Nevin Manimala

Laryngorhinootologie. 2021 Jun 2. doi: 10.1055/a-1472-6130. Online ahead of print.

ABSTRACT

OBJECTIVES: As a result of digitalization, the internet embodies the essential information medium. Especially, patients with sudden sensorineural hearing loss (SSNHL) require profound education due to unclear scientific evidence. Thus, our study investigated a German-language internet search about SSNHL.

DESIGN: The first 30 Google-search results with the term “Hörsturz” (SSNHL in German) were categorized, readability-statistic with different readability-scores (FRES: 0=complex, 100=easy; FKL; SMOG; GFI) calculated, and misinformation documented. A structured content-analysis was performed with the DISCERN-questionnaire (1=low, 5=high quality). Certification of the Health-On-The-Net-Foundation (HON) assessed the abidance of recommended standards.

RESULTS: 18 websites (60.0%) accounted for digital media, 7 (23.3%) manufacturers of medical devices, 2 (6.7%) government institutions, and respectively 1 (3.3%) healthcare provider, support-group, and scientific article. Mean word count was 1307.0±840.2, last update 17.1±32.5 months ago, and FRES 36.1±13.9, with the most difficult text by the scientific article (13.7). Mean of DISCERN was 2.2±0.7 with worst rating of manufacturers of medical devices (1.6±0.5). 2 websites (6.7%) were HON-certified, and 14 (46.7%) contained misinformation.

CONCLUSION: Internet-based patient-information should be assessed cautiously due to poor readability, potential conflict of interests, low quality, or wrong information. Hence, healthcare providers and professional associations are urged to provide high-quality patient-information in the internet.

PMID:34077975 | DOI:10.1055/a-1472-6130

Fam Med. 2021 Jun;53(6):423-432. doi: 10.22454/FamMed.2021.541354.

ABSTRACT

BACKGROUND AND OBJECTIVES: Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation.

METHODS: We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout.

RESULTS: Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82).

CONCLUSIONS: We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.

PMID:34077961 | DOI:10.22454/FamMed.2021.541354

Fam Med. 2021 Jun;53(6):416-422. doi: 10.22454/FamMed.2021.866524.

ABSTRACT

BACKGROUND AND OBJECTIVES: Representation of women in medicine is increasing, including in academic family medicine. Despite this, women continue to hold a minority of senior faculty and leadership roles. This study examines the trends of women first and senior authorship between 2002 and 2017 in five family medicine journals: Family Medicine, Journal of Family Practice, Journal of the American Board of Family Medicine, Annals of Family Medicine, and American Family Physician. The study also examines gender congruence between first and senior authors and women’s membership on editorial boards.

METHODS: We collected and analyzed data on a total of 1,671 original articles published in the five family medicine journals in 2002, 2007, 2012, and 2017. We also examined the gender composition of the journals’ editorial boards.

RESULTS: Overall, women first authorship increased significantly from 32.6% in 2002 to 47.7% in 2017. There was no significant difference in women senior authorship or editorial board representation from 2002 to 2017. Both men and women senior authors partnered with women first authors significantly more over the 15 years.

CONCLUSIONS: While there was a statistically significant increase in women first authors between 2002 and 2017, there is still a gap between women’s authorship and editorial board representation and their representation within academic family medicine. These gaps could help to explain the continued lack of women represented within senior faculty positions.

PMID:34077960 | DOI:10.22454/FamMed.2021.866524

J Mech Behav Biomed Mater. 2021 May 27;121:104612. doi: 10.1016/j.jmbbm.2021.104612. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this in-vitro pilot study was to establish a splint testing method and compare insertion/removal performance of dental splints.

MATERIALS AND METHODS: 56 identical lower jaw splints (n = 8 per group) were manufactured from 2x methacrylate (MA) hand-cast (reference material), deep-drawn Polyethyleneterephthalate, combined deep-draw MA hand-cast, 2x CAD/CAM-milled MA and 3D-printed MA systems. After 10 days water storage (37 °C), cyclic pull-off and insertion performance on a metal jaw was investigated. Statistics; Shapiro-Wilk-test, one-way-ANOVA; post-hoc-Bonferroni, Kaplan-Meier-survival, α = 0.05.

RESULTS: Mean insertion/pull-off cycles varied significantly (p = 0.000) between 864 cycles (MA) and 202640 cycles (Deep Draw MA). Fracture of the splints was characterized by brittle individual fractures in the 31-34 region and most fractures in region 35 (44 of 56 splints). Finite element analysis confirmed the type and location of failure.

CONCLUSIONS: Deep-draw, cast methacrylate and combined systems showed longer insertion/pull-off system cycles in comparison to printed or milled splints. Insertion/pull-off performance showed differences between the tested splint systems and indicates the influence of the processing.

CLINICAL RELEVANCE: The presented in-vitro test allowed for estimating the clinical insertion/pull-off performance of dental splints.

PMID:34077905 | DOI:10.1016/j.jmbbm.2021.104612

Environ Pollut. 2021 May 24;284:117404. doi: 10.1016/j.envpol.2021.117404. Online ahead of print.

ABSTRACT

Epidemiological studies mostly focus on single environmental exposures. This study aims to systematically assess associations between a wide range of prenatal and childhood environmental exposures and cognition. The study sample included data of 1298 mother-child pairs, children were 6-11 years-old, from six European birth cohorts. We measured 87 exposures during pregnancy and 122 cross-sectionally during childhood, including air pollution, built environment, meteorology, natural spaces, traffic, noise, chemicals and life styles. The measured cognitive domains were fluid intelligence (Raven’s Coloured Progressive Matrices test, CPM), attention (Attention Network Test, ANT) and working memory (N-Back task). We used two statistical approaches to assess associations between exposure and child cognition: the exposome-wide association study (ExWAS) considering each exposure independently, and the deletion-substitution-addition algorithm (DSA) considering all exposures simultaneously to build a final multiexposure model. Based on this multiexposure model that included the exposure variables selected by ExWAS and DSA models, child organic food intake was associated with higher fluid intelligence (CPM) scores (beta = 1.18; 95% CI = 0.50, 1.87) and higher working memory (N-Back) scores (0.23; 0.05, 0.41), and child fast food intake (-1.25; -2.10, -0.40), house crowding (-0.39; -0.62, -0.16), and child environmental tobacco smoke (ETS) (-0.89; -1.42, -0.35), were all associated with lower CPM scores. Indoor PM_2.5 exposure was associated with lower N-Back scores (-0.09; -0.16, -0.02). Additional associations in the unexpected direction were found: Higher prenatal mercury levels, maternal alcohol consumption and child higher perfluorooctane sulfonic acid (PFOS) levels were associated with better cognitive performance; and higher green exposure during pregnancy with lower cognitive performance. This first comprehensive and systematic study of many prenatal and childhood environmental risk factors suggests that unfavourable child nutrition, family crowdedness and child indoor air pollution and ETS exposures adversely and cross-sectionally associate with cognitive function. Unexpected associations were also observed and maybe due to confounding and reverse causality.

PMID:34077897 | DOI:10.1016/j.envpol.2021.117404

J Psychiatr Res. 2021 May 22;139:172-178. doi: 10.1016/j.jpsychires.2021.05.026. Online ahead of print.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a chronic recurrent or episodic psychiatric illness that can be successfully treated with oral antidepressants, yet one-in-three patients do not respond to currently-available treatments. According to the FDA and EMA, patients are considered to have treatment-resistant depression (TRD) when their MDD fails to respond adequately to ≥2 successive antidepressants in a single episode.

AIMS: To describe current clinical management of patients with MDD and TRD in England, including treatment strategies and referral to secondary mental healthcare.

METHOD: A retrospective cohort study of adult patients identified in primary care with diagnosed MDD, including a TRD subgroup (≥2 treatment failures as determined by treatment dynamics) was conducted using the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics and Mental Health Services Data Set data (Protocol 19_019R).

RESULTS: 41,375 patients with MDD (mean age 44yrs, 62% female, median follow-up 29mths); and 1,051 (3%) patients with TRD were identified. Mean time-to-TRD was 18 months. Most patients (>99%) received first-line antidepressant monotherapy. Following TRD criteria being met, antidepressant monotherapy use remained most frequent from TRD first-line (70%) to fifth-line (48%). Dual/triple antidepressant use remained constant (range:24%-26%), while augmented antidepressant use increased from TRD first-line (7%) to third-line (17%). Minimal non-pharmacological therapies were observed.

CONCLUSIONS: Despite current clinical guidelines recommending a stepwise approach, many patients frequently cycle through numerous antidepressants with similar mechanisms of action and efficacy. These findings indicate a high unmet need for new treatments that improve outcomes in these patient populations.

PMID:34077893 | DOI:10.1016/j.jpsychires.2021.05.026

J Commun Disord. 2021 May 13;92:106108. doi: 10.1016/j.jcomdis.2021.106108. Online ahead of print.

ABSTRACT

PURPOSE: Intelligibility, the ability to convey a message by speech, is one of the most important variables in speech-language pathology. The assessment of intelligibility is a challenge especially when it comes to spontaneous speech. The aim of the study was to investigate validity and reliability of a method for assessment of intelligibility, syllables perceived as understood (SPU); a method that is more time-efficient than previous methods based on transcription, as it does not require a master transcript for reference.

METHOD: A group of 20 adult listeners transcribed stimuli consisting of spontaneous speech from 16 children (14 with speech sound disorder and two with typical speech and language development, age 4:4 to 8:1, M = 6:0). Intelligibility was calculated based on these orthographic transcripts, as a) proportion of syllables perceived as understood (SPU) and b) proportion of syllables correctly understood (SCU), with reference to a master transcript. Validity was checked through investigation of the correlation and difference between these two measures. Reliability was analysed with inter-listener reliability by intra-class correlation.

RESULTS: The correlation between SPU and SCU (the gold standard intelligibility score) was strong and statistically significant, with SPU being consistently higher than SCU. Inter-listener reliability for single measures of intra-class correlation of the assessment by syllables perceived as understood was moderate to low, whereas the inter-listener reliability for average measures of intra-class correlation was high.

CONCLUSIONS: The method based on SPU might be used for assessment of intelligibility if the median from several listeners is used or when comparing results from the same listener over time. The SPU method might therefore be a valuable tool in a clinical and research context as a more valid option than rating scales and a more time-efficient method than the gold standard SCU method. However, it should be noted that the reliability of the SPU is not as high as for the SCU.

PMID:34077891 | DOI:10.1016/j.jcomdis.2021.106108

Public Health. 2021 May 30;195:89-97. doi: 10.1016/j.puhe.2021.03.027. Online ahead of print.

ABSTRACT

OBJECTIVES: Between 2010 and 2020, Africa witnessed several outbreaks of Ebola virus disease (EVD), each presenting with varying case fatality rate (CFR) and other socio-economic impacts. This study aims to summarize the CFR and identify potential factors that influenced the severity of EVD outbreaks in Africa.

STUDY DESIGN: This was a systematic review and meta-analysis of EVD outbreaks published between January 2010 and March 2020, using Web of Science, Scopus, and PubMed databases.

METHODS: Only English-language articles and reports, including the number of cases and deaths during the outbreak in Africa, were considered. The quality of the included articles was assessed using Murad’s quality assessment tool. The analysis was conducted using Stata (version 12), pooled effect sizes were calculated using the random-effects model, and heterogeneity was tested for using the I² statistic.

RESULTS: Thirteen studies with 32,300 cases and 13,727 deaths were identified, whose pooled CFR was 60% (95% confidence interval [CI]: 47-73%). The most EVD-affected countries were the Democratic Republic of Congo with five outbreaks and a pooled CFR of 65% (95% CI: 59-71%), followed by Uganda with three outbreaks and CFR of 83% (95% CI: 60-99%). Zaire ebolavirus caused the most outbreaks (10), with a CFR of 58% (95% CI: 45-71%). Besides, outbreaks with fewer than 1000 cases reported a higher CFR rate (65%, 95% CI: 54-75%) compared with those with more cases (51%, 95% CI: 33-69%).

CONCLUSION: The study has revealed a considerably high CFR caused by the recurrent EVD outbreaks in Africa. It also notes an implementation gap in the prevention and control strategies and thus identifies a need to strengthen the surveillance systems and response mechanisms to enable early detection and prompt control of future outbreaks.

PMID:34077889 | DOI:10.1016/j.puhe.2021.03.027

Respir Med. 2021 May 25;185:106481. doi: 10.1016/j.rmed.2021.106481. Online ahead of print.

ABSTRACT

Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management.

PMID:34077874 | DOI:10.1016/j.rmed.2021.106481

Comput Methods Programs Biomed. 2021 May 21;207:106190. doi: 10.1016/j.cmpb.2021.106190. Online ahead of print.

ABSTRACT

Cardiovascular disease (CVD) is the leading cause of death worldwide and is a global health issue. Traditionally, statistical models are used commonly in the risk prediction and assessment of CVD. However, the adoption of artificial intelligent (AI) approach is rapidly taking hold in the current era of technology to evaluate patient risks and predict the outcome of CVD. In this review, we outline various conventional risk scores and prediction models and do a comparison with the AI approach. The strengths and limitations of both conventional and AI approaches are discussed. Besides that, biomarker discovery related to CVD are also elucidated as the biomarkers can be used in the risk stratification as well as early detection of the disease. Moreover, problems and challenges involved in current CVD studies are explored. Lastly, future prospects of CVD risk prediction and assessment in the multi-modality of big data integrative approaches are proposed.

PMID:34077865 | DOI:10.1016/j.cmpb.2021.106190