Tag: nevin manimala

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220242. Online ahead of print.

ABSTRACT

BACKGROUND: Smart glass technology offers remote interaction between health professionals for telehealth, alleviating healthcare disparities in isolated areas.

OBJECTIVE: To evaluate the professionals’ perceptions of smart glass technology as a tool for telehealth and distance learning.

METHOD: This mixed-method study on health professionals in 10 different island areas in Korea involved participants experiencing a smart glass-based telehealth system using the scenario of clinical consultation with remote specialists. A group pre- and post-test design was used to examine the change in attitude and perceived importance among health professionals about using smart glasses in telehealth.

RESULTS: Forty-seven participants completed both pre-and post-evaluation of smart glasses. A positive, statistically significant change in participants’ perceptions of smart glasses regarding their implications for telehealth and distance learning (p< 0.05) was found. Fifty-one health workers provided feedback on smart glasses, and a majority expressed their expectations of quality care with telehealth using advanced technology. The main concerns were patients’ privacy issues and inadequate technology for seamless application.

CONCLUSION: The incorporation of smart glass technology offers great potential to enrich telehealth as well as distance learning for unskilled health professionals in isolated areas. Future studies are needed to increase efforts to secure a high level of acceptance for clinical consultation with remote specialists on this newly developed device.

PMID:36442222 | DOI:10.3233/THC-220242

J Parkinsons Dis. 2022 Nov 25. doi: 10.3233/JPD-223522. Online ahead of print.

ABSTRACT

BACKGROUND: A substantial body of research has examined the relationship between alcohol consumption and risk of Parkinson’s disease (PD).

OBJECTIVE: To provide an updated systematic review and meta-analysis of observational studies examining the relationship between alcohol consumption and risk of PD.

METHODS: Eligible studies comparing PD risk in ever vs. never alcohol drinkers were sourced from six databases. Outcomes were pooled using standard meta-analysis techniques. Separate female and male estimates were generated from studies reporting sex-specific data. Additionally, cohort studies stratifying participants by quantity of alcohol intake were integrated in a dose-response analysis.

RESULTS: 52 studies were included, totaling 63,707 PD patients and 9,817,924 controls. Our meta-analysis supported a statistically significant overrepresentation of never drinkers among PD subjects; odds ratio (OR) for ever drinking alcohol 0.84 (95% confidence interval (CI) 0.76 – 0.92). A subgroup analysis revealed similar effect estimates in females and males. A further synthesis of seven cohort studies suggested a negative, dose-dependent association between alcohol and risk of PD.

CONCLUSION: In the absence of a known neuroprotective pathway, there may be reason to doubt a true biological effect. The role of survivor bias, selection and recall bias, misclassification, and residual confounding requires consideration. Alternatively, observations might be attributable to reverse causation if those predestined for PD alter their alcohol habits during the preclinical phase. Major limitations of our study include high between-study heterogeneity (I2 = 93.2%) and lack of adjustment for key confounders, namely smoking status.

PMID:36442208 | DOI:10.3233/JPD-223522

J Alzheimers Dis. 2022 Nov 25. doi: 10.3233/JAD-220942. Online ahead of print.

ABSTRACT

Despite intense research on Alzheimer’s disease, no validated treatment able to reverse symptomatology or stop disease progression exists. A recent systematic review by Kim and colleagues evaluated possible reasons behind the failure of the majority of the clinical trials. As the focus was on methodological factors, no statistical trends were examined in detail. Here, we aim to complete this picture leveraging on Bayesian analysis. In particular, we tested whether the failure of those clinical trials was essentially due to insufficient statistical power or to lack of a true effect. The strong Bayes’ Factor obtained supported the latter hypothesis.

PMID:36442201 | DOI:10.3233/JAD-220942

J Alzheimers Dis. 2022 Nov 24. doi: 10.3233/JAD-220889. Online ahead of print.

ABSTRACT

BACKGROUND: This longitudinal study addressed whether mindfulness practice prevents psychological and behavioral symptoms, especially mood disorders, in Alzheimer’s disease (AD).

OBJECTIVE: To assess the incidence of depression in the course of AD and to determine which non-pharmacological treatment (NPT) is most effective in preventing psychopathological symptoms.

METHODS: We conducted a longitudinal, non-inferiority and equivalence randomized clinical trial, repeated-measures design, with a control group and three experimental treatments: mindfulness, cognitive stimulation, and relaxation. Each experimental group performed three weekly sessions for two years. The pharmacological treatment of all participants was donepezil (10 mg). Participants were patients with probable AD without diagnosed depression from the public neurology services of the Canary Health Service, Spain. Psychological evaluation was performed using the Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), and Neuropsychiatric Inventory (NPI-Q). The statistical analysis included only patients who attended at least 75% of the sessions. A nonparametric, repeated-measures analysis was performed with Kruskal-Wallis H test and between-group differences with Mann-Whitney U test with Bonferroni correction (p < 0.008). Effect size was calculated with partial eta-squared.

RESULTS: The results showed significant differences with large effect sizes (η2p>0.14) between mindfulness and the rest of the experimental groups as well as the control in the GDS, HDRS, and NPI-Q scales.

CONCLUSION: Compared to the other experimental groups, only mindfulness prevented the onset of depression and other psychopathologies in early-stage AD. Based on its effectiveness in maintaining cognitive functions and preventing psychopathology, we recommend mindfulness as the first-choice NPT for mild to moderate AD.

PMID:36442199 | DOI:10.3233/JAD-220889

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220523. Online ahead of print.

ABSTRACT

BACKGROUND: Preeclampsia (PE) has adverse effects on pregnant women, fetuses, and newborns [1], and accounts for 3%-10% of pregnancy-related diseases globally.

OBJECTIVE: This study aimed to screen a series of prenatal markers (pregnancy-associated plasma protein [PAPP-A], β-human chorionic gonadotropin [β-hCG], alpha fetoprotein [AFP], and estriol [uE3]) to establish a risk model and evaluate the diagnostic values of the markers for predicting PE.

METHODS: Sixty-five pregnant women were enrolled in this study. They were divided into two groups containing healthy pregnant women (n= 51, the non-PE group) and pregnant women with PE (n= 14, the PE group). According to the stage of pregnancy, the pregnant women in each group were divided into early, middle, and late pregnancy groups for statistical analysis. The levels of PAPPA-A β-hCG, AFP, and uE3 were compared among these groups. Then, a risk model was established, and PE was diagnosed using receiver operating characteristic (ROC) curve results.

RESULTS: In the early pregnancy group, the differences in the levels of PAPP-A, AFP, and uE3 between the PE and non-PE groups were statistically significant (P< 0.001, P= 0.029, and P= 0.033, respectively), while the difference in the single remaining marker was not statistically significant. A ROC curve analysis revealed that in early pregnancy, the sensitivity and specificity of PAPP-A were 76.5% and 71.4%, respectively, and the sensitivity and specificity of β-hCG were 82.4% and 57.1%, respectively. The sensitivity and specificity of the combination of the two markers for diagnosing PE were 86.3% and 57.1%, respectively.

CONCLUSION: This study demonstrated that the combination of PAPP-A and β-hCG has diagnostic value for PE in pregnant women. Accordingly, we should formulate innovative PE screening strategies to target the prevention of PE and create important conditions for predictive and preventive personalized medical treatments.

PMID:36442168 | DOI:10.3233/THC-220523

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220433. Online ahead of print.

ABSTRACT

BACKGROUND: Prefabricated metal crowns (PMCs) have been widely used in pediatric dentistry due to their great success in various clinical situations. However, it is important to know the local effects, such as changes in pH in the oral environment.

OBJECTIVE: To evaluate the pH variations before and after placement of PMCs.

METHODS: A quasi-experimental study (before and after) was performed with 32 pediatric patients who needed rehabilitation with PMCs at a pediatric dentistry clinic in a public university. Measurements were made using a pH potentiometer before PMC placement, one week after, and one month after placement. ANOVA and Pearson correlation were performed in SPSS.

RESULTS: The average age of the participants was 5.9 ± 1.6 years, and 53.1% were female. The average pH before, one week after, and one month after crown placement was 7.46 ± 0.37, 7.00 ± 0.32, and 7.1 ± 0.19, respectively. Significant differences (p< 0.05) were observed between the three pH measurements. We found differences when comparing the basal pH values to those at one week (p= 0.001) and one month (p= 0.002).

CONCLUSION: Although there were statistically significant differences in the pH change values before and after the placement of crowns, these differences may not have a clinical impact.

PMID:36442164 | DOI:10.3233/THC-220433

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220395. Online ahead of print.

ABSTRACT

BACKGROUND: The continuous decrease of healthcare resources requires hospitals to improve efficiency while striving to improve quality standards that deliver better patient outcomes.

OBJECTIVE: The objective of this study was to analyze whether the implementation of digital support systems during orthopedic surgery positively affected clinical processes and quality ratios.

METHODS: A retrospective case-control study of 297 knee joint replacement procedures was conducted between 2015 and 2020. Thirty-five patients were allocated to the treatment and control groups after they were identified with exact matching and estimation of the propensity score. Both groups were balanced regarding the selected covariates. The effect of the surgical procedure manager (SPM) on the incidence of acute haemorrhagic anaemia between the two groups was evaluated with a t-test, and the odds ratio was calculated.

RESULTS: SPM-supported surgery has no significant influence on the incidence of acute haemorrhagic anaemia but leads to significantly shorter hospital stay (1.93 days), changeover (4.14 minutes) and recovery room time (20.20 minutes). In addition, it reduces the standard deviation of operation room times.

CONCLUSIONS: The study concludes that SPM enhances surgical efficiency and maintains quality outcomes. To overcome their increasing financial pressure hospital management should commercially evaluate the implementation of digital support systems.

PMID:36442162 | DOI:10.3233/THC-220395

Technol Health Care. 2022 Nov 17. doi: 10.3233/THC-220361. Online ahead of print.

ABSTRACT

BACKGROUND: At present, the clinical diagnosis of white matter change (WMC) patients depends on cranial magnetic resonance imaging (MRI) technology. This diagnostic method is costly and does not allow for large-scale screening, leading to delays in the patient’s condition due to inability to receive timely diagnosis.

OBJECTIVE: To evaluate whether the burden of WMC is associated with the degree of invisible hand tremor in humans.

METHODS: Previous studies have shown that tremor is associated with WMC, however, tremor does not always have imaging of WMC. Therefore, to confirm that the appearance of WMC causes tremor, which are sometimes invisible to the naked eye, we achieved an optical-based computer-aided diagnostic device by detecting the invisible hand tremor, and we proposed a calculation method of WMC volume by using the characteristics of MRI images.

RESULTS: Statistical analysis results further clarified the relationship between WMC and tremor, and our devices are validated for the detection of tremors with WMC.

CONCLUSIONS: The burden of WMC volume is positive factor for degree of invisible hand tremor in the participants without visible hand tremor. Detection technology provides a more convenient and low-cost evaluating method before MRI for tremor diseases.

PMID:36442160 | DOI:10.3233/THC-220361

J Dtsch Dermatol Ges. 2022 Nov 28. doi: 10.1111/ddg.14911. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: In recent years, considerable insight has been gained into the pathogenesis, diagnosis and treatment of cutaneous sarcomas, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). Both entities have shown increasing incidence rates in the last decade. This study was initiated to evaluate how these new insights impact the number of diagnoses of AFX/PDS compared to other cutaneous sarcoma entities.

PATIENTS AND METHODS: In a retrospective study of four German skin cancer centers, all histopathological reports of cutaneous sarcomas (AFX, PDS, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, angiosarcoma, and Kaposi sarcoma) confirmed by board-certified dermatopathologists were analyzed during a time-period of seven years (2013-2019). Additionally, utilization of immunohistochemical markers (including pan-cytokeratin, S100, desmin, CD34, CD10, procollagen-1, CD99, CD14, and CD68) as an adjunct to diagnose AFX/PDS was recorded.

RESULTS: Overall, 255 cutaneous sarcomas were included in the present study. The diagnosis of a cutaneous sarcoma has consequently risen from 2013 to 2019 (from 16 to 52 annual cases). The results of AFX/PDS revealed 4.6 times more diagnoses in 2019 than in 2013. Atypical fibroxanthoma represented the most common subtype, displaying 49.3 % of all diagnosed cutaneous sarcomas. Additionally, the increase of AFX/PDS was linked to the use of immunohistochemistry, with specific immunohistochemical markers used in 57.1 % of cases in 2013 compared to 100 % in 2019.

CONCLUSIONS: This retrospective study of four German skin cancer centers demonstrates a substantial rise of AFX/PDS, possibly due to recently established diagnostic and terminology standards. This rise is probably linked to increased utilization of specific immunohistochemical markers. Atypical fibroxanthoma/PDS may be more common than previously thought and seems to represent the most frequent cutaneous sarcoma subtype.

PMID:36442137 | DOI:10.1111/ddg.14911

Proc Natl Acad Sci U S A. 2022 Dec 6;119(49):e2215352119. doi: 10.1073/pnas.2215352119. Epub 2022 Nov 28.

ABSTRACT

Problem-solving and reasoning involve mental exploration and navigation in sparse relational spaces. A physical analogue is spatial navigation in structured environments such as a network of burrows. Recent experiments with mice navigating a labyrinth show a sharp discontinuity during learning, corresponding to a distinct moment of “sudden insight” when mice figure out long, direct paths to the goal. This discontinuity is seemingly at odds with reinforcement learning (RL), which involves a gradual build-up of a value signal during learning. Here, we show that biologically plausible RL rules combined with persistent exploration generically exhibit discontinuous learning. In tree-like structured environments, positive feedback from learning on behavior generates a “reinforcement wave” with a steep profile. The discontinuity occurs when the wave reaches the starting point. By examining the nonlinear dynamics of reinforcement propagation, we establish a quantitative relationship between the learning rule, the agent’s exploration biases, and learning speed. Predictions explain existing data and motivate specific experiments to isolate the phenomenon. Additionally, we characterize the exact learning dynamics of various RL rules for a complex sequential task.

PMID:36442113 | DOI:10.1073/pnas.2215352119