Tag: nevin manimala

N Z Med J. 2023 Sep 15;136(1582):64-86.

ABSTRACT

AIMS: Routinely collected health data can provide rich information for research and epidemiological monitoring of different diseases, but using the data presents many challenges. This study aims to explore the attitudes and preferences of people aged 55 and over regarding the use of their de-identified health data, and their concerns and comfort in different scenarios.

METHODS: An anonymous online survey was conducted with people aged 55 and over currently engaged with health services in a New Zealand health district during June-October 2022. The survey could be completed online or by telephone and was available in eight languages.

RESULTS: Seventy-nine percent of respondents knew that their health information was currently being used in the ways described in the scenarios, and between 80-87% felt comfortable or very comfortable with their data being used as described in the scenarios. In contrast, 4% (n=9) felt “uncomfortable” or “very uncomfortable” across all of the scenarios. Participants expressed concerns about data accuracy, privacy and confidentiality, security, transparency of use, consent, feedback and the risk of data being sold to commercial companies. Some participants identified situations where permission should be required to link data, including being used by people other than health professionals, containing sensitive health issues, or being used for commercial purposes.

CONCLUSION: This study finds general support from patients for the use of their routinely collected data for secondary purposes as long as its use will benefit the population from which the data are taken. It also highlights the necessity of including the perspectives of different cultures in the collection, storage, use and analysis of health information, particularly concerning Māori cultural considerations.

PMID:37708487

N Z Med J. 2023 Sep 15;136(1582):14-27.

ABSTRACT

AIMS: Non-traumatic dental presentations (NTDPs) commonly present to emergency departments (EDs) and may receive orthopantomograms (OPGs, plain X-rays), opiates and antibiotics. “Choosing Wisely” is an international healthcare campaign that aims to reduce unnecessary and low-value patient care. This study aims to identify low-value management of NTDPs.

METHODS: Presentations to the Christchurch Hospital ED with dental pain or dental abscess in 2020 were included. Data collected included patient demographics, management and discharge medications. Descriptive statistics were calculated.

RESULTS: There were 931 NTDPs during the study period, with over-representation of young adults, Māori, Pacific Peoples and those living in high-deprivation areas. Of these, 343 (37%) received an OPG, of which 24% (83) were considered low value. Of patients managed by ED staff who were not referred to specialist dental services, 258 (42%) were prescribed antibiotics, of whom only half had facial swelling, and 71% received a script for analgesia, of which 78% included an opiate. Seventy-three percent of patients presented outside of normal working hours. Fewer than one in five NTDPs received definitive treatment.

CONCLUSIONS: NTDPs may receive non-optimal management in EDs. Continuing to care for NTDPs in this environment may add to increased healthcare costs, access block and poor opioid and antimicrobial stewardship.

PMID:37708483

JCO Oncol Pract. 2023 Sep 14:OP2300242. doi: 10.1200/OP.23.00242. Online ahead of print.

ABSTRACT

PURPOSE: Prime childbearing years occur during medical training and early career, leaving physicians with tough choices between family planning and career growth. Restrictive workplace parental leave (PL) policies may negatively affect physician well-being. We evaluate existing PL and lactation policies, as well as return-to-work experiences, among oncology trainees and early-career faculty.

METHODS: An anonymous 43-question cross-sectional survey was distributed via e-mail and social media channels between May and June 2021 to oncology trainees and physicians within 5 years of terminal training in the United States. The survey was administered through SurveyMonkey. Descriptive statistics were used to analyze data. Two hundred seventy-five participants were recruited via social media and outreach to program directors and coordinators in adult hematology/oncology and radiation oncology program directors.

RESULTS: The average duration of PL was <6 weeks for most participants. Among those who used PL, 50% felt pressured to work while on PL, 60% felt guilty asking coworkers for help, and 79% were overwhelmed with demands of work and home, whereas only 27% had resources available at workplace to assist with transition back to work. Among those who breastfed at return to work, 31% did not have access to a lactation room, 56% did not have adequate pumping breaks, and 66% did not have pumping breaks mandated in contract.

CONCLUSION: Our findings underline the immense magnitude of problems surrounding inadequate PL and support for lactating mothers among trainees and early-career physicians in oncology subspecialities. Policies and practices around PL and lactation should be restructured to meet the needs of the evolving oncology workforce.

PMID:37708434 | DOI:10.1200/OP.23.00242

Eur J Prev Cardiol. 2023 Sep 14:zwad300. doi: 10.1093/eurjpc/zwad300. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is a major risk factor for atrial fibrillation (AF). Compared to stable weight, gaining weight was associated with a higher risk of incident AF in observational studies. The results, however, are conflicting regarding weight loss and risk of AF. This study aimed to assess the association between five-year weight changes and risk of incident AF.

METHODS: The study was based on participants from the Danish Diet, Cancer and Health cohort. Body mass index (BMI) was assessed at a baseline examination and at a second examination five years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry.

RESULTS: In total, 43,758 participants without prior AF were included. The median age was 61 years and 54% were female. During a median follow-up of 15.7 years, 5,312 individuals had incident AF (incidence rate 8.6/1,000 person-years). Compared to stable weight, weight gain between 2.5 to 5 BMI units (kg/m2) was associated with a higher risk of AF (HR 1.24, 95% CI 1.09-1.41). Weight gain of 5 or more BMI units (kg/m2) was associated with a HR of 1.95 (95% CI 1.48-2.56) of incident AF. However, there was no statistically significant association between weight loss and risk of AF.

CONCLUSIONS: Five-year weight gain was associated with greater risk of AF compared with stable weight in the Danish Diet, Cancer and Health cohort. There was no statistically significant association between weight loss and risk of AF.

PMID:37708406 | DOI:10.1093/eurjpc/zwad300

J Neurosurg. 2023 Sep 8:1-10. doi: 10.3171/2023.7.JNS231133. Online ahead of print.

ABSTRACT

OBJECTIVE: The use of stent-assisted coiling (SAC) in acute subarachnoid hemorrhage cases is associated with higher incidence rates of bleeding and ischemic complications. The aim of this study was to evaluate the safety and efficacy of the SAC technique in the treatment of ruptured intracranial aneurysms (RIAs).

METHODS: A retrospective analysis was conducted on patients with RIAs treated with SAC or coiling alone (CA). Univariate analysis compared clinical information between the two groups. Propensity score matching was used to select patients for comparison and analyze surgical complications, prognosis, and imaging outcomes in both groups.

RESULTS: A total of 394 aneurysms were included, and 272 aneurysms remained after application of propensity score matching, with an equal distribution of 136 cases in both the SAC and CA groups. There was no statistically significant difference in the immediate postoperative outcomes between the two groups (63.2% of SAC patients achieved class 1 on the Raymond-Roy occlusion classification scale vs 58.8% of CA patients, difference [95% CI] 4.4% [-0.076 to 0.163]; 33.1% achieved class 2 vs 38.2%, 5.1% [-0.065 to 0.170]; 3.7% achieved class 3 vs 2.9%, 0.8% [-0.047 to 0.062], p = 0.506). At the 1-year follow-up, the SAC group exhibited higher rates of complete occlusion (59.5% vs 42.4%, 17.1% [0.040-0.294]) and stability (24.0% vs 19.2%, 4.8% [-0.061 to 0.156]), while experiencing lower rates of improvement (12.4% vs 22.4%, 10.0% [0.001-0.201]) and recanalization (4.1% vs 16.0%, 11.9% [0.036-0.120]), with statistically significant differences in these outcomes (p < 0.001). No significant disparities were observed in clinical outcomes in terms of modified Rankin Scale (mRS) scores at discharge (76.5% vs 77.2% had mRS score 0-2, 0.7% [-0.098 to 0.113]; 23.5% vs 22.8% had mRS score 3-6, 0.7% [-0.098 to 0.113], p = 0.886) and 1-year follow-up (90.8% vs 92.2% had mRS score 0-2, 1.4% [-0.063 to 0.091]; 9.2% vs 7.8% had mRS score 3-6, 1.4% [-0.063 to 0.091], p = 0.683). Intraoperative rupture occurred more frequently in the SAC group compared with the CA group, although the difference was not statistically significant (5.1% vs 2.9%, 2.2% [-0.035 to 0.081], p = 0.356). The SAC group demonstrated a higher incidence of intraoperative thrombosis, but the difference was not statistically significant (8.1% vs 2.9%, 5.2% [-0.010 to 0.117], p = 0.063). Postoperative thrombosis in the SAC group was 3 times higher, but this difference was not statistically significant (6.6% vs 2.2%, 4.4% [-0.013, 0.106], p = 0.076). The surgery-related mortality rates did not differ significantly between the two groups (4.4% vs 5.9%, 1.5% [-0.048 to 0.077], p = 0.583).

CONCLUSIONS: Although stent treatment for RIA results in some incidents of complications, it is safe and effective. Besides, the SAC group showed better vascular imaging results compared with the CA group.

PMID:37708395 | DOI:10.3171/2023.7.JNS231133

Ann Am Thorac Soc. 2023 Sep 14. doi: 10.1513/AnnalsATS.202305-394OC. Online ahead of print.

ABSTRACT

RATIONALE: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, interpretation of breathlessness responses to CPET is limited by a scarcity of normative data.

OBJECTIVES: We aimed to develop normative reference equations for breathlessness intensity (Borg 0-10 category-ratio [CR10]) response in men and women aged ≥40 years during CPET, in relation to power output (W), rate of oxygen uptake (V’O2), and minute ventilation (V’E).

METHODS: Analysis of ostensibly healthy people aged ≥40 years undergoing a symptom-limited incremental cycle CPET (10 W/min) in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants had <5 pack-years smoking, normal lung function and exercise capacity. The probability of each Borg CR10 breathlessness intensity rating by W, V’O2 or V’E (as absolute or relative value [% of predicted max]) was predicted using ordinal multinomial logistic regression. Model performance was evaluated by fit, calibration, discrimination (c-statistic), and externally validated in an independent sample (n=86) of healthy Canadian adults.

RESULTS: We included 156 participants (43% women) from CanCOLD; mean age 65 (range 42-91) years, mean body mass index 26.3 (SD 3.8) kg/m2. Reference equations were developed for females and males separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (c-statistic males: 0.81-0.92; females: 0.81-0.96).

CONCLUSION: Normative reference equations are provided to compare exertional breathlessness intensity ratings between individuals or groups, and to identify and quantify abnormal breathlessness responses (score > upper limit of normal) during CPET.

PMID:37708387 | DOI:10.1513/AnnalsATS.202305-394OC

Opt Lett. 2023 Sep 15;48(18):4909-4912. doi: 10.1364/OL.500487.

ABSTRACT

Relying on Feynman-Kac path-integral methodology, we present a new statistical perspective on wave single-scattering by complex three-dimensional objects. The approach is implemented on three models-Schiff approximation, Born approximation, and rigorous Born series-and familiar interpretative difficulties such as the analysis of moments over scatterer distributions (size, orientation, shape, etc.) are addressed. In terms of the computational contribution, we show that commonly recognized features of the Monte Carlo method with respect to geometric complexity can now be available when solving electromagnetic scattering.

PMID:37707934 | DOI:10.1364/OL.500487

JMIR Hum Factors. 2023 Sep 14;10:e50232. doi: 10.2196/50232.

ABSTRACT

BACKGROUND: Telehealth can optimize access to specialty care for patients with atrial fibrillation (AF). Virtual AF care, however, may not fit with the complex needs of patients with AF.

OBJECTIVE: This study aims to explore the correlation among attitudes toward health care technologies, self-efficacy, and telehealth satisfaction as part of the future planning of virtual AF clinic care.

METHODS: Patients with AF older than 18 years from an urban-based, highly specialized AF clinic who had an upcoming telehealth visit were invited to participate in a web-based survey. The survey asked about demographic characteristics; use of technology; general, computer, and health care technology self-efficacy (HTSE) and health care technology attitudes, using a validated 30-item tool; and telehealth satisfaction questionnaire using a validated 14-item questionnaire. Data were analyzed with descriptive statistics, correlational analyses, and linear regression modeling.

RESULTS: Participants (n=195 of 579 invited, for a 34% response rate) were primarily older, male, and White, had postsecondary schooling or more, and had high self-reported overall and mental health ratings. A variety of technologies were used in their daily lives and for health care, with the majority of technologies comprising desktop and laptop computers, smartphones, and tablets. Self-efficacy and telehealth satisfaction questionnaire scores were high overall, with male participants having higher general self-efficacy, computer self-efficacy, HTSE, and technology attitude scores. After controlling for age and sex, only HTSE was significantly related to individuals’ attitudes toward health care technology. Both general self-efficacy and attitude toward health care technology were positively related to telehealth satisfaction.

CONCLUSIONS: Consistent with a previous study, only HTSE significantly influenced attitudes toward health care technology. This finding confirms that, in this regard, self-efficacy is not a general perception but is domain specific. Considering participants’ predominant use of the telephone for virtual care, it follows that general self-efficacy and attitude toward health care technology were significant contributors to telehealth satisfaction. Given our patients’ frequent use of technology and high computer self-efficacy and HTSE scores, the use of video for telehealth appointments could be supported.

PMID:37707881 | DOI:10.2196/50232

J Patient Saf. 2023 Sep 15. doi: 10.1097/PTS.0000000000001161. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC).

METHODS: This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: (a) presence of each of 19 specific computer-identified triggers in the EMR and (b) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression.

RESULTS: The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval {CI}, 22.8%-41.8%]; SP = 92.8% [95% CI, 91.6%-94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%-27.4%]; SP = 97.2% [95% CI, 96.4%-98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%-40.6%]; SP = 90.8% [95% CI, 89.4%-92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%-5.2%]; SP = 99.8% [95% CI, 99.6%-100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%-21.1%]; SP = 95.5% [95% CI, 94.5%-96.5%]).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7).

CONCLUSIONS: The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.

PMID:37707868 | DOI:10.1097/PTS.0000000000001161

Lupus. 2023 Sep 14:9612033231202843. doi: 10.1177/09612033231202843. Online ahead of print.

ABSTRACT

BACKGROUND: We present clinical, biochemical, and histopathological characteristics and treatment outcomes of biopsy proven childhood lupus nephritis (LN) from a low/middle income setting treated in the current era of increased use of Mycophenolate Mofetil (MMF) and biologics.

METHODS: Retrospective observational study of children (1-18 years) with biopsy proven LN treated from 01.01.2010 to 31.01.2020.

RESULTS: 60 children met our inclusion criteria (80%, n = 48 were females). The median age at diagnosis was 11 (IQR: 9-12) years. The most common extra-renal manifestation was mucocutaneous (n = 54, 90%) and the most common kidney manifestation was edema (n = 50, 83.3%). The median 24-h urinary protein excretion was 1117.8 (IQR: 795.4-1941.7) mg/m²/day with 67% (n = 40) having nephrotic range proteinuria (>1000 mg/m²/day). 75% (n = 45) children had eGFR <90 mL/min/1.73 m² (median eGFR = 71; IQR: 56-90 mL/min/1.73 m²). Anti-Nuclear Antibody was positive in all, both complement three and four were low in 82% (n = 49) and anti-double stranded DNA antibodies were positive in 63% (n = 38). 85% (n = 51) had proliferative LN with majority being class IV (57%, n = 34). All children received steroids for induction therapy. MMF was given as the sole induction agent in 48% (n = 29) and cyclophosphamide in 27% (n = 16). Rituximab was added in 17% (n = 10) as a rescue agent. Median follow up duration was 50 (IQR: 28-82) months. Six children (10%) died as a result of serious infections and none of them had shown complete response (CR). Out of the 52 children who had a follow up duration of at least 2 years, CR was achieved in 46 children (88%) and partial response (PR) or no response (NR) in three children (6%) each. Although children who were in CR/PR at last follow up had lower proteinuria, higher eGFR, and lower histopathology activity index at onset; low numbers in the NR group precluded us from subjecting them to any statistical correlation tests. 36% (n = 22) of children developed 36 episodes of renal flares with overall incidence of 0.14/person-year.

CONCLUSION: Our study on a contemporary cohort of childhood LN highlights the importance of achieving CR and its feasibility.

PMID:37707867 | DOI:10.1177/09612033231202843