Category: Statistics

World J Urol. 2022 Aug 20. doi: 10.1007/s00345-022-04094-0. Online ahead of print.

ABSTRACT

PURPOSE: Renal cysts comprise benign and malignant entities. Risk assessment profits from CT/MRI imaging using the Bosniak classification. While Bosniak-IIF, -III, and -IV cover complex cyst variants, Bosniak-IIF and -III stand out due to notorious overestimation. Contrast-enhanced ultrasound (CEUS) is promising to overcome this deficit but warrants standardization. This study addresses the benefits of a combined CEUS and CT/MRI evaluation of renal cysts. The study provides a realistic account of kidney tumor boards’ intricacies in trying to validate renal cysts.

METHODS: 247 patients were examined over 8 years. CEUS lesions were graded according to CEUS-Bosniak (IIF, III, IV). 55 lesions were resected, CEUS-Bosniak- and CT/MRI-Bosniak-classification were correlated with histopathological diagnosis. Interobserver agreement between the classifications was evaluated statistically. 105 lesions were followed by ultrasound, and change in CEUS-Bosniak-types and lesion size were documented.

RESULTS: 146 patients (156 lesions) were included. CEUS classified 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-Bosniak-III, and 45 as CEUS-Bosniak-IV. Histopathology of 55 resected lesions revealed benign cysts in all CEUS-Bosniak-IIF lesions (2/2), 40% of CEUS-Bosniak-III and 8% of CEUS-Bosniak-IV, whereas malignancy was uncovered in 60% of CEUS-Bosniak-III and 92% of CEUS-Bosniak-IV. Overall, CEUS-Bosniak-types matched CT/MRI-Bosniak types in 58% (fair agreement, κ = 0.28). CEUS-Bosniak resulted in higher stages than CT/MRI-Bosniak (40%). Ultrasound follow-up of 105 lesions detected no relevant differences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type.

CONCLUSION: The CEUS-Bosniak classification is an essential tool in clinical practice to differentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care.

PMID:35986781 | DOI:10.1007/s00345-022-04094-0

Eur Radiol. 2022 Aug 20. doi: 10.1007/s00330-022-09083-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore radiologists’ opinions regarding the shift from in-person oncologic multidisciplinary team meetings (MDTMs) to online MDTMs. To assess the perceived impact of online MDTMs, and to evaluate clinical and technical aspects of online meetings.

METHODS: An online questionnaire including 24 questions was e-mailed to all European Society of Oncologic Imaging (ESOI) members. Questions targeted the structure and efficacy of online MDTMs, including benefits and limitations.

RESULTS: A total of 204 radiologists responded to the survey. Responses were evaluated using descriptive statistical analysis. The majority (157/204; 77%) reported a shift to online MDTMs at the start of the pandemic. For the most part, this transition had a positive effect on maintaining and improving attendance. The majority of participants reported that online MDTMs provide the same clinical standard as in-person meetings, and that interdisciplinary discussion and review of imaging data were not hindered. Seventy three of 204 (35.8%) participants favour reverting to in-person MDTs, once safe to do so, while 7/204 (3.4%) prefer a continuation of online MDTMs. The majority (124/204, 60.8%) prefer a combination of physical and online MDTMs.

CONCLUSIONS: Online MDTMs are a viable alternative to in-person meetings enabling continued timely high-quality provision of care with maintained coordination between specialties. They were accepted by the majority of surveyed radiologists who also favoured their continuation after the pandemic, preferably in combination with in-person meetings. An awareness of communication issues particular to online meetings is important. Training, improved software, and availability of support are essential to overcome technical and IT difficulties reported by participants.

KEY POINTS: • Majority of surveyed radiologists reported shift from in-person to online oncologic MDT meetings during the COVID-19 pandemic. • The shift to online MDTMs was feasible and generally accepted by the radiologists surveyed with the majority reporting that online MDTMs provide the same clinical standard as in-person meetings. • Most would favour the return to in-person MDTMs but would also accept the continued use of online MDTMs following the end of the current pandemic.

PMID:35986772 | DOI:10.1007/s00330-022-09083-w

J Food Sci. 2022 Aug 20. doi: 10.1111/1750-3841.16281. Online ahead of print.

ABSTRACT

Spent coffee grounds (SCG) are a coproduct that causes environmental impacts worldwide. Thus, consciously reusing the SCG is an eminent need. This work aimed to encapsulate phenolic compounds and antioxidants obtained from SCG extracts through spray- and freeze-drying techniques using different isolated and combined wall materials. The dried powders produced were evaluated for moisture content, water activity, bulk density, hygroscopicity, color, content of phenolic compounds and antioxidants, and the results were compared. The results showed that all evaluated treatments resulted in a powdered product with low values of bulk density, moisture and water activity, especially for freeze-drying. The freeze-dried product also showed higher hygroscopicity. Regarding the content of phenolic compounds and antioxidants, both drying methods showed high levels of these compounds in the dried product and good encapsulation efficiency, reaching 83.43%. In most cases, spray-drying and freeze-drying did not differ statistically (p > 0.05) in relation to bioactive compound content and encapsulation efficiency. In relation to wall materials, albumin showed the worst performance in the retention of bioactive compounds. On the other hand, pure gum arabic combined with maltodextrin led to better preservation of these compounds. PRACTICAL APPLICATION: Spent coffee grounds are a coproduct generated in large quantities in the world. The encapsulation of phenolic and antioxidant compounds protects and enables their application in different food matrices. Therefore, the evaluation of different encapsulation methods and wall materials is important to define good process conditions.

PMID:35986622 | DOI:10.1111/1750-3841.16281

Clin Exp Allergy. 2022 Aug 20. doi: 10.1111/cea.14218. Online ahead of print.

NO ABSTRACT

PMID:35986607 | DOI:10.1111/cea.14218

Mil Med. 2022 Aug 20:usac248. doi: 10.1093/milmed/usac248. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Obstructive sleep apnea (OSA) is a chronic condition that could lead to debilitating and sometimes life-threatening consequences. Oral appliance therapy (OAT) is effective in providing a conservative, nonsurgical treatment option for patients diagnosed with mild-to-moderate OSA. The primary goal of this study is to describe a symptom-based titration protocol and determine if the patients can be effectively managed with oral appliances (OAs).

METHOD: A retrospective chart review of patients who were treated with OAs was analyzed for the management of OSA. Patients were self-titrated for symptomatic improvement before posttreatment titration sleep studies were conducted.

RESULTS: Our study has found that 87.5% of the test population was successfully managed with OAs after overnight titration. Seventy-five percentage of the patients were titrated to Apnea-Hypopnea Index (AHI) < 5 with an average of 79.6% reduction from the baseline. Statistical studies showed that patients’ body mass index and age at baseline polysomnogram studies significantly influenced the reduction in AHI achieved, whereas the baseline AHI did not show any significant correlation.

CONCLUSION: Oral appliance therapy (OAT) can be a reliable treatment modality to treat OSA, and performing a separate overnight posttreatment titration study further ensures its effectiveness. Furthermore, OAT can be an effective treatment modality even for moderate-to-severe OSA with posttreatment titration.

PMID:35986605 | DOI:10.1093/milmed/usac248

Mil Med. 2022 Aug 20:usac254. doi: 10.1093/milmed/usac254. Online ahead of print.

ABSTRACT

INTRODUCTION: Maximizing patient satisfaction is now a significant focus in many outpatient orthopedic clinics as it has been shown to affect many facets of healthcare. With this quality improvement study, we sought to determine the areas of the longest patient wait time during their clinical encounter and evaluate the effect of an identification card system on those times. We hypothesized that utilizing an identification card system would expedite the time patients spend in the clinic and decrease wait times.

METHODS: This quality improvement study was conducted in an orthopedic hand surgery clinic within a military treatment facility. Pre-intervention and intervention data collection consisted of a time sheet that was filled out by surgeons and clinic staff as the patient progressed through their appointment. The intervention consisted of a card system to track the patient throughout their encounter and mark their order in the queue.

RESULTS: There were a total of 130 patients in the pre-intervention group and 113 in the intervention group. Compared with the pre-intervention group, the intervention group patients had significantly less time from check-in to being roomed by the clinic staff with a mean of 13 ± 13 vs. 21 ± 19 minutes in the pre-intervention group (P < .001). In the pre-intervention cohort, the average clinic encounter was 66 ± 38 minutes compared to 57 ± 35 minutes in the intervention cohort, which was not statistically significant (P = .112). The time spent with the orthopedic surgeon and occupational therapists increased in the intervention group.

CONCLUSION: We provided a simple way to decrease patient wait times and increase time with the healthcare team, utilizing our existing clinic space. Time with the orthopedic surgeon significantly increased because of our intervention, while the overall clinic time trended down.

PMID:35986603 | DOI:10.1093/milmed/usac254

J Adv Nurs. 2022 Aug 20. doi: 10.1111/jan.15276. Online ahead of print.

ABSTRACT

AIMS: The study aim was to examine the impact of a home-based programme intervention on organizational contexts, implementation processes and organizational capacity outcomes from multicultural, multilingual participants working at community-based organizations.

DESIGN: This was a sequential exploratory, mixed-methods longitudinal study using community-based participatory research principles.

SAMPLE: Twenty participants from nine multicultural, multilingual community-based organizations were in this public health initiative’s intervention to develop community-designed, home-based programmes.

METHODS: Capacity building providers delivered the intervention selected by the funders. Workshop outcomes were descriptively measured in April/May 2019. In April/May and November 2019, participants completed surveys about organizational contexts, implementation processes and organizational capacity outcomes, which were analysed with t-tests using the organization as the unit of analysis. Qualitative data were analysed using content analysis.

RESULTS: Seven programmes were new and two were modified. As workshop outcomes, 59% of participants reported increased overall implementation knowledge and 74% reported capacity building providers as the most helpful resource. After 6 to 7 months, no statistically significant changes were noted in organizational contexts, implementation processes or organizational capacity outcomes. Participants benefited from capacity building because they had programmes developed, formed partnerships with capacity building providers, gained implementation knowledge, and engaged in networking.

CONCLUSION: Participants reported excellent individual and organizational strengths. Many Initiative factors contributed to no statistical changes. Namely, there was no opportunity for baseline data; limited community-based organization engagement in the intervention model selection, timeline and processes; the Initiative’s timeline did not fit participants’ timeline; insufficient time to develop culturally and linguistically appropriate programmes; late literature review abstracts; lack of adequate, planful and paid capacity building time; and a contract requirement to have the programme due when it was not implementable. These Initiative design factors, as reported by participants, limited the Initiative’s home-based programme development.

IMPACT: This study highlights the strengths of participants, community-based organizations and capacity building providers. Model selection, timeline and budget were identified as key factors for equitable implementation in multicultural, multilingual organizations.

PMID:35986591 | DOI:10.1111/jan.15276

Curr Rheumatol Rev. 2022 Aug 19. doi: 10.2174/1573397118666220819154605. Online ahead of print.

ABSTRACT

BACKGROUND: Negative effects of rheumatoid arthritis (RA) are multi-dimensional. Foot deformities lead to disability, pain, impaired quality of life.

OBJECTIVE: Identifying the difficulties in the functioning of rheumatoid foot and assessing the quality of life in this aspect.

MATERIALS AND METHODS: The material included 50 patients of Rheumatology Policlinic of the Central Clinical Hospital of Interior Affairs in Warsaw, and a matched control group of 50 individuals without RA. The degree of foot joints damage was assessed using the Manchester scale, lower limb movement and quality of life using the American Orthopedic Foot and Ankle Society Score and HAQ.

RESULTS: The duration of symptoms was 16.0±8.9 years. High activity of RA measured by the DAS was observed in 20% of patients, moderate in 26%, low in 54%. The most common foot deformities were: hammer toes (82%), longitudinal flat feet (74%), hyperkeratosis (56%). The least frequent were: stiff toe (38%), overlapping fingers (28%). In RA group the outcomes of FAOS questionnaire were statistically significantly worse than in the control group in all categories (p<0.001). The worst-rated domain was the sport and recreation subscale (median 55.0), the best daily activity (median 86.8). The strongest relationship was demonstrated between the FAOS and HAQ indices. Spearman’s HAQ correlation coefficient with the ADL subscale was r=-0.85, p<0.001, and with the QOL, sport/recreation and pain subscales moderate (r=-0.72; r= 0.71, p <0.001).

CONCLUSIONS: Lower limb movement function, the quality of life are worse in RA patients, pain accompanies climbing, descending stairs; running and jumping require effort.

PMID:35986529 | DOI:10.2174/1573397118666220819154605

J Burn Care Res. 2022 Apr 11:irac047. doi: 10.1093/jbcr/irac047. Online ahead of print.

ABSTRACT

Patients with severe thermal injuries have increased metabolic demands necessitating frequent phosphate supplementation. Patients with acute renal failure may have less requirements, due to reduced elimination. However, patients being supported with renal replacement therapy have varying degree of requirements. Little published evidence depicts the incidence of hypophosphatemia and repletion requirements in patients with severe thermal injuries treated with high-volume hemofiltration (HVHF) and a high-flux membrane. The objective of this retrospective chart review was to determine the incidence of hypophosphatemia and characterize repletion requirements and response in this population. Enrolled patients had at least 20% total body surface area (TBSA) thermal injuries and required continuous hemofiltration with prefilter replacement fluid doses ≥ 35 mL/kg IBW/hr. A randomly selected cohort without acute kidney injury (AKI) and matched based on age and extent of TBSA was used to compare phosphorus requirements over an initial 14-day period. Demographics, diet, and variables affecting phosphorus concentrations were collected. Sixteen patients were included in the retrospective HVHF group and sixteen patients in a case-control cohort to better depict the impact of HVHF. The average age was 60.2 ± 15.1 years and median TBSA was 30% (23.4, 56.3) in the HVHF group, compared to 53.3 ± 16.4 years (p = 0.22) and TBSA 29% (26.4, 33.9; p = 0.73). All patients in the HVHF group were started on HVHF with a 1.6 m2 polyethersulfone (PES) membrane for AKI. As expected, the HVHF group exhibited statistically higher than normal baseline potassium and phosphorous laboratory values. The HVHF group experienced more days with hypophosphatemia (49.6 ± 12.4 % vs 29.3 ± 16.3 %, p = 0.012), despite 0.75 mmol/kg/day phosphorous supplementation (compared to 0.66 mmol/kg/day for the control group, p = 0.45). Patients with longer durations of HVHF therapy experienced increasing risk of hypophosphatemia, reaching 100% by the end of the study period. This study demonstrates severe thermally injured patients receiving HVHF for AKI are at increased risk for hypophosphatemia, and require high phosphate supplementation.

PMID:35986488 | DOI:10.1093/jbcr/irac047

J Burn Care Res. 2022 Jun 21:irac082. doi: 10.1093/jbcr/irac082. Online ahead of print.

ABSTRACT

Severe frostbite is associated with loss of digits or limbs and high levels of morbidity. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequelae from amputation can include severe nerve pain and poor wound healing requiring revision surgery. The aim of this study was to examine the rate of revision surgery after primary amputation and compare this to revision surgery in isolated hand/foot burns. Frostbite and burn patients from 2014 to 2019 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with primary amputations related to isolated hand/foot burns or frostbite were included in the study. Descriptive statistics included Student’s t-test and Fisher’s exact test. A total of 63 patients, 54 frostbite injuries and 9 isolated hand or foot burns, met inclusion criteria for the study. The rate of revision surgery was similar following frostbite and burn injury (24% vs 33%, P = .681). There were no significant differences in age, sex, or length of stay on the primary hospitalization between those that required revision surgery and those that did not. Neither the impacted limb nor the presence of infection or cellulitis on primary amputation was associated with future need for revision surgery. Of the 16 patients requiring revision surgery, 5 (31%) required additional debridement alone, 6 (38%) required reamputation alone, and 5 required both. A total of 6 patients (38%) had cellulitis or infection at the time of revision surgery. Time from primary surgery to revision ranged from 4 days to 3 years. Planned, delayed primary amputation is a mainstay of frostbite management. To our knowledge, this is the first assessment of revision surgery in the setting of severe frostbite injury. Our observed rate of revision surgery following frostbite injury did not differ significantly from revision surgery in the setting of isolated hand or foot burns. This study brings up important questions of timing and surgical planning in these complex patients that will require a multicenter collaborative study.

PMID:35986492 | DOI:10.1093/jbcr/irac082