Nevin Manimala

J Am Coll Surg. 2022 May 1;234(5):748-758. doi: 10.1097/XCS.0000000000000132.

ABSTRACT

BACKGROUND: Intraoperative molecular imaging (IMI) has been shown to improve lesion detection during pulmonary sarcomatous metastasectomy. Our goal in this study was to evaluate whether data garnered from IMI-guided resection of pulmonary sarcoma metastasis translate to improved patient outcomes.

STUDY DESIGN: Fifty-two of 65 consecutive patients with a previous history of sarcomas found to have pulmonary nodules during screening were enrolled in a nonrandomized clinical trial. Patients underwent TumorGlow the day before surgery. Data on patient demographics, tumor biologic characteristics, preoperative assessment, and survival were included in the study analysis and compared with institutional historical data of patients who underwent metastasectomy without IMI. p values < 0.05 were considered significant.

RESULTS: IMI detected 42 additional lesions in 31 patients (59%) compared with the non-IMI cohort where 25% percent of patients had additional lesions detected using tactile and visual feedback only (p < 0.05). Median progression-free survival (PFS) for patients with IMI-guided pulmonary sarcoma metastasectomy was 36 months vs 28.6 months in the historical cohort (p < 0.05). IMI-guided pulmonary sarcoma metastasectomy had recurrence in the lung with a median time of 18 months compared with non-IMI group at 13 months (p < 0.05). Patients with synchronous lesions in the IMI group underwent systemic therapy at a statistically higher rate and tended to undergo routine screening at shorter interval.

CONCLUSIONS: IMI identifies a subset of sarcoma patients during pulmonary metastasectomy who have aggressive disease and informs the medical oncologist to pursue more aggressive systemic therapy. In this setting, IMI can serve both as a diagnostic and prognostic tool without conferring additional risk to the patient.

PMID:35426386 | DOI:10.1097/XCS.0000000000000132

J Am Coll Surg. 2022 May 1;234(5):727-735. doi: 10.1097/XCS.0000000000000133.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination is the core strategy for pandemic management. We hypothesized that a vaccination gap might exist between emergency department (ED) patients admitted for trauma and other ED patients.

STUDY DESIGN: This was an observational quality improvement study using electronic health record data at an academic level-1 trauma center. Participants were all patients presenting to the adult ED with a Tennessee home address between January 1 and June 1, 2021. We measured the proportional difference in vaccination between admitted trauma patients and other ED patients over time (by week) and association via Spearman’s rank correlation coefficient. Binary logistic regression facilitated covariate analysis to account for age, sex, race, home county, and ethnicity without and then with interaction between trauma admission and time. Geographic visual analysis compared county-level vaccination rates with odds of trauma admission by home county using a bivariate chloropleth map.

RESULTS: The proportional difference in vaccination between trauma-admitted and other ED patients increased over time (Spearman’s = 0.699). Adjusting for age, sex, race, home county, and ethnicity, there was a statistically significant vaccination difference between trauma-admitted and other ED patients (odds ratio = 0.53, 95% CI 0.43-0.65, p < 0.0001). Geographic analysis revealed increased trauma admission odds and lower vaccination rates in surrounding counties compared with Davidson County.

CONCLUSIONS: We observed a widening COVID-19 vaccination gap between trauma-admitted and other ED patients. Vaccine outreach during trauma admission may provide a valuable point of contact for unvaccinated patients.

PMID:35426382 | DOI:10.1097/XCS.0000000000000133

Euro Surveill. 2022 Apr;27(15). doi: 10.2807/1560-7917.ES.2022.27.15.2001551.

ABSTRACT

BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R₀ of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.

PMID:35426357 | DOI:10.2807/1560-7917.ES.2022.27.15.2001551

Disabil Rehabil Assist Technol. 2022 Apr 15:1-6. doi: 10.1080/17483107.2022.2061607. Online ahead of print.

ABSTRACT

PURPOSE: Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI.

MATERIALS AND METHODS: Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (PO_peak).

RESULTS: Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between PO_peak and six basic (ρ = 0.41-0.57), eight intermediate (ρ = 0.44-0.59), and nine advanced (ρ = 0.42-0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46-0.59) and one additional skill (i.e., ascends high curb ρ = 0.51).

CONCLUSIONS: More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI.Implications for RehabilitationSignificant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI).This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.

PMID:35426353 | DOI:10.1080/17483107.2022.2061607

Disabil Rehabil Assist Technol. 2022 Apr 15:1-8. doi: 10.1080/17483107.2022.2060352. Online ahead of print.

ABSTRACT

PURPOSE: Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs.

MATERIALS AND METHODS: We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions.

RESULTS: Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78-80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7-61.0) and 63.5% (63.3-63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0-99.0) and 98.4% (98.3-98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively.

CONCLUSION: The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally.IMPLICATIONS FOR REHABILITATIONIt is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age.The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions.The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons.The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning.

PMID:35426341 | DOI:10.1080/17483107.2022.2060352

Gynecol Endocrinol. 2022 Apr 15:1-7. doi: 10.1080/09513590.2022.2053957. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate the expressions of matrix metalloproteinase-9 (MMP-9), estrogen receptor (ER), and progesterone receptor (PR) in thin endometrium.

METHODS: Patients who received treatment in our hospital between January 2018 and September 2020 were enrolled. Endometrial thickness was measured using transvaginal ultrasound; in patients with a midluteal phase endometrial thickness of <7 mm, a sample of endometrial tissue was obtained using a hysteroscope, and the MMP-9, ER, and PR expressions were detected using immunohistochemistry. In addition, the number of endometrial glands was calculated in a complete field of view under a low-power (100×) microscope, and the serum estrogen and progesterone levels were determined. Following hormone therapy, the midluteal phase endometrial thickness was measured again using transvaginal ultrasound, and the patients were divided into two groups: the thin endometrium group and the normal endometrium group (n = 50, each). Patients in the thin endometrium group had an endometrial thickness of <7 mm, while patients in the normal endometrium group had an endometrial thickness of 7-10 mm.

RESULTS: The number of endometrial glands as well as the ER and MMP-9 expressions were lower in the thin endometrium group than in the normal endometrium group; the differences were statistically significant (p < .05). The receiver operator characteristic curve revealed that ER and MMP-9 had a high prediction accuracy in patients with refractory thin endometrium, while the number of endometrial glands was moderately predictive.

CONCLUSION: Compared with other patients with thin endometrium, patients with refractory thin endometrium had a reduced the number of endometrial glands and significantly lower ER and MMP-9 expressions.

PMID:35426338 | DOI:10.1080/09513590.2022.2053957

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Apr 15;36(4):425-430. doi: 10.7507/1002-1892.202109064.

ABSTRACT

OBJECTIVE: To report a new offset parameter for total hip arthroplasty (THA)-greater trochanter offset (GTO), and analyze the effectiveness and feasibility of this parameter based on clinical data.

METHODS: The 47 patients who met the selection criteria and admitted between January 2016 and May 2020 were selected as the research object. The global offset (GO) was used as the offset parameter in preoperative design. Firstly, the test-retest reliability and inter-rater reliability of GTO were analyzed based on pelvic X-ray films. The GTO reconstruction was defined as the difference between the operative side and the healthy side within ±5 mm, and 47 patients were divided into the reconstruction group and the non-reconstruction group. General data (age, gender, type and side of fracture, the interval between injury and operation), visual analogue scale (VAS) score, Harris score, gait score, and leg length discrepancy (LLD) were recorded and compared between two groups. Then, the GTO was used as the offset parameter in preoperative design of 21 patients (GTO group) admitted between June 2020 and December 2020. The pre- and post-operative clinical data were compared between GTO group and GO group to explore the feasibility of GTO for THA.

RESULTS: Statistical analysis showed that GTO had good test-retest reliability (P<0.001) and inter-rater reliability (P<0.001). There was no significant difference in gender, age, type and side of fracture, the interval between injury and operation, preoperative VAS score, and LLD at 1 year after operation between the GTO reconstruction group and the non-reconstruction group, as well as between the GO and GTO groups (P>0.05). The Harris score and gait score at 1 year after operation, and difference of VAS score between pre- and post- operation in the reconstruction group and GTO group were significantly better than those in the non-reconstruction group and GO group, respectively (P<0.05). There were 23 cases (48.9%) in the GO group and 19 cases (90.5%) in the GTO group with GTO reconstruction, and the difference was significant (χ²=10.606, P=0.001). There were 25 cases (53.2%) in the GO group and 13 cases (61.9%) in the GTO group with GO reconstruction, and the difference was not significant (χ²=0.447, P=0.504). There were 34 cases (72.3%) in the GO group and 19 cases (90.5%) in the GTO group with LLD reconstruction, and the difference was not significant (χ²=2.777, P=0.096).

CONCLUSION: GTO has reliable test-retest reliability and inter-rater reliability. GTO as a parameter of preoperative offset reconstruction plan of THA can obtain good reconstruction of offset and limb length, and obtain a good effectiveness.

PMID:35426281 | DOI:10.7507/1002-1892.202109064

Res Synth Methods. 2022 Apr 14. doi: 10.1002/jrsm.1560. Online ahead of print.

ABSTRACT

In meta-analysis, effect sizes often need to be converted into a common metric. For this purpose conversion formulas have been constructed; some are exact, others are approximations whose accuracy has not yet been systematically tested. We performed Monte Carlo simulations where samples with pre-specified population correlations between the x and y-variables were drawn from a normally distributed population. A number of commonly used effect size measures and statistics were calculated from each sample. Using several available conversion formula these statistics were converted into Pearson r and Cohen’s d and compared to r and d calculated directly from the original data. Converted values were systematically lower than the directly calculated values. While conversions to d were quite accurate, some of the conversions to r resulted in large biases. These systematic errors can in most cases be adjusted for by simply multiplying the converted values with a corresponding correction factor. This article is protected by copyright. All rights reserved.

PMID:35426259 | DOI:10.1002/jrsm.1560

J Cosmet Dermatol. 2022 Apr 15. doi: 10.1111/jocd.14992. Online ahead of print.

ABSTRACT

BACKGROUND: Effective anti-aging treatments are an unmet consumer need.

AIM: Ex vivo and clinical tests have evaluated the efficacy of a topical facial serum containing a proprietary blend of neuropeptides, proteins, amino acids, and marine extracts on aged skin.

METHODS: In the ex vivo study the facial serum was compared to a commercially marketed face serum and to an untreated control on skin explants using microrelief, smoothness, and epidermal thickness endpoints. The 12 week monadic clinical study was designed for the test product to be used on the whole face. Subjects functioned as their own control; evaluating change from baseline. Skin was evaluated clinically by a Dermatologist for tolerability and for efficacy. Also part of the product assessment was skin hydration measurements, imaging and a subject questionnaire.

RESULTS: The facial serum improved skin condition by significant reductions in skin surface area occupied by microfolds and in skin roughness. Additionally, it increased epidermal thickness as compared to the untreated control as well as the commercially marketed face serum. The facial serum provided a statistically increased skin moisturization compared to pretreatment values. Dermatological evaluation of the skin concluded that there were statistically and clinically significant improvements in skin smoothness, wrinkles severity, fine lines visibility and lifting and tightening effects at crow’s feet area, forehead and upper lip.

CONCLUSION: A facial serum, containing a proprietary blend of neuropeptides, proteins, amino acids, and marine extracts, has been shown to improve the overall quality of aged skin in a series of ex vivo and clinical tests.

PMID:35426243 | DOI:10.1111/jocd.14992

Int J Older People Nurs. 2022 Apr 15:e12467. doi: 10.1111/opn.12467. Online ahead of print.

ABSTRACT

BACKGROUND: Fear of falling affects older people physically and psychosocially, causing a decrease in their daily activities.

OBJECTIVES: The aim of this study was to determine the relationship between fear of falling (FoF) in hospitalised older people and their difficulty in adapting to old age, quality of life, anxiety, depression and other associated factors.

METHODS: This descriptive correlational study was carried out in a university hospital. The sample consisted of 409 hospitalised older patients. The data were collected using the Falls Efficacy Scale International, Hospital Anxiety and Depression Scale, Assessment Scale of Adaptation Difficulty for the Elderly (ASADE) and the Adaptation of Quality of Life Scale in Older People (CASP-19).

RESULTS: It was found that 74.1% of the older people were found to have high FoF. Five models were created to determine the predictors of FoF, of which Model 5 explained 61% of the total variance (F = 42.455, p = .000). Among the independent variables included in Model 5, being a woman (β = -086, 95% CI -3.5 to -0.52, p = .008), having a chronic disease (β = .293, 95% CI 6.3-10.01, p < .001), using a walking aid (β = .152, 95% CI 1.74-5.49, p < .001), CASP-19 autonomy-satisfaction perception (β = -.242, 95% CI 0.33-0.08, p < .001), CASP-19 disability perception (β = -.111, 95% CI 0.58-1.22, p < .001) and the ASADE role and self-actualisation mode (β = .361, 95% CI -0.50 to 0.08, p < .001) were found to be statistically significant predictors of FoF.

CONCLUSIONS: A large proportion of hospitalised older people tend to have a fear of falling. Being a woman, having a chronic disease, using a walking aid as well as quality of life and difficulty in adapting to old age are the predictors of FoF.

IMPLICATIONS FOR PRACTICE: Nurses should evaluate the associated psychosocial components in order to reduce the fear of falling among hospitalised older people.

PMID:35426238 | DOI:10.1111/opn.12467