Nevin Manimala

Aust Crit Care. 2022 Sep 9:S1036-7314(22)00094-7. doi: 10.1016/j.aucc.2022.07.004. Online ahead of print.

ABSTRACT

BACKGROUND: Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians.

OBJECTIVE: The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records.

METHODS: A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data.

RESULTS: Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient’s death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted.

CONCLUSIONS: This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians’ EOLC practices and education to improve clinician confidence with communication.

PMID:36089461 | DOI:10.1016/j.aucc.2022.07.004

Risk Anal. 2022 Sep 11. doi: 10.1111/risa.14018. Online ahead of print.

ABSTRACT

In this study, a new approach of machine learning (ML) models integrated with the analytic hierarchy process (AHP) method was proposed to develop a holistic flood risk assessment map. Flood susceptibility maps were created using ML techniques. AHP was utilized to combine flood vulnerability and exposure criteria. We selected Quang Binh province of Vietnam as a case study and collected available data, including 696 flooding locations of historical flooding events in 2007, 2010, 2016, and 2020; and flood influencing factors of elevation, slope, curvature, flow direction, flow accumulation, distance from river, river density, land cover, geology, and rainfall. These data were used to construct training and testing datasets. The susceptibility models were validated and compared using statistical techniques. An integrated flood risk assessment framework was proposed to incorporate flood hazard (flood susceptibility), flood exposure (distance from river, land use, population density, and rainfall), and flood vulnerability (poverty rate, number of freshwater stations, road density, number of schools, and healthcare facilities). Model validation suggested that deep learning has the best performance of AUC = 0.984 compared with other ensemble models of MultiBoostAB Ensemble (0.958), Random SubSpace Ensemble (0.962), and credal decision tree (AUC = 0.918). The final flood risk map shows 5075 ha (0.63%) in extremely high risk, 47,955 ha (5.95%) in high-risk, 40,460 ha (5.02%) in medium risk, 431,908 ha (53.55%) in low risk areas, and 281,127 ha (34.86%) in very low risk. The present study highlights that the integration of ML models and AHP is a promising framework for mapping flood risks in flood-prone areas.

PMID:36088657 | DOI:10.1111/risa.14018

BJU Int. 2022 Sep 11. doi: 10.1111/bju.15891. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category.

MATERIALS AND METHODS: Using data from the Prostate Cancer data Base Sweden, we identified a study frame of 5,543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of health care records for a stratified sample of 495/5,543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system.

RESULTS: Both no evidence and moderate evidence for PCa progression was more common in men aged above 85 years at death than those below 85 years (29% vs. 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men above 85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died of PCa, 13% (95% CI: 5%-19%) were estimated to have either no evidence or moderate evidence of PCa progression.

CONCLUSIONS: Weak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localized disease at diagnosis.

PMID:36088648 | DOI:10.1111/bju.15891

J Med Radiat Sci. 2022 Sep 11. doi: 10.1002/jmrs.617. Online ahead of print.

ABSTRACT

INTRODUCTION: In this study, we aimed to investigate the feasibility of gadoxetate low-temporal resolution (LTR) DCE-MRI for voxel-based hepatic extraction fraction (HEF) quantification for liver sparing radiotherapy using a deconvolution analysis (DA) method.

METHODS: The accuracy and consistency of the deconvolution implementation in estimating liver function was first assessed using simulation data. Then, the method was applied to DCE-MRI data collected retrospectively from 64 patients (25 normal liver function and 39 cirrhotic patients) to generate HEF maps. The normal liver function patient data were used to measure the variability of liver function quantification. Next, a correlation between HEF and ALBI score (a new model for assessing the severity of liver dysfunction) was assessed using Pearson’s correlation. Differences in HEF between Child-Pugh score classifications were assessed for significance using the Kruskal-Wallis test for all patient groups and Mann-Whitney U-test for inter-groups. A statistical significance was considered at a P-value <0.05 in all tests.

RESULTS: The results showed that the implemented method accurately reproduced simulated liver function; root-mean-square error between estimated and simulated liver response functions was 0.003, and the coefficient-of-variance of HEF was <20%. HEF correlation with ALBI score was r = -0.517, P < 0.0001, and HEF was significantly decreased in the cirrhotic patients compared to normal patients (P < 0.0001). Also, HEF in Child-Pugh B/C was significantly lower than in Child-Pugh A (P = 0.024).

CONCLUSION: The study demonstrated the feasibility of gadoxetate LTR-DCE MRI for voxel-based liver function quantification using DA. HEF could distinguish between different grades of liver function impairment and could potentially be used for functional guidance in radiotherapy.

PMID:36088635 | DOI:10.1002/jmrs.617

Proteins. 2022 Sep 11. doi: 10.1002/prot.26420. Online ahead of print.

ABSTRACT

Antibodies are key proteins produced by the immune system to target pathogen proteins termed antigens via specific binding to surface regions called epitopes. Given an antigen and the sequence of an antibody the knowledge of the epitope is critical for the discovery and development of antibody based therapeutics. In this work, we present a computational protocol that uses template-based modeling and docking to predict epitope residues. This protocol is implemented in three major steps. First, a template-based modeling approach is used to build the antibody structures. We tested several options, including generation of models using AlphaFold2. Second, each antibody model is docked to the antigen using the FFT based docking program PIPER. Attention is given to optimally selecting the docking energy parameters depending on the input data. In particular, the van der Waals energy terms are reduced for modeled antibodies relative to X-ray structures. Finally, ranking of antigen surface residues is produced. The ranking relies on the docking results, i.e., how often the residue appears in the docking poses’ interface, and also on the energy favorability of the docking pose in question. The method, called PIPER-Map, has been tested on a widely used antibody-antigen docking benchmark. The results show that PIPER-Map improves upon the existing epitope prediction methods. An interesting observation is that epitope prediction accuracy starting from antibody sequence alone does not significantly differ from that of starting from unbound (i.e., separately crystallized) antibody structure.

PMID:36088633 | DOI:10.1002/prot.26420

Colorectal Dis. 2022 Sep 11. doi: 10.1111/codi.16328. Online ahead of print.

ABSTRACT

The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations.

METHODS: This study compared management strategy based on the ACPGBI risk categorisation for malignant polyps. Univariate and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population wide analysis was performed of 1,646 malignant polyps, and the factors which predicted their management strategy, from Queensland, Australia from 2011-2019.

RESULTS: Overall 31.55% of patients with very-low or low risk disease proceeded to resection. Of those with high or very-high risk disease, 36.69% did not proceed to resection. In very-low and low risk polyps, age (p=0.003) and polyp location (p<0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very-high or high risk polyps age (p<0.001), type of facility (public or private) for the colonoscopy (p=0.037), right colonic polyps compared to left colonic (p=0.015) and rectal polyps (p<0.001) and mismatch repair mutations present (p=0.027) were predictive of resection in high risk disease using a multivariable model.

CONCLUSION: Over 30% of patients with very-low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very-high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve understanding management choices into the future.

PMID:36088629 | DOI:10.1111/codi.16328

Orv Hetil. 2022 Sep 11;163(37):1481-1489. doi: 10.1556/650.2022.32573. Print 2022 Sep 11.

ABSTRACT

INTRODUCTION: In international comparison, Hungary is in the forefront of cancer incidence and mortality statistics. Based on paper-based death certificates, mortality statistics are compiled by the Hungarian Central Statistical Office, while population-based measures of cancer incidences are performed by the Hungarian National Cancer Registry.

OBJECTIVE: Linking the records of these two independent databases can highlight their weaknesses and provide an opportunity to reconcile and verify collected data, which may emphasize the need to expand current data exchange protocols.

METHOD: Based on the Hungarian unique health care insurance ID, the mortality database of the Hungarian Central Statistical Office between 2012 and 2020 was compared with the data of the Hungarian National Cancer Registry from 2001 to 2020. Deaths in 2018, in particular those related to lung cancer, were examined in more depth to demonstrate the biases resulting from erroneous data collection.

RESULTS: The mortality database of the Hungarian Central Statistical Office contained 32 586 cases with an underlying cause of death of malignant neoplasm for 2018, of which 29 970 were identified in the Hungarian National Cancer Registry. Out of the 8716 deaths coded to lung cancer, 7957 corresponding individuals were also found in the Registry. From the matches, 7381 cases were marked with lung cancer in the Hungarian National Cancer Registry. For the remaining 576 cases, the Registry recorded different types of cancers, of which in 69 cases with lung metastasis.

DISCUSSION: The differences between the two databases may be caused by methodological differences in data collection, incomplete, inaccurate reporting and differences in processing algorithms. Nevertheless, the majority of the data in the examined databases were found to be appropriate for epidemiological studies.

CONCLUSION: Based on the outcomes of the present analysis, a revision of the data transfer between the two institutions is in order. The introduction of electronic Death certificate recording and validity checks are expected to improve the reliability of ID numbers and may shorten data processing times. Orv Hetil. 2022; 163(37): 1481-1489.

PMID:36088625 | DOI:10.1556/650.2022.32573

Arch Orthop Trauma Surg. 2022 Sep 11. doi: 10.1007/s00402-022-04603-1. Online ahead of print.

ABSTRACT

BACKGROUND: The treatment of periprosthetic femur fractures around a total knee replacement remains a technical challenge for the orthopedic surgeon. Management options include non-operative treatment, plate fixation, intramedullary nailing and distal femur replacement (DFR), with few studies comparing fixation with DFR. This is an up-to-date meta-analysis in the literature to directly compare clinical outcomes between fixation and distal femoral replacement in the treatment of supracondylar periprosthetic femur fractures.

METHODS: A stratified literature search of the Medline, EMBASE and Cochrane databases was performed. All studies in English language were searched from inception to July 2022. The search was performed with the following MeSH terms: Periprosthetic fracture AND ORIF OR Internal Fixation AND Distal Femur Replacement. The search was conducted using a predesigned search strategy where all eligible literature was critically appraised for methodological quality using the Cochrane collaboration tool. We included Level I, II and III studies comparing fixation with DFR in the treatment of periprosthetic supracondylar femur fractures. Data from eligible studies were extracted by two authors (NP and AR) and a table created which included author, year, sample size, mean age, measured parameters, follow-up period, fracture classification, length of stay (days), mortality rate, revision rate and complication rate.

RESULTS: The extracted data were pooled for meta-analysis using RevMan® v5.3.5 software (Nordic Cochrane Centre, Copenhagen, Denmark) and forest plots constructed. A p value < 0.05 was considered statistically significant and confidence intervals (CI) set to 95%. A total of six studies were included in the meta-analysis (n = 406). 153 patients underwent distal femur replacement and 253 patients underwent fixation with a mean follow-up time of 71.4 months. The results of this analysis suggest no statistically significant difference in measured outcomes.

CONCLUSION: The results of this meta-analysis suggest no proven statistically significant difference between DFR and fixation in terms of length of hospital stay, mortality rate, revision rate and complication rate for the treatment of periprosthetic supracondylar femur fractures. Further prospective randomized research may help to define the specific indications for each treatment option which must include fracture configuration. Early functional outcome and cost-effectiveness have yet to be evaluated in the available literature.

PMID:36088601 | DOI:10.1007/s00402-022-04603-1

Folia Med Cracov. 2022;62(1):105-122. doi: 10.24425/fmc.2022.141694.

ABSTRACT

Coronavirus infection (COVID-19) is a highly infectious disease of viral etiology. SARS-CoV-2 virus was first identified during the investigation of the outbreak of respiratory disease in Wuhan, China in December 2019. And already on March 11, 2020 COVID-19 in the world was characterized by the WHO as a pandemic. In Ukraine the situation with incidence COVID-19 remains difficult. The purpose of this study is to to develop a mathematical forecasting model for COVID-19 incidence in Ukraine using an exponential smoothing method. The article analyzes reports on basic COVID-19 incidence rates from 29.02.2019 to 01.10.2021. In order to determine the forecast levels of statistical indicators that characterize the epidemic process of COVID-19 the method of exponential smoothing was used. It is expected that from 29.02.2019 to 01.10.2021 the epidemic situation of COVID-19 incidence will stabilize. The indicator of “active patients” will range from 159.04 to 353.63 per 100 thousand people. The indicator of “hospitalized patients” can reach 15.43 and “fatalities” ‒ 1.87. The use of the method of exponential smoothing based on time series models for modeling the dynamics of COVID-19 incidence allows to develop and implement scientifically sound methods in order to prevent, quickly prepare health care institutions for hospitalization.

PMID:36088596 | DOI:10.24425/fmc.2022.141694

Folia Med Cracov. 2022;62(1):5-17. doi: 10.24425/fmc.2022.141687.

ABSTRACT

INTRODUCTION: The musculus flexor carpi radialis (FCR) is a muscle with an important function for the mechanics and physiology of the hand. Its isolation during intrauterine development occurs relatively late, which may result in the presence of high variability during the fetal period. The aim of this study is to determine the detailed typology of FCR in the fetal period based on the available material.

MATERIAL AND METHODS: A total of 114 human fetuses (53 female, 61 male) aged between 117.0 and 197.0 days of fetal life were included in the study. The research material was derived from the collections of the Department of Anatomy, Medical University of Wrocław. Fetuses were stored in typical conservation solvents. The study incorporated the following methods: anthropological, preparational, and image acquisition, which was obtained using an innovative digital microscope. Statistical analysis was performed using R software.

RESULTS: The typology of FCR was determined based on the characteristics of the distal attachment of the investigated muscle. The statistical analysis revealed a predominance of type I in the examined fetal material – the attachment located on metacarpal bone II (about 82% of cases). Type IV (attachment to the 4th metacarpal bone) occurs with a frequency of less than 10% and the remaining types II and III occur with a frequency of 4-6%. The statistical analysis did not reveal bilateral or dimorphic differences in the prevalence of each FCR type. In respect of the collected anthropometric parameters, no statistically significant dimorphic differences were revealed. For a more complete description, the FCR proportionality index was introduced. The mean value of this index was 0.6 and was independent of the side or sex of the analyzed fetus.

CONCLUSIONS: FCR in the fetal period is characterized by a stable course in both the proximal and distal attachments.

PMID:36088589 | DOI:10.24425/fmc.2022.141687