Nevin Manimala

Anesth Analg. 2021 May 1;132(5):1223-1230. doi: 10.1213/ANE.0000000000005446.

ABSTRACT

BACKGROUND: Sleep disorders affect up to 25% of the general population and are associated with increased risk of adverse perioperative events. The key sleep medicine topics that are most important for the practice of anesthesiology have not been well-defined. The objective of this study was to determine the high-priority sleep medicine topics that should be included in the education of anesthesia residents based on the insight of experts in the fields of anesthesia and sleep medicine.

METHODS: We conducted a prospective cross-sectional survey of experts in the fields of sleep medicine and anesthesia based on the Delphi technique to establish consensus on the sleep medicine topics that should be incorporated into anesthesia residency curricula. Consensus for inclusion of a topic was defined as >80% of all experts selecting “agree” or “strongly agree” on a 5-point Likert scale. Responses to the survey questions were analyzed with descriptive statistical methods and presented as percentages or weighted mean values with standard deviations (SD) for Likert scale data.

RESULTS: The topics that were found to have 100% agreement among experts were the influence of opioids and anesthetics on control of breathing and upper airway obstruction; potential interactions of wake-promoting/hypnotic medications with anesthetic agents; effects of sleep and anesthesia on upper airway patency; and anesthetic management of sleep apnea. Less than 80% agreement was found for topics on the anesthetic implications of other sleep disorders and future pathways in sleep medicine and anesthesia.

CONCLUSIONS: We identify key topics of sleep medicine that can be included in the future design of anesthesia residency training curricula.

PMID:33857964 | DOI:10.1213/ANE.0000000000005446

J Nerv Ment Dis. 2021 Apr 15. doi: 10.1097/NMD.0000000000001348. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians’ concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care.

METHODS: Sources for this article were obtained via a selective literature search in PubMed using the terms “suffering” in the title and the terms “psychiatric disorder,” “mental illness,” “assessment,” “measurement,” “scale,” “existential suffering,” and “unbearable suffering.” Articles of interest were followed up using a snowball technique to examine “similar articles” and “cited by” titles to find additional pertinent articles.

RESULTS: Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders.

CONCLUSIONS AND IMPLICATIONS: Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians’ attention is limited to conventional psychiatric signs and symptoms.

PMID:33857957 | DOI:10.1097/NMD.0000000000001348

Menopause. 2021 Apr 12. doi: 10.1097/GME.0000000000001774. Online ahead of print.

ABSTRACT

OBJECTIVE: To predict the age at natural menopause (ANM).

METHODS: Cox models with time-dependent covariates were utilized for ANM prediction using longitudinal data from 47 to 55-year-old women (n = 279) participating in the Estrogenic Regulation of Muscle Apoptosis study. The ANM was assessed retrospectively for 105 women using bleeding diaries. The predictors were chosen from the set of 32 covariates by using the lasso regression (model 1). Another easy-to-access model (model 2) was created by using a subset of 16 self-reported covariates. The predictive performance was quantified with c-indices and by studying the means and standard deviations of absolute errors (MAE ± SD) between the predicted and observed ANM.

RESULTS: Both models included alcohol consumption, vasomotor symptoms, self-reported physical activity, and relationship status as predictors. Model 1 also included estradiol and follicle-stimulating hormone levels as well as SD of menstrual cycle length, while model 2 included smoking, education, and the use of hormonal contraception as additional predictors. The mean c-indices of 0.76 (95% CI 0.71-0.81) for model 1 and 0.70 (95% CI 0.65-0.75) for model 2 indicated good concordance between the predicted and observed values. MAEs of 0.56 ± 0.49 and 0.62 ± 0.54 years respectively for model 1 and 2 were clearly smaller than the MAE for predicted sample mean (1.58 ± 1.02).

CONCLUSIONS: In addition to sex hormone levels, irregularity of menstrual cycle, and menopausal symptoms, also life habits and socioeconomic factors may provide useful information for ANM prediction. The suggested approach could add value for clinicians’ decision making related to the use of contraception and treatments for menopausal symptoms in perimenopausal women.

Video Summary:http://links.lww.com/MENO/A743.

PMID:33857956 | DOI:10.1097/GME.0000000000001774

Urol Int. 2021 Apr 15:1-8. doi: 10.1159/000506652. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this article is to evaluate the efficacy and safety of prestenting (PS) versus non-PS (NPS) of flexible ureteroscopy (fURS) to treat large upper urinary stones.

METHODS: We conducted a systematic literature research of PubMed, Ovid, Scopus (up to August 2019), and citation lists to identify eligible studies. All studies comparing PS versus NPS of fURS were included. Data were analyzed using the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software.

RESULTS: Overall, 7 studies including 3,145 patients (PS 1,408; NPS 1,737) were included in this article. PS group was associated with older age (weighted mean difference [WMD] 0.91 year; p < 0.001) and more male patients (odds ratio [OR] 1.34; p < 0.001). There were no statistical differences between PS and NPS in BMI (WMD 0.34 kg/m2; p = 0.13), stone size (WMD 0.13 mm; p = 0.77), and operative time (WMD 0.44 min; p = 0.86). Compared with NPS, PS showed better initial success rate (OR 4.04; p < 0.001) and higher SFR (OR 1.64; p < 0.001). There were no statistical differences for complications (OR 0.84; p = 0.42) and Clavien-Dindo score ≥3 complications (OR 1.04; p = 0.93).

CONCLUSION: PS could improve initial success rate and avoid secondary general anesthesia for first ureteral access sheath failed patients. PS could provide better SFR than NPS in the treatment of large upper urinary stones with fURS.

PMID:33857952 | DOI:10.1159/000506652

Complement Med Res. 2021 Apr 15:1-10. doi: 10.1159/000516026. Online ahead of print.

ABSTRACT

INTRODUCTION: Individualized homeopathy (IH) in atopic dermatitis (AD) remained under-researched.

OBJECTIVE: We aimed at evaluating efficacy of IH in AD.

METHODS: A double-blind, randomized, placebo-controlled, short-term, preliminary trial was conducted in an Indian homeopathy hospital. Patients were randomized to either IH (n = 30) or identical-looking placebo (n = 30) using computerized randomization and allocation. Outcomes were patient-oriented scoring of AD (PO-SCORAD; primary end point), Dermatological Life Quality Index (DLQI) score, and AD burden score for adults (ADBSA; secondary end points), measured monthly for 3 months. An intention-to-treat sample was analyzed after adjusting baseline differences.

RESULTS: On PO-SCORAD, improvement was higher in IH against placebo, but nonsignificant statistically (pmonth 1 = 0.433, pmonth 2 = 0.442, pmonth 3 = 0.229). Secondary outcomes were also nonsignificant – both DLQI and ADBSA (p > 0.05). Four adverse events (diarrhea, injury, common cold) were recorded.

CONCLUSIONS: There was a small, but nonsignificant direction of effect towards homeopathy, which renders the trial inconclusive. A properly powered robust trial is indicated.

PMID:33857943 | DOI:10.1159/000516026

Rep Prog Phys. 2021 Apr 15. doi: 10.1088/1361-6633/abf893. Online ahead of print.

ABSTRACT

Charles Richter’s observation that “only fools and charlatans predict earthquakes,” reflects the fact that despite more than 100 years of effort, seismologists remain unable to do so with reliable and accurate results. Meaningful prediction involves specifying the location, time, and size of an earthquake before it occurs to greater precision than expected purely by chance from the known statistics of earthquakes in an area. In this context, “forecasting” implies a prediction with a specification of a probability of the time, location, and magnitude. Two general approaches have been used. In one, the rate of motion accumulating across faults and the amount of slip in past earthquakes is used to infer where and when future earthquakes will occur and the shaking that would be expected. Because the intervals between earthquakes are highly variable, these long-term forecasts are accurate to no better than a hundred years. They are thus valuable for earthquake hazard mitigation, given the long lives of structures, but have clear limitations. The second approach is to identify potentially observable changes in the earth that precede earthquakes. Various precursors have been suggested, and may have been real in certain cases, but none have yet proved to be a general feature preceding all earthquakes or to stand out convincingly from the normal variability of the earth’s behavior. However, new types of data, models, and computational power may provide avenues for progress using machine learning that were not previously available. At present, it is unclear whether deterministic earthquake prediction is possible. The frustrations of this search have led to the observation that (echoing Yogi Berra) “it is difficult to predict earthquakes, especially before they happen.” However, because success would be of enormous societal benefit, the search for methods of earthquake prediction and forecasting will likely continue.

PMID:33857928 | DOI:10.1088/1361-6633/abf893

J Natl Compr Canc Netw. 2021 Apr 15:1-8. doi: 10.6004/jnccn.2020.7684. Online ahead of print.

ABSTRACT

BACKGROUND: Maintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement.

METHODS: We searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult-specific and non-older adult-specific studies were compared using the Fisher exact test.

RESULTS: We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult-specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics.

CONCLUSIONS: Functional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).

PMID:33857918 | DOI:10.6004/jnccn.2020.7684

Water Res. 2021 Apr 5;197:117109. doi: 10.1016/j.watres.2021.117109. Online ahead of print.

ABSTRACT

Tracer tests represent a well-established method for delineating key environmental processes in various media and engineered systems. Tracers like Rhodamine B and WT are frequently applied due to their strong fluorescence even at low concentrations.. However, due to a lack of ecotoxicological data, limit values for these tracers cannot be determined. This study fills this critical data gap by providing ecotoxicity data for Rhodamine B and WT using a battery of short-term standardized tests, including growth rate inhibition tests with algae (Raphidocelis subcapitata) and lethality tests using crustaceans (Daphnia magna) and zebrafish (Danio rerio) embryos, and estimating EQS for surface water. For Rhodamine B, the effective and lethal concentration (EC₅₀ and LC₅₀) -causing 50% toxicity were in the range of 14-24 mg/L. For Rhodamine WT, no statistically significant effects were observed (p<0.05) at the tsted concentrations (up to 91, 100 and 200 mg/L for algae, crustaceans and fish embryos, respectively). Thus for all tested organisms, Rhodamine B was more toxic than Rhodamine WT (more than 14 times more toxic for R. subcapitata, 5.6 times for D. magna, 15 times for D. rerio embryos,based on EC₁₀ and LC₁₀ values). These results signify that read-across assessments using ecotoxicity data obtained with Rhodamine B is not advisable for estimating the ecotoxicity of Rhodamine WT. The annual-average quality standard (AA-QS) and maximum allowable concentration quality standard (MAC-QS) for Rhodamine B were found to be 14 and 140 µg/L, respectively. For Rhodamine WT, the corresponding values were estimated to >91 µg/L (AA-QS) and >910 µg/L (MAC-QS). Hence, concentrations below 140 µg/L or 910 µg/L for Rhodamine B and WT, respectively, are not expected to pose a risk to aquatic freshwater life in the case of intermittent discharges, e.g. tracer experiments released in streams.

PMID:33857893 | DOI:10.1016/j.watres.2021.117109

Epidemics. 2021 Mar 19;35:100457. doi: 10.1016/j.epidem.2021.100457. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had an unprecedented impact on citizens and health care systems globally. Valid near-term projections of cases are required to inform the escalation, maintenance and de-escalation of public health measures, and for short-term health care resource planning.

METHODS: Near-term case and epidemic growth rate projections for Canada were estimated using three phenomenological models: the logistic model, Generalized Richard’s model (GRM) and a modified Incidence Decay and Exponential Adjustment (m-IDEA) model. Throughout the COVID-19 epidemic in Canada, these models have been validated against official national epidemiological data on an ongoing basis.

RESULTS: The best-fit models estimated that the number of COVID-19 cases predicted to be reported in Canada as of April 1, 2020 and May 1, 2020 would be 11,156 (90 % prediction interval: 9,156-13,905) and 54,745 (90 % prediction interval: 54,252-55,239). The three models varied in their projections and their performance over the first seven weeks of their implementation. Both the logistic model and GRM under-predicted cases reported a week following the projection date in nearly all instances. The logistic model performed best at the early stages, the m-IDEA model performed best at the later stages, and the GRM performed most consistently during the full period assessed.

CONCLUSIONS: All three models have yielded qualitatively comparable near-term forecasts of cases and epidemic growth for Canada. Under or over-estimation of projected cases and epidemic growth by these models could be associated with changes in testing policies and/or public health measures. Simple forecasting models can be invaluable in projecting the changes in trajectory of subsequent waves of cases to provide timely information to support the pandemic response.

PMID:33857889 | DOI:10.1016/j.epidem.2021.100457

J Mech Behav Biomed Mater. 2021 Apr 9;119:104505. doi: 10.1016/j.jmbbm.2021.104505. Online ahead of print.

ABSTRACT

This paper presents the results of a study of the actin cytoskeletal structures and the statistical variations in the actin fluorescence intensities and viscoelastic properties of non-tumorigenic breast cells and triple-negative breast cancer cells at different stages of tumor progression. The variation in the actin content of the cell cytoskeletal structures is shown to be consistent with the viscoelastic properties of the cell as it progresses from non-tumorigenic to more metastatic states. The corresponding viscoelastic properties of the nuclei and the cytoplasm (Young’s moduli, viscosities, and relaxation times) of the cells are also measured using Digital Image Correlation (DIC) and shear assay techniques. These properties are shown to exhibit statistical variations that are well characterized by normal distributions. The changes in the mean properties of individual cancer cells are tested using Fisher pairwise comparisons and the analysis of variance (ANOVA). The implications of the results are then discussed for the development of shear assay techniques and mechanical biomarkers for the detection of triple-negative breast cancer at different stages of tumor progression.

PMID:33857875 | DOI:10.1016/j.jmbbm.2021.104505