Nevin Manimala

BMC Musculoskelet Disord. 2024 Aug 8;25(1):632. doi: 10.1186/s12891-024-07748-9.

ABSTRACT

PURPOSE: Patients with spinal metastases undergoing surgical treatment face challenges related to preoperative anemia, intraoperative blood loss, and frailty, emphasizing the significance of perioperative blood management. This retrospective analysis aimed to assess the correlation between hemoglobin-related parameters and outcomes, identifying key markers to aid in blood management.

METHODS: A retrospective review was performed to identify patients who underwent surgical treatment for spinal metastases. Hb-related parameters, including baseline Hb, postoperative nadir Hb, predischarge Hb, postoperative nadir Hb drift, and predischarge Hb drift (both in absolute values and percentages) were subjected to univariate and multivariate analyses. These analyses were conducted in conjunction with other established variables to identify independent markers predicting patient outcomes. The outcomes of interest were postoperative short-term (6-week) mortality, long-term (1-year) mortality, and postoperative 30-day morbidity.

RESULTS: A total of 289 patients were included. Our study demonstrated that predischarge Hb (OR 0.62, 95% CI 0.44-0.88, P = 0.007) was an independent prognostic factor of short-term mortality, while baseline Hb (OR 0.76, 95% CI 0.66-0.88, P < 0.001) was identified as an independent prognostic factor of long-term mortality. Additionally, nadir Hb drift (OR 0.82, 95% CI 0.70-0.97, P = 0.023) was found to be an independent prognostic factor for postoperative 30-day morbidity.

CONCLUSIONS: This study demonstrated that predischarge Hb, baseline Hb, and nadir Hb drift are prognostic factors for outcomes. These findings provide a foundation for precise blood management strategies. It is crucial to consider Hb-related parameters appropriately, and prospective intervention studies addressing these markers should be conducted in the future.

PMID:39118064 | DOI:10.1186/s12891-024-07748-9

BMC Infect Dis. 2024 Aug 8;24(1):799. doi: 10.1186/s12879-024-09725-y.

ABSTRACT

BACKGROUND: Assessment of artificial intelligence (AI)-based models across languages is crucial to ensure equitable access and accuracy of information in multilingual contexts. This study aimed to compare AI model efficiency in English and Arabic for infectious disease queries.

METHODS: The study employed the METRICS checklist for the design and reporting of AI-based studies in healthcare. The AI models tested included ChatGPT-3.5, ChatGPT-4, Bing, and Bard. The queries comprised 15 questions on HIV/AIDS, tuberculosis, malaria, COVID-19, and influenza. The AI-generated content was assessed by two bilingual experts using the validated CLEAR tool.

RESULTS: In comparing AI models’ performance in English and Arabic for infectious disease queries, variability was noted. English queries showed consistently superior performance, with Bard leading, followed by Bing, ChatGPT-4, and ChatGPT-3.5 (P = .012). The same trend was observed in Arabic, albeit without statistical significance (P = .082). Stratified analysis revealed higher scores for English in most CLEAR components, notably in completeness, accuracy, appropriateness, and relevance, especially with ChatGPT-3.5 and Bard. Across the five infectious disease topics, English outperformed Arabic, except for flu queries in Bing and Bard. The four AI models’ performance in English was rated as “excellent”, significantly outperforming their “above-average” Arabic counterparts (P = .002).

CONCLUSIONS: Disparity in AI model performance was noticed between English and Arabic in response to infectious disease queries. This language variation can negatively impact the quality of health content delivered by AI models among native speakers of Arabic. This issue is recommended to be addressed by AI developers, with the ultimate goal of enhancing health outcomes.

PMID:39118057 | DOI:10.1186/s12879-024-09725-y

BMC Prim Care. 2024 Aug 8;25(1):289. doi: 10.1186/s12875-024-02555-6.

ABSTRACT

BACKGROUND: The ‘Taking the screening tests close to the people’ program offers cardiovascular screening to the inhabitants of underprivileged settlements. This study aimed to evaluate the cardiovascular risk factors of underprivileged populations, including individuals who described themselves as belonging to the Roma population.

METHODS: During the program, we collected information about demographic features, lifestyle and current illnesses. A general health assessment (body weight, height, blood pressure and fasting blood glucose) and cardiovascular examination were performed. We analysed data on both Roma and non-Roma groups and used Pearson’s chi-squared test and multiple logistic regression models to analyse the factors that contribute to the onset of comorbidities, with a special focus on ethnicity.

RESULTS: Data from 6211 participants were processed. Based on self-reports, the non-Roma population consisted of 5352 respondents (1364 men (25.5%) and 3988 women (74.5%)), and the Roma population comprised 859 respondents (200 men (23.3%) and 659 women (76.7%)). A total of 91.2% (4849) of the non-Roma population and 92.5% (788) of the Roma population exercised less than 3 h per week (p < 0.001). Of the non-Roma population, 71.7% (3512) had a body mass index above 25 kg/m², while the corresponding figure was 72.4% (609) in the Roma population (p = 0.709). The median body mass index was 28.0 (24.6-31.9) in the non-Roma population and 28.8 (24.5-33.0) in the Roma population (p < 0.001). The prevalence of active smokers was 28.7% (1531) in the non-Roma population and 60.3% (516) in the Roma population (p < 0.001). The prevalence of hypertension was 54.9% (2824) in the non-Roma population and 49.8% (412) in the Roma population (p < 0.001). The prevalence of diabetes was 11.5% (95) in the Roma population and 12.2% (619) in the non-Roma population (p < 0.001).

CONCLUSION: We found a high prevalence of overweight and obesity, a lack of physical activity and an remarkably high smoking rate in the studied underprivileged population. Both type 2 diabetes and hypertension were more common among people living in underprivileged settlements than in the general Hungarian population. People living in underprivileged settlements need more attention in primary care.

PMID:39118056 | DOI:10.1186/s12875-024-02555-6

Int J Surg. 2024 Aug 8. doi: 10.1097/JS9.0000000000002033. Online ahead of print.

ABSTRACT

IMPORTANCE: Successful needle puncture of the renal collecting system is a critical but difficult procedure in percutaneous nephrolithotomy (PCNL). Although fluoroscopy and ultrasound are the standard imaging techniques to guide puncture during PCNL, both have known limitations.

OBJECTIVE: To assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL.

DESIGN: This study employed a single-center randomized controlled trial (RCT) design to assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. Conducted between May 2021 and November 2021, the trial utilized computer-generated random numbers for participant allocation to control for selection bias.

SETTING: The trial was executed at the *********, which serves as an academic medical center.

PARTICIPANTS: All patients who met the inclusion criteria were randomly divided into two groups, with 29 patients in each group. One group underwent PCNL procedures using the new navigation system, while the control group underwent standard ultrasound-guided PCNL procedures. Included patients had renal pelvis or caliceal calculi larger than 2.0 cm in diameter or had multiple or staghorn stones. The puncture procedure was performed with the support of real-time ultrasound imaging and visual guidance displayed on the screen.

MAIN OUTCOMES AND MEASURES: The primary outcome was system feasibility and puncture success rate. Secondary outcomes included puncture time, total surgical time, number of attempts, post-procedure complications, and one-year and three-year stone recurrence rates. Stone clearance was defined by postoperative CT. Descriptive statistics summarized patient demographics, stone size, and location. Independent samples t-tests analyzed puncture time and total surgical time. Chi-square or Fisher’s exact tests compared stone clearance, complications, socioeconomic status, renal hydronephrosis, stone location, race, and medical history. Linear regression examined the correlation between BMI and puncture time. Significance was set at P<0.05.

RESULTS: For all 58 patients undergoing PCNL, needle punctures of the renal collecting system were completed with a success rate of 100%. The average time from planning the puncture protocol to successful puncture was significantly shorter in the AcuSee guidance system group (3.12 min, range 0.2-6.88 min) compared to the standard ultrasound-guided group (7.58 min, range 5.41-10.68 min), representing a reduction of approximately 59%. The total surgical time was also shorter in the AcuSee group for patients with no and mild hydronephrosis (P<0.05). Complication rates were lower in the AcuSee group, with no major complications observed. However, 3 patients in the standard ultrasound-guided group have adverse effects after the PCNL procedure. The one-year stone recurrence rate was significantly lower in the AcuSee group (3.4%) compared to the standard group (24.1%), and the three-year recurrence rate was also lower (6.9% vs. 41.4%). Patient-specific factors such as BMI, renal morphology, and prior surgical history did not significantly affect the performance of the AcuSee system.

CONCLUSIONS AND RELEVANCE: We report the first clinical application of a new navigation system for needle puncture in ultrasound-guided PCNL. It has been demonstrated that it is feasible and safe compared to the standard ultrasound-guided group in percutaneous renal puncture. This technology provides intuitive and easy-to-use visual guidance, which may facilitate safe, accurate and fast needle puncture of the kidney.

PMID:39116453 | DOI:10.1097/JS9.0000000000002033

Int J Surg. 2024 Aug 8. doi: 10.1097/JS9.0000000000002037. Online ahead of print.

ABSTRACT

BACKGROUND: Perforated peptic ulcer (PPU) causes peritonitis and requires surgery based on disease severity. This study aimed to develop and validate a severity scale for PPU with generalized peritonitis.

MATERIALS AND METHODS: This retrospective cohort study used a nationwide multi-center surgical database (2013-2020). Patients aged >15 years who underwent surgery for PPU with generalized peritonitis were included and categorized into the derivation (2013-2018) and two validation (2019 and 2020) cohorts. Possible severity predictors were selected via a literature review, and Lasso models were developed to predict severe postoperative adverse events with 2000 bootstrapping. Final variables for the scoring system were determined based on inclusion frequency (≥90%) in the Lasso models. Discrimination and accuracy were evaluated using c-statistics and calibration plots. Cutoff values for minimal postoperative adverse events were examined using negative predictive values.

RESULTS: Among 12,513 patients included (1,202 underwent laparoscopic surgery), 533 (5.9%), 138 (7.6%), and 117 (6.9%) in the derivation and two validation cohorts experienced postoperative adverse events. Age, dyspnea at rest, preoperative sepsis, III/IV/V of American Society of Anesthesiologists physical status, and albumin and creatinine were selected for the final model. A 0-11 scoring system was developed with c-statistics of 0.812-0.819. Cutoff value was determined as 5, which predicted <3% probability of postoperative adverse events regardless of type of surgery.

CONCLUSIONS: A score of <5 predicts minimal risks for postoperative adverse events and therefore would be clinically useful to determine type of surgery. Further studies are needed to validate the score.

PMID:39116449 | DOI:10.1097/JS9.0000000000002037

J Med Internet Res. 2024 Aug 8;26:e47100. doi: 10.2196/47100.

ABSTRACT

BACKGROUND: The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized.

OBJECTIVE: This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA).

METHODS: Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use.

RESULTS: Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95% CI 6.78-7.81). This relationship held across all broadband access levels assessed.

CONCLUSIONS: This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes.

PMID:39116440 | DOI:10.2196/47100

J Med Internet Res. 2024 Aug 8;26:e53145. doi: 10.2196/53145.

ABSTRACT

BACKGROUND: Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health.

OBJECTIVE: We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre-COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented.

METHODS: In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre-COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre-COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre-COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants’ health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO_2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18.

RESULTS: Dropout rates were low in both cohorts in the IG (pre-COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre-COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre-COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO_2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre-COVID-19 cohort revealed significant increases in VO_2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms.

CONCLUSIONS: With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios.

TRIAL REGISTRATION: German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078.

PMID:39116428 | DOI:10.2196/53145

JMIR Res Protoc. 2024 Aug 8;13:e58580. doi: 10.2196/58580.

ABSTRACT

BACKGROUND: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness.

OBJECTIVE: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group.

METHODS: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model.

RESULTS: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024.

CONCLUSIONS: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58580.

PMID:39116423 | DOI:10.2196/58580

Issues Ment Health Nurs. 2024 Aug 8:1-7. doi: 10.1080/01612840.2024.2370929. Online ahead of print.

ABSTRACT

This study’s purpose is to examine the differences between how men and women use cognitive coping mechanisms in stressful situations, specifically the COVID-19 pandemic. Research suggests that men and women cope with stress differently. Women tend to have a more emotional response to stressors and are expected to spend more time discussing issues with family and friends. Men are socialized for problem-focused coping. Only using problem-focused coping can be problematic when the cause of the stress cannot be changed by the individual. A secondary goal of this study was to evaluate other factors that affected cognitive coping, such as knowing someone who died of COVID-19. Participants ages 18-24 were invited to take part in an online survey evaluating cognitive coping mechanisms. After analysis, we found that in many ways men and women cognitively coped similarly. More often, women use a wider range of coping strategies except for self-blame and other blame. The participants used the coping mechanisms at significantly higher levels than adults during pre-pandemic times. Knowing someone who died of COVID-19 correlated with statistically significantly higher usage of several coping mechanisms. Understanding young adults’ cognitive coping during high-stress scenarios can uncover solutions to improved mental health care.

PMID:39116412 | DOI:10.1080/01612840.2024.2370929

Ophthalmic Epidemiol. 2024 Aug 8:1-7. doi: 10.1080/09286586.2024.2382155. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the association between intraoperative complications of cataract surgery and postoperative mortality.

METHODS: A retrospective review of patients who underwent cataract surgery at our institution from 2014 to 2020 was conducted. Intraoperative complications included choroidal hemorrhage, posterior capsule rupture, vitreous loss, retained lens, and/or severe zonular dialysis in either eye. All-cause mortality statistics were obtained through a collaborative agreement with the Colorado Department of Public Health and Environment. Hazard ratios (HRs) from Cox proportional hazard models were used to estimate survival following cataract surgery.

RESULTS: Among 8,054 patients, the mean follow-up time was 4.4 (SD = 2.3) years and the mortality rate was 15% (n = 1,175). The overall complication rate was 2.2% (n = 181), and the rate of retained lens was 0.7% (n = 58). In univariate analysis, retained lens (HR: 1.86, 95% CI: 1.08-3.21, p = 0.026), severe zonular dialysis (HR: 2.00, 95% CI: 1.29-3.12, p = 0.002), and any intraoperative complication (HR: 1.51, 95% CI: 1.09-2.11, p = 0.015) were associated with higher hazard of mortality. When adjusted for demographic factors, comorbid medical conditions, and pre-operative visual acuity, intraoperative complications were not associated with mortality.

CONCLUSION: Intraoperative cataract surgery complications were associated with mortality in univariate analysis. However, this association was not significant in the multivariable analysis as it is confounded by other factors such as pre-operative visual acuity.

PMID:39116406 | DOI:10.1080/09286586.2024.2382155