Nevin Manimala

BMJ Open. 2021 Nov 26;11(11):e052140. doi: 10.1136/bmjopen-2021-052140.

ABSTRACT

DESIGN AND OBJECTIVES: A cross-sectional study to evaluate the impact of COVID-19 on the psychosocial sphere in both the general population and healthcare workers (HCWs).

METHODS: The study was conducted in Catalonia (Spain) during the first wave of the COVID-19 pandemic when strict lockdown was in force. The study population included all people aged over 16 years who consented to participate in the study and completed the survey, in this case a 74-question questionnaire shared via social media using snowball sampling. A total of 56 656 completed survey questionnaires were obtained between 3 and 19 April 2020.The primary and secondary outcome measures included descriptive statistics for the non-psychological questions and the psychological impact of the pandemic, such as depression, anxiety, stress and post-traumatic stress disorder question scores.

RESULTS: A n early and markedly negative impact on family finances, fear of working with COVID-19 patients and ethical issues related to COVID-19 care among HCWs was observed. A total of seven target groups at higher risk of impaired mental health and which may therefore benefit from an intervention were identified, namely women, subjects aged less than 42 years, people with a care burden, socioeconomically deprived groups, people with unskilled or unqualified jobs, patients with COVID-19 and HCWs working with patients with COVID-19.

CONCLUSIONS: Active implementation of specific strategies to increase resilience and to prepare an adequate organisational response should be encouraged for the seven groups identified as high risk and susceptible to benefit from an intervention.

TRIAL REGISTRATION NUMBER: NCT04378452.

PMID:34836903 | DOI:10.1136/bmjopen-2021-052140

BMJ Open. 2021 Nov 26;11(11):e051711. doi: 10.1136/bmjopen-2021-051711.

ABSTRACT

INTRODUCTION: Previous evidence from several countries, including China, Italy, Mexico, UK and the USA, indicates that among patients with confirmed COVID-19 who were hospitalised, diabetes, obesity and hypertension might be important risk factors for severe clinical outcomes. Several preliminary systematic reviews and meta-analyses have been conducted on one or more of these non-communicable diseases, but the findings have not been definitive, and recent evidence has become available from many more populations. Thus, we aim to conduct a systematic review and meta-analysis of observational studies to assess the relationship of diabetes, obesity and hypertension with severe clinical outcomes in patients with COVID-19.

METHOD AND ANALYSIS: We will search 16 major databases (MEDLINE, Embase, Global Health, CAB Abstracts, PsycINFO, CINAHL, Academic Research Complete, Africa Wide Information, Scopus, PubMed Central, ProQuest Central, WHO Virtual Health Library, Homeland Security COVID-19 collection, SciFinder, Clinical Trials and Cochrane Library) for articles published between December 2019 and December 2020. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2016 guidelines for the design and reporting the results. We will include observational studies that assess the associations of pre-existing diabetes, obesity and hypertension in patients with COVID-19 with risk of severe clinical outcomes such as intensive care unit admission, receiving mechanical ventilation or death. Stata V.16.1 and R-Studio V.1.4.1103 statistical software will be used for statistical analysis. Meta-analysis will be used to estimate the pooled risks and to assess potential heterogeneities in risks.

ETHICS AND DISSEMINATION: The study was reviewed for human subjects concerns by the US CDC Center for Global Health and determined to not represent human subjects research because it uses data from published studies. We plan to publish results in a peer-reviewed journal and present at national and international conferences.

PROSPERO REGISTRATION NUMBER: CRD42021204371.

PMID:34836901 | DOI:10.1136/bmjopen-2021-051711

BMJ Open. 2021 Nov 26;11(11):e050989. doi: 10.1136/bmjopen-2021-050989.

ABSTRACT

OBJECTIVE: Aiming to investigate diabetic retinopathy (DR) risk factors and predictive models by machine learning using a large sample dataset.

DESIGN: Retrospective study based on a large sample and a high dimensional database.

SETTING: A Chinese central tertiary hospital in Beijing.

PARTICIPANTS: Information on 32 452 inpatients with type-2 diabetes mellitus (T2DM) were retrieved from the electronic medical record system from 1 January 2013 to 31 December 2017.

METHODS: Sixty variables (including demography information, physical and laboratory measurements, system diseases and insulin treatments) were retained for baseline analysis. The optimal 17 variables were selected by recursive feature elimination. The prediction model was built based on XGBoost algorithm, and it was compared with three other popular machine learning techniques: logistic regression, random forest and support vector machine. In order to explain the results of XGBoost model more visually, the Shapley Additive exPlanation (SHAP) method was used.

RESULTS: DR occurred in 2038 (6.28%) T2DM patients. The XGBoost model was identified as the best prediction model with the highest AUC (area under the curve value, 0.90) and showed that an HbA1c value greater than 8%, nephropathy, a serum creatinine value greater than 100 µmol/L, insulin treatment and diabetic lower extremity arterial disease were associated with an increased risk of DR. A patient’s age over 65 was associated with a decreased risk of DR.

CONCLUSIONS: With better comprehensive performance, XGBoost model had high reliability to assess risk indicators of DR. The most critical risk factors of DR and the cut-off of risk factors can be found by SHAP method to render the output of the XGBoost model clinically interpretable.

PMID:34836899 | DOI:10.1136/bmjopen-2021-050989

Eur Urol Focus. 2021 Nov 23:S2405-4569(21)00290-X. doi: 10.1016/j.euf.2021.10.011. Online ahead of print.

ABSTRACT

BACKGROUND: Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide.

OBJECTIVE: To develop recommendations for RIRS on the basis of existing data and expert consensus.

DESIGN, SETTING, AND PARTICIPANTS: A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%.

RESULTS AND LIMITATIONS: The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed.

CONCLUSIONS: The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting.

PATIENT SUMMARY: An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.

PMID:34836838 | DOI:10.1016/j.euf.2021.10.011

Pain Manag Nurs. 2021 Nov 23:S1524-9042(21)00216-2. doi: 10.1016/j.pmn.2021.09.007. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric postoperative pain is still undertreated.

AIMS: To assess whether educational intervention increases nurses’ knowledge and improves pediatric postoperative pain management.

DESIGN: Cluster randomized controlled trial with three measurement points (baseline T1, 1 month after intervention T2, and 6 months after intervention T3).

PARTICIPANTS/SUBJECTS: The study was conducted in postanesthesia care units at six hospitals in Norway. Nurses working with children in the included units and children who were undergoing surgery were invited to participate in this study.

METHODS: Nurses were cluster randomized by units to an intervention (n = 129) or a control group (n = 129). This allocation was blinded for participants at baseline. Data were collected using “The Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain: Norwegian Version” (primary outcome), observations of nurses’ clinical practice, and interviews with children. The intervention included an educational day, clinical supervision, and reminders.

RESULTS: At baseline 193 nurses completed the survey (75% response rate), 143 responded at T2, and 107 at T3. Observations of nurses’ (n = 138) clinical practice included 588 children, and 38 children were interviewed. The knowledge level increased from T1 to T3 in both groups, but there was no statistically significant difference between the groups. In the intervention group, there was an improvement between T1 and T2 in the total PNKAS-N score (70% vs. 83%), observed increase use of pain assessment tools (17% vs. 39%), and children experienced less moderate-to-severe pain.

CONCLUSIONS: No significant difference was observed between the groups after intervention, but a positive change in knowledge and practice was revealed in both groups. Additional studies are needed to explore the most potent variables to strengthen pediatric postoperative pain management.

PMID:34836822 | DOI:10.1016/j.pmn.2021.09.007

Biomed Chromatogr. 2021 Nov 26:e5285. doi: 10.1002/bmc.5285. Online ahead of print.

ABSTRACT

Bisphenol-A (BPA) is a high-production-volume industrial chemical mainly used in the production of polycarbonates and epoxy resins utilized in the manufacture of containers, bottles,toys, and medical devices. It has systemic effects as an endocrine-disruptor even at low-doses. In order to analyse the amount at biological materials sensitive and reproducible methods have to be used. Different doses and duration (90μg/L and 900μg/L, 24 hours, 120 hours and 21 days) of BPA exposure to whole body zebrafish was analysed after the specific homogenization of tissue, followed by a modified method by HPLC. The mobile phase was acetonitrile and water with a gradient method of reverse-phase C18 column and ex=227nm/em=313nm. The calibration curve for BPA in HPLC-FLD method was between 1-1000ng/mL concentration range, linear and r² =0.999. The mean and standard error of mean values (4.29±1.05, 2.50±0.92, 2.53±0.68) for control, and (10.43±2.61, 11.46±3.24, 8.55±3.11) for BPA-90μg/L and (17.78±4.39, 21.55±4.37, 25.32±3.25) for BPA-900μg/L (24 hours, 120 hours and 21 days respectively). Although some statistical significance among dose/time was observed between two different dose treated groups, statistical significance was not found in dose/time results within the group. However, the positive result of BPA in the control group can be explained by low-dose, chronic exposure or prevalence of EDC substances.

PMID:34826884 | DOI:10.1002/bmc.5285

J Neurosurg Spine. 2021 Nov 26:1-11. doi: 10.3171/2021.8.SPINE21651. Online ahead of print.

ABSTRACT

OBJECTIVE: Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM.

METHODS: A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0-18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models.

RESULTS: Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10-12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients.

CONCLUSIONS: Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

PMID:34826817 | DOI:10.3171/2021.8.SPINE21651

J Neurosurg Spine. 2021 Nov 26:1-8. doi: 10.3171/2021.8.SPINE21330. Online ahead of print.

ABSTRACT

OBJECTIVE: Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems.

METHODS: An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days.

RESULTS: In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases.

CONCLUSIONS: The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.

PMID:34826805 | DOI:10.3171/2021.8.SPINE21330

Neural Netw. 2021 Nov 16;146:1-10. doi: 10.1016/j.neunet.2021.11.010. Online ahead of print.

ABSTRACT

Prescription of Traditional Chinese Medicine (TCM) is a precious treasure accumulated in the long-term development of TCM. Artificial intelligence (AI) technology is used to build herb recommendation models to deeply understand regularities in prescriptions, which is of great significance to clinical application of TCM and discovery of new prescriptions. Most of herb recommendation models constructed in the past ignored the nature information of herbs, and most of them used statistical models based on bag-of-words for herb recommendation, which makes it difficult for the model to perceive the complex correlation between symptoms and herbs. In this paper, we introduce the properties of herbs as additional auxiliary information by constructing herb knowledge graph, and propose a graph convolution model with multi-layer information fusion to obtain symptom feature representations and herb feature representations with rich information and less noise. We apply the proposed model to the TCM prescription dataset, and the experiment results show that our model outperforms the baseline models in terms of Precision@5 by 6.2%, Recall@5 by 16.0% and F1-Score@5 by 12.0%.

PMID:34826774 | DOI:10.1016/j.neunet.2021.11.010

Clin Imaging. 2021 Nov 22;82:150-155. doi: 10.1016/j.clinimag.2021.11.006. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate if a computer-aided diagnosis (CAD) system on ultrasound (US) can improve the diagnostic performance of inexperienced radiologists.

METHODS: We collected ultrasound images of 256 breast lesions taken between March and May 2020. We asked two experienced and two inexperienced radiologists to retrospectively review the US features of each breast lesion according to the Breast Imaging Reporting and Data System (BI-RADS) categories. A CAD examination with S-Detect™ software (Samsung Healthcare, Seoul, South Korea) was conducted retrospectively by another uninvolved radiologist blinded to the BIRADS values previously attributed to the lesions. Diagnostic performances of experienced and inexperienced radiologists and CAD were compared and the inter-observer agreement among radiologists was calculated.

RESULTS: The diagnostic performance of the experienced group in terms of sensitivity was significantly higher than CAD (p < 0.001). Conversely, the diagnostic performance of inexperienced group in terms of both sensitivity and specificity was significantly lower than CAD (p < 0.001). We obtained an excellent agreement in the evaluation of the lesions among the two expert radiologists (Kappa coefficient: 88.7%), and among the two non-expert radiologists (Kappa coefficient: 84.9%).

CONCLUSION: The US CAD system is a useful additional tool to improve the diagnostic performance of the inexperienced radiologists, eventually reducing the number of unnecessary biopsies. Moreover, it is a valid second opinion in case of experienced radiologists.

PMID:34826773 | DOI:10.1016/j.clinimag.2021.11.006