Nevin Manimala

J Gastrointest Surg. 2022 Jun 29. doi: 10.1007/s11605-022-05394-x. Online ahead of print.

ABSTRACT

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal malignancies carries considerable morbidity; however, the significance of postoperative small bowel obstruction (SBO) is not well defined. We aim to identify predictors for post-CRS/HIPEC SBO and their oncologic associations.

METHODS: A retrospective review was conducted of all CRS/HIPEC cases performed at a surgical oncology center (2013-2018). Patient demographics, tumor characteristics, perioperative factors, and province-wide hospital readmissions were analyzed. Descriptive statistics were used for baseline characteristics, multivariate logistic regression for predictors of SBO at 1 year, and Kaplan-Meier method with log-rank test for survival analysis.

RESULTS: A total of n = 97 CRS/HIPEC procedures were performed for diagnoses of low-grade appendiceal mucinous neoplasm (44%), high-grade appendiceal adenocarcinoma (8%), colorectal adenocarcinoma (34%), and mesothelioma (9%). The median peritoneal carcinomatosis index (PCI) score was 16. Cumulative incidence of post-CRS/HIPEC SBO readmission was 24% at 1 year and 38% at 2 and 3 years. Of 29 patients readmitted with SBO, 14 (48%) had more than one readmission for SBO, and nine surgeries were performed for obstruction. Multivariate regression identified significant independent predictors of SBO within 1-year post-CRS/HIPEC as high-grade appendiceal or colorectal primaries (odds ratio [OR] 4.58, p = 0.02) and PCI ≥ 20 (OR 3.27, p = 0.05). Overall survival (OS) was worse in patients readmitted with SBO within 1 year compared to those without (3-year OS 58% vs. 75%, p = 0.017).

CONCLUSION: SBO is the most common readmission diagnosis post-CRS/HIPEC and is associated with worse survival. High-grade appendiceal and colorectal primary tumors and PCI ≥ 20 are predictors for SBO.

PMID:35852704 | DOI:10.1007/s11605-022-05394-x

J Occup Rehabil. 2022 Jul 19. doi: 10.1007/s10926-022-10055-6. Online ahead of print.

ABSTRACT

PURPOSE: Job crafting is an incremental, employee-initiated job design process used to achieve a better fit between job demands and worker skills. Persons with work limitations face multiple barriers to optimal work performance. Some persons with work limitations may innately use job crafting as a strategy to achieve better alignment with their job tasks and demands, however the extent to which job crafting may be helpful in improving work performance and engagement is unknown. The purpose of this study is (1) to examine the moderating role of work limitations in the relationship between job crafting and work performance and (2) to understand the complex relationship between job crafting, work limitations, work engagement, work performance, readiness to change, and worker characteristics.

METHODS: We conducted an online survey of workers with and without disabilities (final N = 742) in 2020-2021. Our sample included workers aged 18 and older. Descriptive statistics, bivariate statistics, and Partial Least Squares-Structural Equation Modeling (PLS-SEM) were used to assess the relationships among job crafting, work limitations, work engagement, work performance, readiness to change, and worker characteristics.

RESULTS: Work limitation moderates the relationship between job crafting and work performance by weakening the impact of innate job crafting on work performance. Worker characteristics such as education and years of work experience predict crafting behaviors and work engagement mediates the relationship between job crafting and work performance.

CONCLUSIONS: Work limitation weakens the relationship between job crafting and work performance. Workers with limitations may benefit from job crafting interventions to increase work engagement and performance.

PMID:35852695 | DOI:10.1007/s10926-022-10055-6

Intern Emerg Med. 2022 Jul 19. doi: 10.1007/s11739-022-03024-7. Online ahead of print.

ABSTRACT

Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

PMID:35852676 | DOI:10.1007/s11739-022-03024-7

EJNMMI Phys. 2022 Jul 19;9(1):47. doi: 10.1186/s40658-022-00476-w.

ABSTRACT

BACKGROUND: In recent years, a lot of effort has been put in the enhancement of medical imaging using artificial intelligence. However, limited patient data in combination with the unavailability of a ground truth often pose a challenge to a systematic validation of such methodologies. The goal of this work was to investigate a recently proposed method for an artificial intelligence-based generation of synthetic SPECT projections, for acceleration of the image acquisition process based on a large dataset of realistic SPECT simulations.

METHODS: A database of 10,000 SPECT projection datasets of heterogeneous activity distributions of randomly placed random shapes was simulated for a clinical SPECT/CT system using the SIMIND Monte Carlo program. Synthetic projections at fixed angular increments from a set of input projections at evenly distributed angles were generated by different u-shaped convolutional neural networks (u-nets). These u-nets differed in noise realization used for the training data, number of input projections, projection angle increment, and number of training/validation datasets. Synthetic projections were generated for 500 test projection datasets for each u-net, and a quantitative analysis was performed using statistical hypothesis tests based on structural similarity index measure and normalized root-mean-squared error. Additional simulations with varying detector orbits were performed on a subset of the dataset to study the effect of the detector orbit on the performance of the methodology. For verification of the results, the u-nets were applied to Jaszczak and NEMA physical phantom data obtained on a clinical SPECT/CT system.

RESULTS: No statistically significant differences were observed between u-nets trained with different noise realizations. In contrast, a statistically significant deterioration was found for training with a small subset (400 datasets) of the 10,000 simulated projection datasets in comparison with using a large subset (9500 datasets) for training. A good agreement between synthetic (i.e., u-net generated) and simulated projections before adding noise demonstrates a denoising effect. Finally, the physical phantom measurements show that our findings also apply for projections measured on a clinical SPECT/CT system.

CONCLUSION: Our study shows the large potential of u-nets for accelerating SPECT/CT imaging. In addition, our analysis numerically reveals a denoising effect when generating synthetic projections with a u-net. Clinically interesting, the methodology has proven robust against camera orbit deviations in a clinically realistic range. Lastly, we found that a small number of training samples (e.g., ~ 400 datasets) may not be sufficient for reliable generalization of the u-net.

PMID:35852673 | DOI:10.1186/s40658-022-00476-w

Int J Biometeorol. 2022 Jul 19. doi: 10.1007/s00484-022-02330-1. Online ahead of print.

ABSTRACT

Air pollution is considered the most prominent public health. Economically, air pollution imposes additional costs on governments. This study aimed to quantify health effects and associated economic values of reducing PM_2.5 air pollution using BenMAP-CE in Qom in 2019. The air quality data were acquired from Qom Province Environmental Protection Agency, and the population data were collected from Qom Province Management and Planning Organization website. The number of deaths due to Stroke, Chronic Obstructive Pulmonary Disease, Lung Cancer, and Ischemic Heart Disease attributable to PM_2.5 were estimated using BenMAP-CE based on two control scenarios, 2.4 and 10 μg/m³, known as scenarios I and II, respectively. The associated economic effect of premature deaths was assessed by value of a statistical life (VSL) approach. The annual average of PM_2.5 concentration was found to be 16.32 μg/m³ (SD: 9.93). A total of 4694.5 and 2475.94 premature deaths in scenarios I and II were found to be attributable to PM_2.5 in overall, respectively. The total associated cost was calculated to be 855.91 and 451.40 million USD in scenarios I and II, respectively. The total years of life lost due to PM_2.5 exposure in 2019 was 158,657.06 and 78,351.51 in scenarios I and II, respectively. The results of both health and economic assessment indicate the importance of solving the air pollution problem in Qom, as well as other big cities in Iran. The elimination of limitations, such as insufficient local data, should be regarded in future studies.

PMID:35852660 | DOI:10.1007/s00484-022-02330-1

Arch Gynecol Obstet. 2022 Jul 19. doi: 10.1007/s00404-022-06685-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The management of fetal macrosomia remains controversial. A protocol for induction of labor in the case of a suspected macrosomic fetus has been in place in our maternity hospital since 2016. We studied the impact of this protocol by analyzing the mode of delivery. We then studied its safety in terms of maternal and fetal morbidity and mortality and the risk factors of macrosomia.

METHODS: Retrospective, comparative, single-center study including 256 patients between 2016 and 2020 in a type 3 maternity hospital in France. We compared 114 patients induced at 39 weeks of gestation (fetal weight ≥ 95th p; group 1) with 142 patients who after 37 weeks of gestation delivered a macrosomic newborn (≥ 95th p according to Audipog; group 2) not diagnosed antenatally.

RESULTS: The rate of vaginal delivery in the group 1 was 78.9% vs 83.8% in group 2 (p = 0.318). The rate of neonatal acidosis in group 1 was statistically lower than in group 2 (5.2% vs 16.9%; p = 0.004). The other maternal and neonatal outcomes were not significantly different in the two groups. A previous macrosomic newborn appeared to be a risk factor for macrosomia (p = 0.02).

CONCLUSION: The establishment of a protocol for the induction of labor in the case of macrosomia in our maternity hospital did not increase the rate of vaginal delivery, but has a neonatal benefit, by significantly reducing neonatal acidosis.

PMID:35852647 | DOI:10.1007/s00404-022-06685-z

Med Oncol. 2022 Jul 19;39(10):152. doi: 10.1007/s12032-022-01741-9.

ABSTRACT

Excision repair complementary complex 5 (ERCC5) is an important component in the repair pathway of platinum-induced damage. The current study evaluated the effect of ERCC5 variants (rs751402 and rs1047768) on the clinical outcome of platinum-based regimens in non-small cell lung cancer (NSCLC) patients. A prospective, cohort study was conducted on 57 newly diagnosed NSCLC Egyptian patients. Patients received either cisplatin or carboplatin-based chemotherapy. DNA was extracted and the variants were analyzed using real time PCR. This study found no significant difference between the studied variants and patients’ response to chemotherapy, progression-free survival (PFS) or overall survival (OS). However, a statistically significant association was found between the histologic subtypes and the studied variants (p = 0.028 and 0.018 for rs751402 and rs1047768, respectively). A statistically significant association was evident between the type of the allele present in the studied polymorphisms, p value = 0.000040. Moreover, the minor allele frequency (MAF) of the studied variants rs751402 and rs1047768 were similar to those of African and European populations, respectively. Results of this study have concluded that ERCC5 variants did not affect the clinical outcome of platinum-based chemotherapy in NSCLC. A significant coinheritance was found between the two variants of ERCC5. Moreover, the similarity between the MAF of the studied variants and the African or European population can guide future research when extrapolating data from African European populations to their Egyptian counterparts.

PMID:35852645 | DOI:10.1007/s12032-022-01741-9

Acta Neurochir (Wien). 2022 Jul 19. doi: 10.1007/s00701-022-05282-y. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to investigate whether clinical outcomes in patients aged ≥ 70 undergoing decompressive surgery for degenerative cervical myelopathy (DCM) differ from those of younger patients (50-70 years) at 1 year.

METHODS: Data were obtained from the Norwegian Registry for Spine Surgery (NORspine). Among 651 patients included, 177 (27.2%) were ≥ 70 years old. The primary outcome was change in the Neck Disability Index (NDI). Secondary outcomes were changes in the European Myelopathy Score (EMS), quality of life (EuroQoL EQ-5D), numeric rating scales (NRS) for headache, neck pain, and arm pain, and complications.

RESULTS: Significant improvements in all patient-reported outcomes (PROMs) were detected for both age cohorts at 1 year. For the two age cohorts combined, there was a statistically significant improvement in the NDI score (mean 9.2, 95% CI 7.7 to 10.6, P < 0.001). There were no differences between age cohorts in mean change of NDI (- 8.9 vs. – 10.1, P = 0.48), EQ-5D (0.13 vs. 0.17, P = 0.37), or NRS pain scores, but elderly patients experienced a larger improvement in EMS (0.7 vs. 1.3, P = 0.02). A total of 74 patients (15.6%) in the younger cohort and 43 patients (24.3%) in the older cohort experienced complications or adverse effects within 3 months of surgery, mainly urinary and respiratory tract infections.

CONCLUSION: Surgery for DCM was associated with significant improvement across a wide range of PROMs for both younger and elderly patients. Surgery for DCM should not be denied based on age alone.

PMID:35852626 | DOI:10.1007/s00701-022-05282-y

J Cancer Res Clin Oncol. 2022 Jul 19. doi: 10.1007/s00432-022-04201-z. Online ahead of print.

ABSTRACT

PURPOSE: Immune checkpoint inhibitors (ICIs) have improved the prognosis of cancer patients significantly with few predictive makers for treatment efficiency. Since interferon-gamma (IFN-γ) displayed its association with immunotherapy, we explored the correlation between IFN-γ and the efficacy of ICIs in tumor treatment.

METHODS: We retrospectively examined cancer patients who received immune checkpoint inhibitors as first-line therapy at the Fourth Hospital of Hebei Medical University. The patients were divided into a low concentration group of IFN-γ (≤ 1.2 pg/mL) and a high concentration group (≥ 1.3 pg/mL) to evaluate the efficacy, which was indicated by the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS).

RESULTS: Thirty-five patients with low IFN-γ and 56 patients with high IFN-γ were involved in the evaluation, and the DCR was significantly different between these two groups (p = 0.009) with a high group of 81.4% (95% CI 69-94%) and a low group of 51.9% (95% CI 32-72%). The subsequent Kaplan-Meier survival analysis showed that the high IFN-γ patients displayed longer median OS than that of the low IFN-γ patients (p = 0.049), while no statistical difference existed for PFS (p = 0.971). The multivariate analysis also confirmed that the high IFN-γ level was independently associated with a better prognosis (HR: 0.318 95% CI 0.113-0.894, p = 0.030).

CONCLUSIONS: Basal serum IFN-γ levels were associated with the DCR and OS of cancer patients with higher IFN-γ exhibiting beneficial efficiency for ICIs treatment.

PMID:35852620 | DOI:10.1007/s00432-022-04201-z

Z Gerontol Geriatr. 2022 Jul 19. doi: 10.1007/s00391-022-02086-8. Online ahead of print.

ABSTRACT

BACKGROUND: The intervention is a multiday health program of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) for informal caregivers.

AIM OF THE WORK: Does the intervention increase the use of outside help to gain free time for self-care?

MATERIAL AND METHODS: Using a quasi-experimental within-design, we analyze annual benefit data from the SVLFG long-term care insurance for the cluster sample Bavaria from 2017 to 2020 with intervention in 2018/2019. Using fixed effects panel regressions, we determine the effect heterogeneity for care relationship, duration of care and degree of care, adjusting for period effects (intervention and comparison group: 88 and 6045 persons with 207 and 16,091 observations, respectively).

RESULT: After the intervention, the use of services for outside help tends to be higher than before. The effect is significantly more pronounced with increasing care level, care within the partnership and shorter care duration. With care within the partnership, start of care before 1 year and care level 4/5, more outside help is used afterwards for 1160 € (p < 0.001) than before.

DISCUSSION: Design and statistical method would allow a causal conclusion; however, in view of the limitations, in particular the small number of cases in the intervention group and the only limited characteristics available to control for time-dynamic heterogeneity, caution is advisable.

PMID:35852589 | DOI:10.1007/s00391-022-02086-8