Tag: nevin manimala

JMIR Aging. 2022 Jun 21;5(2):e32790. doi: 10.2196/32790.

ABSTRACT

BACKGROUND: The Caregiver Advise Record Enable (CARE) Act is a state level law that requires hospitals to identify and educate caregivers (“family members or friends”) upon discharge.

OBJECTIVE: This study examined the association between the implementation of the CARE Act in a Pennsylvania health system and health service utilization (ie, reducing hospital readmission, emergency department [ED] visits, and mortality) for older adults with diabetes.

METHODS: The key elements of the CARE Act were implemented and applied to the patients discharged to home. The data between May and October 2017 were pulled from inpatient electronic health records. Likelihood-ratio chi-square tests and multivariate logistic regression models were used for statistical analysis.

RESULTS: The sample consisted of 2591 older inpatients with diabetes with a mean age of 74.6 (SD 7.1) years. Of the 2591 patients, 46.1% (n=1194) were female, 86.9% (n=2251) were White, 97.4% (n=2523) had type 2 diabetes, and 69.5% (n=1801) identified a caregiver. Of the 1801 caregivers identified, 399 (22.2%) received discharge education and training. We compared the differences in health service utilization between pre- and postimplementation of the CARE Act; however, no significance was found. No significant differences were detected from the bivariate analyses in any outcomes between individuals who identified a caregiver and those who declined to identify a caregiver. After adjusting for risk factors (multivariate analysis), those who identified a caregiver (12.2%, 219/1801) was associated with higher rates of 30-day hospital readmission than those who declined to identify a caregiver (9.9%, 78/790; odds ratio [OR] 1.38, 95% CI 1.04-1.87; P=.02). Significantly lower rates were detected in 7-day readmission (P=.02), as well as 7-day (P=.03) and 30-day (P=.01) ED visits, among patients with diabetes whose identified caregiver received education and training than those whose identified caregiver did not receive education and training in the bivariate analyses. However, after adjusting for risk factors, no significance was found in 7-day readmission (OR 0.53, 95% CI 0.27-1.05; P=.07), 7-day ED visit (OR 0.63, 95% CI 0.38-1.03; P=.07), and 30-day ED visit (OR 0.73, 95% CI 0.52-1.02; P=.07). No significant associations were found for other outcomes (ie, 30-day readmission and 7-day and 30-day mortality) in both the bivariate and multivariate analyses.

CONCLUSIONS: Our study found that the implementation of the CARE Act was associated with certain health service utilization. The identification of caregivers was associated with higher rates of 30-day hospital readmission in the multivariate analysis, whereas having identified caregivers who received discharge education was associated with lower rates of readmission and ED visit in the bivariate analysis.

PMID:35727611 | DOI:10.2196/32790

JAMA Netw Open. 2022 Jun 1;5(6):e2217653. doi: 10.1001/jamanetworkopen.2022.17653.

NO ABSTRACT

PMID:35727584 | DOI:10.1001/jamanetworkopen.2022.17653

JMIR Form Res. 2022 Jun 21;6(6):e34995. doi: 10.2196/34995.

ABSTRACT

BACKGROUND: Estrogen receptor-positive breast cancer is the most common type of breast cancer in postmenopausal women. Aromatase inhibitors (AIs) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop arthralgia, often resulting in poor adherence and decreased quality of life.

OBJECTIVE: The study is a single-arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability, and potential efficacy of TaiChi4Joint, a remotely delivered 12-week tai chi intervention designed to relieve AI-induced joint pain.

METHODS: Women diagnosed with stage 0-III breast cancer who received an AI for at least 2 months and reported arthralgia with a ≥4 score on a 0 to 10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join tai chi classes delivered over Zoom three times a week for 12 weeks. Program engagement strategies included using a private Facebook study group and a Box cloud for archiving live class recordings. The program uses SMS text messaging and emails with periodic positive quotes and evidence-based information on tai chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments at baseline and at 1-, 2-, and 3-month intervals from study enrollment: Brief Pain Inventory, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory, Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburgh Sleep Quality Index (PSQI), and Center for Epidemiological Studies-Depression (CES-D).

RESULTS: A total of 55 eligible patients were invited to participate, and 39 (71%) consented and completed the baseline assessments. Participants attended 61% (median) of the suggested classes, with no tai chi-related adverse events reported. Of the 39 participants, 22 completed the 3-month follow-up assessment with a 56% retention rate. Study participants reported improvement from baseline compared to 3 months as follows (paired t test): Brief Pain Inventory (P<.001), AUSCAN pain subscale (P=.007), AUSCAN function subscale (P=.004), Fatigue Symptom Inventory (P=.004) and PSQI (P<.001), and HFRDIS (P=.02) and CES-D (P<.001). In particular, for our primary end point of interest, improvements in hip and knee symptoms, measured by WOMAC’s three subscales, were clinically meaningful and statistically significant when adjusted for multiple comparisons from baseline to 3 months post intervention.

CONCLUSIONS: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a telehealth-based tai chi intervention for reducing AI-induced arthralgia. The intervention decreased patient-reported pain and stiffness, and improved sleep quality and depressive symptoms. Fully powered, large, telehealth-based tai chi trials for AI-associated arthralgia are needed considering our promising findings.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04716920; https://www.clinicaltrials.gov/ct2/show/NCT04716920.

PMID:35727609 | DOI:10.2196/34995

JAMA Netw Open. 2022 Jun 1;5(6):e2217686. doi: 10.1001/jamanetworkopen.2022.17686.

ABSTRACT

IMPORTANCE: Value-based purchasing creates pressure to examine whether newer technologies and care processes, including new surgical techniques, yield any economic advantage.

OBJECTIVE: To compare health care costs and utilization between participants randomized to receive endoscopic vein harvesting (EVH) or open vein harvesting (OVH) during a coronary artery bypass grafting (CABG) procedure.

DESIGN, SETTING, AND PARTICIPANTS: This secondary economic analysis was conducted alongside the 16-site Randomized Endo-Vein Graft Prospective (REGROUP) clinical trial funded by the Department of Veterans Affairs (VA) Cooperative Studies Program. Adults scheduled for urgent or elective bypass involving a vein graft were eligible. The first participant was enrolled in September 2013, with most sites completing enrollment by March 2014. The last participant was enrolled in April 2017. A total of 1150 participants were randomized, with 574 participants receiving OVH and 576 receiving EVH. For this secondary analysis, cost and utilization data were extracted through September 30, 2020. Participants were linked to administrative data in the VA Corporate Data Warehouse and activity-based cost data starting with the index procedure.

INTERVENTIONS: EVH vs OVH, with comparisons based on intention to treat.

MAIN OUTCOMES AND MEASURES: Discharge costs for the index procedure as well as follow-up costs (including intended and unintended events; mean [SD] follow-up time, 33.0 [19.9] months) were analyzed, with results from different statistical models compared to test for robustness (ie, lack of variation across models). All costs represented care provided or paid by the VA, standardized to 2020 US dollars.

RESULTS: Among 1150 participants, the mean (SD) age was 66.4 (6.9) years; most participants (1144 [99.5%] were male. With regard to race and ethnicity, 6 participants (0.5%) self-reported as American Indian or Alaska Native, 10 (0.9%) as Asian or Pacific Islander, 91 (7.9%) as Black, 62 (5.4%) as Hispanic, 974 (84.7%) as non-Hispanic White, and 6 (0.5%) as other race and/or ethnicity; data were missing for 1 participant (0.1%). The unadjusted mean (SD) costs for the index CABG procedure were $76 607 ($43 883) among patients who received EVH and $75 368 ($45 900) among those who received OVH, including facility costs, insurance costs, and physician-related costs (commonly referred to as provider costs in Centers for Medicare and Medicaid and insurance data). No significant differences were found in follow-up costs; per 90-day follow-up period, EVH was associated with a mean (SE) added cost of $302 ($225) per patient. The results were highly robust to the statistical model.

CONCLUSIONS AND RELEVANCE: In this study, EVH was not associated with a reduction in costs for the index CABG procedure or follow-up care. Therefore, the choice to provide EVH may be based on surgeon and patient preferences.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01850082.

PMID:35727582 | DOI:10.1001/jamanetworkopen.2022.17686

Indian J Pediatr. 2022 Jun 21. doi: 10.1007/s12098-022-04151-x. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine sleep disorders and quality of life (QOL) in children with cerebral palsy (CP) and to find the association between them.

METHODS: This cross-sectional study included children (4-12 y) with CP (n = 117) and age- and gender-matched healthy controls (n = 117). Pediatric Sleep Questionnaire (PSQ) was used to record sleep-related symptoms. Sleep-related breathing disorder (SRBD) scale and sleep disturbance scale for children (SDSC) were used to evaluate sleep disorders. Cerebral palsy quality-of-life questionnaire for children (CPQOL-CHILD) was used to assess QOL.

RESULTS: Sleep disorders by SRBD scale (score ≥ 0.33) were significantly more in CP (n = 7, 6%) than controls [(n = 0, 0%) (p value 0.014, OR 15.95)]. Using T score > 70 by SDSC scale, sleep disorders were seen in 7.7% (n = 9) CP children and 0% (n = 0) in controls (p value 0.04, OR 20.6). Using T score ≥ 51, 43.6% CP children and 17% controls had sleep disorders (p value 0.001, CI 2.1, 6.9). About 43.6% CP children had abnormal T score on at least one SDSC factor. Presence of epilepsy, motor disabilities, intellectual disabilities, and type of CP significantly correlated with sleep disorders. The overall SRBD scores and SDSC T scores of CP children were negatively correlated with QOL (r = -0.489, p < 0.001 and r = -0.445, p < 0.001, respectively).

CONCLUSION: Sleep disorders are more common in CP which adversely affect QOL. Routine screening and appropriate treatment are suggested.

PMID:35727526 | DOI:10.1007/s12098-022-04151-x

Environ Sci Pollut Res Int. 2022 Jun 21. doi: 10.1007/s11356-022-21604-0. Online ahead of print.

NO ABSTRACT

PMID:35727519 | DOI:10.1007/s11356-022-21604-0

Environ Sci Pollut Res Int. 2022 Jun 21. doi: 10.1007/s11356-022-21456-8. Online ahead of print.

ABSTRACT

Noise has become an important environmental risk factor. Some studies have shown that exposure to noise can cause coronary artery disease, high blood pressure, and stroke. At present, the relationship between noise exposure and the risk of atrial fibrillation (AF) is inconsistent. Based on previous studies, we proposed the hypothesis that noise exposure is associated with a higher risk of AF. Eight databases, such as PubMed, Embase, Cochrane Library, and Web of Science, were searched from inception until January 5, 2022. The pooled relative risk (RR) with its 95% confidence interval (CI) was used to estimate the association between AF and highest noise level and per 10 dB (A) increment of noise. According to the size of heterogeneity, the random or fixed effects model was adopted as the pooling method. A total of 5 articles comprising 3,866,986 participants were identified, providing 7 estimates of highest noise level and 6 estimates of per 10 dB (A) increment of noise exposure. For the highest noise level, there was a statistically significant association between noise exposure and the risk of AF (RR = 1.05; 95% CI: 1.02-1.09; I² = 44.1%). In addition, we found the risk of AF for per 10 dB (A) increment of noise exposure was 1.01 (95% CI: 1.00-1.02; I² = 81.3%). In summary, our study found that noise exposure was associated with a higher risk of AF. More high-quality studies are needed in the future to confirm these conclusions given the limitations of study.

PMID:35727516 | DOI:10.1007/s11356-022-21456-8

Hepatol Int. 2022 Jun 21. doi: 10.1007/s12072-022-10359-y. Online ahead of print.

ABSTRACT

BACKGROUND: The Baveno VI criteria (B6C) have been recommended to screen high-risk varices (HRV) in patients with liver cirrhosis to avoid the use of esophagogastroduodenoscopy (EGD). Due to conservative nature of B6C and the general unavailability of transient elastography in the medical institutions, clinical application of B6C is restricted. We aimed to optimize B6C and attempted to replace the liver stiffness (LS) score with other parameters that could help patients avoid EGD.

METHODS: A total of 1,188 patients with compensated cirrhosis were analyzed and divided into the training cohort (TC) and validating cohort (VC) by the split-sample method. Variables were selected to develop new criteria in the TC before verification in the VC.

RESULTS: The parameters of age ≥ 50 years, LS, platelet count (PLT), and spleen area (SA) were independently associated with HRV. The risk of HRV was 2.39 times greater in patients over 50 years, hence alternative B6C (AB6C) and modified B6C (MB6C) criteria were built based on age. MB6C was built by adjusting the cut-off value of LS and PLT (patients aged < 50 years with PLT > 100 × 10⁹/L and LS < 30 kPa; patients aged ≥ 50 years with a combined PLT > 125 × 10⁹/L and LS < 20 kPa). MB6C helped avoid EGD in 310 (51.2%) patients, whereas 7 (2.3%) cases of HRV were missed. The predicting performance HRV showed no statistical difference between PLT, SA, or LS. SA was selected to replace LS and in the built AB6C (patients aged < 50 years with PLT > 100 × 10⁹/L and SA < 55 cm²; patients aged ≥ 50 years with a combined PLT > 125 × 10⁹/L and SA < 44 cm²). Using AB6C avoided 297 (49.1%) EGDs with a total of 8 (2.7%) cases of HRV that were missed.

CONCLUSIONS: Our novel MB6C and AB6C were stratified by age and provided excellent performance for ruling out HRV, which performed better than B6C and EB6C (expanded B6C) in helping to avoid EGD screening.

CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR-DDD-17013845.

PMID:35727500 | DOI:10.1007/s12072-022-10359-y

Neurotherapeutics. 2022 Jun 21. doi: 10.1007/s13311-022-01235-6. Online ahead of print.

NO ABSTRACT

PMID:35727488 | DOI:10.1007/s13311-022-01235-6

Jpn J Radiol. 2022 Jun 21. doi: 10.1007/s11604-022-01298-7. Online ahead of print.

ABSTRACT

PURPOSE: To develop a support vector machine (SVM) classifier using CT texture-based analysis in differentiating focal-type autoimmune pancreatitis (AIP) and pancreatic duct carcinoma (PD), and to assess the radiologists’ diagnostic performance with or without SVM.

MATERIALS AND METHODS: This retrospective study included 50 patients (20 patients with focal-type AIP and 30 patients with PD) who underwent dynamic contrast-enhanced CT. Sixty-two CT texture-based features were extracted from 2D images of the arterial and portal phase CTs. We conducted data compression and feature selections using principal component analysis (PCA) and produced the SVM classifier. Four readers participated in this observer performance study and the statistical significance of differences with and without the SVM was assessed by receiver operating characteristic (ROC) analysis.

RESULTS: The SVM performance indicated a high performance in differentiating focal-type AIP and PD (AUC = 0.920). The AUC for all 4 readers increased significantly from 0.827 to 0.911 when using the SVM outputs (p = 0.010). The AUC for inexperienced readers increased significantly from 0.781 to 0.905 when using the SVM outputs (p = 0.310). The AUC for experienced readers increased from 0.875 to 0.912 when using the SVM outputs, however, there was no significant difference (p = 0.018).

CONCLUSION: The use of SVM classifier using CT texture-based features improved the diagnostic performance for differentiating focal-type AIP and PD on CT.

PMID:35727458 | DOI:10.1007/s11604-022-01298-7