Tag: nevin manimala

Rev Med Inst Mex Seguro Soc. 2023 Oct 2;61(Suppl 3):S503-S509. doi: 10.5281/zenodo.8319834.

ABSTRACT

Data management “behind the scenes” refers to collection, cleaning, imputation, and demarcation; and despite of being indispensable processes, they are usually neglected and thus, generate erroneous information. During the collection are errors: omission of covariates, deviation from the objective, and insufficient quality. The omission of covariates distorts the result attributed to the main manoeuvre. Deviation from the primary objective commonly occurs when the outcome is rare, delayed, or subjective and promotes substitution by non-equivalent surrogate variables. Moreover, insufficient quality occurs due to inadequate instruments, omission of the measurement procedure, or measurements out of context, such as attribution at the wrong time or equivalent. Furthermore, cleaning implies identifying erroneous, extreme, and missing values, which may or may not be imputed, depending on the percentage. The values of the manoeuvre or the outcome are never imputed, nor are patients eliminated due to a lack of values. Finally, the demarcation of each variable seeks to give it a clinical meaning about the outcome, for which a hierarchical sequence of criteria is followed: 1) previous clinical study, 2) expert agreement, 3) clinical judgment of the investigator/investigators, and 4) statistics. Acting without quality controls in data management frequently causes involuntary lies and confuses instead of clarifying.

PMID:37935026 | DOI:10.5281/zenodo.8319834

J Integr Complement Med. 2023 Nov 8. doi: 10.1089/jicm.2023.0102. Online ahead of print.

ABSTRACT

Objective: Whole person health care, like that being implemented in the U.S. Veterans Health Administration (VHA), involves person-centered approaches that address what matters most to patients to achieve well-being beyond the biomedical absence of disease. As whole health (WH) approaches expand, their integration into clinical practice is predicated on health care employees reconceptualizing practice beyond find-it-fix-it medicine and embracing WH as a new philosophy of care. This study examined employee perspectives of WH and their integration of this approach into care. Design: We conducted a survey with responses from 1073 clinical and 800 nonclinical employees at 5 VHA WH Flagship sites about their perceptions and use of a WH approach. We used descriptive statistics to examine employees’ support for WH and conducted thematic analysis to qualitatively explore their perceptions about this approach from free-text comments supplied by 475 respondents. Results: On structured survey items, employees largely agreed that WH was a valuable approach but were relatively less likely to have incorporated it into practice or report support within their organization for WH. Qualitative comments revealed varying conceptualizations of WH. While some respondents understood that WH represented a philosophical shift in care, many characterized WH narrowly as services. These conceptualizations contributed to lower perceived relevance, skepticism, and misgivings that WH diverted needed resources away from existing clinical services. Organizational context including leadership messaging, siloed structures, and limited educational opportunities reinforced these perceptions. Conclusions: Successfully transforming the culture of care requires a shift in mindset among employees and leadership alike. Employees’ depictions didn’t always reflect WH as a person-centered approach designed to engage patients to enhance their health and well-being. Without consistent leadership messaging and accessible training, opportunities to expand understandings of WH are likely to be missed. To promote WH transformation, additional attention is needed for employees to embrace this approach to care.

PMID:37935016 | DOI:10.1089/jicm.2023.0102

Rev Med Inst Mex Seguro Soc. 2023 Oct 2;61(Suppl 3):S497-S502. doi: 10.5281/zenodo.8319791.

ABSTRACT

The use of diagnostic tests to determine the presence or absence of a disease is essential in clinical practice. The results of a diagnostic test may correspond to numerical estimates that require quantitative reference parameters to be transferred to a dichotomous interpretation as normal or abnormal and thus implement actions for the care of a condition or disease. For example, in the diagnosis of anemia it is necessary to define a cut-off point for the hemoglobin variable and create two categories that distinguish the presence or absence of anemia. The method used for this process is the preparation of diagnostic performance curves, better known by their acronym in English as ROC (Receiver Operating Characteristic). The ROC curve is also useful as a prognostic marker, since it allows defining the cut-off point of a quantitative variable that is associated with greater mortality or risk of complications. They have been used in different prognostic markers in COVID-19, such as the neutrophil/lymphocyte ratio and D-dimer, in which cut-off points associated with mortality and/or risk of mechanical ventilation were identified. The ROC curve is used to evaluate the diagnostic performance of a test in isolation, but it can also be used to compare the performance of two or more diagnostic tests and define which one is more accurate. This article describes the basic concepts for the use and interpretation of the ROC curve, the interpretation of an area under the curve (AUC) and the comparison of two or more diagnostic tests.

PMID:37935015 | DOI:10.5281/zenodo.8319791

Radiat Prot Dosimetry. 2023 Nov 2;199(18):2199-2202. doi: 10.1093/rpd/ncad205.

ABSTRACT

Good response was observed in simultaneously using six RAD7 detectors at high radon concentrations, temperatures and relative humidity conditions. RAD7 detectors were tested in laboratory using radon chambers from 13 up to 59.8 kBq m-3, statistical analysis allows to distinct between counting errors and radon variation. RAD7 detectors were exposure to extreme environmental conditions at uranium flat mine. High radon concentration in soil from a confined uranium mineral was 274.3 kBq m-3 at 44°C temperature and 20% relative humidity. Inside uranium mine radon increased from 1.0 up to 88.5 kBq m-3.

PMID:37934994 | DOI:10.1093/rpd/ncad205

Lab Med. 2023 Nov 2;54(6):652-658. doi: 10.1093/labmed/lmad025.

ABSTRACT

OBJECTIVE: The aim of this study was to optimize the currently used direct spectrophotometric serum prolidase enzyme activity (SPEA) assay method and compare its diagnostic accuracy with current precipitation and direct spectrophotometric assay methods, AST-to-ALT ratio, age platelet index, AST-to-platelet ratio index, cirrhosis discriminate score, Doha score, FIB-4, FibroQ, fibrosis index, Goteborg University Cirrhosis Index , King’s score, and Pohl score for distinguishing Ishak F0 from F1-F3 in patients with chronic hepatitis B (CHB) infection.

METHODS: Liver biopsy results from 112 patients were included in this study.

RESULTS: The SPEA values were 529 (292-794) U/L, 671 (486-927) U/L, and 1077 (867-1399) U/L with the precipitation, current, and optimized direct spectrophotometric assay methods, respectively. According to multivariate logistic regression analysis optimized direct spectrophotometric SPEA was the only statistically significant parameter to predict the early stages of liver fibrosis.

CONCLUSIONS: Optimized direct spectrophotometric SPEA assay method could be used to distinguish early stages of liver fibrosis in patients with CHB infection instead of the currently used spectrophotometric SPEA assay methods and other evaluated liver fibrosis indexes.

PMID:37934976 | DOI:10.1093/labmed/lmad025

J Glob Health. 2023 Nov 9;13:04140. doi: 10.7189/jogh.13.04140.

ABSTRACT

BACKGROUND: The high costs of novel anticancer drugs have caused concern among healthcare stakeholders. To address the knowledge gap on the proportion of survival benefit with the related economic expenditure, we aimed to assess the correlation between the costs and value of innovative drugs targeted to specific tumours, before and after price negotiation policy implementation.

METHODS: We identified new drugs for lung and breast cancer that entered the National Reimbursement Drug List (NRDL) through price negotiation from 2016 to 2023. Therapeutic value consisted of traditional clinical endpoints, like the percentage improvement of overall survival (ΔOS%) and progression-free survival (ΔPFS%), and the quantified gains of the American Society of Clinical Oncology Value Framework (ASCO-VF) and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). We calculated monthly drug costs and used Spearman’s correlation coefficient and Cohen’s kappa statistics for statistical analysis.

RESULTS: Twenty-nine innovative price-negotiated drugs were collected between 2016 and 2023. The median monthly costs were US$3381.31 out of NRDL and US$1095.88 within NRDL, with an ΔOS% of 22.24% (IQR = 6.45-29.48) and a ΔPFS% of 83.82% (IQR = 50.41-104.05). The median ASCO-VF score was 40.98, and 17 drugs scored the meaningful benefit of ESMO-MCBS. We found no association between clinical benefits and their costs before and after NRDL, either overall or for specific cancers. The agreement between the two frameworks was stable.

CONCLUSIONS: The negotiation policy decreased medication costs, but did not generate the expected correlation between the value and costs of anticancer drugs. Comprehensive value assessments need to be performed in the future to explore more in-depth findings and promote the affordability and availability of effective anticancer drugs.

PMID:37934965 | DOI:10.7189/jogh.13.04140

J Public Health (Oxf). 2023 Nov 2:fdad214. doi: 10.1093/pubmed/fdad214. Online ahead of print.

ABSTRACT

BACKGROUND: This meta-analysis reports the relationship between hepatitis B virus (HBV), hepatitis C virus (HCV), smoking and their combined impact on the development of hepatocellular carcinoma (HCC).

METHODS: We conducted a systematic search of PubMed, Web of Science and Scopus databases up to 15 July 2023. Observational studies investigating the association between HBV, HCV and smoking in the development of HCC were included. We assessed between-study heterogeneity using the I2 statistics. The effect sizes were estimated as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model.

RESULTS: Out of 20 794 studies identified in the initial search, 32 observational studies involving 22 282 participants met the inclusion criteria. Our meta-analysis showed that the combined impact of HBV and smoking was associated with an OR of 19.81 (95% CI: 14.77, 26.58), HCV and smoking was associated with an OR of 24.86 (95% CI: 12.41, 49.79), and coinfection of HBV and HCV was associated with an OR of 32.58 (95% CI: 20.57, 51.60).

CONCLUSIONS: Our findings indicate a significant interaction between HBV, HCV and smoking in the development of HCC and highlight the importance of addressing smoking cessation and viral hepatitis prevention and treatment as potential strategies for reducing HCC.

PMID:37934962 | DOI:10.1093/pubmed/fdad214

J Public Health (Oxf). 2023 Nov 2:fdad209. doi: 10.1093/pubmed/fdad209. Online ahead of print.

ABSTRACT

BACKGROUND: This article addresses the urgent need for more evidence-based research using primary data to document how the COVID-19 pandemic affected the health and social wellbeing of disabled individuals. Our study sought to determine if adults with disabilities, and with specific types of disability, were more likely to suffer adverse health and social impacts related to COVID-19 than nondisabled adults in metropolitan Texas, during the first 18 months of the pandemic.

METHODS: We collected primary data from randomly selected residents in eight Texas metropolitan areas through a bilingual telephone survey in July 2021. Statistical analysis comprised multivariable generalized estimating equations that control for relevant sociodemographic and COVID-related risk factors, and spatial clustering.

RESULTS: Disabled survey respondents had been more adversely affected by COVID-19 than nondisabled respondents, in terms of mental and physical health, health care access, living conditions and social life. Significant disparities were also found for almost all COVID-19 impacts when the disabled category was disaggregated by disability type. Respondents experiencing cognitive and independent living difficulties were negatively impacted in all five areas of life examined.

CONCLUSIONS: Findings emphasize the need to consider a wide range of impacts associated with the COVID-19 pandemic that negatively affect the health and social wellbeing of disabled persons, as well as develop disability-inclusive policies that provide adequate protections.

PMID:37934958 | DOI:10.1093/pubmed/fdad209

Menopause. 2023 Nov 7. doi: 10.1097/GME.0000000000002273. Online ahead of print.

ABSTRACT

OBJECTIVE: Carotid artery intima media thickness (cIMT) and adventitial diameter (AD) are subclinical atherosclerosis indicators. Metabolic syndrome (MetS) and obesity are risk factors for atherosclerosis, but their combined impact on atherosclerosis risk is unknown. This study sought to examine the effect of the co-occurrence of MetS with obesity on cIMT and AD.

METHODS: The Study of Women’s Health Across the Nation (SWAN) is a multi-center, multi-ethnic study. Carotid ultrasound assessments and concurrent physiologic measurements were undertaken between 2009 and 2013. This cross-sectional analysis included 1,433 women with body mass index ≥18.5 kg/m2 and free of prevalent clinical cardiovascular disease. Multivariable linear regression models were used to relate maximum cIMT and AD (dependent variables) with obesity, MetS and their interaction.

RESULTS: The average age was 60.1 years (standard deviation [SD], 2.7 y). The prevalence of obesity and MetS was 44% and 35%, respectively. Women with obesity had a 0.051 mm larger mean cIMT and women with MetS had a 0.057 mm larger cIMT versus women without the respective conditions (both P < 0.001). There was a statistically significant interaction between obesity and MetS (P = 0.011); women with both had a model-adjusted predicted mean cIMT of 0.955 mm (95% confidence interval [CI], 0.897-1.013), higher than those with MetS alone (0.946 mm; 95% CI, 0.887-1.005), obesity alone (0.930 mm; 95% CI, 0.873-0.988), or neither condition (0.878 mm; 95% CI, 0.821-0.935). AD results were similar.

CONCLUSIONS: Early detection and treatment of atherosclerotic changes may prevent significant disease. This study suggests there is a minimal impact of obesity on carotid artery thickness beyond MetS alone. All individuals with metabolic dysfunction, regardless of obesity status, should be considered at increased risk for atherosclerotic changes.

PMID:37934935 | DOI:10.1097/GME.0000000000002273

J Chem Inf Model. 2023 Nov 7. doi: 10.1021/acs.jcim.3c01490. Online ahead of print.

ABSTRACT

The electrostatic properties of proteins arise from the number and distribution of polar and charged residues. Electrostatic interactions in proteins play a critical role in numerous processes such as molecular recognition, protein solubility, viscosity, and antibody developability. Thus, characterizing and quantifying electrostatic properties of a protein are prerequisites for understanding these processes. Here, we present PEP-Patch, a tool to visualize and quantify the electrostatic potential on the protein surface in terms of surface patches, denoting separated areas of the surface with a common physical property. We highlight its applicability to elucidate protease substrate specificity and antibody-antigen recognition and predict heparin column retention times of antibodies as an indicator of pharmacokinetics.

PMID:37934909 | DOI:10.1021/acs.jcim.3c01490