Nevin Manimala

BMJ Open Respir Res. 2021 Jul;8(1):e000805. doi: 10.1136/bmjresp-2020-000805.

ABSTRACT

BACKGROUND AND OBJECTIVE: A high frequency of infections complicating rheumatoid arthritis (RA) has been reported due to the immunomodulatory effect of RA or to agents with immunosuppressive effects used in its treatment. We aimed to assess clinical and radiological characteristics of pulmonary cryptococcosis in patients with and without RA.

METHODS: We retrospectively reviewed the medical records of 52 patients with pulmonary cryptococcosis and divided them into two groups, those with RA and without RA, and compared clinical characteristics and radiological findings between them.

RESULTS: Eleven (21.2%) of the 52 patients had RA. Median follow-up periods were 51.2 (range: 1.1-258.7) months for patients with RA and 19.1 (range: 0.63-246.9) months for patients without RA. Among the patients with RA, 81.8% were women, with a mean age of 68.1 years. Female sex and respiratory comorbidities were significantly more frequent in patients with RA than in patients without RA. Frequencies of concomitant cryptococcal meningitis and respiratory failure were not different between the groups. There were no significant differences in frequency of any radiological findings, locations and number between the two groups. Among patients with RA, all but one responded well to antifungal treatment. During the antifungal treatment course, one (9.1%) patient with RA died of cryptococcosis. Despite continuing antirheumatic drugs, no patients had recurrence of pulmonary cryptococcosis during follow-up.

CONCLUSION: Other than some differences in background, there were no clinical, radiological or prognostic differences between the patients with and without RA with pulmonary cryptococcosis. The administration of antirheumatic therapy had no negative effect on the clinical course of antifungal treatment.

PMID:34326152 | DOI:10.1136/bmjresp-2020-000805

J Neurosci. 2021 Jul 29:JN-RM-2459-20. doi: 10.1523/JNEUROSCI.2459-20.2021. Online ahead of print.

ABSTRACT

Many decisions, from crossing a busy street to choosing a profession, require integration of discrete sensory events. Previous studies have shown that integrative decision-making favours more reliable stimuli, mimicking statistically optimal integration. It remains unclear, however, whether reliability biases operate even when they lead to suboptimal performance. To address this issue, we asked human observers to reproduce the average motion direction of two suprathreshold coherent motion signals presented successively and with varying levels of reliability, while simultaneously recording whole-brain activity using electroencephalography. By definition, the averaging task should engender equal weighting of the two component motion signals, but instead we found robust behavioural biases in participants’ average decisions that favoured the more reliable stimulus. Using population-tuning modelling of brain activity we characterised tuning to the average motion direction. In keeping with the behavioural biases, the neural tuning profiles also exhibited reliability biases. A control experiment revealed that observers were able to reproduce motion directions of low-and high-reliability with equal precision, suggesting that unbiased integration in this task was not only theoretically optimal but demonstrably possible. Our findings reveal that temporal integration of discrete sensory events in the brain is automatically and sub-optimally weighted according to stimulus reliability.Significance statement:Many everyday decisions require integration of several sources of information. To safely cross a busy road, for example, one must consider the movement of vehicles with different speeds and trajectories. Previous research has shown that individual stimuli are weighted according to their reliability. Whereas reliability biases typically yield performance that closely mimic statistically optimal integration, it remains unknown whether such biases arise even when they lead to suboptimal performance. Here we combined a novel integrative decision-making task with concurrent brain recording and modelling to address this question. While unbiased decisions were optimal in the task, observers nevertheless exhibited robust reliability biases in both behaviour and brain activity, suggesting that reliability-weighted integration is automatic and dissociable from statistically optimal integration.

PMID:34326142 | DOI:10.1523/JNEUROSCI.2459-20.2021

AJNR Am J Neuroradiol. 2021 Jul 29. doi: 10.3174/ajnr.A7236. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Noninvasive angiography is commonly used to assess the outcome of surgical or endovascular treatment of intracranial aneurysms in clinical series or randomized trials. We sought to assess whether a standardized 3-grade classification system could be reliably used to compare the CTA and MRA results of both treatments.

MATERIALS AND METHODS: An electronic portfolio composed of CTAs of 30 clipped and MRAs of 30 coiled aneurysms was independently evaluated by 24 raters of diverse experience and training backgrounds. Twenty raters performed a second evaluation 1 month later. Raters were asked which angiographic grade and management decision (retreatment; close or long-term follow-up) would be most appropriate for each case. Agreement was analyzed using the Krippendorff α (α_K) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests.

RESULTS: Interrater agreement was substantial (α_K = 0.63; 95% CI, 0.55-0.70); results were slightly better for MRA results of coiling (α_K = 0.69; 95% CI, 0.56-0.76) than for CTA results of clipping (α_K = 0.58; 95% CI, 0.44-0.69). Intrarater agreement was substantial to almost perfect. Interrater agreement regarding clinical management was moderate for both clipped (α_K = 0.49; 95% CI, 0.32-0.61) and coiled subgroups (α_K = 0.47; 95% CI, 0.34-0.54). The choice of clinical management was strongly associated with the size of the residuum (mean Cramer V = 0.77 [SD, 0.14]), but complete occlusions (grade 1) were followed more closely after coiling than after clipping (P = .01).

CONCLUSIONS: A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.

PMID:34326106 | DOI:10.3174/ajnr.A7236

BJGP Open. 2021 Jul 29:BJGPO.2021.0051. doi: 10.3399/BJGPO.2021.0051. Online ahead of print.

ABSTRACT

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease which causes painful discharging nodules and skin tunnels. HS has associations with several systemic diseases, including cardiovascular (CV) disease and anxiety-depression. High levels of chronic morbidity suggest an important role for Primary Care. However, little evidence exists regarding current management of HS and its co-morbidities in UK General Practice.

AIM: To describe current practice amongst UK GPs in treating and referring people with HS DESIGN & SETTING: Web-based survey circulated to UK Primary Care Dermatology Society members and GPs in Forth Valley, Scotland.

METHOD: Survey responses were analysed with descriptive statistics.

RESULTS: 134 UK GPs completed the survey. 71% (n=94) saw at least one patient with HS in the previous month. 94% (n=125) reported confidence in diagnosis, and 87% (n=120) in initial treatment of HS. Most GPs initiated topical treatments and extended courses of oral antibiotic for HS, and many advised regarding adverse lifestyle factors. A minority provided analgesia, or screening for CV disease risk factors and anxiety-depression. Most GPs referred to Dermatology if Secondary Care input was required, with few referrals to specialised multi-disciplinary services.

CONCLUSION: GPs regularly diagnose and manage uncomplicated HS, but screening for important co-morbidities associated with HS is not common practice.

PMID:34326099 | DOI:10.3399/BJGPO.2021.0051

Diabetes Care. 2021 Jul 29:dc210531. doi: 10.2337/dc21-0531. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to test whether type 2 diabetes (T2D)-associated TCF7L2 genetic variants affect insulin sensitivity or secretion in autoantibody-positive relatives at risk for type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS: We studied autoantibody-positive TrialNet Pathway to Prevention study participants (N = 1,061) (mean age 16.3 years) with TCF7L2 single nucleotide polymorphism (SNP) information and baseline oral glucose tolerance test (OGTT) to calculate indices of insulin sensitivity and secretion. With Bonferroni correction for multiple comparisons, P values < 0.0086 were considered statistically significant.

RESULTS: None, one, and two T2D-linked TCF7L2 alleles were present in 48.1%, 43.9%, and 8.0% of the participants, respectively. Insulin sensitivity (as reflected by 1/fasting insulin [1/I_F]) decreased with increasing BMI z score and was lower in Hispanics. Insulin secretion (as measured by 30-min C-peptide index) positively correlated with age and BMI z score. Oral disposition index was negatively correlated with age, BMI z score, and Hispanic ethnicity. None of the indices were associated with TCF7L2 SNPs. In multivariable analysis models with age, BMI z score, ethnicity, sex, and TCF7L2 alleles as independent variables, C-peptide index increased with age, while BMI z score was associated with higher insulin secretion (C-peptide index), lower insulin sensitivity (1/I_F), and lower disposition index; there was no significant effect of TCF7L2 SNPs on any of these indices. When restricting the analyses to participants with a normal OGTT (n = 743; 70%), the results were similar.

CONCLUSIONS: In nondiabetic autoantibody-positive individuals, TCF7L2 SNPs were not related to insulin sensitivity or secretion indices after accounting for BMI z score, age, sex, and ethnicity.

PMID:34326068 | DOI:10.2337/dc21-0531

BMJ Open. 2021 Jul 29;11(7):e053212. doi: 10.1136/bmjopen-2021-053212.

ABSTRACT

INTRODUCTION: While healthcare transition (HCT) interventions are recognised as an important area in paediatric rehabilitation, there has been limited research focusing on young people with spinal cord injuries (SCI). In this study, researchers will collaborate with young people with SCI and their parents/caregivers to develop, implement and evaluate the feasibility and acceptability of a HCT intervention aimed at supporting young people with SCI during their transition from paediatric to adult healthcare services.

METHODS AND ANALYSIS: A participatory action research (PAR) approach will be used to co-develop the HCT intervention with young people with SCI aged 14-25 years and their parents/caregivers. Three phases will be conducted to address the five objectives of this study. Phase 1 will use semi-structured interviews to explore young people and parent/caregivers’ experiences of HCT. In Phase 2a, both young people and parent/caregivers will be co-researchers. They will be included in the analysis of the interviews and will be asked to participate in co-design workshops to inform the development of a prototype HCT intervention. In Phase 2b, using focus groups, feedback on the prototype HCT intervention will be collected. In Phase 3, the refined prototype HCT intervention will be implemented, and young people with SCI and parent/caregivers will evaluate the feasibility and acceptability of the HCT intervention in semi-structured interviews. A reference group, including stakeholders and end users, will be consulted at different time points.

ETHICS AND DISSEMINATION: The study has received ethics approval from Western Sydney University Human Research and Ethics Committee (H14029). The researcher will use the results of this study as chapters in a thesis to obtain a Doctor of Philosophy degree. The findings will be disseminated via publication in peer-reviewed journals and will be presented at local, national or international conferences.

TRIAL REGISTRATION NUMBER: ACTRN12621000500853.

PMID:34326059 | DOI:10.1136/bmjopen-2021-053212

BMJ Open. 2021 Jul 29;11(7):e051823. doi: 10.1136/bmjopen-2021-051823.

ABSTRACT

INTRODUCTION: Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems.

METHODS AND ANALYSIS: Study areas are in rural zones of Côte d’Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes’ data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects.

ETHICS AND DISSEMINATION: Ethics committees in Côte d’Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS.

TRIAL REGISTRATION NUMBER: PACTR201904664660639; Pre-results.

PMID:34326056 | DOI:10.1136/bmjopen-2021-051823

J Educ Eval Health Prof. 2021;18:17. doi: 10.3352/jeehp.2021.18.17. Epub 2021 Jul 30.

ABSTRACT

Appropriate sample size calculation and power analysis have become major issues in research and publication processes. However, the complexity and difficulty of calculating sample size and power require broad statistical knowledge, there is a shortage of personnel with programming skills, and commercial programs are often too expensive to use in practice. The review article aimed to explain the basic concepts of sample size calculation and power analysis; the process of sample estimation; and how to calculate sample size using G*Power software (latest ver. 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) with 5 statistical examples. The null and alternative hypothesis, effect size, power, alpha, type I error, and type II error should be described when calculating the sample size or power. G*Power is recommended for sample size and power calculations for various statistical methods (F, t, χ2, Z, and exact tests), because it is easy to use and free. The process of sample estimation consists of establishing research goals and hypotheses, choosing appropriate statistical tests, choosing one of 5 possible power analysis methods, inputting the required variables for analysis, and selecting the “Calculate” button. The G*Power software supports sample size and power calculation for various statistical methods (F, t, χ2, z, and exact tests). This software is helpful for researchers to estimate the sample size and to conduct power analysis.

PMID:34325496 | DOI:10.3352/jeehp.2021.18.17

J Educ Eval Health Prof. 2021;18:16. doi: 10.3352/jeehp.2021.18.16. Epub 2021 Jul 30.

ABSTRACT

PURPOSE: Simulation teaching refers to the replication of real-life scenarios, enabling students to practice nursing skills and learn actively in a safe environment. It also helps students control their anxiety and fears when caring for real patients. This study investigated the relationships of Vietnamese nursing students’ self-confidence in clinical practice with their satisfaction and self-confidence in simulation-based practice.

METHODS: This cross-sectional descriptive study included 182 nursing students. The data collection included 2 separate stages with 2 main questionnaires. The Student Satisfaction and Self-Confidence in Learning Scale was used to measure students’ satisfaction and self-confidence after learning in the simulation room. The Confidence Scale was used to measure students’ self-confidence when first performing techniques on actual patients. Data were analyzed by descriptive and Pearson correlation statistics.

RESULTS: Students’ satisfaction and self-confidence during the simulation course were quite high (mean±standard deviation [SD], 4.06±0.48 and 4.11±0.46 out of 5.0, respectively). In contrast, their confidence when first practicing on a patient was moderate (mean±SD, 3.19±0.62 out of 5.0). Students’ satisfaction showed moderate and weak positive correlations with self-confidence in pre-clinical practice and in clinical practice (r=0.33, P<0.001 and r=0.26, P<0.001, respectively).

CONCLUSION: Simulation has become an effective teaching strategy that can help nursing students be well-prepared for clinical placements in Vietnam. An effective nursing education strategy is needed to enhance the satisfaction and self-confidence of nursing students in simulation and then in clinical practice to help achieve professional engagement and development.

PMID:34325495 | DOI:10.3352/jeehp.2021.18.16

J Am Geriatr Soc. 2021 Jul 29. doi: 10.1111/jgs.17384. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. We describe the PRIME-KNEE study as an example of ongoing research to validate provocative clinical tests and biomarkers that predict resilience to specific health stressors.

METHODS: PRIME-KNEE is an ongoing, prospective cohort study that will enroll 250 adults ≥60 years undergoing total knee arthroplasty. Data are collected at baseline (pre-surgery), during surgery, daily for 7 days after surgery, and at 1, 2, 4, and 6 months post-surgery. Provocative tests include a cognition-motor dual-task walking test, cerebrovascular reactivity assessed by functional near-infrared spectroscopy, peripheral blood mononuclear cell reactivity ex vivo to lipopolysaccharide toxin and influenza vaccine, and heart rate variability during surgery. Cognitive, psychological, and physical performance batteries are collected at baseline to estimate prestressor reserve. Demographics, medications, comorbidities, and stressor characteristics are abstracted from the electronic medical record and via participant interview. Blood-based biomarkers are collected at baseline and postoperative day 1. Repeated measures after surgery include items from a delirium assessment tool and pain scales administered daily by telephone for 7 days and cognitive change index (participant and informant), lower extremity activities of daily living, pain scales, and step counts assessed by Garmin actigraphy at 1, 2, 4, and 6 months after surgery. Statistical models use these measures to characterize resilience phenotypes and evaluate prestressor clinical indicators associated with poststressor resilience.

CONCLUSION: If PRIME-KNEE validates feasible clinical tests and biomarkers that predict recovery trajectories in older surgical patients, these tools may inform surgical decision-making, guide pre-habilitation efforts, and elucidate mechanisms underlying resilience. This study design could motivate future geriatric research on resilience.

PMID:34325481 | DOI:10.1111/jgs.17384