Nevin Manimala

Simul Healthc. 2022 Oct 18. doi: 10.1097/SIH.0000000000000672. Online ahead of print.

ABSTRACT

INTRODUCTION: Reliability is pivotal in surgical skills assessment. Video-based assessment can be used for objective assessment without physical presence of assessors. However, its reliability for surgical assessments remains largely unexplored. In this study, we evaluated the reliability of video-based versus physical assessments of novices’ surgical performances on human cadavers and 3D-printed models-an emerging simulation modality.

METHODS: Eighteen otorhinolaryngology residents performed 2 to 3 mastoidectomies on a 3D-printed model and 1 procedure on a human cadaver. Performances were rated by 3 experts evaluating the final surgical result using a well-known assessment tool. Performances were rated both hands-on/physically and by video recordings. Interrater reliability and intrarater reliability were explored using κ statistics and the optimal number of raters and performances required in either assessment modality was determined using generalizability theory.

RESULTS: Interrater reliability was moderate with a mean κ score of 0.58 (range 0.53-0.62) for video-based assessment and 0.60 (range, 0.55-0.69) for physical assessment. Video-based and physical assessments were equally reliable (G coefficient 0.85 vs. 0.80 for 3D-printed models and 0.86 vs 0.87 for cadaver dissections). The interaction between rater and assessment modality contributed to 8.1% to 9.1% of the estimated variance. For the 3D-printed models, 2 raters evaluating 2 video-recorded performances or 3 raters physically assessing 2 performances yielded sufficient reliability for high-stakes assessment (G coefficient >0.8).

CONCLUSIONS: Video-based and physical assessments were equally reliable. Some raters were affected by changing from physical to video-based assessment; consequently, assessment should be either physical or video based, not a combination.

PMID:36260767 | DOI:10.1097/SIH.0000000000000672

J Plast Surg Hand Surg. 2022 Oct 19:1-8. doi: 10.1080/2000656X.2022.2117704. Online ahead of print.

ABSTRACT

Background: There is still no consensus on managing zone II level partial flexor tendon lacerations, and the management of zone II partial flexor tendon injuries is controversial. No reliable large cohort studies or metaanalysis papers on partial flexor tendon laceration management are available in PubMed or Embase.Methods: We searched PubMed, Embase, Cochrane Library, Insight, Scopus, and Web of Science databases for primary research articles investigating outcomes of patients with partial flexor tendon injuries. The initial search was limited to human studies that were published from 1970-2021 and indexed as randomized controlled or clinical trials or observational, cross-sectional, or cohort studies. We used statistical package R version 4.1.2 for this meta-analysis.Results: The Standardised mean difference (SMD) of the common effects model was 2.020 (95% CI; 1.583-2.457; P < 0.0001), indicating that the results of conservative treatment without surgical intervention are similar to surgical intervention or better in some articles. The SMD of the random effect model was 7.093 (95% CI; 1.090-13.096; P < 0.0206), indicating the same result. Higgins’ I2 value was 97.6%, indicating serious heterogeneity.Conclusions: In this first meta-analysis on flexor zone II conservative treatment, five papers with publication bias were analyzed. It is meaningful to verify the result of conservative treatment statistically. Even though this is a heterogeneous paper, conservative treatment seems to have a lot of benefits for the patient, including offering a fairly solid longterm prognosis with very few complications.

PMID:36260732 | DOI:10.1080/2000656X.2022.2117704

Sci Adv. 2022 Oct 21;8(42):eabn9450. doi: 10.1126/sciadv.abn9450. Epub 2022 Oct 19.

ABSTRACT

Mathematical models are getting increasingly detailed to better predict phenomena or gain more accurate insights into the dynamics of a system of interest, even when there are no validation or training data available. Here, we show through ANOVA and statistical theory that this practice promotes fuzzier estimates because it generally increases the model’s effective dimensions, i.e., the number of influential parameters and the weight of high-order interactions. By tracking the evolution of the effective dimensions and the output uncertainty at each model upgrade stage, modelers can better ponder whether the addition of detail truly matches the model’s purpose and the quality of the data fed into it.

PMID:36260678 | DOI:10.1126/sciadv.abn9450

Sci Adv. 2022 Oct 21;8(42):eade6585. doi: 10.1126/sciadv.ade6585. Epub 2022 Oct 19.

ABSTRACT

Statistical and machine learning methods help social scientists and other researchers make causal inferences from texts.

PMID:36260667 | DOI:10.1126/sciadv.ade6585

Sci Adv. 2022 Oct 21;8(42):eabk1942. doi: 10.1126/sciadv.abk1942. Epub 2022 Oct 19.

ABSTRACT

Machine learning (ML) methodology used in the social and health sciences needs to fit the intended research purposes of description, prediction, or causal inference. This paper provides a comprehensive, systematic meta-mapping of research questions in the social and health sciences to appropriate ML approaches by incorporating the necessary requirements to statistical analysis in these disciplines. We map the established classification into description, prediction, counterfactual prediction, and causal structural learning to common research goals, such as estimating prevalence of adverse social or health outcomes, predicting the risk of an event, and identifying risk factors or causes of adverse outcomes, and explain common ML performance metrics. Such mapping may help to fully exploit the benefits of ML while considering domain-specific aspects relevant to the social and health sciences and hopefully contribute to the acceleration of the uptake of ML applications to advance both basic and applied social and health sciences research.

PMID:36260666 | DOI:10.1126/sciadv.abk1942

BJS Open. 2022 Sep 2;6(5):zrac126. doi: 10.1093/bjsopen/zrac126.

ABSTRACT

BACKGROUND: Patients with colonic cancer who require emergency colonic cancer surgery often experience poorer outcomes compared with their elective counterparts. In this setting, several treatments approaches are available. In 2009, Danish guidelines recommended treatment with stent for obstruction in left-sided tumours as a bridge to surgery, if expertise is accessible. The aim of this study was to compare the use of elective and emergency resections for colonic cancer and postoperative mortality in two similar demographic populations.

METHODS: All patients who underwent a major resection for colonic cancer, between 2005 and 2016 in Denmark and Yorkshire (UK) were identified. The proportion undergoing emergency surgery, the proportion receiving a stent procedure before their resection, and 30-day postoperative mortality were compared between the populations. Logistic regression was used to determine changes in the proportion of those undergoing emergency surgery and 30-day postoperative mortality.

RESULTS: Out of 45 397 patients treated during the study interval, 41 880 were selected. Emergency surgery decreased in Denmark from 16.6 per cent in 2005-07 to 12.9 per cent in 2014-16, but increased in Yorkshire (13.5 per cent to 16.8 per cent). Danish patients with left-sided tumours were less likely to undergo emergency surgery (risk ratio 0.90, 95 per cent c.i. 0.82 to 0.99) and an increase in stent use coincided with a statistically significant decrease in emergency surgery in these patients. Thirty-day postoperative mortality in all resections (elective and emergency) decreased in both populations, but a larger decrease was observed in Denmark (7.7 per cent to 3.0 per cent in Denmark and 7.1 per cent to 3.3 per cent in Yorkshire).

CONCLUSION: Patients in Denmark experienced a reduction in the use of emergency resection and increase in stenting procedures, following the policy implemented in some departments of converting potential emergency resections into elective resections.

PMID:36260651 | DOI:10.1093/bjsopen/zrac126

PLoS One. 2022 Oct 19;17(10):e0276391. doi: 10.1371/journal.pone.0276391. eCollection 2022.

ABSTRACT

INTRODUCTION: Hot flashes, the most bothering symptom of menopause, are linked to a metabolic inflammation. Due to estrogen deficiency in menopause, dysbiosis is observed. The intestinal barrier affects the interaction of microbiota in healthy or unhealthy individuals. This study investigates the relationship between hot flashes and gut permeability in postmenopausal women.

PARTICIPANTS AND DESIGN: In this cross-sectional study, we divided 289 women, aged 40-65 years, into four groups based on their hot-flash severity: HF0: never experienced hot flashes; HFm: mild hot flashes; HFM: moderate hot flashes; HFS: severe hot flashes. The measured variables included the clinical parameters; hot flashes experience; fasting plasma levels of zonulin, fatty acid binding protein 2 (FABP2), endotoxin, and cytokines/chemokines. We used multiple linear regression analysis to evaluate the relationship between hot flashes and the previously mentioned gut barrier proteins.

SETTINGS: The study was performed in a hospital medical center.

RESULTS: The hot flashes had a positive tendency toward increased levels of circulating FABP2 (P-trend = 0.001), endotoxin (P-trend = 0.031), high-sensitivity C-reactive protein (hs-CRP) (P-trend = 0.033), tumor necrosis factor alpha (TNF-α) (P-trend = 0.017), and interferon-inducible protein-10 (IP10) (P-trend = 0.021). Spearman’s correlation analysis revealed significant correlations of FABP2 with endotoxin, TNF-α, monocyte chemoattractant protein-1, IP10, and hs-CRP in the 289 postmenopausal women included in this study. Linear regression analysis revealed that hot-flash severity had significant assoiciations with FABP2 (P-trend = 0.002), but not with zonulin. After adjusting for body mass index, age, and menopause duration, multivariate linear regression analysis revealed the differences between HFs (% difference (95% confidence interval), 22.36 (8.04, 38.59), P = 0.01) and HF0 groups in terms of FABP2 levels.

CONCLUSIONS: This study shows that hot flashes are significantly associated with FABP2 levels in postmenopausal women. It suggests that severe hot flashes are linked to an increase in intestinal barrier permeability and low-grade systemic inflammation.

PMID:36260646 | DOI:10.1371/journal.pone.0276391

J Sci Food Agric. 2022 Oct 19. doi: 10.1002/jsfa.12282. Online ahead of print.

ABSTRACT

BACKGROUND: Rice-duck coculture is an ecological agricultural mode; however, the nutritional and environmental benefits of transforming from conventional rice monoculture to rice-duck coculture are unknown. Based on survey data and the life-cycle assessment approach, this study conducted a carbon footprint evaluation of conventional rice monoculture (CR), organic rice monoculture (OR), and organic rice-duck coculture (ORD) using different functional units.

RESULTS: The carbon footprint per hectare of ORD (7842±284 kg CO₂ eq ha^-1 ) was slightly lower than that of CR (7905±412 kg CO₂ eq ha^-1 ), while higher than that of OR (7786±235 kg CO₂ eq ha^-1 ). Although the rice yield of ORD was slightly lower than that of CR, its nutrient density unit (NDU) did not decrease significantly due to the additional duck yield. Thus, the carbon footprint per NDU of ORD was significantly lower than that of OR by 24.3% (p<0.05) and was 5.8% higher than that of CR, but this was not statistically significant. Due to the higher economic profits of ORD, its unit of carbon footprint per economic profit was significantly reduced (by 47.1-75.7%) compared with the other two farming modes, while the net ecosystem economic budget was significantly increased by 98.5-341.9% (p<0.05).

CONCLUSION: Transforming from a rice monoculture to a coculture system will contribute to a win-win situation for human health and environmental sustainability. This study highlighted the abundant nutritional output function of the rice-duck coculture and analyzed the urgency and necessity of transitioning from traditional agriculture to ecological agriculture from the production and consumption perspectives. This article is protected by copyright. All rights reserved.

PMID:36260409 | DOI:10.1002/jsfa.12282

J Med Internet Res. 2022 Oct 19;24(10):e36767. doi: 10.2196/36767.

ABSTRACT

BACKGROUND: Patients’ knowledge was found to be a key contributor to the success of therapy. Many efforts have been made to educate patients in their disease. However, research found that many patients still lack knowledge regarding their disease. Integrating patient education into social media platforms can bring materials closer to recipients.

OBJECTIVE: The aim of this study is to test the effectiveness of patient education via Instagram.

METHODS: A randomized controlled trial was conducted to test the effectiveness of patient education via Instagram among patients with inflammatory bowel disease. Participants were recruited online from the open Instagram page of a patient organization. The intervention group was educated via Instagram for 5 weeks by the research team; the control group did not receive any educational intervention. The knowledge about their disease was measured pre- and postintervention using the Inflammatory Bowel Disease Knowledge questionnaire. Data were analyzed by comparing mean knowledge scores and by regression analysis. The trial was purely web based.

RESULTS: In total, 49 participants filled out both questionnaires. The intervention group included 25 participants, and the control group included 24 participants. The preintervention knowledge level of the intervention group was reflected as a score of 18.67 out of 24 points; this improved by 3 points to 21.67 postintervention. The postintervention difference between the control and intervention groups was 3.59 points and was statistically significant (t_32.88=-4.56, 95% CI 1.98-5.19; P<.001). Results of the regression analysis, accounting for preintervention knowledge and group heterogeneity, indicated an increase of 3.33 points that was explained by the intervention (P<.001).

CONCLUSIONS: Patient education via Instagram is an effective way to increase disease-related knowledge. Future studies are needed to assess the effects in other conditions and to compare different means of patient education.

TRIAL REGISTRATION: German Clinical Trials Register DRKS00022935; https://tinyurl.com/bed4bzvh.

PMID:36260385 | DOI:10.2196/36767

J Med Internet Res. 2022 Oct 19;24(10):e38729. doi: 10.2196/38729.

ABSTRACT

BACKGROUND: In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care.

OBJECTIVE: However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system.

METHODS: Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons.

RESULTS: The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions.

CONCLUSIONS: Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.

PMID:36260379 | DOI:10.2196/38729