Nevin Manimala

Acta Psychol (Amst). 2021 Mar 22;215:103271. doi: 10.1016/j.actpsy.2021.103271. Online ahead of print.

ABSTRACT

Despite the essential role of statistical learning in shaping human behavior, there are still controversies concerning its measurement. In this paper, we present a novel online target-detection task in an acoustic word segmentation paradigm, which is able to track the process of learning and does not build on deliberation and decision making. Beside testing the novel online task, we also examined its relationship with two offline measures: the traditional two-alternative forced choice (2AFC) task, and the statistically-induced chunking recall (SICR) task (Isbilen et al., 2017). Participants showed a significant learning effect on the online task, reflected in the decrease of reaction times during training and in the differences between reaction times to predictable versus unpredictable targets. Online learning scores correlated with the 2AFC scores, but this association was only present when participants did not have explicit knowledge about stimuli. SICR scores were not associated with any of the other measures. The internal consistency was higher for online learning measures than for the other two tasks. These findings show that the online target detection task is a good tool for assessing statistical learning, and invite further research on its psychometric properties.

PMID:33765521 | DOI:10.1016/j.actpsy.2021.103271

Int J Drug Policy. 2021 Mar 22;94:103206. doi: 10.1016/j.drugpo.2021.103206. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of infective endocarditis (IE) and other systemic bacterial infections is increasing, and people who inject drugs (PWID) have higher rates of discharge against medical advice (AMA) for these infections than patients whose infections are not injection-related. In this study, we characterize factors that contribute to AMA hospital discharge among PWID.

METHODS: We conducted qualitative interviews with twenty PWID hospitalized with serious injection-related bacterial infections in West Virginia. Participants completed a brief survey and in-depth qualitative interview. Interviews were recorded and transcribed verbatim and analyzed using a codebook developed based on deductive and inductive thematic analysis. We also conducted medical records abstraction and used descriptive statistics to summarize medical and survey data.

RESULTS: Average age was 34 years, 55% were female, 95% identified as white, and 75% had a primary diagnosis of IE. Drugs injected prior to hospitalization were methamphetamine (60%), prescription opioids (38%), and/or heroin/fentanyl (25%). Participants cited multiple contributors to AMA discharge including negative interactions with hospital staff that they perceived as stigmatizing, including being searched or monitored for illicit drug use; inadequate management of pain and withdrawal; boredom and confinement during lengthy hospitalizations; and isolation from family and other social supports.

CONCLUSION: We identified multiple factors contributing to AMA discharge that are amenable to intervention. Given the significant morbidity, mortality, and financial costs associated with hospitalizing PWID for serious injection-related bacterial infections, hospitals should be highly motivated to develop and test interventions designed to improve outcomes among these patients.

PMID:33765516 | DOI:10.1016/j.drugpo.2021.103206

Eur J Cancer. 2021 Mar 22;148:287-296. doi: 10.1016/j.ejca.2021.01.053. Online ahead of print.

ABSTRACT

AIM: To present the pre-specified analyses of >5-years follow-up of the Phase III ALTTO trial.

PATIENTS AND METHODS: 8381 patients with stage I-III HER2 positive breast cancer randomised to chemotherapy plus 1-year of trastuzumab (T), oral lapatinib (L; no longer evaluated), trastuzumab followed by lapatinib (T→L), and lapatinib + trastuzumab (L+T). The primary endpoint was disease-free survival (DFS). A secondary analysis examined DFS treatment effects by hormone receptor status, nodal status and chemotherapy timing; time to recurrence; overall survival (OS) and safety (overall and cardiac).

RESULTS: At a median follow-up of 6.9 years, 705 DFS events for L+T versus T were observed. Hazard Ratio (HR) for DFS was 0.86 (95% CI, 0.74-1.00) for L+T versus T and 0.93 (95% CI, 0.81-1.08) for T→L versus T. The 6-year DFS were 85%, 84%, and 82% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T versus T and 0.88 (95% CI, 0.71-1.08) for T→L versus T. The 6-year OS were 93%, 92%, and 91% for L+T, T→L, and T, respectively. Subset analyses showed a numerically better HR for DFS in favour of L+T versus T for the hormone-receptor-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS% = 84% versus 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS% = 83% versus79%)] subgroups.

CONCLUSION: T+L did not significantly improve DFS and OS over T alone, both with chemotherapy, and, therefore, cannot be recommended for adjuvant treatment of early-stage HER2-positive breast cancer.

TRIAL REGISTRATION: clinicaltrials.gov Identifier NCT00490139.

PMID:33765513 | DOI:10.1016/j.ejca.2021.01.053

Midwifery. 2021 Mar 15;98:102988. doi: 10.1016/j.midw.2021.102988. Online ahead of print.

ABSTRACT

OBJECTIVE: Variation in practice in relation to indications and timing for both induction of labour (IOL) and planned caesarean section (CS) clearly exists. However, the extent of this variation, and how this variation is explained by clinicians remains unclear. The aim of this study was to map the variation in IOL and planned CS at eight Australian hospitals, and understand why variation occurs from the perspective of clinicians at these hospitals. Our ultimate aim was to identify opportunities for improvement as evidenced by hospital data, clinician experiences, and feedback.

DESIGN: A two-phased mixed method study using sequential explanatory study design. The first phase consisted of an analysis of routinely collected patient data to map variation between hospitals. The second phase consisted of focus groups with clinicians to gain their perspectives on the reasons for variation.

SETTING AND PARTICIPANTS: Patient data consisted of routine data from 19,073 women giving birth at eight Sydney hospitals between November 2017 and October 2018. Focus groups were attended by a total of 61 medical staff and 121 midwives.

RESULTS: Hospital data analysis found substantial variation, before and after adjustment for case-mix, in rates of both IOL (adjusted rates 27.6%-42%) and planned CS (adjusted rate 15.4%-22.6%). Planned CS by gestation also showed variation, although after restricting analysis to term (≥37 weeks gestation) births, variation was reduced. At focus groups, five main themes explaining variation emerged: local guidelines, policies and procedures (inconsistency and ambiguity); uncertainty of the evidence/what is best practice (contradictory research and different interpretations of evidence); clinician preferences, beliefs and values; the culture of the unit; and organisational influences (access to specialised clinics, theatre time).

KEY CONCLUSIONS: Considerable variation in IOL and planned CS, even after case-mix adjustment, was found in this sample of Australian hospitals. Engagement with hospital clinicians identified likely sources of this variation and enabled clinicians at each hospital to consider appropriate local responses to address variation, such as more detailed review of their planned birth cases.

IMPLICATIONS FOR PRACTICE: At a macro level, measures to reduce unwarranted variation should initially focus on consistent national guidelines, while supporting equitable access to operating theatres for optimal CS timing, and shared decision-making training to reduce influence of clinician preference.

PMID:33765483 | DOI:10.1016/j.midw.2021.102988

West Afr J Med. 2021 Mar 22;38(3):222-227.

ABSTRACT

BACKGROUND: Sickle cell anaemia (SCA, HbSS) is a genetic disorder of haemoglobin with marked variation in clinical manifestation. The aim of this study was to determine the foetal haemoglobin (HbF) status of patients with HbSS, compared with that of individuals with HbAS and HbAA control as well as to establish the relationship between HbF level and age and gender of the participants.

METHODS: This was a cross-sectional study in which HbF values of known HbSS patients along with HbAS and HbAA controls were analysed using High Performance Liquid Chromatography. Socio-demographic and other information were obtained with the use of questionnaire. Data was analyzed using SPSS software, version 20.0. Ethical approval was obtained for the study.

RESULTS: One hundred and two (102) participants were recruited for the study, comprising 60 patients with HbSS, 22 HbAS and 20 HbAA controls, with mean age of 11.0 years±9.6, 11.7 years ±8.8 and 12.3 years±8.1 respectively. There were 30 (61.2%) males and 30 (56.6%) females for HbSS group, 9 (18.4%) males and 13(24.5%) females for HbAS group and 10(20.4%) males and 10(18.9%) for HbAA group. Mean HbF level among HbSS participants was 8.0 ±6.1% and was significantly higher than that of HbAS (3.0 ±3.4%) and HbAA (2.2 ±4.1%) control (P<0.05). Mean HbF level was higher in children (<18 years) than adults (e”18 years) among HbSS, HbAS and HbAA participants, though not statistically significant (p >0.05). Mean HbF level was also higher among female HbSS, HbAS and HbAA groups compared to corresponding male groups, though only HbSS female group was significant (p = 0.031).

CONCLUSION: Patients with HbSS have significantly higher HbF level than individuals with HbAS and HbAA. Foetal haemoglobin level tend to decrease with advancing age and higher in females. Increased HbF level may play a compensatory mechanism in sickling in HbSS, thus the use of agent that increase HbF level may improve clinical outcome.

PMID:33765368

Asia Pac J Clin Oncol. 2021 Mar 25. doi: 10.1111/ajco.13559. Online ahead of print.

ABSTRACT

AIMS: To analyze lung cancer incidence and mortality rates from 2013 to 2017 in Qingdao, Shandong Province, China.

METHODS: The lung cancer new cases and death data during 2013-2017 were collected from the Qingdao Cancer Surveillance System. The crude incidence and mortality rates were calculated by residential area and gender. The annual percentage change (APC) was determined to evaluate the incidence and mortality rate trends.

RESULTS: Between 2013 and 2017, 31 653 new lung cancer cases and 24 965 deaths from lung cancer were retrieved. The age-standardized incidence rates by Chinese standard population (ASIRC) were 42.1 per 100 000. The crude incidence rates for men and women increased from 85.2 and 46.3 per 100 000 in 2013 to 124.0 and 67.4 per 100 000 in 2017, respectively. The APCs were 7.8% for men (P < .001) and 7.5% (P = .027) for women. The crude mortality rates increased from 56.3 per 100 000 in 2013 to 68.0 per 100 000 in 2017. The age-standardized mortality rates by ASIRC were 32.3 per 100 000. The APCs of mortality rates were higher in men than in women and were higher in rural than in urban areas. Age-specific incidence and mortality rates were lower in individuals aged <40 years, increased sharply in those aged >40 years, and were the highest in 80-year-old individuals.

CONCLUSION: These data show different patterns of incidence and mortality rate according to gender and resident area during 2013-2017. Early screening and targeted prevention should be implemented to control the increased trend of lung cancer.

PMID:33765360 | DOI:10.1111/ajco.13559

J Surg Oncol. 2021 Mar 25. doi: 10.1002/jso.26477. Online ahead of print.

ABSTRACT

BACKGROUND: One of the challenges to surgical reconstruction following oncologic proximal femur resection is reliable re-establishment of the abductor mechanism. Surgical and functional outcomes following re-approximation of the abductor mechanism to a metallic endoprosthetic after tumor resection of the proximal femur have not been well established in the literature.

METHODS: A retrospective review was performed, inclusive of patients who received a proximal femur replacement with a metallic endoprosthesis following tumor resection. Patients were divided into two groups: (1) those that received an abductor repair involving a trochanteric osteotomy and osseous fixation of the greater trochanter/abductor mechanism to the endoprosthesis, and (2) those that did not have a trochanteric osteotomy and therefore had an abductor repair consisting of only soft tissue reattachment to the endoprosthesis. The two groups were assessed for demographic characteristics, diagnosis, surgical outcomes including rates of complication and failure, radiographic evidence of trochanteric failure, and functional outcomes. Descriptive statistics, comparative statistics, and logistic regression analyses were performed to discern differences between the two study groups.

RESULTS: Fifty-three patients were included in the analysis, 29 had abductor reconstructions involving reattachment of the greater trochanter to the metallic endoprosthesis and 24 had soft tissue reconstruction of the abductor mechanism without bony fixation. There were no differences between the two groups for demographic data, cancer diagnosis, follow up, or survivorship. Radiographic evidence of trochanteric dissociation from the endoprosthesis was observed in 45% of osteotomy cases. Only 10% of patients in the trochanter osteotomy group and 38% of the soft tissue only group were able to resume a normal, non-Trendelenburg gait at final postoperative visit (p = .024). Need for an assistive ambulatory device was seen in 83% and 67% of the osteotomy and soft-tissue-only patients, respectively (p = .21).

CONCLUSION: Re-establishing the abductor mechanism following proximal femur oncologic resection remains a challenge to orthopedic oncologists. Even when possible, salvage of the greater trochanter for reattachment to the endoprosthesis did not lead to improved function in this series, when compared to a similar cohort that received a soft-tissue-only abductor repair. Abductor mechanism reconstruction with a greater trochanteric osteotomy and subsequent fixation to the proximal femur endoprosthesis had a high rate of radiographic failure. Additionally, reattachment of the greater trochanter to the proximal femur endoprosthesis demonstrated no improvement in Trendelenburg gait or reliance on an assistive ambulatory device when compared to a soft-tissue-only abductor repair.

PMID:33765357 | DOI:10.1002/jso.26477

Worldviews Evid Based Nurs. 2021 Mar 25. doi: 10.1111/wvn.12500. Online ahead of print.

ABSTRACT

BACKGROUND: One critical factor in effective implementation of evidence-based practices (EBPs) in nursing is an organizational context that facilitates and supports implementation efforts. Measuring implementation climate can add useful insights on the extent to which the organizational context supports EBP implementation.

AIMS: This study cross-validates and examines the psychometric properties of the Implementation Climate Scale (ICS), which measures nurses’ perceptions of their unit’s climate for EBP implementation.

METHODS: This study analyzed ICS data from two cross-sectional studies, including 203 nurses from California and 301 nurses from Florida. Analyses included evaluation of internal consistency, multilevel aggregation statistics, and confirmatory factor analyses.

RESULTS: The 18-item ICS demonstrated comparable psychometric properties to the original measure development paper in both samples. Confirmatory factor analyses provided support for the scale’s factor structure in both samples.

LINKING EVIDENCE TO PRACTICE: The ICS is a pragmatic measure that can be used to assess unit implementation climate in nursing contexts. Results from the ICS from nurses and nurse leaders can provide insights into implementation-specific barriers and facilitators within the organizational context.

PMID:33765356 | DOI:10.1111/wvn.12500

Hepatology. 2021 Mar 25. doi: 10.1002/hep.31829. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Genetic alterations in intrahepatic cholangiocarcinoma (iCCA) are increasingly well-characterized, but their impact on outcome and prognosis remain unknown.

APPROACH/RESULTS: This bi-institutional study of patients with confirmed iCCA (n=412) used targeted next-generation sequencing of primary tumors to define associations among genetic alterations, clinicopathological variables, and outcome. The most common oncogenic alterations were IDH1 (20%), ARID1A (20%), TP53 (17%), CDKN2A (15%), BAP1 (15%), FGFR2 (15%), PBRM1 (12%), and KRAS (10%). IDH1/2 mutations (mut) were mutually exclusive with FGFR2 fusions (fus), but neither was associated with outcome. For all patients, TP53 (p<0.0001), KRAS (p=0.0001), and CDKN2A (p<0.0001) alterations predicted worse overall survival (OS). These high-risk alterations were enriched in advanced disease but adversely impacted survival across all stages, even when controlling for known correlates of outcome (multifocal disease, lymph node involvement, bile duct type, periductal infiltration). In resected patients (n=209), TP53mut (HR=1.82, 95%CI=1.08-3.06, p=0.03) and CDKN2A deletions (del) (HR=3.40, 95%CI=1.95-5.94, p<0.001) independently predicted shorter OS, as did high-risk clinical variables (multifocal liver disease [p<0.001]; regional lymph node metastases [p<0.001]), whereas KRASmut (HR=1.69, 95%CI=0.97-2.93, p=0.06) trended toward statistical significance. The presence of both or neither high-risk clinical or genetic factors represented outcome extremes (median OS=18.3 vs. 74.2 months, p<0.001), with high-risk genetic alterations alone (median OS=38.6 months, 95%CI=28.8-73.5) or high-risk clinical variables alone (median OS=37.0 months, 95%CI=27.6-NA) associated with intermediate outcome. TP53mut, KRASmut, and CDKN2Adel similarly predicted worse outcome in patients with unresectable iCCA. CDKN2Adel tumors with high-risk clinical features were notable for limited survival and no benefit of resection over chemotherapy.

CONCLUSIONS: TP53, KRAS, and CDKN2A alterations were independent prognostic factors in iCCA when controlling for clinical and pathologic variables, disease stage, and treatment. Since genetic profiling can be integrated into pre-treatment therapeutic decision-making, combining clinical variables with targeted tumor sequencing may identify patient subgroups with poor outcome irrespective of treatment strategy.

PMID:33765338 | DOI:10.1002/hep.31829

Cancer. 2021 Mar 25. doi: 10.1002/cncr.33494. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic therapy (ST) can be deferred in patients who have metastatic renal cell carcinoma (mRCC) and slow-growing metastases. Currently, this subset of patients managed with active surveillance (AS) is not well described in the literature.

METHODS: This was a prospective observational study of patients with mRCC across 46 US community and academic centers. The objective was to describe baseline characteristics and demographics of patients with mRCC initially managed by AS, reasons for AS, and patient outcomes. Descriptive statistics were used to characterize demographics, baseline characteristics, and patient-related outcomes. Wilcoxon 2-sample rank-sum tests and χ² tests were used to assess differences between ST and AS cohorts in continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to assess survival.

RESULTS: Of 504 patients, mRCC was initially managed by AS (n = 143) or ST (n = 305); 56 patients were excluded from the analysis. Disease was present in 69% of patients who received AS, whereas the remaining 31% had no evidence of disease. At data cutoff, 72 of 143 patients (50%) in the AS cohort had not received ST. The median overall survival was not reached (95% CI, 122 months to not estimable) in patients who received AS versus 30 months (95% CI, 25-44 months) in those who received ST. Quality of life at baseline was significantly better in patients who were managed with AS versus ST.

CONCLUSIONS: AS occurs frequently (32%) in real-world clinical practice and appears to be a safe and appropriate alternative to immediate ST in selected patients.

PMID:33765337 | DOI:10.1002/cncr.33494