHHS) were retrieved to analyze trends and associated policy gaps.

EVALUATION: Approximately 590 000 US children aged 1 through 5 years had elevated blood lead levels of 3.5 μg/dL and greater in 2016, and 4.3 million children resided in homes with lead paint in 2019. Despite large improvements, racial and other disparities remain stubbornly and statistically significant. The NHANES and the AHHS require larger sample sizes. The Centers for Disease Control and Prevention has not published children’s blood lead surveillance and NHANES data in several years; the Department of Housing and Urban Development (HUD) has no analogous housing surveillance system; and the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) have not updated training, Superfund, and occupational standards in decades.

DISCUSSION: The nation has been without a plan and an associated budget for more than 2 decades. Congress has not reformed the nation’s main lead poisoning prevention laws in more than 30 years. Such reforms include stopping US companies from producing new residential lead paint in other countries; enabling the disclosure law to identify all residential lead hazards; closing loopholes in federally assisted housing regulations and mortgage insurance standards; harnessing tax policy to help homeowners mitigate lead hazards; streamlining training requirements; increasing the size of health and housing surveys and surveillance systems; and updating housing codes, medical guidance, dust lead standards, training, Superfund, and worker exposure limits. Congress and the president should reauthorize a cabinet-level task force (dormant since 2010) to develop a new strategic plan with an interagency budget to implement it. These reforms will scale and optimize markets, subsidies, enforcement, and other proven interventions to end ineffective, costly, harmful, and irrational cost shifting that threatens children, workers, and affordable housing. International Lead Poisoning Prevention Week in October 2022 presents an opportunity to initiate long-overdue reforms in the United States.

PMID:36442070 | DOI:10.1097/PHH.0000000000001664

Ann Intern Med. 2022 Nov 29. doi: 10.7326/M22-2202. Online ahead of print.

ABSTRACT

BACKGROUND: Clinicians and patients want to know the benefits and harms of outpatient treatment options for SARS-CoV-2 infection.

PURPOSE: To assess the benefits and harms of 12 different COVID-19 treatments in the outpatient setting.

DATA SOURCES: Epistemonikos COVID-19 L·OVE Platform, searched on 4 April 2022.

STUDY SELECTION: Two reviewers independently screened abstracts and full texts against a priori-defined criteria. Randomized controlled trials (RCTs) that compared COVID-19 treatments in adult outpatients with confirmed SARS-CoV-2 infection were included.

DATA EXTRACTION: One reviewer extracted data and assessed risk of bias and certainty of evidence (COE). A second reviewer verified data abstraction and assessments.

DATA SYNTHESIS: The 26 included studies collected data before the emergence of the Omicron variant. Nirmatrelvir-ritonavir and casirivimab-imdevimab probably reduced hospitalizations (1% vs. 6% [1 RCT] and 1% vs. 4% [1 RCT], respectively; moderate COE). Nirmatrelvir-ritonavir probably reduced all-cause mortality (0% vs. 1% [1 RCT]; moderate COE), and regdanvimab probably improved recovery (87% vs. 72% [1 RCT]; moderate COE). Casirivimab-imdevimab reduced time to recovery by a median difference of 4 days (10 vs. 14 median days [1 RCT]; high COE). Molnupiravir may reduce all-cause mortality, sotrovimab may reduce hospitalization, and remdesivir may improve recovery (low COE). Lopinavir-ritonavir and azithromycin may have increased harms, and hydroxychloroquine may result in lower recovery rates (low COE). Other treatments had insufficient evidence or no statistical difference in efficacy and safety versus placebo.

LIMITATION: Many outcomes had few events and small samples.

CONCLUSION: Some antiviral medications and monoclonal antibodies may improve outcomes for outpatients with mild to moderate COVID-19. However, the generalizability of the findings to the currently dominant Omicron variant is limited.

PRIMARY FUNDING SOURCE: American College of Physicians. (PROSPERO: CRD42022323440).

PMID:36442056 | DOI:10.7326/M22-2202

Plast Reconstr Surg. 2022 Nov 29. doi: 10.1097/PRS.0000000000009937. Online ahead of print.

ABSTRACT

BACKGROUND: “Spin” refers to a manipulation of language that implies benefit for an intervention when none may exist. Randomized clinical trials (RCTs) in other fields have been demonstrated to employ spin, which can mislead clinicians to use ineffective or unsafe interventions. This study’s objective was to determine the strategies, severity, and extent of spin in plastic surgery RCTs with non-significant primary outcomes.

METHODS: A literature search of the top 15 plastic surgery journals using MEDLINE was performed (2000-2020). Parallel 1:1 RCTs with a clearly identified primary outcome showing statistically non-significant results (p ≥ .05) were included. Screening, data extraction, and spin analysis were performed by two independent reviewers. The spin analysis was then independently assessed in duplicate by two plastic surgery residents with graduate level training in clinical epidemiology.

RESULTS: From 3,497 studies identified, 92 RCTs were included in this study. Spin strategies were identified in 78 RCTs (85%), including 64 Abstracts (70%) and 77 Main Texts (84%). Severity of spin was rated moderate or high in 43 Abstract Conclusions (47%) and 42 Main Text Conclusions (46%). The most identified spin strategy in the Abstract was claiming equivalence for statistically non-significant results (26%), and in the Main Text was focusing on another objective (24%).

CONCLUSIONS: This study suggests that 85% of statistically non-significant RCTs in plastic surgery employ spin. Readers of plastic surgery research should be aware of strategies, whether intentional or unintentional, used to manipulate language in reports of statistically non-significant RCTs when applying research findings to clinical practice.

PMID:36442055 | DOI:10.1097/PRS.0000000000009937

Psychol Assess. 2022 Nov 28. doi: 10.1037/pas0001182. Online ahead of print.

ABSTRACT

Identifying substance use disorders (SUDs) early and accurately improves case formulation and treatment. Previous studies have investigated validity and reliability of the Child and Adolescent Symptom Inventory (CASI) for anxiety, mood, and behavior problems. The present study’s aim was to test if the embedded CASI Substance Use (SU) subscale can discriminate adolescents and young adults (AYA) with and without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework. N = 479 outpatient AYA (age 14-21) and their caregivers completed K-SADS-PLW semistructured diagnostic interviews; caregivers completed the CASI and adolescents completed a parallel version, the Youth (self-report) Inventory (YI). K-SADS-PLW indicated that 33 youth met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUDs. Receiver Operating Characteristic (ROC) analyses found that both CASI and YI Substance Use subscale scores significantly identified K-SADS-diagnosed SUDs in AYA: Caregiver area under curve (AUC) = .91, p < .0005; YI(AUC) = .90, p < .0005. There was no significant difference in diagnostic accuracy between informants. Both subscales showed diagnostic and clinical utility in identifying AYA SUDs in outpatient mental health settings. Findings suggest that the CASI-4R subscale could be a helpful screening instrument for AYA SUDs. A case vignette illustrates the clinical application of study findings. Future research should examine rapport as a moderator of reporting accuracy, and replicate use of these measures under varying clinical scenarios. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36442043 | DOI:10.1037/pas0001182

J Exp Psychol Gen. 2022 Nov 28. doi: 10.1037/xge0001323. Online ahead of print.

ABSTRACT

We determined the scope of five decision models of choices across four environmental niches defined by whether outcome probabilities are described (risk) or experienced by sampling (uncertainty) and whether lotteries are simple (one or two outcomes per prospect) or complex (three or four). The majority of participants chose in accordance with cumulative prospect theory only in simple environments involving decisions from description (75%). In complex environments involving decisions from description and experience, however, skewness-preference models were more prevalent (57% and 68%, respectively). Consequently, in niches outside of simple lotteries under risk, rank dependence and nonlinear probability weighting failed to accurately describe the majority of choices. Exploiting elicited subjective beliefs in decisions from experience, we found that experienced (sampled) outcome likelihoods outperformed elicited beliefs in predicting choices and found scant evidence for two-stage models of decisions under uncertainty. Finally, we found statistically significant evidence that 90% of participants chose as if they relied on different models across environments; nonetheless, assuming as if participants used a single model across all environments to predict out-of-sample choice only minimally reduced prediction accuracy. We discuss the implications of model mimicry and task diagnosticity in light of these results in terms of both economic and statistical significance, both for model comparisons and inference. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36442037 | DOI:10.1037/xge0001323