Nevin Manimala

Fam Med. 2023 Apr;55(4):225-232. doi: 10.22454/FamMed.2023.486345. Epub 2023 Feb 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown.

METHODS: We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents’ perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs.

RESULTS: PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training.

CONCLUSIONS: Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.

PMID:37043182 | DOI:10.22454/FamMed.2023.486345

Int Urol Nephrol. 2023 Apr 12. doi: 10.1007/s11255-023-03551-y. Online ahead of print.

ABSTRACT

PURPOSE: Renin-angiotensin system hyperactivation in autosomal-dominant polycystic kidney disease (ADPKD) patients leads to early hypertension. Cystic enlargement probably causes parenchymal hypoxia, renin secretion, and endothelial dysfunction. Sympathetic and parasympathetic balance is altered in this condition, especially during the night, also affecting blood pressure circadian rhythm. Aim of this study was to evaluate sympathetic/parasympathetic balance using heart rate variability (HRV) parameters and find a correlation between HRV and renal damage progression, as total kidney volume enlargement, in ADPKD patients.

METHODS: Sixteen adult ADPKD patients were enrolled in the study. Eleven patients (68.8%) were male, and the median age was 42 years (IQR 36-47.5). HRV parameters were calculated using 24 h-ECG Holter. A kidney magnetic resonance imaging (MRI) scan 3 Tesla was performed to evaluate total kidney volume (TKV) and total fibrotic volume (TFV).

RESULTS: A statistically significant positive linear correlation was observed between length of kidneys and frequency domain parameters as low frequency (LF) (r = 0.595, p < 0.05) and LFday (r = 0.587, p < 0.05). Moreover, a statistically significant positive linear correlation exists between high frequency (HF) and TFV (r = 0.804, p < 0.01) or height-adjusted (ha) TFV (r = 0.801, p < 0.01). Finally, we found a statistically significant positive linear correlation between HFnight and TKV (r = 0.608, p < 0.05), ha-TKV (r = 0.685, p < 0.01), TFV (r = 0.594, p < 0.05), and ha-TFV (r = 0.615, p < 0.05).

CONCLUSION: We suppose that the increase in TKV and TFV could lead to a parasympathetic tone hyperactivation, probably in response to hypoxic stress and vasoconstriction due to cystic enlargement.

PMID:37043156 | DOI:10.1007/s11255-023-03551-y

Eur J Epidemiol. 2023 Apr 12. doi: 10.1007/s10654-023-00998-2. Online ahead of print.

ABSTRACT

Excess death estimates have great value in public health, but they can be sensitive to analytical choices. Here we propose a multiverse analysis approach that considers all possible different time periods for defining the reference baseline and a range of 1 to 4 years for the projected time period for which excess deaths are calculated. We used data from the Human Mortality Database on 33 countries with detailed age-stratified death information on an annual basis during the period 2009-2021. The use of different time periods for reference baseline led to large variability in the absolute magnitude of the exact excess death estimates. However, the relative ranking of different countries compared to others for specific years remained largely unaltered. The relative ranking of different years for the specific country was also largely independent of baseline. Averaging across all possible analyses, distinct time patterns were discerned across different countries. Countries had declines between 2009 and 2019, but the steepness of the decline varied markedly. There were also large differences across countries on whether the COVID-19 pandemic years 2020-2021 resulted in an increase of excess deaths and by how much. Consideration of longer projected time windows resulted in substantial shrinking of the excess deaths in many, but not all countries. Multiverse analysis of excess deaths over long periods of interest can offer an approach that better accounts for the uncertainty in estimating expected mortality patterns, comparative mortality trends across different countries, and the nature of observed mortality peaks.

PMID:37043153 | DOI:10.1007/s10654-023-00998-2

Support Care Cancer. 2023 Apr 12;31(5):256. doi: 10.1007/s00520-023-07717-3.

ABSTRACT

Early-stage Hodgkin lymphoma has become one of the most curable hematologic malignancies. Depending upon the disease location, possible toxicities, and patient preference, chemotherapy alone with ABVD remains an accepted treatment modality for this disease. There remains a paucity of data regarding the longitudinal trajectory of health-related quality of life (HRQoL) in patients treated for HL. The impact of disease and treatment on HRQoL is increasingly important to understand as the number of long-term survivors increases. We report the longitudinal HRQoL using data prospectively collected from diagnosis up to 10 years post-treatment in the ABVD arm of the HD.6 randomized controlled trial for early-stage HL patients (N=169). We analyzed HRQoL using the EORTC QLQ-C30 collected at baseline, 3 months, 6 months, and 12 months after completion of chemotherapy and yearly up to year 10. Clinically and statistically significant improvements were noted for specific domains including emotional (3 months post-treatment), social (12 months post-treatment) and financial functioning (2 years post-treatment), and the specific symptom of fatigue (6 months post-treatment) during the follow-up period. To our knowledge, this is the first prospective, longitudinal analysis of HRQoL specifically among patients with early-stage HL treated with ABVD therapy alone. Although improvements were noted, sustained clinically and statistically significant improvements were noted only in select symptoms emphasizing the need to better understand and optimize HRQoL among this patient group.

PMID:37043087 | DOI:10.1007/s00520-023-07717-3

J Anesth. 2023 Apr 12. doi: 10.1007/s00540-023-03192-6. Online ahead of print.

ABSTRACT

PURPOSE: To assess the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block in controlling postoperative pain and promoting recovery of lower extremity after total hip arthroplasty (THA), and to compare its effectiveness with supra-inguinal fascia iliaca compartment block (S-FICB).

MATERIALS AND METHODS: 92 patients undergoing THA with general anesthesia were randomly allocated to receive either a PENG with LFCN block (n = 46) using 30 ml 0.33% ropivacaine (20 ml for PENG block, 10 ml for LFCN block), or an S-FICB (n = 46) using 30 ml 0.33% ropivacaine. The primary outcome was the time to first postoperative walk. The secondary outcomes included intraoperative remifentanil consumption, postoperative hip flexion degree and muscle strength of the operative lower limbs in the supine position, pain scores (static and dynamic), rescue analgesia, postoperative nausea and vomiting (PONV), and nerve block-related complications.

RESULTS: The combination of PENG with LFCN blocks resulted in an earlier first postoperative walking time (19.6 ± 9.6 h vs 26.5 ± 8.2 h, P < 0.01), greater postoperative hip flexion degree at 6 h, 24 h and 48 h (all P < 0.01), and higher muscle strength of the operative lower limbs at 6 h after surgery (P = 0.03) compared to S-FICB. The difference in pain scores (static and dynamic) was only statistically significant at 48 h (P < 0.05). There were no differences in the other outcomes.

CONCLUSIONS: PENG with LFCN blocks is more effective than S-FICB in shortening the time to first postoperative walk and preservation hip motion after THA, which makes it a suitable addition to enhanced recovery programs following surgery.

PMID:37043081 | DOI:10.1007/s00540-023-03192-6

Matern Child Health J. 2023 Apr 12. doi: 10.1007/s10995-022-03524-0. Online ahead of print.

ABSTRACT

BACKGROUND: Recent legislative decisions in the United States have encouraged discussion about national parental leave programs. Currently, over 47% of the United States workforce is female. However, the United States is the only nation of the 37 member countries in the Organization for Economic Co-Operation and Development (OECD) to have no national requirement for maternity leave. The first few months of a child’s life are vital to their physical and mental development. Likewise, a gradual return to pre-partum functioning is important for a newly postpartum woman. While it has been shown that maternity leave positively impacts various measures of maternal and infant mental and physical health, we lack consensus on the optimal length of paid or unpaid maternity leave. Accordingly, we conducted a systematic review and meta-analysis to evaluate the optimal length of paid or unpaid maternity leave to encourage maternal and infant mental and physical health in the United States.

METHODS: A systematic review and meta-analysis were conducted to synthesize and critically evaluate the current research investigating the association between maternity leave and maternal and infant mental and physical health using the Preferred Reporting in Systematic Reviews and Meta-Analyses guidelines. Databases EMBASE, PsycInfo, and PubMed were searched using specific inclusion and exclusion criteria. Methodological Index for Non-Randomized Studies scale assessed the methodological quality of the included eligible studies. The magnitude of heterogeneity between-study was tested using The Cochrane χ² test and the Moran’s I² statistic. Possible publication bias was assessed through the funnel plot and the Egger regression test. A p-value of < 0.10 will be considered as an indication for the existence of potential publication bias. All statistical analyses were carried out with Stata software version 15.

RESULTS: A total of 21 studies were analyzed. It was found that longer maternity leave may decrease rates of maternal mental and physical health complaints. It was also found that longer maternity leave leads to more positive mother-child interactions, decreased infant mortality, and longer periods of breastfeeding.

CONCLUSION: Maternity leave of 12 weeks or more confers the greatest benefit for mothers and their infants.

PMID:37043071 | DOI:10.1007/s10995-022-03524-0

Bull Exp Biol Med. 2023 Apr 12. doi: 10.1007/s10517-023-05766-6. Online ahead of print.

ABSTRACT

The frequency of D. melanogaster embryonic death was estimated using the method of dominant lethal mutations after exposure to ionizing γ-radiation and non-ionizing pulsed magnetic field. γ-Radiation had a dose-dependent mutational effect on D. melanogaster. A pronounced increase in embryonic death was observed starting from a dose of 3 Gy and reaches a plateau at 60 Gy due to the maximum death of eggs. When D. melanogaster was exposed to pulsed magnetic field, the effect did not depend on the exposure time; a statistically significant genotoxic effect was detected after 5-h exposure.

PMID:37043061 | DOI:10.1007/s10517-023-05766-6

Clin Oral Investig. 2023 Apr 12. doi: 10.1007/s00784-023-04992-6. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to train deep learning models for recognition of contiguity between the mandibular third molar (M3M) and inferior alveolar canal using panoramic radiographs and to investigate the best effective fold of data augmentation.

MATERIALS AND METHODS: The total of 1800 M3M cropped images were classified evenly into contact and no-contact. The contact group was confirmed with CBCT images. The models were trained from three pretrained models: AlexNet, VGG-16, and GoogLeNet. Each pretrained model was trained with the original cropped panoramic radiographs. Then the training images were increased fivefold, tenfold, 15-fold, and 20-fold using data augmentation to train additional models. The area under the receiver operating characteristic curve (AUC) of the 15 models were evaluated.

RESULTS: All models recognized contiguity with AUC from 0.951 to 0.996. Ten-fold augmentation showed the highest AUC in all pretrained models; however, no significant difference with other folds were found. VGG-16 showed the best performance among pretrained models trained at the same fold of augmentation. Data augmentation provided statistically significant improvement in performance of AlexNet and GoogLeNet models, while VGG-16 remained unchanged.

CONCLUSIONS: Based on our images, all models performed efficiently with high AUC, particularly VGG-16. Ten-fold augmentation showed the highest AUC by all pretrained models. VGG-16 showed promising potential when training with only original images.

CLINICAL RELEVANCE: Ten-fold augmentation may help improve deep learning models’ performances. The variety of original data and the accuracy of labels are essential to train a high-performance model.

PMID:37043029 | DOI:10.1007/s00784-023-04992-6

Eur Arch Otorhinolaryngol. 2023 Apr 12. doi: 10.1007/s00405-023-07961-7. Online ahead of print.

ABSTRACT

PURPOSE: The main objective of this study is to evaluate the short-term and long-term audiological outcomes in patients who underwent cochlear implantation with a robot-assisted system to enable access to the cochlea, and to compare outcomes with a matched control group of patients who underwent cochlear implantation with conventional access to the cochlea.

METHODS: In total, 23 patients were implanted by robot-assisted cochlear implant surgery (RACIS). To evaluate the effectiveness of robotic surgery in terms of audiological outcomes, a statistically balanced control group of conventionally implanted patients was created. Minimal outcome measures (MOM), consisting of pure-tone audiometry, speech understanding in quiet and speech understanding in noise were performed pre-operatively and at 3 months, 6 months, 12 months and 2 years post-activation of the audioprocessor.

RESULTS: There was no statistically significant difference in pure-tone audiometry, speech perception in quiet and speech perception in noise between robotically implanted and conventionally implanted patients pre-operatively, 3 months, 6 months, 12 months and 2 years post-activation. A significant improvement in pure-tone hearing thresholds, speech understanding in quiet and speech understanding in noise with the cochlear implant has been quantified as of the first measurements at 3 months and this significant improvement remained stable over a time period of 2 years for HEARO implanted patients.

CONCLUSION: Clinical outcomes in robot-assisted cochlear implant surgery are comparable to conventional cochlear implantation. CLINICALTRAILS.

GOV TRAIL REGISTRATION NUMBERS: NCT03746613 (date of registration: 19/11/2018), NCT04102215 (date of registration: 25/09/2019).

PMID:37043021 | DOI:10.1007/s00405-023-07961-7

Environ Monit Assess. 2023 Apr 12;195(5):555. doi: 10.1007/s10661-023-11137-5.

ABSTRACT

The general circulation models (GCMs) and emission scenarios (RCP 4.5 and 8.5) have proven to be significantly functional in evaluating the impacts of climate change (CC) on hydrology, although their performance and accuracy varies on a regional scale. The objective of the present study is to evaluate the performance of five CMIP5 GCMs (CanESM2, BNU-ESM, CNRM-CM5, MPI-ESM-LR and MPI-ESM-MR) on a regional scale in the West Flowing River Basins-2 (WFRB-2) in India to model the impact of CC and its scenario uncertainty using reliability ensemble average (REA) method. For quantifying the results, the upper, middle and lower regions of WFRB-2 are separately analysed. The MPIMR and MPILR GCM model shows highest reliability factor range (0.3-0.6) in predicting the annual mean and annual maximum rainfall for most of the grids in the region. The GCM-simulated runoff using VIC (variable infiltration capacity) model is evaluated using statistical parameters such as root mean square error (RMSE), percentage bias (Pbias) and standard deviation (Std). The annual mean (maximum) runoff obtained using REA ensemble shows least RMSE, Pbias and Std values, i.e. 21.08%, 9.10 mm and 8.9 mm (6%, 39.1 mm, 39.1 mm), respectively for the middle region, which demonstrates higher reliability of GCM outputs in the flood-prone regions of WFRB-2. Furthermore, the future projection of annual maximum rainfall/runoff shows an increase of 50 mm/15 mm in the near future (2011-2040) for lower and 20 mm/6 mm for middle regions, which may cause flooding activities in the lower and middle region of WFRB-2.

PMID:37043020 | DOI:10.1007/s10661-023-11137-5