Tag: nevin manimala

Int J Surg. 2023 Nov 27. doi: 10.1097/JS9.0000000000000935. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate prognostication of oncological outcomes is crucial for the optimal management of patients with renal cell carcinoma (RCC) after surgery. Previous prediction models were developed mainly based on retrospective data in the Western populations and their predicting accuracy remain limited in the contemporary, prospective validation. We aimed to develop contemporary RCC prognostic models for recurrence and overall survival using prospective population-based patient cohort and compare their performance with existing mostly utilized ones.

METHODS: In this prospective analysis and external validation study, the development set included 11,128 consecutive patients with non-metastatic RCC treated at a tertiary urology center in China between 2006 and 2022, and the validation set included 853 patients treated at 13 medical centers in the USA between 1996 and 2013. The primary outcome was progression-free survival (PFS), and the secondary outcome was overall survival (OS). Multivariable Cox regression was used for variable selection and model development. Model performance was assessed by discrimination (Harrell’s C-index and time-dependent areas under the curve [AUC]) and calibration (calibration plots). Models were validated internally by bootstrapping and externally by examining their performance in the validation set. The predictive accuracy of the models was compared with validated models commonly used in clinical trial designs and with recently developed models without extensive validation.

RESULTS: Of the 11,128 patients included in the development set, 633 PFS and 588 OS events occurred over a median follow-up of 4.3 years (IQR 1.7-7.8). Six common clinicopathologic variables (tumor necrosis, size, grade, thrombus, nodal involvement, and perinephric or renal sinus fat invasion) were included in each model. The models demonstrated similar C-indices in the development set (0.790 [95% CI 0.773-0.806] for PFS and 0.793 [95% CI 0.773-0.811] for OS) and in the external validation set (0.773 [0.731-0.816] and 0.723 [0.731-0.816]). A relatively stable predictive ability of the models was observed in the development set (PFS: time-dependent AUC 0.832 at 1 y to 0.760 at 9 y; OS: 0.828 at 1 y to 0.794 at 9 y). The models were well calibrated and their predictions correlated with the observed outcome at 3-, 5-, and 7-year in both development and validation sets. In comparison to existing prognostic models, the present models showed superior performance, as indicated by C-indices ranging from 0.722 to 0.755 (all P<0.0001) for PFS and from 0.680 to 0.744 (all P<0.0001) for OS. The predictive accuracy of the current models was robust in patients with clear-cell and non-clear-cell RCC.

CONCLUSIONS: Based on a prospective population-based patient cohort, the newly developed prognostic models were externally validated and outperform the currently available models for predicting recurrence and survival in patients with non-metastatic RCC after surgery. The current models have the potential to aid in clinical trial design and facilitate clinical decision making for both clear cell and non-clear cell RCC patients at varying risk of recurrence and survival.

PMID:38016139 | DOI:10.1097/JS9.0000000000000935

Int J Surg. 2023 Nov 28. doi: 10.1097/JS9.0000000000000923. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and non-surgical scenarios and assess the strength of evidence.

MATERIALS AND METHODS: We performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence.

RESULTS: 75 meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For non-surgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in non-emergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation.

CONCLUSIONS: Antibiotic prophylaxis in surgical and non-surgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.

PMID:38016138 | DOI:10.1097/JS9.0000000000000923

Rev Med Inst Mex Seguro Soc. 2023 Sep 18;61(Suppl 2):S246-S253.

ABSTRACT

BACKGROUND: Nutrition in the Intensive Care Unit (ICU) is a cornerstone; however, energy requirements are a controversial issue that has not yet been resolved. Calorimetry is the gold standard for calculating energy expenditure, but it is expensive and not available in all ICU areas. Formulas have been developed to calculate basal energy expenditure (BAE) and make the process easier.

OBJECTIVE: To validate the predictive formulas of BAE compared to that obtained with ventilatory indirect calorimetry (IC) within the nutritional assessment in ICU patients.

MATERIAL AND METHODS: Analytical cross-sectional retrolective study. We performed BAE measurement on patients in the ICU of a third level hospital with ventilatory indirect calorimetry and compared the results obtained with those of the Harris Benedict, Muffin-St. Jeor, Institute of Medicine, and Faisy equations.

RESULTS: A total of 49 patients were included; a moderate correlation with statistical significance was found between the BAE measurements obtained by indirect calorimetry, with those obtained by four predictive equations that were studied. The Faisy equation obtained the strongest correction with r = 0.461 (p = 0.001).

CONCLUSION: The correlation between the BAE obtained by predictive equations and by IC goes from mild to moderate, due to the heterogeneity of critical patients and their changing nature throughout their disease.

PMID:38016112

Vopr Kurortol Fizioter Lech Fiz Kult. 2023;100(5):14-20. doi: 10.17116/kurort202310005114.

ABSTRACT

The problem of comprehensive physical therapy in polymorbidity (PM) identifies among the most urgent difficulties of modern rehabilitation medicine. It is known that PM are more common than it is generally accepted, and their impact on the endpoints of rehabilitative treatment is more significant. Yet, many problems of PM have not been investigated and properly solved.

OBJECTIVE: To evaluate the efficacy of comprehensive physical therapy (CPT) in PM in the age aspect on the basis of correlation analysis and ANOVA indicators (OR, RR, Q, x², r²), as well as evidence-based medicine (EBM), in particular randomized comparative study (RCS).

MATERIAL AND METHODS: A number of patients with PM equal 554 underwent CPT, of which 204 (36.8%) were male and 350 (63.2%) female. The identified age cohorts were following: the 1st group – 188 (33.9%) patients aged from 45 to 59; the 2nd group – 366 (66.1%) patients aged from 60 to 74. The ratio of middle-aged and elderly patients was 1.9:1.

RESULTS: The efficacy of CPT in patients with PM was judged, first of all, by documentary (medical histories and medical records of patients) and mathematical data (OR, RR, Q, x², r²). The evidence level of CPT effect was determined on the basis of the analysis of the particular method’s study results.

CONCLUSION: The incidence of positive CPT result in middle-aged patients was higher than in elderly. The positive strong statistical correlation between comprehensive physical therapy and the endpoint in most classes of diseases of patients with PM. The comparative assessment of CPT efficacy based on the EBM principles revealed the advantages of their use for elderly patients relative to middle-aged group.

PMID:38016052 | DOI:10.17116/kurort202310005114

Trans R Soc Trop Med Hyg. 2023 Nov 28:trad083. doi: 10.1093/trstmh/trad083. Online ahead of print.

ABSTRACT

BACKGROUND: Nigeria instituted the National Health Insurance Scheme (NHIS) for universal health coverage. This study compared the NHIS and out-of-pocket (OOP) antibiotic prescribing with the World Health Organization (WHO) optimal values.

METHODS: A total of 2190 prescription forms from the NHIS and OOP were included in this study conducted at Obafemi Awolowo University Teaching Hospitals Complex, Nigeria from January 2021 to December 2022 and analysed using WHO drug prescribing guidelines.

RESULTS: The average number of drugs per encounter was higher in the NHIS prescribing (χ2=58.956, p=0.00) than in OOP prescribing. The percentage of encounters with an antibiotic prescribed is higher in NHIS prescribing (χ2=46.034, p=0.000) than in OOP prescribing. The percentage of parenteral antibiotic prescribing is higher in OOP prescribing (χ2=25.413, p=0.000) than in NHIS prescribing. The percentage of antibiotic prescribed from the National Essential Medicine List is higher in NHIS prescribing (χ2=8.227, p=0.000) as well as the antibiotics prescribed from the Access category of the WHO Access, Watch and Reserve (AWaRe) Classification of antibiotics (χ2=23.946, p=0.000) when compared with OOP prescribing.

CONCLUSIONS: Prescribing indicators show better performances with NHIS antibiotic prescribing and are closer to the WHO-recommended optimal values than in OPP prescribing. Hence NHIS prescribing can be an easy target for hospital antibiotic stewardship intervention for optimal antibiotic prescribing.

PMID:38016023 | DOI:10.1093/trstmh/trad083

Cornea. 2023 Nov 28. doi: 10.1097/ICO.0000000000003438. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to report a case series of central toxic keratopathy (CTK) after collagen cross-linking (CXL) in keratoconus.

METHODS: This is a retrospective case series between January 2020 and September 2021. In this period, CXL was performed for progressive keratoconus in 964 eyes. CXL was performed using the epithelium-off accelerated protocol in all patients with a riboflavin soak time of 20 minutes and a UVA light exposure of 9 mW for 10 minutes using the Avedro KXL (Glaukos Inc, Aliso Viejo, CA) cross-linking system.

RESULTS: Twelve of 964 eyes (1.2%) developed CTK within 1 week of CXL. All patients presented with well-circumscribed, central disciform haze that was broader in the anterior stroma and narrower in the posterior stroma. We noted initial flattening in keratometry up to 3 months post-CXL in these patients, which gradually steepened over 12 months, but did not reach preoperative levels. We also noted exuberant flattening in pachymetry in the first 3 months, which improved over 12 months. There was a statistically significant decrease in pachymetry in patients who developed CTK at 3 and 12 months postoperatively when compared to patients who underwent CXL but did not develop CTK.

CONCLUSIONS: Several reports of CTK postrefractive surgery have been described previously. However, the association of CXL in the development of CTK has not been described previously. Here, we elucidated the clinical features of CTK after CXL and how it differs from corneal scarring or haze that occurs post-CXL.

PMID:38016022 | DOI:10.1097/ICO.0000000000003438

PLoS One. 2023 Nov 28;18(11):e0294947. doi: 10.1371/journal.pone.0294947. eCollection 2023.

ABSTRACT

This article is based on the statistical yearbook data of 30 provinces, municipalities and autonomous regions in China (excluding Hong Kong, Macao, Taiwan, and Tibet Autonomous Region) from 2000 to 2017, a total of 18 years of statistical yearbook data was used to conduct in-depth research on the reduction of CO2 emissions from the development of new energy in the region. First, it is proposed that the regional new energy development has a significant negative effect on CO2 emissions. Meanwhile, this impact has a significant time lag effect, and the development of new energy cannot be quickly and effectively applied in the short term to replace traditional fossil energy in the dynamic model. Therefore, there is a significant positive impact in the short term, but the significant negative effect of new energy development on CO2 emission can be shown in the long run. Secondly, the new energy development has a significant non-linear impact on CO2 emissions, showing an inverted U-shaped relationship, which confirms the existence of the Environmental Kuznets Curve (EKC) of CO2 emissions based on new energy development. Finally, in order to alleviate the continuous impact of national economic development on CO2 emissions, the DID model is used to prove that the level of technological innovation has a significant moderating effect on the CO2 emission reduction effect of new energy development, which confirms theoretically the importance of technological innovation in accelerating new energy substitution and improving energy efficiency.

PMID:38016002 | DOI:10.1371/journal.pone.0294947

PLoS One. 2023 Nov 28;18(11):e0294844. doi: 10.1371/journal.pone.0294844. eCollection 2023.

ABSTRACT

OBJECTIVES: To describe inpatient and outpatient cardiac rehabilitation (CR) utilization patterns over time and by subgroups among patients admitted for acute heart failure (AHF) in Japan.

BACKGROUND: Cardiac rehabilitation (CR) is a crucial secondary prevention strategy for patients with heart failure. While the number of older patients with AHF continues to rise, trends in inpatient and outpatient CR participation following AHF in Japan have not been described to date.

METHODS: We conducted a retrospective cohort study of adult patients hospitalized for AHF in Japan between April 2008 and December 2020. Using data from the Medical Data Vision database, we measured trends in inpatient and outpatient CR participation following AHF. Descriptive analyses and summary statistics for AHF patients by CR participation status were reported.

RESULTS: The analytic cohort included 88,052 patients. Among these patients, 37,810 (42.9%) participated in inpatient and/or outpatient CR. Of those, 36,431 (96.4%) participated in inpatient CR only and 1,277 (3.4%) participated in both inpatient and outpatient CR. Rates of inpatient CR rose more than 6-fold over the study period, from 9% in 2009 to 55% in 2020, whereas rates of outpatient CR were consistently low.

CONCLUSIONS: The rate of inpatient CR participation among AHF patients in Japan rose dramatically over a 12-year period, whereas outpatient CR following AHF was vastly underutilized. Further study is needed to assess the clinical effectiveness of inpatient CR and to create infrastructure and incentives to support and encourage outpatient CR.

PMID:38015991 | DOI:10.1371/journal.pone.0294844

PLoS One. 2023 Nov 28;18(11):e0294575. doi: 10.1371/journal.pone.0294575. eCollection 2023.

ABSTRACT

Inclusive citizen science, an emerging field, has seen extensive research. Prior studies primarily concentrated on creating theoretical models and practical strategies for diversifying citizen science (CS) projects. These studies relied on ethical frameworks or post-project empirical observations. Few examined active participants’ socio-demographic and behavioral data. Notably, none, to our knowledge, explored prospective citizen scientists’ traits as intrinsic factors to enhance diversity and engagement in CS. This paper presents a new inclusive CS engagement model based on quantitative analysis of surveys administered to 540 participants of the dedicated free informal education MOOC (Massive Open Online Course) ‘Your Right to Privacy Online’ from eight countries in the EU funded project, CSI-COP (Citizen Scientists Investigating Cookies and App GDPR compliance). The surveys were filled out just after completing the training stage and before joining the project as active CSs. Out of the 540 participants who completed the surveys analyzed in this study, only 170 (32%) individuals actively participated as CSs in the project. Therefore, the study attempted to understand what characterizes these participants compared to those who decided to refrain from joining the project after the training stage. The study employed descriptive analysis and advanced statistical tests to explore the correlations among different research variables. The findings revealed several important relationships and predictors for becoming a citizen scientist based on the surveys analysis, such as age, gender, culture, education, Internet accessibility and apps usage, as well as the satisfaction with the MOOC, the mode of training and initial intentions for becoming a CS. These findings lead to the development of the empirical model for inclusive engagement in CS and enhance the understanding of the internal factors that influence individuals’ intention and actual participation as CSs. The devised model offers valuable insights and key implications for future CS initiatives. It emphasizes the necessity of targeted recruitment strategies, focusing on underrepresented groups and overcoming accessibility barriers. Positive learning experiences, especially through MOOCs, are crucial; enhancing training programs and making educational materials accessible and culturally diverse can boost participant motivation. Acknowledging varying technological proficiency and providing necessary resources enhances active engagement. Addressing the intention-engagement gap is vital; understanding underlying factors and creating supportive environments can transform intentions into active involvement. Embracing cultural diversity through language-specific strategies ensures an inclusive environment for effective contributions.

PMID:38015965 | DOI:10.1371/journal.pone.0294575

PLoS One. 2023 Nov 28;18(11):e0292832. doi: 10.1371/journal.pone.0292832. eCollection 2023.

ABSTRACT

This study aims to review the long-term subjective and objective efficacy of mandibular advancement devices (MAD) in the treatment of adult obstructive sleep apnea (OSA). Electronic databases such as PubMed, Embase, and Cochrane Library were searched. Randomized controlled trials (RCTs) and non-randomized self-controlled trials with a treatment duration of at least 1 year with MAD were included. The quality assessment and data extraction of the included studies were conducted in the meta-analysis. A total of 22 studies were included in this study, of which 20 (546 patients) were included in the meta-analysis. All the studies had some shortcomings, such as small sample sizes, unbalanced sex, and high dropout rates. The results suggested that long-term treatment of MAD can significantly reduce the Epworth sleepiness scale (ESS) by -3.99 (95%CI -5.93 to -2.04, p<0.0001, I2 = 84%), and the apnea-hypopnea index (AHI) -16.77 (95%CI -20.80 to -12.74) events/h (p<0.00001, I2 = 97%). The efficacy remained statistically different in the severity (AHI<30 or >30 events/h) and treatment duration (duration <5y or >5y) subgroups. Long-term use of MAD could also significantly decrease blood pressure and improve the score of functional outcomes of sleep questionnaire (FOSQ). Moderate evidence suggested that the subjective and objective effect of MAD on adult OSA has long-term stability. Limited evidence suggests long-term use of MAD might improve comorbidities and healthcare. In clinical practice, regular follow-up is recommended.

PMID:38015938 | DOI:10.1371/journal.pone.0292832