Nevin Manimala

Telemed J E Health. 2022 Sep 7. doi: 10.1089/tmj.2022.0042. Online ahead of print.

ABSTRACT

Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.

PMID:36070555 | DOI:10.1089/tmj.2022.0042

Invest Radiol. 2022 Sep 1. doi: 10.1097/RLI.0000000000000923. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to compare a new compressed sensing (CS) method for T2-weighted propeller acquisitions (T2CS) with conventional T2-weighted propeller sequences (T2conv) in terms of achieving a higher image quality, while reducing the acquisition time.

MATERIALS AND METHODS: Male participants with a clinical suspicion of prostate cancer were prospectively enrolled and underwent prostate magnetic resonance imaging at 3 T. Axial and sagittal images of the T2conv sequence and the T2CS sequence were acquired. Sequences were qualitatively assessed by 2 blinded radiologists concerning artifacts, image-sharpness, lesion conspicuity, capsule delineation, and overall image quality using 5-point Likert items ranging from 1 (nondiagnostic) to 5 (excellent). The apparent signal-to-noise ratio and apparent contrast-to-noise ratio were evaluated. PI-RADS scores were assessed for both sequences. Statistical analysis was performed by using Wilcoxon signed rank test and paired samples t test. Intrarater and interrater reliability of qualitative image evaluation was assessed using intraclass correlation coefficient (ICC) estimates.

RESULTS: A total of 29 male participants were included (mean age, 66 ± 8 years). The acquisition time of the T2CS sequence was respectively 26% (axial plane) and 24% (sagittal plane) shorter compared with the T2conv sequence (eg, axial: 171 vs 232 seconds; P < 0.001). In the axial plane, the T2CS sequence had fewer artifacts (4 [4-4.5] vs 4 [3-4]; P < 0.001), better image-sharpness (4 [4-4.5] vs 3 [3-3.5]; P < 0.001), better capsule delineation (4 [3-4] vs 3 [3-3.5]; P < 0.001), and better overall image quality (4 [4-4] vs 4 [3-4]; P < 0.001) compared with the T2conv sequence. The ratings of lesion conspicuity were similar (4 [4-4] vs 4 [3-4]; P = 0.166). In the sagittal plane, the T2CS sequence outperformed the T2conv sequence in the categories artifacts (4 [4-4] vs 3 [3-4]; P < 0.001), image sharpness (4 [4-5] vs 4 [3-4]; P < 0.001), lesion conspicuity (4 [4-4] vs 4 [3-4]; P = 0.002), and overall image quality (4 [4-4] vs 4 [3-4]; P = 0.002). Capsule delineation was similar between both sequences (3 [3-4] vs 3 [3-3]; P = 0.07). Intraobserver and interobserver reliability for qualitative scoring were good (ICC intra: 0.92; ICC inter: 0.86). Quantitative analysis revealed a higher apparent signal-to-noise ratio (eg, axial: 52.2 ± 9.7 vs 22.8 ± 3.6; P < 0.001) and a higher apparent contrast-to-noise ratio (eg, axial: 44.0 ± 9.6 vs 18.6 ± 3.7; P ≤ 0.001) of the T2CS sequence. PI-RADS scores were the same for both sequences in all participants.

CONCLUSIONS: CS-accelerated T2-weighted propeller acquisition had a superior image quality compared with conventional T2-weighted propeller sequences while significantly reducing the acquisition time.

PMID:36070533 | DOI:10.1097/RLI.0000000000000923

Clin Cardiol. 2022 Sep 7. doi: 10.1002/clc.23900. Online ahead of print.

ABSTRACT

BACKGROUND: The definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA), which has good long-term outcomes. However, after surgery, a quarter of the patients still have residual pulmonary hypertension (RPH). In pulmonary hemodynamics, there are no unified criteria for RPH, even though the level may affect long-term survival.

METHODS: Between March 1997 and December 2021, 253 CTEPH patients were treated at our center with PEA. Patients were evaluated retrospectively and classified into early (1997-2014) and late (2015-2021) groups. The clinical characteristics and perioperative outcomes of the two groups were compared, and risk factor analysis for RPH and long-term survival for all cases was performed.

RESULTS: There was no statistically significant difference in demographics between the two groups. However, the Early Group had a significantly higher rate of perioperative death (9.8% vs. 1.2%, p = .001), RPH (48.8% vs. 14.0%, p < .001), and reperfusion pulmonary edema (18.3% vs. 2.9%, p < .001). The median follow-up time was 66.0 months, and overall survival rates at 5, 10, 15, and 18 years after PEA were 91.2%, 83.9%, 64.5%, and 46.0%, respectively. Age and postoperative systolic pulmonary artery pressure (sPAP) were independently related to long-term outcomes in the multivariate Cox analyses. Patients with postoperative sPAP less than 46 mm Hg had a higher chance of survival.

CONCLUSIONS: PEA improved CTEPH hemodynamics immediately and had a positive effect on long-term survival. Patients with postoperative sPAP ≥ 46 mm Hg indicate clinically significant RPH and have a lower long-term survival rate.

PMID:36070474 | DOI:10.1002/clc.23900

Adv Wound Care (New Rochelle). 2022 Sep 7. doi: 10.1089/wound.2022.0017. Online ahead of print.

ABSTRACT

Significance Chronic wounds are associated with significant morbidity, marked loss of quality of life and considerable economic burden. Evidence-based risk prediction to guide improved wound prevention and treatment is limited by the complexity in their aetiology, clinical underreporting and a lack of studies using large high-quality datasets. Recent Advancements The objective of this review is to summarise key components and challenges in the development of personalised risk prediction tools for both prevention and management of chronic wounds, while highlighting several innovations in the development of better risk stratification. Critical issues Regression-based risk prediction approaches remain important for assessment of prognosis and risk stratification in chronic wound management. Advances in statistical computing have boosted the development of several promising machine learning and other semi-automated classification tools. These methods may be better placed to handle large number of wound healing risk factors from large datasets, potentially resulting in better risk prediction when combined with conventional methods and clinical experience and expertise. Future directions Where the number of predictors is large and heterogenous, the correlations between various risk factors complex, and very large data sets are available, then machine learning may prove a powerful adjuvant for risk-stratifying patients predisposed to chronic wounds. Conventional regression-based approaches remain important, particularly where the number of predictors is relatively small. Translating estimated risk derived from machine learning algorithms into practical prediction tools for use in clinical practice remains challenging.

PMID:36070447 | DOI:10.1089/wound.2022.0017

Phys Ther. 2022 Sep 7:pzac118. doi: 10.1093/ptj/pzac118. Online ahead of print.

NO ABSTRACT

PMID:36070432 | DOI:10.1093/ptj/pzac118

J Contin Educ Health Prof. 2022 Sep 5. doi: 10.1097/CEH.0000000000000455. Online ahead of print.

ABSTRACT

INTRODUCTION: Blended learning is an educational approach that integrates face-to-face with online instruction. This overview of existing systematic reviews aims to evaluate the impact of blended learning on educational outcomes in health care professional education, identify gaps in the current evidence, and direction for future reviews.

METHODS: Five databases were searched (January 1, 2000 to January 14, 2021) for systematic reviews of blended versus nonblended learning approaches for health care education. “Flipped classroom”, unpublished studies, abstracts, and study protocols were excluded. The extracted data included details of included reviews, description of populations, and outcomes according to Kirkpatrick levels. A narrative review is presented, along with an overarching meta-analysis, which evaluates a synthesized estimate of the effect of blended learning based on standardized mean differences.

RESULTS: Eleven systematic reviews were included, comprising of 160 primary studies (including 117 randomized controlled trials) from 56 countries with over 18,000 participants. The overall level of evidence was very low quality. An overarching meta-analysis of 93 studies addressing knowledge acquisition favored blended over nonblended learning methods (standardized mean difference 0.768 [95% confidence interval 0.594-0.941]; P < .001). None of the reviews identified an adverse effect on other educational outcomes.

DISCUSSION: Blended learning may be superior to traditional teaching approaches in improving knowledge acquisition. We recommend further research to describe the relative benefits of blended learning in each individual context and identify which elements of instructional design are beneficial for each outcome. Finally, we recommend the use of clear and consistent terminology in reported studies.

PMID:36070399 | DOI:10.1097/CEH.0000000000000455

Nicotine Tob Res. 2022 Sep 7:ntac209. doi: 10.1093/ntr/ntac209. Online ahead of print.

ABSTRACT

INTRODUCTION: E-cigarette advertising exposure is linked to e-cigarette initiation and use. Thus, monitoring trends in e-cigarette advertising practices is important to understand e-cigarette use patterns observed over recent years.

METHODS: E-cigarette advertising expenditures (January 2016-July 2021; Numerator Ad Intel) for 154 U.S. market areas were harmonized with U.S. Census sociodemographic data through Nielsen market area/zip code designations. Descriptive statistics and multivariable linear regressions were used to examine trends in e-cigarette advertising expenditures across media outlets and associations between sociodemographic characteristics and e-cigarette advertising over time.

RESULTS: E-cigarette advertising expenditures peaked in 2018/2019, followed by a sharp decline in 2020. Expenditures were concentrated primarily on print (58.9%), TV (20.6%) and radio (14.4%). Major print outlets were Sports Illustrated, Rolling Stone, and Star magazines. Top TV channels were AMC, Investigation Discovery, and TBS. TV advertisements were purchased commonly during popular movies/series (e.g., King of Queens, Everybody Loves Raymond, The Walking Dead). Higher expenditures were associated with U.S. market areas that had (a) a larger percentage of non-rural zip codes (radio), (b) smaller male populations (radio), and (c) larger White/Caucasian, Black/African American, American Indian/Alaska Native, Asian, and Other/Multiracial populations (radio, print, online display, online video).

CONCLUSIONS: E-cigarette companies advertised in print magazines geared toward males and youth/young adults, radio commercials focused in urban areas with smaller male populations, and nationwide TV commercials. Declines in e-cigarette advertising expenditures in 2020 demonstrate the potential impact that federal policies may have on protecting populations who are at higher risk for tobacco use from predatory advertising practices.

IMPLICATIONS: E-cigarette advertising exposure is associated with initiation and use of e-cigarettes. This study shows how e-cigarette marketing expenditures in the U.S. may have targeted specific consumers (e.g., youth/young adults) between 2016 and 2021. The precipitous drop in advertising expenditures across all outlets during early 2020 corresponds with the implementation of the Tobacco 21 federal policy, the federal enforcement policy to remove most unauthorized flavored e-cigarette cartridges from the U.S. market, preparations for FDA’s premarket review of e-cigarette products, and the decision by several TV broadcast companies to stop showing e-cigarette ads. The potential impact of federal policies may have far-reaching implications for protecting populations who are at high risk for tobacco use and its health consequences.

PMID:36070398 | DOI:10.1093/ntr/ntac209

PLoS Comput Biol. 2022 Sep 7;18(9):e1010430. doi: 10.1371/journal.pcbi.1010430. Online ahead of print.

ABSTRACT

Genetic risk for complex traits is strongly enriched in non-coding genomic regions involved in gene regulation, especially enhancers. However, we lack adequate tools to connect the characteristics of these disruptions to genetic risk. Here, we propose RWAS (Regulome Wide Association Study), a new application of the MAGMA software package to identify the characteristics of enhancers that contribute to genetic risk for disease. RWAS involves three steps: (i) assign genotyped SNPs to cell type- or tissue-specific regulatory features (e.g., enhancers); (ii) test associations of each regulatory feature with a trait of interest for which genome-wide association study (GWAS) summary statistics are available; (iii) perform enhancer-set enrichment analyses to identify quantitative or categorical features of regulatory elements that are associated with the trait. These steps are implemented as a novel application of MAGMA, a tool originally developed for gene-based GWAS analyses. Applying RWAS to interrogate genetic risk for schizophrenia, we discovered a class of risk-associated AT-rich enhancers that are active in the developing brain and harbor binding sites for multiple transcription factors with neurodevelopmental functions. RWAS utilizes open-source software, and we provide a comprehensive collection of annotations for tissue-specific enhancer locations and features, including their evolutionary conservation, AT content, and co-localization with binding sites for hundreds of TFs. RWAS will enable researchers to characterize properties of regulatory elements associated with any trait of interest for which GWAS summary statistics are available.

PMID:36070311 | DOI:10.1371/journal.pcbi.1010430

PLoS One. 2022 Sep 7;17(9):e0273078. doi: 10.1371/journal.pone.0273078. eCollection 2022.

ABSTRACT

A growing number of studies suggest that climate may impact the spread of COVID-19. This hypothesis is supported by data from similar viral contagions, such as SARS and the 1918 Flu Pandemic, and corroborated by US influenza data. However, the extent to which climate may affect COVID-19 transmission rates and help modeling COVID-19 risk is still not well understood. This study demonstrates that such an understanding is attainable through the development of regression models that verify how climate contributes to modeling COVID-19 transmission, and the use of feature importance techniques that assess the relative weight of meteorological variables compared to epidemiological, socioeconomic, environmental, and global health factors. The ensuing results show that meteorological factors play a key role in regression models of COVID-19 risk, with ultraviolet radiation (UV) as the main driver. These results are corroborated by statistical correlation analyses and a panel data fixed-effect model confirming that UV radiation coefficients are significantly negatively correlated with COVID-19 transmission rates.

PMID:36070304 | DOI:10.1371/journal.pone.0273078

PLoS One. 2022 Sep 7;17(9):e0273195. doi: 10.1371/journal.pone.0273195. eCollection 2022.

ABSTRACT

The selection of dialysate calcium concentration (D-Ca) is still controversial among chronic hemodialysis (HD) regimens. We examined the trajectories of CKD MBD parameters among the J-DAVID trial participants to see the effect of D-Ca and alfacalcidol. The trial was an open-label randomized clinical trial including 976 HD patients with intact PTH of 180 pg/mL or lower which compared the users of vitamin D receptor activator (oral alfacalcidol) and non-users over a median of 4 years. The main D-Ca used at baseline were 3.0 mEq/L in 70% and 2.5 mEq/L in 25%, respectively. The primary endpoint was the composite of fatal and non-fatal cardiovascular events and the secondary endpoint was all-cause mortality. Multivariable Cox proportional hazard regression analyses in which D-Ca was included as a possible effect modifier and serum laboratory data as time-varying covariates showed no significant effect modification for composite cardiovascular events or all-cause mortality. This post hoc analysis showed that the effects of alfacalcidol on cardiovascular outcomes were not significantly modified by D-Ca.

PMID:36070301 | DOI:10.1371/journal.pone.0273195