Nevin Manimala

Prim Care Companion CNS Disord. 2024 Dec 3;26(6):24m03777. doi: 10.4088/PCC.24m03777.

ABSTRACT

Objective: To evaluate a novel curriculum aimed to increase nonpsychiatry providers’ confidence in treating mental health conditions.

Methods: The study sample consisted of a cohort of convenience of nonbehavioral health physicians and advanced practice providers. The authors administered pre and posttests to measure provider confidence in treating specific mental health diagnoses, utilizing specific classes of psychotropic medications, and managing specific clinical scenarios. Questions were ranked using a Likert scale from 1 (least comfortable) to 5 (very comfortable). Paired sample t-tests were utilized to compare the pre- and posttest survey results. A follow-up survey was administered 1 month following the completion of the seminar, and the results were analyzed qualitatively.

Results: Twenty nonbehavioral health care providers attended an educational 2-day seminar on August 3-4, 2023. There were statistically significant improvements between the pre- and posttest measures of confidence in all 31 items measured. At 1-month follow-up, 87.5% (N = 14) rated their overall impression of the seminar as “excellent” and 12.5% (N = 2) rated their impression as “very good.” At the 1- month follow-up, 15 participants reported treating patients for depression and anxiety, compared to 13 who had done so prior to the seminar.

Conclusions: An educational seminar hosted by psychiatrists is an effective intervention for increasing provider confidence in treating mental health conditions and could serve as a valuable method for expanding the mental health workforce.

Prim Care Companion CNS Disord2024;26(6):24m03777.

Author affiliations are listed at the end of this article.

PMID:39642384 | DOI:10.4088/PCC.24m03777

J Neurosurg. 2024 Dec 6:1-12. doi: 10.3171/2024.7.JNS241102. Online ahead of print.

ABSTRACT

OBJECTIVE: Maximum extent of resection in glioma yields enhanced survival outcomes. The contemporary literature presents contradictory results regarding the benefit of intraoperative MRI (iMRI). This meta-analysis aimed to investigate the efficacy and safety of iMRI-guided surgery.

METHODS: The authors searched the PubMed, Embase, and Cochrane Reviews databases for eligible prospective randomized controlled trials through the end of February 2024. Endpoints were extent of resection, progression-free survival (PFS), overall survival, neurological functioning, and surgical complications. Individual patient data regarding PFS were reconstructed using the R package IPDfromKM.

RESULTS: From 1923 identified results, 3 randomized controlled trials with 384 patients met the inclusion criteria. Extended resections after iMRI were performed in 29.2% of the iMRI cases. Intraoperative MRI-guided glioma surgery (OR 5.40, 95% CI 3.25-8.98; p < 0.00001) outperformed conventional navigation-guided surgery in attaining gross-total resection (GTR). In patients in whom a GTR was achieved, the median time to progression was 16.0 months (95% CI 12.3-19.7 months), while the median PFS in patients with a subtotal resection was 9.7 months (95% CI 6.9-12.5 months) (p < 0.001). Despite increased GTR rates, postoperative neurological deterioration was equal among the iMRI and control groups (OR 1.0, 95% CI 0.6-1.7; p = 0.91, I2 = 0%). Intraoperative MRI use prolongs surgery by 42 minutes on average (95% CI 3.3-80.7 minutes; p = 0.03, I2 = 56%). The risk of postoperative intracranial hemorrhage (OR 1.9, 95% CI 0.2-16.9; p = 0.55, I2 = 0%) was not increased, while in one study significantly increased infections were observed in the iMRI arm.

CONCLUSIONS: Intraoperative MRI outperforms conventional surgery in achieving complete glioma resections of all contrast-enhancing tumor portions, enhancing PFS without added risk. Intraoperative MRI is a tool that facilitates these aims without reducing safety in terms of neurological deficits and surgical complications.

PMID:39642374 | DOI:10.3171/2024.7.JNS241102

J Med Internet Res. 2024 Dec 6;26:e55635. doi: 10.2196/55635.

ABSTRACT

BACKGROUND: Although significant research has explored the digital phenotype in mood disorders, the time-lagged and bidirectional relationship between mood and global positioning system (GPS) mobility remains relatively unexplored. Leveraging the widespread use of smartphones, we examined correlations between mood and behavioral changes, which could inform future scalable interventions and personalized mental health monitoring.

OBJECTIVE: This study aims to investigate the bidirectional time lag relationships between passive GPS data and active ecological momentary assessment (EMA) data collected via smartphone app technology.

METHODS: Between March 2020 and May 2022, we recruited 45 participants (mean age 42.3 years, SD 12.1 years) who were followed up for 6 months: 35 individuals diagnosed with mood disorders referred by psychiatrists and 10 healthy control participants. This resulted in a total of 5248 person-days of data. Over 6 months, we collected 2 types of smartphone data: passive data on movement patterns with nearly 100,000 GPS data points per individual and active data through EMA capturing daily mood levels, including fatigue, irritability, depressed, and manic mood. Our study is limited to Android users due to operating system constraints.

RESULTS: Our findings revealed a significant negative correlation between normalized entropy (r=-0.353; P=.04) and weekly depressed mood as well as between location variance (r=-0.364; P=.03) and depressed mood. In participants with mood disorders, we observed bidirectional time-lagged associations. Specifically, changes in homestay were positively associated with fatigue (β=0.256; P=.03), depressed mood (β=0.235; P=.01), and irritability (β=0.149; P=.03). A decrease in location variance was significantly associated with higher depressed mood the following day (β=-0.015; P=.009). Conversely, an increase in depressed mood was significantly associated with reduced location variance the next day (β=-0.869; P<.001). These findings suggest a dynamic interplay between mood symptoms and mobility patterns.

CONCLUSIONS: This study demonstrates the potential of utilizing active EMA data to assess mood levels and passive GPS data to analyze mobility behaviors, with implications for managing disease progression in patients. Monitoring location variance and homestay can provide valuable insights into this process. The daily use of smartphones has proven to be a convenient method for monitoring patients’ conditions. Interventions should prioritize promoting physical movement while discouraging prolonged periods of staying at home.

PMID:39642364 | DOI:10.2196/55635

Ann Am Thorac Soc. 2024 Dec 6. doi: 10.1513/AnnalsATS.202407-799OC. Online ahead of print.

ABSTRACT

RATIONALE: Multiple clinical practice guidelines lack recommendations pertaining to non-invasive ventilation (NIV) in acute asthma exacerbations due to a paucity of evidence. However, the evidence syntheses for these guidelines were performed years ago and more recent randomized controlled trials (RCTs) and observational studies have been published.

OBJECTIVE: Update the evidence syntheses from previous guidelines to further clarify the effects of NIV in acute asthma exacerbations.

METHODS: A systematic search of Medline, Embase and the Cochrane Library was conducted, studies comparing NIV plus standard medical therapy to standard medical therapy alone in adults with acute asthma exacerbation were selected using a priori selection criteria, and relevant data were extracted. Weighted aggregation (meta-analysis) was performed to summarize effects, which were appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

RESULTS: Eight RCTs and five observational studies were selected. NIV was associated with a reduced intubation rate (RCTs RR 0.46, CI 0.16-1.29 and observational studies RR 0.55, CI 0.45-0.68), admission rate (RR 0.57, CI 0.34-0.98), and time to improvement in accessory muscle use (Mean difference -1.13 hours, CI -1.28 – -0.99). Additional outcomes favored NIV plus standard medical therapy but didn’t reach statistical significance including dyspnea measures and spirometry measures. There were too few deaths to reliably assess mortality. The quality of evidence ranged from low to very low for all outcomes.

CONCLUSION: All statistically significant outcomes favored NIV plus standard medical therapy over standard medical therapy alone in adults with acute asthma exacerbation. Our aggregate data suggests that intubation rate may be reduced with NIV plus SMT, though the overall quality of the evidence is low. If this is a true effect, it may be clinically important because intubation has been shown to correlate with mortality in multiple observational trials. Given these findings, patients with acute asthma exacerbations may benefit from a trial of NIV in addition to standard medical therapy.

PMID:39642363 | DOI:10.1513/AnnalsATS.202407-799OC

JMIR Res Protoc. 2024 Dec 6;13:e65043. doi: 10.2196/65043.

ABSTRACT

BACKGROUND: Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital-the “disposition” decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making. However, little is known about how these conversations are conducted and the real-world context in which they take place. Best practices in ED communication and shared decision-making for persons living with dementia and their care partners are limited.

OBJECTIVE: This study aims to characterize current practices in ED disposition conversations for persons living with dementia and their care partners, informed by perspectives from patient and care partner participants.

METHODS: This study will use an ethnographic design, including direct observation methods with a semistructured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow-up qualitative, semistructured interviews will be conducted with persons living with dementia and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation.

RESULTS: Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. This study is expected to be completed by December 2024.

CONCLUSIONS: Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real-world settings for persons living with dementia. Findings can inform more patient-centered interventions for disposition decision-making.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/65043.

PMID:39642361 | DOI:10.2196/65043

Am J Phys Med Rehabil. 2024 Dec 3. doi: 10.1097/PHM.0000000000002675. Online ahead of print.

ABSTRACT

OBJECTIVE: Ideal volume of 5% dextrose (D5W) for median nerve hydrodissection (HD) for treating carpal tunnel syndrome (CTS) is still unknown. This study assessed the efficacy of nerve hydrodissection using varying volumes of D5W for treating mild to moderate CTS.

DESIGN: Eighty participants with unilateral mild to moderate CTS were randomized into groups to receive either 5 ml of normal saline (NS), 5 ml of D5W, 10 ml of NS, and 10 ml of D5W, with each group undergoing one session of ultrasound-guided HD. Visual Analogue Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), grip and pinch strength, cross-sectional area (CSA) of median nerve, and electrophysiological assessment were performed at baseline and weeks 4 and 12.

RESULTS: In the 10 ml D5W group, VAS scores considerably improved compared with those in the NS groups. Although nerve CSA values decreased in all groups during follow-ups, the 10 mL D5W group showed a statistically significant improvement compared to the NS groups by the 12th week (p ≤ 0.01).

CONCLUSION: Ultrasound-guided median nerve HD with 10 ml D5W was more effective in reducing pain and nerve size than the NS groups at the 12th week.

PMID:39642354 | DOI:10.1097/PHM.0000000000002675

Am J Phys Med Rehabil. 2024 Dec 3. doi: 10.1097/PHM.0000000000002674. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was compare the effects of Combined Training (CombT), which included Robot-Assisted Gait Training in addition to Traditional Balance Training (TBT), and TBT alone on balance and fear of falling (FoF) in patients with stroke based on objective assessment methods.

DESIGN: Patients were randomized into CombT Group (CombTG) (n = 21) and TBT Group (TBTG) (n = 21) for duration of 5-weeks. Balance were assessed with EncephaLog App recorded stand-up time (SUT), sit-down time (SDT), and directional sways during walking, Berg Balance Scale (BBS) and Timed Up and Go Test (TUG). International Fall Efficacy Scale (FES-I) measured fear of falling (FoF). Fugl Meyer Assessment-Lower Extremity (FMA-LE) assessed limb impairment. Foot posture were assessed with Foot Posture Index (FPI-6).

RESULTS: After the treatments, EncephaLog sways (anterior, medial, lateral: P = 0.04, P = 0.01, P = 0.02), SUT (P = 0.006), SDT (P = 0.002); BBS (P < 0.001); FES-I (P = 0.002) improved in CombTG. TUG (P = 0.01) and FMA-LE (P < 0.001) improved in TBTG. SUT (P = 0.01) and SDT (P = 0.04) showed statistically significant improvement in CombTG compared to TBTG; FMA-LE (P = 0.002) demonstrated statistically significant improvement in TBTG compared to CombTG.

CONCLUSION: Objective assessment indicated that combined treatments in subacute and chronic stroke rehabilitation enhance balance and reduce FoF more effectively than isolated approaches.

PMID:39642346 | DOI:10.1097/PHM.0000000000002674

Neurology. 2025 Jan 14;104(1):e210079. doi: 10.1212/WNL.0000000000210079. Epub 2024 Dec 6.

ABSTRACT

BACKGROUND AND OBJECTIVES: Disease-modifying treatments (DMTs) are a major unmet need in Parkinson disease (PD). To date, trials investigating DMT candidates in PD most often used a randomized controlled trial (RCT) design. Unfortunately, RCTs to date have not led to a breakthrough, in part because of the large sample sizes and length of follow-up required. In the interest of testing DMT candidates in a more efficient manner, it may be worthwhile to perform futility trials, which are smaller clinical trials that have originally been developed as phase 2 trials in oncology and more recently been used in progressive multiple sclerosis. In this investigation, we used original, patient-level data from DATATOP and PRECEPT, 2 large RCTs in early PD, to explore the feasibility of using the Simon 2-Stage futility trial design in early PD.

METHODS: This is a post hoc analysis of original, patient-level data from the DATATOP and PRECEPT RCTs in early PD. In our analyses, we use descriptive statistics, survival analysis, and binary logistic regression to explore thresholds of change in the Unified Parkinson Disease Rating Scale (UPDRS) motor score as the primary outcome measure, length of follow-up, inclusion and exclusion criteria, and projected sample sizes for Simon 2-Stage futility trials in early PD. We also performed bootstrapping experiments to illustrate the ability of trials using the Simon 2-Stage futility design to identify selegiline as nonfutile and tocopherol as futile.

RESULTS: PRECEPT included 806 participants (mean age 59.7 years, SD 10.3, 64.4% male), and DATATOP included 800 participants (mean age 61.1 years, SD 9.5, 64.4% male). Our analyses suggest that futility trials using the Simon 2-Stage methodology are feasible in PD. We propose a 5-point worsening on the UPDRS motor score as the primary outcome measure and a length of follow-up of 12 months. Trial simulations based on these data suggest the required sample size for such clinical trials to be lower than 200 participants.

DISCUSSION: Based on our analysis of DATATOP and PRECEPT, phase 2 clinical trials using the Simon 2-Stage methodology are feasible in PD and may offer an opportunity to expedite the discovery of promising treatments in early PD.

PMID:39642339 | DOI:10.1212/WNL.0000000000210079

Neurology. 2025 Jan 14;104(1):e210218. doi: 10.1212/WNL.0000000000210218. Epub 2024 Dec 6.

NO ABSTRACT

PMID:39642337 | DOI:10.1212/WNL.0000000000210218

JCO Clin Cancer Inform. 2024 Dec;8:e2400179. doi: 10.1200/CCI-24-00179. Epub 2024 Dec 6.

ABSTRACT

PURPOSE: Oral adjuvant endocrine therapy (AET) reduces the risk of cancer recurrence and death for women with hormone receptor-positive (HR+) breast cancer. Because of adverse symptoms and socioecologic barriers, AET adherence rates are low. We conducted post hoc analyses of a randomized trial of a remote symptom and adherence monitoring app to evaluate characteristics associated with higher app use, satisfaction, and how app use was associated with AET adherence.

METHODS: Patients prescribed AET were randomly assigned to receive one of three intervention conditions: app, app + feedback, or enhanced usual care. Baseline and 6-month follow-up surveys, app use, and pillbox-monitored AET adherence data for app and app + feedback participants were used. Logistic regression evaluated the association between sociodemographic/clinical characteristics and app utilization and satisfaction, and how app use was associated with AET adherence (>80%).

RESULTS: Overall, 163 women with early-stage HR+ breast cancer were included; 35.0% had high app use (≥75% of weeks enrolled). No sociodemographic characteristics were associated with app use. Satisfaction with the app was higher among those who were younger (88.9% for age 31-49 years v 54.9% for age 65+ years, P < .001), identified as White (76.8% v 60.1% for Black, P = .045), had lower health literacy (85.4% v 68.2% with higher health literacy, P = .017), or were nonurban residents (85.7% v 68.6% for urban, P = .021). Most participants (90.3%) with high app use were AET-adherent compared with 66.8% for those with lower app use (P < .001).

CONCLUSION: Use of a remote monitoring app was similar across sociodemographic characteristics, and more frequent app use was associated with a higher likelihood of 6-month AET adherence. Encouraging women to monitor medication adherence and communicate adverse symptoms could improve AET adherence.

PMID:39642329 | DOI:10.1200/CCI-24-00179