Nevin Manimala

Am J Emerg Med. 2024 Nov 24;88:96-104. doi: 10.1016/j.ajem.2024.11.077. Online ahead of print.

ABSTRACT

BACKGROUND: Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts.

METHODS: This retrospective registry-based cohort study utilized records from the Military Airborne Combat Evacuation Unit (MACEU) and the Israeli National Trauma Registry. Eligible patients evacuated by MACEU between 07.17.14 and 08.16.14 and between 10.27.23 and 03.17.24 were compared. Ground-evacuated casualties were excluded. Demographics, prehospital interventions, and clinical outcomes were compared.

RESULTS: During the 2014 conflict, 251 patients were evacuated alive, compared to 940 in 2023. Both conflicts involved mostly young males injured by explosions, with comparable injury distributions across body regions. The time from injury to hospital arrival decreased from 65 min (IQR 47-94) in 2014 to 60 min (IQR 47-180) in 2023 (d = 0.5, p < 0.001). The proportion of severely injured patients (ISS ≥ 16) increased from 18.3 % to 25.2 % (OR 1.5 [95 % CI 1.06-2.14], p = 0.03), and critically injured patients (ISS ≥ 25) from 7.6 % to 12.8 % (OR 1.79 [95 % CI 1.08-2.96], p = 0.03). Prehospital advanced airway interventions and tube thoracostomies decreased from 11.6 % to 6.0 % (OR 0.48 [95 % CI 0.30-0.76], p < 0.001) and from 7.0 % to 2.1 % (OR 0.28 [95 % CI 0.15-0.54], p < 0.001), respectively. Prehospital blood transfusions use increased from 6.6 % to 16.4 % (OR 2.78 [95 % CI 1.64-4.76], p < 0.001). In-hospital mortality rates remained stable (2.7 % vs. 2.5 %, OR 1.12 [95 % CI 0.44-2.81], p = 0.99). Although not statistically significant, lower mortality rates were recorded among the severely (13.0 % vs. 8.4 %, OR 0.61 [95 % CI 0.23-1.61, p = 0.48) and critically injured (26.3 % vs. 15.8 %, OR 0.53 [95 % CI 0.17-1.64], p = 0.32).

CONCLUSION: Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the “less is more” approach in modern prehospital combat casualty care.

PMID:39612529 | DOI:10.1016/j.ajem.2024.11.077

J Plast Reconstr Aesthet Surg. 2024 Nov 14;100:104-111. doi: 10.1016/j.bjps.2024.11.014. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the association between nonsyndromic craniosynostosis (NSC) and academic achievement.

METHODS: Registry data were analyzed on demographic background, presence of craniosynostosis and other comorbidities, grades, and results on national standardized tests (NSTs) across primary and upper secondary school, as well as the presence of academic degrees. The analysis used regression modeling on a sample of N = 1110 individuals with NSC and a matched cohort of N = 10,654 individuals.

RESULTS: There was a significant negative association between NSC and NST scores in third grade for both mathematics (aOR 0.76, 95% CI 0.60-0.99, p = .020) and Swedish (aOR 0.69, 95% CI 0.54-0.89, p = .004). The association seemed to primarily be carried by females with NSC (aORs for the interaction term 0.26-0.45, all ps <.05). Further, a slightly stronger negative association was observed in individuals with psychiatric comorbidities (aOR 0.44, 95% CI 0.22-0.90, p = .025 for mathematics; aOR 0.45, 95% CI 0.21-0.98, p = .045 for Swedish). No statistically significant association was found between NSC and NST scores or grades in later school years, or with academic degrees.

CONCLUSIONS: There is evidence for a limited temporary negative association between NSC and academic achievement. A stronger negative association between NSC and academic achievement seems to be present in girls, and for individuals with psychiatric comorbidities. This has important implications for clinical management and provision of support in educational contexts.

PMID:39612517 | DOI:10.1016/j.bjps.2024.11.014

Health Promot Int. 2024 Dec 1;39(6):daae170. doi: 10.1093/heapro/daae170.

ABSTRACT

Disadvantaged adolescents, including those from lower socioeconomic status (SES) or geographically remote backgrounds, engage in higher rates of risk behaviours, including poor diet, alcohol and tobacco use. While digital interventions targeting lifestyle risk behaviours show potential, few studies have focused on their implementation and relevance for this population. This study conducted a process evaluation of ‘Health4Life’, a universal school-based digital program targeting multiple behaviours, among a sample of disadvantaged adolescents. Participants were from six schools classified as low SES (Index of Community Socio-educational Advantage percentile score ≤ 25%), and/or regional using the Australian Statistical Geography Standard. Self-reported student (n = 214) and teacher evaluations (n = 16) assessed Health4Life’s acceptability, with qualitative questions capturing areas for improvement. Teacher-reported implementation data (n = 16) measured intervention fidelity and feasibility. Quantitative data were analysed using descriptive statistics and open-ended responses were thematically analysed. Compared to the entire sample, this subset of students evaluated Health4Life less favourably (66% versus 75%), with fewer enjoying the stories (63% versus 75%) and planning to use the skills and information (60% versus 70%). Teacher evaluations were mostly positive and aligned closely with the entire sample. Fidelity data also indicated comparable levels of student engagement (~92% versus ~85%). Key themes for refinement included improving content relevance and technical execution to better resonate with disadvantaged adolescents. While teacher evaluations suggest Health4Life is a valuable program in low SES or regional contexts, students’ lower ratings indicate refinements are needed. Identified areas for improvement will guide co-designing the program’s adaptation to improve effectiveness and relevance for disadvantaged adolescents. Trial registration: The Health4Life trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).

PMID:39612512 | DOI:10.1093/heapro/daae170

J Med Internet Res. 2024 Nov 29;26:e63032. doi: 10.2196/63032.

ABSTRACT

BACKGROUND: Researchers have many options for web-based survey data collection, ranging from access to curated probability-based panels, where individuals are selectively invited to join based on their membership in a representative population, to convenience panels, which are open for anyone to join. The mix of respondents available also varies greatly regarding representation of a population of interest and in motivation to provide thoughtful and accurate responses. Despite the additional dataset-building labor required of the researcher, convenience panels are much less expensive than probability-based panels. However, it is important to understand what may be given up regarding data quality for those cost savings.

OBJECTIVE: This study examined the relative costs and data quality of fielding equivalent surveys on Amazon’s Mechanical Turk (MTurk), a convenience panel, and KnowledgePanel, a nationally representative probability-based panel.

METHODS: We administered the same survey measures to MTurk (in 2021) and KnowledgePanel (in 2022) members. We applied several recommended quality assurance steps to enhance the data quality achieved using MTurk. Ipsos, the owner of KnowledgePanel, followed their usual (industry standard) protocols. The survey was designed to support psychometric analyses and included >60 items from the Patient-Reported Outcomes Measurement Information System (PROMIS), demographics, and a list of health conditions. We used 2 fake conditions (“syndomitis” and “chekalism”) to identify those more likely to be honest respondents. We examined the quality of each platform’s data using several recommended metrics (eg, consistency, reliability, representativeness, missing data, and correlations) including and excluding those respondents who had endorsed a fake condition and examined the impact of weighting on representativeness.

RESULTS: We found that prescreening in the MTurk sample (removing those who endorsed a fake health condition) improved data quality but KnowledgePanel data quality generally remained superior. While MTurk’s unweighted point estimates for demographics exhibited the usual mismatch with national averages (younger, better educated, and lower income), weighted MTurk data matched national estimates. KnowledgePanel’s point estimates better matched national benchmarks even before poststratification weighting. Correlations between PROMIS measures and age and income were similar in MTurk and KnowledgePanel; the mean absolute value of the difference between each platform’s 137 correlations was 0.06, and 92% were <0.15. However, correlations between PROMIS measures and educational level were dramatically different; the mean absolute value of the difference across these 17 correlation pairs was 0.15, the largest difference was 0.29, and the direction of more than half of these relationships in the MTurk sample was the opposite from that expected from theory. Therefore, caution is needed if using MTurk for studies where educational level is a key variable.

CONCLUSIONS: The data quality of our MTurk sample was often inferior to that of the KnowledgePanel sample but possibly not so much as to negate the benefits of its cost savings for some uses.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12891-020-03696-2.

PMID:39612505 | DOI:10.2196/63032

J Neurosurg. 2024 Nov 29:1-9. doi: 10.3171/2024.7.JNS232274. Online ahead of print.

ABSTRACT

OBJECTIVE: Gamma Knife radiosurgery (GKRS) is a treatment option for refractory trigeminal neuralgia (TN). However, there is a paucity of data regarding the effectiveness of GKRS for relapsing TN following microvascular decompression (MVD). The aim of this study was to characterize the response rate, complications, pain relief durability, and predictors of pain relapse for salvage GKRS following MVD for TN.

METHODS: A retrospective study of all patients who received GKRS for Burchiel type 1 TN (TN1) or type 2 TN (TN2) pain at Wake Forest University School of Medicine was conducted. Pain was measured using the Barrow Neurological Institute (BNI) pain intensity score. After an initial pain response of BNI scores I-III, a BNI score of IV or V constituted relapse. Durability of pain relief was characterized using the Kaplan-Meier estimator. Predictors of relapse were investigated using Cox regression models. Statistical significance was set at p < 0.05.

RESULTS: Of 2065 patients with TN1 or TN2, 59 had GKRS post-MVD. Forty-nine (83.1%) of these patients experienced a BNI pain score of I-III at the first follow-up post-GKRS. The median time to relapse was 1.75 years; freedom rates from relapse were 77%, 45.9%, and 30.7% at 1, 2, and 5 years, respectively. Radiofrequency ablation prior to MVD significantly decreased the likelihood of an initial response to salvage GKRS (Fisher’s exact test, p = 0.02). After controlling for baseline and clinical characteristics, facial numbness significantly decreased the likelihood of pain relapse (Cox regression, HR 0.15, 95% CI 0.03-0.73; p = 0.01). Conversely, a worse initial pain response significantly increased the likelihood of pain relapse (Cox regression, HR 3.64, 95% CI 1.02-12.95; p = 0.04). Pain relapse within 24 months of the original MVD did not predict durability of pain relief following salvage GKRS (Cox regression, HR 0.94, 95% CI 0.40-2.22; p = 0.89). The overall toxicity rate of salvage GKRS was 35.6%.

CONCLUSIONS: Salvage GKRS presents an effective, noninvasive option for recurring TN after MVD, with a comparable response rate to primary GKRS or MVD, and a favorable complications profile relative to salvage MVD. Patients with postoperative facial numbness and a better initial pain response may experience more durable pain relief following salvage GKRS.

PMID:39612504 | DOI:10.3171/2024.7.JNS232274

J Neurosurg Spine. 2024 Nov 29:1-12. doi: 10.3171/2024.7.SPINE24340. Online ahead of print.

ABSTRACT

OBJECTIVE: Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs).

METHODS: The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis.

RESULTS: Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0-6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0-9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery.

CONCLUSIONS: Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient’s background and the plan for postoperative adjuvant therapy.

PMID:39612495 | DOI:10.3171/2024.7.SPINE24340

Interact J Med Res. 2024 Nov 29;13:e53304. doi: 10.2196/53304.

ABSTRACT

BACKGROUND: Interdisciplinary evaluation of older adults’ health care is a priority in the prevention of chronic health conditions and maintenance of daily functioning. While many studies evaluate different physical performance tests (PPTs) from a retrospective view in predicting mortality or cardiopulmonary health, it remains unclear which of the commonly used PPTs is the most effective at evaluating the current health of older adults. Additionally, the time and participant burden for each PPT must be considered when planning and implementing them for clinical or research purposes.

OBJECTIVE: This cross-sectional study aimed to determine how elements of overall physical capacity, performance, and other nongait factors in older adults affect the results of 3 commonly used tests: the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), and Incremental Shuttle Walk Test (ISWT).

METHODS: A total of 53 community-dwelling older adults met the inclusion and exclusion criteria (mean age 77.47, SD 7.25 years; n=41, 77% female; and n=21, 40% Hispanic). This study evaluated older adults using 3 different PPTs including the SPPB, 6MWT, and ISWT, as well as constructed multiple linear regression models with measures of physical activity, static balance, and fear of falling (FoF). The nongait measures included 7 days of physical activity monitoring using the ActiGraph GT9X Link instrument, objective measurement of static balance using the BTrackS Balance System, and FoF using the short Fall Efficacy Scale-International.

RESULTS: The models revealed that the complete SPPB provided the most comprehensive value, as indicated by a greater R² value (0.523), and that performance on the SPPB was predicted by both moderate to vigorous physical activity (P=.01) and FoF (P<.001). The ISWT was predicted by moderate to vigorous physical activity (P=.02), BMI (P=.02), and FoF (P=.006) and had a similar R² value (0.517), whereas the gait component of the SPPB (P=.001) and 6MWT (P<.001) was predicted by only FoF and had lower R² values (0.375 and 0.228, respectively).

CONCLUSIONS: The results indicated the value of a multicomponent, comprehensive test, such as the SPPB, in evaluating the health of older adults. Additionally, a comparison of the 2 field walking tests (ISWT and 6MWT) further distinguished the ISWT as more responsive to overall health in older adults. In comparing these commonly used PPTs, clinicians and researchers in the field can determine and select the most optimal test to evaluate older adults in communities and research settings.

PMID:39612490 | DOI:10.2196/53304

J Med Internet Res. 2024 Nov 29;26:e53157. doi: 10.2196/53157.

ABSTRACT

BACKGROUND: Smart glasses have emerged as a promising solution for enhancing communication and care coordination among distributed medical teams. While prior research has explored the feasibility of using smart glasses to improve prehospital communication between emergency medical service (EMS) providers and remote physicians, a research gap remains in understanding the specific requirements and needs of EMS providers for smart glass implementation.

OBJECTIVE: This study aims to iteratively design and evaluate a smart glass application tailored for prehospital communication by actively involving prospective users in the system design process.

METHODS: Grounded in participatory design, the study consisted of 2 phases of design requirement gathering, rapid prototyping, usability testing, and prototype refinement. In total, 43 distinct EMS providers with diverse backgrounds participated in this 2-year long iterative design process. All qualitative data (eg, transcribed interviews and discussions) were iteratively coded and analyzed by at least 2 researchers using thematic analysis. Quantitative data, such as System Usability Scale (SUS) scores and feature ratings, were analyzed using statistical methods.

RESULTS: Our research identified challenges in 2 essential prehospital communication activities: contacting online medical control (OLMC) physicians for medical guidance and notifying receiving hospital teams of incoming patients. The iterative design process led to the identification of 5 key features that could potentially address the identified challenges: video call functionality with OLMC physicians, call priority indication for expedited OLMC contact, direct communication with receiving hospitals, multimedia patient information sharing, and touchless interaction methods for operating the smart glasses. The SUS score for our system design improved from a mean of 74.3 (SD 11.3) in the first phase (classified as good usability) to 80.3 (SD 13.1) in the second phase (classified as excellent usability). This improvement, along with consistently high ratings for other aspects (eg, willingness to use and feature design), demonstrated continuous enhancement of the system’s design across the 2 phases. Additionally, significant differences in SUS scores were observed between EMS providers in urban areas (median 85, IQR 76-94) and rural areas (median 72.5, IQR 66-83; Mann-Whitney U=43; P=.17), as well as between paramedics (median 72.5, IQR 70-80) and emergency medical technicians (median 85, IQR: 74-98; Mann-Whitney U=44.5; P=.13), suggesting that EMS providers in urban settings and those with less training in treating patients in critical conditions perceived the smart glass application as more useful and user-friendly. Finally, the study also identified several concerns regarding the adoption of the smart glass application, including technical limitations, environmental constraints, and potential barriers to workflow integration.

CONCLUSIONS: Using a participatory design approach, this study provided insights into designing user-friendly smart glasses that address the current challenges EMS providers face in dynamic prehospital settings.

PMID:39612486 | DOI:10.2196/53157

Medicine (Baltimore). 2024 Nov 29;103(48):e40192. doi: 10.1097/MD.0000000000040192.

ABSTRACT

BACKGROUND: Rhinosinusitis (RS), a common inflammatory disorder, adversely affects quality of life and can progress to serious complications without intervention. Conventional therapies, including antibiotics and corticosteroids, exhibit inherent limitations and risks. Traditional Chinese medicine (TCM), with its extensive historical use in RS management, remains understudied in contemporary evaluations. This systematic review evaluates the efficacy and safety of TCM in RS treatment, aiming to guide clinical decision-making.

METHODS: A systematic search was undertaken in Chinese and English databases, such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Web of Science, and other relevant databases, to gather randomized controlled trials of TCM for patients with RS from January 2014 to February 2024. Two researchers independently curated and synthesized data from eligible literature, conducted meta-analyses with ReviewManager 5.4.1, and assessed evidence quality via GRADEPro GDT.

RESULTS: A total of 48 articles included 4490 patients, of which 2249 were control group and 2241 were in the experimental group. Meta-analytic outcomes revealed that the integration of TCM with western medicine conventional treatment significantly enhanced the total effective rate [risk ratio=1.20, 95% confidence interval (CI) (1.17, 1.23), P < 0.05] and yielded a notable reduction in Lund-Kennedy score [mean difference (MD)=-1.32, 95% CI (-1.72, -0.93), P < 0.05], Lund-Mackay score [MD=-1.13, 95% CI (-1.27, -1.00), P < 0.05], SNOT-20 score [MD=-3.02, 95% CI (-4.34, -1.69), P < 0.05], nasal congestion Visual Analogue Scale (VAS) score [MD=-1.05, 95% CI (-1.65, -0.45), P < 0.05], runny nose VAS score [MD=-0.84, 95% CI (-1.13, -0.54), P < 0.05], headache VAS score [MD=-0.90, 95% CI (-1.45, -0.35), P < 0.05], olfactory impairment VAS score [MD=-1.43, 95% CI (-1.75, -1.11), P < 0.05], and total TCM syndrome score [standardized mean difference (SMD)=-1.78, 95% CI (-2.58, -0.97), P < 0.05]. Additionally, significant decreases were observed in levels of tumor necrosis factor-α [SMD=-2.14, 95% CI (-3.42, -0.87), P < 0.05] and interleukin-6 [SMD=-1.64, 95% CI (-2.08, -1.21), P < 0.05], with statistical significance achieved for all measured outcomes. Regarding safety considerations, an insignificant variance was observed between the 2 therapeutic approaches, with no statistically discernible difference (P > 0.05).

CONCLUSION: Combining TCM with western medicine in RS treatment yields superior outcomes over western medicine alone, with enhanced efficacy, reduced nasal symptoms, and lower inflammation. Rigorous multicenter RCTs are warranted to affirm these advantages and bolster the evidence for TCM in RS management.

PMID:39612467 | DOI:10.1097/MD.0000000000040192

Medicine (Baltimore). 2024 Nov 29;103(48):e40645. doi: 10.1097/MD.0000000000040645.

ABSTRACT

A typical surgical technique for pregnant women with potentially fatal problems affecting the mother or fetus is an emergency cesarean section (ECS). The decision-to-delivery interval (DDI) for ECS should be within 30 minutes. The objective of this study was to investigate crash ECS indications and effects on maternal and neonatal outcomes. In this retrospective study, all women undergoing crash cesarean section (CS) at Obstetrics and Gynecology department at King Abdulaziz University hospital, Jeddah, Saudi Arabia during 2022 and 2023 were evaluated. Data about demographic and obstetric characteristics of mother, ECS indications, DDI, and outcomes for mothers and newborns was gathered from the patient’s sheet. One hundred 3 crash CS were performed during study period. Crash CS indications were fetal bradycardia (64.1%), prolapsed cord (24.3%), uterine rupture (6.8%), and severe antepartum hemorrhage (4.9%). D-D time range from 2 to 30 minutes. DDI was ≤15 minutes in 90 patients (87.4%) and >15 minutes in 13 patients (12.6%). Gestational age was <32 weeks (16.7%), between 32 and <37 weeks (15.5%), and ≥37 weeks (68.0%). Good maternal outcome was reported in 89 (86.4%), while 24 (13.6%) had complications. Intensive care unit maternal admission was significantly higher in gestational age 32 to <37 weeks versus <32 weeks and ≥37 weeks of gestation (18.8% vs 5.9% and 2.9%, P = .050). Fetal outcome was good in 69 (67.0%), while 34 (33.0%) had complications. Neonatal body weights, Apgar score at 1, 5, 10 minutes, and umbilical cord arterial pH were significantly decreased in preterm versus termed neonates (P < .0001, P < .0001, P < .0001, P = .014, and P = .003). Moreover, respiratory distress syndrome, jaundice, intubation, neonatal deaths, and sepsis were significantly higher in preterm versus term deliveries (P < .0001, P = .029, P < .0001, P = .010, and P = .031). Good neonatal outcome was significantly higher (P < .0001); while respiratory distress syndrome was significantly lower (P = .007) in deliveries with DDI ≤ 15 minutes versus > 15 minutes. The 30-minute standard for DDI time interval may be a feasible guideline at least for level-3 hospitals. Crash CS indication was mostly due to fetal bradycardia. The maternal and neonatal outcomes were better in term than preterm deliveries. The positive effect of very short intervals on neonatal outcome still needs to be proven.

PMID:39612466 | DOI:10.1097/MD.0000000000040645