Category: Nevin Manimala

Ann Surg Oncol. 2022 Apr 12. doi: 10.1245/s10434-022-11521-4. Online ahead of print.

ABSTRACT

BACKGROUND: The BREAST-Q is the most commonly used patient-reported outcome measure (PROM) for breast reconstruction research. However, clinical implementation of this PROM has been impeded by a lack of context for score interpretation. The aim of this study was to define reference values for the BREAST-Q at discrete timepoints following surgery, generating a tool for real-time score interpretation.

METHODS: BREAST-Q scores were prospectively obtained in women who underwent implant or autologous post-mastectomy breast reconstruction preoperatively and for 2 years following surgery at Memorial Sloan Kettering Cancer Center (MSK). Descriptive statistics were used to create reference values for BREAST-Q satisfaction and quality-of-life subscales. Reference values were externally validated by comparing patient characteristics and BREAST-Q scores between the MSK and the Mastectomy Reconstruction Outcomes Consortium (MROC) study cohorts.

RESULTS: Overall, 3268 MSK patients and 2814 MROC patients were included for analysis. When MSK and MROC cohorts were compared for validation, there were some statistical differences in BREAST-Q scores; however, most of these differences did not meet the minimal clinically important difference of 4 points. Reference values were used to create the BREAST-Q Real-time Engagement and Communication Tool (REACT).

CONCLUSIONS: Using a large cohort of patients, we have defined BREAST-Q reference values for post-mastectomy breast reconstruction patients for use in clinical practice. The BREAST-Q REACT will help breast reconstruction providers gauge patient wellbeing and satisfaction relative to the “average” breast reconstruction patient and determine which patients may benefit from additional intervention.

PMID:35415816 | DOI:10.1245/s10434-022-11521-4

Andrologia. 2022 Apr 12:e14432. doi: 10.1111/and.14432. Online ahead of print.

ABSTRACT

Numerous studies conducted to study the role of testosterone in erectile dysfunction (ED) extensively, but less is known of the association between estradiol level and ED. To assess the strong association between estradiol and ED by quantitatively synthesizing all studies evaluating the relationship between estradiol and ED. An extensive literature search was conducted by two authors independently in three electronic databases, including PubMed, Web of Science and Cochrane Library, up to January 10, 2021. The Patient Population or Problem, Intervention, Comparison, Outcomes and Setting (PICOS) were used for inclusion criteria to identify studies. The Newcastle-Ottawa Scale was applied to assess the quality of studies. The standardized mean difference (SMD) and their corresponding 95% confidence intervals (95% CIs) were used to compare the estradiol level between ED patients and healthy subjects, and the pooled OR and 95%CI were used to evaluate the strong association between estradiol level and ED. Finally, six studies were included in this meta-analysis, satisfying predefined inclusion criteria. Five studies were considered to be high quality, and only one was judged of moderate quality. The estradiol level of ED patients was statistically higher than that in healthy subjects (SMD 0.45, 95%CI 0.28-0.63, p <0.0001). The pooled OR demonstrated that the estradiol was correlated to the ED significantly (OR 1.08, 95%CI 1.05-1.12, p <0.0001). Subgroup analyses were conducted based on age, diagnosis way, country, sample size, detection method and estradiol level. There was no substantial change in the result of SMD ranging from 0.41 (95% CI 0.31-0.51) to 0.53 (95% CI 0.44-0.62) when performing sensitivity analysis. No publication bias was detected by the Begg test or Egger test. This meta-analysis demonstrated that the estradiol level is correlated to ED significantly.

PMID:35415900 | DOI:10.1111/and.14432

J Med Toxicol. 2022 Apr 12. doi: 10.1007/s13181-022-00890-7. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the evidence in support of the use of buprenorphine in the treatment of OUD and increasing ability of emergency medicine (EM) clinicians to prescribe it, emergency department (ED)-initiated buprenorphine is uncommon. Many EM clinicians lack training on how to manage acute opioid withdrawal or initiate treatment with buprenorphine. We developed a brief buprenorphine training program and assessed the impact of the training on subsequent buprenorphine initiation and knowledge retention.

METHODS: We conducted a pilot randomized control trial enrolling EM clinicians to receive either a 30-min didactic intervention about buprenorphine (standard arm) or the didactic plus weekly messaging and a monetary inducement to administer and report buprenorphine use (enhanced arm). All participants were incentivized to complete baseline, immediate post-didactic, and 90-day knowledge and attitude assessment surveys. Our objective was to achieve first time ED buprenorphine prescribing events in clinicians who had not previously prescribed buprenorphine in the ED and to improve EM-clinician knowledge and perceptions about ED-initiated buprenorphine. We also assessed whether the incentives and reminder messaging in the enhanced arm led to more clinicians administering buprenorphine than those in the standard arm following the training; we measured changes in knowledge of and attitudes toward ED-initiated buprenorphine.

RESULTS: Of 104 EM clinicians enrolled, 51 were randomized to the standard arm and 53 to the enhanced arm. Clinical knowledge about buprenorphine improved for all clinicians immediately after the didactic intervention (difference 19.4%, 95% CI 14.4% to 24.5%). In the 90 days following the intervention, one-third (33%) of all participants reported administering buprenorphine for the first time. Clinicians administered buprenorphine more frequently in the enhanced arm compared to the standard arm (40% vs. 26.3%, p = 0.319), but the difference was not statistically significant. The post-session knowledge improvement was not sustained at 90 days in the enhanced (difference 9.6%, 95% CI – 0.37% to 19.5%) or in the standard arm (difference 3.7%, 95% CI – 5.8% to 13.2%). All the participants reported an increased ability to recognize patients with opioid withdrawal at 90 days (enhanced arm difference .55, 95% CI .01-1.09, standard arm difference .85 95% CI .34-1.37).

CONCLUSIONS: A brief educational intervention targeting EM clinicians can be utilized to achieve first-time prescribing and improve knowledge around buprenorphine and opioid withdrawal. The use of weekly messaging and gain-framed incentivization conferred no additional benefit to the educational intervention alone. In order to further expand evidence-based ED treatment of OUD, focused initiatives that improve clinician competence with buprenorphine should be explored.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03821103.

PMID:35415804 | DOI:10.1007/s13181-022-00890-7

Updates Surg. 2022 Apr 12. doi: 10.1007/s13304-022-01275-9. Online ahead of print.

ABSTRACT

Liver function tests help in the follow-up of postoperative patients with iatrogenic bile duct injury. There is not clear evidence regarding their predictive role on anastomosis dysfunction. We describe our experience with postoperative liver function tests and a predictive model of long-term patency after repair. This is retrospective cohort study of patients with bilioenteric anastomosis for bile duct injury and their long-term follow-up. A binomial logistic regression model was performed to ascertain the effects of the grade of bile duct injury and liver function test in the postoperative period. A total of 329 patients were considered for the analysis. In the logistic regression model two predictor variables were statistically significant for anastomosis stenosis: type of bilioenteric anastomosis and alkaline phosphatase levels. A ROC curve analysis was made for alkaline phosphatase with an area under the curve of 0.758 (95% CI 0.67-0.84). A threshold of 323 mg/dL was established (OR 6.0, 95% CI 2.60-13.83) with a sensitivity of 75%, specificity of 67%, PPV of 20%, NPV of 96%, PLR of 2.27 and NLR of 0.37. Increased alkaline phosphatase (above 323 mg/dL) after the fourth operative week was found to be a predictor of long-term dysfunction.

PMID:35415799 | DOI:10.1007/s13304-022-01275-9

Int J Comput Assist Radiol Surg. 2022 Apr 12. doi: 10.1007/s11548-022-02627-x. Online ahead of print.

ABSTRACT

PURPOSE: Low-energy virtual monochromatic images (VMIs) derived from dual-energy computed tomography (DECT) systems improve lesion conspicuity of head and neck cancer over single-energy CT (SECT). However, DECT systems are installed in a limited number of facilities; thus, only a few facilities benefit from VMIs. In this work, we present a deep learning (DL) architecture suitable for generating pseudo low-energy VMIs of head and neck cancers for facilities that employ SECT imaging.

METHODS: We retrospectively analyzed 115 patients with head and neck cancers who underwent contrast enhanced DECT. VMIs at 70 and 50 keV were used as the input and ground truth (GT), respectively. We divided them into two datasets: for DL (104 patients) and for inference with SECT (11 patients). We compared four DL architectures: U-Net, DenseNet-based, and two ResNet-based models. Pseudo VMIs at 50 keV (pVMI_50keV) were compared with the GT in terms of the mean absolute error (MAE) of Hounsfield unit (HU) values, peak signal-to-noise ratio (PSNR), and structural similarity (SSIM). The HU values for tumors, vessels, parotid glands, muscle, fat, and bone were evaluated. pVMI_50keV were generated from actual SECT images and the HU values were evaluated.

RESULTS: U-Net produced the lowest MAE (13.32 ± 2.20 HU) and highest PSNR (47.03 ± 2.33 dB) and SSIM (0.9965 ± 0.0009), with statistically significant differences (P < 0.001). The HU evaluation showed good agreement between the GT and U-Net. U-Net produced the smallest absolute HU difference for the tumor, at < 5.0 HU.

CONCLUSION: Quantitative comparisons of physical parameters demonstrated that the proposed U-Net could generate high accuracy pVMI_50keV in a shorter time compared with the established DL architectures. Although further evaluation on diagnostic accuracy is required, our method can help obtain low-energy VMI from SECT images without DECT systems.

PMID:35415780 | DOI:10.1007/s11548-022-02627-x

J Gen Intern Med. 2022 Apr 12. doi: 10.1007/s11606-021-07035-6. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the focus on overdose deaths co-involving opioids and benzodiazepines, little is known about the epidemiologic characteristics of benzodiazepine-involved overdose deaths in the USA.

OBJECTIVE: To characterize co-involved substances, intentionality, and demographics of benzodiazepine-involved overdose deaths in the USA from 2000 to 2019.

DESIGN: Cross-sectional study using national mortality records from the National Vital Statistics System.

SUBJECTS: US residents in the 50 states and District of Columbia who died from a benzodiazepine-involved overdose from 2000 to 2019.

MAIN MEASURES: Demographic characteristics, intention of overdose, and co-involved substances KEY RESULTS: A total of 118,208 benzodiazepine-involved overdose deaths occurred between 2000 and 2019 (median age, 43 [IQR, 32-52]; male, 58.6%; White, 93.3%; Black, 4.9%; American Indian and Alaska Native, 0.9%; Asian American and Pacific Islander, 0.9%; Hispanic origin, 6.4%). Opioids were co-involved in 83.5% of the deaths. Nine percent of benzodiazepine-involved overdose deaths did not involve opioids, cocaine, other psychostimulants, barbiturates, or alcohol. Overdose deaths were classified as suicides in 8.5% of cases with benzodiazepine and opioid co-involvement and 36.2% of cases with benzodiazepine but not opioid involvement. Rates of benzodiazepine-involved overdose deaths increased from 0.46 per 100,000 individuals in 2000 to 3.55 per 100,000 individuals in 2017 before decreasing to 2.96 per 100,000 individuals in 2019. Benzodiazepine-involved overdose mortality rates increased from 2000 to 2019 among all racial groups, both sexes, and individuals of Hispanic and non-Hispanic origin. Rates of benzodiazepine-involved overdose deaths decreased among White individuals, but not Black individuals, from 2017 to 2019.

CONCLUSIONS: Interventions to reduce benzodiazepine-involved overdose mortality should consider the demographics of, co-involved substances in, and presence of suicides among benzodiazepine-involved overdose deaths.

PMID:35415793 | DOI:10.1007/s11606-021-07035-6

Ir J Med Sci. 2022 Apr 12. doi: 10.1007/s11845-022-03013-x. Online ahead of print.

ABSTRACT

BACKGROUND: Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period.

AIMS: The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO₂ (PETCO₂) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask.

METHODS: The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO₂ levels were measured at 0-4th-5th and 9th hours of the work-shift.

RESULTS: Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO₂ levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003).

CONCLUSION: Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO₂ levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.

PMID:35415774 | DOI:10.1007/s11845-022-03013-x

Ir J Med Sci. 2022 Apr 12. doi: 10.1007/s11845-022-03003-z. Online ahead of print.

ABSTRACT

BACKGROUND: Ireland has a mixed model of healthcare delivery with a public healthcare system funded by general taxation and a large private healthcare insurance system, covering 43% of the population in 2012 and 2016. We set out to examine disparities in outcomes among patients with breast cancer treated in a private hospital compared to national outcomes over a comparable period.

METHODS: Medical records of patients diagnosed with early (Stage 1-3 as per AJCC version 5) breast cancer between 2010 and 2015 at Bon Secours Hospital, Cork, Ireland were reviewed. Staging was confirmed and 5-year disease specific survival (DSS) and overall survival (OS) were calculated. DSS was compared to 5-year net survival (NS) figures from the National Cancer Registry of Ireland (NCRI) for a comparable period (2010-2014).

RESULTS: DSS (Bon Secours) and NS (NCRI) are summarized in Table 5 and Fig. 2. 5-year survival figures are numerically higher in the private hospital compared with national data for individual stage. Taking stages 1 to 3 combined, the 95% confidence intervals do not cross, indicating statistical significance.

CONCLUSIONS: We found evidence of superior outcomes in patients with early breast cancer treated at a private hospital compared with national outcome figures. This was demonstrated in ‘all comers’ (stages 1-3 combined), and particularly in patients with stage 3 breast cancer. Potential reasons for this disparity include differences in socioeconomic status, health-seeking behaviours and/or underlying health status between the two populations included. Differences in extent or timeliness of access to therapies may also contribute.

PMID:35415773 | DOI:10.1007/s11845-022-03003-z

Int J Epidemiol. 2022 Apr 13:dyac068. doi: 10.1093/ije/dyac068. Online ahead of print.

NO ABSTRACT

PMID:35415748 | DOI:10.1093/ije/dyac068

Faraday Discuss. 2022 Apr 13. doi: 10.1039/d1fd00090j. Online ahead of print.

ABSTRACT

Induction time, a measure of how long one will wait for nucleation to occur, is an important parameter in quantifying nucleation kinetics and its underlying mechanisms. Due to the stochastic nature of nucleation, efficient methods for measuring large numbers of independent induction times are needed to ensure statistical reproducibility. In this work, we present a novel approach for measuring and analyzing induction times in sessile arrays of microdroplets via deliquescence/recrystallization cycling. With the help of a recently developed image analysis protocol, we show that the interfering diffusion-mediated interactions between microdroplets can be eliminated by controlling the relative humidity, thereby ensuring independent nucleation events. Moreover, possible influence of heterogeneities, impurities, and memory effect appear negligible as suggested by our 2-cycle experiment. Further statistical analysis (k-sample Anderson-Darling test) reveals that upon identifying possible outliers, the dimensionless induction times obtained from different datasets (microdroplet lines) obey the same distribution and thus can be pooled together to form a much larger dataset. The pooled dataset showed an excellent fit with the Weibull function, giving a mean supersaturation at nucleation of 1.61 and 1.85 for the 60 pL and 4 pL microdroplets respectively. This confirms the effect of confinement where smaller systems require higher supersaturations to nucleate. Both the experimental method and the data-treatment procedure presented herein offer promising routes in the study of fundamental aspects of nucleation kinetics, particularly confinement effects, and are adaptable to other salts, pharmaceuticals, or biological crystals of interest.

PMID:35415724 | DOI:10.1039/d1fd00090j