Category: Nevin Manimala

J Gerontol Soc Work. 2022 Jul 26:1-13. doi: 10.1080/01634372.2022.2103762. Online ahead of print.

ABSTRACT

Caregiving has become an increasingly important medical and social issue in recent decades. We performed a cross-sectional study on pulmonary patients and accompanying informal caregivers who were hospitalized in the chest disease ward of a tertiary center in Turkey between January 2020 and April 2021. Informal caregivers were asked to complete the Zarit Caregiver Burden Interview. A total of 141 inpatients (39% female, mean age: 76.8 ± 10.2 years) and their informal caregivers (77% female, mean age: 54 ± 11.9 years) were evaluated. The caregivers were classified as light to medium burden (group 1, burden score ≤40) and medium to heavy burden (group 2, burden score >40). The mean burden score was 35.7 ± 13.3 points. The number of female caregivers was higher in group 2 (p = 0.025). There was a positive correlation between the burden score and female gender (p = 0.002) and the number of chronic diseases of caregivers (p = 0.020). Statistical analysis revealed a negative correlation between the burden score and the level of education (r = > -0.174, p = 0.040). Caregiver burden is related to the characteristics of the caregiver rather than those of the patient being cared for. Female caregivers with lower education and more than one chronic disease perceive a higher caregiver burden.

PMID:35880439 | DOI:10.1080/01634372.2022.2103762

Curr Med Res Opin. 2022 Jul 26:1-26. doi: 10.1080/03007995.2022.2105072. Online ahead of print.

ABSTRACT

OBJECTIVE: Factor VIII (FVIII) replacement and emicizumab have demonstrated efficacy for prevention of bleeds among patients with hemophilia A (PwHA) compared to on-demand use. Evidence investigating clinical outcomes and healthcare costs of non-inhibitor PwHA switching from prophylaxis with FVIII concentrates to emicizumab has not been well-established within large real-world datasets. This study aimed to investigate billed annualized bleed rates (ABR_b) and total cost of care (TCC) among non-inhibitor PwHA switching from FVIII-prophylaxis to emicizumab-prophylaxis.

METHODS: This retrospective, observational study was conducted using IQVIA PharMetrics® Plus, a US administrative claims database. The date of first claim for emicizumab was defined as the index date. On-demand patients and inhibitor patients were excluded. Bleeds were identified using a list of 535 diagnosis codes. Bayesian models were developed to estimate the probability ABR_b worsens and TCC increases after switching to emicizumab. Wilcoxon rank-sum tests were used to test statistical significance of changes in ABR_b and TCC after switch.

RESULTS: Among the 121 identified patients, the difference in mean ABR_b between FVIII-prophylaxis (0.68 [SD =1.28]) and emicizumab (0.55 [SD =1.48]) was insignificant (p = 0.142). The mean annual TCC significantly increased for patients switching from FVIII-prophylaxis ($518,151 [SD=$289,934]) to emicizumab ($652,679 [SD=$340,126]; p< 0.0001). The Bayesian models estimated a 21.0% probability of the ABR_b worsening and a 99.9% probability of increasing TCC after switch.

CONCLUSION: This study found that in male non-inhibitor PwHA, switching from FVIII prophylaxis to emicizumab incurs substantial cost increase with no significant benefit in ABR_b. This evidence may help guide providers, payers, and patients in shared decision-making conversations around best treatment options.

PMID:35880468 | DOI:10.1080/03007995.2022.2105072

Per Med. 2022 Jul 26. doi: 10.2217/pme-2022-0014. Online ahead of print.

ABSTRACT

The application of artificial intelligence (AI) to healthcare has garnered significant enthusiasm in recent years. Despite the adoption of new analytic approaches, medical education on AI is lacking. We aim to create a usable AI primer for medical education. We discuss how to generate a clinical question involving AI, what data are suitable for AI research, how to prepare a dataset for training and how to determine if the output has clinical utility. To illustrate this process, we focused on an example of how medical imaging is employed in designing a machine learning model. Our proposed medical education curriculum addresses AI’s potential and limitations for enhancing clinicians’ skills in research, applied statistics and care delivery.

PMID:35880428 | DOI:10.2217/pme-2022-0014

Bosn J Basic Med Sci. 2022 Jul 25. doi: 10.17305/bjbms.2022.7440. Online ahead of print.

ABSTRACT

The aim of this in vitro study was to evaluate the effect of three final irrigants, namely QMix, MTAD and EDTA, combined with three irrigation techniques, namely conventional needle irrigation (CNI), passive ultrasonic irrigation (PUI) and photon-induced photoacoustic streaming (PIPS), on smear layer removal, dentin mineral content and microhardness in oval-shaped canals. 130 decoronated premolars with single, oval root canals were equally divided into1 blank control group and 12 treatment groups (n=10) according to the final irrigation protocols. Roots in treatment groups were instrumented with ProTaper Gold to size F4 and subjected to final irrigation. Smear layer removal was assessed by using a four-level scoring system under an environmental scanning electron microscope. Energy dispersive X-ray spectroscopy was performed to measure the dentin mineral content. Dentin microhardness was measured by Knoop microhardness testing. Statistical analysis of the data was performed by using Kruskal-Wallis test, followed by Dunn’s post hoc test with Bonferroni correction. PUI- and PIPS-activated QMix and EDTA removed smear layer more effectively than MTAD groups (p<0.05). Regarding the dentin mineral content and microhardness, QMix groups yielded the least calcium (Ca), phosphorus (P) and Ca/P ratio, followed by EDTA groups and MTAD groups (p<0.05). QMix groups produced significantly lower dentin microhardness values and higher hardness reduction percentages than MTAD groups (p<0.05). Within the limitations of the present study, it was concluded that QMix and EDTA were superior to MTAD in smear layer removal, especially when activated by PUI and PIPS, but these agents produced more pronounced effect on dentin mineral content and microhardness than MTAD.

PMID:35880401 | DOI:10.17305/bjbms.2022.7440

Brief Bioinform. 2022 Jul 25:bbac286. doi: 10.1093/bib/bbac286. Online ahead of print.

ABSTRACT

Single-cell RNA-sequencing (scRNA-seq) enables researchers to quantify transcriptomes of thousands of cells simultaneously and study transcriptomic changes between cells. scRNA-seq datasets increasingly include multisubject, multicondition experiments to investigate cell-type-specific differential states (DS) between conditions. This can be performed by first identifying the cell types in all the subjects and then by performing a DS analysis between the conditions within each cell type. Naïve single-cell DS analysis methods that treat cells statistically independent are subject to false positives in the presence of variation between biological replicates, an issue known as the pseudoreplicate bias. While several methods have already been introduced to carry out the statistical testing in multisubject scRNA-seq analysis, comparisons that include all these methods are currently lacking. Here, we performed a comprehensive comparison of 18 methods for the identification of DS changes between conditions from multisubject scRNA-seq data. Our results suggest that the pseudobulk methods performed generally best. Both pseudobulks and mixed models that model the subjects as a random effect were superior compared with the naïve single-cell methods that do not model the subjects in any way. While the naïve models achieved higher sensitivity than the pseudobulk methods and the mixed models, they were subject to a high number of false positives. In addition, accounting for subjects through latent variable modeling did not improve the performance of the naïve methods.

PMID:35880426 | DOI:10.1093/bib/bbac286

Acta Otorhinolaryngol Ital. 2022 Jun;42(3):281-286. doi: 10.14639/0392-100X-N1951.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate vestibular functions with video head impulse test (VHIT) and to understand the value of VHIT in differential diagnosis in patients with vestibular migraine (VM) during dizziness attack.

MATERIALS AND METHODS: Two groups were enrolled in this study. The first consisted of 84 vestibular migraine patients, and second group of 74 healthy subjects. VHIT was applied to patients with VM during vertigo attack and the results were compared with the VHIT values applied to subjects in the control group.

RESULTS: The mean vestibulo-ocular reflex (VOR) in all semicircular canals in the VM group was lower than healthy individuals, but the results were not statistically significant. Refixation saccades were found in 52.3% of VM patients and in 10.2% of healthy individuals.

CONCLUSIONS: When patients with VM were evaluated with VHIT during vertiginous attack, VOR gain values were not different from healthy individuals, but the number of catch-up saccades were higher in VM patients, which indicates peripheral vestibular involvement. For differential diagnosis in patients with VM, vestibular tests should be performed during the vertigo attack. When evaluating VHIT results, the presence of refixation saccades should also be evaluated.

PMID:35880368 | DOI:10.14639/0392-100X-N1951

J Orthop Res. 2022 Jul 26. doi: 10.1002/jor.25421. Online ahead of print.

ABSTRACT

Inertial measurement units (IMUs) are commonly used for gait assessment, yet their potential for quantifying improvements in gait function and patterns after total hip arthroplasty (THA) has not been fully explored. The primary aim of this study was to compare spatiotemporal parameters and sagittal plane kinematic patterns of patients with hip osteoarthritis (OA) before and after THA, and to asymptomatic controls. The secondary aim was to assess the association between dynamic hip range of motion (ROM) during walking and the Hip Osteoarthritis Outcome Scores (HOOS). Twenty-four patients with hip OA and 24 matched asymptomatic controls completed gait analyses using the RehaGait® sensor system. Patients were evaluated pre- and 1 year postoperatively, controls in a single visit. Differences in kinematic data were analyzed using statistical parametric mapping, and correlations between dynamic hip ROM and HOOS were calculated. Walking speed and stride length significantly increased (+0.08 m/s, P=0.019; +0.06m, P=0.048) after THA but did not reach the level of asymptomatic controls (-0.11 m/s, P=0.028; -0.14 m, P=0.001). Preoperative hip and knee kinematics differed significantly from controls. After THA, they improved significantly and did not differ from controls. Dynamic hip flexion-extension ROM correlated positively with all HOOS subscores (r>0.417; P≤0.001). The change in HOOS symptoms in patients was explained by the combination of baseline HOOS symptoms and change in dynamic hip ROM (r² =0.748) suggesting that the additional information gained with IMU gait analysis helps to complement and objectify PROMs pre- and postoperatively and to monitor treatment related improvements. This article is protected by copyright. All rights reserved.

PMID:35880355 | DOI:10.1002/jor.25421

J Orthop Res. 2022 Jul 26. doi: 10.1002/jor.25422. Online ahead of print.

ABSTRACT

Cryopreserved bone allografts(CBA) are susceptible to infection, nonunion and late stress fracture. While surgical revascularization by intramedullary implantation of an arteriovenous-bundle generates a neoangiogenic blood supply, there is potential for vascular ingrowth-mediated bone resorption to weaken the graft. For this reason, we have evaluated changes in CBA mechanical properties of structural tibial allografts with and without surgically induced angiogenesis. Cryopreserved tibia bone allografts were transplanted to reconstruct a 3.5 cm segmental tibial defect in 16 Yucatan mini pigs. Surgical revascularization was performed in half by implantation of a cranial tibial arteriovenous bundle, revascularization group. A control group of identical size had a ligated AV bundle implanted, ligated group. At 20 weeks micro-computed tomography measured Bone Mineral Density as well as bone union, Reference Point Indentation (RPI) compared cortex material properties, and axial compression determined the allotransplant compressive modulus. Seven of 8 tibiae in the angiogenesis group were healed at both junction points at 20 weeks. Only 4 of 8 tibiae healed in the ligated control group. There was no significant difference between the revascularization and ligated control groups in bone mineral density and axial compression test. Similarly, RPI parameters were statistically equal. In paired comparisons with contralateral tibias, however, some RPI values were significantly worse in the ligated control group tibiae. This study demonstrates no adverse effect of surgical angiogenesis on cryopreserved structural bone allograft biomechanical properties in a large animal orthotopic segmental tibial defect model. These data suggest the potential value of surgical angiogenesis in clinical limb-sparing reconstructive surgery. This article is protected by copyright. All rights reserved.

PMID:35880353 | DOI:10.1002/jor.25422

Foot Ankle Spec. 2022 Jul 26:19386400221114488. doi: 10.1177/19386400221114488. Online ahead of print.

ABSTRACT

BACKGROUND: The lateral extensile approach (LEA) is an operative approach for calcaneal fractures. High rates of wound complications have led to alternative approaches such as the sinus tarsi approach to grow in popularity. The LEA affords substantial visualization of the calcaneus. This visualization has never been compared in a quantitative manner with the sinus tarsi approach (STA). We aim to quantify the calcaneal visualization afforded by STA and LEA.

METHODS: Seven pair-matched, fresh-frozen, below-knee cadaver extremities were included. For each pair, one side received an LEA and the other side received an STA.

RESULTS: There were no statistically significant differences in the articular surfaces accessible between the 2 approaches. The total calcaneal surface area accessible was 3107.08 mm² for LEA and 1444.19 mm² for STA (P = .02). The LEA allowed better exposure to the lateral wall (P = .01) and the dorsal tuberosity of the calcaneus (P = .04).

CONCLUSION: The STA allows for equivalent articular surface exposure when compared with the LEA. Although LEA allows for greater exposure of the lateral wall and dorsal tuberosity, direct visualization of these structures may not warrant the higher risk of wound complications. Surgeons should consider these differences when choosing an operative approach in the treatment of calcaneal fractures.

Level III.

PMID:35880349 | DOI:10.1177/19386400221114488

Hand (N Y). 2022 Jul 26:15589447221109632. doi: 10.1177/15589447221109632. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this systematic review was to analyze the available literature on fixation of distal radius fractures (DRFs) under wide-awake local anesthesia no-tourniquet (WALANT), and to examine postoperative pain scores and functional outcomes, operative data including operative time and blood loss, and the frequency of adverse events.

METHODS: Embase, MEDLINE, Web of Science, and SCOPUS were searched from inception until May 2022 for relevant studies. Studies were screened in duplicate, and data on pain scores, functional outcomes, and adverse events were recorded. Due to methodological and statistical heterogeneity, the results are presented in a descriptive fashion.

RESULTS: Ten studies were included comprising 456 patients with closed, unilateral DRFs, of whom 226 underwent fixation under WALANT. These patients had a mean age of 52.8 ± 8.3 years, were 48% female, and had a mean follow-up time of 11.6 months (range: 6-24). Operative time for WALANT patients averaged 60.4 ± 6.5 minutes, with mean postoperative pain scores of 1.4 ± 0.6 on a 10-point scale. Studies that compared WALANT to general anesthesia found shorter hospital stays with most WALANT patients being sent home the same day, decreased postoperative pain scores, and decreased costs to the healthcare system. No adverse events were reported for WALANT patients.

CONCLUSIONS: A growing body of literature reports that for closed, unilateral DRF, surgical fixation under WALANT is a safe and effective option. It allows patients to have surgery sooner, with improved pain scores and good functional outcomes, with a very low incidence of adverse events.

PMID:35880346 | DOI:10.1177/15589447221109632