Tag: nevin manimala

JAMA Cardiol. 2022 Jun 8. doi: 10.1001/jamacardio.2022.1378. Online ahead of print.

ABSTRACT

IMPORTANCE: De novo hypertensive disorders of pregnancy (HDP) are associated with adverse maternal and offspring outcomes. Heterogeneity among racial and ethnic subgroups may be masked with aggregate reporting of race and ethnicity, such as Asian or Pacific Islander or Hispanic.

OBJECTIVE: To determine patterns in de novo HDP rates among individuals in Asian and Hispanic subgroups with a first live birth in the United States in the period 2011 through 2019.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional analysis used data from 2011 through 2019 for individuals aged 15 to 44 years with singleton first live births obtained from the US National Center for Health Statistics natality database.

EXPOSURES: Stratification by self-report of maternal race and ethnicity: Hispanic/Latina (overall and Hispanic/Latina subgroups [Central/South American, Cuban, Mexican, and Puerto Rican]), non-Hispanic Asian and Pacific Islander (overall and non-Hispanic Asian subgroups [Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese]), non-Hispanic Black, non-Hispanic White.

MAIN OUTCOMES AND MEASURES: De novo HDP was defined as new-onset hypertension during pregnancy (gestational hypertension or preeclampsia). Age-standardized rates of HDP (per 1000 live births) and respective mean annual percent change in race and ethnicity groups and subgroups were calculated.

RESULTS: Among 13 238 918 individuals, the mean (SD) age was 26.3 (5.8) years. Overall, HDP rates increased 7.3% per year (95% CI, 6.5%-8.1%), from 57.2 (95% CI, 56.8-57.6) per 1000 live births in 2011 to 99.7 (95% CI, 99.2-100.2) per 1000 live births in 2019. Rates of HDP significantly increased in all racial and ethnic groups and subgroups over the study period. The highest HDP prevalence among non-Hispanic Asian subgroups in 2019 was in Filipina individuals (92.5 [95% CI, 86.3-98.8] per 1000 live births), and the highest among Hispanic/Latina subgroups in 2019 was in Puerto Rican individuals (98.6 [95% CI, 94.2-102.9] per 1000 live births) with significant heterogeneity observed among subgroups across the study period.

CONCLUSIONS AND RELEVANCE: Rates of HDP among individuals with a singleton first live birth increased in the United States from 2011 to 2019 across all race and ethnicity subgroups, with considerable heterogeneity in HDP rates in non-Hispanic Asian and Hispanic/Latina subgroups.

PMID:35675084 | DOI:10.1001/jamacardio.2022.1378

JAMA Netw Open. 2022 Jun 1;5(6):e2215885. doi: 10.1001/jamanetworkopen.2022.15885.

ABSTRACT

IMPORTANCE: The patient-physician clinical encounter is the cornerstone of medical training, yet residents spend as little as 12% of their time in direct patient contact.

OBJECTIVES: To use a real-time locating system (RTLS) to characterize intern work experiences in the hospital, understand factors associated with time spent at patients’ bedsides, and inform future interventions to increase time spent with patients.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from July 1, 2018, to June 30, 2019 (ie, the academic year 2018-2019). Internal medicine residents from postgraduate year 1 (interns) at an academic medical center wore an infrared badge that recorded location and duration (eg, patient room, ward hall, physician workroom). Data were analyzed from September 1, 2020, to August 30, 2021.

MAIN OUTCOMES AND MEASURES: Main outcome was time (in minutes) at the bedside; the unit of analysis was a 24-hour intern day or interval of time within the day (eg, rounding period). Descriptive statistics are reported overall, by intern, and for 5 clinical service categories. Multilevel modeling assessed the association of intern, service, and calendar time with time spent at the bedside.

RESULTS: Data from 43 of 52 interns (82.7%) encompassing 95 275 hours of observations were included for analyses. Twenty-six interns (60.5%) were women. Interns were detected for a mean (SD) of 722.8 (194.4) minutes per 24-hour period; 13.4% of this time was spent in patient rooms (mean [SD] time, 96.8 [57.2] minutes) and 33.3% in physician workrooms (mean [SD] time, 240.9 [228.8] minutes). Mean percentage of time at the bedside during a 24-hour period varied among interns from 8.8% to 18.3%. Mean (SD) percentage of time at the bedside varied by service for the 24-hour period from 11.7% (6.6%) for nononcology subspecialties to 15.4% (6.0%) for oncology, and during rounds from 8.0% (12.4%) for nononcology subspecialties to 26.5% (12.1%) for oncology. In multilevel modeling, the individual intern accounted for 8.1% of overall variance in time spent at the bedside during a 24-hour period, and service accounted for 18.0% of variance during rounds.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study support previous evidence suggesting that interns spend only a small proportion of time with hospitalized patients. The differences in time spent in patients’ rooms among interns and during rounds constitute an opportunity to design interventions that bring trainees back to the bedside.

PMID:35675075 | DOI:10.1001/jamanetworkopen.2022.15885

J Pain Palliat Care Pharmacother. 2022 Jun 8:1-7. doi: 10.1080/15360288.2022.2084208. Online ahead of print.

ABSTRACT

The opioid crisis continues to place a significant burden on American families and the healthcare system. To date, there is an evolving body of evidence demonstrating that pharmacists can positively impact patient care in the pain management specialty. The purpose of this study is to evaluate 24-hour average pain scores before and after a clinical pharmacist completes a physician-ordered pain consult in a community hospital setting. For the primary outcome, there was a statistically significant reduction in pain scores 48 hours post consult (6.5 vs. 5.2; p < 0.001; Table 3) and 24 hours prior to discharge (6.1 vs. 4.5; p < 0.001; Table 3) when compared to pain scores 24 hours prior to consult. Additionally, there was a statistically significant reduction in the number of morphine milligram equivalents (MMEs) at 48 hours post consult (149.4 vs. 133.8; p < 0.001; Table 4) and 24 hours prior to discharge (136.5 vs. 100.6; p < 0.001; Table 4) when compared to 24 hours prior to consult. This pharmacist-driven pain consult service demonstrated a statistically significant reduction in pain scores while simultaneously reducing MME utilization and the number of opioids ordered, using a multimodal evidence-driven approach to pain management in a community hospital.

PMID:35675066 | DOI:10.1080/15360288.2022.2084208

JAMA Netw Open. 2022 Jun 1;5(6):e2216628. doi: 10.1001/jamanetworkopen.2022.16628.

ABSTRACT

IMPORTANCE: Vaccine incentives have been used across the US to encourage COVID-19 vaccine uptake and include programs targeted to adolescents and young adults. However, little is known about youths’ views regarding these initiatives.

OBJECTIVE: To assess experiences and perceptions of COVID-19 vaccine incentives in a nationwide sample of US youth.

DESIGN, SETTING, AND PARTICIPANTS: A qualitative survey study was conducted using the MyVoice text message-based polling platform from October 22 to October 29, 2021. Participants were US adolescents and young adults aged 14 to 24 years, who were sent 5 open-ended questions to assess their experiences and perceptions of COVID-19 vaccine incentives. Qualitative responses were analyzed thematically. Descriptive statistical analysis was performed in January 2022.

MAIN OUTCOMES AND MEASURES: Experiences, perceptions, and opinions related to COVID-19 vaccine incentives as measured by survey response.

RESULTS: A total of 1125 of 1206 youth (93%) responded to the survey and had a mean (SD) age of 20 (2) years, 664 (59%) identified as male, and 769 (68%) identified as non-Hispanic White. Of respondents, 871 (79%) reported having heard of vaccine incentives, and 892 (82%) believed they were a good idea or had positive attributes. Notably, 305 youth (28%) expressed concerns about vaccine incentives, citing uncertainty about their effectiveness (86 [28%]), their ethical use (63 [21%]), the impact on vaccine motivations (51 [17%]), and confidence (39 [13%]), and lack of fairness (35 [11%]). Only 73 youth (7%) reported that an incentive influenced their decision to get a COVID-19 vaccine. When asked what they thought would motivate others to get a COVID-19 vaccine, youth with an opinion (536 of 1032 [52%]) most commonly reported incentives (112 [21%]) and additional COVID-19 vaccine testing, safety, or regulation (115 [21%]).

CONCLUSIONS AND RELEVANCE: COVID-19 vaccine incentives are well known to youth but not a significant self-reported motivator for vaccination. Although generally viewed favorably, more than a quarter of youth expressed concerns regarding vaccine incentives, including but not limited to their ethics, effectiveness, fairness, and impacts on vaccine motivation and confidence. Policymakers considering targeted use of COVID-19 vaccine incentives should weigh youths’ perspectives on these initiatives alongside objective effectiveness and cost-effectiveness data.

PMID:35675072 | DOI:10.1001/jamanetworkopen.2022.16628

J Vis. 2022 Jun 1;22(7):3. doi: 10.1167/jov.22.7.3.

ABSTRACT

Visual search is a complex behavior influenced by many factors. To control for these factors, many studies use highly simplified stimuli. However, the statistics of these stimuli are very different from the statistics of the natural images that the human visual system is optimized by evolution and experience to perceive. Could this difference change search behavior? If so, simplified stimuli may contribute to effects typically attributed to cognitive processes, such as selective attention. Here we use deep neural networks to test how optimizing models for the statistics of one distribution of images constrains performance on a task using images from a different distribution. We train four deep neural network architectures on one of three source datasets-natural images, faces, and x-ray images-and then adapt them to a visual search task using simplified stimuli. This adaptation produces models that exhibit performance limitations similar to humans, whereas models trained on the search task alone exhibit no such limitations. However, we also find that deep neural networks trained to classify natural images exhibit similar limitations when adapted to a search task that uses a different set of natural images. Therefore, the distribution of data alone cannot explain this effect. We discuss how future work might integrate an optimization-based approach into existing models of visual search behavior.

PMID:35675057 | DOI:10.1167/jov.22.7.3

J Periodontal Res. 2022 Jun 8. doi: 10.1111/jre.13021. Online ahead of print.

ABSTRACT

BACKGROUND: Previous epidemiological studies regarding the association between chronic periodontitis (CP) and carotid intima-media thickness (cIMT) and subclinical atherosclerosis have been inconclusive.

OBJECTIVE: The aim of this study was to determine whether CP is associated with subclinical atherosclerosis in a large population-based cohort study conducted in northern Germany (the Hamburg City Health study).

METHODS: Baseline data from 5781 participants of the Hamburg City Health Study with complete oral health and carotid ultrasound data (50.7% female, mean age: 62.1 ± 8.4 years) were evaluated. A standardized duplex sonography of the carotid artery was performed with measurement of carotid intima-media thickness (cIMT) and atherosclerotic plaques. Oral health was assessed by recording the decayed, missing, and filled teeth (DMFT) index, clinical attachment loss (CAL), bleeding on probing (BOP), and the dental plaque index (PI). Correlations were tested for statistical significance by means of descriptive statistics and multivariate regression analyses.

RESULTS: Moderate and severe CP were associated with the prevalence of cIMT ≥ 1 mm (none or mild CP: 5.1%, moderate CP: 6.1%, severe CP: 10%) and mean cIMT (none or mild CP: 0.72 mm, moderate CP: 0.75 mm, severe CP: 0.78 mm) in bivariate analyses (p < .001). Additionally, severe and moderate CP were associated with higher prevalence of carotid atherosclerotic plaques (plaque = yes: none or mild CP: 23.9%, moderate CP: 29%, severe CP: 40.2%,). After adjustment for age, sex, smoking, diabetes, hypertension, educational level, hypercholesterolemia, and hsCRP, severe CP still correlated significantly with cIMT and the prevalence of cIMT ≥1 mm and/or presence of carotid atherosclerotic plaques.

CONCLUSION: In this study, severe CP was associated with increased cIMT and higher prevalence of carotid plaques independent of common risk factors.

PMID:35675038 | DOI:10.1111/jre.13021

Int Ophthalmol. 2022 Jun 8. doi: 10.1007/s10792-022-02227-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the outcomes and complications of simultaneous silicon oil removal (SOR) and phacoemulsification and intra ocular lens implantation.

METHODS: In this retrospective non-comparative case series, the visual, refractive and anatomical outcomes of patients who underwent combined phacoemulsification/silicone oil removal (5700 centistokes) surgery between 2017 and 2019 in a single center were evaluated.

RESULTS: Forty-four eyes of 44 patients (eighteen males) were included. The mean age of the patients was 51.45 ± 11.59 years. The primary pathology was tractional retinal detachment (TRD) secondary to diabetic retinopathy in 36 eyes and rhegmatogenous retinal detachment (RRD) in 8 eyes. The median time period between silicone oil tamponade and removal was 9 months. There was no statistically significant difference between best corrected visual acuity (-0.14 ± 0.69 LogMAR, p= 0.19) and intraocular pressure (p= 0.26) before and after the surgery. Mean post-operative spherical equivalent (SE) at last visit was 0.36 ± 1.64 which was different from the target refraction (- 0.5D). After cataract/SOR surgery, one eye (2.3%) developed retinal re-detachment in RRD patient. Vitreous hemorrhage occurred in nine eyes (20.5%) which all had TRD as the primary pathology.

CONCLUSION: Combined phacoemulsification, silicone oil and IOL implantation removal surgery seems to be a safe and useful procedure with high success rate and acceptable visual, refractive and anatomical outcomes.

PMID:35674997 | DOI:10.1007/s10792-022-02227-3

Magn Reson Chem. 2022 Jun 8. doi: 10.1002/mrc.5292. Online ahead of print.

ABSTRACT

We preprocess the raw NMR spectrum and extract key features by using two different methodologies, called equidistant sampling and peak sampling for subsequent substructure pattern recognition. We also provide a strategy to address the imbalance issue frequently encountered in statistical modelling of NMR data set and establish two conventional SVM and KNN models to assess the capability of two feature selections, respectively. Our results in this study show that the models using the selected features of peak sampling outperform those using equidistant sampling. Then we build the Recurrent Neural Network (RNN) model trained by data collected from peak sampling. Furthermore, we illustrate the easier optimization of hyper parameters and the better generalization ability of the RNN deep learning model by detailed comparison with traditional machine learning SVM and KNN models.

PMID:35674984 | DOI:10.1002/mrc.5292

J Exp Orthop. 2022 Jun 8;9(1):53. doi: 10.1186/s40634-022-00495-7.

ABSTRACT

PURPOSE: To evaluate the clinical outcomes, MRI imaging and histological characteristics of biopsy samples of the tendon from patients in whom rotator cuff repair was previously performed with a bioinductive type I bovine collagen implants.

METHODS: Prospective study of 30 patients with partial or complete rotator cuff tears who underwent arthroscopic repair and augmentation with a resorbable type I bovine collagen implant. Preoperatively and at 6 and 12 months after surgery, the VAS, ASES and Constant-Murley scores were evaluated and an MRI study was performed. At 6 months, biopsies of the resulting tissue were obtained and examined histologically.

RESULTS: Patients experienced statistically significant and sustained improvement from baseline for all scores and the mean tendon thickness increased by 1.84 mm. Magnetic resonance imaging evidence of complete healing was found in 27 patients and a considerable reduction in defect size, greater than 50%, was shown in 3. In all samples obtained, the new tissue generated had the histological appearance of a tendon, and was indistinguishable from the native tendon. There was no evidence of any remaining collagen implant.

CONCLUSIONS: Biopsies of tissue formed from bioinductive type I bovine collagen implants showed, six months after surgery, the generation of a neotendon indistinguishable from the native one. Histology and MRI imaging, revealed complete integration of the implant and absence of inflammatory or foreign body reactions. The clinical parameters, thickness and MRI signal of the tendon improved significantly at 6 months, regardless of the type and size of the tear, and remained unchanged until 12 months.

LEVEL OF EVIDENCE: Level IV, case series.

PMID:35674990 | DOI:10.1186/s40634-022-00495-7

Rheumatol Ther. 2022 Jun 8. doi: 10.1007/s40744-022-00460-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Sustained improvement of high degree in clinical outcomes have been demonstrated in phase 3 trials with secukinumab in both psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The objective of the SERENA study was to evaluate the effectiveness, retention rates, and safety of secukinumab in patients with PsA and AS.

METHODS: SERENA is an ongoing, longitudinal, real-world observational study involving patients with moderate-to-severe psoriasis, PsA, or AS. Patients had received at least 16 weeks of secukinumab treatment before recruitment to the study. Retention rate was defined as percentage of patients who continued secukinumab treatment over the course of study. Effectiveness of secukinumab in AS and PsA cohorts was assessed using descriptive statistics.

RESULTS: The current interim analysis included 1004 patients with PsA or AS. Overall secukinumab retention rates at 2 years after enrolment were 74.9 and 78.9% in patients with PsA and AS, respectively. At baseline and at 2 years, swollen joint count [3.3 (5.8) vs. 2.9 (5.8)], tender joint count [6.3 (9.4) vs. 5.6 (7.2)] in patients with PsA and BASDAI scores [3.2 (2.3) vs. 2.9 (2.3)] in patients with AS, suggest sustained effectiveness for patients remaining on secukinumab for at least 2 years after enrolment. A total of 73 patients had treatment interruption; 78% of these patients reinitiated secukinumab without a loading dose. No new or unexpected safety signals were reported.

CONCLUSIONS: After more than 2 years since initiation, secukinumab demonstrated high retention rates and favorable safety profile as well as sustained effectiveness in patients who continued secukinumab treatment.

PMID:35674938 | DOI:10.1007/s40744-022-00460-x