Tag: nevin manimala

Circulation. 2023 May 18. doi: 10.1161/CIRCULATIONAHA.123.064053. Online ahead of print.

ABSTRACT

BACKGROUND: Existing data and clinical trials could not determine whether faster intravenous thrombolytic therapy (IVT) translates into better long-term functional outcomes after acute ischemic stroke among those treated with endovascular thrombectomy (EVT). Patient-level national data can provide the required large population to study the associations between earlier IVT, versus later, with longitudinal functional outcomes and mortality in patients receiving IVT+EVT combined treatment.

METHODS: This cohort study included older US patients (age ≥65 years) who received IVT within 4.5 hours or EVT within 7 hours after acute ischemic stroke using the linked 2015 to 2018 Get With The Guidelines-Stroke and Medicare database (38 913 treated with IVT only and 3946 with IVT+EVT). Primary outcome was home time, a patient-prioritized functional outcome. Secondary outcomes included all-cause mortality in 1 year. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the associations between door-to-needle (DTN) times and outcomes.

RESULTS: Among patients treated with IVT+EVT, after adjusting for patient and hospital factors, including onset-to-EVT times, each 15-minute increase in DTN times for IVT was associated with significantly higher odds of zero home time in a year (never discharged to home) (adjusted odds ratio, 1.12 [95% CI, 1.06-1.19]), less home time among those discharged to home (adjusted odds ratio, 0.93 per 1% of 365 days [95% CI, 0.89-0.98]), and higher all-cause mortality (adjusted hazard ratio, 1.07 [95% CI, 1.02-1.11]). These associations were also statistically significant among patients treated with IVT but at a modest degree (adjusted odds ratio, 1.04 for zero home time, 0.96 per 1% home time for those discharged to home, and adjusted hazard ratio 1.03 for mortality). In the secondary analysis where the IVT+EVT group was compared with 3704 patients treated with EVT only, shorter DTN times (≤60, 45, and 30 minutes) achieved incrementally more home time in a year, and more modified Rankin Scale 0 to 2 at discharge (22.3%, 23.4%, and 25.0%, respectively) versus EVT only (16.4%, P<0.001 for each). The benefit dissipated with DTN>60 minutes.

CONCLUSIONS: Among older patients with stroke treated with either IVT only or IVT+EVT, shorter DTN times are associated with better long-term functional outcomes and lower mortality. These findings support further efforts to accelerate thrombolytic administration in all eligible patients, including EVT candidates.

PMID:37199147 | DOI:10.1161/CIRCULATIONAHA.123.064053

Biom J. 2023 May 18:e2200108. doi: 10.1002/bimj.202200108. Online ahead of print.

ABSTRACT

Logistic regression is one of the most commonly used approaches to develop clinical risk prediction models. Developers of such models often rely on approaches that aim to minimize the risk of overfitting and improve predictive performance of the logistic model, such as through likelihood penalization and variance decomposition techniques. We present an extensive simulation study that compares the out-of-sample predictive performance of risk prediction models derived using the elastic net, with Lasso and ridge as special cases, and variance decomposition techniques, namely, incomplete principal component regression and incomplete partial least squares regression. We varied the expected events per variable, event fraction, number of candidate predictors, presence of noise predictors, and the presence of sparse predictors in a full-factorial design. Predictive performance was compared on measures of discrimination, calibration, and prediction error. Simulation metamodels were derived to explain the performance differences within model derivation approaches. Our results indicate that, on average, prediction models developed using penalization and variance decomposition approaches outperform models developed using ordinary maximum likelihood estimation, with penalization approaches being consistently superior over the variance decomposition approaches. Differences in performance were most pronounced on the calibration of the model. Performance differences regarding prediction error and concordance statistic outcomes were often small between approaches. The use of likelihood penalization and variance decomposition techniques methods was illustrated in the context of peripheral arterial disease.

PMID:37199142 | DOI:10.1002/bimj.202200108

Haematologica. 2023 May 18. doi: 10.3324/haematol.2023.282935. Online ahead of print.

ABSTRACT

Androgens have represented the historical therapeutic backbone of bone marrow failure (BMF) syndromes. However, their role has been rarely analyzed in prospective setting and systematic and long-term data are currently unavailable regarding their usage, effectiveness and toxicity in both acquired and inherited BMF. Here, taking advantage of a unique disease-specific international dataset, we retrospectively analyzed the so far largest cohort of BMF patients who received androgens before or in absence of an allogeneic hematopoietic cell transplantation (HCT), reappraising their current use in these disorders. We identified 274 patients across 82 EBMT affiliated centers, 193 with acquired (median age of 32) and 81 with inherited BMF (median age of 8 years). With a median duration of androgen treatment of 5.6 and 20 months respectively, complete/partial remission rates at 3 months were of 6%/29% in acquired and 8%/29% in inherited disorders. Five-year overall survival and failure free survival (FFS) were respectively 63% and 23% in acquired and 78% and 14% in inherited contexts. Androgen initiation after second line treatments for acquired, and after > 12 months post-diagnosis for inherited group were identified as factors associated with improved FFS in multivariable analysis. Androgen use was associated with a manageable incidence of organ-specific toxicity and low rates of solid and hematological malignancies. Sub-analysis of transplant-related outcomes after exposure to these compounds showed probabilities of survival and complications similar to other transplanted BMF cohorts. This study delivers a unique opportunity to track androgen use in BMF syndromes and represents the basis for general recommendations on their use on behalf of the SAAWP of the EBMT.

PMID:37199126 | DOI:10.3324/haematol.2023.282935

Pediatrics. 2023 May 18:e2022058579. doi: 10.1542/peds.2022-058579. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with a language for care other than English (LOE) face communication barriers and inequitable outcomes in health care. Professional interpretation can improve outcomes but is underutilized. Our pediatric emergency department (ED) implemented quality improvement (QI) interventions over a 5-year period with an aim to increase interpreter use to 80% of patient encounters with LOE.

METHODS: Overall interpreter use for ED encounters was measured over time, with a baseline period of October 2015 to December 2016 and during 5 years of QI interventions from January 2017 to August 2021. Interventions included staff education, data feedback, reducing barriers to interpreter use, and improving identification of language for care with plan-do-study-act cycles. Outcomes were analyzed by using statistical process control charts and standard rules for special cause variation.

RESULTS: We analyzed a total of 277 309 ED encounters during the study period, 12.2% with LOE. The overall use of interpretation increased from a baseline of 53% to 82% of encounters. Interpretation throughout the ED visit and the number of interpreted interactions per hour also increased. There was improvement across language types, patient age groups, acuity levels, and during different times of day. Special cause variation was associated with multiple QI interventions.

CONCLUSION: We reached our primary aim of providing professional interpretation for 80% of patient encounters with LOE. There were several QI interventions associated with improvements, including staff education, data feedback, improved access to interpretation, and improved identification and visualization of language for care. Efforts to improve interpreter use may benefit from a similar multifaceted approach.

PMID:37199106 | DOI:10.1542/peds.2022-058579

J Child Adolesc Psychiatr Nurs. 2023 May 18. doi: 10.1111/jcap.12422. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to examine the mediating effect of a sense of coherence (SOC) in the relationship between eating attitudes and self-esteem in adolescents.

METHODS: The study was conducted in a descriptive-correlational exploratory design. The sample of the study consisted of 1175 adolescents who met the inclusion criteria. Data were obtained by the researchers using personal information form, the Sense of Coherence Scale (SOC-13), the Eatıng Attitude Test (EAT-26), and the Rosenberg Self-Esteem Scale (RSES).

RESULTS: SOC-13 mean score was 50.21 ± 11.06, EAT-26 mean score was 14.53 ± 10.17, and RSES mean score was 4.17 ± 1.66. It was found that there was a statistically significant negative relationship between the mean scores of RSES and the EAT, a positive relationship between the mean scores of the RSES and SOC, and a negative relationship between the mean scores of EAT and SOC. Moreover, the mediating role of SOC was found to be moderate. Furthermore, 4.5% of adolescents’ SOC scores are explained by eating attitude. On the other hand, 16.4% of self-esteem scores are explained by eating attitude and SOC.

CONCLUSION: As a result of this study, it was determined that students’ SOC moderately mediated the relationship between eating attitude and self-esteem. At the same time, eating attitude had a direct predictive effect on self-esteem.

PMID:37199070 | DOI:10.1111/jcap.12422

J Clin Ultrasound. 2023 May 18. doi: 10.1002/jcu.23476. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate fetal epicardial fat thickness (EFT) along with fetal myocardial performance index (MPI) and its effects on perinatal outcomes in non-severe idiopathic polyhydramnios (IP).

MATERIALS AND METHODS: This prospective study included 92 participants, 32 diagnosed with non-severe IP, and 60 healthy pregnant women. Amniotic fluid indices (AFI), umbilical and middle cerebral artery Doppler, EFT, and MPI measurements were performed for all patients.

RESULTS: The fetal EFT and MPI values were statistically higher in the non-severe IP group than in the control group (p = 0.0001, p = 0.014, respectively). The optimal fetal EFT cutoff value for predicting non-severe IP disease was found as 1.3 mm with a specificity of 81.7% and sensitivity of 59.4%. The EFT cutoff for predicting cesarean section in non-severe IP cases was 1.25 mm (p = 0.038). Apgar scores, neonatal intensive care unit, respiratory distress syndrome, and stillbirth rates were not different between groups.

CONCLUSION: In this study, EFT and MPI were found to be higher in non-severe IP cases compared to controls. It was observed that the increase in MPI and EFT was associated with the increase in cesarean rates, but not with adverse fetal outcomes.

PMID:37199060 | DOI:10.1002/jcu.23476

Cancer Med. 2023 May 18. doi: 10.1002/cam4.6095. Online ahead of print.

ABSTRACT

BACKGROUND: The rising cancer incidence in patients with oral leukoplakia (OL) highlights the importance of identifying potential biomarkers for high-risk individuals and lesions because these biomarkers are useful in developing personalized management strategies for OL patients. This study systematically searched and analyzed the literature on potential saliva and serum biomarkers for OL malignant transformation.

METHODS: PubMed and Scopus were searched for studies published up to April 2022. The primary outcome of this study was the difference in biomarker concentrations in saliva or serum samples from healthy control (HC), OL and oral cancer (OC) populations. Cohen’s d with 95% credible interval was calculated and pooled using the inverse variance heterogeneity method.

RESULTS: A total of seven saliva biomarkers were analyzed in this paper, including interleukin-1alpha, interleukin-6 (IL-6), interleukin-6-8, tumor necrosis factor alpha (TNF-α), copper, zinc, and lactate dehydrogenase. IL-6 and TNF-α exhibited statistically significant deviations in comparisons between HC versus OL and OL versus OC. A total of 13 serum biomarkers were analyzed, including IL-6, TNF-α, C-reactive protein, total cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins, albumin, protein, β2-microglobulin, fucose, lipid-bound sialic acid (LSA), and total sialic acid (TSA). LSA and TSA exhibited statistically significant deviations in comparisons between HC versus OL and OL versus OC.

CONCLUSION: IL-6 and TNF-α in saliva have strong predictive values for OL deterioration, and LSA and TSA concentration levels in serum also have the potential to serve as biomarkers for OL deterioration.

PMID:37199052 | DOI:10.1002/cam4.6095

Brain Behav. 2023 May 18:e3066. doi: 10.1002/brb3.3066. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Coronavirus disease (COVID-19) is still considered a global pandemic. The prognosis of COVID-19 patients varies greatly. We aimed to assess the impact of preexisting, chronic neurological diseases (CNDs) and new-onset acute neurological complications (ANCs) on the disease course, its complications, and outcomes.

METHODS: We conducted a monocentric retrospective analysis from all hospitalized COVID-19 patients between May 1, 2020 and January 31, 2021. Employing multivariable logistic regression models, we explored the association of CNDs and ANCs separately with hospital mortality and functional outcome.

RESULTS: A total of 250 among 709 patients with COVID-19 had CNDs. We found a 2.0 times higher chance of death (95% confidence interval [CI]: 1.37-2.92) for CND patients than for non-CND patients. The chance for an unfavorable functional outcome (modified Rankin Scale > 3 at discharge) was 1.67 times higher in patients with CNDs than those without (95% CI: 1.07-2.59). Furthermore, 117 of all patients had 135 ANCs in total. We observed a 1.86 times higher chance to die (95% CI: 1.18-2.93) for patients with ANCs than without. The chance for a worse functional outcome was 3.6-fold higher in ANC patients than without (95% CI: 2.22-6.01). Patients with CNDs had 1.73 times higher odds for developing ANCs (95% CI: 0.97-3.08).

CONCLUSION: Preexisting neurologic disorders or ANCs in COVID-19 patients were associated with higher mortality and poorer functional outcome at discharge. Furthermore, development of acute neurologic complications was more frequent in patients with preexisting neurologic disease. Early neurological evaluation appears to be an important prognostic factor in COVID-19 patients.

PMID:37199051 | DOI:10.1002/brb3.3066

Nurs Open. 2023 May 18. doi: 10.1002/nop2.1831. Online ahead of print.

ABSTRACT

AIM: This study aimed to assess chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda, conducted between May and June 2022.

DESIGN: Institutional-based cross-sectional design conducted between May and June 2022.

METHODS: The study included 498 participants recruited from six health facilities. A 12-Item Short Form Survey tool was used to collect data on chronic stress, while a researcher-developed questionnaire was used to collect data on coping strategies. Descriptive statistics, binary logistic regression and multiple regression were conducted for data analysis. A p-value of 0.05 was considered statistically significant.

RESULTS: Out of 498 participants, 153 (30.7%) were aged between 31 and 40 years, 341 (68.5%) were female, 288 (57.8%) were married, and 266 (53.4%) had less than Diploma. Of the 498 participants, 351 (70.5%) experienced chronic stress. The protective factors against chronic stress were being married (AOR: 0.132; 95% CI: 0.043-0.408; p < 0.001), optimizing shift length (AOR: 0.056; 95% CI: 0.027-0.115; p < 0.001), religiosity/Spirituality (AOR: 2.750; 95% CI: 1.376-5.497; p = 0.004), and regular exercise and breaks (AOR: 0.405; 95% CI: 0.223-0.737; p = 0.003).

PMID:37199048 | DOI:10.1002/nop2.1831

Am J Biol Anthropol. 2023 May 17. doi: 10.1002/ajpa.24754. Online ahead of print.

ABSTRACT

OBJECTIVES: Data collection is a major hindrance in many types of analyses in human evolutionary studies. This issue is fundamental when considering the scarcity and quality of fossil data. From this perspective, many research projects are impeded by the amount of data available to perform tasks such as classification and predictive modeling.

MATERIALS AND METHODS: Here we present the use of Monte Carlo based methods for the simulation of paleoanthropological data. Using two datasets containing cross-sectional biomechanical information and geometric morphometric 3D landmarks, we show how synthetic, yet realistic, data can be simulated to enhance each dataset, and provide new information with which to perform complex tasks with, in particular classification. We additionally present these algorithms in the form of an R library; AugmentationMC. We also use a geometric morphometric dataset to simulate 3D models, and emphasize the power of Machine Teaching, as opposed to Machine Learning.

RESULTS: Our results show how Monte Carlo based algorithms, such as the Markov Chain Monte Carlo, are useful for the simulation of morphometric data, providing synthetic yet highly realistic data that has been tested statistically to be equivalent to the original data. We additionally provide a critical overview of bootstrapping techniques, showing how Monte Carlo based methods perform better than bootstrapping as the data simulated is not an exact copy of the original sample.

DISCUSSION: While synthetic datasets should never replace large and real datasets, this can be considered an important advance in how paleoanthropological data can be handled.

PMID:37199044 | DOI:10.1002/ajpa.24754