Nevin Manimala

J Patient Rep Outcomes. 2022 Jul 20;6(1):80. doi: 10.1186/s41687-022-00477-4.

ABSTRACT

BACKGROUND: Detecting anxiety in oncology patients is important, requiring valid yet brief measures. One increasingly popular approach is the Patient Reported Outcomes Measurement Information System (PROMIS); however, its validity is not well established in oncology. We assessed the convergent and criterion validity of PROMIS anxiety measures in an oncology sample.

METHODS: 132 oncology/haematology outpatients completed the PROMIS Anxiety Computer Adaptive Test (PROMIS-A-CAT) and the 7 item (original) PROMIS Anxiety Short Form (PROMIS-A-SF) along with six well-established measures: Hospital Anxiety and Depression Scale-Anxiety (HADS-A); Generalised Anxiety Disorder-7 (GAD-7); Depression, Anxiety and Stress Scale-Anxiety (DASS-A) and Stress (DASS-S); Distress Thermometer (DT) and PSYCH-6. Correlations, area under the curve (AUC) and diagnostic accuracy statistics were calculated with Structured Clinical Interview as the reference standard.

RESULTS: Both PROMIS measures correlated with all legacy measures at p < .001 (Rho = .56-.83). AUCs (> .80) were good for both PROMIS measures and comparable to or better than all legacy measures. At the recommended mild cut-point (55), PROMIS-A-SF had sensitivity (.67) comparable to or better than all the legacy measures, whereas PROMIS-A-CAT sensitivity (.59) was lower than GAD-7 (.67) and HADS-A (.62), but comparable to PSYCH-6 and higher than DASS-A, DASS-S and DT. Sensitivity for both was .79. A reduced cut-point of 51 on both PROMIS measures improved sensitivity (.83-.84) although specificity was only adequate (.61-.62).

CONCLUSIONS: The convergent and criterion validity of the PROMIS anxiety measures in cancer populations was confirmed as equivalent, but not superior to, established measures (GAD-7 and HADS-A). The PROMIS-A-CAT did not demonstrate clear advantages over PROMIS-A-SF.

PMID:35857151 | DOI:10.1186/s41687-022-00477-4

Eur Spine J. 2022 Jul 20. doi: 10.1007/s00586-022-07322-8. Online ahead of print.

ABSTRACT

PURPOSE: To compare the radiological outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either a domino connector was applied for osteotomy correction or not.

METHODS: Retrospective review of a prospective, multicenter adult spinal deformity database (5 sites). Inclusion criteria were adult patients who underwent PSO between L3 and L5 with a minimum follow-up of 2 years. Among 1243 patients in the database, 79 met the inclusion criteria, 41 in the no-domino (ND) group and 38 in the domino (D) group. The domino technique consisted of using 2 parallel rods connected by a domino on one side of the PSO in order to achieve gradual and controlled compression at the osteotomy site. Demographic data, operative parameters, spinopelvic parameters and complications were collected.

RESULTS: Demographic data and operative parameters were globally similar between both groups, and they showed a comparable preoperative sagittal malalignment. Segmental lordosis improved by 22° and 31° (p < 0.05) and L1S1 lordosis improved by 23° and 32° (p < 0.05) in the ND and D group, respectively. The use of multiple rods was similar between the groups (58% vs. 57%). Also, mechanical complications rate was globally similar between both groups with no statistically significant difference (22% vs. 28.9%).

CONCLUSION: Domino connector is a safe, powerful and efficient tool for pedicle subtraction osteotomy site closure. It improved the lumbar lordosis correction angle with an acceptable rate of complications.

PMID:35857129 | DOI:10.1007/s00586-022-07322-8

Langenbecks Arch Surg. 2022 Jul 20. doi: 10.1007/s00423-022-02605-6. Online ahead of print.

ABSTRACT

PURPOSE: The COVID-19 pandemic led to unprecedented changes in volume and quality of surgery. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, the current study assesses the impact of COVID-19 on surgical volume during each quarter of 2020 in comparison to 2019. Quality of surgical care during 2020 was also investigated by assessing postoperative complications, readmissions, and reoperations during 2020 in comparison to the previous 5 years.

MATERIALS AND METHODS: The NSQIP database was queried from 2015 to 2020. Descriptive statistics and a chi-squared test were utilized to compare demographic variables. A seasonal autoregressive integrated moving average time-series model was fit to assess the trend and seasonality of complications from 2015 to 2019 and was used to forecast the proportion of complications in the year 2020 and compared the forecast with the actual proportions graphically.

RESULTS: There were fewer patients operated on in 2020 compared to 2019, with the most dramatic drop in Q2 with a nearly 27% decrease. Patients with ASA class 3 or greater were operated on at a greater proportion in every quarter of 2020. Q2 of 2020 represented the highest proportion of any operative complications since 2015 at ~13%. Q4 of 2020 demonstrated a return to 2020 Q1 complication proportions.

CONCLUSION: Surgical volume was heavily affected in 2020, particularly in Q2. Patients during Q2 of 2020 were generally of a higher ASA class and had increased operative complications. Operative volume and overall surgical complication rate normalized over the next two quarters.

PMID:35857096 | DOI:10.1007/s00423-022-02605-6

Graefes Arch Clin Exp Ophthalmol. 2022 Jul 20. doi: 10.1007/s00417-022-05735-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the limbal ischemia objectively in ocular surface chemical injuries by using anterior segment optical coherence tomography angiography (AS-OCTA).

METHODS: In this cross-sectional study, acute ocular surface chemical injury patients with less than 1 week injury history were enrolled. Demographic data of the patients were noted, and detailed ophthalmological examination with Dua classification was performed. AS photographs and AS-OCTA images were obtained and used for the assessment of limbal ischemia. To visualize the limbal vasculature, the device was focused manually to get a sharp image for all 4 quadrants of the limbus. The absence of vasculature was regarded as “ischemia,” and the amount of the ischemia was defined in clock hours. The limbal ischemia detected in clinical evaluation with biomicroscopy was compared with the AS-OCTA detected ischemia amount to make a conclusion for the correlation.

RESULTS: Nineteen eyes of 18 patients with acute ocular surface chemical injury were enrolled to the study (2 female, 16 male). The mean age was 35.1 ± 10 (18-55), and the mean best corrected visual acuity was 0.75 ± 1 (0.1-3.1) LogMAR. The causative agents were acid in 6 and alkaline in 12 patients. Limbal ischemia detected by using AS-OCTA was greater ((5.8 ± 2.6 (2-10) clock hours) than that detected in biomicroscopy (4.8 ± 2.4 (2-12) clock hours). The difference was statistically significant (p < 0.0005).

CONCLUSION: AS-OCTA has a significant importance on limbal vascularity visualization; therefore, its use for more objective and sensitive evaluation of limbal ischemia in ocular surface chemical injuries seems to have a crucial impact. AS-OCTA images may reveal the extension of limbal ischemia more precisely than clinical evaluation with biomicroscopy. However, future studies with higher number of patients are needed to come to a specific conclusion.

PMID:35857088 | DOI:10.1007/s00417-022-05735-1

J Cataract Refract Surg. 2022 Jul 20. doi: 10.1097/j.jcrs.0000000000001016. Online ahead of print.

NO ABSTRACT

PMID:35857079 | DOI:10.1097/j.jcrs.0000000000001016

Strahlenther Onkol. 2022 Jul 20. doi: 10.1007/s00066-022-01977-4. Online ahead of print.

ABSTRACT

BACKGROUND: Small cell lung cancer (SCLC) is characterized by a high risk of brain metastasis and poor survival. This study aims to assess the prognostic role of lactate dehydrogenase (LDH) in limited-stage small cell lung cancer (LS-SCLC) treated with thoracic radiotherapy (TRT) and prophylactic cranial irradiation (PCI).

METHODS: This study retrospectively evaluated 197 consecutive patients who underwent TRT and PCI for LS-SCLC between November 2005 and October 2017. Both pretreatment and maximal serum LDH levels (mLDH) during treatment were checked, and an increased LDH level was defined as more than 240 IU/ml. Clinical factors were tested for associations with intracranial progression-free survival (IPFS) and overall survival (OS) after PCI. The Kaplan-Meier method was used to calculate survival rates, and multivariate Cox regression analyses were carried out to identify variables associated with survival.

RESULTS: Of the total patients, 28 had higher pretreatment LDH levels and mLDH levels were increased in 95 patients during treatment. In patients in the normal and elevated mLDH groups, the 1‑, 2‑, and 5‑year IPFS rates were 96.7% vs. 90.1%, 91.7% vs. 73.8%, and 87.8% vs. 61.0% (P < 0.01), respectively. Compared to those with normal LDH levels, patients with increased mLDH levels had a higher cumulative risk of intracranial metastasis (hazard ratio [HR] 3.87; 95% confidence interval [CI] 1.73-8.63; P < 0.01) and worse overall survival (HR 2.59; 95% CI 1.67-4.04; P < 0.01). The factors LDH level at baseline or changes between pretreatment level and maximum level during treatment failed to predict brain metastases or OS with statistical significance. In the multivariate analyses, both mLDH during treatment (HR 3.53; 95% CI 1.57-7.92; P = 0.002) and patient age ≥ 60 (HR 2.46; 95% CI 1.22-4.94; P = 0.012) were independently associated with worse IPFS. Factors significantly associated with worse OS included mLDH during treatment (HR 2.45; 95% CI 1.56-3.86; P < 0.001), IIIB stage (HR 1.75; 95% CI 1.06-2.88; P = 0.029), and conventional radiotherapy applied in TRT (HR 1.66; 95% CI 1.04-2.65; P = 0.034).

CONCLUSION: The mLDH level during treatment predicts brain metastasis and survival in LS-SCLC patients treated with TRT and PCI, which may provide valuable information for identifying patients with poor survival outcomes and possible candidates for treatment intensification.

PMID:35857072 | DOI:10.1007/s00066-022-01977-4

J Comp Physiol B. 2022 Jul 20. doi: 10.1007/s00360-022-01449-2. Online ahead of print.

ABSTRACT

Environmental stress is a major driver of ecological and evolutionary processes in nature. To cope with stress, organisms can adjust through phenotypic plasticity and/or adapt through genetic change. Here, we compared short-term behavioural (activity) and physiological (corticosterone levels, CORT) responses of Rana arvalis tadpoles from two divergent populations (acid origin, AOP, versus neutral origin, NOP) to acid and predator stress. Tadpoles were initially reared in benign conditions at pH 7 and then exposed to a combination of two pH (acid versus neutral) and two predator cue (predator cue versus no predator cue) treatments. We assessed behavioural activity within the first 15 min, and tissue CORT within 8 and 24 h of stress exposure. Both AOP and NOP tadpoles reduced their activity in acidic pH, but the response to the predator cue differed between the populations: AOP tadpoles increased whereas NOP tadpoles decreased their activity. The AOP and NOP tadpoles differed also in their CORT responses, with AOP being more responsive (CORT levels of NOP tadpoles did not differ statistically across treatments). After 8 h exposure, AOP tadpoles had elevated CORT levels in the acid-predator cue treatment and after 24 h exposure they had elevated CORT levels in all three stress treatments (relative to the benign neutral-no-cue treatment). These results suggest that adaptation to environmental acidification in R. arvalis is mediated, in part, via behavioural and hormonal plasticity.

PMID:35857071 | DOI:10.1007/s00360-022-01449-2

Clin Ter. 2022 Jul-Aug;173(4):384-395. doi: 10.7417/CT.2022.2450.

ABSTRACT

AIM: To investigate whether and how ten ethical principles are mentioned within documents on critical care resources allocation during public health emergencies.

MATERIALS AND METHODS: We conducted a search of documents con-cerning critical resources allocation during public emergencies publicly available from Google and two specific international websites, up to November 2020. Each document was analyzed by two independent reviewers to assess whether a reference to any of the 10 key ethical principles indicated by the Northern Italy Ethical Committee could be found in the documents. Cohen’s K statistic was used.

RESULTS: We obtained 34 documents, of which 19 were allocation frameworks, 15 crisis standards of care, 4 clinical triage protocol, 3 clinical guidelines and 2 public health emergency response plans. The principles most frequently mentioned as important for decision-making was “number of lives saved”, followed by “transparency”, “equity”, “respect of person and their autonomy”. The most cited tiebreakers were “younger first/life cycle” and “lottery”.

CONCLUSIONS: All documents aim to protect the life and health of the largest number of people and should be objective, ethical, transparent, applied equitably, and be publicly disclosed. It is plausible that short- and long-term prognostic tools can help allocate critical resources, but it remains strong that the decision-making process must be guided by a multi-principle ethical model that is not always easy to apply.

PMID:35857058 | DOI:10.7417/CT.2022.2450

Clin Ter. 2022 Jul-Aug;173(4):362-368. doi: 10.7417/CT.2022.2447.

ABSTRACT

BACKGROUND: The aim of this study is to investigate the effect of of 12 weeks of water aerobic exercise and atrovastain drug on apolipoproteins changes A1, ANP, BNP and CRP in older men with cardiovascular disesaes.

METHODS: In this study, we chose 40 patients with cardiovascular disease that were divideded in to four groups. Experimental groups selected exercise 3 times per weeks during 3 months with the method ofwalking on the water and carnal swimming.

RESULTS: The results were expressed as the mean ± sd, and all statistical comparisons were made by means of a one-way ANOVA test, followed by Tukey’sPost-Hoc analysis.

CONCLUSION: The effect of exercise and intervention taking Atorvastatin increased Apolipoproteins A1changes, but reducedANP, BNP, and CRP, followed by the reduction of disease cardiovascular and improve cardiovascular function.

PMID:35857055 | DOI:10.7417/CT.2022.2447

Palliat Support Care. 2022 Jul 20:1-11. doi: 10.1017/S147895152200092X. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to (i) develop a screening tool for determining distress and supportive care needs of adolescent and young adult cancer patients (AYAs) based on the NCCN’s Distress Thermometer and Problem List (DTPL), (ii) evaluate its feasibility, discriminant validity, and test-retest reliability in clinical settings, and (iii) report prevalence of distress and unmet needs.

METHOD: In the development phase, after translation of the Japanese version of the DTPL (DTPL-J) from English into Japanese and back translation, cognitive debriefing was performed. Items in the problem list were modified to better reflect AYAs’ concerns after interviews. The modified items were reviewed and accepted unanimously by healthcare professionals. In the feasibility phase, the DTPL-J for AYAs was used in a clinical setting for 3 months. Descriptive statistics of participants’ demographics, selected items, and DT scores were calculated to report prevalence of distress and unmet needs. Response and referral rates to experts were assessed to evaluate feasibility. Some items were compared with patient demographics to assess discriminant validity. Among the patients who responded at least twice, correlations between two consecutive screenings were assessed to evaluate test-retest reliability.

RESULTS: The DTPL-J consisted of 49 items in five categories. Of 251 patients, 232 (92.4%) were provided the DTPL-J and 230 (91.6%) responded. Based on the DT cutoff of ≥4, 69 of 230 patients (30%) had high distress. Anxiety (n = 85, 36.6%) was the most commonly selected item. Primary nurses referred 45 (21.7%) patients to an attending physician or another expert. Referral rates after DTPL-J use were higher than rates before use, but the difference was not statistically significant (p = 0.06). The items compared were consistent with their social background. A positive correlation was observed between two responses for some items.

SIGNIFICANCE OF RESULTS: The feasibility, discriminant validity, and test-retest reliability of the tool were suggested.

PMID:35856280 | DOI:10.1017/S147895152200092X