Category: Statistics

Diagn Cytopathol. 2021 May 18. doi: 10.1002/dc.24801. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnosis of spindle cell neoplasms (SCN) of the upper gastrointestinal (GI) tract, hepatobiliary tract, and pancreas detected by fine needle aspiration (FNA) is challenging. We describe a single-center experience of these samples with follow-up data and characterization of the morphologic findings.

METHODS: We retrospectively reviewed pathology records for all FNAs diagnostic for or suggestive of SCN on esophagus, stomach, small bowel, liver, and pancreas in a 15 year period. All cases with at least 6 month follow-up were included. Surgical material (biopsy or resection) was the diagnostic gold standard. All FNAs with subsequent surgical specimens were reviewed and assessed for cellularity, architectural features, and nuclear features.

RESULTS: In 15 years, 5101 FNAs of the upper GI tract, hepatobiliary tract, and pancreas were performed. SCN was diagnosed in 98 (2%) patients. Seventy-two patients had definitive pathologic diagnoses: 68 were neoplastic and four were non-neoplastic. Cytomorphologic review in relationship to final diagnosis revealed three statistically significant features: low cellularity favors a benign process (P = .00544), epithelioid nuclear morphology favors malignancy (P = .00278), and identification of perinuclear vacuoles favors a diagnosis of GIST over non-GIST SCN (P = .04236).

CONCLUSIONS: Among cases with follow-up, final pathologic diagnoses were SCN in 94% of cases diagnosed as SCN on FNA of upper GI, hepatobiliary tract, and pancreas. Although some cytomorphologic criteria are more suggestive of malignancy, arriving at a specific diagnosis relies on collaboration of clinical, radiologic, cytomorphologic, and immunohistochemical data.

PMID:34003599 | DOI:10.1002/dc.24801

J Viral Hepat. 2021 May 18. doi: 10.1111/jvh.13546. Online ahead of print.

ABSTRACT

Improvement of health-related quality of life (HRQoL) is frequently reported as a benefit when treating hepatitis C virus infection (HCV) with direct acting antivirals (DAA). As most of the available data were obtained from clinical trials, limited generalizability to the real-world population might exist. This study aimed to investigate the impact of DAA therapy on changes in HRQoL in a real-world setting. HRQoL of 1,180 participants of the German-Hepatitis C-Registry was assessed by short-Form 36 (SF-36) questionnaires. Scores at post treatment weeks 12-24 (FU12/24) were compared to baseline (BL). Changes of ≥2.5 in mental and physical component summary scores (MCS and PCS) were defined as a minimal clinical important difference (MCID). Potential predictors of HRQoL changes were analyzed. Overall, a statistically significant increase in HRQoL after DAA therapy was observed, that was robust among various subgroups. However, roughly half of all patients failed to achieve a clinically important improvement in MCS and PCS. Low MCS (p<0.001, OR=0.925) and PCS (p<0.001, OR=0.899) BL levels were identified as predictors for achieving a clinically important improvement. In contrast, presence of fatigue (p=0.023, OR=1.518), increased GPT levels (p=0.005, OR=0.626) and RBV-containing therapy regimens (p=0.001, OR=1.692) were associated with a clinically important decline in HRQoL after DAA therapy. In conclusion, DAA treatment is associated with an overall increase of HRQoL in HCV-infected patients. Nevertheless, roughly half of the patients fail to achieve a clinically important improvement. Especially patients with a low HRQoL seem to benefit most from the modern therapeutic options.

PMID:34003549 | DOI:10.1111/jvh.13546

J Hum Nutr Diet. 2021 May 18. doi: 10.1111/jhn.12919. Online ahead of print.

ABSTRACT

PURPOSE: Head and neck cancers (HNC) are strongly associated with malnutrition. This systematic review aimed to investigate the optimal frequency of individualised nutrition counselling (INC) pre-, peri- and post-treatment for patients with HNC.

METHODS: Pubmed, EMBASE, Cinahl and Scopus were searched from inception through to April 2020 to identify randomised controlled trials (RCTs) that focused on the INC frequency for adult patients with HNC (Registration no. 178868). Outcomes assessed were nutritional status, dietary intake, weight change, treatment interruptions, unplanned hospital admissions, quality of life, complications and morbidity. Certainty of evidence was assessed using GRADE.

RESULTS: Four RCTs were identified with five manuscripts (n=500 total participants). The certainty of evidence was ‘high’ for nutritional status and quality of life, ‘moderate’ for treatment interruptions and unplanned hospital admissions and ‘low’ for % weight change, complications/morbidity and dietary intake. Compared to control groups, there were consistent improvements for nutritional status, quality of life, treatment interruptions, unplanned hospital admissions, dietary intake, % weight change and morbidity when weekly INC was provided peri-treatment and fortnightly INC was provided post-treatment. No statistical significance was found for treatment interruptions, dietary intake and weight change when INC was provided fortnightly peri-treatment only. There were no RCTs in the current review that offered INC pre-treatment.

CONCLUSION: This systematic review shows beneficial effects with weekly INC peri-treatment and fortnightly INC post-treatment for patients with HNC in all outcomes studied. Future research should focus on models of care to address the optimal frequency of pre-treatment INC as well as the duration of post-treatment INC.

PMID:34003532 | DOI:10.1111/jhn.12919

J Viral Hepat. 2021 May 18. doi: 10.1111/jvh.13545. Online ahead of print.

ABSTRACT

A goal of the WHO strategy on the elimination of hepatitis as a public threat is a 65% reduction in the attributable mortality. Deaths related to hepatitis B and C infections are mostly due to decompensated cirrhosis and hepatocellular carcinoma (HCC) but accurately measuring mortality is challenging as death certificates often do not capture the underlying disease. The aim of this collaborative study between European Centre for Disease Prevention and Control (ECDC) and the European Association for the Study of the Liver (EASL) was to assess a WHO-developed protocol to support countries in implementing studies to collect data on the fraction of cirrhosis and hepatocellular carcinoma attributable to hepatitis B and C. Three sentinel sites (in Bulgaria, Norway and Portugal) collected data for patients first admitted or seen in their centres during 2016. Patients with cirrhosis or HCC were identified through patient files or healthcare databases using ICD-10 codes. The proportion of patients with cirrhosis and HCC who tested positive for HBV and HCV were calculated to estimate the aetiological fractions. After the pilot study was completed, each site was asked about the feasibility and acceptability of the protocol. A total of 1249 patients presenting with cirrhosis and/or HCC were evaluated across the three sites. The prevalence of HBV and HCV among cases of cirrhosis showed that in Norway and Portugal, HCV was responsible for about one quarter of the cases, whereas in Bulgaria, HBV was more common. HCV was responsible for more than one-third of HCC cases in Norway and Portugal, while in Bulgaria HBV was more frequent as HCC underlying cause. Results obtained during the pilot study were comparable to published estimates obtained through statistical modelling or meta-analyses. Several challenges were reported from the sites involved in the pilot including the considerable time needed for reviewing the hospital records and extracting the patient’s data.The pilot demonstrated the feasibility of collecting data on the prevalence of HBV and HCV infection among patients with cirrhosis and HCC in sentinel sites. This method can be used to estimate mortality attributable to HBV and HCV for elimination monitoring. Where easily implementable, sentinel studies are the best way to empower countries, get up-to date data, and closely monitor the changes in the attributable fraction at a country level.

PMID:34003542 | DOI:10.1111/jvh.13545

J Adv Nurs. 2021 May 18. doi: 10.1111/jan.14855. Online ahead of print.

ABSTRACT

AIM: To develop a consensus paper on the central points of an international invitational think-tank on nursing and artificial intelligence (AI).

METHODS: We established the Nursing and Artificial Intelligence Leadership (NAIL) Collaborative, comprising interdisciplinary experts in AI development, biomedical ethics, AI in primary care, AI legal aspects, philosophy of AI in health, nursing practice, implementation science, leaders in health informatics practice and international health informatics groups, a representative of patients and the public, and the Chair of the ITU/WHO Focus Group on Artificial Intelligence for Health. The NAIL Collaborative convened at a 3-day invitational think tank in autumn 2019. Activities included a pre-event survey, expert presentations and working sessions to identify priority areas for action, opportunities and recommendations to address these. In this paper, we summarize the key discussion points and notes from the aforementioned activities.

IMPLICATIONS FOR NURSING: Nursing’s limited current engagement with discourses on AI and health posts a risk that the profession is not part of the conversations that have potentially significant impacts on nursing practice.

CONCLUSION: There are numerous gaps and a timely need for the nursing profession to be among the leaders and drivers of conversations around AI in health systems.

IMPACT: We outline crucial gaps where focused effort is required for nursing to take a leadership role in shaping AI use in health systems. Three priorities were identified that need to be addressed in the near future: (a) Nurses must understand the relationship between the data they collect and AI technologies they use; (b) Nurses need to be meaningfully involved in all stages of AI: from development to implementation; and (c) There is a substantial untapped and an unexplored potential for nursing to contribute to the development of AI technologies for global health and humanitarian efforts.

PMID:34003504 | DOI:10.1111/jan.14855

Environ Toxicol Chem. 2021 May 18. doi: 10.1002/etc.5119. Online ahead of print.

ABSTRACT

Benthic communities contain some of the most threatened organisms in aquatic habitats due to different anthropogenic pressures. The high abundance of microplastics (MPs) in sediments will continue to increase in the future, further increasing the probability of interactions between macroinvertebrates and MPs. In the present study, a benthic community in a relatively pristine shallow pond was exposed either to an environmentally relevant high concentration of an MP mixture of 80 g m^-2 in the sediment, or a control sediment, without the addition of MPs. The mixture of MPs contained irregular shaped polyethylene (PE), polyvinyl-chloride (PVC), and polyamide (PA) in a ratio of 50%: 25%: 25%, respectively. The in situ experiment lasted for 100 days. The total number of taxa that colonized the microcosms was 22 (17 in the control, 18 in the MP treatment), and the colonization was not affected by the treatment. The most dominant group within the macroinvertebrate community was the dipteran family Chironomidae, both in the control and the MP treatment. No significant differences in the abundance and biomass at a community level were recorded between the groups by PERMANOVA ((F=0.993; p=0.456 and F=0.344; p=0.797, respectively). The mixture of MPs did not influence the abundance or biomass of the functional feeding groups (F=1.810; p=0.137 and F=0.377; p=0.736, respectively). The species richness (S), species abundance (N), species biomass (B), Shannon’s diversity index (H) and Simpson’s index of diversity (D) showed no statistically significant differences between the control and treatment groups. Czekanowski’s quantitative similarity index indicated that 84% of the community remained unaffected after MPs exposure. This article is protected by copyright. All rights reserved.

PMID:34003520 | DOI:10.1002/etc.5119

J Viral Hepat. 2021 May 18. doi: 10.1111/jvh.13544. Online ahead of print.

ABSTRACT

Patient reported experience (PRE) is critical for engagement in hepatitis C (HCV) therapy in hard to reach populations. However, there is no data on patient reported experience with DAA therapy among homeless patients accessing shelters. We assessed PRE with DAA treatment following implementation of HCV therapy within homeless shelters in two diverse regions in the United States. In a study of integrated HCV testing and treatment in four homeless shelters in San Francisco (SF) and Minnesota (MN), 66 patients received DAA therapy from 11/2018-4/2020. PREs were assessed at the end of therapy with constructs: satisfaction with communication with their HCV treatment provider, receipt of social support during therapy, perceived stigma associated with HCV infection, and their overall satisfaction with DAA therapy. Descriptive statistics and factors associated with satisfaction with HCV therapy were assessed. At end of therapy, 41 patients completed the questionnaire (response rate was 62%). Median age was 56 years, 74.4% were men, 44% White (45% Black, 6% Latino), 35% had more than a high school diploma, 65% had a history of IV drug use, 56% had received SUD treatment, and 12% were co-infected with HIV. During DAA treatment, the majority of patients lived in shelters, 37% used illicit drugs, 24% consumed alcohol, and 14% received psychiatric treatment. Patient reported experience with DAA therapy were as follows: 100% agreed or strongly agreed that HCV providers seemed non-judgmental, 98% reported that their provider seemed to care about them, 98% reported that people close to them had been supportive of their care, and 98% were satisfied with their HCV treatment. There were no patient level or clinical predictors associated with PREs of stigma, perceived lack of social support or satisfaction with DAA treatment. In conclusion, nearly all (>95%) homeless patients receiving integrated HCV testing and therapy within homeless shelters felt supported and reported favorable views toward their providers and a high level of satisfaction with DAA treatment. As patient reported experience is key for engagement in HCV therapy, our onsite treatment intervention within shelters can serve as a model of HCV care to enhance treatment uptake in patients experiencing homelessness.

PMID:34003525 | DOI:10.1111/jvh.13544

Spine Deform. 2021 May 18. doi: 10.1007/s43390-021-00360-0. Online ahead of print.

ABSTRACT

Adult spinal deformity (ASD) is a complex and heterogeneous disease that can severely impact patients’ lives. While it is clear that surgical correction can achieve significant improvement of spinopelvic parameters and quality of life measures in adults with spinal deformity, there remains a high risk of complication associated with surgical approaches to adult deformity. Over the past decade, utilization of surgical correction for ASD has increased dramatically as deformity correction techniques have become more refined and widely adopted. Along with this increase in surgical utilization, there has been a massive undertaking by spine surgeons to develop more robust models to predict postoperative outcomes in an effort to mitigate the relatively high complication rates. A large part of this revolution within spine surgery has been the gradual adoption of predictive analytics harnessing artificial intelligence through the use of machine learning algorithms. The development of predictive models to accurately prognosticate patient outcomes following ASD surgery represents a dramatic improvement over prior statistical models which are better suited for finding associations between variables than for their predictive utility. Machine learning models, which offer the ability to make more accurate and reproducible predictions, provide surgeons with a wide array of practical applications from augmenting clinical decision making to more wide-spread public health implications. The inclusion of these advanced computational techniques in spine practices will be paramount for improving the care of patients, by empowering both patients and surgeons to more specifically tailor clinical decisions to address individual health profiles and needs.

PMID:34003461 | DOI:10.1007/s43390-021-00360-0

Equine Vet J. 2021 May 18. doi: 10.1111/evj.13450. Online ahead of print.

ABSTRACT

BACKGROUND: Ischaemic postconditioning (IPoC) has been shown to ameliorate ischaemia reperfusion injury in different species and tissues.

OBJECTIVES: To assess the feasibility of IPoC in equine small intestinal ischaemia and to assess its effect on histomorphology, electrophysiology and paracellular permeability.

STUDY DESIGN: Randomised in vivo experiment.

METHODS: Experimental jejunal ischaemia was induced for 90 min in horses under general anaesthesia. In the control group (C; n = 7), the jejunum was reperfused without further intervention. In the postconditioning group (IPoC; n = 7), reocclusion was implemented following release of ischaemia by clamping the mesenteric vessels in three cycles of 30 seconds. This was followed by 120 minutes of reperfusion in both groups. Intestinal microperfusion and oxygenation was measured during IPoC using spectrophotometry and Doppler flowmetry. Histomorphology and histomorphometry of the intestinal mucosa were assessed. Furthermore, electrophysiological variables and unidirectional flux rates of ³ H-mannitol were determined in Ussing chambers. Western blot analysis was performed to determine the tight junction protein levels of claudin-1, claudin-2 and occludin in the intestinal mucosa. Comparisons between the groups and time points were performed using a two-way repeated measures analysis of variance (ANOVA) or non-parametric statistical tests for the ordinal and not normally distributed data (significance P < .05).

RESULTS: IPoC significantly reduced intestinal microperfusion during all clamping cycles yet affected oxygen saturation only during the first cycle. After reperfusion, Group IPoC showed significantly less mucosal villus denudation (mean difference 21.5%, P = .02) and decreased mucosal-to-serosal flux rates (mean difference 15.2 nM/cm² /h, P = .007) compared to Group C. There were no significant differences between the groups for the other tested variables.

MAIN LIMITATIONS: Small sample size, long-term effects were not investigated.

CONCLUSIONS: Following IPoC, the intestinal mucosa demonstrated significantly less villus denudation and paracellular permeability compared to the untreated control group, possibly indicating a protective effect of IPoC on ischaemia reperfusion injury.

PMID:34003501 | DOI:10.1111/evj.13450

J Behav Med. 2021 May 18. doi: 10.1007/s10865-021-00231-z. Online ahead of print.

ABSTRACT

Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.

PMID:34003418 | DOI:10.1007/s10865-021-00231-z