Tag: nevin manimala

J Infect Dis. 2023 Sep 15:jiad388. doi: 10.1093/infdis/jiad388. Online ahead of print.

ABSTRACT

BACKGROUND: There is no consensus on how to best quantify disease severity in infants with respiratory syncytial virus (RSV) and/or bronchiolitis; this lack of a sufficiently validated score complicates the provision of clinical care and, the evaluation of trials of therapeutics and vaccines. The ReSVinet score appears to be one of the most promising; however it is too time-consuming to be incorporated into routine clinical care. We aimed to develop and externally validate simplified versions of this score.

METHODS: Data were used from a multinational (Netherlands, Spain & United Kingdom) multicentre case-control observational study of infants with RSV to develop simplified versions of the ReSVinet by conducting a grid search to determine the best combination of equally weighted parameters to maximise for the discriminative ability of the scores across a range of outcomes (hospitalisation, intensive care unit admission, ventilation requirement). Subsequently discriminative validity of the score for a range of secondary care outcomes was externally validated by conducting a secondary analysis of data collected in infants with respiratory infection from tertiary hospitals in Rwanda and Colombia.

RESULTS: Three candidate simplified scores were identified using the development dataset; they were excellent (area under the receiver-operator characteristic curve [AUROC] >0.9) in the development dataset at discriminating for a range of outcomes, and their performance was not statistically significantly different to the original ReSVinet score despite having fewer parameters. In the external validation datasets, the simplified scores were moderate-excellent (AUROC 0.7-1) across a range of outcomes. In all outcomes, except for in a single dataset at predicting admission to the high dependency unit, they performed at least as well as the original ReSVinet score.

CONCLUSIONS: Three promising candidate simplified scores were developed; however further external validation work in larger datasets, ideally from resource-limited settings needs to be conducted before any recommendation regarding their use.

PMID:37712125 | DOI:10.1093/infdis/jiad388

J Korean Neurosurg Soc. 2023 Sep 15. doi: 10.3340/jkns.2023.0035. Online ahead of print.

ABSTRACT

OBJECTIVE: Three-dimensional (3D) printing in vascular surgery is trending and is useful for the visualisation of intracranial aneurysms for both surgeons and trainees. The 3D models give the surgeon time to practice before hand and plan the surgery accordingly. The aim of this study was to examine the effect of preoperative planning with 3D printing models of aneurysms in terms of surgical time and patient outcomes.

METHODS: Forty patients were prospectively enrolled in this study and divided into two groups: Groups I and II. In group I, only the angiograms were studied before surgery. Solid 3D modelling was performed only for group II before the operation and was studied accordingly. All surgeries were performed by the same senior vascular neurosurgeon. Demographic data, surgical data, both preoperative and postoperative modified Rankin Scale scores (mRS), and Glasgow Outcome Scores (GOS) were evaluated.

RESULTS: The average time of surgery was shorter in Group II, and the difference was statistically significant between the two groups (p < 0.001). However, no major differences were found for the GOS, hospitalisation time, or mRS.

CONCLUSION: This study is the first prospective study of the utility of 3D aneurysm models. We show that 3D models are useful in surgery preparation. In the near future, these models will be used widely to educate trainees and pre-plan surgical options for senior surgeons.

PMID:37709549 | DOI:10.3340/jkns.2023.0035

J Korean Neurosurg Soc. 2023 Sep 15. doi: 10.3340/jkns.2023.0143. Online ahead of print.

ABSTRACT

OBJECTIVE: Decompressive craniectomy (DC) with duroplasty is one of the common surgical treatments for life-threatening increased intracranial pressure (ICP). Once ICP is controlled, cranioplasty (CP) with reinsertion of the cryopreserved autologous bone flap or a synthetic implant is considered for protection and esthetics. Although with the risk of autologous bone flap resorption (BFR), cryopreserved autologous bone flap for CP is one of the important material due to its cost effectiveness. In this article, we performed conventional statistical analysis and the machine learning technique understand the risk factors for BFR.

METHODS: Patients aged >18 years who underwent autologous bone CP between January 2015 and December 2021 were reviewed. Demographic data, medical records, and volumetric measurements of the autologous bone flap volume from 94 patients were collected. BFR was defined with absolute quantitative method (BFR-A) and relative quantitative method (BFR%). Conventional statistical analysis and random forest with hyper-ensemble approach (RF with HEA) was performed. And overlapped partial dependence plots (PDP) were generated.

RESULTS: Conventional statistical analysis showed that only the initial autologous bone flap volume was statistically significant on BFR-A. RF with HEA showed that the initial autologous bone flap volume, interval between DC and CP, and bone quality were the factors with most contribution to BFR-A, while, trauma, bone quality, and initial autologous bone flap volume were the factors with most contribution to BFR%. Overlapped PDPs of the initial autologous bone flap volume on the BRF-A crossed at approximately 60 mL, and a relatively clear separation was found between the non-BFR and BFR groups. Therefore, the initial autologous bone flap of over 60 mL could be a possible risk factor for BFR.

CONCLUSION: From the present study, BFR in patients who underwent CP with autologous bone flap might be inevitable. However, the degree of BFR may differ from one to another. Therefore, considering artificial bone flaps as implants for patients with large DC could be reasonable. Still, the risk factors for BFR are not clearly understood. Therefore, chronological analysis and pathophysiologic studies are needed.

PMID:37709548 | DOI:10.3340/jkns.2023.0143

Radiol Technol. 2023 Sep;95(1):17-25.

ABSTRACT

PURPOSE: To investigate determinants of radiation safety culture among radiologic technologists to determine whether factors related to the primary imaging modality affect the perception of workplace radiation safety.

METHODS: A secondary analysis was performed on deidentified data from 425 radiologic technologists collected with the Radiation Actions and Dimensions of Radiation Safety (RADS) questionnaire, a 35-item survey with valid and reliable psychometric properties. The data included radiologic technologists working in radiography, computed tomography (CT), and mammography. Descriptive statistics were used to report RADS determinant outcomes by imaging discipline, and 1-way analysis of variance and Games-Howell post hoc tests were conducted to analyze the hypothesis.

RESULTS: Mean differences in the radiologic technologists’ perceptions of teamwork across imaging stakeholders pertaining to radiation safety were found (P < .001). Mammographers had the most favorable perceptions of teamwork compared with radiographers and CT technologists.

DISCUSSION: Collaboration in mammography between imaging stakeholders is dictated by professional practice standards and federal law. The resultant engagement might influence mammographers’ perceptions of radiation safety. Additional research is warranted to determine if perception differences exist among technologists in other modalities and whether intentional collaboration drives improved perceptions of radiation safety culture.

CONCLUSION: An analysis of the collaborative actions in the mammography department is needed, and the findings could be applied in radiography and CT to improve perceptions of radiation safety-related teamwork.

PMID:37709523

BMJ Mil Health. 2023 Sep 14:e002535. doi: 10.1136/military-2023-002535. Online ahead of print.

ABSTRACT

INTRODUCTION: Older veterans with multimorbidity experience physical, mental and social factors which may negatively impact health and healthcare access. Physical function, behaviour change skills and loneliness may not be addressed during traditional physical rehabilitation. Thus, a multicomponent telerehabilitation programme could address these unmet needs. This programme evaluation assessed the safety, feasibility and change in patient outcomes for a multicomponent telerehabilitation programme.

METHODS: Individuals were eligible if they were a veteran/spouse, age ≥50 years and had ≥3 comorbidities. The telerehabilitation programme included four core components: (1) High-intensity rehabilitation, (2) Coaching interventions, (3) Social support and (4) Technology. Physical therapists delivered the 12-week programme and collected patient outcomes at baseline, 4 weeks, 8 weeks and 12 weeks. Programme evaluation measures included safety events (occurrence and type), feasibility (adherence) and patient outcomes (physical function). Safety and feasibility outcomes were analysed using descriptive statistics. The mean pre-post programme difference and 95% CI for patient outcomes were generated using paired t-tests.

RESULTS: Twenty-one participants enrolled in the telerehabilitation programme; most were male (81%), white (72%) and non-Hispanic (76%), with an average of 5.7 (3.0) comorbidities. Prevalence of insession safety events was 3.2% (0.03 events/session). Fifteen (71.4%) participants adhered to the programme (attended ≥80% of sessions). Mean (95% CI) improvements for physical function are as follows: 4.7 (2.4 to 7.0) repetitions for 30 s sit to stand, 6.0 (4.0 to 9.0) and 5.0 (2.0 to 9.0) repetitions for right arm curl and left arm curl, respectively, and 31.8 (15.9 to 47.7) repetitions for the 2 min step test.

CONCLUSION: The telerehabilitation programme was safe, feasible and demonstrated preprogramme to postprogramme improvements in physical function measures while addressing unmet needs in a vulnerable population. These results support a randomised clinical trial while informing programme and process adaptations.

PMID:37709508 | DOI:10.1136/military-2023-002535

Arch Dis Child Fetal Neonatal Ed. 2023 Sep 14:fetalneonatal-2023-325649. doi: 10.1136/archdischild-2023-325649. Online ahead of print.

ABSTRACT

BACKGROUND: Perinatal advance care planning (PnACP) is a process of formal decision-making to help families plan for their baby’s care when recognised that they may have a life-limiting condition. While PnACP is recommended in policy, there is a lack of evidence to support implementation and development in the perinatal setting.

OBJECTIVE: To conduct an online survey of UK and Ireland perinatal providers to examine how PnACP is operationalised in current practice.

METHODS: A secure online questionnaire was developed to collect data on (1) ‘what’ is being implemented, (2) the ‘processes’ being used, (3) perceived impact and (4) unmet support needs. Data were analysed using basic descriptive statistics, thematic analysis and through a conceptual lens of Normalisation Process Theory.

RESULTS: Questionnaires were completed by 108 health professionals working in 108 maternity and neonatal services, representing 90 organisations across the UK and Ireland. This revealed many resources and examples of good practice to support PnACP. However, there was wide variation in how PnACP was conceptualised and implemented. Existing frameworks, pathways and planning tools are not routinely embedded into care, and respondents identified many barriers that negatively impact the quality of care. They called for better integration of palliative care principles into acute settings and more investment in staff training to support families at existentially difficult times.

CONCLUSIONS: Priorities for additional perinatal service development include greater sharing of best practice and effective strategies to target the unique challenges of PnACP, such as time-sensitive collaborative working and decision-making in the face of high uncertainty.

PMID:37709497 | DOI:10.1136/archdischild-2023-325649

Anal Chim Acta. 2023 Oct 16;1278:341720. doi: 10.1016/j.aca.2023.341720. Epub 2023 Aug 18.

ABSTRACT

Ion mobility coupled with mass spectrometry (IM-MS), an emerging technology for analysis of complex matrix, has been facing challenges due to the complexities of chemical structures and original data, as well as low-efficiency and error-proneness of manual operations. In this study, we developed a structural similarity networking assisted collision cross-section prediction interval filtering (SSN-CCSPIF) strategy. We first carried out a structural similarity networking (SSN) based on Tanimoto similarities among Morgan fingerprints to classify the authentic compounds potentially existing in complex matrix. By performing automatic regressive prediction statistics on mass-to-charge ratios (m/z) and collision cross-sections (CCS) with a self-built Python software, we explored the IM-MS feature trendlines, established filtering intervals and filtered potential compounds for each SSN classification. Chemical structures of all filtered compounds were further characterized by interpreting their multidimensional IM-MS data. To evaluate the applicability of SSN-CCSPIF, we selected Ginkgo biloba extract and dripping pills. The SSN-CCSPIF subtracted more background interferences (43.24%∼43.92%) than other similar strategies with conventional ClassyFire criteria (10.71%∼12.13%) or without compound classification (35.73%∼36.63%). Totally, 229 compounds, including eight potential new compounds, were characterized. Among them, seven isomeric pairs were discriminated with the integration of IM-separation. Using SSN-CCSPIF, we can achieve high-efficient analysis of complex IM-MS data and comprehensive chemical profiling of complex matrix to reveal their material basis.

PMID:37709461 | DOI:10.1016/j.aca.2023.341720

BMJ Support Palliat Care. 2023 Sep 14:spcare-2023-004572. doi: 10.1136/spcare-2023-004572. Online ahead of print.

ABSTRACT

OBJECTIVES: Virtual reality (VR) might improve symptom management, but there is limited evidence regarding VR in palliative care. We evaluated the feasibility of VR and impact on anxiety and pain for patients in a hospital palliative care consultation service.

METHODS: Patients referred to a hospital specialist palliative care team, with anxiety or pain, were offered a VR intervention (a short audiovisual experience). Participants rated anxiety and pain on a 0-10 Likert severity scale pre intervention/post intervention and completed an evaluation form. Change in symptom scores was analysed by parametric statistics.

RESULTS: 28 participants used VR a total of 42 times with no adverse events. Mean pain score reduced by 29% from 4.10 (SD=2.71) pre intervention to 2.93 (SD=2.45) post intervention (t(27)=5.150, p<0.001). Mean anxiety scores reduced by 40% from 4.43 (SD=2.56) to 2.65 (SD=2.24) (t(27)=5.058, p<0.001). Patients rated the experience on average 4.75/5 and all would recommend use to a friend. VR was described as absorbing and relaxing.

CONCLUSION: VR may improve anxiety and pain and was acceptable in this setting. Large-scale evaluation will generate important data on feasibility and implementation.

PMID:37709365 | DOI:10.1136/spcare-2023-004572

BMJ Open. 2023 Sep 13;13(9):e069512. doi: 10.1136/bmjopen-2022-069512.

ABSTRACT

OBJECTIVE: The major objective of this project is to find the best suitable model for district-wise infant mortality rate (IMR) data of Bangladesh over the period 2014-2020 that captures the regional variability and overtime variability of the data.

DESIGN, SETTING AND PARTICIPANTS: Data from seven consecutive cross-sectional surveys that were conducted in Bangladesh between 2014 and 2020 as a part of the Sample Vital Registration System (SVRS) were used in this study. The study included a total of 13 173 (with 390 infant deaths), 17 675 (with 512 infant deaths), 17 965 (with 501 infant deaths), 23 205 (with 556 infant deaths), 23 094 (with 498 infant deaths), 23 090 (with 497 infant deaths) and 23 297 (with 495 infant deaths) complete cases from SVRS datasets for each respective year.

METHOD: A linear mixed effects model (LMM) with a quadratic trend over time in the fixed effects part and a nested random intercept, as well as a nested random slope for a linear trend over time in the part of the random effect, was implemented to describe the situation. This model was selected based on two popular selection criteria: Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC).

RESULTS: The LMMs analysis results demonstrated statistically significant variations in IMR across different districts and over time. Examining the district-specific area under the logarithm of the IMR curves yielded valuable insights into the disparities in IMR among different districts and regions. Furthermore, a significant inverse relationship was observed between IMR and life expectancy at birth, underscoring the significance of mitigating IMR as a means to enhance population health outcomes.

CONCLUSION: This study accentuates district-wise and temporal variability when modelling IMR data and highlights regional heterogeneity in infant mortality rates in Bangladesh. Area-based programmes should be created for mothers residing in locations with a higher risk of IMR. Further research can examine socioeconomic elements generating these discrepancies.

PMID:37709341 | DOI:10.1136/bmjopen-2022-069512

BMJ Open. 2023 Sep 13;13(9):e068989. doi: 10.1136/bmjopen-2022-068989.

ABSTRACT

INTRODUCTION: There is only limited and controversial information available on the cardiovascular (CV) risk in coeliac disease (CD). In this study, we plan to investigate the body composition and CV risk-related metabolic parameters at the diagnosis of CD and on a gluten-free diet in a Hungarian cohort of patients with CD.

METHODS AND ANALYSIS: This study consists of two case-control studies and a prospective cohort study, involving newly diagnosed and treated patients with CD with age and sex-matched non-CD control subjects with an allocation ratio of 1:1. CD-related symptoms, quality of life, quality of the diet and CV risk will be assessed with questionnaires. Our primary outcomes are body composition parameters, which will be estimated with InBody 770 device. Secondary outcomes are CV-risk related metabolic parameters (eg, serum lipids, haemoglobin A1c, homeostatic model assessment index, liver enzymes, homocysteine, interleukin 6, galectin-3) and enteral hormones (leptin, ghrelin, adiponectin) measured from venous blood samples for all participants. Fatty liver disease will be assessed by transabdominal ultrasonography. In statistical analysis, descriptive and comparative statistics will be performed. With this study, we aim to draw attention to the often neglected metabolic and CV aspect of the management of CD. Findings may help to identify parameters to be optimised and reassessed during follow-up in patients with CD.

ETHICS AND DISSEMINATION: The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: NCT05530070.

PMID:37709338 | DOI:10.1136/bmjopen-2022-068989