Nevin ManimalaPLoS Biol. 2022 Nov 22;20(11):e3001809. doi: 10.1371/journal.pbio.3001809. eCollection 2022 Nov.
ABSTRACT
This Formal Comment uses re-analysis after appropriate corrections to claim that the extreme decline effect reported by Clements et al. is a statistical artefact caused by the way they corrected for zeros in percentage data, exacerbated by errors in data compilation, selective data inclusions and missing studies with strong effects.
PMID:36413526 | DOI:10.1371/journal.pbio.3001809
Vascular. 2022 Nov 22:17085381221141118. doi: 10.1177/17085381221141118. Online ahead of print.
ABSTRACT
BACKGROUND: Endovascular aortic aneurysm repair (EVAR) has become the standard procedure for treating infrarenal abdominal aortic aneurysms (AAA). Various associated complications can lead to open conversion (OC). Thorough follow-up after the procedure is mandatory for the early detection of complications. Persisting perfusion of the aneurysm, a so-called endoleak (EL), paired with structural instability because of aortic wall atrophy and impaired cell functionality induced by EVAR, results in a high risk for aortic rupture.
PURPOSE: The goal of this study was to detect the risk factors for elective and urgent OC as a result of EVAR-induced pathophysiological changes inside the aortic wall.
RESEARCH DESIGN: Retrospective data analysis was performed on all open aortic repairs from January 2016 to December 2020.
DATA COLLECTION AND ANALYSIS: Fifty patients were identified as treated by OC for failure of an infrarenal EVAR. The patients were divided into two subgroups, here depending on the urgency of surgery. Statistical analysis of patient characteristics and outcomes was performed.
RESULTS: The most common indications for OC were various types of EL (74%), resulting in an aortic rupture in 15 patients. Patients with insufficient or absent follow-up were treated more frequently in an emergency setting (16% vs. 63%). The mortality rate was higher in cases of emergency OC (3% vs. 26%).
CONCLUSIONS: Particularly in cases of insufficient or absent follow-up, complications such as EL pose an enormous risk for fatal aortic rupture.
PMID:36413465 | DOI:10.1177/17085381221141118
Int Forum Allergy Rhinol. 2022 Nov 22. doi: 10.1002/alr.23115. Online ahead of print.
ABSTRACT
BACKGROUND: The effect of nasal airway surgery on olfaction has not been well established. The goal of this study is to assess changes in olfaction after septoplasty with inferior turbinate reduction through both objective and patient-reported measures.
METHODS: Prospective, observational study of patients with nasal airway obstruction presenting between July 2017 and October 2019 who underwent septoplasty with inferior turbinate reductions. Nasal airflow was characterized with a Nasal Obstruction Symptom Evaluation (NOSE) scale and an 11-point Ease-of-Breathing (EOB) Likert scale and olfaction was assessed with an 11-point Olfactory Likert Scale and a 40 item University of Pennsylvania Smell Identification Test (UPSIT-40), pre- and post-operatively. Pearson correlations were used to assess the relationship between measures of nasal obstruction and olfaction.
RESULTS: Among 80 patients, mean NOSE scores improved from 67.4 preoperatively to 19.6 postoperatively (p<0.001). EOB Likert scores improved from a mean of 3.9/10 to 8.1/10 after surgery (p<0.001). Olfactory Likert scores improved from a baseline of 6.1/10 pre-operatively to 7.9/10 after surgery (p<0.001). No statistically significant difference was noted in UPSIT testing pre and post-operatively. A moderate correlation was noted between degree of change in NOSE scores and improved olfactory Likert scores (r = 0.51, p<0.001) and between the degree of change in EOB Likert scores and improved olfactory Likert scores (r = 0.55, p<.0001).
CONCLUSIONS: Based on our data, subjective tests of olfaction may improve with nasal airway surgery in some patients. Changes in olfaction best correlate with the extent to which surgery can improve subjective nasal obstructive symptoms. This article is protected by copyright. All rights reserved.
PMID:36413461 | DOI:10.1002/alr.23115
Cancer Epidemiol Biomarkers Prev. 2022 Nov 22:EPI-22-0253. doi: 10.1158/1055-9965.EPI-22-0253. Online ahead of print.
ABSTRACT
BACKGROUND: Despite the success of smoking cessation campaigns, lung cancer remains the leading cause of cancer death in the United States. Variations in smoking behavior and lung cancer mortality are evident by sex and region.
METHODS: Applying geospatial methods to lung cancer mortality data from the National Vital Statistics System and county-level estimates of smoking prevalences from the National Cancer Institute’s Small Area Estimates of Cancer-Related Measures, we evaluated patterns in lung cancer mortality rates (2005-2018) in relation to patterns in ever cigarette smoking prevalences (1997-2003).
RESULTS: Overall, ever smoking spatial patterns were generally associated with lung cancer mortality rates, which were elevated in the Appalachian region and lower in the West for both sexes. However, we also observed geographic variation in mortality rates that is not explained by smoking. Using Lee’s L statistic for assessing bivariate spatial association, we identified counties where the ever smoking prevalence was low and lung cancer rates were high. We observed a significant cluster of counties (n=25; p-values ranging from 0.001 to 0.04) with low ever smoking prevalence and high mortality rates among females around the Mississippi River region south of St. Louis, Missouri and a similar and smaller cluster among males in Western Mississippi (n=12; p-values ranging from 0.002 to 0.03) that has not been previously described.
CONCLUSIONS: Our analyses identified U.S. counties where factors other than smoking may be driving lung cancer mortality Impact: These novel findings highlight areas where investigation of environmental and other risk factors for lung cancer is needed.
PMID:36413442 | DOI:10.1158/1055-9965.EPI-22-0253
Can J Diet Pract Res. 2022 Nov 22:1-5. doi: 10.3148/cjdpr-2022-027. Online ahead of print.
ABSTRACT
Ultra-processed foods (UPFs) have become a major contributor to the diets of Canadians, with a recent report from Statistics Canada suggesting Canadians are consuming almost one-half of their calories from UPFs. Research has linked UPF consumption with increased risk for chronic diseases such as cardiovascular disease and type 2 diabetes, among others. This paper sought to investigate the popularity of UPFs, particularly among children and teens, utilizing the socioecological model as a framework to illustrate how influences at multiple levels (i.e., public policy, organizational, community, interpersonal, and individual) have played a role in the proliferation of UPFs. Evidence from previous studies is used to identify how factors at different levels may influence UPF consumption and discuss potential strategies for reducing UPF consumption. To meaningfully reduce UPF consumption among Canadians, all levels should be considered, with the goal of creating a healthier Canadian population.
PMID:36413422 | DOI:10.3148/cjdpr-2022-027
Crit Pathw Cardiol. 2022 Dec 1;21(4):194-200. doi: 10.1097/HPC.0000000000000295. Epub 2022 Jun 22.
ABSTRACT
INTRODUCTION: Atrial fibrillation (AF) recurrence after a successful external electrical cardioversion (ECV) is common. Assessing an individual’s risk of AF recurrence is a critical part of the treatment plan. We aimed to develop a prognostic prediction score to predict AF recurrence in AF patients who underwent successful ECV.
METHODS: A retrospective cohort study that included AF patients who underwent successful ECV was conducted with a primary outcome of AF recurrence at 6 months. Logistic regression analysis was done to identify variables, and a prognostic prediction score was created and internally validated.
RESULTS: Four prognostic predictors were identified, including the type of AF, persistent AF (1 point) and long-standing persistent AF (4 points), previous cardioversion (1 point), stroke/transient ischemic attack (3 points), and left atrial volume index ≥40 mL/m2 (6 points). The total score of 14 was further divided into 3 risk groups; low-risk (0-2 points), moderate-risk (3-7 points), and high-risk (8-14 points). The positive likelihood ratio for a moderate-risk patient was 2.08 (95% CI, 1.64-2.63) and for a high-risk patient was 7.90 (95% CI, 2.48-25.17). The score showed good discrimination power with the c-statistic of 0.74 (95% CI, 0.69-0.79).
CONCLUSIONS: A simple prognostic prediction score for AF recurrence after successful ECV was created with a promising internally validated discrimination power. An external assessment of its usefulness as a tool to identify patients with low, moderate, and high risk for AF recurrence is warranted.
PMID:36413399 | DOI:10.1097/HPC.0000000000000295
Crit Pathw Cardiol. 2022 Dec 1;21(4):191-193. doi: 10.1097/HPC.0000000000000298. Epub 2022 Oct 14.
ABSTRACT
BACKGROUND: Obesity is a risk factor for cardiovascular disease. The goal of this study was to evaluate any association between aortic valve disease and obesity using a very large database.
METHODS: The Nationwide Inpatient Sample database was utilized for statistical analysis using ICD-9 codes for aortic valve disease and obesity in the United States from 2003 to 2007. A 25% random sample of nonobese patients was used for comparison of aortic valve disease prevalence during the same 5-year period.
RESULTS: A total of 1,971,812 patients with obesity were identified from 2003 to 2007. Comparing this population with a random sample of nonobese patients during the same years, there was no significant difference between obese and nonobese patients in regards to the prevalence of aortic valve disease (1.1-1.2% in 2003 and 2004, 1.2% in 2005-2007, P = NS). After adjusting for age, gender, and race, obesity was associated with lower prevalence of aortic valve disease in 2003-2007 (odds ratio 0.81-0.86, P < 0.01).
CONCLUSIONS: Using a very large database, we found a decrease in the prevalence of aortic valve disease in the obese population. This suggests that obesity alone does not pathologically affect the aortic valve.
PMID:36413398 | DOI:10.1097/HPC.0000000000000298
Crit Pathw Cardiol. 2022 Dec 1;21(4):176-178. doi: 10.1097/HPC.0000000000000304. Epub 2022 Nov 1.
ABSTRACT
BACKGROUND: Distal trans-radial access (dTRA) is a novel technique of arterial cannulation in coronary interventions. The comparative efficacy of dTRA and conventional trans-radial access (TRA) in attenuating peri-procedural complications is unknown.
METHODS: Embase and PubMed/MEDLINE were searched from their inception until June 25, 2022, for randomized clinical trials. Outcomes included were radial artery occlusion (RAO), radial artery spasm, hemostasis time, access time, unsuccessful cannulation, crossover rate, and early discharge after trans-radial stenting of coronary arteries (EASY) type I-III hematomas. Statistical analysis was conducted using the random effects model to derive risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs).
RESULTS: A total of 6 randomized clinical trials comprising 3240 patients were included. Subjects were predominantly male (73%) and had a mean age of 66 years. The dTRA group had a lower risk of RAO [RR 0.43 (95% CI, 0.26-0.69); P = 0.0005; I2 = 0%] and had a shorter hemostasis time [MD -22.85 min (95% CI, -39.06 to -6.65); P = 0.006; I2 = 99%]. The dTRA group had a higher crossover rate [RR 3.04 (95% CI, 1.88-4.91); P = 0.00001; I2 = 56%] and a longer access time [MD 0.68 min (95% CI, 0.17-1.18); P = 0.009; I2 = 99%]. The TRA group had a lower rate of unsuccessful cannulation [RR 0.81 (95% CI, 0.70-0.95); P = 0.01; I2 = 92%]. There was no significant difference between the groups for radial artery spasm and EASY type I-III hematomas.
CONCLUSION: dTRA is a safe alternative to conventional TRA for coronary interventions with a lower risk of RAO. Future trials are required to further compare both approaches.
PMID:36413395 | DOI:10.1097/HPC.0000000000000304
JMIR Mhealth Uhealth. 2022 Nov 22;10(11):e39819. doi: 10.2196/39819.
ABSTRACT
BACKGROUND: Along with the rapid growth of the global aging society, the mobile and health digital market has expanded greatly. Countless mobile medical apps (mmApps) have sprung up in the internet market, aiming to help patients with chronic diseases achieve medication safety.
OBJECTIVE: Based on the medication safety action plans proposed by the World Health Organization, we aimed to explore the effectiveness of mmApps in ensuring the medication safety of patients with chronic diseases, including whether mmApps can improve the willingness to report adverse drug events (ADEs), improve patients’ medication adherence, and reduce medication errors. We hoped to verify our hypothesis through a systematic review and meta-analysis.
METHODS: The meta-analysis was performed in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included literature searched from 7 databases-PubMed, Web Of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, and SinoMed. The publication time was limited to the time of database establishment to April 30, 2022. Studies were screened based on inclusion and exclusion criteria. The data extracted included authors, years of publication, countries or regions, participants’ characteristics, intervention groups, and control groups, among others. Our quality assessment followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. RevMan 5.2 software (Cochrane Collaboration) was used to analyze the statistical data, and a sensitivity analysis was performed to assess data stability. The degree of stability was calculated by using a different statistical method and excluding large-sample studies from the analysis.
RESULTS: We included 8 studies from 5 countries (China, the United States, France, Canada, and Spain) that were published from January 1, 2014, to December 31, 2021. The total number of participants was 1355, and we analyzed the characteristics of included studies, each app’s features, the risk of bias, and quality. The results showed that mmApps could increase ADE reporting willingness (relative risk [RR] 2.59, 95% CI 1.26-5.30; P=.009) and significantly improve medication adherence (RR 1.17, 95% CI 1.04-1.31; P=.007), but they had little effect on reducing medication errors (RR 1.54, 95% CI 0.33-7.29; P=.58).
CONCLUSIONS: We analyzed the following three merits of mmApps, with regard to facilitating the willingness to report ADEs: mmApps facilitate more communication between patients and physicians, patients attach more importance to ADE reporting, and the processing of results is transparent. The use of mmApps improved medication adherence among patients with chronic diseases by conveying medical solutions, providing educational support, tracking medications, and allowing for remote consultations. Finally, we found 3 potential reasons for why our medication error results differed from those of other studies.
TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022322072; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322072.
PMID:36413386 | DOI:10.2196/39819
JAMA Netw Open. 2022 Nov 1;5(11):e2243215. doi: 10.1001/jamanetworkopen.2022.43215.
ABSTRACT
IMPORTANCE: Benzodiazepines are prescribed for the treatment of adolescent sleep disorders; however, benzodiazepine overdoses occur, often in combination with opioids.
OBJECTIVE: To evaluate whether benzodiazepine treatment for sleep disorders, compared with alternative pharmacologic treatments (trazodone, hydroxyzine, zolpidem, zaleplon, and eszopiclone), is associated with increased risk of drug overdose for young people.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included privately insured people 10 to 29 years of age identified from a US commercial claims database (MarketScan), from January 1, 2009, to December 31, 2018. Young people with a sleep disorder diagnosis initiating benzodiazepine (n = 23 084) or comparator pharmacologic treatments (n = 66 706) were included in the study. Statistical analysis was performed from November 1, 2021, to May 16, 2022.
EXPOSURES: New use of benzodiazepine treatment or comparator pharmacologic treatments (defined as ≥1 year without a prescription for benzodiazepine or comparator medications).
MAIN OUTCOMES AND MEASURES: Incident diagnosed drug overdoses were identified from inpatient and emergency department records within 6 months of treatment initiation. The propensity score-adjusted cumulative incidence of overdose and hazard ratios (HRs) were estimated with intention-to-treat (analyzed based on initial treatment) and as-treated analyses (added censoring at treatment discontinuation). Results were stratified by prior prescription opioid fill.
RESULTS: The cohort included 23 084 young people initiating benzodiazepine treatment (14 444 female participants [62.6%]; mean [SD] age, 23 [4.1] years) and 66 706 initiating a comparator treatment (38 446 female participants [57.6%]; mean [SD] age, 22 [4.4] years). Six months after treatment initiation, 9.7% (95% CI, 9.3%-10.1%) of benzodiazepine users and 12.3% (95% CI, 12.1%-12.6%) of the comparator group were still receiving treatment. The crude incidence of drug overdose at 6 months was 0.9% for benzodiazepine initiators and 0.8% for comparator treatment initiators. In adjusted analyses, an increased risk of drug overdose was associated with benzodiazepines vs comparator treatments (intention-to-treat analysis: HR, 1.25 [95% CI, 1.03-1.51]; as-treated analysis: HR, 1.44 [95% CI, 1.14-1.80]). This association was stronger among young people with a recent prescription opioid fill vs those without a recent prescription opioid fill (as-treated analysis: adjusted HR, 2.01 [95% CI, 1.24-3.25] vs adjusted HR, 1.31 [95% CI, 1.00-1.70]).
CONCLUSIONS AND RELEVANCE: The findings of this study suggest that benzodiazepines, compared with alternative pharmacologic treatments for common sleep disorders, were associated with an increased risk of drug overdose among young people during the following 6-month period, especially among those with a recent opioid prescription. Drug overdose is an important safety consideration when treating young people with benzodiazepines.
PMID:36413369 | DOI:10.1001/jamanetworkopen.2022.43215