Tag: nevin manimala

Res Social Adm Pharm. 2021 Nov 27:S1551-7411(21)00383-1. doi: 10.1016/j.sapharm.2021.11.011. Online ahead of print.

ABSTRACT

BACKGROUND: The perceived service quality scale (pSQS) is a patient-reported experience measure (PREM) previously developed for measuring perceived service quality (pSQ) in community pharmacies. While measuring pSQ is feasible, further psychometric evaluation of the pSQS is warranted. In addition, the length of the 20-item pSQS may lead to fatigue among patients. It remains to be determined whether a short form of the pSQS has acceptable psychometric properties.

OBJECTIVES: The aim of this study was to psychometrically test the pSQS with a specific focus on making scoring recommendations and developing a short form pSQS with acceptable psychometric properties.

METHODS: Participants were recruited either in community pharmacies or via an online panel to complete a questionnaire including the pSQS. Confirmatory factor analyses (CFA) were conducted using robust statistics, including tests of factorial invariance. Alternative models were tested including a bifactor model. Spearman’s correlation was used to conduct test-retest analyses on responses obtained one month apart.

RESULTS: Data were analysed from 319 participants recruited in-store and 303 participants recruited online, 86 participants providing test-retest reliability. Tests of factorial invariance indicated that the pSQS is stable across settings. The most parsimonious and best-fitting solution was obtained with a 19-item bifactor model with 5 factors plus a “general” factor. Factor scores obtained from the “general” factor explained sufficient variance and are unlikely to be excessively biased in regression models. A short-form 6-item scale (pSQ-SF6) demonstrated acceptable psychometric properties and similar predictive capacity to the original pSQS for patient loyalty intentions. Test-retest analyses indicated acceptable reliability for pSQS and PSQ-SF6.

CONCLUSION: This study confirms that the pSQS has acceptable psychometric properties including temporal stability. It is recommended that a 19-item pSQS be used to obtain a comprehensive overview of patients’ pSQ. The short-form pSQ-SF6 is suitable as a community pharmacy PREM.

PMID:34857482 | DOI:10.1016/j.sapharm.2021.11.011

Acad Radiol. 2021 Nov 29:S1076-6332(21)00529-8. doi: 10.1016/j.acra.2021.11.003. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients.

MATERIALS AND METHODS: The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups’ trends and differences between the lactating and cancer cohorts were statistically assessed.

RESULTS: CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001).

CONCLUSION: BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.

PMID:34857455 | DOI:10.1016/j.acra.2021.11.003

J Cardiol. 2021 Nov 29:S0914-5087(21)00316-6. doi: 10.1016/j.jjcc.2021.11.006. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical risk assessment with quantitative formal risk scores may add to intuitive physician risk assessment and are advised by the international guidelines for the management of acute coronary syndrome (ACS) patients. Most previous studies have used the binary regression/classification approach (dead/alive) for long-term mortality post-ACS, without considering the time-to-event as in survival analysis. The use of machine learning (ML)-based survival models has yet to be validated. The primary objective was to compare survival prediction performance of 1-year mortality following ACS of two newly developed ML-based models [random survival forest (RSF) and deep learning (DeepSurv)] with the traditional Cox-proportional hazard (CPH) model. The secondary objective was external validation of the findings.

METHODS: This was a retrospective, supervised learning data mining study based on the Acute Coronary Syndrome Israeli Survey (ACSIS) and the Myocardial Ischemia National Audit Project (MINAP). The ACSIS data were divided to train/test in a 70/30 fashion. Next, the models were externally validated on the MINAP data. Harrell’s C-index, inverse probability of censoring weighting (IPCW), and the Brier-score were used for models’ performance comparison.

RESULTS: RSF performed best among the three models, with Harrell’s C-index on training and testing sets reaching 0.953 and 0.924 respectively, followed by CPH multivariate selected model (0.805/0.849), CPH Univariate selected model (0.828/0.806), DeepSurv model (0.801/0.804), and the traditional CPH model (0.826/0.738). The RSF model also had the highest performance on the validation data set with 0.811 for Harrell’s C-index, 0.844 for IPCW, and 0.093 for Brier score. The CPH model performance on the validation set had C-index range between 0.689 to 0.790, 0.713 to 0.826 for IPCW, and 0.094 to 0.103 Brier score.

CONCLUSIONS: RSF survival predictions for long-term mortality post-ACS show improved model performance compared with the classic statistical method. This may benefit patients by allowing better risk stratification and tailored therapy, however further prospective evaluations are required.

PMID:34857429 | DOI:10.1016/j.jjcc.2021.11.006

J Voice. 2021 Nov 29:S0892-1997(21)00366-0. doi: 10.1016/j.jvoice.2021.11.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Voice is the one of the sexual maturation characteristics that differs between boys and girls. Voice analysis is a non-invasive diagnostic tool and well-tolerated by children. Our aim is to investigate the capability of MDVP to predict precocious puberty (PP). To our knowledge, this is the only study to assess the voice parameters in the diagnosis of PP.

MATERIAL AND METHODS: The data of PP and control group were retrospectively reviewed. Voice parameters including fundamental frequency, jitter, shimmer and harmonic-to-noise ratio (HNR), age, and gender of subjects were noted. ROC curve was performed to the statistically significant parameters after double group comparisons and cut-off values were defined. 2 × 2 table were created and compared between the groups.

RESULTS: A total of 54 children comprising 32 subjects (8 boys and 24 girls) in the PP group and 22 (10 boys and 12 girls) in the control group were included, and the mean age of girls were 8.17 and 7.92 years, and those of the boys were 8.83 and 7.90, respectively. Jitter and HNR values were statistically significant in the girls but not in boys between the 2 groups (P = 0.013, P = 0.032, respectively). The cut-off points were 1.31 for jitter, 6.39 for HNR. Univariate analysis according to cut-off values of jitter and HNR revealed a statistically significant difference between the 2 groups (P = 0.004, OR: 8.80 [1.26- 61,15] and P = 0.012, OR: 5.00 [1.27-19.68], respectively).

CONCLUSIONS: Our findings suggest that, along with an evaluation of other secondary sexual maturation characteristics, voice analysis may be used by pediatric endocrinologists and otolaryngologists to diagnose PP in girls but not in boys.

PMID:34857449 | DOI:10.1016/j.jvoice.2021.11.001

Nutr Metab Cardiovasc Dis. 2021 Sep 22:S0939-4753(21)00457-9. doi: 10.1016/j.numecd.2021.09.017. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The role of serum uric acid (SUA) in stroke remains controversial and analyses of changes in SUA and stroke are limited. The objective of the study was to investigate the associations of changes in SUA with stroke and its subtypes (ischemic and hemorrhagic stroke).

METHODS AND RESULTS: A total of 51 441 participants (mean age 52.69 ± 11.71 years) without history of myocardial infarction or stroke were enrolled. Participants were divided into four groups based on SUA level changes during 2006 and 2010: stable low, increasing, decreasing, and stable high. SUA score was quantified on a 3-point scale with 1 point awarded for hyperuricemia at either year 2006, 2008 or 2010. Multivariate Cox proportion models were used to calculated hazard ratios (HRs) and their 95% confidence intervals (CIs). During 7.03-year follow up, 1611 stroke (1410 ischemic stroke, 199 hemorrhagic stroke, and 47 subarachnoid hemorrhage) were identified. Participants with stable high SUA had higher risk of hemorrhagic stroke, the HR was 1.93 (95% CI: 1.06-3.51), compared to those with stable low SUA. Furthermore, cumulative high SUA exposure also increased the risk of hemorrhagic stroke, the HR (95%CI) was 2.99 (1.55-5.74), compared with cumulative low SUA exposure. However, no significant evidence indicated changes in SUA was associated with the risk of total and ischemic stroke, the HRs (95% CIs) were 0.98 (0.74-1.29) and 0.88 (0.65-1.19), respectively.

CONCLUSIONS: Stable high SUA was positively associated with the risk of hemorrhagic stroke, but not with total and ischemic stroke risk.

PMID:34857424 | DOI:10.1016/j.numecd.2021.09.017

Ultrasound Med Biol. 2021 Nov 29:S0301-5629(21)00457-9. doi: 10.1016/j.ultrasmedbio.2021.10.017. Online ahead of print.

ABSTRACT

The objective of the current study was to examine the validity and repeatability of panoramic ultrasound in evaluating the anatomical cross-sectional area (ACSA) of the pectoralis major. Specifically, we aimed to quantify the measurement errors generated during the image acquisition and analysis (repeatability), as well as when comparing with magnetic resonance imaging (MRI) (validity). Moreover, we aimed to analyze the influence of the operator’s experience on these measurement errors. Both sides of the chest of 16 participants (n = 32) were included. Errors made by two operators (trained and novice) when measuring pectoralis major ACSA (50% of sternum-areola mammae distance) were examined. Acquisition errors included the comparison of two images acquired 5 min apart. Acquisition 1 was analyzed twice to quantify analysis errors. Thereafter, acquisition 1 was compared with MRI. Statistics include the standard error of measurement (SEM), expressed in absolute (cm²) and relative (%) terms as a coefficient of variation (CV), and the calculation of systematic bias. Errors made by the trained operator were lower than those made by the novice, especially during the image acquisition (SEM = 0.25 vs. 0.66 cm², CV = 1.06 vs. 2.98%) and when compared with MRI (SEM = 0.27 vs. 1.90 cm², CV = 1.13 vs. 8.16%). Furthermore, although both operators underestimated the ACSA, magnitude and variability [SD] of these errors were lower for the trained operator (bias = -0.19 [0.34] cm²) than for the novice (bias = -1.97 [2.59] cm²). Panoramic ultrasound is a valid and repeatable technique for measuring pectoralis major ACSA, especially when implemented by a trained operator.

PMID:34857426 | DOI:10.1016/j.ultrasmedbio.2021.10.017

Vaccine. 2021 Nov 29:S0264-410X(21)01532-2. doi: 10.1016/j.vaccine.2021.11.058. Online ahead of print.

ABSTRACT

INTRODUCTION: Due to the lack of understanding of the protective effects and safety of 23-valent pneumococcal polysaccharide vaccine (PPV23) in immune-deficient populations, the vaccination rate of PPV23 among HIV-infected patients is still very low in China. The main objectives of this study were to determine whether the efforts to assess measures for the prevention of pneumococcal pneumonia are still worthwhile, and provide designated vaccination program of HIV-infected persons for government policy based on.

METHODS: 60 HIV-infected adults in Lanshan county who had never been vaccinated with any pneumococcal vaccine were enrolled in this study, voluntary vaccination of PPV23 and One-year follow-up after vaccination can be completed.

RESULT: 76.67% patients (46/60) had serologic response at 12 months after vaccine, CD4 count(≤500 cells/ul or > 500 cells/ul) and Month from diagnosis to first antiviral therapy (≤1 month or > 1 month) were related to antibody responses (p < 0.05).In this study, PPV23 was well tolerated, no adversereaction was reported.11 Streptococcus pneumoniae pneumonia (9.17%,11/120) occurred in the Unvaccinated group and 1 case(1.67%,1/60)in the vaccination group within one year after vaccination(Fisher’s exact probability, P = 0.225). The VE was 81.79%. The per capita benefit was 39.32 dollars, thebenefit-costratio = 1.19. There are significant statistical differences between the vaccinated group and the non-vaccinated group in outpatient costs (p < 0.05, 95 %CI: 9.29-32.11), Medicine costs (p = 0.017, 95 %CI: 2.47-24.44), and disease related indirect costs (p = 0.038, 95 %CI: 0.93-33.63) within one year of vaccination.

CONCLUSION: Our study results showed that PPV23 can be safely and effectively administered to HIV-1 infected individuals and effectively preventing Streptococcal pneumonia. Considering the cost-benefit of vaccination among HIV-infected persons, as it has been reported in our study, it is necessary to promote the widespread use of the vaccine among HIV-infected persons in the future.

PMID:34857419 | DOI:10.1016/j.vaccine.2021.11.058

Gynecol Oncol. 2021 Nov 29:S0090-8258(21)01607-3. doi: 10.1016/j.ygyno.2021.11.013. Online ahead of print.

ABSTRACT

BACKGROUND: Age and ethnicity are among several factors that influence overall survival (OS) in ovarian cancer. The study objective was to determine whether ethnicity and age were of prognostic significance in women enrolled in a clinical trial evaluating the addition of bevacizumab to front-line therapy.

METHODS: Women with advanced stage ovarian, primary peritoneal, or fallopian tube cancer were enrolled in a phase III clinical trial. All women had surgical staging and received adjuvant chemotherapy with one of three regimens. Cox proportional hazards models were used to evaluate the relationship between OS with age and race/ethnicity among the study participants.

RESULTS: One-thousand-eight-hundred-seventy-three women were enrolled in the study. There were 280 minority women and 328 women over the age of 70. Women age 70 and older had a 34% increase risk for death when compared to women under 60 (HR = 1.34; 95% CI 1.16-1.54). Non-Hispanic Black women had a 54% decreased risk of death with the addition of maintenance bevacizumab (HR = 0.46, 95% CI:0.26-0.83). Women of Asian descent had more hematologic grade 3 or greater adverse events and a 27% decrease risk of death when compared to non-Hispanic Whites (HR = 0.73; 95% CI: 0.59-0.90).

CONCLUSIONS: Non-Hispanic Black women showed a decreased risk of death with the addition of bevacizumab and patients of Asian ancestry had a lower death rate than all other minority groups, but despite these clinically meaningful improvements there was no statistically significant difference in OS among the groups.

PMID:34857397 | DOI:10.1016/j.ygyno.2021.11.013

J Hazard Mater. 2021 Nov 21:127762. doi: 10.1016/j.jhazmat.2021.127762. Online ahead of print.

ABSTRACT

Longwall caving mining (LCM) can lead to many environmental problems that have drawn worldwide attention. A previous survey found that most scholars tend to analyze the two issues separately, that is, coal mining-induced subsidence and heavy metal pollution sources in the soil of the mining regions. Based on field monitoring as well as the collection and analysis of soil samples, a previous study estimated ground settlement and analyzed the surface subsidence law and spatial distribution characteristics of heavy metals in soils. Moreover, a geographic information system was combined with multivariate statistical analysis methods to analyze the heavy metal pollution sources in soils. At the same time, the mechanism of heavy metal accumulation in the subsidence area was analyzed. The study found that the most active subsidence of settlement was 137.5 m behind the workface and moved forward with the workface. LCM has already caused significant disturbance to the soils in the Hengyuan Mine. Moreover, the distribution pattern of eight heavy metals was consistent with the surface subsidence law. The sources of heavy metal pollution in the soils were also identified; namely, coal mining-induced subsidence (64.1%) and mixed transportation and wind-mediated spread (35.9%), offering a reinterpretation of the LCM’s footprint.

PMID:34857402 | DOI:10.1016/j.jhazmat.2021.127762

Br J Anaesth. 2021 Nov 29:S0007-0912(21)00649-8. doi: 10.1016/j.bja.2021.10.006. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality.

METHODS: Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE.

RESULTS: We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L^-1 above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds.

CONCLUSIONS: Perioperative increases in hsTnT ≥14 ng L^-1 above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE.

CLINICAL TRIAL REGISTRATION: NCT03436238.

PMID:34857357 | DOI:10.1016/j.bja.2021.10.006