Tag: nevin manimala

Medwave. 2024 Jun 17;24(5):e2781. doi: 10.5867/medwave.2024.05.2781.

ABSTRACT

INTRODUCTION: Updating recommendations for guidelines requires a comprehensive and efficient literature search. Although new information platforms are available for developing groups, their relative contributions to this purpose remain uncertain.

METHODS: As part of a review/update of eight selected evidence-based recommendationsfor type 2 diabetes, we evaluated the following five literature search approaches (targeting systematic reviews, using predetermined criteria): PubMed for MEDLINE, Epistemonikos database basic search, Epistemonikos database using a structured search strategy, Living overview of evidence (L.OVE) platform, and TRIP database. Three reviewers independently classified the retrieved references as definitely eligible, probably eligible, or not eligible. Those falling in the same “definitely” categories for all reviewers were labelled as “true” positives/negatives. The rest went to re-assessment and if found eligible/not eligible by consensus became “false” negatives/positives, respectively. We described the yield for each approach and computed “diagnostic accuracy” measures and agreement statistics.

RESULTS: Altogether, the five approaches identified 318 to 505 references for the eight recommendations, from which reviewers considered 4.2 to 9.4% eligible after the two rounds. While Pubmed outperformed the other approaches (diagnostic odds ratio 12.5 versus 2.6 to 5.3), no single search approach returned eligible references for all recommendations. Individually, searches found up to 40% of all eligible references (n = 71), and no combination of any three approaches could find over 80% of them. Kappa statistics for retrieval between searches were very poor (9 out of 10 paired comparisons did not surpass the chance-expected agreement).

CONCLUSION: Among the information platforms assessed, PubMed appeared to be more efficient in updating this set of recommendations. However, the very poor agreement among search approaches in the reference yield demands that developing groups add information from several (probably more than three) sources for this purpose. Further research is needed to replicate our findings and enhance our understanding of how to efficiently update recommendations.

PMID:38885522 | DOI:10.5867/medwave.2024.05.2781

Ann Intern Med. 2024 Jun 18. doi: 10.7326/M23-2038. Online ahead of print.

ABSTRACT

BACKGROUND: Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy.

OBJECTIVE: To evaluate the teratogenicity of metformin use in the first trimester of pregnancy.

DESIGN: In an observational cohort of pregnant women with pregestational type 2 diabetes receiving metformin monotherapy before the last menstrual period (LMP), a target trial with 2 treatment strategies was emulated: insulin monotherapy (discontinue metformin treatment and initiate insulin within 90 days of LMP) or insulin plus metformin (continue metformin and initiate insulin within 90 days of LMP).

SETTING: U.S. Medicaid health care administration database (2000 to 2018).

PARTICIPANTS: 12 489 pregnant women who met the eligibility criteria.

MEASUREMENTS: The risk and risk ratio of nonlive births, live births with congenital malformations, and congenital malformations among live births were estimated using standardization to adjust for covariates.

RESULTS: A total of 850 women were in the insulin monotherapy group and 1557 in the insulin plus metformin group. The estimated risk for nonlive birth was 32.7% under insulin monotherapy (reference) and 34.3% under insulin plus metformin (risk ratio, 1.02 [95% CI, 1.01 to 1.04]). The estimated risk for live birth with congenital malformations was 8.0% (CI, 5.7% to 10.2%) under insulin monotherapy and 5.7% (CI, 4.5% to 7.3%) under insulin plus metformin (risk ratio, 0.72 [CI, 0.51 to 1.09]).

LIMITATION: Possible residual confounding by glycemic control and body mass index.

CONCLUSION: Compared with switching to insulin monotherapy, continuing metformin and adding insulin in early pregnancy resulted in little to no increased risk for nonlive birth among women receiving metformin before pregnancy. Under conventional statistical criteria, anything between a 49% decrease and a 9% increase in risk for congenital malformations was highly compatible with our data.

PRIMARY FUNDING SOURCE: National Institutes of Health.

PMID:38885505 | DOI:10.7326/M23-2038

JMIR Form Res. 2024 Jun 17;8:e56687. doi: 10.2196/56687.

ABSTRACT

BACKGROUND: Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor’s clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor’s credentials and accomplishments patients prioritize during their selection process.

OBJECTIVE: Our primary aim is to delve deeper into the correlation between physicians’ static characteristics-such as their qualifications, experiences, and profiles on the internet-and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction.

METHODS: We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors’ internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice.

RESULTS: The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (ρ=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001).

CONCLUSIONS: Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction.

PMID:38885498 | DOI:10.2196/56687

Lupus. 2024 Jun 17:9612033241260334. doi: 10.1177/09612033241260334. Online ahead of print.

ABSTRACT

OBJECTIVE: In this pilot study, we used untargeted metabolomics to identify biochemical mechanisms or biomarkers potentially underlying SLE-related fatigue.

METHODS: Metabolon conducted untargeted metabolomic plasma profiling using ultrahigh performance liquid chromatography/tandem mass spectrometry on plasma samples of 23 Black females with systemic lupus erythematosus (SLE) and 21 no SLE controls. Fatigue phenotypes of general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation were measured with the reliable and valid Multidimensional Fatigue Inventory (MFI).

RESULTS: A total of 290 metabolites were significantly different between the SLE and no SLE groups, encompassing metabolites related to glycolysis, TCA cycle activity, heme catabolism, branched chain amino acids, fatty acid metabolism, and steroids. Within the SLE group, controlling for age and co-morbidities, TCA cycle metabolites of alpha-ketoglutarate (AKG) and succinate were statistically significantly associated (p < .05) with physical and general fatigue.

CONCLUSION: While pervasive perturbations in the entire TCA cycle have been implicated as a potential mechanism for fatigue, our results suggest individual metabolites of AKG and succinate may be potential biomarkers or targets of intervention for fatigue symptom management in SLE. Additionally, perturbations in heme metabolism in the SLE group provide additional insights into mechanisms that promote systemic inflammation.

PMID:38885489 | DOI:10.1177/09612033241260334

Anesth Analg. 2024 Jul 1;139(1):211-219. doi: 10.1213/ANE.0000000000006967. Epub 2024 Jun 17.

ABSTRACT

BACKGROUND: Postoperative acute kidney injury (PO-AKI) is a frequent complication after surgery. Various tools have been proposed to identify patients at high risk for AKI, including preoperative serum creatinine or estimated glomerular filtration rate (eGFR), urinary cell cycle arrest, and tubular damage biomarkers; however, none of these can appropriately assess AKI risk before surgery. Renal functional reserve (RFR) screened by the Doppler-derived intraparenchymal renal resistive index variation (IRRIV) test has been proposed to identify patients at risk for AKI before a kidney insult. IRRIV test has been developed in healthy individuals and previously investigated in cardiac surgery patients. This study aims to evaluate the value of the IRRIV test in identifying PO-AKI among patients undergoing robotic abdominal surgery in the Trendelenburg position for pelvic oncological disease.

METHODS: We performed a prospective, double-blinded, observational study. Preoperative baseline renal function and RFR were assessed in 53 patients with baseline eGFR >60 mL/min/1.73 m2, undergoing robotic surgery in the Trendelenburg position for pelvic oncological disease. The capability of Doppler-derived RFR in predicting PO-AKI was investigated with the area under the receiver operating characteristic curve (ROC-AUC).

RESULTS: Approximately 15.1% of patients developed AKI within the first 3 postoperative days. Thirty-one (58.5%) patients had a physiologic delta-RRI (ie, ≥0.05), while 22 (41.5%) patients did not. The ROC-AUC for PO-AKI was 0.85 (95% confidence interval [CI], 0.74-0.97; P = .007) for serum creatinine, 0.84 (95% CI, 0.71-0.96; P = .006) for eGFR, and 0.84 (95% CI, 0.78-0.91; P = .017) for delta-RRI. When combined with eGFR, the ROC-AUC for delta-RRI was 0.95 (95% CI, 0.9-1).

CONCLUSIONS: Our findings show that the preoperative assessment of Doppler-derived RFR combined with baseline renal function improves the capability of identifying patients at high risk for PO-AKI with eGFR >60 mL/min/1.73 m2 after robotic abdominal surgery in Trendelenburg position for pelvic oncological disease.

PMID:38885478 | DOI:10.1213/ANE.0000000000006967

JCO Oncol Pract. 2024 Jun 17:OP2400016. doi: 10.1200/OP.24.00016. Online ahead of print.

ABSTRACT

PURPOSE: This study used willingness-to-pay (WTP) exercises to explore the relationships between race, financial toxicity, and treatment decision making among people with cancer.

METHODS: A convenience sample of people with multiple myeloma who attended an academic medical center in 2022 was surveyed. Financial toxicity was assessed by the Comprehensive Score for financial Toxicity, with scores <26 indicating financial toxicity. WTP was assessed with (1) a discrete choice experiment (DCE), (2) fixed-choice tasks, and (3) a bidding game.

RESULTS: In total, 156 people were approached, and 130 completed the survey. The majority of the sample was White (n = 99), whereas 24% (n = 31) was African American or Black. Forty-six percent (n = 60) of the sample were experiencing financial toxicity. In the DCE, the relative importance of cost was twice as high for those with financial toxicity (30% compared with 14%; P < .001). In the fixed-choice tasks, they were twice as likely to accept a treatment with shorter progression-free survival but lower costs (adjusted odds ratio [aOR], 2.47; P = .049). In the bidding game, the median monthly WTP of those with financial toxicity was half that of those without ($100 in US dollars [USD] compared with $200 USD; P < .001). Only in the bidding game was race statistically associated with WTP; after controlling for financial toxicity, African American or Black participants were three times as likely (aOR, 3.06; P = .007) to report a lower WTP.

CONCLUSION: Across all three exercises, participants with financial toxicity reported lower WTP than those without. As financial toxicity disproportionally affects some segments of patients, it is possible that financial toxicity contributes to cancer disparities.

PMID:38885465 | DOI:10.1200/OP.24.00016

J Chem Theory Comput. 2024 Jun 17. doi: 10.1021/acs.jctc.4c00510. Online ahead of print.

ABSTRACT

We present a reduction of the Milestoning (ReM) algorithm to analyze the high-dimensional Milestoning kinetic network. The algorithm reduces the Milestoning network to low dimensions but preserves essential kinetic information, such as local residence time, exit time, and mean first passage time between any two states. This is achieved in three steps. First, nodes (milestones) in the high-dimensional Milestoning network are grouped into clusters based on the metastability identified by an auxiliary continuous-time Markov chain. Our clustering method is applicable not only to time-reversible networks but also to nonreversible networks generated from practical simulations with statistical fluctuations. Second, a reduced network is established via network transformation, containing only the core sets of clusters as nodes. Finally, transition pathways are analyzed in the reduced network based on the transition path theory. The algorithm is illustrated using a toy model and a solvated alanine dipeptide in two and four dihedral angles.

PMID:38885437 | DOI:10.1021/acs.jctc.4c00510

Psychol Trauma. 2023 Sep;15(Suppl 2):S352-S356. doi: 10.1037/tra0001483.

ABSTRACT

OBJECTIVE: Moral COVID-19 pandemic. This study aims to explore the relationship between moral injury (MI), posttraumatic stress disorder (PTSD), and suicidal behaviors approximately 1 year after the pandemic peaked in mainland China.

METHODS: An online survey was conducted from March 27 to April 26, 2021, across mainland China. A total of 3,465 health professionals completed the Chinese version of the MI Symptoms Scale-Health Professional, Suicidal Behaviors Questionnaire-Revised, and PTSD Checklist for DSM-5 (PCL-5).

RESULTS: The prevalence of PTSD and suicidal behavior among health professionals were 26.9% and 24.2%, respectively. MI is associated with a higher risk of PTSD (OR =3.52, 95% CI [3.01, 4.13]), and a higher risk of suicidal behaviors (OR= 2.13, 95% CI [1.81, 2.50]) under the controlling of sociodemographic variables. And the interaction of PTSD and MI was associated with a significantly increased risk of suicidal behaviors (ORinteraction = 1.61, 95% CI [1.29, 2.02]).

CONCLUSIONS: The MI symptoms are associated with a higher risk of PTSD, and suicidal behaviors among health professionals 1 year after the peak of the COVID-19 pandemic in China. The findings underscore the importance of identifying and treating MI as one way to manage PTSD and suicidal behaviors among health professionals during the postpandemic period. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38885427 | DOI:10.1037/tra0001483

Psychol Trauma. 2023 Sep;15(Suppl 2):S297-S304. doi: 10.1037/tra0001497.

ABSTRACT

OBJECTIVE: The current study evaluates the psychometric properties of the Protective and Compensatory Experiences Survey (PACES; Morris et al., 2018) within a military population. The study’s aims are to evaluate if the PACES is a reliable measure to use with military samples and to examine the validity of the PACES measure when exploring protective experiences in relation to adverse childhood experiences (ACEs) and adult traumatic stress (ATS) in an active duty military sample.

METHOD: Active duty Service members were recruited to complete an online survey that included measures pertaining to ACEs, PACES, and ATS.

RESULTS: The reliability and validity of PACES indicate that Service members who are involved in protective and compensatory experiences as youth are less likely to have experiences of stress both as children and as adults.

CONCLUSIONS: Given the need for mission readiness of Service members and their higher likelihood to experience ACEs than civilians, the role of protective and compensatory factors is vital to their livelihood and career. PACES psychometrics offer a reliable and valid measure to use when exploring the risk and resilience experiences of Service members across the lifespan. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38885426 | DOI:10.1037/tra0001497

Bioinformatics. 2024 Jun 17:btae373. doi: 10.1093/bioinformatics/btae373. Online ahead of print.

ABSTRACT

MOTIVATION: Metabolomics, as an essential tool in systems biology, is now widely accessible to researchers of all levels. Yet challenges remain in data analysis and result interpretation. To address these challenges, we introduced MetaboReport, a versatile and interactive web app that simplifies metabolomics experiment design, data preprocessing, exploration, statistical analysis, visualization, and reporting.

RESULTS: MetaboReport produces a comprehensive HTML report, including project details, an introduction, interactive plots and tables, statistical results and an in-depth explanations and interpretation of the results. MetaboReport is particularly tailored for research labs and metabolomics core facilities that provide metabolomics services, allowing them to efficiently manage and document different metabolomics projects, and effectively report the metabolomics results to users.

AVAILABILITY: MetaboReport is freely accessible on https://metaboreport.com,with source code available on GitHub (https://github.com/YonghuiDong/MetReport). Alternatively, users can install MetaboReport as a standalone desktop app (https://metaboreport.sourceforge.io).

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:38885410 | DOI:10.1093/bioinformatics/btae373