Nevin Manimala

Clin Ter. 2021 Nov 22;172(6):542-546. doi: 10.7417/CT.2021.2375.

ABSTRACT

BACKGROUND: Tibial plateau fractures pose multiple challenges to the surgeon given their frequent intra-articular involvement and the tendency to displace under axial load. The aim of this study is to de-scribe the clinical outcomes of a retrospective case series in which tibial plateau fractures were not treated with PL fragment osteosynthesis.

METHODS: In the present retrospective study, we included patients treated for tibial plateau fracture with PL fragment in our department from January 2016 to January 2020. All patients were seen at the outpa-tient clinic 2 and 5 weeks after surgery, and at 3, 6 and 12 months, and thereafter at regular intervals, depending on the overall clinical status. Every patient included in this study was then contacted by phone to assess self-reported clinical outcomes. The Oxford Knee Score (OKS) questionnaire was used to assess functional outcomes. Patients were divided in six groups depending on the three-column classification by Lou (groups A1-A6). Patients were also divided in four groups based on the whole area of the PL column and on the depression of the PL fragment (group B1-B4). One-way ANOVA was used to compare groups of patients.

RESULTS: OKS scores, extension and step-off of the PL fragment were analyzed in groups A1 – A6. No significant differences between OKS scores and step-off were found, while statistical difference was found between surfaces of PL fragment. No significant difference was found between OKS scores in groups B1-B4.

CONCLUSION: Our findings suggest that the treatment outcome is influenced not only by the superficial involvement or collapse of PL fragments, but also by other variables, including BMI, pre-injury physi-cal health, and age.

PMID:34821349 | DOI:10.7417/CT.2021.2375

Rev Esp Salud Publica. 2021 Nov 25;95:e202111195.

ABSTRACT

OBJECTIVE: National hip fracture registries have been established in several countries and recent publications show that the care process has been audited inspecting the representativeness according to quality standards. The aim of this study was to analyse if the Spanish National Hip Fracture Registry (RNFC) represents the Spanish population aged 75 and older admitted for hip fractures, and to compare its results regarding the care process with the national average, according to the National Inpatient register (Minimum Basic Dataset, CMBD).

METHODS: The 2017-2018 National Minimum Basic Dataset (Conjunto Mínimo Básico de Datos, CMBD) was used as reference. For analysis, we included 83,110 cases from the CMBD and 21,130 from the RNFC. Eight common variables of both registries were selected for comparison.

RESULTS: No significant differences were observed in the patient-related common variables (age, sex, type of fracture and fracture side), but statistically significant differences were found in the variables describing the care process (proportion of patients operated, deceased, surgical procedures and postoperative length of stay).

CONCLUSIONS: The RNFC, designed as a convenience sample, is also representative of the population of patients aged 75 and older treated for hip fractures in Spain. However, there is a participation bias related to the professionals and the hospitals interested in voluntarily participating in a quality improvement program, which would explain the better results observed in the care process, compared to the national average as collected by the CMBD.

PMID:34821224

Expert Rev Neurother. 2021 Nov 25. doi: 10.1080/14737175.2022.2011215. Online ahead of print.

ABSTRACT

INTRODUCTION: . Children with Autism Spectrum Disorder (ASD) experience difficulties in Executive Functions (EF) performances. However, efficacy of EF intervention needs to be further investigated.

OBJECTIVE: to evaluate the efficacy of different EF interventions in children and adolescents with ASD.

METHODS: A systematic review and meta-analysis were carried out according to PRISMA guidelines. Relevant databases including Pubmed, Psychinfo, Scopus and Web of Science were searched up to November 2019. Papers included in the study have the following characteristics: randomized controlled trial or quasi-experimental design and be published in English or Spanish.

RESULTS: After the elimination of duplicates, 949 were screened. Among these six were included in the systematic review. The main approaches for EF in ASD were computer-based interventions, cognitive-behavioral therapy and assisted-animal therapy. Statistically significant results (p=0.003) were found in using exergames.

CONCLUSION: Different approaches can be used for improving EF intervention, with positive effects on working memory, behavior, and flexibility.

PMID:34821185 | DOI:10.1080/14737175.2022.2011215

Clin Rehabil. 2021 Nov 25:2692155211062110. doi: 10.1177/02692155211062110. Online ahead of print.

ABSTRACT

OBJECTIVE: To test with the Rasch analysis the psychometric properties of the Falls Efficacy Scale International, a questionnaire for measuring concern about falling.

DESIGN: Longitudinal observational study, before-after rehabilitation.

SETTING: Inpatient rehabilitation.

SUBJECTS: A total of 251 neurological patients with balance impairment.

INTERVENTIONS: Physiotherapy and occupational therapy aimed at reducing the risk of falling.

MAIN MEASURES: Participants (median age, first-third quartile: 74.0, 65.5-80.5 years; stroke and polyneuropathy: 43% and 21% of the sample, respectively) received a balance assessment (Falls Efficacy Scale International included) pre- and post-rehabilitation. Rasch analysis was used to evaluate the Falls Efficacy Scale International. Differential item functioning, which assesses the measures’ stability in different conditions (e.g. before vs. after treatment) and in different groups of individuals, was tested for several variables.

RESULTS: Patients suffered a moderate balance impairment (Mini-BESTest median score; first-third quartile: 15; 11-19), mild-moderate concern about falling (Falls Efficacy Scale International: 28; 21-37) and motor disability (Functional Independence Measure, motor domain: 70.0; 57.0-76.5). Falls Efficacy Scale International items fitted the Rasch model (range of infit and outfit mean square statistics: 0.8-1.32 and 0.71-1.45, respectively) and the questionnaire’s reliability was satisfactory (0.87). No differential item functioning was found for treatment, gender, age and balance impairment. Differential item functioning was found for diagnosis and disability severity, but it is shown that it is not such as to bias measures.

CONCLUSIONS: Falls Efficacy Scale International ordinal scores can be turned into interval measures, i.e. measures of the type of temperature. Being differential item functioning-free for treatment, these measures can be safely used to compare concern about falling before and after rehabilitation, such as when interested in assessing the rehabilitation effectiveness.

PMID:34821159 | DOI:10.1177/02692155211062110

Clin Rehabil. 2021 Nov 25:2692155211057656. doi: 10.1177/02692155211057656. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of proprioceptive training on balance performance, trunk control, and gait speed in people with stroke.

METHODS: We searched PubMed, Science Direct, Cochrane, Embase, and Medline for randomized controlled trials that evaluated the effects of proprioceptive training for patients with stroke from the date of each database’s inception to July 26, 2021. Two reviewers independently screened the titles and abstracts of potentially eligible articles that were identified on the basis of the search criteria. Methodological quality was determined using version 2 of the Cochrane risk of bias tool for randomized trials. Data were analyzed using Comprehensive Meta-Analysis software. The treatment effect was estimated by calculating Hedges’ g and 95% confidence intervals (CIs) using a random-effects model. Statistical heterogeneity was assessed according to the I² value. The primary outcome was balance performance and secondary outcomes were trunk control, gait speed, and basic functional mobility.

RESULTS: In total, 17 trials involving 447 people with stroke were included. Proprioceptive training had a significant effect on balance performance (Hedges’ g = 0.69, 95% CI = 0.36-1.01), gait speed (Hedges’ g = 0.57, 95% CI = 0.19-0.94), trunk control (Hedges’ g = 0.75, 95% CI = 0.33-1.17), and basic functional mobility (Hedges’ g = 0.63, 95% CI = 0.31-0.94) among people with stroke.

CONCLUSION: Proprioceptive training may be effective in improving balance performance, gait speed, trunk control, and basic functional mobility among people with stroke.

PMID:34821158 | DOI:10.1177/02692155211057656

Health Informatics J. 2021 Oct-Dec;27(4):14604582211052259. doi: 10.1177/14604582211052259.

ABSTRACT

Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders’ support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders’ support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders’ support for the service (β ranging from 0.41 to 0.44, p < 0.001). Leaders’ support for the service was also associated with how well the leaders provided information about the service to their subordinates (β =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals’ work. The developers of SCs should focus more on features that decrease health professionals’ workload as well as how the solution can benefit patients.

PMID:34821152 | DOI:10.1177/14604582211052259

Radiol Oncol. 2021 Nov 19;55(4):426-432. doi: 10.2478/raon-2021-0043.

ABSTRACT

BACKGROUND: The aim of the study was to evaluate the diagnostic accuracy of p16/Ki-67 dual immunostaining (p16/ Ki-67 DS) in cervical cytology and the number of positive p16/Ki-67 cells to diagnose high grade cervical intraepithelial neoplasia (CIN2+) in colposcopy population.

SUBJECTS AND METHODS: We performed an analysis on a subset cohort of 174 women enrolled within a large-scale randomised controlled human papillomavirus (HPV) self-sampling project organised as part of the population-based Cervical Cancer Screening Programme ZORA in Slovenia. This subset cohort of patients was invited to the colposcopy clinic, underwent p16/Ki-67 DS cervical cytology and had the number of p16/Ki-67 positive cells determined.

RESULTS: Among analysed women, 42/174 (24.1%) had histologically confirmed CIN2+. The risk for CIN2+ was increasing with the number of positive cells (p < 0.001). The sensitivity of p16/Ki-67 DS for detection of CIN2+ was 88.1%, specificity was 65.2%, positive predictive value was 44.6% and negative predictive value was 94.5%.

CONCLUSIONS: Dual p16/Ki-67 immunostaining for the detection of CIN2+ has shown high sensitivity and high negative predictive value in our study, which is comparable to available published data. The number of p16/Ki-67 positive cells was significantly associated with the probability of CIN2+ detection. We observed a statistically significant and clinically relevant increase in specificity if the cut-off for a positive test was shifted from one cell to three cells.

PMID:34821133 | DOI:10.2478/raon-2021-0043

J Clin Periodontol. 2021 Nov 24. doi: 10.1111/jcpe.13576. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate effects of a six-week Mediterranean diet (MD) intervention on gingival inflammatory and anthropometric parameters of patients with gingivitis.

MATERIALS AND METHODS: Forty-two participants were allocated to MD group (MDG) or control group (CG). After a two weeks equilibration period regarding dental care procedures, only MDG changed their diet to MD for six weeks, supported by a diet counseling. Gingival and anthropometric parameters were assessed at baseline (T0), Week 2 (T1, beginning of MD intervention), and Week 8 (T2). Adherence to MD was assessed by the Mediterranean Diet Adherence Screener (MEDAS), dietary behavior was evaluated by the German Health Interview and Examination Survey for Adults Food Frequency Questionnaire (DEGS-FFQ).

RESULTS: Plaque values remained constant in both groups. Inflammatory periodontal and anthropometric parameters decreased in the MDG only (gingival index: T1 1.51±0.21, T2 1.49±0.24; bleeding on probing: T1 51.00±14.65, T2 39.93±13.74; body weight: T1 79.01±15.62, T2 77.29±17.00; waist circumference: T1 84.41±10.1, T2 83.17±10.47 (p < 0.05). MEDAS revealed a sufficient diet adherence for MDG.

CONCLUSION: Within this study, gingival inflammatory parameters were significantly reduced by MD, whereas plaque parameters remained constant. The diet counseling achieved sufficient adherence with beneficial changes in weight loss and waist circumference.

PMID:34818686 | DOI:10.1111/jcpe.13576

Eur Surg Res. 2021 Nov 24:1-13. doi: 10.1159/000519718. Online ahead of print.

ABSTRACT

Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study.

METHODS: Patients with early-stage (Tis-1-2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed.

RESULTS: One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001).

CONCLUSION: The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

PMID:34818662 | DOI:10.1159/000519718

Gynecol Obstet Invest. 2021 Nov 24. doi: 10.1159/000520979. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019.

METHODS: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis.

RESULTS: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia.

LIMITATION: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data.

CONCLUSION: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

PMID:34818651 | DOI:10.1159/000520979