Tag: nevin manimala

J Am Acad Orthop Surg. 2023 May 16. doi: 10.5435/JAAOS-D-22-00800. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacroiliac joint (SIJ) fusion is a surgical treatment option for SIJ pathology in select patients who have failed conservative management. More recently, minimally invasive surgical (MIS) techniques have been developed. This study aimed to determine the trends in procedure volume and reimbursement rates for SIJ fusion.

METHODS: Publicly available Medicare databases were assessed using the National Summary Data Files for 2010 to 2020. Files were organized according to current procedural terminology (CPT) codes. CPT codes specific to open and MIS SI joint fusion (27279 and 27280) were identified and tracked. To track surgeon reimbursements, the CMS Medicare Physician Fee Schedule Look-Up Tool was used to extract facility prices. Descriptive statistics and linear regression were used to evaluate trends in procedure volume, utilization, and reimbursement rates. Compound annual growth rates were calculated, and discrepancies in inflation were corrected for using the Consumer Price Index.

RESULTS: A total of 33,963 SIJ fusions were conducted in the Medicare population between 2010 and 2020, with an overall increase in procedure volume of 2,350.9% from 318 cases in 2010 to 7,794 in 2020. Since the introduction of the 27279 CPT code in 2015, 8,806 cases (31.5%) have been open and 19,120 (68.5%) have been MIS. Surgeon reimbursement for open fusions increased nominally by 42.8% (inflation-adjusted increase of 20%) from $998 in 2010 to $1,425 in 2020. Meanwhile, reimbursement for MIS fusion experienced a nominal increase of 58.4% (inflation-adjusted increase of 44.9%) from $582 in 2015 to $922 in 2020.

CONCLUSION: SIJ fusion volume in the Medicare population has increased substantially in the past 10 years, with MIS SIJ fusion accounting for most of the procedures since the introduction of the 27279 CPT code in 2015. Reimbursement rates for surgeons have also increased for both open and MIS procedures, even after adjusting for inflation.

PMID:37192412 | DOI:10.5435/JAAOS-D-22-00800

J Am Assoc Nurse Pract. 2023 May 16. doi: 10.1097/JXX.0000000000000893. Online ahead of print.

ABSTRACT

BACKGROUND: The human papilloma virus (HPV) is the leading cause of cervical cancer worldwide and is responsible for genital warts and five other types of cancers. The HPV vaccine was introduced in 2006 and demonstrated to be safe and more effective than expected, yet adolescent rates of immunization in the United States remain low.

LOCAL PROBLEM: Adolescent HPV vaccine rates were below the national average, and effective vaccine recommendation strategies were not used at an urban pediatric primary care office in southern Florida.

METHODS: The percentage of HPV vaccine rates in this primary care office were measured among adolescents ages 13-17 years using data obtained from Florida’s state vaccine registry before implementation of the intervention, after the intervention, and monthly over a 90-day period.

INTERVENTIONS: Interventions aimed to improve vaccine rates included implementing an HPV protocol consisting of education on providing a strong bundled recommendation, appointing a vaccine champion, implementing standing vaccine orders, and educational materials.

RESULTS: The vaccine rates among adolescents increased by 11% for the initial dose, 7% for the second dose, and 6% for the vaccine completion rate. Chi-square test demonstrated statistical significance, for the initial vaccine.

CONCLUSION: A nurse practitioner-led application of an evidenced-based HPV vaccine protocol positively affected the care of adolescents in this primary care setting.

PMID:37192408 | DOI:10.1097/JXX.0000000000000893

Swiss Med Wkly. 2023 May 15;153:40072. doi: 10.57187/smw.2023.40072.

ABSTRACT

INTRODUCTION: The combined use of intraoperative MRI and awake surgery is a tailored microsurgical resection to respect functional neural networks (mainly the language and motor ones). Intraoperative MRI has been classically considered to increase the extent of resection for gliomas, thereby reducing neurological deficits. Herein, we evaluated the combined technique of awake microsurgical resection and intraoperative MRI for primary brain tumours (gliomas, metastasis) and epilepsy (cortical dysplasia, non-lesional, cavernomas).

PATIENTS AND METHODS: Eighteen patients were treated with the commonly used “asleep awake asleep” (AAA) approach at Lille University Hospital, France, from November 2016 until May 2020. The exact anatomical location was insular with various extensions, frontal, temporal or fronto-temporal in 8 (44.4%), parietal in 3 (16.7%), fronto-opercular in 4 (22.2%), Rolandic in two (11.1%), and the supplementary motor area (SMA) in one (5.6%).

RESULTS: The patients had a mean age of 38.4 years (median 37.1, range 20.8-66.9). The mean surgical duration was 4.1 hours (median 4.2, range 2.6-6.4) with a mean duration of intraoperative MRI of 28.8 minutes (median 25, range 13-55). Overall, 61% (11/18) of patients underwent further resection, while 39% had no additional resection after intraoperative MRI. The mean preoperative and postoperative tumour volumes of the primary brain tumours were 34.7 cc (median 10.7, range 0.534-130.25) and 3.5 cc (median 0.5, range 0-17.4), respectively. Moreover, the proportion of the initially resected tumour volume at the time of intraoperative MRI (expressed as 100% from preoperative volume) and the final resected tumour volume were statistically significant (p= 0.01, Mann-Whitney test). The tumour remnants were commonly found posterior (5/9) or anterior (2/9) insular and in proximity with the motor strip (1/9) or language areas (e.g. Broca, 1/9). Further resection was not required in seven patients because there were no remnants (3/7), cortical stimulation approaching eloquent areas (3/7) and non-lesional epilepsy (1/7). The mean overall follow-up period was 15.8 months (median 12, range 3-36).

CONCLUSION: The intraoperative MRI and awake microsurgical resection approach is feasible with extensive planning and multidisciplinary collaboration, as these methods are complementary and synergic rather than competitive to improve patient oncological outcomes and quality of life.

PMID:37192405 | DOI:10.57187/smw.2023.40072

Adv Gerontol. 2023;36(1):83-88.

ABSTRACT

The object of the study was senile people, who sought dental orthopedic care in municipal healthcare institutions of the town of Cheboksary, the Chuvash Republic. The sample size was 1 000 people. The obtained quantitative indicators were subjected to statistical processing using parametric and nonparametric statistical methods. The analysis of mounted orthopedic dent prosthetic structures manufactured and installed in elderly and senile patients shows that the choice of material and method of manufacture is largely determined by such a social factor as the average monthly income. This, in turn, largely depends on income-generating employment and the possibility of obtaining additional financial support from family members in which the patient lives. Social factors have a significant impact on the quality of life in elderly and senile people.

PMID:37192359

Environ Sci Technol. 2023 May 16. doi: 10.1021/acs.est.3c00845. Online ahead of print.

ABSTRACT

There are widespread policy assumptions that the phase-out of gasoline and diesel internal combustion engines will over time lead to much reduced emissions of Volatile Organic Compounds (VOCs) from road transport and related fuels. However, the use of real-world emissions measurements from a new mobile air quality monitoring station demonstrated a large underestimation of alcohol-based species in road transport emissions inventories. Scaling of industry sales statistics enabled the discrepancy to be attributed to the use of ancillary solvent products such as screenwash and deicer which are not included in internationally applied vehicle emission methodologies. A fleet average nonfuel nonexhaust VOC emission factor of 58 ± 39 mg veh^-1 km^-1 was calculated for the missing source, which is greater than the total of all VOCs emitted from vehicle exhausts and their associated evaporative fuel losses. These emissions are independent of the vehicle energy/propulsion system and therefore applicable to all road vehicle types including those with battery-electric powertrains. In contrast to predictions, vehicle VOC emissions may actually increase given a predicted growth in total vehicle kilometers driven in a future electrified fleet and will undergo a complete VOC respeciation due to the source change.

PMID:37191998 | DOI:10.1021/acs.est.3c00845

JMIR Serious Games. 2023 May 16;11:e40931. doi: 10.2196/40931.

ABSTRACT

BACKGROUND: Cognitive assessment using tangible objects can measure fine motor and hand-eye coordination skills along with other cognitive domains. Administering such tests is often expensive, labor-intensive, and error prone owing to manual recording and potential subjectivity. Automating the administration and scoring processes can address these difficulties while reducing time and cost. e-Cube is a new vision-based, computerized cognitive assessment tool that integrates computational measures of play complexity and item generators to enable automated and adaptive testing. The e-Cube games use a set of cubes, and the system tracks the movements and locations of these cubes as manipulated by the player.

OBJECTIVE: The primary objectives of the study were to validate the play complexity measures that form the basis of developing the adaptive assessment system and evaluate the preliminary utility and usability of the e-Cube system as an automated cognitive assessment tool.

METHODS: This study used 6 e-Cube games, namely, Assembly, Shape-Matching, Sequence-Memory, Spatial-Memory, Path-Tracking, and Maze, each targeting different cognitive domains. In total, 2 versions of the games, the fixed version with predetermined sets of items and the adaptive version using the autonomous item generators, were prepared for comparative evaluation. Enrolled participants (N=80; aged 18-60 years) were divided into 2 groups: 48% (38/80) of the participants in the fixed group and 52% (42/80) in the adaptive group. Each was administered the 6 e-Cube games; 3 subtests of the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; Block Design, Digit Span, and Matrix Reasoning); and the System Usability Scale (SUS). Statistical analyses at the 95% significance level were applied.

RESULTS: The play complexity values were correlated with the performance indicators (ie, correctness and completion time). The adaptive e-Cube games were correlated with the WAIS-IV subtests (r=0.49, 95% CI 0.21-0.70; P<.001 for Assembly and Block Design; r=0.34, 95% CI 0.03-0.59; P=.03 for Shape-Matching and Matrix Reasoning; r=0.51, 95% CI 0.24-0.72; P<.001 for Spatial-Memory and Digit Span; r=0.45, 95% CI 0.16-0.67; P=.003 for Path-Tracking and Block Design; and r=0.45, 95% CI 0.16-0.67; P=.003 for Path-Tracking and Matrix Reasoning). The fixed version showed weaker correlations with the WAIS-IV subtests. The e-Cube system showed a low false detection rate (6/5990, 0.1%) and was determined to be usable, with an average SUS score of 86.01 (SD 8.75).

CONCLUSIONS: The correlations between the play complexity values and performance indicators supported the validity of the play complexity measures. Correlations between the adaptive e-Cube games and the WAIS-IV subtests demonstrated the potential utility of the e-Cube games for cognitive assessment, but a further validation study is needed to confirm this. The low false detection rate and high SUS scores indicated that e-Cube is technically reliable and usable.

PMID:37191993 | DOI:10.2196/40931

J Dent Educ. 2023 May 16. doi: 10.1002/jdd.13240. Online ahead of print.

ABSTRACT

PURPOSE: This work aimed to utilize virtual reality (VR) in dental radiographic anatomical interpretation in junior dental students and test if it can enhance student learning, engagement, and performance.

METHODS: VR software for panoramic anatomy was developed. Sixty-nine first-year dental students were divided into a control group (lecture-based) and an experimental group (VR) to learn panoramic radiographic anatomy. Both groups were then tested on knowledge via a 20-question quiz. Student feedback on VR experience was collected via an online survey.

RESULTS: There was a statistically significant difference between lecture-based and VR students in the correct identification of anatomical landmarks. Lecture-based students scored higher in identifying the ear lobe, hyoid bone, condylar neck, and external oblique ridge, whereas VR students scored higher in identifying zygoma (Chi-squared test, p < 0.005). The VR group reported high evaluation on all perception items of the online feedback survey on their experience (Student t-test, p < 0.005).

CONCLUSIONS: Lecture-based students generally showed better performance in panoramic radiographic anatomy. Several structures were not correctly identified in both groups of novice students. The positive feedback of VR experience encourages future implementation in education to augment conventional methods of radiographic anatomy in dentistry with considerations to repeated exposures throughout undergraduate dental education.

PMID:37191982 | DOI:10.1002/jdd.13240

JAMA Netw Open. 2023 May 1;6(5):e2313220. doi: 10.1001/jamanetworkopen.2023.13220.

ABSTRACT

IMPORTANCE: The neural retina is considered a unique window to systemic health, but its biological link with systemic health remains unknown.

OBJECTIVE: To investigate the independent associations of retinal ganglion cell-inner plexiform layer thickness (GCIPLT) metabolic profiles with rates of mortality and morbidity of common diseases.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated UK Biobank participants enrolled between 2006 and 2010, and prospectively followed them up for multidisease diagnosis and mortality. Additional participants from the Guangzhou Diabetes Eye Study (GDES) underwent optical coherence tomography scanning and metabolomic profiling and were included for validation.

MAIN OUTCOMES AND MEASURES: Systematic analysis of circulating plasma metabolites to identify GCIPLT metabolic profiles; prospective associations of these profiles with mortality and morbidity of 6 common diseases with their incremental discriminative value and clinical utility.

RESULTS: Among 93 838 community-based participants (51 182 [54.5%] women), the mean (SD) age was 56.7 (8.1) years and mean (SD) follow-up was 12.3 (0.8) years. Of 249 metabolic metrics, 37 were independently associated with GCIPLT, including 8 positive and 29 negative associations, and most were associated with the rates of future mortality and common diseases. These metabolic profiles significantly improved the models for discriminating type 2 diabetes over clinical indicators (C statistic: 0.862; 95% CI, 0.852-0.872 vs clinical indicators only, 0.803; 95% CI, 0.792-0.814; P < .001), myocardial infarction (0.792; 95% CI, 0.775-0.808 vs 0.768; 95% CI, 0.751-0.786; P < .001), heart failure (0.803; 95% CI, 0.786-0.820 vs 0.790; 95% CI, 0.773-0.807; P < .001), stroke (0.739; 95% CI, 0.714-0.764 vs 0.719; 95% CI, 0.693-0.745; P < .001), all-cause mortality (0.747; 95% CI, 0.734-0.760 vs 0.724; 95% CI, 0.711-0.738; P < .001), and cardiovascular disease mortality (0.790; 95% CI, 0.767-0.812 vs 0.763; 95% CI, 0.739-0.788; P < .001). Additionally, the potential of GCIPLT metabolic profiles for risk stratification of cardiovascular diseases were further confirmed in the GDES cohort using a different metabolomic approach.

CONCLUSIONS AND RELEVANCE: In this prospective study of multinational participants, GCIPLT-associated metabolites demonstrated the potential to inform mortality and morbidity risks. Incorporating information on these profiles may facilitate individualized risk stratification for these health outcomes.

PMID:37191963 | DOI:10.1001/jamanetworkopen.2023.13220

JMIR Res Protoc. 2023 Mar 12. doi: 10.2196/41811. Online ahead of print.

ABSTRACT

BACKGROUND: The epidemiology, morbidity, and burden of the disease related to airway sequelae associated with invasive mechanical ventilation (IMV) in the context of the COVID-19 pandemic remain unclear.

OBJECTIVE: This scoping review aims to summarize the current knowledge regarding airway sequelae after severe SARS-CoV2 infection. This knowledge will help guide research endeavors and decision-making in clinical practice.

METHODS: This scoping review will include participants of all genders and no particular age group who developed post-COVID airway related complication will be excluded. No exclusion criteria will be applied from country, language or document type. The information source will include analytical observational, observational studies. Unpublished data will not be completely covered as grey literature will be covered. A total of 2 independent reviewers will participate in the process of screening, selection, and data extraction, and the whole process will be performed blindly. Conflict between reviewers will be solve through discussion and additional reviewer. Results will be reported by using descriptive statistics and information will be displayed on RedCap.

RESULTS: The literature search was conducted in May 2022 in in the following databases; PubMed, EMBASE, SCOPUS, Cochrane Library, LILACS and Grey literature to identify observational studies; a total of 738 results were retrieved. The scoping review will be finished by March-2023.

CONCLUSIONS: This scoping review will describe current knowledge on the most frequently encountered laryngeal and/or tracheal sequelae in patients exposed to mechanical ventilation due to SARS-CoV-2 infection. This scoping review will find the incidence of airway sequelae post-COVID19 and the most common sequelae such as; airway granuloma, vocal fold paralysis, and airway stenoses. Future studies should evaluate the incidence of these disorders.

INTERNATIONAL REGISTERED REPORT: PRR1-10.2196/41811.

PMID:37191952 | DOI:10.2196/41811

Int Ophthalmol. 2023 May 16. doi: 10.1007/s10792-023-02734-x. Online ahead of print.

ABSTRACT

PURPOSE: The use of video-based social media platforms is increasing among trainee residents, fellows, and practicing ophthalmologists. In this study, we objectively evaluate the quality of Ahmed glaucoma valve (AGV) implantation videos on open access, video-based internet platforms.

DESIGN: Internet-based cross-sectional study.

PARTICIPANTS: Not applicable.

METHODS: In this cross-sectional study, 23 websites publishing medical surgery training video content were queried using the keyword “Ahmed glaucoma valve implantation”.

MAIN OUTCOME MEASURES: The descriptive statistics of video parameters were noted, and the videos were assessed using established scoring systems-Sandvik, Health on the Net Foundation Code of Conduct (HON code), mDISCERN, and Global Quality Score (GQS) scores. Video Quality Score (VQS) was determined based on the 14 steps per the AGV implantation rubric.

RESULTS: One hundred and nineteen videos were evaluated, and 35 were excluded. The total quality of all 84 videos according to their Sandvik, HON Code, GQS, DISCERN, and VQS scores was 11.79 ± 1.70 (excellent quality), 6.86 ± 0.75 (excellent quality), 3.97 ± 0.93 (good quality), 3.26 ± 0.66 (fair quality) and 11.45 ± 2.67 (good quality), respectively. No significant correlation was found between the descriptive parameters and video quality score. However, no significant correlation was found between the descriptive parameters and video quality score.

CONCLUSIONS: The objective analysis showed that the video quality ranged from good to excellent. AGV implantation videos were sparse on exclusive ophthalmology surgical video portals. Therefore, more peer-reviewed videos following standardized rubric are needed on open-access surgical video platforms.

PMID:37191927 | DOI:10.1007/s10792-023-02734-x