Tag: nevin manimala

Pain Physician. 2024 Dec;27(10):E979-E982.

ABSTRACT

BACKGROUND: The use of facet joint interventions for spinal pain management experienced rapid growth between 2000 and 2010, with an annual increase of 14.2%. However, this trend slowed significantly from 2010 to 2019, with a reduced growth rate of just 2.9% annually. A more recent analysis highlighted a steep decline in facet joint interventions and sacroiliac joint injections, with an overall decrease of 33.2% and an annual decline rate of 12% per 100,000 Medicare beneficiaries between 2019 and 2022.

OBJECTIVE: This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. Medicare population over three periods: 2000-2010, 2010-2019, and 2019-2022.

STUDY DESIGN: A retrospective cohort study analyzing utilization trends and influencing factors for facet joint interventions in the FFS Medicare population in the United States from 2000 to 2022.

METHODS: Data were obtained from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2022). Utilization rates were calculated based on Medicare beneficiaries for each year and expressed as procedures per 100,000 beneficiaries. Episodes or procedural visits included only primary codes, while services encompassed all procedure levels, including add-on codes.

RESULTS: Utilization patterns showed substantial fluctuations. From 2000 to 2010, facet joint intervention rates grew at 14.4% annually, slowing to 2.2% from 2010 to 2019. The COVID-19 pandemic led to a 19.3% decline in episodes. From 2019 to 2022, episodes of facet joint interventions decreased by 21.2% per 100,000 beneficiaries, while the rate of services dropped by 37%, with an annual decrease of 14.3%. Specific declines included lumbar and cervical facet joint injections (38.8% and 40.2%, respectively) and lumbosacral and cervicothoracic facet joint neurolysis (33.6% and 30.8%, respectively). The reduction in facet joint injections and nerve blocks was greater than that observed for neurolytic procedures.

LIMITATIONS: Data were limited to the FFS Medicare population and were available only through 2022, excluding patterns for Medicare Advantage Plans, which covered nearly half of Medicare enrollees in 2022. Additionally, this study shares the common limitations of retrospective claims-based reviews.

CONCLUSION: This retrospective analysis reveals a substantial decline in facet joint intervention episodes, with an overall decrease of 21.2% per 100,000 Medicare beneficiaries and an annual decline rate of 7.6% for episodes from 2019 to 2022.

PMID:39688820

J Patient Rep Outcomes. 2024 Dec 17;8(1):143. doi: 10.1186/s41687-024-00819-4.

ABSTRACT

OBJECTIVE: Translating the newly developed Empowerment Audiology Questionnaire, EmpAQ-15 to Swedish, and performing content validation on the Swedish version.

DESIGN: Best-practice principles using forward and back translations which were revised by a committee prior to field testing. Field testing was conducted by cognitive interviews with hearing-aid users talking through and rating the items in the translated questionnaire. Content validation was assessed by examining equivalence, accessibility, acceptability, comprehensiveness, and relevance of interview data. Questionnaire introduction and scoring instructions were evaluated by Swedish audiologists.

STUDY SAMPLE: Ten adult native speaking Swedish hearing aid users, recruited with purposive sampling. Maximum variation based on age, gender, hearing aid usage, and degree of hearing loss. Seven Swedish audiologists assessing instructions for result calculations.

RESULTS: The conceptual equivalence between the Swedish translation and the English original questionnaire was judged to be high overall. The instructions and majority of items were experienced as accessible, acceptable, comprehensive, and relevant. The audiologists showed that they could follow scoring instructions and reason about the results.

CONCLUSIONS: This content validity study was the first step towards a Swedish version of a self- report measure of Empowerment for people with hearing loss.

PMID:39688803 | DOI:10.1186/s41687-024-00819-4

Int Urol Nephrol. 2024 Dec 17. doi: 10.1007/s11255-024-04328-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Panurethral strictures represent the most severe form within the anterior urethral stricture spectrum, requiring more technically complex repairs and resulting in poorer outcomes compared to localized anterior urethral strictures (penile or bulbar). This abstract aims to describe the distinct characteristics of patients with panurethral strictures in a low socioeconomic status population.

METHODS: Patients presenting with localized anterior (penile or bulbar) or panurethral strictures at University Hospital in Newark, NJ, between 2021 and 2023 were retrospectively identified. Data were extracted from electronic medical records and analyzed statistically using IBM SPSS Software.

RESULTS: Among the patients, 33 had localized anterior urethral strictures, and 22 had panurethral stricture disease. Hispanic and African American patients accounted for the majority of stricture cases (63.6%), including 59% of the panurethral stricture cohort. The only statistically significant factor contributing to panurethral disease was lichen sclerosis (p < 0.05). Patients with panurethral strictures had a higher incidence of inflammatory and systemic diseases such as STDs, recurrent UTIs, diabetes, and hypertension, while those with localized anterior urethral strictures showed a higher incidence of iatrogenic factors, including prior catheterizations and transurethral surgeries. However, these factors did not reach a statistical significance. Hypospadias repair was observed in 6% of localized anterior urethral stricture cases, compared to 13.6% of panurethral stricture cases.

CONCLUSION: While iatrogenic causes remain the predominant contributors, inflammatory and systemic conditions, particularly lichen sclerosis, significantly influence the development of panurethral strictures. Early surgical intervention and better management of systemic diseases may prevent the progression of localized anterior urethral strictures to panurethral disease, but further studies utilizing larger number of patients may shed light on the significance of these systemic factors.

PMID:39688799 | DOI:10.1007/s11255-024-04328-7

Ther Innov Regul Sci. 2024 Dec 17. doi: 10.1007/s43441-024-00720-8. Online ahead of print.

ABSTRACT

A data monitoring committee (DMC) can have an extremely challenging job. Stop a trial too soon, and results are inconclusive and the trial fails to obtain answers to important questions that could inform future clinical practice. Stop a trial too late, and trial participants are exposed to potentially harmful or ineffective interventions longer than necessary. Securing convincing and conclusive evidence and the ethical responsibility to current and future patients are weighed carefully during DMC deliberations. The ability to interpret complex information, and appreciation of issues affecting scientific integrity, are critical for the DMC to protect trial participants and public trust. Challenges faced by and issues of prudence faced by DMCs are discussed including interim analysis issues, assessing the totality of information with statistical boundaries as guidelines, interpretation of composite and surrogate outcomes, reactions to early trends, benefit:risk assessment, landscape changes, subgroup analyses, composing information for a comprehensive understanding of patient-centric effects, and evaluating the value of additional data. Case studies illustrate how DMCs addressed the challenges.

PMID:39688768 | DOI:10.1007/s43441-024-00720-8

J Math Biol. 2024 Dec 17;90(1):8. doi: 10.1007/s00285-024-02172-y.

ABSTRACT

We propose an integral model describing an epidemic of an infectious disease. The model is behavioural in the sense that the force of infection includes the information index that describes the opinion-driven human behavioural changes. The information index contains a memory kernel to mimic how the individuals maintain memory of the past values of the infection. We obtain sufficient conditions for the endemic equilibrium to be locally stable. In particular, we show that when the infectivity function is represented by an exponential distribution, stability is guaranteed by the weak Erlang memory kernel. However, through numerical simulations, we show that oscillations, possibly self-sustained, may arise when the memory is more focused in the disease’s past history, as exemplified by the strong Erlang kernel. We also show the model solutions in cases of different infectivity functions taken from studies where specific diseases like Influenza and SARS are considered.

PMID:39688746 | DOI:10.1007/s00285-024-02172-y

J Robot Surg. 2024 Dec 17;19(1):28. doi: 10.1007/s11701-024-02175-3.

ABSTRACT

The adoption of robot-assisted microsurgery (RAMS) is a cutting-edge advancement in the realm of microsurgery. The Symani Surgical System is CE approved and has recently gained FDA approval. It provides tremor elimination, motion scaling and improved ergonomics. This study reports on the first 100 consecutive cases of RAMS at a high-volume academic center, representing the largest series to date, and assesses its clinical application and efficacy. A prospective database captured all RAMS cases at a single institution between February 2023 and April 2024. Parameters recorded included patient demographics, surgical details, and outcomes. Surgeons completed a comprehensive 12 h training program to ensure adept use of the system. One-hundred patients with a mean age of 54 yrs were identified, predominantly male (66%). RAMS was performed in a wide range of procedures, notably free flaps (73%), nerve surgery (20%), and lymphovenous anastomoses (LVA) (6%). 159 anastomoses and coaptations were performed. Major complications occurred in 12 cases (12%). There were two complete free flap losses (2.7% of free flaps) and one partial free flap loss (1.4%). LVAs had significantly longer times per stitch than other types of anastomoses (p < 0.01). RAMS presents a viable alternative to traditional microsurgery with a commendable safety profile, marked by a 3% conversion rate to conventional techniques and complication rates that align with current literature. While challenges such as longer anastomosis times and higher costs exist, the results affirm the feasibility of RAMS in a high-volume microsurgical center.

PMID:39688744 | DOI:10.1007/s11701-024-02175-3

Eur Radiol. 2024 Dec;34(12):7645-7646. doi: 10.1007/s00330-024-11070-2. Epub 2024 Sep 13.

NO ABSTRACT

PMID:39688724 | DOI:10.1007/s00330-024-11070-2

Eur Radiol. 2024 Dec;34(12):7647-7649. doi: 10.1007/s00330-024-11071-1. Epub 2024 Sep 12.

NO ABSTRACT

PMID:39688723 | DOI:10.1007/s00330-024-11071-1

J Racial Ethn Health Disparities. 2024 Dec 17. doi: 10.1007/s40615-024-02248-x. Online ahead of print.

ABSTRACT

BACKGROUND: The burden of obesity falls disproportionately on some racial and ethnic minority groups.

OBJECTIVE: To assess for racial and ethnic differences in the utilization of obesity-management medications among clinically eligible individuals.

DESIGN: Medical Expenditure Panel Survey (2011-2016, 2018 and 2020) data and a cross-sectional study design was used to assess for racial and ethnic differences in obesity-management medication utilization. Descriptive statistics and multivariable logistic regression models were used to identify the association of race and ethnicity with obesity-management medication utilization. Adjusted models controlled for demographics, socioeconomic status, obesity class, diabetes status, number of chronic conditions, insurance status, and geographic region.

PARTICIPANTS: Adults with a BMI ≥ 30 kg/m² and individuals with a BMI ≥ 27 kg/m² with ≥ 1 weight-related condition.

MAIN MEASURES: The primary outcome measure was utilization of an FDA-approved medication for obesity-management during the study period. The primary independent predictor was race and ethnicity. Separate indicator variables were created for each racial and ethnic group (Non-Hispanic Asian, Non-Hispanic Black, Hispanic, and Non-Hispanic White (reference group)).

KEY RESULTS: In adjusted analyses, Asian (aOR, 0.36; 95% CI, 0.16 to 0.77; P < 0.01), Black (aOR, 0.51; 95% CI, 0.39 to 0.68; P < 0.001) and Hispanic individuals (aOR, 0.70; 95% CI, 0.49 to 0.98; P = 0.04) had significantly lower odds of utilizing obesity-management medications compared to White individuals.

CONCLUSIONS: The results of this study suggest that there are racial and ethnic disparities in the use of obesity-management medications.

PMID:39688718 | DOI:10.1007/s40615-024-02248-x

Brain Struct Funct. 2024 Dec 17;230(1):8. doi: 10.1007/s00429-024-02884-3.

ABSTRACT

To investigate the microstructural integrity, tract volume analysis, and functional connectivity (FC) alterations of the left uncinate fasciculus (UF) in patients with amyotrophic lateral sclerosis (ALS) compared to healthy controls (HCs). Fourteen limb-onset ALS patients were recruited at baseline and ten at follow-up, along with 14 HCs. All participants underwent 3D T1-weighted, diffusion tensor imaging and kurtosis imaging (DTI/DKI), and resting-state functional MRI (rs-fMRI) using a 3 Tesla scanner with 64-channel coils. Eight metrics of diffusion, rs-FC of the left UF, and graph theory analyses were extracted. Statistical group comparisons and correlation analysis for significant diffusion metrics were also conducted. Significantly lower radial kurtosis (RK), mean kurtosis (MK), and higher DTI diffusivity metrics were observed in the left UF of ALS patients than in HCs. RK and MK were correlated with various cognitive scores, particularly executive function and visuospatial ability. The volume of the left UF was positively correlated only with RK and MK at follow-up. While rs-FC analysis did not reveal group differences, a negative functional link between the left UF and cerebellum was observed in HCs but not in patients. Graph theory analysis suggested decreased connectivity in baseline patients and potential compensatory effects during the follow-up. Our study reveals microstructural abnormalities and potential network changes in left UF. DKI metrics, especially RK and MK, may be more sensitive biomarkers than DTI metrics, particularly longitudinally. Diffusion changes appear to precede volume and functional connectivity alterations, suggesting diffusion as a potential early biomarker.

PMID:39688717 | DOI:10.1007/s00429-024-02884-3