Nevin Manimala

Technol Health Care. 2023 Nov 9. doi: 10.3233/THC-230380. Online ahead of print.

ABSTRACT

BACKGROUND: The success of assisted pregnancy relies heavily on the effectiveness of the embryo transfer process. Currently, embryo transfer is typically conducted with the assistance of abdominal ultrasound.

OBJECTIVE: The primary aim of this study was to evaluate the influence of targeted nursing interventions on the embryo transfer procedure, its impact on pregnancy outcomes, and the level of patient comfort concerning bladder management throughout the procedure.

METHODS: A total of 247 patients who underwent embryo transfer at the Reproductive Center of Peking University People’s Hospital from December 2019 to August 2020 were included in this study. These patients were categorized into two groups: the control group (n= 124) and the experimental group (n= 123). Within the control group, patients received conventional preoperative education, whereas those within the experimental group were subjected to targeted nursing interventions. Furthermore, patients in the experimental group were furnished with explicit instructions pertaining to the volume and timing of water intake. Multiple factors were assessed in this study, encompassing bladder filling, the quality of uterine imaging, the utilization of assistive devices during the surgical procedure, and pregnancy outcomes. Additionally, a post-operative questionnaire was administered to both groups to gauge their comfort levels regarding urinary retention.

RESULTS: Following the targeted nursing intervention, ultrasound scans indicated an increase in bladder depth (5.91 ± 1.76 vs. 5.40 ± 1.61, P= 0.02), resulting in clearer endometrial imaging (96.74% vs. 88.71%, P= 0.02). Additionally, the experimental group reported significantly higher levels of comfort with urine retention (P= 0.01) compared to the control group, and these differences held statistical significance. Furthermore, the pregnancy rate in the experimental group was greater than that in the control group (52.85% vs. 50.8%, P> 0.05).

CONCLUSION: Based on the premise that pregnancy rates remain unaffected, the implementation of targeted nursing care has the potential to augment bladder filling, enhance the quality of endometrial imaging, reduce the requirement for instrument-assisted embryo transfers, and notably enhance the comfort of patients in relation to urine retention.

PMID:38007682 | DOI:10.3233/THC-230380

J Pediatr Rehabil Med. 2023 Nov 18. doi: 10.3233/PRM-220082. Online ahead of print.

ABSTRACT

PURPOSE: Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine.

METHODS: This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame.

RESULTS: Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: < 0.001-0.003), and referrals (X2 = 132, p < 0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p < 0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015.

CONCLUSION: Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.

PMID:38007679 | DOI:10.3233/PRM-220082

J Neonatal Perinatal Med. 2023 Nov 22. doi: 10.3233/NPM-230050. Online ahead of print.

ABSTRACT

BACKGROUND: Timely communication is essential in attaining maternal satisfaction, developing an excellent physician-patient rapport, and increasing trust. This study reports a significant improvement in maternal communication rates through the quality improvement method.

METHODS: An educational module was developed, and NICU staff was presented with the slides, followed by a performance questionnaire to demonstrate understanding. The first phase was completed by obtaining feedback from mothers through a questionnaire. The first plan-do-study-act (PDSA) cycle, carried out for eight weeks looking at the rates of the maternal update provided within an hour of admission of their neonates to the NICU, was followed by the second PDSA cycle, carried out for ten weeks. The improvement was calculated using conventional statistics and a statistical process control chart.

RESULTS: During the first phase of the study, thirty-six percent of the mothers were updated within an hour of admission of their neonates to the NICU. During the first PDSA cycle, we did not notice a special cause variation or process change. A significant shift, eight consecutive points above the mean, was noted on the control chart during PDSA cycle 2. The mean±SD of the weekly update rate increased significantly during PDSA cycle 2 (76.8±11) compared to PDSA cycle 1 (47.5±14), p-value = 0.0002.

CONCLUSION: We improved the maternal update rates through the educational module following the QI improvement model using the PDSA cycles.

PMID:38007675 | DOI:10.3233/NPM-230050

J Alzheimers Dis. 2023;96(3):1051-1058. doi: 10.3233/JAD-230481.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is a debilitating condition that is widely known to adversely affect gray matter (GM) and white matter (WM) tracts within the brain. Recently, precision medicine has shown promise in alleviating the clinical and gross morphological trajectories of patients with AD. However, regional morphological changes have not yet been adequately characterized.

OBJECTIVE: Investigate regional morphological responses to a precision medicine-guided intervention with regards to white and gray matter in AD and mild cognitive impairment (MCI).

METHODS: Clinical and neuroimaging data were compiled over a 9-month period from 25 individuals who were diagnosed with AD or MCI receiving individualized treatment plans. Structural T1-weighted MRI scans underwent segmentation and volumetric quantifications via Neuroreader. Longitudinal changes were calculated via annualized percent change of WM or GM ratios.

RESULTS: Montreal Cognitive Assessment scores (p < 0.001) and various domains of the Computerized Neurocognitive Screening Vital Signs significantly improved from baseline to 9-month follow-up. There was regional variability in WM and GM atrophy or hypertrophy, but none of these observed changes were statistically significant after correction for multiple comparisons.

PMID:38007669 | DOI:10.3233/JAD-230481

J Alzheimers Dis. 2023 Nov 18. doi: 10.3233/JAD-230632. Online ahead of print.

ABSTRACT

BACKGROUND: Epidemiological studies showed that COVID-19 increases risk of Alzheimer’s disease (AD). However, it remains unknown if there is a potential genetic predispositional effect.

OBJECTIVE: To examine potential effects of genetic susceptibility of COVID-19 on the risk and progression of AD, we performed a non-overlapping 2-sample Mendelian randomization (MR) study using summary statistics from genome-wide association studies (GWAS).

METHODS: Two-sample Mendelian randomization (MR) analysis of over 2.6 million subjects was used to examine whether genetic susceptibility of COVID-19 is not associated with the risk of AD, cortical amyloid burden, hippocampal volume, or AD progression score. Additionally, a validation analysis was performed on a combined sample size of 536,190 participants.

RESULTS: We show that the AD risk was not associated with genetic susceptibility of COVID-19 risk (OR = 0.98, 95% CI 0.81-1.19) and COVID-19 severity (COVID-19 hospitalization: OR = 0.98, 95% CI 0.9-1.07, and critical COVID-19: OR = 0.98, 95% CI 0.92-1.03). Genetic predisposition to COVID-19 is not associated with AD progression as measured by hippocampal volume, cortical amyloid beta load, and AD progression score. These findings were replicated in a set of 536,190 participants. Consistent results were obtained across models based on different GWAS summary statistics, MR estimators and COVID-19 definitions.

CONCLUSIONS: Our findings indicated that the genetic susceptibility of COVID-19 is not associated with the risk and progression of AD.

PMID:38007657 | DOI:10.3233/JAD-230632

J Alzheimers Dis. 2023 Nov 21. doi: 10.3233/JAD-230391. Online ahead of print.

ABSTRACT

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer’s disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD.

OBJECTIVE: We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia.

METHODS: We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (n = 40) that received three times a week one session per day of 20 minutes in the NSC and a control group (n = 37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis.

RESULTS: Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, p = 0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, p = 0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, p = 0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, p = 0.003).

CONCLUSIONS: The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.

PMID:38007648 | DOI:10.3233/JAD-230391

J Alzheimers Dis. 2023 Nov 21. doi: 10.3233/JAD-230352. Online ahead of print.

ABSTRACT

BACKGROUND: The Cogstate Brief Battery (CBB) is a computerized cognitive test battery used commonly to identify cognitive deficits related to Alzheimer’s disease (AD). However, AD and normative samples used to understand the sensitivity of the CBB to AD in the clinic have been limited, as have the outcome measures studied.

OBJECTIVE: This study investigated the sensitivity of CBB outcomes, including potential composite scores, to cognitive impairment in mild cognitive impairment (MCI) and dementia due to AD, in carefully selected samples.

METHODS: Samples consisted of 4,871 cognitively unimpaired adults and 184 adults who met clinical criteria for MCI (Clinical Dementia Rating (CDR) = 0.5) or dementia (CDR > 0.5) due to AD and CBB naive. Speed and accuracy measures from each test were examined, and theoretically- and statistically-derived composites were created. Sensitivity and specificity of classification of cognitive impairment were compared between outcomes.

RESULTS: Individual CBB measures of learning and working memory showed high discriminability for AD-related cognitive impairment for CDR 0.5 (AUCs ∼ 0.79-0.88), and CDR > 0.5 (AUCs ∼ 0.89-0.96) groups. Discrimination ability for theoretically derived CBB composite measures was high, particularly for the Learning and Working Memory (LWM) composite (CDR 0.5 AUC = 0.90, CDR > 0.5 AUC = 0.97). As expected, statistically optimized linear composite measures showed strong discrimination abilities albeit similar to the LWM composite.

CONCLUSIONS: In older adults, the CBB is effective for discriminating cognitive impairment due to MCI or AD-dementia from unimpaired cognition with the LWM composite providing the strongest sensitivity.

PMID:38007647 | DOI:10.3233/JAD-230352

Clin Hemorheol Microcirc. 2023 Nov 24. doi: 10.3233/CH-231999. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the discriminatory diagnostic value of multimodal ultrasound(US) combined with blood cell analysis(BCA) for Granulomatous Lobular Mastitis (GLM) and Invasive Ductal Carcinoma(IDC) of the breast.

METHODS: A total of 157 breast disease patients were collected and divided into two groups based on postoperative pathological results: the GLM group(57 cases with 57 lesions) and the IDC group(100 cases with 100 lesions). Differences in multimodal ultrasound features and the presence of BCA were compared between the two groups. The receiver operating characteristic(ROC) curve was used to calculate the optimal cutoff values, sensitivity, specificity, 95% confidence interval(CI), and the area under the curve(AUC) for patient age, lesion size, lesion resistive index(RI), and white blood cell(WBC) count in BCA. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and AUC were calculated for different diagnostic methods.

RESULTS: There were statistically significant differences(P < 0.05) observed between GIM and IDC patients in terms of age, breast pain, the factors in Conventional US(lesion size, RI, nipple delineation, solitary/multiple lesions, margin, liquefaction area, growth direction, microcalcifications, posterior echogenicity and abnormal axillary lymph nodes), the factors in CEUS(contrast agent enhancement intensity, enhancement pattern, enhancement range, and crab-like enhancement) and the factors in BCA(white blood cells, neutrophils, lymphocytes and monocytes). ROC curve analysis results showed that the optimal cutoff values for distinguishing GLM from IDC were 40.5 years for age, 7.15 cm for lesion size, 0.655 for lesion RI, and 10.525*109/L for white blood cells. The diagnostic accuracy of conventional US combined with CEUS(US-CEUS) was the highest(97.45%). The diagnostic performance AUCs for US-CEUS, CEUS, and US were 0.965, 0.921 and 0.832, respectively.

CONCLUSION: Multifactorial analysis of multimodal ultrasound features and BCA had high clinical application value in the differential diagnosis of GLM and IDC.

PMID:38007642 | DOI:10.3233/CH-231999

Work. 2023 Nov 18. doi: 10.3233/WOR-230179. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous systems for detecting driver drowsiness have been developed; however, these systems have not yet been widely used in real-time.

OBJECTIVE: The purpose of this study was to investigate at the feasibility of detecting alert and drowsy states in drivers using an integration of features from respiratory signals, vehicle lateral position, and reaction time and out-of-vehicle ways of data collection in order to improve the system’s performance and applicability in the real world.

METHODS: Data was collected from 25 healthy volunteers in a driving simulator-based study. Their respiratory activity was recorded using a wearable belt and their reaction time and vehicle lateral position were measured using tests developed on the driving simulator. To induce drowsiness, a monotonous driving environment was used. Different time domain features have been extracted from respiratory signals and combined with the reaction time and lateral position of the vehicle for modeling. The observer of rating drowsiness (ORD) scale was used to label the driver’s actual states. The t-tests and Man-Whitney test was used to select only statistically significant features (p < 0.05), that can differentiate between the alert and drowsy states effectively. Significant features then combined to investigate the improvement in performance using the Multilayer Perceptron (MLP), the Support Vector Machines (SVMs), the Decision Trees (DTs), and the Long Short Term Memory (LSTM) classifiers. The models were implemented in Python library 3.6.

RESULTS: The experimental results illustrate that the support vector machine classifier achieved accuracy of 88%, precision of 85%, recall of 83%, and F1 score of 84% using selected features.

CONCLUSION: These results indicate the possibility of very accurate detection of driver drowsiness and a viable solution for a practical driver drowsiness system based on combined measurement using less-intrusive and out-of-vehicle recording methods.

PMID:38007634 | DOI:10.3233/WOR-230179

J Aging Soc Policy. 2023 Nov 26:1-16. doi: 10.1080/08959420.2023.2284575. Online ahead of print.

ABSTRACT

There is growing recognition that older persons, both male and female, may experience sexual assault. One clearly identified gap in the body of scientific literature is examination of the criminal justice response for older adults who have been sexually assaulted. This retrospective age-group comparative data analysis examines publicly available population and police statistics for 2018 to describe rates (per 100,000) of reported sexual assault across adult age categories (young adult, n = 748; adult, n = 1,478; middle age, n = 290; older adult, n = 58) and compare (using Chi-square bivariate analysis) the criminal justice response to sexual assault for these adult age categories in New Zealand (NZ). Sexual assault was perpetrated against victims across all age and sex groups examined. The rate of reported sexual assault against older adults was significantly lower after the age of 65 years (7.90 per 100,000) compared to younger adults aged 20-64 years (87.57 per 100,000). Across age categories no difference was found in the proportion of cases proceeded to court action. This study raises awareness of the topic of sexual assault perpetrated against older persons and shows that a substantial number of older adults experience sexual assault in cases that do not result in court action. It points to the need for policy-makers to consider the reporting of sexual assaults against older persons to justice services.

PMID:38007620 | DOI:10.1080/08959420.2023.2284575