Tag: nevin manimala

Support Care Cancer. 2022 Mar 25. doi: 10.1007/s00520-022-06996-6. Online ahead of print.

ABSTRACT

BACKGROUND: Dyspnea is common in patients with advanced cancer. Diagnostic procedures in patients with dyspnea are mandatory but often time-consuming and hamper rapid treatment of the underlying refractory symptoms. Opioids are the first-line drugs for the treatment of refractory dyspnea in palliative care patients with advanced lung cancer.

METHODS: To evaluate the knowledge levels of medical doctors with different educational levels on the diagnosis of and treatment options for dyspnea in patients with advanced lung cancer in a palliative care setting, a case report and survey were distributed to physicians at the University Hospital Krems, describing acute dyspnea in a 64-year-old stage IV lung cancer patient. A total of 18 diagnostic and 22 therapeutic options were included in the survey. The physicians were asked to suggest and rank in order of preference their diagnosis and treatment options. Statistical analyses of the data were performed, including comparison of the responses of the senior doctors and the physicians in training.

RESULTS: A total of 106 surveys were completed. The respondents were 82 senior physicians and 24 physicians in training (response rates of 86% and 80%, respectively). Regarding diagnostic investigations, inspection and reading the patient’s chart were the most important diagnostic tools chosen by the respondents. The choices of performing blood gas analysis (p = 0.01) and measurement of oxygen saturation (p = 0.048) revealed a significant difference between the groups, both investigations performed more frequently by the physicians in training. As for non-pharmacological treatment options, providing psychological support was one of the most relevant options selected. A significant difference was seen in choosing the option of improving a patient’s position in relation to level of training (65.9% senior physicians vs. 30.4% physicians in training, p = 0.04). Regarding pharmacological treatment options, oxygen application was the most chosen approach. The second most frequent drug chosen was a ß-2 agonist. Only 9.8% of the senior physicians and 8.7% of the physicians in training suggested oral opioids as a treatment option, whereas intravenous opioids were suggested by 43.9% of the senior physicians and 21.7% of the physicians in training (p = 0.089). For subcutaneous application of opioids, the percentage of usage was significantly higher for the physicians in training than for the senior physicians (78.3% vs. 48.8%, p = 0.017, respectively).

CONCLUSION: The gold standard treatment for treating refractory dyspnea in patients with advanced lung cancer is opioids. Nevertheless, this pharmacological treatment option was not ranked as the most important. Discussing hypothetical cases of patients with advanced lung cancer and refractory dyspnea with experienced doctors as well as doctors at the beginning of their training may help improve symptom control for these patients.

PMID:35338391 | DOI:10.1007/s00520-022-06996-6

Eur Arch Psychiatry Clin Neurosci. 2022 Mar 25. doi: 10.1007/s00406-022-01394-9. Online ahead of print.

ABSTRACT

This article provides an overview and retrospective on metacognitive training for psychosis (MCT), which first appeared approximately 2 decades ago. We recount how our empirical understanding of psychosis at that time led to the first preliminary version of the program. We describe setbacks and challenges that led to major changes, including revisions to existing modules (e.g., more focus on metacognitive variables, particularly on decision confidence as one of the primary targets of treatment) and the creation of new modules addressing mood, as well as attempts to improve sustainability of effects via homework exercises and a smartphone app ( www.uke.de/mct_app ). We have also enhanced dissemination efforts by creating new culturally sensitive language versions and facilitating low-threshold training through e-learning courses ( www.uke.de/e-mct ). Finally, we discuss several meta-analyses on the efficacy of MCT that have been published over the last decade. While reviews were initially inconsistent, possibly reflecting the insufficient statistical power and lower design quality of the first MCT studies, more recent meta-analyses have confirmed the efficacy of MCT on positive symptoms, insight, and cognitive biases, which has led to the inclusion of MCT in some national treatment guidelines for schizophrenia.

PMID:35338378 | DOI:10.1007/s00406-022-01394-9

Nature. 2022 Mar 25. doi: 10.1038/s41586-022-04660-x. Online ahead of print.

NO ABSTRACT

PMID:35338354 | DOI:10.1038/s41586-022-04660-x

Pediatr Res. 2022 Mar 25. doi: 10.1038/s41390-022-02021-y. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to investigate the influence of early-life pain/stress and medical characteristics on neurobehavioral outcomes in preterm infants.

METHODS: A prospective cohort study was conducted with 92 preterm infants (28-32 weeks gestational age [GA]). Early-life pain/stress was measured via the Neonatal Infant Stressor Scale (NISS) during the first 28 days of NICU hospitalization. Neurobehavioral outcomes were evaluated using the NICU Network Neurobehavioral Scale at 36-38 weeks post-menstrual age. Functional regression and machine learning models were performed to investigate the predictors of neurobehavioral outcomes.

RESULTS: Infants experienced daily acute pain/stress (24.99 ± 7.13 frequencies) and chronic events (41.13 ± 17.81 h). Up to 12 days after birth, both higher acute and chronic NISS scores were associated with higher stress scores; and higher chronic NISS scores were also related to lower self-regulation and quality of movement. Younger GA predicted worse neurobehavioral outcomes; GA < 31.57 weeks predicted worse stress/abstinence, self-regulation, and excitability; GA < 30.57 weeks predicted poor quality of movement. A higher proportion of maternal breastmilk intake predicted better self-regulation, excitability, and quality of movement in older GA infants.

CONCLUSIONS: Preterm infants are vulnerable to the impact of early-life pain/stress. Neurobehavioral outcomes are positively associated with increased GA and higher maternal breastmilk intake.

IMPACT: During the first 12 days of life, preterm infant neurobehavioral outcomes were vulnerable to the negative impact of acute and chronic pain/stress. Future research is warranted to investigate the long-term effects of early-life pain/stress on neurobehavioral outcomes. Gestational age remains one of the critical factors to predict neurobehavioral outcomes in preterm infants; older gestational age significantly predicted better neurobehavioral outcomes. Feeding with a higher proportion of maternal breastmilk predicted better neurobehavioral outcomes. Future research is warranted to investigate how maternal breastmilk may buffer the negative effects of early-life pain/stress on neurobehavioral outcomes.

PMID:35338349 | DOI:10.1038/s41390-022-02021-y

Lung Cancer. 2022 Mar 15;166:228-241. doi: 10.1016/j.lungcan.2022.03.010. Online ahead of print.

ABSTRACT

OBJECTIVES: Radiotherapy-induced toxicity may negatively impact health-related quality of life (HRQoL). This report investigates the impact of curative-intent radiotherapy on HRQoL and toxicity in early stage and locally-advanced non-small cell lung cancer patients treated with radiotherapy or chemo-radiotherapy enrolled in the observational prospective REQUITE study.

MATERIALS AND METHODS: HRQoL was assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire up to 2 years post radiotherapy. Eleven toxicities were scored by clinicians using the Common Terminology Criteria for Adverse Events (CTCAE) version 4. Toxicity scores were calculated by subtracting baseline values. Mixed model analyses were applied to determine statistical significance (p ≤ 0.01). Meaningful clinical important differences (MCID) were determined for changes in HRQoL. Analysis was performed on the overall data, different radiotherapy techniques, multimodality treatments and disease stages.

RESULTS: Data of 510 patients were analysed. There was no significant change in HRQoL or its domains, except for deterioration in cognitive functioning (p = 0.01). Radiotherapy technique had no significant impact on HRQoL. The addition of chemotherapy was significantly associated with HRQoL over time (p <.001). Overall toxicity did not significantly change over time. Acute toxicities of radiation-dermatitis (p =.003), dysphagia (p =.002) and esophagitis (p <.001) peaked at 3 months and decreased thereafter. Pneumonitis initially deteriorated but improved significantly after 12 months (p =.011). A proportion of patients experienced meaningful clinically important improvements and deteriorations in overall HRQoL and its domains. In some patients, pre-treatment symptoms improved gradually.

CONCLUSIONS: While overall HRQoL and toxicity did not change over time, some patients improved, whereas others experienced acute radiotherapy-induced toxicities and deteriorated HRQoL, especially physical and cognitive functioning. Patient characteristics, more so than radiotherapy technique and treatment modality, impact post-radiotherapy toxicity and HRQoL outcomes. This stresses the importance of considering the potential impact of radiotherapy on individuals’ HRQoL, symptoms and toxicity in treatment decision-making.

PMID:35334417 | DOI:10.1016/j.lungcan.2022.03.010

J Public Health Manag Pract. 2022 May-Jun 01;28(3):309-316. doi: 10.1097/PHH.0000000000001512.

ABSTRACT

CONTEXT: As response rates to health surveys conducted by telephone continue to decline and costs continue to increase, practitioners are increasingly considering a transition to self-administered mail contact modes.

OBJECTIVE: To compare empirical differences observed across adjacent administrations of the Healthy Chicago Survey (HCS) conducted by telephone versus self-administered via mail contact.

DESIGN: Data from the 2016, 2018, and 2020 administrations of the HCS are contrasted, and demographic distributions are benchmarked against the American Community Survey to investigate differences that may be linked to the HCS’ transition from a telephone to self-administered mail mode between 2018 and 2020.

SETTING: All survey data were collected from adult residents of Chicago, Illinois, between 2016 and 2020.

MAIN OUTCOME MEASURES: Costs, response rates, key health statistics, demographic distributions, and measures of precision generated from the HCS.

RESULTS: The mail mode led to a response rate increase of 6.8% to 38.2% at half the cost per complete. Mail respondents are more likely to be nonminority, female, and hold a college degree. Key health statistic differences are mixed, but design effects are larger in the mail mode, which we attribute to more detailed geographic stratification and weighting employed in 2020.

CONCLUSIONS: The mail mode is a less costly data collection strategy for the HCS, but it comes with trade-offs. The quasi-random selection of an individual in the household exacerbates sociodemographic distribution disparities.

PMID:35334486 | DOI:10.1097/PHH.0000000000001512

Lung Cancer. 2022 Mar 19;166:221-227. doi: 10.1016/j.lungcan.2022.03.014. Online ahead of print.

ABSTRACT

BACKGROUND: Prediction of prognosis is a key step of malignant pleural mesothelioma (MPM) management and treatment assignment. Aim of this study was to identify simple prognostic factors, focusing on inflammation-related parameters.

METHODS: Baseline clinical and laboratory data were extracted from a single-center 20-year cohort of consecutive patients exhibiting a proven MPM. Inflammation-related ratios and composite scores were evaluated as prognostic indicators.

RESULTS: 468 patients were identified. Mean age and BMI were 73.0 years and 25.1 kg/m². The histologic subtype was epithelioid, sarcomatoid, or biphasic in 80.3%, 6.2%, and 13.5% of cases, respectively. Mean Neutrophil to Lymphocyte Ratio (NLR), systemic Inflammation Index (SII) and Advanced Lung cancer inflammation Index (ALI) were 5.8, 1,836.6, and 29.6. Median survival was 13.0 months. Univariate analyses revealed that age > 70 years, persistent asthenia, hemoglobin < 13 g/dL, and non-epithelioid histologic type were associated with poorer survival, as well as the following high-inflammation-related criteria: CRP > 25 mg/L, white blood cell count (WBC) > 10⁹/dL, NLR > 5, SII > 1,270, and ALI < 18. Multivariate regression showed that age, histology, hemoglobin, and WBC were independent predictors of survival. Also, the inflammation-related factors ALI and NLR were independently associated with survival. Interestingly, hemoglobin was statistically significant predictor of survival in all multivariate models. We found higher proportion of survival > 18 months (66th percentile) in patients exhibiting SII < 2,000 and NLR < 5.

CONCLUSION: The prognosis of MPM is strongly influenced by systemic inflammation and patients exhibiting higher NLR, SII and lower ALI have shorter survival, which strengthens the level of evidence about the major role played by inflammation in MPM.

PMID:35334416 | DOI:10.1016/j.lungcan.2022.03.014

Dev Cogn Neurosci. 2022 Mar 14;54:101096. doi: 10.1016/j.dcn.2022.101096. Online ahead of print.

ABSTRACT

Electroencephalography (EEG) has been widely adopted by the developmental cognitive neuroscience community, but the application of machine learning (ML) in this domain lags behind adult EEG studies. Applying ML to infant data is particularly challenging due to the low number of trials, low signal-to-noise ratio, high inter-subject variability, and high inter-trial variability. Here, we provide a step-by-step tutorial on how to apply ML to classify cognitive states in infants. We describe the type of brain attributes that are widely used for EEG classification and also introduce a Riemannian geometry based approach for deriving connectivity estimates that account for inter-trial and inter-subject variability. We present pipelines for learning classifiers using trials from a single infant and from multiple infants, and demonstrate the application of these pipelines on a standard infant EEG dataset of forty 12-month-old infants collected under an auditory oddball paradigm. While we classify perceptual states induced by frequent versus rare stimuli, the presented pipelines can be easily adapted for other experimental designs and stimuli using the associated code that we have made publicly available.

PMID:35334336 | DOI:10.1016/j.dcn.2022.101096

Diabetes Metab Syndr. 2022 Mar 16;16(4):102463. doi: 10.1016/j.dsx.2022.102463. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: To determine the suitability of 11 basic statistical models for estimating child-growth of under-five children and to bring-forth estimated growth curves for mean height & mean weight by their selected birth-weight categories for Central Region of India.

METHODS: The study used fourth round of National Family Health Survey-4 (NFHS-4) data of India, consisting of 75,645 under-five children, belonging to 3 Indian States – Chhattisgarh, Madhya Pradesh & Uttar Pradesh. The children of the Region were first divided into 4 sub categories according to their birth-weight: (i) < 2000 gm, (ii) 2000-2499 gm, (iii) 2500-2999 gm (iv) 3000+gm, growth curve for mean height and mean weight were estimated for two sexes.

RESULTS: The significant association of 7 socio-demographic factors studied, namely – age & sex of child, birth-order, BMI, mother’s highest level of education, place of residence and wealth index. Further, Cubic Model and Power Model, demonstrated best-fit to height & weight data of under-five children, belonging to different birth-weight categories, for estimating growth of boys & girls separately. These models enabled us to estimate mean height and mean weight, with 95% CI, for boys and girls separately by different birth-weight categories.

CONCLUSIONS: Study concluded that 7 socio-demographic factors were significantly associated with birth-weight. Further, Cubic Model and Power Model were most suitable for estimating child growth in terms of mean height & mean weight for boys and girls – considering specific birth-weight categories.

PMID:35334409 | DOI:10.1016/j.dsx.2022.102463

Food Chem. 2022 Mar 22;386:132746. doi: 10.1016/j.foodchem.2022.132746. Online ahead of print.

ABSTRACT

To prevent PGI (Protected Geographical Indication) cherry tomato of Pachino (Sicily, Italy) from frauds, an alternative method, which includes chemometric treatments, was proposed. The content of 32 inorganic elements (macro-micronutrients and lanthanides) present in 16 PGI and 24 not PGI cherry tomato samples cv Naomy, and in 16 PGI and 8 not PGI soil samples, was determined by Inductively Coupled Plasma – Mass Spectrometer (ICP-MS). To identify the elements able to differentiate PGI and not PGI cherry tomato samples, Principal Components Analysis (PCA) and Canonical discriminant analysis (CDA) were performed. The first two principal components (PC1-PC2) explain a total variance of 71,41% between PGI and not PGI group, whereas CDA showed Zn, Cd, Mn and Ca as inorganic markers able to correctly classify the 100% of samples. Furthermore, with a translocation factor (K), evaluated in soil/plant chain, the comparison of absorption trends for PGI and not PGI samples was realized.

PMID:35334318 | DOI:10.1016/j.foodchem.2022.132746