Nevin Manimala

J Dent. 2021 Oct 24:103861. doi: 10.1016/j.jdent.2021.103861. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the present prospective multicenter clinical study was to compare the detection of proximal caries with near-infrared light reflection (NILR) versus bitewing radiography (BWR).

MATERIALS AND METHODS: Intraoral scans were performed on 100 patients in five dental clinics using an intraoral scanner (iTero Element 5D, Align Technology, Tempe, AZ, USA) that includes a near-infrared light source (850nm) and sensor. Reflected near-infrared light images of posterior teeth were used by the individual dentists to detect proximal caries and the results were compared to the BWRs. In a total of 3499 proximal surfaces of molars and premolars which were examined 223 carious lesions were detected by BWR while NILR detected 549 carious lesions. Caries detection using both methods was also done by an expert team of five dentists, highly experienced in NILR image interpretation, who used the same sets of clinically-obtained data. Sensitivity, specificity, and accuracy were calculated for caries detection by both the dentists and the expert team. Fifty-nine of the detected carious lesions were clinically treated and the observations during caries excavation were compared with those done with NILR and BWR. Statistical analysis to compare between NILR and BWR diagnosis was performed using non-parametric two-sided McNemar’s Chi-Square test with the significance level set at p<0.05. Kappa coefficients were calculated to assess the level of agreement between the two caries detection methods.

RESULTS: Accuracy of NILR detection of early enamel lesions was 88% and that of carious lesions involving the dentino-enamel junction (DEJ) was 97%. Accuracy was found to be higher at 96% and 99%, respectively, when the same data were examined by the expert team. Direct observation during caries-excavation treatment suggested that NILR detected early enamel lesions that were not detectable with BWR alone.

CONCLUSIONS: Within the limitations of the present study, NILR was more sensitive than BWR in detecting early enamel lesions and comparable to BWR in detecting lesions that involved the DEJ.

CLINICAL RELEVANCE: Reflected near-infrared light images that are generated simultaneously with 3D intra-oral scanning may be used reliably for detection, screening, and monitoring of proximal caries, thus potentially minimizing the traditional use of ionizing radiation.

PMID:34706269 | DOI:10.1016/j.jdent.2021.103861

Appl Clin Inform. 2021 Oct;12(5):996-1001. doi: 10.1055/s-0041-1736338. Epub 2021 Oct 27.

ABSTRACT

BACKGROUND: Overuse of cardiac telemetry monitoring (telemetry) can lead to alarm fatigue, discomfort for patients, and unnecessary medical costs. Currently there are evidence-based recommendations describing appropriate telemetry use, but many providers are unaware of these guidelines.

OBJECTIVES: At our multihospital health system, our goal was to support providers in ordering telemetry on acute care in accordance with evidence-based guidelines and discontinuing telemetry when it was no longer medically indicated.

METHODS: We implemented a multipronged electronic health record (EHR) intervention at two academic medical centers, including: (1) an order set requiring providers to choose an indication for telemetry with a recommended duration based on American Heart Association guidelines; (2) an EHR-generated reminder page to the primary provider recommending telemetry discontinuation once the guideline-recommended duration for telemetry is exceeded; and (3) documentation of telemetry interpretation by telemetry technicians in the notes section of the EHR. To determine the impact of the intervention, we compared number of telemetry orders actively discontinued prior to discharge and telemetry duration 1 year pre- to 1 year post-intervention on acute care medicine services. We evaluated sustainability at years 2 and 3.

RESULTS: Implementation of the EHR initiative resulted in a statistically significant increase in active discontinuation of telemetry orders prior to discharge: 15% (63.4-78.7%) at one site and 13% at the other (64.1-77.4%) with greater improvements on resident teams. Fewer acute care medicine telemetry orders were placed on medicine services across the system (1,503-1,305) despite an increase in admissions and the average duration of telemetry decreased at both sites (62 to 47 hours, p < 0.001 and 73 to 60, p < 0.001, respectively). Improvements were sustained 2 and 3 years after intervention.

CONCLUSION: Our study showed that a low-cost, multipart, EHR-based intervention with active provider engagement and no additional education can decrease telemetry usage on acute care medicine services.

PMID:34706394 | DOI:10.1055/s-0041-1736338

Respiration. 2021 Oct 27:1-8. doi: 10.1159/000519279. Online ahead of print.

ABSTRACT

BACKGROUND: Transbronchial cryobiopsy (TBCB), a novel way of obtaining a specimen of lung tissue using a flexible cryoprobe, can obtain large lung biopsies without crush artifacts. The freezing time of TBCB was empirically selected from 3 to 7 s in the previous studies. However, no consensus has yet been reached regarding the optimal freezing time used in TBCB.

OBJECTIVES: The primary endpoint was biopsy size in different freezing times. The secondary endpoints included sample histological quality, diagnostic confidence, and complications in different freezing times.

METHODS: Patients who were suspected of DPLD requiring histopathological examination for further evaluation were enrolled in this study. Distinct biopsies were obtained by using different freezing times increased from 3 to 6 s sequentially. Samples were reviewed by 2 external expert pathologists.

RESULTS: A total of 33 patients were enrolled, and 143 transbronchial cryobiopsies were taken in this trial. An average of 4.33 samples were taken from each patient. The mean biopsy size of different freezing times from 3 to 6 s was 9.10 ± 4.37, 13.23 ± 5.83, 16.26 ± 5.67, and 18.83 ± 7.50 mm2, respectively. A strong correlation between freezing time and biopsy size was observed (r = 0.99, p < 0.01). Statistically significant difference of biopsy size was detected in the freezing time of 3 s versus 4 s (p < 0.01) and 4 s versus 5 s (p = 0.02), but not in the freezing time of 5 s versus 6 s (p = 0.10). Overall bleeding in different freezing times from 3 to 6 s was 53.33%, 67.50%, 89.47%, and 77.14%, respectively. A significantly higher overall bleeding was observed when the freezing time exceeded 4 s (RR = 1.67, p < 0.01). Pneumothorax occurred in 4 cases (12.12%). One lethal case (3.03%) was noted 25 days after TBCB. Lung parenchyma was preserved well in all cryobiopsy samples. Thirty-one (93.94%) patients’ histopathological findings were identified as sufficient to establish a CRP diagnosis. There was no statistical difference in diagnostic confidence between different freezing times.

CONCLUSION: A longer freezing time was associated with a larger size of the biopsy sample but a higher risk of bleeding. The optimal transbronchial cryobiopsy freezing time is 3-4 s, which is easily achievable and provides an adequate biopsy size whilst creating a safety threshold from complications.

PMID:34706367 | DOI:10.1159/000519279

Hand Surg Rehabil. 2021 Oct 24:S2468-1229(21)00598-3. doi: 10.1016/j.hansur.2021.10.314. Online ahead of print.

ABSTRACT

Several surgical and anesthesia techniques are used in carpal tunnel surgery. The practices of members of the American Society for Surgery of the Hand and the Canadian Society of Plastic Surgery were recently published and compared. Because of the great difference in these practices, we investigated the practices of the members of the French Society for Surgery of the Hand and how they have changed. An online survey including 14 close-ended and 12 open-ended questions was sent by email to all 685 surgeons who were members of the French Society for Surgery of the Hand in July 2019. Data were analyzed using descriptive statistics. The survey was completed by 129 members (19%). The open approach was used by 56% of the surgeons (8% by standard open technique, 48% by minimally invasive open technique), endoscopic techniques by 40% and ultrasound-guided techniques by 4%. Most surgeons used regional anesthesia (69%) or local anesthesia (25%). Half of the surgeons (50%) would consider changing their surgical technique. Sixty-one percent were interested in ultrasound-guided techniques and 34% in endoscopic techniques. Almost half the surgeons (48%) would consider changing their anesthesia technique and 97% were interested in local anesthesia. Our study showed that the open approach and regional anesthesia were the most frequently used techniques but that an increase in endoscopic and ultrasound-guided techniques as well as local anesthesia techniques was likely.

PMID:34706303 | DOI:10.1016/j.hansur.2021.10.314

Am J Audiol. 2021 Oct 27:1-8. doi: 10.1044/2021_AJA-21-00062. Online ahead of print.

ABSTRACT

Purpose This study examined medication use by individuals with tinnitus who were seeking help for their tinnitus by means of a psychological intervention. Method This study used a cross-sectional survey design and included individuals with tinnitus enrolled in an Internet-based cognitive behavioral therapy trial (n = 439). Study participants provided demographic details, completed various structured questionnaires and provided details about the medications used. The self-reported medications were classified using the United States Pharmacopeial Medicare Model Guidelines v7.0. Results Current medication use was reported by 67% (n = 293) of the study participants. Those currently using medication were older; had consulted their primary care physician, had greater tinnitus severity, depression, anxiety, and insomnia when compared with those not reporting any current medication use. The top 10 medication used included cardiovascular agents (n = 162; 55.3%), antidepressants (n = 80; 27.3%), electrolytes/minerals/metals/vitamins (n = 70; 23.9%), respiratory tract/pulmonary agents (n = 62; 21.2%), anxiolytics (n = 59; 20.1%), hormonal agents/stimulant/replacement/modifying (thyroid; n = 45; 15.4%), gastrointestinal agents (n = 43; 14.7%), analgesics (n = 33; 11.3%), blood glucose regulators (n = 32; 10.9%), and anticonvulsants (n = 26; 8.87%). Some associations between type of medication used and demographic or tinnitus-related variables were noted especially for the cardiovascular agents, electrolytes/minerals/metals/vitamins, and anxiolytics. Conclusions This exploratory study indicated a large percentage of patients using medication and a range of medications. Further studies are required to assess the effects of such medications on the tinnitus percept and concurrent medication moderate treatment effects.

PMID:34706212 | DOI:10.1044/2021_AJA-21-00062

BJU Int. 2021 Oct 27. doi: 10.1111/bju.15625. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze if exposure to sunitinib in the SURTIME trial which investigated opposite sequences of cytoreductive nephrectomy (CN) and systemic therapy is associated with the overall survival (OS) benefit observed in the deferred CN arm.

SUBJECTS AND METHODS: A post-hoc analysis of SURTIME trial data. Variables analysed included number of patients receiving sunitinib, time from randomisation to start sunitinib, overall response rate (ORR) by RECIST 1.1, and duration of drug exposure and dose in the intention-to-treat population of the immediate and deferred arm. Descriptive methods and 95% confidence-intervals (CI) were used.

RESULTS: In the deferred arm, 97.7%(CI:89.3-99.6; n=48) received sunitinib versus 80% (CI:66.9-88.7,n=40) in the immediate arm. Following immediate CN, 19.6% progressed 4 weeks after CN and median time to start sunitinib was 39.5 days versus 4.5 days in the deferred arm. At week 16, 46.0% had progressed at metastatic sites in the immediate CN arm versus 32.7% in the deferred arm. Sunitinib dose reductions, escalations and interruptions were not statistically significantly different between arms. Among patients who received sunitinib in the immediate or deferred arm the median total sunitinib treatment duration was 172.5 versus 248 days. Reduction of target lesions was more profound in the deferred arm.

CONCLUSIONS: In comparison to the deferred CN approach, immediate CN impairs administration, onset, and duration of sunitinib. Starting with systemic therapy leads to early and more profound disease control and identification of progression prior to planned CN which may have contributed to the observed OS benefit.

PMID:34706141 | DOI:10.1111/bju.15625

Equine Vet J. 2021 Oct 27. doi: 10.1111/evj.13527. Online ahead of print.

ABSTRACT

BACKGROUND: Synovial sepsis is a frequent cause of morbidity and mortality in horses. Despite advances in diagnostics and treatments, persistent infection or chronic lameness can occur.

OBJECTIVES: To perform a scoping review to identify and evaluate the current evidence on factors implicated in the success of treatment for synovial sepsis.

STUDY DESIGN: Joanna Briggs Institute scoping review.

METHODS: A protocol was registered and a systematic literature search was performed on CAB abstracts, Medline, Scopus and Embase. Inclusion and exclusion criteria were developed and studies systematically reviewed against this. Studies relating to factors affecting treatment success following synovial sepsis were retained and data was extracted on study method, population characteristics and factors significantly associated with treatment outcome.

RESULTS: In total, 2338 studies were identified, and 61 were included to full paper analysis. Eight papers reported significant factors, identifying 15 risk factors associated with two measurements of outcome, either survival and/or return to athletic function. The 15 factors were identified and categorised into pre-, intra- and post-operative factors. Risk factors that were identified included the number or type of synovial structures involved, the presence of pannus, tendon and bone pathology, and the use of systemic antimicrobials. There were many discrepancies in inclusion criteria of cases of synovial sepsis as well as measurement and description of outcome variables.

MAIN LIMITATIONS: Non-English language studies or conference proceedings were not included. Only small numbers of papers had similar findings.

CONCLUSIONS: Standardisation of inclusion criteria is essential to enable comparisons and analysis between studies on synovial sepsis. Future studies should use methodologies to reduce bias including multicentre and multinational studies, prospective study design, and robust statistical modelling.

PMID:34706106 | DOI:10.1111/evj.13527

Int J Cancer. 2021 Oct 27. doi: 10.1002/ijc.33856. Online ahead of print.

ABSTRACT

Treatment advances over the past five decades have resulted in significant improvements in survival from childhood cancer. Although survival rates are relatively high, social disparities in outcomes have been sometimes observed. In a population-based study, we investigated social inequalities by sex and deprivation in treatment receipt in childhood cancer in Ireland. Cancers incident in people aged 0-19 during 1994-2012 and treatments received were abstracted from the National Cancer Registry Ireland. Multivariable modified Poisson regression with robust error variance (adjusting for age, and year) was used to assess associations between sex and deprivation category of area of residence at diagnosis and receipt of cancer-directed surgery, chemotherapy or radiotherapy. 3,704 childhood cancers were included. Girls were significantly less likely than boys to receive radiotherapy for leukaemia overall (relative risk (RR)=0.70; 95% CI: 0.50-0.98), and ALL specifically (RR=0.54; 95% CI: 0.36-0.79), and surgery for CNS overall (RR=0.83; 95% CI: 0.74-0.93) and other CNS (RR=0.76; 95% CI: 0.60-0.96). Girls were slightly less likely to receive chemotherapy for NHL and surgery for Hodgkin lymphoma, but these results were not statistically significant. Children residing in more deprived areas were significantly less likely to receive chemotherapy for AML or surgery for lymphoma overall and Hodgkin lymphoma, but more likely to receive chemotherapy for medulloblastoma. These results may suggest social inequalities in treatment receipt for childhood cancers. Further research is warranted to explore whether similar patterns are evident in other childhood cancer populations and to better understand the reasons for the findings. This article is protected by copyright. All rights reserved.

PMID:34706069 | DOI:10.1002/ijc.33856

Aust Dent J. 2021 Oct 27. doi: 10.1111/adj.12881. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding factors that influence patients’ preferences towards oral cancer (OC) screening is imperative to provide high-quality evidence-based OC screening interventions that can be targeted for population-level uptake. This study determined adult patients’ knowledge and awareness of OC, and how health behaviours influenced their preferences towards OC screening.

METHODS: This cross-sectional study used a 42-point questionnaire, between February and May 2020 using a combination of in-person and telephone interviews. Chi-square test and multiple logistic regression analysis was applied to confounding factors that returned statistical significance against OC knowledge and awareness. Significance of p < 0.05 was accepted.

RESULTS: 68 (38.6%) participants out of a total 176 had good knowledge of OC and 89 (50.6%) had good awareness. 31.8% reported preference for OC screening by a general dental practitioner (GDP) over a general medical practitioner (GMP). Majority (72.7%) reported acceptance of OC screening at their next GDP visit. Ages 56-70 (OR=0.357, 95% CI) and previous smokers (OR=0.336, 95% CI) significantly influenced screening preferences. Knowledge of risk factors did not significantly influence OC screening preferences (χ2= 3.178, p=0.075).

CONCLUSIONS: Significant gaps in OC knowledge, screening and role of GDPs exist with smoking history and age influencing OC screening preferences.

PMID:34706067 | DOI:10.1111/adj.12881

Cancer. 2021 Oct 27. doi: 10.1002/cncr.33990. Online ahead of print.

ABSTRACT

BACKGROUND: Angiogenesis has an important role in thymic epithelial tumors (TETs). Regorafenib inhibits vascular endothelial growth factor receptors (VEGFRs), platelet-derived growth factor receptor β (PDGFR-β), and fibroblast growth factor receptors (FGFRs). This study explored the activity of regorafenib as monotherapy in patients with advanced or recurrent B2-B3 thymoma (T) and thymic carcinoma (TC) previously treated with platinum-containing chemotherapy.

METHODS: A Fleming single-arm, single-stage, phase 2 trial to evaluate the activity of regorafenib (160 mg once a day by mouth for 3 weeks on/1 week off) was planned. The study was designed to reject the null hypothesis of an 8-week progression-free survival (PFS) rate ≤25% with a type I error of 0.10 and a statistical power of 80% at the alternative hypothesis of an 8-week PFS rate of ≥50% (≥8 of 19 evaluable patients progression-free at 2 months).

RESULTS: From June 2016 to November 2017, 19 patients were enrolled (11T/8TC). We observed partial response (PR) in 1 patient (1T) (5.3%), stable disease (SD) in 14 patients (9T/5TC) (73.7%), and progressive disease in 2 patients (1T/1TC) (10.5%), with a disease control rate of 78.9%. According to Choi-criteria, 13 patients (68.4%) achieved PR, and 2 patients SD (10.5%). The median PFS was 9.6 months whereas median overall survival was 33.8 months. The 8-week PFS rate was 78.9% (15 of 19 patients). Grade 3-4 treatment-related adverse events were observed in 10 patients (52.6%).

CONCLUSIONS: The primary end point of this study was reached. The high rate of PR (Choi-criteria) suggests antitumor activity of regorafenib in TETs. On the basis of survival outcomes, the efficacy of regorafenib should be further evaluated in larger studies.

PMID:34706060 | DOI:10.1002/cncr.33990