Nevin Manimala

Radiol Med. 2024 Oct 30. doi: 10.1007/s11547-024-01903-x. Online ahead of print.

ABSTRACT

PURPOSE: To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM).

METHODS: We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist.

RESULTS: Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001).

CONCLUSIONS: PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.

PMID:39476275 | DOI:10.1007/s11547-024-01903-x

Naunyn Schmiedebergs Arch Pharmacol. 2024 Oct 30. doi: 10.1007/s00210-024-03549-y. Online ahead of print.

ABSTRACT

Bupropion (Bpn), an FDA-approved NDRI (norepinephrine-dopamine reuptake inhibitor), poses risks of seizures and liver failure due to its stimulant properties, necessitating the development of alternative formulations. This research aims to develop a Bpn nanoformulation within bilosomal vesicles to enhance therapeutic efficacy at lower doses, using three bile salts, span 20 surfactants, and cholesterol via thin-film hydration. Optimization of bilosomal stability is achieved by trialing various ingredient concentrations, identifying a surfactant-to-cholesterol-to-bile salt ratio of 1.5:1:0.17 µM, with sodium cholate (B.SC_F) yielding the most stable system. Bpn encapsulated in the optimized bilosomal vesicle ([email protected] _F) demonstrated high encapsulation efficiency of 78.142 ± 11.07% and drug-retaining capacity compared to the niosomal system. The in vitro and in vivo toxicity profile of the product is superior to the niosomal system and shows negligible toxicity with a viability rate of not less than 95%, with a sustained release profile in artificial cerebrospinal fluid (ACSF). In vivo, behavioral analysis on zebrafish revealed that [email protected] _F treatment more effectively improved depressive behavior compared to free Bpn and other treatments, evidenced by increased exploration rates and reduced irregular movements, as shown through statistical and trajectory data. Hence, it is concluded that the bilosomal structure, compared to the niosomal system, is a better carrier of drugs to achieve brain delivery and improve mood.

PMID:39476247 | DOI:10.1007/s00210-024-03549-y

JAMA Netw Open. 2024 Oct 1;7(10):e2440269. doi: 10.1001/jamanetworkopen.2024.40269.

ABSTRACT

IMPORTANCE: Missed test results, defined as test results not followed up within an appropriate time frame, are common and lead to delays in diagnosis and treatment.

OBJECTIVE: To evaluate the effect of a quality improvement collaborative, the Virtual Breakthrough Series (VBTS), on the follow-up rate of 2 types of test results prone to being missed: chest imaging suspicious for lung cancer and laboratory findings suggestive of colorectal cancer.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster-randomized clinical trial was conducted between February 2020 and March 2022 at 12 Department of Veterans Affairs (VA) medical centers, with a predefined 3-cohort roll-out. Each cohort was exposed to 3 phases: preintervention, action, and continuous improvement. Follow-up ranged from 0 to 12 months, depending on cohort. Teams at each site were led by a project leader and included diverse interdisciplinary representation, with a mix of clinical and technical experts, senior leaders, nursing champions, and other interdisciplinary team members. Analysis was conducted per protocol, and data were analyzed from April 2022 to March 2024.

INTERVENTION: All teams participated in a VBTS, which included instruction on reducing rates of missed test results at their site.

MAIN OUTCOMES AND MEASURES: The primary outcome was changes in the percentage of abnormal test result follow-up, comparing the preintervention phase with the action phase. Secondary outcomes were effects across cohorts and the intervention’s effect on sites with the highest and lowest preintervention follow-up rates. Previously validated electronic algorithms measured abnormal imaging and laboratory test result follow-up rates.

RESULTS: A total of 11 teams completed the VBTS and implemented 47 (mean, 4 per team; range, 3-8 per team; mode, 3 per team) unique interventions to improve missed test results. A total of 40 027 colorectal cancer-related tests were performed, with 5130 abnormal results, of which 1286 results were flagged by the electronic trigger (e-trigger) algorithm as being missed. For lung cancer-related studies, 376 765 tests were performed, with 7314 abnormal results and 2436 flagged by the e-trigger as being missed. There was no significant difference in the percentage of abnormal test results followed up by study phase, consistent across all 3 cohorts. The estimated mean difference between the preintervention and action phases was -0.78 (95% CI, -6.88 to 5.31) percentage points for the colorectal e-trigger and 0.36 (95% CI, -5.19 to 5.9) percentage points for the lung e-trigger. However, there was a significant effect of the intervention by site, with the site with the lowest follow-up rate at baseline increasing its follow-up rate from 27.8% in the preintervention phase to 55.6% in the action phase.

CONCLUSIONS AND RELEVANCE: In this cluster-randomized clinical trial of the VBTS intervention, there was no improvement in the percentage of test results receiving follow-up. However, the VBTS may offer benefits for sites with low baseline performance.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04166240.

PMID:39476237 | DOI:10.1001/jamanetworkopen.2024.40269

JAMA Netw Open. 2024 Oct 1;7(10):e2441765. doi: 10.1001/jamanetworkopen.2024.41765.

ABSTRACT

IMPORTANCE: Cardiovascular disease (CVD) can be recurrent during type 2 diabetes (T2D) progression in this aging population. The effectiveness of sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy on total (ie, first and subsequent) CVD among patients with T2D in clinical practice remains uncertain.

OBJECTIVE: To analyze the comparative association of SGLT2i vs dipeptidyl peptidase 4 inhibitor (DPP4i) therapy with total CVD among patients with T2D in clinical practice.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used electronic medical records at the National Cheng Kung University Hospital, a leading medical center in Taiwan, from 2015 through 2021. Adult patients with T2D who initiated first use of the study drugs from 2016 through 2019, with up to 6 years of follow-up, were identified.

MAIN OUTCOMES AND MEASURES: The primary outcomes included total composite CVD events and individual CVD subtypes (ie, atrial fibrillation, coronary heart disease, heart failure, stroke, myocardial infarction, and transient ischemic attack). A shared frailty model analysis was used to assess the association of treatment with repeat CVD events. Data from patients at high risk for CVD recurrence were further analyzed. Data were analyzed from September 1, 2022, to December 31, 2023.

RESULTS: Overall, 8384 patients with T2D were identified (mean [SD] age, 63.7 [12.4] years; 4645 [55.4%] male). A total of 1632 propensity score-matched pairs of SGLT2i (mean [SD] age, 57.8 [12.0] years; 673 [41.2%] female and 959 [58.8%] male) and DPP4i (mean [SD] age, 58.2 [12.9] years; 655 [40.1%] female and 977 [59.9%] male) users were included. SGLT2i was associated with reduced total CVD risk vs DPP4i therapy (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98]) but not the first CVD event (with the use of SGLT2i therapy were more prominent for patients at high risk of CVD (ie, HR, 0.70 [95% CI, 0.62-0.80] for individuals with estimated glomerular filtration rate lower than 60 mL/min/1.73 m2; HR, 0.70 [95% CI, 0.64-0.78]; for individuals having any diabetes-related complications; and HR, 0.72 [95% CI, 0.65-0.80] for individuals with a history of CVD) compared with the overall cohort. Among patients at high risk of CVD, greater reduced total CVD burden associated with SGLT2i therapy was observed for women vs men (eg, HR, 0.59 [95% CI, 0.49-0.72] in the subgroup with CVD history).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with T2D, the use of SGLT2is vs DPP4is was associated with reduced total cardiovascular burden, suggesting that long-term use of this therapy may optimize treatment benefit among patients with chronic CVD. The SGLT2i-associated benefit among patients with high risk of CVD encourages the prioritization of SGLT2i use for these vulnerable individuals.

PMID:39476235 | DOI:10.1001/jamanetworkopen.2024.41765

JAMA Netw Open. 2024 Oct 1;7(10):e2442218. doi: 10.1001/jamanetworkopen.2024.42218.

ABSTRACT

IMPORTANCE: An improved understanding of autism spectrum disorder (ASD) prevalence over time and across the lifespan can inform health care service delivery for the growing population of autistic children and adults.

OBJECTIVE: To describe trends in the prevalence of ASD diagnoses using electronic records data from a large network of health systems in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined annual diagnosis rates in health records of patients in US health systems from January 1, 2011, to December 31, 2022. Eligible individuals were included in the study sample for a given calendar year if they were enrolled in a participating health system for at least 10 months out of the year. Data were extracted from 12 sites participating in the Mental Health Research Network, a consortium of research centers embedded within large, diverse health care systems.

MAIN OUTCOME AND MEASURES: Diagnoses of ASD were ascertained using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) revision codes. Annual diagnosis rates were calculated as the number of unique members diagnosed, divided by the total members enrolled.

RESULTS: A total of 12 264 003 members were enrolled in 2022 (2 359 359 children aged 0 to 17 years [19.2%]; 6 400 222 female [52.2%]; 93 002 American Indian or Alaska Native [0.8%], 1 711 950 Asian [14.0%], 952 287 Black or African American [7.8%], 2 971 355 Hispanic [24.2%], 166 144 Native Hawaiian or Pacific Islander [1.4%], and 6 462 298 White [52.7%]). The ASD diagnosis rate was greatest among 5-to-8-year-olds throughout the study period and increased by 175% among the full sample, from 2.3 per 1000 in 2011 to 6.3 per 1000 in 2022. The greatest relative increase in diagnosis rate from 2011 to 2022 occurred among 26-to-34-year-olds (450%) and increases were greater for female vs male individuals among children (305% [estimated annual percentage change (EAPC), 13.62 percentage points; 95% CI, 12.49-14.75 percentage points] vs 185% [EAPC, 9.63 percentage points; 95% CI, 8.54-10.72 percentage points], respectively) and adults (315% [EAPC, 13.73 percentage points; 95% CI, 12.61-14.86 percentage points] vs 215% [EAPC, 10.33 percentage points; 95% CI, 9.24-11.43 percentage points]). Relative increases were greater in racial and ethnic minority groups compared with White individuals among children, but not adults.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of children and adults in the US, ASD diagnosis rates increased substantially between 2011 and 2022, particularly among young adults, female children and adults, and children from some racial or ethnic minority groups. Diagnosis prevalence trends generated using health system data can inform the allocation of resources to meet the service needs of this growing, medically complex population.

PMID:39476234 | DOI:10.1001/jamanetworkopen.2024.42218

JAMA Netw Open. 2024 Oct 1;7(10):e2442319. doi: 10.1001/jamanetworkopen.2024.42319.

ABSTRACT

IMPORTANCE: Resting heart rate (RHR) is a widely available measure of cardiovascular fitness that has been associated with several cardiovascular outcomes. RHR has previously been associated with the risk of atrial fibrillation (AF) among individuals of European ancestry, but little is known about this association in Black adults.

OBJECTIVE: To evaluate the association between RHR and incident AF in a large community-based sample of Black adults, independently of established risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from the Jackson Heart Study, a prospective community-based cohort in Jackson, Mississippi. Participants without prevalent AF were included and were monitored for new-onset AF during follow-up, from 2000 through 2016. Data analysis was performed from August 1 to December 11, 2023.

EXPOSURE: RHR was assessed from resting 12-lead electrocardiograms performed at examination 1 (2000-2004) and examination 3 (2009-2013).

MAIN OUTCOMES AND MEASURES: AF was identified from study electrocardiograms, hospitalization discharge diagnosis codes, and Medicare claims diagnosis codes. Cox regression was used to evaluate the association between baseline (examination 1) RHR and incident AF, adjusting for established AF risk factors.

RESULTS: Among 4965 Black adults eligible for analysis, the mean (SD) age was 55 (13) years, 1830 (37%) were male, and the mean (SD) RHR at baseline was 65 (11) beats per minute (bpm). During a median (IQR) 14 (12-15) years of follow-up, there were 458 incident AF events, resulting in an incident rate of 7.5 per 1000 person-years (95% CI, 6.8-8.2 incidents per 1000 person-years). Each 10-bpm higher RHR was associated with a 9% higher risk of incident AF after adjustment for AF risk factors (hazard ratio, 1.09; 95% CI, 1.00-1.19). In a sensitivity analysis that excluded individuals with prior heart failure, prior myocardial infarction, and antiarrhythmic medication use at baseline, the hazard ratio was 1.14 (95% CI, 1.02-1.28). There was little evidence of effect modification of these associations by age, sex, body mass index, hypertension, or physical activity level.

CONCLUSIONS AND RELEVANCE: In this large prospective cohort study of Black adults, elevated baseline RHR was associated with increased risk of incident AF, consistent with findings from previous studies of European ancestry populations. Future research should focus on determining whether RHR can be used to screen patients at high risk of AF.

PMID:39476232 | DOI:10.1001/jamanetworkopen.2024.42319

J Neurophysiol. 2024 Oct 30. doi: 10.1152/jn.00298.2024. Online ahead of print.

ABSTRACT

Recent interest in dynamic sound localisation models has created a need to better understand the head movements made by humans. Previous studies have shown that static head positions and small oscillations of the head obey Donders’ law: for each facing direction there is one unique three-dimensional orientation. It is unclear whether this same constraint applies to audiovisual localisation, where head movement is unrestricted and subjects may rotate their heads depending on the available auditory information. In an auditory guided visual search task, human subjects were instructed to localise an audiovisual target within a field of visual distractors in the frontal hemisphere. During this task, head and torso movements were monitored using a motion capture system. Head rotations were found to follow Donders’ law during search tasks. Individual differences were present in the amount of roll that subjects deployed, though there was no statistically significant improvement in model performance when including these individual differences in a gimbal model. The roll component of head rotation could therefore be predicted with a truncated Fick gimbal, which consists of a pitch axis nested within a yaw axis. This led to a reduction from three to two degrees of freedom when modelling head movement during localisation tasks.

PMID:39475488 | DOI:10.1152/jn.00298.2024

Death Stud. 2024 Oct 30:1-12. doi: 10.1080/07481187.2024.2419605. Online ahead of print.

ABSTRACT

Insecure attachment styles have been linked to an increased risk for suicidality, functioning as a distal risk factor for suicide behaviors in adulthood. Studies on the subject are numerous, but heterogeneous in methodology. This study aimed to sensibly group study findings and quantify the magnitude of this relationship. We performed a systematic literature search to select studies investigating insecure adult attachment styles and suicidal ideation and attempt, and present quantitative data that could be pooled into a meta-analysis. Six random-effect meta-analyses were performed, comprising 47 studies with 50,214 individuals. A small effect size association was found for the relationship between suicidal ideation and insecure attachment styles (anxious, avoidant, and fearful); similar findings were found for the relationship between suicide attempt and insecure attachment (Pearson’s r ranged from 0.16 to 0.26, all ps <0.05). The type of attachment measure moderated the association of suicidal ideation with anxious and avoidant attachment.

This review has been preregistered at The International Prospective Register of Systematic Reviews (PROSPERO) – Registration number CRD42023401459.

PMID:39475484 | DOI:10.1080/07481187.2024.2419605

Glob Health Action. 2024 Dec 31;17(1):2401849. doi: 10.1080/16549716.2024.2401849. Epub 2024 Oct 30.

ABSTRACT

BACKGROUND: Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa’s most populous country with a restrictive abortion law and a high rate of unsafe abortions.

OBJECTIVE: The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals’ practice of safe abortion and post-abortion care.

METHODS: The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants’ experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti.

RESULTS: The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants’ experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives.

CONCLUSION: Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women’s access to safe abortion care in Nigeria.

PMID:39475477 | DOI:10.1080/16549716.2024.2401849

J Gerontol Nurs. 2024 Nov;50(11):6-12. doi: 10.3928/00989134-20241014-02. Epub 2024 Nov 1.

ABSTRACT

PURPOSE: The current study explored the association of nursing home (NH) residents’ demographic and clinical attributes and NH characteristics with resident-reported satisfaction with NH communities.

METHOD: Pearson correlations and multiple linear regression were used to test the association of demographic and clinical attributes of residents and NH characteristics with resident-reported NH satisfaction with 197 NH residents from 28 NHs.

RESULTS: Correlational analysis and regressions indicated an association among residents’ demographic and clinical characteristics, NH characteristics, and self-reported NH satisfaction. Higher age, higher education, and race (minority status) were associated with greater resident-reported NH satisfaction. Greater NH staffing and for-profit ownership status were associated with less NH satisfaction. Greater resident depressive symptoms and dressing assistance were associated with lower resident-reported NH satisfaction.

CONCLUSION: Administrators and staff should look beyond NH characteristics and consider their residents’ diverse personal characteristics to create an environment that promotes satisfaction and well-being. [Journal of Gerontological Nursing, 50(11), 6-12.].

PMID:39475472 | DOI:10.3928/00989134-20241014-02