Tag: nevin manimala

Dev Neurorehabil. 2022 Oct 3:1-9. doi: 10.1080/17518423.2022.2131922. Online ahead of print.

ABSTRACT

This study aimed to examine the acute changes in dynamic balance Postural Control experienced by children with Autism Spectrum Disorder (ASD) who undertook a 6-month extracurricular Service-Learning Physical Education (PE) program. The study used a quasi-experimental design with 23 participants divided into an experimental group and a control group. Limits of Stability protocol was used to measure the children’s postural control. The results showed that the experimental group achieved statistically significant improvements. To conclude, this study provides substantial input about how extracurricular PE activities aimed at developing the general motor proficiency of ASD children can improve their dynamic balance.

PMID:36191252 | DOI:10.1080/17518423.2022.2131922

Ultrasound Obstet Gynecol. 2022 Oct 3. doi: 10.1002/uog.26089. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a model based on factors available at diagnosis of twin-twin transfusion syndrome (TTTS) that predicts chance of dual twin survival following fetoscopic laser photocoagulation (FLPC) using machine learning algorithm.

METHODS: A retrospective analysis of data collected from two university-affiliated tertiary fetal centers between 2012 and 2021. The cohort included monochorionic twin pregnancies complicated by TTTS who underwent FLPC. Data were stratified based on survival rates 30 days after delivery, dual survival cases were compared to the rest. Following random forest, as an ensemble machine-learning algorithm, relative importance value was calculated for each parameter that presented statistically significant difference. Holdout method was applied to check overfitting of the random forest algorithm. A prediction model for having dual twin survival 30 days after delivery was constructed to a graphic nomogram based on the testing set.

RESULTS: The study included 537 women, of them 346 (64.4%) had dual twin survival at 30 days and were compared to 191 (35.6%) that had one or no survivors. Univariate analysis demonstrated no differences in demographic parameters between the groups. At time of diagnosis, the dual survival groups presented lower rates of donor’s estimated fetal weight below 10^th centile for gestational age (56.4% vs. 69.4% p=0.004), intertwin growth discordance above 25% (40.8% vs. 56.5%, p=0.001), and anterior placenta (40.5% vs. 50%, p=0.034). Doppler differences between the groups demonstrated lower rates of elevated pulsatility index (PI) above 95^th centile, measured in the donor’s umbilical artery and ductus venosus, as well as lower rates of decreased PI below 5^th centile, measured in the donor’s middle cerebral artery. Importance value for each of these 6 parameters was calculated allowing the construction of a prediction model with area under ROC curve (AUC=0.916, 95% CI= 0.887-0.946).

CONCLUSIONS: Incorporating six variables: donor’s estimated fetal weight below 10^th centile, intertwin growth discordance above 25%, anterior placenta, pulsatility index in the umbilical artery, ductus venosus and middle cerebral artery, obtained at time of diagnosis of TTTS into a predictive model for dual twin survival following FLPC has been developed. This clinically applicable tool may allow improved treatment plans and patient counseling. This article is protected by copyright. All rights reserved.

PMID:36191157 | DOI:10.1002/uog.26089

IEEE Trans Neural Syst Rehabil Eng. 2022 Oct 3;PP. doi: 10.1109/TNSRE.2022.3211450. Online ahead of print.

ABSTRACT

The side effects and complications of traditional treatments for treating pathological tremor have led to a growing research interest in wearable tremor suppression devices (WTSDs) as an alternative approach. Similar to how the human brain coordinates the function of the human system, a tremor estimator determines how a WTSD functions. Although many tremor estimation algorithms have been developed and validated, whether they can be implemented on a cost-effective embedded system has not been studied; furthermore, their effectiveness on tremor signals with multiple harmonics has not been investigated. Therefore, in this study, four tremor estimators were implemented, evaluated, and compared: Weighted-frequency Fourier Linear Combiner (WFLC), WFLC-based Kalman Filter (WFLC-KF), Band-limited Multiple FLC, and enhanced High-order WFLC-KF (eHWFLC-KF). This study aimed to evaluate the performance of each algorithm on a bench-top tremor suppression system with 18 recorded tremor motion datasets; and compare the performance of each estimator. The experimental evaluation showed that the eHWFLC-KF-based WTSD achieved the best performance when suppressing tremor with an average of 89.3% reduction in tremor power, and an average error when tracking voluntary motion of 6.6°/s. Statistical analysis indicated that the eHWFLC-KF-based WTSD is able to reduce the power of tremor better than the WFLC and WFLC-KF, and the BMFLC-based WTSD is better than the WFLC. The performance when tracking voluntary motion is similar among all systems. This study has proven the feasibility of implementing various tremor estimators in a cost-effective embedded system, and provided a real-time performance assessment of four tremor estimators.

PMID:36191110 | DOI:10.1109/TNSRE.2022.3211450

IEEE Trans Ultrason Ferroelectr Freq Control. 2022 Oct 3;PP. doi: 10.1109/TUFFC.2022.3211484. Online ahead of print.

ABSTRACT

Biaxial transducers are an emerging technology that can steer generated ultrasound waves using a single piezoceramic component. Simulations have also shown that biaxial transducers can passively estimate the direction of arrival of sound waves when operating in receive mode. This research seeks to experimentally verify biaxial directivity estimates and establish directivity as an independent parameter detected by biaxial transducers. Three cuboid (3.84 mm x 3.84 mm x 5.92 mm) biaxial piezoceramics with two pairs of orthogonal electrodes (one pair applied laterally and one pair applied in the polling direction) were manufactured and characterized. Each transducer was placed in a water tank where an independent hemispherical source was attached to a moveable arm and operated at 250 kHz. Terminal voltages were recorded for eighty-one source positions in a plane parallel to the transducer’s front face and at a depth of approximately 9 cm. Collection was repeated three times per transducer to ensure reproducibility. In-silico results were compared with the experimental results. Two derived metrics were then calculated using both the forward and lateral terminal voltages: the phase difference and amplitude ratio. Biaxial transducers demonstrate an ability to estimate the direction of arrival of incident sound waves, independently of any time-of-flight information. The phase difference and amplitude ratio complement each other to provide statistically significant and repeatable estimates over a range of 48 degrees (from -24 degrees to +24 degrees). These results can be used to augment a variety of medical, geophysical, and industrial passive ultrasound imaging techniques.

PMID:36191096 | DOI:10.1109/TUFFC.2022.3211484

Clin Spine Surg. 2022 Aug 3. doi: 10.1097/BSD.0000000000001365. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective randomized Food and Drug Administration investigational device exemption clinical trial.

OBJECTIVE: The purpose of the present study is to report the 1-year clinical and radiographic outcomes and safety profile of patients who underwent lumbar facet arthroplasty through implantation of the Total Posterior Spine System (TOPS) device.

SUMMARY OF BACKGROUND DATA: Lumbar facet arthroplasty is one proposed method of dynamic stabilization to treat grade-1 spondylolisthesis with stenosis; however, there are currently no Food and Drug Administration-approved devices for facet arthroplasty.

METHODS: Standard demographic information was collected for each patient. Radiographic parameters and patient-reported outcome measures were assessed preoperatively and at regular postoperative intervals. Complication and reoperation data were also collected for each patient.

RESULTS: At the time of this study, 153 patients had undergone implantation of the TOPS device. The mean surgical time was 187.8 minutes and the mean estimated blood loss was 205.7cc. The mean length of hospital stay was 3.0 days. Mean Oswestry Disability Index, Visual Analog Score leg and back, and Zurich Claudication Questionnaire scores improved significantly at all postoperative time points (P>0.001). There were no clinically significant changes in radiographic parameters, and all operative segments remained mobile at 1-year follow-up. Postoperative complications occurred in 11 patients out of the 153 patients (7.2%) who underwent implantation of the TOPS device. Nine patients (5.9%) underwent a total of 13 reoperations, 1 (0.6%) of which was for device-related failure owing to bilateral L5 pedicle screw loosening.

CONCLUSIONS: Lumbar facet arthroplasty with the TOPS device demonstrated a statistically significant improvement in all patient-reported outcome measures and the ability to maintain motion at the index level while limiting sagittal translation with a low complication rate.

PMID:36191093 | DOI:10.1097/BSD.0000000000001365

Hum Reprod Update. 2022 Oct 3:dmac034. doi: 10.1093/humupd/dmac034. Online ahead of print.

ABSTRACT

BACKGROUND: Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates.

OBJECTIVE AND RATIONALE: This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach.

SEARCH METHODS: An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence.

OUTCOMES: There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge’s g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07-1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate.

WIDER IMPLICATIONS: This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.

PMID:36191078 | DOI:10.1093/humupd/dmac034

J Am Assoc Nurse Pract. 2022 Oct 1;34(10):1174-1180. doi: 10.1097/JXX.0000000000000774.

ABSTRACT

BACKGROUND: Goals of care conversations (GoCCs) are essential discussions, for those with chronic diseases, to identify a health care surrogate, initiate and review advance directives, and refer for palliative care. Prognosis with pulmonary hypertension (PH) related to heart failure (HF) remains challenging due to variation in trajectory of disease progression. The Gagne Combined Comorbidity score, an electronic prognostication score (E-Gagne), can be used to identify patients with high (>10%) 1-year mortality.

LOCAL PROBLEM: Implementation of E-Gagne tool to identify HF patients with high 1-year mortality risk and trigger GoCCs.

METHODS: Plan-Do-Study-Act cycles were used throughout nine-week pre- and postintervention in an outpatient setting. Descriptive statistics and Chi-square analysis were used to compare GoCCs pre and post intervention.

INTERVENTION: Using the E-Gagne tool, PH patients with high mortality risk were identified, within 1 week of their scheduled appointments. GoCCs education was provided to all stakeholders. Medical records were reviewed for four aspects of GoCCs: presence and review of advanced directive, documented health care surrogates, and referral for palliative care.

RESULTS: Documentation of GoCCs was greater postintervention compared with preintervention (0%, n = 0/47 and 88%, n = 35/40 respectively, p < .001). Documentation of each of the four aspects of GoCCs was variable with the greatest improvement in documentation of health care surrogate and review of advance directives. There were no referrals for palliative care (0%, n = 0/47 and 0%, n = 0/40).

CONCLUSION: Implementation of the E-Gagne tool, an electronic prognostication tool, identified high-risk PH HF patients and was effective in increasing documentation of GoCCs.

PMID:36191076 | DOI:10.1097/JXX.0000000000000774

Spine (Phila Pa 1976). 2022 Sep 30. doi: 10.1097/BRS.0000000000004489. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort.

OBJECTIVE: To quantify any reduction in venous thromboembolic events (VTE) caused by chemoprophylaxis among lumbar surgery patients.

SUMMARY OF BACKGROUND DATA: Chemoprophylactic anticoagulation (chemoprophylaxis) is used to prevent VTE after lumbar surgery. However, the treatment effect of chemoprophylaxis has not been reported among spine surgery patients, as conventional statistical methods preclude such inferences.

METHODS: 1243 consecutive lumbar fusions and 1433 non-instrumented lumbar decompressions performed at our institution over a six-year period were identified, and clinical and demographic data were collected, including on VTE events within 30 days postoperatively. Instrumented lumbar fusions and non-instrumented lumbar surgeries were analyzed separately. Patients who were given chemoprophylaxis (treatment) and controls were matched according to known VTE risk factors, including age, body mass index, sex, diabetes, chronic kidney disease, history of VTE, estimated blood loss, length of surgery, transfusion, whether surgery was staged, and whether surgery used an anterior approach. K-nearest neighbor propensity score matching was performed, and the treatment effect of chemoprophylaxis was calculated.

RESULTS: Unadjusted, there was no difference in the rate of VTE between treatment and controls in either population. Baseline clinical and demographic characteristics differed significantly between treatment and control groups. 575 lumbar fusion patients and 435 non-instrumented lumbar decompression patients were successfully propensity score matched, yielding balanced models (Rubin’s B<25, 0.5<Rubin’s R<2.0) and >60% reduction in known bias for both populations. The treatment effect of chemoprophylaxis after lumbar fusion in our patient population was a reduction in VTE incidence from 9.4% to 4.2% (P<0.05), and propensity score adjusted regression confirmed a reduced odds of VTE with chemoprophylaxis (OR=0.37, P=0.035). The treatment effect was not significant for non-instrumented lumbar decompression patients.

CONCLUSION: Among patients undergoing instrumented lumbar fusions, chemoprophylactic anticoagulation causes a significant reduction in VTE, but causes no significant reduction among patients undergoing non-instrumented lumbar decompression.

PMID:36191060 | DOI:10.1097/BRS.0000000000004489

J Am Assoc Nurse Pract. 2022 Oct 1;34(10):1133-1138. doi: 10.1097/JXX.0000000000000775.

ABSTRACT

BACKGROUND: Anterior capsular contraction syndrome (ACCS) describes the progressive fibrotic phimosis of the anterior capsular bag that usually occurs a few months after cataract surgery. YAG laser anterior capsulotomy (YAGAC) is the most common treatment option due to the low-risk profile of this intervention.

PURPOSE: In this series, we evaluated the outcomes of an advanced nurse practitioner (ANP) in conducting this laser intervention, comparing the results with those of ophthalmologists.

METHODOLOGY: Our study represents a single-centre, retrospective, continuous case series of 108 eyes that underwent YAGAC due to ACCS between January 2017 and July 2020 at the Birmingham and Midland Eye Centre, the second largest tertiary referral centre in the United Kingdom.

RESULTS: The groups treated by ANPs and ophthalmologists were similar in respect to age, gender, and laterality of the laser procedure. Eyes treated by ophthalmologists had significantly more ocular comorbidities (p < .001), the most common of which was glaucoma. Although the complication rate was higher in the ophthalmologist group, it did not reach statistical significance. However, there was a trend toward significance in the retreatment rate, with 8.6% (7/81) of eyes lasered by ophthalmologists requiring further YAGAC, and no repeat procedure was needed in the ANP group.

CONCLUSIONS: YAGAC leads to good visual outcomes and a low complication rate in both ophthalmologist and ANP groups.

IMPLICATIONS: Advanced nurse practitioners can deliver results that are comparable with those of experienced ophthalmologists.

PMID:36191073 | DOI:10.1097/JXX.0000000000000775

Spine (Phila Pa 1976). 2022 Oct 3. doi: 10.1097/BRS.0000000000004499. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective study.

OBJECTIVE: The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center.

SUMMARY OF BACKGROUND DATA: Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well established.

METHODS: We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes and risk factors.

RESULTS: A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation (P<0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery (P=0.010), thoracic kyphosis ≥45° (P=0.039), and intraoperative dural injury (P=0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS.

CONCLUSION: The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine durgery, thoracic kyphosis≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS.

LEVEL OF EVIDENCE: 4.

PMID:36191058 | DOI:10.1097/BRS.0000000000004499