Tag: nevin manimala

J Orofac Orthop. 2022 Mar 31. doi: 10.1007/s00056-022-00393-8. Online ahead of print.

ABSTRACT

OBJECTIVES: New opportunities have arisen to manufacture three-dimensional computer-aided design/computer-aided manufacturing (3D CAD/CAM) retainers from titanium blocks by digital cutting technology. These novel technologies need to fulfill requirements regarding digital planning and position accuracy. The aim of the present study was to investigate the digital construction, the CAD/CAM production and the intraoral positioning accuracy of custom-manufactured novel 3D CAD/CAM titanium retainers.

MATERIALS AND METHODS: A total of 37 prime4me® RETAIN3R (Dentaurum, Ispringen, Germany) retainers were inserted to stabilize the upper anterior front teeth. Following insertion, an intraoral scan was used to record the position. The intraoral position was compared to the virtual setup using 3D superimposition software. Measurement points were evaluated in all three dimensions (horizontal, sagittal and vertical planes). Data were analyzed using Kruskal-Wallis test followed by Dunn’s multiple comparison test.

RESULTS: A total of 185 measurements were performed. The horizontal plane and the sagittal plane demonstrated a high level of positioning accuracy between the planned and the intraoral position. Statistically significant deviations between the preceding virtual setup and the intraoral situation were observed in the vertical dimension. Within the retainer, the intraoral positioning accuracy decreased for the measurement points in the direction of the distal retainer segment.

CONCLUSION: Based on the results, the present study shows a high level of congruence between the 3D virtually planning and the final intraoral position of the fabricated novel 3D CAD/CAM titanium retainers.

PMID:35357509 | DOI:10.1007/s00056-022-00393-8

J Am Med Inform Assoc. 2022 Mar 31:ocac045. doi: 10.1093/jamia/ocac045. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether synthetic data derived from a national COVID-19 data set could be used for geospatial and temporal epidemic analyses.

MATERIALS AND METHODS: Using an original data set (n = 1,854,968 SARS-CoV-2 tests) and its synthetic derivative, we compared key indicators of COVID-19 community spread through analysis of aggregate and zip-code level epidemic curves, patient characteristics and outcomes, distribution of tests by zip code, and indicator counts stratified by month and zip code. Similarity between the data was statistically and qualitatively evaluated.

RESULTS: In general, synthetic data closely matched original data for epidemic curves, patient characteristics, and outcomes. Synthetic data suppressed labels of zip codes with few total tests (mean=2.9±2.4; max=16 tests; 66% reduction of unique zip codes). Epidemic curves and monthly indicator counts were similar between synthetic and original data in a random sample of the most tested (top 1%; n = 171) and for all unsuppressed zip codes (n = 5,819), respectively. In small sample sizes, synthetic data utility was notably decreased.

DISCUSSION: Analyses on the population-level and of densely-tested zip codes (which contained most of the data) were similar between original and synthetically-derived data sets. Analyses of sparsely-tested populations were less similar and had more data suppression.

CONCLUSION: In general, synthetic data were successfully used to analyze geospatial and temporal trends. Analyses using small sample sizes or populations were limited, in part due to purposeful data label suppression – an attribute disclosure countermeasure. Users should consider data fitness for use in these cases.

PMID:35357487 | DOI:10.1093/jamia/ocac045

JAMA Netw Open. 2022 Mar 1;5(3):e224759. doi: 10.1001/jamanetworkopen.2022.4759.

ABSTRACT

IMPORTANCE: The identification of variation in health care is important for quality improvement. Little is known about how different pediatric subspecialties are using telehealth and what is driving variation.

OBJECTIVE: To characterize trends in telehealth use before and during the COVID-19 pandemic across pediatric subspecialties and the association of delivery change with no-show rates and access disparities.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, 8 large pediatric medical groups in California collaborated to share aggregate data on telehealth use for 11 pediatric subspecialties from January 1, 2019, to December 31, 2021.

MAIN OUTCOMES AND MEASURES: Monthly in-person and telehealth visits for 11 subspecialties, characteristics of patients participating in in-person and telehealth visits, and no-show rates. Monthly use rates per 1000 unique patients were calculated. To assess changes in no-show rates, a series of linear regression models that included fixed effects for medical groups and calendar month were used. The demographic characteristics of patients served in person during the prepandemic period were compared with those of patients who received in-person and telehealth care during the pandemic period.

RESULTS: In 2019, participating medical groups conducted 1.8 million visits with 549 306 unique patients younger than 18 years (228 120 [41.5%] White and 277 167 [50.5%] not Hispanic). A total of 72 928 patients (13.3%) preferred a language other than English, and 250 329 (45.6%) had Medicaid. In specialties with lower telehealth use (cardiology, orthopedics, urology, nephrology, and dermatology), telehealth visits ranged from 6% to 29% of total visits from May 1, 2020, to April 30, 2021. In specialties with higher telehealth use (genetics, behavioral health, pulmonology, endocrinology, gastroenterology, and neurology), telehealth constituted 38.8% to 73.0% of total visits. From the prepandemic to the pandemic periods, no-show rates slightly increased for lower-telehealth-use subspecialties (9.2% to 9.4%) and higher-telehealth-use subspecialties (13.0% to 15.3%), but adjusted differences (comparing lower-use and higher-use subspecialties) in changes were not statistically significant (difference, 2.5 percentage points; 95% CI, -1.2 to 6.3 percentage points; P = .15). Patients who preferred a language other than English constituted 6140 in-person visits (22.2%) vs 2707 telehealth visits (11.4%) in neurology (P < .001).

CONCLUSIONS AND RELEVANCE: There was high variability in adoption of telehealth across subspecialties and in patterns of use over time. The documentation of variation in telehealth adoption can inform evolving telehealth policy for pediatric patients, including the appropriateness of telehealth for different patient needs and areas where additional tools are needed to promote appropriate use.

PMID:35357455 | DOI:10.1001/jamanetworkopen.2022.4759

Eur J Public Health. 2022 Mar 31:ckac028. doi: 10.1093/eurpub/ckac028. Online ahead of print.

ABSTRACT

BACKGROUND: While there is increasing literature on the health effects of work-life interference, few studies have investigated the relationship between a direct measure of work-life interference and objective sickness absence measures. The aim of this study is to investigate whether work-life interference is a risk factor for subsequent long-term sickness absence (LTSA).

METHODS: Data were derived from the Swedish Longitudinal Occupational Survey of Health 2010, 2012, 2014 and 2016. Data were linked to register data on LTSA (having at least one continuous period of medically certified sick leave exceeding 14 days) the following 2 years after each data collection wave. We applied generalized estimating equations, odds ratios (ORs) and 95% confidence intervals (CIs). The sample included 15 244 individuals (43.1% men and 56.9% women). Nearly a fifth of the sample (18.7%, n = 1110) started at least one period of LTSA at any point between 2010 and 2018.

RESULTS: Work-life interference was found to be a risk factor for subsequent LTSA (OR = 1.55; 95% CI = 1.44-1.67) even when adjusting for relevant factors including general health (OR = 1.39; 95% CI = 1.29-1.51). We found no significant moderating effect of gender.

CONCLUSION: The results of this study indicate that work-life interference is a risk factor for subsequent LTSA for working men and women in Sweden.

PMID:35357468 | DOI:10.1093/eurpub/ckac028

JAMA Netw Open. 2022 Mar 1;5(3):e225026. doi: 10.1001/jamanetworkopen.2022.5026.

ABSTRACT

IMPORTANCE: Nearly 30% of individuals with gestational diabetes (GDM) do not achieve glycemic control with lifestyle modification alone and require medication treatment. Oral agents, such as glyburide, have several advantages over insulin for the treatment of GDM, including greater patient acceptance; however, the effectiveness of glyburide for the treatment of GDM remains controversial.

OBJECTIVE: To compare the perinatal and neonatal outcomes associated with glyburide vs insulin using causal inference methods in a clinical setting with information on glycemic control.

DESIGN, SETTING, AND PARTICIPANTS: The population-based cohort study included patients with GDM who required medication treatment from 2007 to 2017 in Kaiser Permanente Northern California. Machine learning and rigorous casual inference methods with time-varying exposures were used to evaluate associations of exposure to glyburide vs insulin with perinatal outcomes. Data analysis was conducted from March 2018 to July 2017.

EXPOSURES: Time-varying exposure to glyburide vs insulin during pregnancy.

MAIN OUTCOMES AND MEASURES: Outcomes evaluated separately included neonatal hypoglycemia, jaundice, shoulder dystocia, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, size-for-gestational age, and cesarean delivery. Inverse probability weighting (IPW) estimation was used to separately compare perinatal outcomes between those initiating glyburide and insulin. This approach was combined with Super Learning for propensity score estimation to account for both baseline and time-dependent confounding in both per-protocol (primary) and intention-to-treat (secondary) analyses to evaluate sustained exposure to the same therapy.

RESULTS: From 2007 to 2017, 11 321 patients with GDM (mean [SD] age, 32.9 [4.9] years) initiated glyburide or insulin during pregnancy. In multivariate models, the risk of neonatal respiratory distress was 2.03 (95% CI, 0.13-3.92) per 100 births lower and the risk of NICU admission was 3.32 (95% CI, 0.20-6.45) per 100 births lower after continuous exposure to glyburide compared with insulin. There were no statistically significant differences in glyburide vs insulin initiation in risk for neonatal hypoglycemia (0.85 [95% CI, -1.17 to 2.86] per 100 births), jaundice (0.02 [95% CI, -1.46 to 1.51] per 100 births), shoulder dystocia (-1.05 [95% CI, -2.71 to 0.62] per 100 births), or large-for-gestational age categories (-2.75 [95% CI, -6.31 to 0.80] per 100 births).

CONCLUSIONS AND RELEVANCE: Using data from a clinical setting and contemporary causal inference methods, our findings do not provide evidence of a difference in the outcomes examined between patients with GDM initiating glyburide compared with those initiating insulin.

PMID:35357451 | DOI:10.1001/jamanetworkopen.2022.5026

BJS Open. 2022 Mar 8;6(2):zrac014. doi: 10.1093/bjsopen/zrac014.

ABSTRACT

BACKGROUND: As the outcome of modern colorectal cancer (CRC) surgery has significantly improved over the years, however, renewed and adequate risk stratification for mortality is important to identify high-risk patients. This population-based study was conducted to analyse postoperative outcomes in patients with CRC and to create a risk model for 30-day mortality.

METHODS: Data from the Dutch Colorectal Audit were used to assess differences in postoperative outcomes (30-day mortality, hospital stay, blood transfusion, postoperative complications) in patients with CRC treated from 2009 to 2017. Time trends were analysed. Clinical variables were retrieved (including stage, age, sex, BMI, ASA grade, tumour location, timing, surgical approach) and a prediction model with multivariable regression was computed for 30-day mortality using data from 2009 to 2014. The predictive performance of the model was tested among a validation cohort of patients treated between 2015 and 2017.

RESULTS: The prediction model was obtained using data from 51 484 patients and the validation cohort consisted of 32 926 patients. Trends of decreased length of postoperative hospital stay and blood transfusions were found over the years. In stage I-III, postoperative complications declined from 34.3 per cent to 29.0 per cent (P < 0.001) over time, whereas in stage IV complications increased from 35.6 per cent to 39.5 per cent (P = 0.010). Mortality decreased in stage I-III from 3.0 per cent to 1.4 per cent (P < 0.001) and in stage IV from 7.6 per cent to 2.9 per cent (P < 0.001). Eight factors, including stage, age, sex, BMI, ASA grade, tumour location, timing, and surgical approach were included in a 30-day mortality prediction model. The results on the validation cohort documented a concordance C statistic of 0.82 (95 per cent c.i. 0.80 to 0.83) for the prediction model, indicating good discriminative ability.

CONCLUSION: Postoperative outcome improved in all stages of CRC surgery in the Netherlands. The developed model accurately predicts postoperative mortality risk and is clinically valuable for decision-making.

PMID:35357416 | DOI:10.1093/bjsopen/zrac014

JAMA Otolaryngol Head Neck Surg. 2022 Mar 31. doi: 10.1001/jamaoto.2022.0167. Online ahead of print.

ABSTRACT

IMPORTANCE: Individuals with persistent unilateral vestibular deficits experience loss of quality of life and increased risk of falling, and they have few well-supported options for effective treatment.

OBJECTIVES: To evaluate whether vestibular retraining using computerized dynamic posturography is associated with reduced participant-reported disability for patients with an objectively assessed unilateral peripheral vestibular deficit and to assess the feasibility of conducting a randomized clinical trial of vestibular retraining using computerized dynamic posturography.

DESIGN, SETTING, AND PARTICIPANTS: This single-group cohort study was conducted from April 29 to July 23, 2021, in a tertiary neurotology clinic among 13 individuals with a stable unilateral vestibular deficit present for more than 6 months, confirmed with videonystagmography and vestibular evoked myogenic potential testing. Statistical analysis was performed from July 7, 2021, to January 25, 2022.

INTERVENTIONS: Twelve twice-weekly sessions of posturography-assisted vestibular retraining with prescribed weight shifting tasks guided by an interactive display.

MAIN OUTCOMES AND MEASURES: Change in scores on the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence (ABC) Scale, and the Falls Efficacy Scale-International (FES-I), which participants completed before and after retraining to measure their perception of their disability. They also completed posturography measurements. Secondary outcomes included tolerability of the intervention and rate of completion of the full protocol.

RESULTS: A total of 13 participants (8 men [62%]; median age, 51 years [range, 18-67 years]) were enrolled. All 13 participants completed the intervention and all follow-up. After treatment, the median changes in scores were -16 points (95% CI, -20 to 2) for the DHI, -9 (95% CI, -14 to 1) for the FES-I, and 11.9 (95% CI, 0-17.3) for the ABC Scale. Eight participants (62%) improved by greater than the minimum clinically important difference (MCID) for the DHI, whereas 4 (31%) exceeded the MCID for the ABC Scale, and 3 (23%) exceeded the MCID for the FES-I. Participants with moderate to severe disability at baseline (n = 7) had a larger magnitude of improvement in DHI scores than those with mild disability (n = 6) (-18 [95% CI, -78 to 2] vs -1 [95% CI, -8 to 16]). Six of the 7 patients (86%) with moderate to severe disability improved by greater than the MCID for DHI, wherease 4 of 7 patients (57%) improved by greater than the MCID for the ABC Scale, and 3 of 7 patients (43%) improved by greater than the MCID for the FES-I.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that computerized, dynamic posturography-assisted retraining was associated with clinically meaningful improvements in participant-reported disability among those with stable unilateral vestibular deficit and moderate to severe disability. Further studies should compare posturography-assisted vestibular retraining with conventional physical therapy rehabilitation techniques.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04875013.

PMID:35357406 | DOI:10.1001/jamaoto.2022.0167

JAMA Otolaryngol Head Neck Surg. 2022 Mar 31. doi: 10.1001/jamaoto.2022.0162. Online ahead of print.

NO ABSTRACT

PMID:35357398 | DOI:10.1001/jamaoto.2022.0162

J Pediatr Orthop B. 2022 Mar 31:BPB.0000000000000972. doi: 10.1097/BPB.0000000000000972. Online ahead of print.

ABSTRACT

YouTube is an increasingly accessible platform for families to obtain health information from; however, it is unregulated. The aim of this article was to assess the quality, reliability and accuracy of YouTube videos related to three common pediatric hip conditions: development dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease. YouTube was searched using a variety of keyword combinations. Videos were analysed using Journal of the American Medical Association, Global Quality Score and condition-specific scores created specifically for this study. Video duration and the number of views were also recorded. In total 120 videos were analysed, 40 for each of DDH, SCFE and Perthes disease. YouTube videos from physicians and academic institutions/hospitals are of significantly higher quality, reliability and accuracy than videos from patients, nonphysicians and commercial outlets. The higher quality for physician videos is associated with significantly longer video. Differences between the three pediatric orthopaedic conditions were not statistically significant. Videos of higher quality may be used as an adjunctive tool to strengthen clinical consultation. Parents and caregivers should be guided to videos from academic institutions or hospitals as a way of improving health literacy.

PMID:35357371 | DOI:10.1097/BPB.0000000000000972

Medicine (Baltimore). 2022 Mar 25;101(12):e29142. doi: 10.1097/MD.0000000000029142.

ABSTRACT

Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients’ information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.

PMID:35357356 | DOI:10.1097/MD.0000000000029142