Tag: nevin manimala

Popul Health Manag. 2023 Nov 2. doi: 10.1089/pop.2023.0162. Online ahead of print.

ABSTRACT

The rise in health care costs, caused by older and more complex patient populations, requires Population Health Management approaches including risk stratification. With risk stratification, patients are assigned individual risk scores based on medical records. These patient stratifications focus on future high costs and expensive care utilization such as hospitalization, for which different models exist. With this study, the research team validated the accuracy of risk prediction scores for future hospitalization and high health care costs, calculated by the Adjusted Clinical Group (ACG)’s risk stratification models, using Dutch primary health care data registries. In addition, they aimed to adjust the US-based predictive models for Dutch primary care. The statistical validity of the existing models was assessed. In addition, the underlying prediction models were trained on 95,262 patients’ data from de Zoetermeer region and externally validated on data of 48,780 patients from Zeist, Nijkerk, and Urk. Information on age, sex, number of general practitioner visits, International Classification of Primary Care coded information on the diagnosis and Anatomical Therapeutic Chemical Classification coded information on the prescribed medications, were incorporated in the model. C-statistics were used to validate the discriminatory ability of the models. Calibrating ability was assessed by visual inspection of calibration plots. Adjustment of the hospitalization model based on Dutch data improved C-statistics from 0.69 to 0.75, whereas adjustment of the high-cost model improved C-statistics from 0.78 to 0.85, indicating good discrimination of the models. The models also showed good calibration. In conclusion, the local adjustments of the ACG prediction models show great potential for use in Dutch primary care.

PMID:37917048 | DOI:10.1089/pop.2023.0162

Euro Surveill. 2023 Nov;28(44). doi: 10.2807/1560-7917.ES.2023.28.44.2300019.

ABSTRACT

BackgroundThe NHS Test and Trace (NHSTT) programme was established in May 2020 in England to deliver SARS-CoV-2 testing and contact tracing in order to identify infected individuals and reduce COVID-19 spread. To further control transmission, people identified as contacts were asked to self-isolate for 10 days and test only if they became symptomatic. From March 2021, eligibility criteria for PCR testing expanded to include asymptomatic contacts of confirmed cases.AimTo analyse testing patterns of contacts before and after the change in testing guidance in England to assess the impact on PCR testing behaviour with respect to symptom status and contact type.MethodsTesting and contact tracing data were extracted from the national data systems and linked. Subsequently, descriptive statistical analysis was applied to identify trends in testing behaviour.ResultsBetween 1 January and 31 July 2021, over 5 million contacts were identified and reached by contact tracers; 42.3% took a PCR test around the time they were traced. Overall positivity rate was 44.3% and consistently higher in symptomatic (60-70%) than asymptomatic (around 20%, March-June) contacts. The proportion of tests taken by asymptomatic contacts increased over time, especially after the change in testing guidance. No link was observed between uptake of PCR tests and vaccination coverage. Fully vaccinated contacts showed lower positivity (23.8%) than those with one dose (37.2%) or unvaccinated (51.0%).ConclusionAlmost 1 million asymptomatic contacts were tested for SARS-CoV-2, identifying 214,056 positive cases, demonstrating the value of offering PCR testing to this group.

PMID:37917031 | DOI:10.2807/1560-7917.ES.2023.28.44.2300019

J Stud Alcohol Drugs. 2023 Oct 30. doi: 10.15288/jsad.23-00055. Online ahead of print.

ABSTRACT

OBJECTIVE: Understanding transitions in nicotine and cannabis use has implications for prevention and efforts to reduce harmful use. Focusing on cross-substance associations, we examined how use of one substance was associated with year-to-year transitions in frequency of use of the other among young adults in the context of legalized nonmedical cannabis.

METHOD: A statewide sample from Washington (N = 4,039; ages 18-25 at baseline) provided up to three years of annual data on past-month cannabis use and nicotine use (tobacco cigarettes and e-cigarettes/vaping). Manifest Markov models examined how use of each substance was associated with transitions in the other across categories of past-month no use, occasional use (1-19 days), and frequent use (20+ days).

RESULTS: Occasional and frequent nicotine use (vs. no use) predicted higher probability of transitioning from no cannabis use to occasional or frequent cannabis use and from occasional use to frequent use, while associations with cessation and de-escalation were inconsistent in direction, small in magnitude, and not statistically significant. Cannabis use positively predicted onset of nicotine use, and associations of cannabis use with escalation from occasional to frequent nicotine use, de-escalation in use, and cessation in use were small and inconsistent in direction.

CONCLUSIONS: The findings corroborate prior research on cannabis and nicotine use as risk factors to address in prevention efforts. The findings do not provide strong support for prioritization of dual abstinence in efforts to encourage reductions in or cessation of cannabis or nicotine use among young adults.

PMID:37917015 | DOI:10.15288/jsad.23-00055

J Anat. 2023 Nov 2. doi: 10.1111/joa.13967. Online ahead of print.

ABSTRACT

Muscle volume must increase substantially during childhood growth to generate the power required to propel the growing body. One unresolved but fundamental question about childhood muscle growth is whether muscles grow at equal rates; that is, if muscles grow in synchrony with each other. In this study, we used magnetic resonance imaging (MRI) and advances in artificial intelligence methods (deep learning) for medical image segmentation to investigate whether human lower leg muscles grow in synchrony. Muscle volumes were measured in 10 lower leg muscles in 208 typically developing children (eight infants aged less than 3 months and 200 children aged 5 to 15 years). We tested the hypothesis that human lower leg muscles grow synchronously by investigating whether the volume of individual lower leg muscles, expressed as a proportion of total lower leg muscle volume, remains constant with age. There were substantial age-related changes in the relative volume of most muscles in both boys and girls (p < 0.001). This was most evident between birth and five years of age but was still evident after five years. The medial gastrocnemius and soleus muscles, the largest muscles in infancy, grew faster than other muscles in the first five years. The findings demonstrate that muscles in the human lower leg grow asynchronously. This finding may assist early detection of atypical growth and allow targeted muscle-specific interventions to improve the quality of life, particularly for children with neuromotor conditions such as cerebral palsy.

PMID:37917014 | DOI:10.1111/joa.13967

Eurasian J Med. 2023 Nov 2. doi: 10.5152/eurasianjmed.2023.22281. Online ahead of print.

ABSTRACT

Surgery is the primary treatment for pulmonary hydatid cysts. This systematic review and meta-analysis aimed to compare the results of capitonnage and uncapitonnage techniques for the surgery of pulmonary hydatid cysts. Descriptive Boolean queries were used to search PubMed, Scopus, and Web of Science for articles published up to June 2022 to evaluate the outcomes of pulmonary hydatid cysts in terms of mortality, postoperative complications, and hospital stay. A total of 12 studies were included. An analysis of the total side effects revealed that there was a statistically significant difference between the capitonnage and uncapitonnage groups (odds ratio=3.81, 95% confidence interval=[1.75-8.31], P < .001). The results showed that more side effects were observed in the uncapitonnage group than in the capitonnage group. The risk of side effects in the uncapitonnage group is 3.81 times higher than in the capitonnage group. The results showed that more prolonged air leak was seen in uncapitonnage group than in the capitonnage group (odds ratio=4.18, 95% confidence interval=[1.64-10.64], P=.003). The results show that more empyema was observed in uncapitonnage group than in the capitonnage group (odds ratio=4.76, 95% confidence interval=[1.29-17.57], P =0.020). An analysis of atelectasis and mean hospital stay revealed that there was no statistically significant difference between the capitonnage and uncapitonnage groups. The results reveal the advantages of capitonnage in the treatment of pulmonary hydatid cysts and that the capitonnage method is quite effective in reducing complications compared to the uncapitonnage method.

PMID:37916996 | DOI:10.5152/eurasianjmed.2023.22281

J Magn Reson Imaging. 2023 Nov 2. doi: 10.1002/jmri.29089. Online ahead of print.

ABSTRACT

BACKGROUND: Previous in vitro studies have described sub-linear longitudinal and heightened transverse H₂ O relaxivities of gadolinium-based contrast agents (GBCAs) in blood due to their extracellular nature. However, in vivo validation is lacking.

PURPOSE: Validate theory describing blood behavior of R₁ and R₂ * in an animal model.

STUDY TYPE: Prospective, animal.

ANIMAL MODEL: Seven swine (54-65 kg).

FIELD STRENGTH/SEQUENCE: 1.5 T; time-resolved 3D spoiled gradient-recalled echo (SPGR) and quantitative Look-Locker and multi-echo fast field echo sequences.

ASSESSMENT: Seven swine were each injected three times with 0.1 mmol/kg intravenous doses of one of three GBCAs: gadoteridol, gadobutrol, and gadobenate dimeglumine. Injections were randomized for rate (1, 2, and 3 mL/s) and order, during which time-resolved aortic 3D SPGR imaging was performed concurrently with aortic blood sampling via an indwelling catheter. Time-varying [GBCA] was measured by mass spectrometry of sampled blood. Predicted signal intensity (SI) was determined from a model incorporating sub-linear R₁ and R₂ * effects (whole-blood model) and simpler models incorporating linear R₁ , with and without R₂ * effects. Predicted SIs were compared to measured aortic SI.

STATISTICAL TESTS: Linear correlation (coefficient of determination, R² ) and mean errors were compared across the SI prediction models.

RESULTS: There was an excellent correlation between predicted and measured SI across all injections and swine when accounting for the non-linear dependence of R₁ and high blood R₂ * (regression slopes 0.91-1.04, R² ≥ 0.91). Simplified models (linear R₁ with and without R₂ * effects) showed poorer correlation (slopes 0.67-0.85 and 0.54-0.64 respectively, both R² ≥ 0.89) and higher averaged mean absolute and mean square errors (128.4 and 177.4 vs. 42.0, respectively, and 5506 and 11,419 vs. 699, respectively).

DATA CONCLUSION: Incorporating sub-linear R₁ and high first-pass R₂ * effects in arterial blood models allows accurate SPGR SI prediction in an in vivo animal model, and might be utilized when modeling MR blood SI.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 1.

PMID:37916957 | DOI:10.1002/jmri.29089

Int J Surg. 2023 Nov 2. doi: 10.1097/JS9.0000000000000828. Online ahead of print.

ABSTRACT

BACKGROUND: Stress urinary incontinence (SUI) is common among women, and surgical interventions have significantly improved patients’ symptoms. The long-term effectiveness of these surgeries is increasingly drawing attention, yet it remains sparsely documented in the literature.

OBJECTIVE: To compare the long-term effectiveness and safety of retropubic tension-free vaginal tape (TVT-RP), tension-free vaginal tape-obturator (TVT-O), transobturator tape (TOT), single-incision sling (SIS), Burch colposuspension, and pubovaginal sling (PVS).

METHODS: A comprehensive and systematic literature review was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov from inception to May 2023. Selected trials were evaluated for potential bias using the Cochrane tool. Treatment modalities were compared using network meta-analysis to assess objective success rate, subjective success rate, and complications as outcomes.

RESULTS: A total of 37 studies involving 5,720 patients were included. No significant statistical differences were found among the interventions regarding objective success rate. PVS had the highest surface under the cumulative ranking curve SUCRA value (93.1). For subjective success rate, TVT-RP, TVT-O, and PVS demonstrated superiority over SIS, with PVS having the highest SUCRA value (80.1). SIS had lower overall complication and pain rates compared to other methods, with statistical significance. There were no differences in reoperation rate, exposure rate, and urinary tract infection occurrence among the surgical approaches.

CONCLUSIONS: In terms of long-term effectiveness and safety, TVT-RP and TVT-O appear to be the preferred options for patients opting for synthetic slings, while for patients seeking non-synthetic slings, PVS may represent the optimal choice.

PMID:37916939 | DOI:10.1097/JS9.0000000000000828

Int J Surg. 2023 Nov 2. doi: 10.1097/JS9.0000000000000814. Online ahead of print.

ABSTRACT

BACKGROUND: Papillary thyroid cancer (PTC) is one of the most common endocrine malignancies with different risk levels. However, preoperative risk assessment of PTC is still a challenge in the worldwide. Here, we first report a Preoperative Risk Assessment Classifier for PTC (PRAC-PTC) by multidimensional features including clinical indicators, immune indices, genetic feature, and proteomics.

MATERIALS AND METHODS: The 558 patients collected from June 2013 to November 2020 were allocated to three groups: discovery set (274 patients, 274 FFPE), retrospective test set (166 patients, 166 FFPE) and prospective test set (118 patients, 118 FNA). Proteomic profiling was conducted by formalin-fixed paraffin-embedded (FFPE) and fine-needle aspiration (FNA) tissues from the patients. Preoperative clinical information and blood immunological indices were collected. The BRAFV600E mutation were detected by the amplification refractory mutation system (ARMS).

RESULTS: We developed a machine learning model of 17 variables based on multidimensional features of 274 PTC patients from a retrospective cohort. The PRAC-PTC achieved areas under the curve (AUC) of 0.925 in the discovery set and validated externally by blinded analyses in a retrospective cohort of 166 PTC patients (0.787 AUC) and a prospective cohort of 118 PTC patients (0.799 AUC) from two independent clinical centres. Meanwhile, the preoperative predictive risk effectiveness of clinicians was improved with the assistance of PRAC-PTC, and the accuracies reached at 84.4% (95% CI 82.9-84.4) and 83.5% (95% CI 82.2-84.2) in the retrospective and prospective test sets, respectively.

CONCLUSION: This study demonstrated that the PRAC-PTC that integrating clinical data, gene mutation information, immune indices, high-throughput proteomics and machine learning technology in multi-centre retrospective and prospective clinical cohorts can effectively stratify the preoperative risk of PTC and may decrease unnecessary surgery or overtreatment.

PMID:37916932 | DOI:10.1097/JS9.0000000000000814

J Magn Reson Imaging. 2023 Nov 2. doi: 10.1002/jmri.29109. Online ahead of print.

ABSTRACT

BACKGROUND: Programmed cell death ligand-1 (PD-L1) is a promising target for immune checkpoint blockade therapy in breast cancer. However, the preoperative evaluation of PD-L1 expression in breast cancer is rarely explored.

PURPOSE: To determine the ability of radiomics signatures based on preoperative dynamic contrast-enhanced (DCE) MRI to evaluate PD-L1 expression in breast cancer.

STUDY TYPE: Retrospective.

POPULATION: 196 primary breast cancer patients with preoperative MRI and postoperative pathological evaluation of PD-L1 expression, divided into training (n = 137, 28 PD-L1-positive) and test cohorts (n = 59, 12 PD-L1-positive).

FIELD STRENGTH/SEQUENCE: 3.0T; volume imaging for breast assessment DCE sequence.

ASSESSMENT: Radiomics features were extracted from the first phase of DCE-MRI by using the minimum redundancy maximum relevance method and least absolute shrinkage and selection operator algorithm. Three radiomics signatures were constructed based on the intratumoral, peritumoral, and combined intra- and peritumoral regions. The performance of the signatures was assessed using area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy.

STATISTICAL TESTS: Univariable and multivariable logistic regression analysis, t-tests, chi-square tests, Fisher exact test or Yates correction, ROC analysis, and one-way analysis of variance. P < 0.05 was considered significant.

RESULTS: In the test cohort, the combined radiomics signature (AUC, 0.853) exhibited superior performance compared to the intratumoral (AUC, 0.816; P = 0.528) and peritumoral radiomics signatures (AUC, 0.846; P = 0.905) in PD-L1 status evaluation, although the differences did not reach statistical significance.

DATA CONCLUSION: Intratumoral and peritumoral radiomics signatures based on preoperative breast MRI showed some potential accuracy for the non-invasive evaluation of PD-L1 status in breast cancer.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

PMID:37916918 | DOI:10.1002/jmri.29109

J Magn Reson Imaging. 2023 Nov 2. doi: 10.1002/jmri.29053. Online ahead of print.

ABSTRACT

BACKGROUND: Independent factors are needed to supplement vesical imaging-reporting and data system (VI-RADS) to improve its ability to identify muscle invasive bladder cancer (MIBC).

PURPOSE: To assess the correlation between MIBC and diffusion kurtosis imaging (DKI) ratio, VI-RADS, and other factors (such as tumor location).

STUDY TYPE: Retrospective.

POPULATION: Sixty-eight patients (50 males and 18 females; age: 70.1 ± 9.5 years) with bladder urothelial carcinoma.

FIELD STRENGTH/SEQUENCE: 1.5 T, conventional diffusion-weighted imaging (DWI), and DKI (single shot echo-planar sequence).

ASSESSMENT: Three radiologists independently measured the diffusion parameters of each bladder cancer (BCa) and obturator internus, including the mean apparent diffusion coefficient (ADCmean), mean kurtosis (MK), and mean diffusion (MD). And the ratio of diffusion parameters between BCa and obturator internus was calculated (diffusion parameter ratio = bladder cancer:obturator internus). Based on the VI-RADS, the target lesions were independently scored. Furthermore, the actual tumor-wall contact length (ACTCL) and absolute tumor-wall contact length (ABTCL) were measured.

STATISTICAL TESTS: Multicollinearity among independent variables was evaluated using the variance inflation factor (VIF). Multivariable logistic regression analysis was used to determine the independent risk factors of MIBC. The receiver operating characteristic curve was used to evaluate the efficacy of each variable in detecting MIBC. The DeLong test was used to compare the area under the curve (AUC). A P < 0.05 was considered statistically significant.

RESULTS: MKratio (median: 0.62) and VI-RADS were independent risk factors for MIBC. AUCs for MKratio, VI-RADS, and MKratio combined with VI-RADS in assessing MIBC were 0.895, 0.871, and 0.973, respectively. MKratio combined with VI-RADS was more effective in diagnosing MIBC than VI-RADS alone.

DATA CONCLUSIONS: MKratio has potential to assist the assessment of MIBC. MKratio can be used as a supplement to VI-RADS for detecting MIBC.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

PMID:37916908 | DOI:10.1002/jmri.29053