Nevin Manimala

Integr Cancer Ther. 2021 Jan-Dec;20:15347354211019107. doi: 10.1177/15347354211019107.

ABSTRACT

OBJECTIVE: The purpose of this study is both to estimate the efficacy and the safety of Yukgunja-tang (YGJT) and to establish evidence for the use of herbal medicines in the management of patients with cancer-related anorexia.

METHODS: We enrolled 40 patients with cancer-related anorexia. The enrolled participants were randomly allocated to 2 groups: the control group (n = 20), which received nutrition counseling, and the treatment group (n = 20), which received nutrition counseling and was administered YGJT at twice a day for 4 weeks (a total of 56 times @ 3.0 g each time). The primary outcome of this study was the score on the anorexia/cachexia subscale (ACS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The secondary outcomes were the FAACT score with the ACS score excluded, the score on the Visual Analog Scale (VAS) for appetite, and the results on laboratory tests regarding appetite, such as leptin, tumor necrosis factors (TNF-α), interleukin-6 (IL-6), and ghrelin. All variables related to the safety assessment, such as vital signs, electrocardiography results, laboratory test results (complete blood cell count, chemistry, urine test), and adverse events, were documented on the case report form (CRF) at every visit.

RESULT: The difference in the primary outcome, that is, the score on the anorexia/cachexia subscale (ACS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT), between the control and the treatment groups was statistically significant (P = .023) as was the difference in the FAACT scores with the ACS score excluded, a secondary outcome, between the 2 groups; however, no statistically significant differences were noted in the scores on the VAS or the levels of leptin, TNF-α, IL-6, and ghrelin. In addition, no significant differences in the numbers and the types of adverse events or in the results on the laboratory tests between the control and the treatment groups were recorded.

CONCLUSION: These results obtained in this research confirmed the efficacy and the safety of using YGJT as a herb-medicine treatment option for patients with cancer-related anorexia.

PMID:34032151 | DOI:10.1177/15347354211019107

Inquiry. 2021 Jan-Dec;58:469580211018285. doi: 10.1177/00469580211018285.

ABSTRACT

Hospital readmission of stroke elderly remains a need for detecting preventable risks. This study aims to develop a Readmission Stroke Screening Tool or RRST. The mixed research design was employed, phase1; systematic reviews from 193 articles extracting to be 14 articles, 9 experts’ consensus, and try out the RRST Internal consistency; IOC = .93, ICC = between .93 and .56, phase 2; Data collecting 150 of strokes patients in the stroke units during 2019 to 2020; 30 nurses employed the RRST to screen stroke elderly before discharge. Statistical analysis, Exploring Principal Factor Analysis to test the best predictor factor, and Confirmatory Factor Analysis to test the model identity were employed. Results: The multi-domain RRST; 4 factors: Intra, inter, and external factors of patients can predict the hospital readmission of Stroke elderly at a high level in 28 days. The ADL: Activities in the Daily life domain was the highest level of predicting (Eigen Value = 6.76, 1.15, Variances = 79.19%) significantly. 53.3% of user nurses reflected; the RRST tool’s effectiveness was achievable in usefulness, benefit, accuracy, and easy to use; however, the rest users identified to improve the RRST easier and quicker. Conclusion; The new RRST; can predict the high-risk readmission effectively = 92.5%. User nurses satisfied the RRST predicted quality. the multi-domain RRST could be detecting the Thai Stroke’s high-risk group for reducing avoidable risks, suggestion; more effort will be investigated prospectively in readmission by expanded volume of the Asian’ Stroke elderly for increasing accuracy predicting and extended tool quality utilized standard scored correctly.

PMID:34032150 | DOI:10.1177/00469580211018285

Cleft Palate Craniofac J. 2021 May 25:10556656211012858. doi: 10.1177/10556656211012858. Online ahead of print.

ABSTRACT

OBJECTIVE: Utilize 3-dimensional (3D) photography to evaluate the nasolabial changes in infants with bilateral cleft lip and palate (BCLP) who underwent nasoalveolar molding (NAM) and primary reconstructive surgery.

DESIGN: This is a retrospective serial longitudinal study of consecutively enrolled infants from September 2012 to July 2016 with BCLP who underwent NAM before primary lip and nose reconstructive surgery. It included infants who had digital 3dMD stereophotogrammetry records at initial presentation (T1), completion of NAM (T2), and 3 weeks following primary repair (T3). Twelve infants fulfilled the inclusion criteria. 3dMD Vultus software was used to orient images and plot 16 nasolabial points with x, y, z coordinates to obtain the linear and angular measurements. Nasal form changes were measured and analyzed between T1 (0.5 months old), T2 (5 months old), and T3 (6 months old). Intraclass correlation coefficient was performed for intrarater reliability. Averaged data from the 3D images was statistically analyzed from T1 to T2 and T2 to T3 with Wilcoxon tests. Unaffected infant norms from the Farkas publication were used as a control sample.

RESULTS: After NAM therapy, statistically significant changes in the position of subnasale and labius superius improved nasolabial symmetry. Both retruded after NAM were displaced downward after NAM and surgical correction with respect to soft tissue nasion. The nasal tip’s projection was maintained with NAM and surgical correction. The columella lengthened from 1.4 to 4.71 mm following NAM.

CONCLUSIONS: There was a significant improvement in the nasolabial anatomy after NAM, and this was further enhanced after primary reconstructive surgery.

PMID:34032145 | DOI:10.1177/10556656211012858

J Comp Eff Res. 2021 May 25. doi: 10.2217/cer-2021-0026. Online ahead of print.

ABSTRACT

In 2008, the Programa Rede Farmácia de Minas (RFM, literally translated: ‘Minas Gerais Pharmacy Network’ program) was created as a strategy to expand access to medicines. Aim: Measure access to medicines in public pharmacies through comparison between municipalities that joined or not the RFM. Materials & methods: Cross-sectional, evaluative study, gathering information from a representative sample of the municipalities in Minas Gerais between July 2014 and May 2015. The Poisson regression results were obtained by calculating the prevalence ratios. Results: Adequate access to medicines in Minas Gerais was 69.9%, being 75.8% in municipalities with and 69.2% without the RFM. The municipalities with the RFM showed statistically higher percentages in the Availability, Adequacy/Accommodation, and Acceptability dimensions. Conclusion: RFM appears an efficient strategy for promoting access to medicines.

PMID:34032143 | DOI:10.2217/cer-2021-0026

J Am Heart Assoc. 2021 May 25:e019343. doi: 10.1161/JAHA.120.019343. Online ahead of print.

ABSTRACT

Background Hypertriglyceridemia is associated with increased risk of coronary heart disease but the association is often attributed to concomitant metabolic abnormalities. We investigated the epidemiology of primary isolated hypertriglyceridemia (PIH) and associated cardiovascular risk in a population-based setting. Methods and Results We identified adults with at least one triglyceride level ≥500 mg/dL between 1998 and 2015 in Olmsted County, Minnesota. We also identified age- and sex-matched controls with triglyceride levels <150 mg/dL. There were 3329 individuals with elevated triglyceride levels; after excluding those with concomitant hypercholesterolemia, a secondary cause of high triglycerides, age <18 years or an incomplete record, 517 patients (49.4±14.0 years, 72.0% men) had PIH (triglyceride 627.6±183.6 mg/dL). The age- and sex-adjusted prevalence of PIH in adults was 0.80% (0.72-0.87); the diagnosis was recorded in 60%, 46% were on a lipid-lowering medication for primary prevention and a triglyceride level <150 mg/dL was achieved in 24.1%. The association of PIH with coronary heart disease was attenuated but remained significant after adjustment for demographic, socioeconomic, and conventional cardiovascular risk factors (hazard ratio [HR], 1.53; 95% CI, 1.06-2.20; P= 0.022). There was no statistically significant association between PIH and cerebrovascular disease (HR, 1.06; 95% CI, 0.65-1.73, P= 0.813), peripheral artery disease (HR, 1.27; 95% CI, 0.43-3.75; P= 0.668), or the composite end point of all 3 (HR, 1.28; 95% CI, 0.92-1.80; P=0.148) in adjusted models. Conclusions PIH was associated with incident coronary heart disease events (although there was attenuation after adjustment for conventional risk factors), supporting a causal role for triglycerides in coronary heart disease. The condition is relatively prevalent but awareness and control are low.

PMID:34032140 | DOI:10.1161/JAHA.120.019343

J Manag Care Spec Pharm. 2021 May 25:1-11. doi: 10.18553/jmcp.2021.21036. Online ahead of print.

ABSTRACT

BACKGROUND: Medication therapy management (MTM) and comprehensive medication management (CMM) have been practiced by clinical pharmacists as a predominantly manual activity with interventions documented in a record-keeping system. Program evaluations, largely based on estimations of projected savings and utilization reductions, have not accurately predicted actual claims and utilization changes, leading many to doubt the efficacy of medication management. OBJECTIVE: To assess the impact on actual medical claims of a novel artificial intelligence (AI) platform that identifies members and provides decision support to clinicians in performing telephonic interventions similar to MTM and CMM with high-risk Medicaid members. METHODS: This retrospective observational study used mixed-effects regression models that flexibly account for general trends in cost, as measured by actual claims, to identify the amount of savings and associated impact. To study the economics, total cost of care (TCoC), defined as all medication costs plus all noncapitated medical costs, was evaluated. Utilization was evaluated through the number of emergency department (ED) visits, hospital admissions, bed days, and readmissions. The study included 2,150 predominantly middle-aged (aged 40-64 years) Medicaid members with an average of 10 medications for chronic conditions among an average of 25 total medications. The analysis considered cost and utilization data from August 2017 through April 2019. Interventions occurred between January 2018 and February 2019. RESULTS: Statistically significant correlations were found between receiving interventions and decreased costs and utilization. The economic study found a 19.3% reduction in the TCoC (P < 0.001) that, applied to a preintervention monthly cost of $2,872, yielded a savings of $554 per member per month (PMPM). Medication costs showed a 17.4% reduction (P < 0.001), which, when applied to preintervention cost of $1,110, yielded a savings of $192 PMPM. The utilization study found a 15.1% reduction in ED visits (P = 0.002), a 9.4% reduction in hospital admissions (P = 0.008), and a 10.2% reduction in bed days (P = 0.01). Return on investment is 12.4:1 based on TCoC savings and program costs. CONCLUSIONS: This study evaluated the CMM-Wrap program, which used an advanced AI platform integrated with health plan data, clinical pharmacists trained in disease management, telephonic patient engagement, and closed-loop provider coordination. The results correlate cost and utilization savings with the program. The TCoC savings of $554 PMPM translates to approximately $1.2M a month and more than $14M annually for the 2,150 members in the study. We believe Medicaid and Medicare payment of AI enhanced telephonic CMM services would substantially decrease government health care expenditures, whereas improving health program expansion to Medicaid members with similar risks could save the Health Plan $109M annually. For instance, we estimate that California’s Medicaid (Medi-Cal) program could save more than $1B annually by applying the program’s observed impact to a similar high-risk cohort (about 1.6%) of Medi-Cal members. Additionally, benefits will accrue to nonmanaged health plans based on the savings themselves. DISCLOSURES: There was no external funding for this study. The program itself was funded by Inland Empire Health Plan. The retrospective study was a collaboration of the 3 partners (Surveyor Health, Inland Empire Health Plan, and Preveon Health) each of which funded its additional costs of preparing the study. Kessler, Mebine, E. Von Schweber, and L. Von Schweber are employed by Surveyor Health. McConnell and Jai are employed by Inland Empire Health Plan. Nguyen, Kiroyan, and Ho are employed by Preveon Health. Desai reports fees from Surveyor Health for work on this study. E. Von Schweber and L. Von Schweber have 2 patents licensed to Surveyor Health: Unified Evaluation, Presentation and Modification of Healthcare Regimens Method and Apparatus for Information Surveying.

PMID:34032130 | DOI:10.18553/jmcp.2021.21036

Huan Jing Ke Xue. 2021 Jun 8;42(6):3010-3017. doi: 10.13227/j.hjkx.202008312.

ABSTRACT

Soil nitrogen and phosphorus influence physical, chemical, and biological processes in soil, therefore, clarifying their contents and spatial patterns is of great significance for soil resource management and utilization. The spatial patterns of soil total nitrogen (TN) and phosphorus (TP) and the influencing factors in Jungar Banner were studied using classical statistical and geostatistical methods. The results showed that soil TN and TP contents decreased with soil depth, and the weighted mean values of TN and TP were 0.29 g·kg^-1 and 0.26 g·kg^-1, respectively. The nugget effect values of soil TN and TP were concentrated in the ranges 0.15-0.43 and 0.34-0.53, respectively, indicating that soil TN (except in the 0-10 cm and 80-100 cm zones) and TP were moderately spatially dependent, dominated by structural and random factors. The spatial distributions of soil nutrients were related to soil layers and elements, even in same layer, while the distributions of TN and TP were not consistent. Soil total nitrogen was mainly affected by soil organic carbon, while TP was mainly affected by latitude, altitude, vegetation, and soil texture.

PMID:34032101 | DOI:10.13227/j.hjkx.202008312

Huan Jing Ke Xue. 2021 Jun 8;42(6):2769-2777. doi: 10.13227/j.hjkx.202010216.

ABSTRACT

The soil and water assessment tool (SWAT) model is currently one of the most widely used watershed models in China. Since the model has been developed with distributed parameters and is customized to satisfy the environmental characteristics of the U.S.A., determining appropriate parameter values that reflect local features for model application in China is crucial. Some studies have proposed parameter values for the SWAT model by summarizing reported values in the literature; however, these studies neither differentiate the literature with respect to its quality nor consider non-uniformity in parameter values and the impact of extreme values. To address this, an indicator system for assessing the quality of SWAT model research was established, taking into account the process of model development, parameter calibration, and model validation as well as model performance. This screening approach was applied to a total of 428 journal articles on SWAT model research published between 2015 and 2017 were retrieved from the China National Knowledge Infrastructure database. The reported values of 15 model parameters involved in hydrology and sediment and nutrient simulation were extracted from highly credible articles and analysed in terms of statistical distributions, differences among geographic regions, and discrepancies between calibrated and default values. Results showed that the 129 highly credible journal articles screened generally followed good modelling practice and consisted of case studies from different regions across China. The statistical distributions of the 15 model parameters derived from the SWAT model studies exhibited a range of features including positive and negative skewness, and those of 4 parameters showed significant differences among regions where the watersheds are located. Furthermore, the calibrated values of 12 out of 15 parameters were significantly different from their default values. Considering the statistical characteristics of these model parameters, recommended parameter values for SWAT model application in China are proposed in the form of confidence intervals, and specific suggestions are also provided based on data availability.

PMID:34032076 | DOI:10.13227/j.hjkx.202010216

Zhongguo Gu Shang. 2021 May 25;34(5):442-7. doi: 10.12200/j.issn.1003-0034.2021.05.009.

ABSTRACT

OBJECTIVE: To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique.

METHODS: Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed.

RESULTS: All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group <Ultrabraid suture group <FiberWire suture group, and had statistical differences among groups (P<0.05);comparison of cyclic displacement at 100, 500 and 1 000 cycles showed that Ethibond suturegroup>Ultrabraid suture group >FiberWire suture group, and had statistical differences among groups (P<0.05);the results showed the suture strength in Ethibond was the best, Ultrabraid suture took the second place, and FiberWire suture was the worst. (2)As for different suture sites, comparison of the maximum failure load, yield load and stiffness showed that red zone fixation group >red-white region fixation group, and had statistical difference between two groups(P< 0.05);comparison of cyclic displacement at 100, 500 and 1 000 cycles showed that red zone fixation group <red-white zone fixation group, and had statistical difference between two groups (P<0.05);the results showed that suture strength in red zone fixation group was better than that of red white zone fixation group.

CONCLUSION: Mason-Allen suture could effectively fix posterior root tear of the medial meniscus and meet needs of early partial weight bearing after surgery. Suturing with Fiberwire in red zone is stronger and better for the meniscus healing and rehabilitation.

PMID:34032046 | DOI:10.12200/j.issn.1003-0034.2021.05.009

Zhongguo Gu Shang. 2021 May 25;34(5):429-37. doi: 10.12200/j.issn.1003-0034.2021.05.007.

ABSTRACT

OBJECTIVE: To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis.

METHODS: From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand (DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared.

RESULTS: Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta analysis result showed that after operation at 12 months, there were no significant difference in radial height [MD=0.04, 95%CI (-0.90, 0.99), P=0.93], tendon rupture [RR=1.82, 95%CI (0.71, 4.67), P=0.21], carpal tunnel syndrome [RR=2.15, 95%CI(0.98, 4.70), P=0.06], complex regional pain syndrom [RR=0.63, 95%CI(0.31, 1.27)P=0.78] between two groups. While there were significant difference in palm inclination angle [MD=1.38, 95%CI (0.83, 1.93), P< 0.000 01], ulnar deflection angle[MD=0.99, 95%CI(0.54, 1.45), P<0.000 1], ulna variability[MD=0.66, 95%CI(0.21, 1.12), P=0.005], DASH score[MD=2.42, 95%CI(0.37, 4.46), P=0.02], incidence of complications[RR=0.83, 95%CI(0.71, 0.96), P=0.01], infection rate[RR=0.20, 95%CI(0.11, 0.36), P<0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groups [MD=3.88, 95%CI (1.56, 9.64), P<0.003].

CONCLUSION: Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.

PMID:34032044 | DOI:10.12200/j.issn.1003-0034.2021.05.007