Nevin Manimala

J Med Internet Res. 2024 Jun 7;26:e45469. doi: 10.2196/45469.

ABSTRACT

BACKGROUND: Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction.

OBJECTIVE: Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention.

METHODS: Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes.

RESULTS: For the entire sample (N=19,211), mean weight loss was -3.24% (SD 4.58%) at 3 months and -5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P_{3 months}<.001 and P_{6 months}=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (P_Switzerland<.001, P_{United Kingdom}=.12, and P_Germany=.005). Higher age was associated with stronger weight loss in the 3-month period (P_Switzerland=.001, P_{United Kingdom}=.002, and P_Germany<.001) and, for Germany, also in the 6-month period (P_Switzerland=.09, P_{United Kingdom}=.46, and P_Germany=.03). In Switzerland, higher numbers of patients’ messages to coaches were associated with higher weight loss (P_{3 months}<.001 and P_{6 months}<.001). Messages from coaches were not significantly associated with weight loss (all P>.05).

CONCLUSIONS: Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design.

PMID:38848556 | DOI:10.2196/45469

JMIR Mhealth Uhealth. 2024 Jun 7;12:e54642. doi: 10.2196/54642.

ABSTRACT

BACKGROUND: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues.

OBJECTIVE: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs.

METHODS: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis.

RESULTS: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7% vs 8.8%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for “ease of task completion” (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), “satisfaction with completion time” (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and “satisfaction with support” (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3% vs 93.3%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps.

CONCLUSIONS: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED.

PMID:38848554 | DOI:10.2196/54642

Clin Exp Dermatol. 2024 Jun 8:llae226. doi: 10.1093/ced/llae226. Online ahead of print.

ABSTRACT

INTRODUCTION: Melasma is a skin pigmentation disorder that lacks consistent treatment success despite various methods used. Tranexamic Acid (TXA) has shown hypopigmentation properties, but whether TXA administration should be combined with standard treatment or not, is still not clarified. We aimed to perform an investigation of oral TXA effectiveness and safety as an adjuvant of Triple Combination Cream (TCC) Therapy in melasma.

METHODS: We searched PubMed, EMBASE and Cochrane Central for studies comparing TCC plus adjuvant TXA to TCC therapy alone in patients with melasma. Outcomes of interest included change from the baseline of Melasma Area Severity Index (MASI) score, recurrence of melasma and adverse events. Statistical analysis was performed using R Studio 4.3.2.

RESULTS: Four trials, involving 480 patients were included. In the pooled analysis, the decrease from baseline in the MASI score (mean difference [MD] -3.10; 95% confidence interval [CI] -5.85 to -0.35) was significantly higher in patients treated with oral tranexamic acid as an adjuvant to TCC compared to TCC alone. Melasma recurrence (RR 0.28; 95% CI 0.16-0.49) was significantly lower in the group treated with TCC and TXA. Regarding erythema (RR 0.63; 95% CI 0.34-1.17) and burning (RR 0.59; 95% CI 0.30-1.17), there was no significant difference.

CONCLUSION: This meta-analysis demonstrated statistically significant benefits of TCC plus TXA combination treatment compared with TCC alone. Furthermore, the results suggest that the addition of TXA to TCC therapy may reduce melasma recurrence.

PMID:38848545 | DOI:10.1093/ced/llae226

WHO South East Asia J Public Health. 2023 Jul 1;12(2):110-115. doi: 10.4103/WHO-SEAJPH.WHO-SEAJPH_177_22. Epub 2024 Jan 19.

ABSTRACT

Periodontal disease is quite common in many developing countries, but no nationally representative data on periodontal disease is available in Myanmar until 2016. A nationwide cross-sectional survey with a stratified two-stage sampling method was conducted among 4668 participants aged 12-74 years. Periodontal assessments and self-administered questionnaire surveys were conducted to assess the periodontal status and risk factors in the Myanmar population using data from the first national oral health survey in 2016-2017. Descriptive statistics and logistic regression analysis were performed to assess the prevalence of periodontitis and its association with potential risk factors. The prevalence of gingivitis was 38.2%, 41.5%, 44.4%, and 43.7% in 12, 15-18, 35-44, and 60-74 year-olds, respectively. The prevalence of periodontitis in the latter three age groups was 2.3%, 16.3%, and 35.2%, respectively. After adjusting for other risk factors, younger participants aged 15-18 years (odds ratio [OR]: 0.1, 95% confidence interval [95% CI]: 0.0-0.2) and aged 35-44 years (OR: 0.4, 95% CI: 0.3-0.5) were less likely to have periodontitis. Moreover, participants educated upto junior high school level (OR: 1.6, 95% CI: 1.1-2.7), primary school and below level (OR: 1.9, 95% CI: 1.2-3.2), everyday smokers (OR: 1.6, 95% CI: 1.3-2.0), and everyday tobacco chewers (OR: 1.5, 95% CI: 1.2-1.8) were associated with increased risk of periodontitis. Periodontal complications were prevalent in Myanmar older adults. Prevention efforts should focus on tobacco control and oral hygiene.

PMID:38848531 | DOI:10.4103/WHO-SEAJPH.WHO-SEAJPH_177_22

WHO South East Asia J Public Health. 2023 Jul 1;12(2):104-109. doi: 10.4103/WHO-SEAJPH.WHO-SEAJPH_113_22. Epub 2024 Jan 19.

ABSTRACT

High prevalence of Vitamin D deficiency has been reported among selective population, but its population prevalence from representative adult population is lacking in India. The aim of this study was to estimate the prevalence and identify the correlates of Vitamin D deficiency among urban and rural areas of the National Capital Region (NCR) of Delhi, India. Serum Vitamin D levels of 1403 adults (aged 30 years above), 702 from urban and 701 from rural NCR of Delhi, who participated in a representative cross-sectional survey were measured using the quantitative chemiluminescent immunoassay method. The prevalence of Vitamin D deficiency was classified as severe deficient, and insufficient at three serum levels of 25-hydroxyvitamin D-<10, 10-<20, and 20-<30 ng/mL, respectively. The median (interquartile range) 25-hydroxyvitamin D levels in urban and rural areas were 7.7 (5.2, 10.8) ng/mL and 16.2 (10.9, 22.3) ng/mL, respectively. The prevalence of Vitamin D severe deficiency, deficiency, and insufficiency in urban areas were 71%, 27%, and 2%, respectively. The corresponding prevalence in rural areas was 20%, 47%, and 25%. Urban location (odds ratio [OR] [95% confidence interval [CI]: 11.7 [8.6, 15.9]), female gender (OR [95% CI]: 1.5 [1.1, 2.2]), and abdominal obesity (OR [95% CI]:1.5 [1.1, 2.0]) were independently associated with severe deficiency. This study revealed a high prevalence of severe vitamin deficiency among the adult living in NCR, more so among urban areas, women, and obese.

PMID:38848530 | DOI:10.4103/WHO-SEAJPH.WHO-SEAJPH_113_22

WHO South East Asia J Public Health. 2023 Jul 1;12(2):93-98. doi: 10.4103/WHO-SEAJPH.WHO-SEAJPH_13_23. Epub 2024 Jan 19.

ABSTRACT

Among all types of health-care workers, nursing professionals are at the highest risk of violence since they have to deal with patients and their families directly and frequently. This study aimed to assess the magnitude of both physical and psychological workplace violence (WPV) among nurses at a public hospital in Myanmar and identify related factors. A cross-sectional study was carried out among 192 nurses with a minimum 1-year of working service at a large tertiary hospital using a standard self-administered questionnaire developed by the World Health Organization/International Labour Organization in 2003. The prevalence of overall WPV in the past 12 months was 29.2%. In particular, verbal abuse was the most frequent type (27.1%), followed by bullying/mobbing (7.8%) and physical violence (1.6%). Majority of perpetrators were patient’s relatives (62.7%) for verbal abuse and staff members (64.3%) for bullying/mobbing. The reporting rate was very low for verbal abuse (13.5%) and bullying/mobbing were not reported. Logistic regression analysis showed that respondents who were older than 45 years’ group (adjusted odds ratio [AOR]: 19.32; 95% confidence interval (CI): 1.99-186.95, P = 0.011), those who were staff nurses (AOR: 17.87; 95% CI: 1.05-33.20, P = 0.046), and those who 1-5 years and 5.1-10 years of working experiences (AOR: 18.68; 95% CI: 3.43-101.65, P = 0.001) (AOR: 15.74; 95% CI: 2.80-88.42, P = 0.002) were more likely to be exposed to WPV than their respective counterparts. Awareness generation about the importance of WPV, enforcing available legal instruments, and establishing management strategies for safe working environments should be emphasized.

PMID:38848528 | DOI:10.4103/WHO-SEAJPH.WHO-SEAJPH_13_23

JCO Precis Oncol. 2024 Jun;8:e2400116. doi: 10.1200/PO.24.00116.

ABSTRACT

In oncology drug development, using biomarkers to select a study population more likely to benefit from a therapeutic effect is critical to increase the efficiency of a clinical trial in demonstrating effectiveness. This perspective delves into therapeutic product approvals that were tested in pivotal trials with all-comers populations, but ultimately received US Food and Drug Administration approval for use within specific patient subgroups identified by biomarkers. Despite initial designs for efficacy and safety assessments in overall populations, a favorable benefit-risk assessment was primarily established in biomarker-positive subgroups. Analyzing these cases, we summarize key considerations pivotal to totality of evidence for regulatory benefit-risk assessments for biomarker-defined subgroup versus all-comers approvals, including biological and clinical rationales, biomarker prevalence, safety data, overall trial design, and subgroup efficacy characterization. Furthermore, a decision tree is proposed to guide optimal clinical trial design, delineating between patient enrichment and stratification, accounting for key factors including biological and clinical rationale, marker type (discreate or continuous), prevalence, assay readiness, and turnaround times for marker assessment. Finally, a recommended approach for subgroup characterization involves prespecifying magnitude of improvement that would be considered clinically meaningful in the biomarker-negative subgroup, which can be supplemented with methodologies such as Bayesian to incorporate evidence from similar studies when available. In summary, this perspective underscores the importance of clinical trial innovations, statistical methodologies and regulatory considerations, to optimize biomarker-driven drug development for patients with cancer.

PMID:38848518 | DOI:10.1200/PO.24.00116

Schizophr Bull. 2024 Jun 7:sbae087. doi: 10.1093/schbul/sbae087. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Schizophrenia (SCZ) and anorexia nervosa (AN) are 2 severe and highly heterogeneous disorders showing substantial familial co-aggregation. Genetic factors play a significant role in both disorders, but the shared genetic etiology between them is yet to be investigated.

STUDY DESIGN: Using summary statistics from recent large genome-wide association studies on SCZ (Ncases = 53 386) and AN (Ncases = 16 992), a 2-sample Mendelian randomization analysis was conducted to explore the causal relationship between SCZ and AN. MiXeR was employed to quantify their polygenic overlap. A conditional/conjunctional false discovery rate (condFDR/conjFDR) framework was adopted to identify loci jointly associated with both disorders. Functional annotation and enrichment analyses were performed on the shared loci.

STUDY RESULTS: We observed a cross-trait genetic enrichment, a suggestive bidirectional causal relationship, and a considerable polygenic overlap (Dice coefficient = 62.2%) between SCZ and AN. The proportion of variants with concordant effect directions among all shared variants was 69.9%. Leveraging overlapping genetic associations, we identified 6 novel loci for AN and 33 novel loci for SCZ at condFDR <0.01. At conjFDR <0.05, we identified 10 loci jointly associated with both disorders, implicating multiple genes highly expressed in the cerebellum and pituitary and involved in synapse organization. Particularly, high expression of the shared genes was observed in the hippocampus in adolescence and orbitofrontal cortex during infancy.

CONCLUSIONS: This study provides novel insights into the relationship between SCZ and AN by revealing a shared genetic component and offers a window into their complex etiology.

PMID:38848516 | DOI:10.1093/schbul/sbae087

Neurology. 2024 Jun 25;102(12):e209454. doi: 10.1212/WNL.0000000000209454. Epub 2024 Jun 7.

ABSTRACT

BACKGROUND AND OBJECTIVES: Home-time is a patient-prioritized stroke outcome that can be derived from administrative data linkages. The effect of faster time-to-treatment with endovascular thrombectomy (EVT) on home-time after acute stroke is unknown.

METHODS: We used the Quality Improvement and Clinical Research registry to identify a cohort of patients who received EVT for acute ischemic stroke between 2015 and 2022 in Alberta, Canada. We calculated days at home in the first 90 days after stroke. We used ordinal regression across 6 ordered categories of home-time to evaluate the association between onset-to-arterial puncture and higher home-time, adjusting for age, sex, rural residence, NIH Stroke Scale, comorbidities, intravenous thrombolysis, and year of treatment. We used restricted cubic splines to assess the nonlinear relationship between continuous variation in time metrics and higher home-time, and also reported the adjusted odds ratios within time categories. We additionally evaluated door-to-puncture and reperfusion times. Finally, we analyzed home-time with zero-inflated models to determine the minutes of earlier treatment required to gain 1 day of home-time.

RESULTS: We had 1,885 individuals in our final analytic sample. There was a nonlinear increase in home-time with faster treatment when EVT was within 4 hours of stroke onset or 2 hours of hospital arrival. There was a higher odds of achieving more days at home when onset-to-puncture time was <2 hours (adjusted odds ratio 2.36, 95% CI 1.77-3.16) and 2 to <4 hours (1.37, 95% CI 1.11-1.71) compared with ≥6 hours, and when door-to-puncture time was <1 hour (aOR 2.25, 95% CI 1.74-2.90), 1 to <1.5 hours (aOR 1.89, 95% CI 1.47-2.41), and 1.5 to <2 hours (1.35, 95% CI 1.04-1.76) compared with ≥2 hours. Results were consistent for reperfusion times. For every hour of faster treatment within 6 hours of stroke onset, there was an estimated increase in home-time of 4.7 days, meaning that approximately 1 day of home-time was gained for each 12.8 minutes of faster treatment.

DISCUSSION: Faster time-to-treatment with EVT for acute stroke was associated with greater home-time, particularly within 4 hours of onset-to-puncture and 2 hours of door-to-puncture time. Within 6 hours of stroke onset, each 13 minutes of faster treatment is associated with a gain of 1 day of home-time.

PMID:38848515 | DOI:10.1212/WNL.0000000000209454

Int J Prosthodont. 2024 Jun 7;0(0):1-22. doi: 10.11607/ijp.8968. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of digital scanning combined with reverse engineering technology in the demonstration of full crown tooth preparation.

METHODS: Thirty-one students were randomly divided into the two groups. The students in the control group carried out traditional demonstration by the use of eye-measurement methods. The students in the experimental group carried out improved demonstration by the use of digital intraoral scan with 3D measurement data. The students in both groups were provided with two resin teeth to conduct full crown tooth preparation on head model dental simulators. The teeth prepared before and after demonstration were scored by Chinese Stomatological Association Group Standards, with a total score of 100 points. Analysis of covariance was performed to comparatively analyze the scores related to the tooth surfaces, and convergence angle between two groups.

RESULTS: Analysis of two prepared teeth (tooth #11 and #16) in two groups showed that there was a statistical significant difference in the mean score between the control group and experimental group (tooth #11, P = 0.0039) (tooth #16, P = 0.0120).The demonstration of the tooth #16 showed that there were statistical significant differences in the scores related to buccolingual surface (P = 0.0205) and proximal surface (P = 0.0023) between the control group and experimental group; There was a statistical significant difference in the score related to the convergence angle of buccolingual surface between the control group and experimental group (P = 0.0265).

CONCLUSION: The digital methods can effectively improve the quality of tooth preparations and has a pedagogical advantage for posterior teeth, which present greater operational challenges.

PMID:38848506 | DOI:10.11607/ijp.8968