Nevin Manimala

Stroke. 2022 Nov 3. doi: 10.1161/STROKEAHA.122.039090. Online ahead of print.

ABSTRACT

BACKGROUND: We studied the evolution over time of diffusion weighted imaging (DWI) lesion volume and the factors involved on early and late infarct growth (EIG and LIG) in stroke patients undergoing endovascular treatment (EVT) according to the final revascularization grade.

METHODS: This is a prospective cohort of patients with anterior large artery occlusion undergoing EVT arriving at 1 comprehensive stroke center. Magnetic resonance imaging was performed on arrival (pre-EVT), <2 hours after EVT (post-EVT), and on day 5. DWI lesions and perfusion maps were evaluated. Arterial revascularization was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) grades. We recorded National Institutes of Health Stroke Scale at arrival and at day 7. EIG was defined as (DWI volume post-EVT-DWI volume pre-EVT), and LIG was defined as (DWI volume at 5d-DWI volume post-EVT). Factors involved in EIG and LIG were tested via multivariable lineal models.

RESULTS: We included 98 patients (mean age 70, median National Institutes of Health Stroke Scale score 17, final mTICI≥2b 86%). Median EIG and LIG were 48 and 63.3 mL in patients with final mTICI<2b, and 3.6 and 3.9 cc in patients with final mTICI≥2b. Both EIG and LIG were associated with higher National Institutes of Health Stroke Scale at day 7 (ρ=0.667; P<0.01 and ρ=0.614; P<0.01, respectively). In patients with final mTICI≥2b, each 10% increase in the volume of DWI pre-EVT and each extra pass leaded to growths of 9% (95% CI, 7%-10%) and 14% (95% CI, 2%-28%) in the DWI volume post-EVT, respectively. Furthermore, each 10% increase in the volume of DWI post-EVT, each extra pass, and each 10 mL increase in TMax6s post-EVT were associated with growths of 8% (95% CI, 6%-9%), 9% (95% CI, 0%-19%), and 12% (95% CI, 5%-20%) in the volume of DWI post-EVT, respectively.

CONCLUSIONS: Infarct grows during and after EVT, especially in nonrecanalizers but also to a lesser extent in recanalizers. In recanalizers, number of passes and DWI volume influence EIG, while number of passes, DWI, and hypoperfused volume after the procedure determine LIG.

PMID:36325911 | DOI:10.1161/STROKEAHA.122.039090

Disaster Med Public Health Prep. 2022 Nov 3:1-18. doi: 10.1017/dmp.2022.264. Online ahead of print.

ABSTRACT

INTRODUCTION: Owing to daily exposure to high job stress, nurses need to use coping techniques. One of the coping strategies helping a person to cope with stressful situations effectively is resiliency skills. The aim of this cross-sectional study was to examine the factors related to nurses’ resiliency during COVID-19 epidemic.

METHODS: The present study was cross-sectional and assessed the resiliency of 288 nurses working in the COVID-19 and non-COVID-19 wards was investigated. 25 items Connor & Davidson Resilience Questionnaire which scores the items between zero (completely incorrect) and five (always correct was used) was used for this end. This study was conducted in 2021 in four referral hospitals at Shiraz. In this study, nurses working in the COVID-19 care wards were selected as the study group and nurses in non-COVID-19 wards were selected as the control group.

RESULTS: The mean age of participants was 32. The average resilience score in the in the participants worked in COVID-19 wards was 95.30 for men and 87.72 for women, and in the non-COVID-19 wards was 85.82 for men and 88.48 for women. Factors affecting resilience included age, job status, gender and job expectancy. The results of the present study showed that the mean resiliency scores of nurses working in COVID-19 and non-COVID-19 wards did not show a statistically significant difference.

CONCLUSION: In this study Resiliency of nurses working in COVID-19 wards were not significantly differed from nurses of non-COVID-19 ones. This result should be further investigated and elaborated. With job planning regarding the employment and employment of nurses, considering their job expectation, gender, age and job status, we can be better prepared for future health system pandemics.

PMID:36325879 | DOI:10.1017/dmp.2022.264

Stud Health Technol Inform. 2022 Nov 3;299:235-241. doi: 10.3233/SHTI220990.

ABSTRACT

The spread of a new coronavirus infection in the last two years together with HIV infection preserves and even increases the potential for the spread of tuberculosis in the world. Sverdlovsk oblast (SO) of Russian Federation is the region with high levels of HIV and tuberculosis (TB). The search for new methods of forecasting of the future epidemic situation for tuberculosis has become particularly relevant. The aim was to develop an effective method for predicting the epidemic situation of tuberculosis using an artificial intelligence (AI) method in the format of a dynamic simulation model based on AI technologies. Statistical data was loaded from the state statistical reporting on TB patients for the period 2007-2017. The parameters were controlled through a system of inequalities. The proposed SDM made it possible to identify and reliably calculate trends of TB epidemiological indicators. Comparison of the predicted values made in 2017 with the actual values of 2018-2021 revealed a reliable coincidence of the trend of movement of TB epidemiological indicators in the region, the maximum deviation was no more than 14.82%. The forecast results obtained with SDM are quite suitable for practical use. Especially, in operational resource planning of measures to counteract the spread of tuberculosis at the regional level.

PMID:36325869 | DOI:10.3233/SHTI220990

Stud Health Technol Inform. 2022 Nov 3;299:151-156. doi: 10.3233/SHTI220974.

ABSTRACT

Improving the interoperability of healthcare information systems is a crucial clinical care issue involving disparate but coexisting information systems. However, healthcare organizations are also facing the dilemma of choosing the right ETL tool and architecture pattern as data warehouse enterprises. This article gives an overview of current ETL tools for healthcare data integration. In addition, we demonstrate three ETL processes for clinical data integration using different ETL tools and architecture patterns, which map data from various data sources (e.g. MEONA and ORBIS) to diverse standards (e.g. FHIR and openEHR). Depending on the project’s technical requirements, we choose our ETL tool and software architecture pattern to boost team efficiency.

PMID:36325856 | DOI:10.3233/SHTI220974

JMIR Res Protoc. 2022 Nov 2. doi: 10.2196/40894. Online ahead of print.

ABSTRACT

BACKGROUND: The consensus of the optimal treatment strategy for chronic Achilles tendinopathy (AT) is still debated and treatment options are limited. This results in a significant medical need for more effective treatment options.

OBJECTIVE: The aim of this study is to investigate the therapeutic effects of percutaneous bioelectric current stimulation (PBCS) on AT.

METHODS: A multi-center, randomized, double-blind, placebo-controlled clinical trial will be conducted. A total of 72 participants with chronic (>3 months) midpoint AT will be randomized and receive 4 PBCS (either verum or placebo) over 3 weeks. Both groups will complete daily Achilles tendon loading exercises in addition to the intervention. Evaluation sessions will be completed at baseline and intervention (weeks 0-3). Self-reported outcome measures will be completed at the follow-up in weeks 4, 12, 26, 52.Primary outcome: Victorian Institute of Sports Assessment – Achilles Questionnaire(Version: VISA-A) score: Statistical evaluation of intraindividual differences between baseline and 12 weeks after initial treatment after verum therapy compared to control. Secondary outcomes will assess pain disability index (PDI), average pain (11-point numeric rating scale – NRS), return to sports, and use of emergency medication.

RESULTS: Study began in May 2021. As of October 2022, we randomized 66 out of 72 participants. We anticipate completing recruiting in the fourth quarter of 2022 and primary data analysis in the first quarter of 2023.

CONCLUSIONS: The study will evaluate the effects of PBCS on pain, physical function and clinical outcomes.

CLINICALTRIAL: DRKS, DRKS00017293. Registered 1. February 2022. Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017293.

PMID:36325808 | DOI:10.2196/40894

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Oct;44(5):815-821. doi: 10.3881/j.issn.1000-503X.14608.

ABSTRACT

Objective To analyze the personality traits and nutrition package feeding behaviors of infant caregivers in remote rural areas of Sichuan province and explore the relationship between them. Methods A multi-stage random cluster sampling method was employed to select the infants of 6-24 months old and their caregivers in the remote rural areas of Sichuan province.A structured questionnaire was designed to collect the basic characteristics of infants and their caregivers,as well as the feeding behaviors of the caregivers.The Ten-Item Personality Inventory in China was used to evaluate the caregivers’ personality traits in five dimensions:extraversion,agreeableness,conscientiousness,emotional stability,and openness.Multivariate Logistic regression was adopted to analyze the relationship between personality traits and nutrition package feeding behaviors of infant caregivers. Results A total of 895 pairs of infants and their caregivers were investigated.The caregivers showed the average scores of 9.01±2.64,10.60±1.99,9.41±2.06,9.01±2.38,and 8.57±2.29 in the dimensions of extraversion,agreeableness,conscientiousness,emotional stability,and openness,respectively.The effective feeding rate of nutrition package was 53.3% (477/895).The results of regression analysis showed that under the premise of controlling for other factors,the caregiver’s conscientious personality (OR=1.08,95%CI=1.004-1.153,P=0.038) was the protective factor for the effective feeding of nutrition package. Conclusion The feeding behavior of infant caregivers in the remote rural areas of Sichuan province remains to be improved,and the caregivers with high conscientious personality are more likely to feed their infants effectively.

PMID:36325779 | DOI:10.3881/j.issn.1000-503X.14608

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Oct;44(5):802-808. doi: 10.3881/j.issn.1000-503X.14695.

ABSTRACT

Objective To understand the prevalence and influencing factors of hypertension among the elderly aged 60 years and above in Mianyang City,Sichuan Province,so as to provide clues for targeted prevention and control of hypertension. Methods A total of 115 775 permanent residents aged 60 and above screened out from Mianyang demonstration sites from October 2017 to April 2019 were investigated by questionnaire and physical examination,and the data of personal basic information,lifestyle,body height,body weight,waist circumference,and blood pressure were collected.SPSS 22.0 was used for descriptive analysis,single factor analysis,and Logistic regression analysis. Results The prevalence rate of hypertension in the elderly aged 60 years and above in Mianyang was 50.60%.Specifically,the prevalence rates of hypertension in men and women were 50.27% and 50.85%,respectively.The prevalence rate of hypertension increased with the increase in age([Formula: see text]=370.199,P<0001).Multivariate Logistic regression analysis showed that the independent risk factors of hypertension included age of 70-79 years(OR=1.327,95%CI=1.292-1.363,P<0.001),the age of 80 years and above(OR=1.455,95%CI=1.386-1.527,P<0.001),widowhood(OR=1.343,95%CI=1.296-1.392,P<0.001),divorce(OR=1.255,95%CI=1.033-1.525,P=0.022),overweight(OR=1.431,95%CI=1.391-1.473,P<0.001),obesity(OR=2.171,95%CI=2.076-2.270,P<0.001),waist-to-height ratio>0.5(OR=1.317,95%CI=1.281-1.354,P<0.001),history of diabetes(OR=1.865,95%CI=1.791-1.941,P<0.001),history of smoking(OR=1.107,95%CI=1.068-1.148,P<0.001),and history of drinking(OR=1.950,95%CI=1.894-2.009,P<0.001).Living in urban-rural fringe areas(OR=0.628,95%CI=0.594-0.664,P<0.001),education background of junior high school and above(OR=0.942,95%CI=0.912-0.974,P<0.001),and low body weight(OR=0.785,95%CI=0.742-0.830,P<0.001) were protective factors for hypertension. Conclusions More than 50% of the elderly aged 60 years and above in Mianyang suffer from hypertension.The elderly with advanced age,widowhood,divorce,overweight,obesity,waist-to-height ratio>0.5,diabetes history,smoking history,and drinking history are the high-risk groups of hypertension.

PMID:36325777 | DOI:10.3881/j.issn.1000-503X.14695

J Korean Neurosurg Soc. 2022 Nov 3. doi: 10.3340/jkns.2022.0200. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution.

METHODS: Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated.

RESULTS: A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p < 0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p < 0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p < 0.001). There was no TXA-related adverse event.

CONCLUSION: The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.

PMID:36325752 | DOI:10.3340/jkns.2022.0200

J Appl Clin Med Phys. 2022 Nov 3:e13820. doi: 10.1002/acm2.13820. Online ahead of print.

ABSTRACT

PURPOSE: To develop an independent log file-based intensity-modulated radiation therapy (IMRT) quality assurance (QA) tool for the 0.35 T magnetic resonance-linac (MR-linac) and investigate the ability of various IMRT plan complexity metrics to predict the QA results. Complexity metrics related to tissue heterogeneity were also introduced.

METHODS: The tool for particle simulation (TOPAS) Monte Carlo code was utilized with a previously validated linac head model. A cohort of 29 treatment plans was selected for IMRT QA using the developed QA tool and the vendor-supplied adaptive QA (AQA) tool. For 27 independent patient cases, various IMRT plan complexity metrics were calculated to assess the deliverability of these plans. A correlation between the gamma pass rates (GPRs) from the AQA results and calculated IMRT complexity metrics was determined using the Pearson correlation coefficients. Tissue heterogeneity complexity metrics were calculated based on the gradient of the Hounsfield units.

RESULTS: The median and interquartile range for the TOPAS GPRs (3%/3 mm criteria) were 97.24% and 3.75%, respectively, and were 99.54% and 0.36% for the AQA tool, respectively. The computational time for TOPAS ranged from 4 to 8 h to achieve a statistical uncertainty of <1.5%, whereas the AQA tool had an average calculation time of a few minutes. Of the 23 calculated IMRT plan complexity metrics, the AQA GPRs had correlations with 7 out of 23 of the calculated metrics. Strong correlations (|r| > 0.7) were found between the GPRs and the heterogeneity complexity metrics introduced in this work.

CONCLUSIONS: An independent MC and log file-based IMRT QA tool was successfully developed and can be clinically deployed for offline QA. The complexity metrics will supplement QA reports and provide information regarding plan complexity.

PMID:36325743 | DOI:10.1002/acm2.13820

Hosp Pract (1995). 2022 Nov 3. doi: 10.1080/21548331.2022.2144066. Online ahead of print.

ABSTRACT

OBJECTIVES: In the United States, approximately 18-25 percent of carotid duplex ultrasound (CUS) studies are ordered to assess patients with non-lateralizing neurological complaints such as syncope, blurry vision, lightheadedness, headache, and altered mental status. The purpose of this study is to evaluate the benefit of CUS in the evaluation of patients presenting with non-lateralizing signs or symptoms.

MATERIALS AND METHODS: We conducted a retrospective analysis to assess the degree and laterality of carotid stenosis among patients with non-lateralizing neurological complaints who underwent CUS interpreted by certified vascular neurologists over a period of three years. The primary endpoint was to identify the prevalence of moderate to severe carotid artery stenosis among 280 patients who met inclusion criteria.

RESULTS: 17.7% of CUS studies were ordered for non-lateralizing symptoms. 261 patients (93.21%) had either normal imaging or mild carotid stenosis of <50%. 19 patients (6.79%) were found to have stenosis of ≥50%. In this subgroup, age and known pre-existing carotid artery atherosclerotic disease were the only variables found to have a statistically significant association with the level of stenosis found on CUS. Two patients with asymptomatic stenosis of >70% underwent a revascularization procedure.

CONCLUSION: At least 17.7% of CUS studies were completed for non-lateralizing symptoms. The study is of low-yield with the prevalence of moderate to severe stenosis being comparable to that in the general asymptomatic population. We conclude that there is minimal clinical value in the use of CUS to investigate non-lateralizing neurological complaints, resulting in unnecessary healthcare costs.

PMID:36325737 | DOI:10.1080/21548331.2022.2144066