Nevin Manimala

J Ultrasound Med. 2024 Jan 8. doi: 10.1002/jum.16395. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the added diagnostic value of contrast-enhanced ultrasound (CEUS) in pediatric chest abnormalities by comparing interpretation of CEUS studies and confidence level to conventional US studies.

METHODS: CEUS studies in patients with a variety of clinically suspected chest abnormalities performed between 2016 and 2020 were reviewed and compared to same-day conventional US studies. Examinations were independently interpreted by 4 radiologists blinded to clinical and other imaging data. Rater confidence was classified as low, moderate, or high. Diagnostic accuracy was determined by comparing image interpretation to patient outcome as the ground truth. Interobserver agreement was also assessed.

RESULTS: Sixteen patients (10 male) with 18 CEUS studies were included. Median rater agreement with ground truth was significantly higher for CEUS (100%) than conventional US (50%; P = .004). Median rater confidence was high (3.0) for CEUS, and low-moderate (1.5) for conventional US (P < .001). CEUS sensitivity (54.6-81.8%) and specificity (63.4-100.0%) were greater than conventional US (45.5-72.7% and 12.5-63.5%, respectively). CEUS false positives (0-4) and false negatives (2-5) were fewer than conventional US (4-7 and 3-6, respectively). Except for one rater pair where agreement was substantial (κ = .78, P < .01), inter-rater agreement for CEUS for all other rater pairs was nonsignificant (κ = .25-0.51, P ≥ .07). Agreement for conventional US was moderate and statistically significant for 3 rater pairs (κ = .55-0.78) and nonsignificant for the remaining 3 rater pairs (P ≥ .06).

CONCLUSIONS: CEUS adds diagnostic value to the assessment of a variety of chest abnormalities. The data support further evaluation of the role of CEUS as a non-invasive, problem-solving technique in children.

PMID:38189176 | DOI:10.1002/jum.16395

Int J Gynaecol Obstet. 2024 Jan 8. doi: 10.1002/ijgo.15339. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to evaluate the outcomes of placenta accreta spectrum (PAS) disorder managed by a multidisciplinary care team (MCT) compared with a conventional care team (CCT) in a PAS referral center in Thailand.

METHODS: This retrospective single-center cohort study analyzed PAS management outcomes in the PSU PAS Center between January 2010 and December 2022. The incidence of hemorrhage ≥3500 mL and the composite maternal and neonatal outcomes of PAS were compared before and after the introduction of an MCT in 2016.

RESULTS: Of 227 PAS cases, 219 (96.5%) had pathological confirmation. There were 52 (22.9%) cases of placenta accreta, 119 (52.4%) cases of placenta increta, and 56 (24.7%) cases of placenta percreta. The incidence of estimated blood loss (EBL) ≥3500 mL decreased from 61.8% to 34.3% (P < 0.001) after the establishment of the MCT. The median EBL decreased from 4000 (IQR: 2600,7250) mL to 2250 (1300, 4750) mL (P < 0.001). EBL reduction was statistically significant in the accreta and increta groups (P < 0.001). Red blood cell transfusions decreased from five (3, 9) to two (1, 6) units (P < 0.001) per patient. The length of maternal hospital stays and ICU admissions were statistically shorter when PAS was managed by an MCT (P < 0.001). The length of newborn hospital and ICU stays decreased significantly (P < 0.001).

CONCLUSION: The incidence of massive postpartum hemorrhage and a composite of maternal and neonatal morbidities in pregnant women with PAS disorder improved significantly after the establishment of an MCT to manage PAS in a middle-income country setting.

PMID:38189162 | DOI:10.1002/ijgo.15339

Scand J Caring Sci. 2024 Jan 8. doi: 10.1111/scs.13232. Online ahead of print.

ABSTRACT

BACKGROUND: Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses’ perspectives in a Danish context has yet to be assessed.

AIM: The aim of this descriptive qualitative study was to explore frontline nurses’ experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID-19 pandemic.

METHODS: An online questionnaire, including open-ended questions, was developed. Data were analysed using descriptive statistics and content analysis.

FINDINGS: 116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision-making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care.

CONCLUSION: Restricting relatives’ access challenged the nurses’ professional values, and it seems to have affirmed their appreciation of relatives’ role as important partners in contemporary hospital-based health care.

PMID:38189138 | DOI:10.1111/scs.13232

Circ Cardiovasc Qual Outcomes. 2024 Jan 8:e007803. doi: 10.1161/CIRCOUTCOMES.120.007803. Online ahead of print.

ABSTRACT

BACKGROUND: Propensity score methods are used in observational studies to compensate for the lack of random allocation by balancing measured baseline characteristics between treated and untreated patients. We sought to explain the treatment effect estimates derived from different propensity score methods.

METHODS: We performed a retrospective analysis of long-term mortality after single internal mammary artery versus bilateral internal mammary artery (BIMA) conduit in 47 984 index isolated coronary artery bypass grafting procedures from 1992 to 2014 in the Northern New England Cardiovascular Disease Study Group registry using multivariable Cox regression, 1:1 propensity score matching, inverse probability weighting (IPW) among the treated, and IPW among the overall population treatment estimates.

RESULTS: The mean duration of follow-up was 13.2 (interquartile range, 7.4-17.7) years. In multivariable Cox regression, the adjusted hazard ratio for mortality was 0.83 (95% CI, 0.75-0.92) in patients receiving BIMA compared with a single internal mammary artery. The 1:1 propensity matched (hazard ratio, 0.79 [95% CI, 0.69-0.91]) and IPW among the treated (hazard ratio, 0.83 [95% CI, 0.75-0.92]) estimates showed a protective treatment effect of BIMA use on mortality. However, the IPW estimate of treatment effect for the overall population showed an increased risk of mortality after BIMA that was not statistically significant (hazard ratio, 1.08 [95% CI, 0.94-1.24]).

CONCLUSIONS: While the multivariable Cox regression, 1:1 propensity matching, and IPW treatment effect in the treated estimates demonstrate that BIMA was associated with a statistically significantly decreased risk of mortality, the IPW treatment effect in the average study population showed an increased risk of mortality associated with BIMA that was not statistically significant. This is attributed to the different populations (weighted to look like the overall study population versus treated group) represented by the 2 IPW approaches. Determining how the study population is balanced is a large driver of the treatment effect. Ultimately, the treatment effect estimate desired should drive the choice of the propensity score method.

PMID:38189126 | DOI:10.1161/CIRCOUTCOMES.120.007803

Int J Lang Commun Disord. 2024 Jan 8. doi: 10.1111/1460-6984.13002. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence supports the effectiveness of shared book reading for promoting language and literacy development, but it is known that families experiencing vulnerability may have reduced access to books and are less likely to share books regularly at home. Community hubs often provide support to families experiencing vulnerability and may provide an opportunity to create environments that support families to engage in shared book reading, especially if families are invited into the creation of these environments through co-design. However, there is currently little evidence regarding the impact of co-designing shared book reading environments with families in community settings.

AIMS: The current study is part of a broader project which used co-design to develop a shared book reading environment in collaboration with stakeholders in a community hub. This small-scale study aimed to provide a preliminary evaluation of the impact of this co-designed shared book reading environment at the community hub on (1) the frequency of shared book reading at the hub; (2) participants’ confidence and enjoyment of reading with children at the hub; and (3) participants’ experiences of shared book reading at the hub.

METHOD & PROCEDURES: The co-design project was carried out in four phases with families, staff and community partners at the community hub. A convergent mixed-methods approach was used to collect and analyse quantitative and qualitative data in the first and last phase of the project to evaluate project outcomes. Quantitative data (environmental observations of reading at the hub and participant ratings of confidence and enjoyment of reading with children at the hub) were analysed using descriptive statistics and nonparametric statistical tests. Qualitative data (participants’ responses regarding their experiences of changes implemented in the community hub) were analysed using inductive content analysis.

OUTCOME & RESULTS: An increased frequency of shared book reading was observed within the community hub after changes were implemented, and positive changes in enjoyment of book reading were recorded. Qualitative responses from participants following conclusion of the project were organised into three main categories, which showed that (1) children and families were reading more and enjoying reading activities that were happening; (2) children and families were borrowing more books; and (3) families had changed the way they were reading at home with their children.

CONCLUSIONS & IMPLICATIONS: A co-designed shared book reading environment within a community hub had a positive impact on shared book reading experiences for families in areas with high levels of vulnerability.

WHAT THIS PAPER ADDS: What is already known on this subject Community hubs provide a unique opportunity to support early language and literacy development in partnership with families in areas of vulnerability; however, there is limited literature investigating the impacts of these supports. A previous study utilised co-design to develop a shared book reading environment with stakeholders at a community hub in an area where a high proportion of children are considered to be ‘vulnerable’ in terms of language and literacy development. It was found that co-design enabled the development of collaborative changes to support shared book reading that were valued and owned by families, staff and community partners at the community hub. What this study adds The current study focused on evaluating the impact of a co-design project on the frequency of shared book reading at the hub and participants’ experiences, confidence and enjoyment of reading with children at the hub. Analysis of pre- and post-data provide preliminary evidence that a co-designed shared book reading environment in a community hub can have a positive impact on increasing families’ awareness and engagement with book borrowing, engagement in shared book reading activities in the community and at home, and participants’ confidence and enjoyment of reading with children. What are the clinical implications of this work? Speech pathologists have an important role to play in prevention and promotion. This study has shown that collaboration with families experiencing vulnerability can support the implementation of strategies to promote shared reading in a community hub and demonstrate increased quality and frequency of shared book reading. The utilisation of a community hub also highlights the opportunities for the speech pathology profession to deliver community-based promotion and prevention initiatives as a strategy to address equitable language outcomes.

PMID:38189112 | DOI:10.1111/1460-6984.13002

Int J Gynaecol Obstet. 2024 Jan 8. doi: 10.1002/ijgo.15344. Online ahead of print.

ABSTRACT

OBJECTIVE: Duplex kidney is a relatively frequent form of urinary system abnormality. This study aimed to elucidate the value of chromosomal microarray analysis (CMA) and whole exome sequencing (WES) for duplex kidney and the perinatal outcomes of duplex kidney fetuses.

METHODS: This retrospective cohort study included 63 patients with duplex kidney diagnosed using antenatal ultrasound between August 2013 and January 2023. We reviewed the clinical characteristics, genetic test results, and pregnancy outcomes of the patients.

RESULTS: Among the 63 cases based on the inclusion criteria, the CMA detected seven (11.1%) clinically significant variants and nine variants of uncertain significance (VUS), and the pathogenic/likely pathogenic (P/LP) copy number variations (CNVs) in the recurrent region that were associated with prenatal duplex kidney included 17q12, 17p13.3, and 22q11.2. No significant disparity was observed in the CMA detection rate between the unilateral and bilateral groups, or between the isolated and non-isolated groups. WES identified three (50%) P/LP single-gene variants in six fetuses with duplex kidney. We detected the following pathogenic genes in the duplex kidney fetuses: KMT2D, SMPD4, and FANCI. Pregnancy termination in cases where clinically significant variants were detected by genetic testing was different in statistical significance from that in cases with negative results (9/10, 90.0% vs 8/48, 16.7%, P < 0.001).

CONCLUSION: This study elucidated the value of CMA and WES for fetal duplex kidney, proving that CMA and WES may be useful tools in prenatal diagnosis and genetic counseling.

PMID:38189110 | DOI:10.1002/ijgo.15344

Expert Rev Pharmacoecon Outcomes Res. 2024 Jan 8. doi: 10.1080/14737167.2024.2302423. Online ahead of print.

ABSTRACT

OBJECTIVE: The burden of diabetes on individuals, healthcare systems, and society must be explored to improve and sustain diabetes care. With this aim, we estimated both past and future diabetes-related direct health expenditures in Slovenia.

METHODS: Analysis of expenditures from the healthcare payer perspective during the 2019-2022 period was based on individual patient data on expenditures for seven groups of diabetes-related medical conditions from the population-level database of the Health Insurance Institute of Slovenia. Expenditure projections were prepared using the European Commission’s methodology for budgetary projections.

RESULTS: In the 2019-2022 period, average annual diabetes-related expenditures equaled €174.1 million (€1,108 per patient), with their average annual growth rate reaching 12.5%. Expenditures due to inpatient care (33%) and drugs used in diabetes (24%) had the highest shares. More than half of the expenditures were due to complications of diabetes. The diabetes-related expenditures as a share of GDP are projected to increase by 19.2% from 2019 to 2030, with slower yet continued growth up to 2050.

CONCLUSIONS: Diabetes-related expenditures in Slovenia continue to rise. By focusing on the prevention and optimal management of diabetes, its impact on the healthcare system could be reduced significantly, given the magnitude of expenditures attributed to complications.

PMID:38189093 | DOI:10.1080/14737167.2024.2302423

Ren Fail. 2024 Dec;46(1):2300302. doi: 10.1080/0886022X.2023.2300302. Epub 2024 Jan 8.

ABSTRACT

BACKGROUND: To evaluate the efficacy, effectiveness and safety of fermented Ophiocordyceps sinensis mycelium (FOSM) products for preventing contrast-associated acute kidney injury (CA-AKI).

METHODS: Randomized controlled trials were searched from four Chinese and four English electronic databases and three clinical trial registries up to July 2023. Methodological quality was assessed by using the Cochrane risk-of-bias tool 2.0. Risk difference (RD) or risk ratio (RR) and mean difference (MD) were calculated along with the 95% confidence intervals (CIs).

RESULTS: Fourteen trials testing three types of FOSM products (Bailing, Zhiling, and Jinshuibao capsules) involving 1271 participants injected contrast agents were included. For the risk of bias, all trials were rated as some concerns. Compared with routine preventive procedure (RPP) (saline hydration and alprostadil), FOSM products plus RPP showed beneficial effects in reducing the incidence of CA-AKI (14.62% and 5.35%, respectively; RD -0.06, 95% CI -0.09 to -0.03). Subgroup analysis showed that Bailing/Jinshuibao plus RPP demonstrated lower incidence of CA-AKI compared to RPP. However, there was no statistically significant difference between Zhiling with RPP and RPP in the incidence of CA-AKI. Additionally, only when FOSM products were taken before injection of the contrast, it was superior to RPP in reducing the incidence of CA-AKI. There was no statistical difference in adverse events between these two groups.

CONCLUSIONS: Low certainty evidence suggests that preventive oral use of FOSM products as an adjuvant agent was safe and might decrease the incidence of CA-AKI. However, high-quality placebo-controlled trials are needed to confirm its benefit.

PMID:38189088 | DOI:10.1080/0886022X.2023.2300302

Expert Rev Pharmacoecon Outcomes Res. 2024 Jan 8. doi: 10.1080/14737167.2024.2302431. Online ahead of print.

ABSTRACT

INTRODUCTION: An avalanche of early stage cancer clinical trials is coming. The majority of these solely use surrogate outcomes that have not been validated against a target outcome of interest (e.g. overall survival). Current HTA guidance on surrogate outcome validation are not methodologically or practically conducive to this scenario.

AREAS COVERED: We provide a high-level overview of methods, approaches and conceptual thinking for making better use of limited evidence within early stage cancer HTA submissions. We outline regulatory and HTA issues and emphasize how evidence transitions from one to another, what major gaps currently exist, and how these may be bridged. We summarize current methodologies and practices, their pros and cons. We outline how complementary measurements strengthen evaluations and address fallacies and biases of conventional statistical methods for surrogate outcomes validation. The value of real-world data to support some of the necessary validity components is discussed. Lastly, we address the importance of the patient voice for better understanding which surrogate outcomes may appropriately inform HTA.

EXPERT OPINION: Conventional surrogate outcome validation represents a fraught and sub-optimal framework for HTA purposes, particularly for early stage cancer. Tools for optimizing use of limited evidence exist. Education of stakeholders is highly needed.

PMID:38189086 | DOI:10.1080/14737167.2024.2302431

Eur J Midwifery. 2024 Jan 5;8. doi: 10.18332/ejm/174478. eCollection 2024.

ABSTRACT

INTRODUCTION: Family planning is a right and a tool that offers the possibility of choosing how many children to have. Its importance lies in the possibility of avoiding an unwanted pregnancy and its consequences. Our objective was to determine the factors associated with discontinuing hormonal contraceptives in women of childbearing age who attended the La Libertad Health Center in January 2023.

METHODS: The study was observational, analytical, and cross-sectional. A total of 100 women of childbearing age who were users of hormonal contraceptives were included. Descriptive statistics were performed, frequency measurements and measures of central tendency were calculated, bivariate statistics were performed and the prevalence ratio (PR) was calculated, and a robust Poisson regression model was performed to assess the associated independent factors. All calculations were made with a confidence level of 95%.

RESULTS: The educational level (PR=1.74; 95% CI: 1.22-2.48, p=0.006), the distance to the health center (PR=7.32; 95% CI: 1.1-48.5, p=0.001), having presented adverse events (PR=26.38; 95% CI: 3.8-183, p=0.001), and that the health staff had not identified the need for contraception (PR=3.12; 95% CI: 0.87-11.10, p=0.01) were associated with stopping a hormonal contraceptive. After introducing the variables to the regression model, the only independently associated factor was having presented an adverse event with the use of hormonal contraceptives (adjusted prevalence ratio, APR=3.33; 95% CI: 2.1-5.2, p<0.001).

CONCLUSIONS: In this population, the factors associated with the discontinuation of hormonal contraceptives were education level, distance to the health center, having presented some adverse event with its use, and that health staff had not identified the need for contraception. The only independently associated factor was having presented an adverse event.

PMID:38189079 | PMC:PMC10767759 | DOI:10.18332/ejm/174478