Nevin Manimala

Stud Health Technol Inform. 2023 Oct 20;309:199-203. doi: 10.3233/SHTI230778.

ABSTRACT

Health disparities between urban and rural America have been studied extensively, and findings consistently show many inequities. The objective of this study was to evaluate patient experiences and utilization among patients in North Carolina who use telemedicine. A retrospective cohort study was performed to examine the utilization and satisfaction of patients using a virtual care service at a Southeastern Medical Center in the U.S. Of 1974 telemedicine patients, 1366 (79.3%) were female, 1046(60.7%) were between 35-64 years, 913(53%) had insurance coverage. Statistically significant differences between rural and urban patients in how patients rated both their provider (p<0.01) and overall telemedicine experience (p<0.01). Our findings showed high satisfaction scores among both rural and urban communities in using the telemedicine platform with slightly higher scores among rural patients, which shows the need for on-demand telemedicine to increase health access and patient outcomes among rural communities.

PMID:37869842 | DOI:10.3233/SHTI230778

Stud Health Technol Inform. 2023 Oct 20;309:126-130. doi: 10.3233/SHTI230755.

ABSTRACT

The Data Integration Centers (DICs), all part of the German Medical Informatics Initiative (MII), prepare routine care data captured in university hospitals to enable its reuse in clinical research. Tackling this challenging task requires them to maintain multiple data stores, implement the necessary transformation processes, and provide the required terminology services, all while also addressing the use case specific needs researchers might have. An MII wide application of the standardized profiles defined in the IHE QRPH domain might therefore be able to drastically reduce the overhead at any one DIC. The MII DIC reference model built in 3LGM2, a method to describe complex information system architectures, serves as a starting point to evaluate whether such an application is possible. We first extend the IHE modeling capabilities of 3LGM2 to also support the five profiles from the QRPH domain that our experts evaluated as relevant in the MII DIC context. We then expand the DIC reference model by some IHE QRPH actors and transactions, showing that their application could be beneficial in the MII DIC context, provided they surpass their trial status.

PMID:37869821 | DOI:10.3233/SHTI230755

Stud Health Technol Inform. 2023 Oct 20;309:97-98. doi: 10.3233/SHTI230748.

ABSTRACT

In this paper, we describe Neonatal Resuscitation Training Simulator (NRTS), an Android mobile app designed to support medical experts to input, transmit and record data during a High-Fidelity Simulation course for neonatal resuscitation. This mobile app allows one to automatically send all the recorded data from the Neonatal Intensive Care Unit (NICU) of Casale Monferrato Children’s Hospital, (Italy) to a server in the cloud managed by the University of Piemonte Orientale (Italy). The medical instructor can then view statistics on simulation exercises, that may be used during the debriefing phase for the evaluation of multidisciplinary teams involved in the simulation scenarios.

PMID:37869815 | DOI:10.3233/SHTI230748

Stud Health Technol Inform. 2023 Oct 20;309:78-82. doi: 10.3233/SHTI230743.

ABSTRACT

Clinical texts are written with acronyms, abbreviations and medical jargon expressions to save time. This hinders full comprehension not just for medical experts but also laypeople. This paper attempts to disambiguate acronyms with their given context by comparing a web mining approach via the search engine BING and a conversational agent approach using ChatGPT with the aim to see, if these methods can supply a viable resolution for the input acronym. Both approaches are automated via application programming interfaces. Possible term candidates are extracted using natural language processing-oriented functionality. The conversational agent approach surpasses the baseline for web mining without plausibility thresholds in precision, recall and F1-measure, while scoring similarly only in precision for high threshold values.

PMID:37869810 | DOI:10.3233/SHTI230743

Stud Health Technol Inform. 2023 Oct 20;309:38-42. doi: 10.3233/SHTI230735.

ABSTRACT

In multiple publications over 3 decades, most recently in The Book of Why, Judea Pearl has led what he regards as the ‘causal revolution’. His central contention is that, prior to it, no discipline had produced a rigorous ‘scientific’ way of making the causal inferences from observational data necessary for policy and decision making. The concentration on the statistical processing of data, outputting frequencies or probabilities, had proceeded without adequately acknowledging that this statistical processing is operating, not only on a particular set of data, but on a set of causal assumptions about that data, often unarticulated and unanalysed. He argues that the arrival of the directed acyclic graph (DAG), a ‘language of causation’ has enabled this fundamental weakness to be remedied. We outline the DAG approach to the extent necessary to make the key point, captured in this paper’s title regarding DAG’s potential contribution to improved decision or policy making.

PMID:37869802 | DOI:10.3233/SHTI230735

Low Urin Tract Symptoms. 2023 Oct 22. doi: 10.1111/luts.12506. Online ahead of print.

ABSTRACT

OBJECTIVES: Pelvic organ prolapse (POP) causes voiding lower urinary tract symptoms (vLUTS). In the present study, we investigated the association between vLUTS and pelvic organ mobility (POM), including relevant supportive structures, on dynamic magnetic resonance imaging (dMRI).

METHODS: We included 118 patients who had POP of stage II or less before straining and stage III or more when straining during dMRI. The presence of vLUTS and overactive bladder (OAB) was determined by a voiding subscore of the International Prostate Symptom Score (vIPSS) ≥5 and the OAB symptom score, respectively. POM was measured by dMRI before and during straining, and patients with and without vLUTS as well as patients with and without vLUTS and/or OAB were compared. p < .05 was considered to be statistically significant.

RESULTS: According to vIPSS, 42 patients (35.6%) had vLUTS. On dMRI, patients with vLUTS showed a significantly more ventral position and/or movement of the bladder and cervix. Moreover, patients with vLUTS and OAB had significantly more ventral movement of the uterine cervix and a larger strain on imaginary uterosacral and cardinal ligaments than those without these symptoms. In addition, patients with vLUTS and OAB had significantly higher vIPSS than those with vLUTS alone.

CONCLUSIONS: vLUTS may be associated with the proximity of the bladder and cervix to the pubic bone and consequent compression of the urethra by the prolapsed organs. vLUTS with OAB might indicate more advanced lower urinary tract dysfunction than vLUTS alone.

PMID:37866821 | DOI:10.1111/luts.12506

World Neurosurg. 2023 Oct 20:S1878-8750(23)01480-8. doi: 10.1016/j.wneu.2023.10.076. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the efficacy of neuroendoscopic hematoma evacuation (NHE) and burr hole craniotomy (BHC) for treating Septated chronic subdural hematoma (sCSDH) and analyze the technical advantages of NHE in sCSDH treatment by data anylise.

METHODS: This study recruited 77 patients with sCSDH According to the type of operation, the patients were divided into NHE (n = 45) or BHC (n = 32) groups. Clinical data were retrospectively analyzed to evaluate and compare the efficacy of NHE and BHC for treating sCSDH.

RESULTS: NHE demonstrated higher complete hematoma clearance and postoperative midline recovery rates and shorter subdural drainage and postoperative bed rest durations compared with BHC (P < 0.05). The average NHE time (72.27 ± 18.27 min) was longer than that of BHC (54.91 ± 16.04 min) (P < 0.05). The average follow-up period was 30.9 (range, 7-51) months. The results revealed that 1 and 12 cases recurred in the NHE (2.2%) and BHC (18.8%) groups, respectively (P < 0.05). Additionally, a statistically significant difference in the Modified Rankin Scale scores of the two groups was observed 6 months after the operation (P < 0.05). During the follow-up period, neither group demonstrated any obvious operative complications.

CONCLUSION: NHE is more effective than BHC for treating sCSDH and is worth popularizing on a large scale; however, ways to better deal with the outer membrane of hematoma warrant further consideration.

PMID:37866781 | DOI:10.1016/j.wneu.2023.10.076

World Neurosurg. 2023 Oct 20:S1878-8750(23)01472-9. doi: 10.1016/j.wneu.2023.10.070. Online ahead of print.

ABSTRACT

BACKGROUND: Tarlov cysts are known contributors to radiculopathy but are often misdiagnosed and mismanaged due to a paucity of information. This is particularly true of cervical spine Tarlov cysts since most attention has been focused on sacral cysts. In this study we describe our longitudinal experience with patients who underwent surgery for cervical spine Tarlov cysts. We hypothesized that patients undergoing surgical treatment for cervical spine Tarlov cysts would report improvement following surgery.

METHODS: We conducted a prospective study of patients who underwent surgical treatment for cervical Tarlov cysts between 2010 and 2021. The Short-Form 36 (SF-36) survey was administered at preoperative and follow-up visits. Repeated measures analyses were used to assess changes in preoperative to postoperative status.

RESULTS: 37 patients with cervical spine cysts were included in the study, of which follow up data were obtained on 27 with a median follow-up of 1 year. 97.3% of the cohort was female, with an average age of 47.5 ± 10.3 years. Patients reported statistically significant improvement in 2 of the 4 SF-36 physical health domains (physical function, P< 0.001 and bodily pain, P<0.001) and 2 of the 4 mental health domains (vitality/energy, P<0.003 and social functioning, P = 0.007). Patients also reported less interference in work, education, and retirement activities at follow-up (P=0.017).

CONCLUSION: Our longitudinal series consisted of patients with symptomatic cervical spine Tarlov cysts which, to our knowledge, is the largest series described. Significant improvement in SF-36 domains were documented, indicating these patients can be successfully treated surgically.

PMID:37866779 | DOI:10.1016/j.wneu.2023.10.070

Acta Trop. 2023 Oct 20:107044. doi: 10.1016/j.actatropica.2023.107044. Online ahead of print.

ABSTRACT

Anthrax is reported globally with varying disease intensity and seasonality among countries. In Vietnam, anthrax epidemiology and ecology remain understudied. We used historical data of human and livestock anthrax from 2004-2021 in Lai Chau province, to identify spatial clusters of human and livestock anthrax, describe epidemiological characteristics, and compare livestock anthrax vaccine coverage to human and livestock disease incidence. Local Moran’s I (LISA) using spatial Bayes smoothed commune-level cumulative incidence (per 10000) for the study period, epidemiological descriptive statistics, livestock vaccine coverage data, and annual incidence rates (per 10000) at provincial level were used. LISA identified a human anthrax hotspot (high-high) in the southeast which did not overlap spatially with livestock anthrax hotspots in southeastern and northeastern communes. Most human cases were male, aged 15-59 years, handled sick animals, and/or consumed contaminated meat. Almost all cases were reported by grassroot health facilities with a delay of 6.3 days between exposure and case notification to the national surveillance system. 80% of human cases were reported from June-October. The increase in disease incidence occurred shortly after livestock anthrax vaccine coverage decreased. This study informs vaccination strategy and targeted surveillance and control measures in newly identified high-risk areas and seasons of anthrax.

PMID:37866728 | DOI:10.1016/j.actatropica.2023.107044

Ann Vasc Surg. 2023 Oct 20:S0890-5096(23)00694-5. doi: 10.1016/j.avsg.2023.08.037. Online ahead of print.

ABSTRACT

BACKGROUND: Since its introduction, thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of type B aortic dissections (TBAD). However, the proximal aspect of the aortic pathology treated may infringe on the origin of the left subclavian artery or even more proximally. Hence, to ensure durable outcomes, the origin of these vessels needs to be covered, but an extra-anatomical bypass is required to perfuse vital branches, known as aortic arch debranching. This series aims to describe and delineate the disparities of aortic arch debranching during TEVAR for TBAD.

METHODS: A retrospective review and analysis of a multicentre international database was conducted to identify patients with TBAD treated with TEVAR between 2005 to 2021. Data analyzed included patient demographics, disease characteristics, operative characteristics, and postoperative outcomes with follow-up on mortality and reintervention. All statistical analyses were carried out using IBM SPSS 26. Patient survival was calculated using a Kaplan-Meier survival analysis, and a p-value of less than 0.05 was considered statistically significant.

RESULTS: A total of 58 patients were included in the analysis, of which 27 (46.6%) presented with complicated disease and 31 were uncomplicated, of which 10 (17.2%) were classed as high risk and 21 (36.2%) low risk. Zone 2 was the most common proximal landing zone for the stent graft. Left subclavian artery bypass was performed selectively (26%), with one stroke occurring, likely due to embolic reasons. A further 6 underwent more proximal aortic debranching before TEVAR (10%) and was a significant risk factor for mortality and the number of stents deployed. The overall rates of reintervention and mortality were 17.2% (n=10) and 29.3% (n=17).

CONCLUSION: Aortic arch debranching and TEVAR for Type B aortic dissection is associated with significant mortality. Future developments to treat aortic arch pathology could incorporate branched graft devices, eliminating the need for debranching, improving stroke rates, and reducing future reinterventions.

PMID:37866676 | DOI:10.1016/j.avsg.2023.08.037