Tag: nevin manimala

JAMA Surg. 2024 Mar 27. doi: 10.1001/jamasurg.2024.0235. Online ahead of print.

ABSTRACT

IMPORTANCE: When considering nonoperative treatment in a patient with acute appendicitis, it is crucial to accurately rule out complicated appendicitis. The Atema score, also referred to as the Scoring System of Appendicitis Severity (SAS), has been designed to differentiate between uncomplicated and complicated appendicitis but has not been prospectively externally validated.

OBJECTIVE: To externally validate the SAS and, in case of failure, to develop an improved SAS (2.0) for estimating the probability of complicated appendicitis.

DESIGN, SETTING, AND PARTICIPANTS: This prospective study included adult patients who underwent operations for suspected acute appendicitis at 11 hospitals in the Netherlands between January 2020 and August 2021.

MAIN OUTCOMES AND MEASURES: Appendicitis severity was predicted according to the SAS in 795 patients and its sensitivity and negative predictive value (NPV) for complicated appendicitis were calculated. Since the predefined targets of 95% for both were not met, the SAS 2.0 was developed using the same cohort. This clinical prediction model was developed with multivariable regression using clinical, biochemical, and imaging findings. The SAS 2.0 was externally validated in a temporal validation cohort consisting of 565 patients.

RESULTS: In total, 1360 patients were included, 463 of whom (34.5%) had complicated appendicitis. Validation of the SAS resulted in a sensitivity of 83.6% (95% CI, 78.8-87.6) and an NPV of 85.0% (95% CI, 80.6-88.8), meaning that the predefined targets were not achieved. Therefore, the SAS 2.0 was developed, internally validated (C statistic, 0.87; 95% CI, 0.84-0.89), and subsequently externally validated (C statistic, 0.86; 95% CI, 0.82-0.89). The SAS 2.0 was designed to calculate a patient’s individual probability of having complicated appendicitis along with a 95% CI.

CONCLUSIONS AND RELEVANCE: In this study, external validation of the SAS fell short in accurately distinguishing complicated from uncomplicated appendicitis. The newly developed and externally validated SAS 2.0 was able to assess an individual patient’s probability of having complicated appendicitis with high accuracy in patients with acute appendicitis. Use of this patient-specific risk assessment tool can be helpful when considering and discussing nonoperative treatment of acute appendicitis with patients.

PMID:38536188 | DOI:10.1001/jamasurg.2024.0235

JAMA Netw Open. 2024 Mar 4;7(3):e243854. doi: 10.1001/jamanetworkopen.2024.3854.

ABSTRACT

IMPORTANCE: There is substantial interest in capturing cancer treatment tolerability from the patient’s perspective using patient-reported outcomes (PROs).

OBJECTIVE: To examine whether a PRO question, item 5 from the Functional Assessment of Cancer Therapy-General General Physical Wellbeing Scale (GP5), was associated with early treatment discontinuation (ETD) due to adverse events.

DESIGN, SETTING, AND PARTICIPANTS: This prospective survey study was conducted from February to April 2023. Among participants in the ECOG-ACRIN E1A11 trial (a phase 3, parallel design trial conducted between 2013 and 2019), patients with newly diagnosed multiple myeloma were randomized to receive bortezomib (VRd) or carfilzomib (KRd) plus lenalidomide and dexamethasone as induction therapy. The GP5 item was administered at baseline (pretreatment) and at 1 month, 2.8 months, and 5.5 months postbaseline. Eligible participants included patients with newly diagnosed multiple myeloma treated at community oncology practices or academic medical centers in the US.

EXPOSURES: GP5 response options were “very much,” “quite a bit,” “somewhat,” “a little bit,” and “not at all.” Responses at each assessment while undergoing treatment (1 month, 2.8 months, and 5.5 months) were categorized as high adverse event bother (ie, “very much,” and “quite a bit”) and low adverse event bother (ie, “somewhat,” “a little bit,” or “not at all”). In addition, change from baseline to each assessment while undergoing treatment was calculated and categorized as worsening by 1 response category and 2 or more response categories.

MAIN OUTCOME AND MEASURE: ETD due to adverse events (yes vs no) was analyzed using logistic regression adjusting for treatment group, performance status, gender, race, and disease stage.

RESULTS: Of the 1087 participants in the original trial, 1058 (mean [SD] age 64 [9] years; 531 receiving VrD [50.2%]; 527 receiving KRd [49.8%]) responded to item GP5 and were included in the secondary analysis. A small proportion (142 patients [13.4%]) discontinued treatment early due to AEs. For those with high adverse-effect bother, GP5 while undergoing treatment was associated with ETD at 1 month (adjusted odds ratio [aOR], 2.20; 95% CI, 1.25-3.89), 2.8 months (aOR, 3.41; 95% CI, 2.01-5.80), and 5.5 months (aOR, 4.66; 95% CI, 1.69-12.83). Worsening by 2 or more response categories on the GP5 was associated with ETD at 2.8 months (aOR, 3.02; 95% CI, 1.64-5.54) and 5.5 months (aOR, 5.49; 95% CI, 1.45-20.76).

CONCLUSIONS AND RELEVANCE: In this survey study of the E1A11 trial, worse GP5 response was associated with ETD. These findings suggest that simple assessment of adverse-effect bother while receiving treatment is an efficient way to indicate treatment tolerability and ETD risk.

PMID:38536173 | DOI:10.1001/jamanetworkopen.2024.3854

JAMA Dermatol. 2024 Mar 27. doi: 10.1001/jamadermatol.2024.0091. Online ahead of print.

ABSTRACT

IMPORTANCE: Cellulitis is misdiagnosed in up to 30% of cases due to mimic conditions termed pseudocellulitis. The resulting overuse of antibiotics is a threat to patient safety and public health. Surface thermal imaging and the ALT-70 (asymmetry, leukocytosis, tachycardia, and age ≥70 years) prediction model have been proposed as tools to help differentiate cellulitis from pseudocellulitis.

OBJECTIVES: To validate differences in skin surface temperatures between patients with cellulitis and patients with pseudocellulitis, assess the optimal temperature measure and cut point for differentiating cellulitis from pseudocellulitis, and compare the performance of skin surface temperature and the ALT-70 prediction model in differentiating cellulitis from pseudocellulitis.

DESIGN, SETTING, AND PARTICIPANTS: This prospective diagnostic validation study was conducted among patients who presented to the emergency department with acute dermatologic lower extremity symptoms from October 11, 2018, through March 11, 2020. Statistical analysis was performed from July 2020 to March 2021 with additional work conducted in September 2023.

MAIN OUTCOMES AND MEASURES: Temperature measures for affected and unaffected skin were obtained. Cellulitis vs pseudocellulitis was assessed by a 6-physician, independent consensus review. Differences in temperature measures were compared using the t test. Logistic regression was used to identify the temperature measure and associated cut point with the optimal performance for discriminating between cellulitis and pseudocellulitis. Diagnostic performance characteristics for the ALT-70 prediction model, surface skin temperature, and both combined were also assessed.

RESULTS: The final sample included 204 participants (mean [SD] age, 56.6 [16.5] years; 121 men [59.3%]), 92 (45.1%) of whom had a consensus diagnosis of cellulitis. There were statistically significant differences in all skin surface temperature measures (mean temperature, maximum temperature, and gradients) between cellulitis and pseudocellulitis. The maximum temperature of the affected limb for patients with cellulitis was 33.2 °C compared with 31.2 °C for those with pseudocellulitis (difference, 2.0 °C [95% CI, 1.3-2.7 °C]; P < .001). The maximum temperature was the optimal temperature measure with a cut point of 31.2 °C in the affected skin, yielding a mean (SD) negative predictive value of 93.5% (4.7%) and a sensitivity of 96.8% (2.3%). The sensitivity of all 3 measures remained above 90%, while specificity varied considerably (ALT-70, 22.0% [95% CI, 15.8%-28.1%]; maximum temperature of the affected limb, 38.4% [95% CI, 31.7%-45.1%]; combination measure, 53.9% [95% CI, 46.5%-61.2%]).

CONCLUSIONS AND RELEVANCE: In this large diagnostic validation study, significant differences in skin surface temperature measures were observed between cases of cellulitis and cases of pseudocellulitis. Thermal imaging and the ALT-70 both demonstrated high sensitivity, but specificity was improved by combining the 2 measures. These findings support the potential of thermal imaging, alone or in combination with the ALT-70 prediction model, as a diagnostic adjunct that may reduce overdiagnosis of cellulitis.

PMID:38536160 | DOI:10.1001/jamadermatol.2024.0091

JAMA Cardiol. 2024 Mar 27. doi: 10.1001/jamacardio.2024.0284. Online ahead of print.

ABSTRACT

IMPORTANCE: Accurate risk prediction of morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF) may help clinicians risk stratify and inform care decisions.

OBJECTIVE: To develop and validate a novel prediction model for clinical outcomes in patients with HFpEF using routinely collected variables and to compare it with a biomarker-driven approach.

DESIGN, SETTING, AND PARTICIPANTS: Data were used from the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial to derive the prediction model, and data from the Angiotensin Receptor Neprilysin Inhibition in Heart Failure With Preserved Ejection Fraction (PARAGON-HF) and the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-PRESERVE) trials were used to validate it. The outcomes were the composite of HF hospitalization (HFH) or cardiovascular death, cardiovascular death, and all-cause death. A total of 30 baseline candidate variables were selected in a stepwise fashion using multivariable analyses to create the models. Data were analyzed from January 2023 to June 2023.

EXPOSURES: Models to estimate the 1-year and 2-year risk of cardiovascular death or hospitalization for heart failure, cardiovascular death, and all-cause death.

RESULTS: Data from 6263 individuals in the DELIVER trial were used to derive the prediction model and data from 4796 individuals in the PARAGON-HF trial and 4128 individuals in the I-PRESERVE trial were used to validate it. The final prediction model for the composite outcome included 11 variables: N-terminal pro-brain natriuretic peptide (NT-proBNP) level, HFH within the past 6 months, creatinine level, diabetes, geographic region, HF duration, treatment with a sodium-glucose cotransporter 2 inhibitor, chronic obstructive pulmonary disease, transient ischemic attack/stroke, any previous HFH, and heart rate. This model showed good discrimination (C statistic at 1 year, 0.73; 95% CI, 0.71-0.75) in both validation cohorts (C statistic at 1 year, 0.71; 95% CI, 0.69-0.74 in PARAGON-HF and 0.75; 95% CI, 0.73-0.78 in I-PRESERVE) and calibration. The model showed similar discrimination to a biomarker-driven model including high-sensitivity cardiac troponin T and significantly better discrimination than the Meta-Analysis Global Group in Chronic (MAGGIC) risk score (C statistic at 1 year, 0.60; 95% CI, 0.58-0.63; delta C statistic, 0.13; 95% CI, 0.10-0.15; P < .001) and NT-proBNP level alone (C statistic at 1 year, 0.66; 95% CI, 0.64-0.68; delta C statistic, 0.07; 95% CI, 0.05-0.08; P < .001). Models derived for the prediction of all-cause and cardiovascular death also performed well. An online calculator was created to allow calculation of an individual’s risk.

CONCLUSIONS AND RELEVANCE: In this prognostic study, a robust prediction model for clinical outcomes in HFpEF was developed and validated using routinely collected variables. The model performed better than NT-proBNP level alone. The model may help clinicians to identify high-risk patients and guide treatment decisions in HFpEF.

PMID:38536153 | DOI:10.1001/jamacardio.2024.0284

Int J Prosthodont. 2024 Mar 22;0(0):1-19. doi: 10.11607/ijp.8843. Online ahead of print.

ABSTRACT

PURPOSE: To update data on the transfer accuracy of digital implant impressions by using a coordinate-based analysis, latest intraoral scanners (IOSs) were investigated in an established clinical close model set-up.

MATERIALS AND METHODS: An implant master model (IMM) of the maxilla with four implants in the posterior area (#14/#24 and #16/#26) and a reference cube was scanned with four different IOS (i700 (Medit), Primescan (Dentsply Sirona), Trios 4 and Trios 5 (3Shape) ten times each. Datasets were compared with a reference dataset of IMM that was generated with x-ray computed tomography in advance. 3D deviations for the implant-abutment-interface points (IAIPs) were calculated. Statistical analysis was performed by multifactorial ANOVA (p < .05).

RESULTS: Overall deviations for trueness (mean) ± precision (SD) of the IAIPs ranged from 88±47 μm for the Primescan, followed by 112±57 μm for the i700, 121±42 μm for the Trios 4 and 124±43 μm for the Trios 5 with decreasing accuracy along the scan path. For trueness, one significant difference between the Primescan and the T4 was detected for one implant position. For precision, no significant differences were noticed.

CONCLUSIONS: Although the latest IOS showed a significant improvement in transfer accuracy, the accumulating deviation along the scan path is not yet resolved. Considering the Trios system, the innovation seems to be limited as no improvement could be detected between Trios 4 and 5.

PMID:38536148 | DOI:10.11607/ijp.8843

Int J Prosthodont. 2024 Mar 22;0(0):1-23. doi: 10.11607/ijp.8895. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effect of cheek retractors on the accuracy of capturing peripheral borders in totally edentulous digital scans by comparing the conventional impression technique to digital scans made using two different cheek retractors.

MATERIAL AND METHODS: Sixteen edentulous maxillary impressions were made using three techniques: the conventional impression technique, using modeling thermoplastic compound and zinc oxide eugenol paste; the digital intraoral scanning technique using the DIO scan retractor (DIO); and using the Br.nemark lip retractor (BRAN). The control impressions of each patient were poured, scanned using a desktop scanner, then transferred into a three-dimensional analysis software. DIO and BRAN groups were scanned using an intraoral scanner, imported, and superimposed using best fit algorithm on the corresponding control. The root mean square for the whole surface and for particular interest regions were calculated to assess the degree of trueness. The patients’ perceptions of the impression techniques were the secondary outcomes. Statistical analyses were performed using the one sample T-test and Wilcoxon test (α=.05).

RESULTS: Significant discrepancies were found for BRAN and DIO compared to the control. No significant discrepancies were found when comparing RMS of BRAN and DIO at different regions. Scan retractors had a significant impact on patient satisfaction, with patients preferring DIO.

CONCLUSIONS: Edentulous intraoral scans made using cheek retractors had similar deviations when compared to each other but diverged from the conventional impression in edentulous maxilla. Patient preferences for intraoral scans over conventional impressions were confirmed.

CLINICAL IMPLICATIONS: The use of different retracting methods during intraoral scanning of totally edentulous maxillary arches does not affect the peripheral border registration.

PMID:38536145 | DOI:10.11607/ijp.8895

J Chem Theory Comput. 2024 Mar 27. doi: 10.1021/acs.jctc.3c01173. Online ahead of print.

ABSTRACT

The concept that a fluid has a position-dependent free energy density appears in the literature but has not been fully developed or accepted. We set this concept on an unambiguous theoretical footing via the following strategy. First, we set forth four desiderata that should be satisfied by any definition of the position-dependent free energy density, f(R), in a system comprising only a fluid and a rigid solute: its volume integral, plus the fixed internal energy of the solute, should be the system free energy; it deviates from its bulk value, f_bulk, near a solute but should asymptotically approach f_bulk with increasing distance from the solute; it should go to zero where the solvent density goes to zero; and it should be well-defined in the most general case of a fluid made up of flexible molecules with an arbitrary interaction potential. Second, we use statistical thermodynamics to formulate a definition of the free energy density that satisfies these desiderata. Third, we show how any free energy density satisfying the desiderata may be used to analyze molecular processes in solution. In particular, because the spatial integral of f(R) equals the free energy of the system, it can be used to compute free energy changes that result from the rearrangement of solutes as well as the forces exerted on the solutes by the solvent. This enables the use of a thermodynamic analysis of water in protein binding sites to inform ligand design. Finally, we discuss related literature and address published concerns regarding the thermodynamic plausibility of a position-dependent free energy density. The theory presented here has applications in theoretical and computational chemistry and may be further generalizable beyond fluids, such as to solids and macromolecules.

PMID:38536144 | DOI:10.1021/acs.jctc.3c01173

J Opioid Manag. 2024 Jan-Feb;20(1):77-85. doi: 10.5055/jom.0809.

ABSTRACT

INTRODUCTION: Orthopedic surgical procedures are expected to increase annually, making it imperative to understand the correlations between patient genetic makeup and post-operative pain levels.

METHODS: We performed a systematic literature review using PubMed and Cochrane databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 299 articles were initially selected, 20 articles remained after title and abstract review, and nine articles were selected for inclusion upon full text review.

RESULTS: Genetic risk factors identified included the A allele of the 5HT2A gene single nucleotide polymorphism, the AA genotype of the ADRB2 gene, the CG genotype of the IL6 gene, the genotypes CT and TT of the NTRK1 gene, genotypes AA and GA of the OPRM gene, and the AA and GA genotypes of the COMT gene. Additional studies in the review discuss statistical significance of other variants of the COMT gene.

CONCLUSION: There have been genetic association studies performed on the patient heterogeneity and its relationship on patient pain levels, but more data need to be collected to understand the clinical utility of stratifying patients based on genomic sequence.

PMID:38533718 | DOI:10.5055/jom.0809

J Opioid Manag. 2024 Jan-Feb;20(1):31-50. doi: 10.5055/jom.0848.

ABSTRACT

OBJECTIVE: To evaluate the impact of recent changes to the Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day threshold recommendations on healthcare utilization.

DESIGN: A retrospective cohort study of new chronic opioid users (NCOUs).

SETTING: Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new use between January 2014 and March 2015.

PATIENTS: NCOUs with ≥60-day coverage of opioids within a 90-day period with ≥30-day opioid-free period prior to the date of the first qualifying opioid -prescription.

INTERVENTIONS: NCOU categorized by the CDC three-tiered risk-based average MME/day thresholds: low (>0 to <50), medium (≥50 to <90), and high (≥90).

MAIN OUTCOME MEASURES: Multivariable logistic regression was used to calculate adjusted odds of incurring an acute care encounter (ACE) (all-cause and opioid-related) between the thresholds (adjusted odds, 95 percent confidence interval).

RESULTS: In adjusted analyses, when compared to low threshold, there was no difference in the odds of all-cause ACE across the medium (1.01, 0.94-1.28) and high (1.01, 0.84-1.22) thresholds. When compared to low threshold, a statistically insignificant increase was observed when evaluating opioid-related ACE among medium (1.86, 0.86-4.02) and high (1.51, 0.65-3.52) thresholds.

CONCLUSIONS: There was no difference in odds of an all-cause or opioid-related ACE associated with the thresholds. Early-intervention programs and policies exploring reduction of MME/day among NCOUs may not result in short-term reduction in all-cause or opioid-related ACEs. Further assessment of potential long-term reduction in ACEs among this cohort may be insightful.

PMID:38533714 | DOI:10.5055/jom.0848

J Emerg Manag. 2024 Jan-Feb;22(1):101-108. doi: 10.5055/jem.0782.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the Jordanians’ compliance rates in terms of personal hygiene habits in response to the coronavirus disease 2019 (COVID-19) pandemic.

METHODS: A descriptive cross-sectional design was utilized to collect data from 651 Jordanians via an electronic self-report questionnaire. Data was analyzed using Statistical Package for Social Sciences software Results: The overall compliance rate for personal hygiene habits among Jordanians was 79 percent (11.85/15, SD = 9). Personal hygiene practices differ significantly across age groups (F = 2, 89, p = .04), gender (t = 5.18, p = .003), marital status (F = 3.09, p = .029), and being a member of a healthcare specialty (t = -2.20, p = .028). Gender, educational level, occupation, and living place were statistically significant predictors for compliance with personal hygiene habits. Compliance rates increased drastically (82 percent) in response to the COVID-19 pandemic.

CONCLUSION: Compliance with personal hygiene habits among Jordanians was encouraging in response to the COVID-19 pandemic. Still, there is a chance for more improvement to reach optimum levels of safe and healthy per-sonal hygiene habits. Healthcare authorities shall adopt change management programs and theories to target personal hygiene habits where opportunities for improvement are found.

PMID:38533704 | DOI:10.5055/jem.0782