Nevin Manimala

J Neurol Surg B Skull Base. 2022 Sep 13;84(5):463-469. doi: 10.1055/a-1885-1111. eCollection 2023 Oct.

ABSTRACT

Objectives Informed consent is fundamental to good practice. We hypothesized that a personalized three-dimensional (3D)-printed model of skull base pathology would enhance informed consent and reduce patient anxiety. Design Digital images and communication in medicine (DICOM) files were 3D printed. After a standard pre-surgery consent clinic, patients completed part one of a two-part structured questionnaire. They then interacted with their personalized 3D printed model and completed part two. This explored their perceived involvement in decision-making, anxiety, concerns and also their understanding of lesion location and surgical risks. Descriptive statistics were used to report responses and text classification tools were used to analyze free text responses. Setting and Participants In total,14 patients undergoing elective skull base surgery (with pathologies including skull base meningioma, craniopharyngioma, pituitary adenoma, Rathke cleft cyst, and olfactory neuroblastoma) were prospectively identified at a single unit. Results After 3D model exposure, there was a net trend toward reduced patient-reported anxiety and enhanced patient-perceived involvement in treatment. Thirteen of 14 patients (93%) felt better about their operation and 13/14 patients (93%) thought all patients should have access to personalized 3D models. After exposure, there was a net trend toward improved patient-reported understanding of surgical risks, lesion location, and extent of feeling informed. Thirteen of 14 patients (93%) felt the model helped them understand the surgical anatomy better. Analysis of free text responses to the model found mixed sentiment: 47% positive, 35% neutral, and 18% negative. Conclusion In the context of skull base neurosurgery, personalized 3D-printed models of skull base pathology can inform the surgical consent process, impacting the levels of patient understanding and anxiety.

PMID:37671293 | PMC:PMC10477011 | DOI:10.1055/a-1885-1111

J Eur Acad Dermatol Venereol. 2023 Sep 5. doi: 10.1111/jdv.19491. Online ahead of print.

ABSTRACT

BACKGROUND: In vivo reflectance confocal microscopy (RCM) enables the study of architectural and cytological aspects in horizontal sections, which closely correlate with histologic features. However, traditional histopathological vertical sections cannot totally reproduce the image of in vivo RCM horizontal section.

OBJECTIVE: To evaluate the concordance between in vivo RCM and histopathologic transverse sections for melanocytic lesions, basal cell carcinoma, and seborrheic keratoses.

METHODS: Prospectively collected benign melanocytic and non-melanocytic tumours diagnosed by dermoscopy were evaluated for common RCM features and compared to histopathology in horizontal sections with haematoxylin and eosin staining.

RESULTS: A total of 44 skin tumours including 19 melanocytic lesions (9 compound, 5 junctional and 5 intradermal nevi), 12 basal cell carcinomas and 13 seborrheic keratoses were collected in the Department of Dermatology of Hospital Clinic of Barcelona. The RCM features that had statistically significant agreement with the histopathological horizontal sections were the preserved and visible honeycomb pattern, well-defined DEJ, small bright particles, dermal nests, tumour islands and dark silhouettes, clefting, collagen bundles, thickened collagen bundles and cytologic atypia.

CONCLUSIONS: Histopathology evaluation of horizontal sections of skin tumours can be correlated with main RCM findings. The results of this study have improved the understanding and interpretation of RCM features in relation to skin tumours, thus reinforcing the utility of RCM as a diagnostic tool.

PMID:37669864 | DOI:10.1111/jdv.19491

J Eur Acad Dermatol Venereol. 2023 Sep 5. doi: 10.1111/jdv.19494. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited data about the clinical meaningfulness of the Scoring of Atopic Dermatitis (SCORAD) and Patient-Oriented SCORAD (PO-SCORAD), particularly in children with mild-to-moderate AD. Regular use of patient-reported outcomes, may deliver more accurate information about the overall health status of AD patients than routine but sparse physician assessments.

OBJECTIVE: To confirm the correlation between SCORAD, PO-SCORAD, Patient-Oriented Eczema Measure (POEM) and Investigator’s Global Assessment (IGA). To evaluate the interpretability and clinical usefulness of the SCORAD and PO-SCORAD scores in children.

METHODS: Data were drawn from a 12-week randomized controlled trial in 335 children, aged 2-6 years, with mainly mild-to-moderate AD. Investigators captured SCORAD and IGA at each study visit. Parents used PO-SCORAD twice-weekly, and POEM once-weekly.

RESULTS: There were strong correlations between PO-SCORAD and SCORAD (r=0.874), PO-SCORAD and POEM (0.734), and PO-SCORAD and IGA (0.613). The best fit (‘k’ statistic: 0.68) between SCORAD and IGA classes was noted for the following SCORAD categories: <12 (clear/almost clear); 12-25 (mild); and ≥25 (moderate/severe). PO-SCORAD area under the curve over 8 weeks was significantly greater than that of SCORAD (P=0.0002), giving a better estimate of disease severity between visits. Patients with a flare within the next 7 days had significantly higher PO-SCORAD scores 7 days before the flare (P<0.0001). Moderate erythema was the most significant flare predictor (P<0.0001).

CONCLUSION: PO-SCORAD is robust and reliable and appears to warrant far greater utility in routine clinical practice than other scores. PO-SCORAD, used twice-weekly, may improve the management of patients with AD.

PMID:37669855 | DOI:10.1111/jdv.19494

Tob Control. 2023 Sep 5:tc-2023-058003. doi: 10.1136/tc-2023-058003. Online ahead of print.

ABSTRACT

BACKGROUND: Tobacco remains the leading cause of preventable death globally. Vietnam’s 2012 Law on Prevention and Control of Tobacco Harms establishes all healthcare facilities as smoke-free environments. We aimed to evaluate the implementation of these policies within health facilities across Vietnam.

METHODS: A cross-sectional study was undertaken at 40 central, provincial, district and commune healthcare facilities in four provinces of Vietnam. The presence of tobacco sales, smoke-free signage, evidence of recent tobacco use and smoking behaviours by patients and staff were observed over a 1-week period at multiple locations within each facility. Adherence with national regulations was reported using descriptive statistics.

RESULTS: 23 out of 40 facilities (57.5%) followed the requirements of the national smoke-free policy regarding tobacco sales, advertising and signage. Smoking was observed within health facility grounds at 26 (65%) facilities during the observation period. Indirect evidence of smoking was observed at 35 (88%) facilities. Sites where smoking was permitted (n=2) were more likely to have observed smoking behaviour (relative risk (RR) 2.16, 95% CI 1.83 to 2.56). Facilities where tobacco was sold (n=7) were more likely to have smoking behaviour observed at any of their sites (RR 1.53, 95% CI 0.93 to 2.51).

CONCLUSIONS: Implementation of current smoke-free hospital regulations remains incomplete, with widespread evidence of smoking observed at three levels of the Vietnamese healthcare facilities. Further interventions are required to establish the reputation of Vietnamese healthcare facilities as smoke-free environments.

PMID:37669854 | DOI:10.1136/tc-2023-058003

BMJ Open. 2023 Sep 5;13(9):e068441. doi: 10.1136/bmjopen-2022-068441.

ABSTRACT

OBJECTIVE: To assess the uptake of human papillomavirus (HPV) vaccination and its associated factors among adolescents in Gambella town, Southwest Ethiopia.

DESIGN: A community-based cross-sectional study.

SETTING: Gambella town, Southwest Ethiopia.

PARTICIPANTS: A total of 882 adolescents were included between May and July 2022.

OUTCOME: Uptake of HPV vaccination.

METHODS: A cluster sampling technique was used to select study participants. An interviewer-administered and pretested questionnaire was used to collect the data. The collected data were entered into Epi-data V.4.6 and exported to STATA V.16 for cleaning, coding and analysis. A binary logistic regression model was used to test the association between independent and dependent variables. Variables with a p<0.05 in the multivariable logistic regression were considered statistically significant factors for the uptake of HPV vaccination.

RESULTS: A total of 825 adolescents participated in this study. Among participants, 48% (95% CI 44.6% to 51.4%) have been vaccinated for HPV. Ever heard of the HPV vaccine (AOR 2.5, 95% CI 1.23 to 5.08), good knowledge of HPV infection (AOR 3.62, 95% CI 2.17 to 6.02), good knowledge of the HPV vaccine (AOR 5.54, 95% CI 3.28 to 9.36) and attitude towards the HPV vaccine (AOR 2.74, 95% CI 1.88 to 3.98) were significantly associated HPV vaccination.

CONCLUSION: In the current study, the uptake of HPV vaccination was found to be low. The finding highlights the importance of promoting community health education about HPV infection and vaccines and providing behaviour change education, which plays a substantial role in promoting the uptake of HPV vaccination.

PMID:37669848 | DOI:10.1136/bmjopen-2022-068441

BMJ Open. 2023 Sep 5;13(9):e073049. doi: 10.1136/bmjopen-2023-073049.

ABSTRACT

INTRODUCTION: Medical patients, admitted acutely to hospital, are at risk of venous thromboembolism (VTE). Clinical guidelines advise thromboprophylaxis prophylaxis for those at high risk of VTE. VTE is a common sequela of cancer, but guidelines take little consideration of cancer as an independent risk factor and their utility in palliative care patients is unclear. The hospice inpatient deep vein thrombosis (DVT) detection study (HIDDen) reported a 28% prevalence of asymptomatic iliofemoral DVT in hospice patients of poor performance status (PS) and prognosis, calling into question the utility of thromboprophylaxis in the palliative care setting. However, the majority of cancer inpatients receiving palliative care are admitted to hospital through the acute medical setting, yet their risk factors for VTE may differ from those admitted to hospices.

OBJECTIVE: To better understand the prevalence and behaviours of VTE in patients with cancer receiving palliative care who are admitted as an acute medical emergency.

DESIGN: Multicentre, observational cohort study.

SETTING: Secondary care acute hospitals in South Wales, UK.

PATIENTS: We plan to recruit 232 patients≥18 years old with a diagnosis of incurable cancer, and/or receiving palliative or best supportive care who are admitted acutely to hospital. Patients will be followed up for a maximum of 6 months following registration.

PRIMARY OUTCOME: Presence of lower extremity DVT.

SECONDARY OUTCOMES: Symptom burden attributed to DVT or pulmonary embolism, patient PS, patient demographics and development of new VTE within 90 days of registration.

ANALYSIS: The study statistical analysis plan will document analysis, methodology and procedures.

ETHICS AND DISSEMINATION: Ethical approval was obtained from the Wales Research Ethics Committee, reference 22/WA/0037 (IRAS 306352)-the main trial results will be analysed as soon as practically possible and the publication shared with investigators and on sponsor website; applications to access trial data will be subject to sponsor review process.

PMID:37669841 | DOI:10.1136/bmjopen-2023-073049

Int J Gynecol Cancer. 2023 Sep 5:ijgc-2023-004658. doi: 10.1136/ijgc-2023-004658. Online ahead of print.

ABSTRACT

OBJECTIVE: Cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review was to assess the rate of complications associated with HIPEC in epithelial ovarian cancer surgery over two time periods.

METHODS: This study was registered in PROSPERO (CRD42022328928). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Ovid/Medline, Ovid/Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 2004 to April 2022. We included studies reporting on patients with advanced primary or recurrent epithelial ovarian cancer who underwent cytoreductive surgery and HIPEC. We evaluated two different time periods: 2004-2013 and 2014-2022. A random-effects meta-analysis was used to produce an overall summary. Subgroup analyses were planned according to recruited period for each specific complication type. Heterogeneity was assessed using the I² statistic.

RESULTS: A total of 4928 patients were included from 69 studies for this systematic review; 19 published from 2004-2013, and 50 published from 2014-2022. No significant differences were found between the two time periods in terms of blood transfusions (33% vs 51%; p=0.46; I²=95%) overall gastrointestinal complications (15% vs 21%; p=0.36; I²=98%), infectious diseases (16% vs 13%; p=0.62; I²=93%), overall respiratory complications (12% vs 12%; p=0.88; I²=91%), overall urinary complications (6% vs 12%; p=0.06; I²=94%), or thromboembolic events (5% vs 3%; p=0.25; I²=63%). Also, no differences were found in intensive care unit (ICU) admissions (89% vs 28%; p=0.06; I²=99%), reoperations (8% vs 7%; p=0.50; I²=37%), or deaths (3% vs 3%; p=0.77; I²=57%).

CONCLUSIONS: Our review showed that overall complications have not changed over time for patients undergoing HIPEC in the setting of primary or recurrent ovarian cancer. There was no decrease in the rates of ICU admissions, reoperations, or deaths.

PMID:37669829 | DOI:10.1136/ijgc-2023-004658

J Nucl Med Technol. 2023 Sep;51(3):196-203. doi: 10.2967/jnmt.123.265808.

ABSTRACT

The Nuclear Medicine Technology Certification Board performed an impact survey on the coronavirus disease 2019 pandemic to better assess the current state of nuclear medicine practice within the United States, as well as the perceptions and experiences of technologists working during the pandemic. Methods: A web-based automation platform was used to create, collect, and analyze the survey data. Results: The survey revealed many department protocol variations during the pandemic, a decrease in patient volume, and several other concerns and issues. Experiences regarding staffing and wage changes were varied. Conclusion: This research showed significant inconsistencies in practice and stresses to nuclear medicine technology during the pandemic, as well as concerns for the workforce pipeline. NMTCB decided to delay the JTA process and conduct additional research regarding the workforce.

PMID:37669814 | DOI:10.2967/jnmt.123.265808

Can J Ophthalmol. 2023 Sep 2:S0008-4182(23)00251-X. doi: 10.1016/j.jcjo.2023.08.005. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this research is to report on real-world anti-vascular endothelial growth factor (anti-VEGF) treatment patterns in retinal vein occlusions (RVO).

DESIGN: Retrospective cohort study.

PARTICIPANTS: Treatment-naive RVO patients initiating anti-VEGF injections between 2015 and 2021.

METHODS: Medical records available until June 2022 were reviewed. Demographics, diagnosis, number of injections, treatment length, reason for discontinuation, and baseline and final data (e.g., date, age, best-corrected visual acuity [BCVA], and central subfield thickness) were recorded. Statistical analyses performed with STATA 17.0 assessed differences between baseline and final values, branch (BRVO) and central retinal vein occlusion (CRVO), and treatment-discontinuation subgroups.

RESULTS: A total of 219 treatment-naive eyes were included (70.3 ± 13.2 years of age, 52.5% female), with 99 BRVOs and 120 CRVOs (2482 injections). The discontinuation rate was 76.7% (168 of 219), with 72.7% of patients (77 of 99) with BRVOs and 75.8% of patients (91 of 120) with CRVOs discontinuing injections. Reasons for discontinuation included stable off active therapy (98 eyes), severe comorbidity or death (17 eyes), switched to intraocular steroid (implant or injection) (12 eyes), lack of visual benefit (10 eyes), ocular comorbidity (5 eyes), patient decision (5 eyes), and patient transfer (5 eyes). Among the remaining 67 eyes, 16 (24%) were lost to follow-up. Reasons for discontinuation differed between BRVO and CRVO patients (p = 0.002). Eyes with CRVO presented with worse BCVA (p < 0.0001) and achieved worse final BCVA (p < 0.0001), but both groups experienced improvements (p < 0.0001). Younger age, better baseline BCVA, and a diagnosis of BRVO were independent predictors of better final visual acuity.

CONCLUSION: Over 7.5 years, treatment was discontinued for three-quarters of RVOs. Stable disease was the most common reason for discontinuation, with nearly half (45%) of all RVOs in the cohort stable off active therapy. Better visual outcomes were achieved in BRVO than in CRVO, although both groups benefited from treatment.

PMID:37669742 | DOI:10.1016/j.jcjo.2023.08.005

Int J Pharm. 2023 Sep 3:123368. doi: 10.1016/j.ijpharm.2023.123368. Online ahead of print.

ABSTRACT

The drying capacity of a continuous vibrated fluid bed dryer was studied using a DoE by varying microcrystalline cellulose content in the formulation, water amount in the twin-screw granulation, inlet air temperature, air flow rate and the acceleration of the horizontal fluid-bed. Temperature and humidity profiles were measured along the dryer using wireless sensors. For the parameter space explored in this study, acceleration was the most influential process parameter of the dryer regarding the resulting granule moisture content. An empirical model was developed that allowed for fast and accurate moisture content prediction that could be incorporated into an enhanced control strategy. In addition, a mechanistic model was formulated that allow for prediction of temperature and moisture profiles, and most importantly the moisture content of the granules inside the dryer. The mechanistic model can be integrated to other unit operation models to provide overall understanding of an integrated continuous process line. The mechanistic model also makes it possible to define the equipment design requirements (e.g., length of the dryer) to meet the specific needs in terms of drying capacity, temperature and moisture profile.

PMID:37669728 | DOI:10.1016/j.ijpharm.2023.123368