Tag: nevin manimala

Ir J Med Sci. 2021 Oct 16. doi: 10.1007/s11845-021-02812-y. Online ahead of print.

ABSTRACT

BACKGROUND: Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction.

AIMS: Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle.

METHODS: A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification.

FINDINGS: A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, – 0.976 (p = 0.00025), and Weber A ankle fractures, – 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, – 0.701 (p = 0.129) and Weber B ankle fractures, – 0.786 (p = 0.235), though not achieving statistical significance.

CONCLUSIONS: Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.

PMID:34655402 | DOI:10.1007/s11845-021-02812-y

J Patient Rep Outcomes. 2021 Oct 16;5(1):107. doi: 10.1186/s41687-021-00384-0.

ABSTRACT

BACKGROUND: Patient-reported outcome measures are increasingly used by clinicians to support communication in telephone- or face-to-face consultations with patients. A renal disease questionnaire has been developed, but not sufficiently evaluated through clinimetrics in clinical setting. Hence, we aimed to evaluate the content validity, construct validity and the test-retest reliability of a renal disease questionnaire to be used for clinical decision-making.

METHODS: A content, construct validity and test-retest reliability study was conducted in 3 nephrology outpatient clinics in Central Denmark Region, Denmark. Content validity (face validity, comprehensibility and relevance) was assessed among 8 patients and 6 clinicians. Reliability was assessed by asking outpatients with chronic kidney disease to complete the questionnaire twice. Reliability was assessed by kappa statistics and agreement by percentage. Construct validity was determined using 4 a priori defined hypotheses and comparing 2 known groups.

RESULTS: Five new domains emerged, 6 items were rephrased and 3 items were removed following the content validity test. A total of 160 patients completed the questionnaire with median 8 days (IQR 2 days) between assessments. The test-retest reliability parameters of the single items in the questionnaire were substantial to almost perfect as all the observed weighted kappa values ranged from 0.61 to 0.91, 95% CI (0.34 to 0.95). In total, 61% of the single items showed almost perfect agreement. In total, 3 of the 4 hypotheses were accepted and 44% of the items showed satisfying known-group discriminative validity.

CONCLUSION: A renal disease questionnaire used for clinical decision-making in outpatient follow-up showed acceptable content validity and substantial to almost perfect reliability. Sufficient construct validity was not established. Incorporating the questionnaire into routine clinical practice may improve the evaluation of disease burden in patients with chronic kidney disease. We ask patients with chronic kidney disease (CKD) in Central Region Denmark to complete a questionnaire before each outpatient visit. The answers they provide are used to support communication with their health care provider. A questionnaire requires testing to ensure it can accurately capture important information about patient’s symptoms and quality of life. When questionnaires are used to support communication between patients and health care professionals, they need to have good measurement properties. This means they need to be: (1) trustworthy, (2) relevant to a patient’s health condition, (3) consistent and produce stable results every time. We explored the measurement properties of a questionnaire designed to be used in the face-to face outpatient visits for patients with CKD. We found that the questionnaire captured consistent and stable results. Using this questionnaire may help health care professionals to assess the patients´ burden of symptoms with a more patient-centered approach. Potentially, the use of the questionnaire will increase the patients´ ability to cope with their symptoms and strengthen patients´ involvement in the clinical decisions concerning their treatment.

PMID:34655365 | DOI:10.1186/s41687-021-00384-0

Environ Sci Pollut Res Int. 2021 Oct 16. doi: 10.1007/s11356-021-16912-w. Online ahead of print.

ABSTRACT

The balanced amelioration of mechanical characteristics of fat clay with an additive refers to the attainment of high strength without compromising ductility, which is unattainable by solitary usage of a cementing additive. For this purpose, an amalgamated binary admixture (ABA) is proposed by assimilating shredded face mask (FM) waste, which is posing serious environmental concerns these days, with a cementitious waste material, i.e., silica fume (SF). However, for such ABA, the optimization of mix design is desirable because an excessive amount of one component could disturb the required balance. To address this issue, response surface methodology (RSM) is used in the current study, which is a strong technique used during the process of production to develop, improve, and optimize product inputs. Several experiments are designed and conducted to evaluate mechanical responses, i.e., unconfined compressive strength (q_u), brittleness index (I_B), deformability index (I_D), and California bearing ratio (CBR) value, of treated fat clay by varying mix designs of ABA. Based on the test results, mathematical models are developed which are found to be statistically valid to predict the subjected responses using SF and FM as inputs. Afterward, an optimized mix design is determined by integrating developed models with a desirability function model and setting maximization of strength and ductility as the optimization goals. An ABA having 7.9% SF and 1.2% FM is observed to provide the highest strength and ductility for multiple applications, i.e., road and buildings, with desirability factor close to unity; responses of which are also validated by performing tests. Furthermore, analysis of cleaning aspect shows that the use of optimized ABA in place of cement for subgrade improvement of 1 km two-lane road could avoid CO₂ emission of around 79,032 kg of C, save 42,720 kWh and 1174.8 GJ of electrical and thermal energy, respectively, and clean 43 Mg of FM waste; however, astute protocols of COVID-19 FM waste handling and disinfection are needed to be established and followed.

PMID:34655381 | DOI:10.1007/s11356-021-16912-w

Int J Cardiovasc Imaging. 2021 Oct 16. doi: 10.1007/s10554-021-02438-2. Online ahead of print.

ABSTRACT

Hypo-attenuated leaflet thickening (HALT) of transcatheter aortic valves is detected on multidetector computed tomography (MDCT) and reflects leaflet thrombosis. Whether HALT affects left ventricular (LV) reverse remodeling, a favorable effect of LV afterload reduction after transcatheter aortic valve implantation (TAVI) is unknown. The aim of this study was to examine the association of HALT after TAVI with LV reverse remodeling. In this multicenter case-control study, patients with HALT on MDCT were identified, and patients without HALT were propensity matched for valve type and size, LV ejection fraction (LVEF), sex, age and time of scan. LV dimensions and function were assessed by transthoracic echocardiography before and 12 months after TAVI. Clinical outcomes (stroke or transient ischemic attack, heart failure hospitalization, new-onset atrial fibrillation, all-cause mortality) were recorded. 106 patients (age 81 ± 7 years, 55% male) with MDCT performed 37 days [IQR 32-52] after TAVI were analyzed (53 patients with HALT and 53 matched controls). Before TAVI, all echocardiographic parameters were similar between the groups. At 12 months follow-up, patients with and without HALT showed a significant reduction in LV end-diastolic volume, LV end-systolic volume and LV mass index (from 125 ± 37 to 105 ± 46 g/m², p = 0.001 and from 127 ± 35 to 101 ± 27 g/m², p < 0.001, respectively, p for interaction = 0.48). Moreover, LVEF improved significantly in both groups. In addition, clinical outcomes were not statistically different. Improvement in LVEF and LV reverse remodeling at 12 months after TAVI were not limited by HALT.

PMID:34655348 | DOI:10.1007/s10554-021-02438-2

Eur J Health Econ. 2021 Oct 16. doi: 10.1007/s10198-021-01384-z. Online ahead of print.

ABSTRACT

Cost-effective threshold (CET) is essential for health technology assessment and decision-making based on health economic evaluations. Recently, it has been argued that the commonly used once and three times of gross domestic product (GDP) per capita CETs of a quality-adjusted life year (QALY) are not necessarily empirically supported in all countries. Therefore, we aimed to estimate the CET of a QALY as times of GDP per capita in China, of which the reimbursement coverage decisions are increasingly engaging economic evaluations. Estimates on the value of statistical life (VSL) in China were identified from several studies in the literature and converted to times of GDP per capita, the weighted average of which was used for subsequent calculation. By pooling data on population mortality, health utility, and age distribution, we estimated the value of a statistical QALY (VSQ) from VSL using an established mathematical process, which represented the theoretical upper bound of CET. The corresponding point estimate and theoretical lower bound were obtained using their numerical relationships with the upper bound. Scenarios analyses were also conducted. The estimated CET, its upper bound, and its lower bound were 1.45, 2.90, and 1.16 times of GDP per capita in China, respectively. In different scenarios, the estimated CET varied but was greater than once GDP per capita in most cases. As such, the CET of a QALY in China is close to 1.5 times of GDP per capita, which should be benchmarked for future ICER-based coverage decisions.

PMID:34655364 | DOI:10.1007/s10198-021-01384-z

Support Care Cancer. 2021 Oct 16. doi: 10.1007/s00520-021-06555-5. Online ahead of print.

ABSTRACT

PURPOSE: Patients with primary malignant brain tumors have high symptom burden and commonly rely on family caregivers for practical and emotional support. This can lead to negative mental and physical consequences for caregivers. We investigated effectiveness of an 8-week nurse-led online needs-based support program (SmartCare^©) with and without online self-guided cognitive behavioral therapy (CBT) for depression compared to enhanced care as usual (ECAU) on depressive symptoms, caregiving-specific distress, anxiety, mastery, and burden.

METHODS: Family caregivers scoring ≥ 6 on a depressive symptoms inventory were randomized to three groups: ECAU plus self-guided CBT and SmartCare^©; ECAU plus SmartCare^©; ECAU only. Primary outcomes (depressive symptoms; caregiving-specific distress) and secondary outcomes (anxiety, caregiver mastery, and caregiver burden) were assessed online. Intention to treat (ITT) and per protocol (PP) analyses of covariance corrected for baseline scores were performed for outcomes at 4 months.

RESULTS: In total, 120 family caregivers participated. Accrual and CBT engagement were lower than expected, therefore intervention groups were combined (n = 80) and compared to ECAU (n = 40). For depressive symptoms, no statistically significant group differences were found. Caregiving-specific distress decreased in the intervention group compared with ECAU (ITT: p = 0.01, partial ɳ² = 0.08; PP: p = 0.02, partial ɳ² = 0.08). A trend towards improvement in mastery for the intervention group compared with ECAU was identified (ITT: p = 0.08, partial ɳ² = 0.04; PP: p = 0.07, partial ɳ² = 0.05).

CONCLUSIONS: SmartCare^©, with or without self-guided CBT, reduced caregiving-specific distress with a trend towards improving mastery. SmartCare^© has the potential to improve the lives of families coping with a brain tumor diagnosis.

TRIAL REGISTRATION NUMBER: NCT02058745; 10 February 2014.

PMID:34655326 | DOI:10.1007/s00520-021-06555-5

Protein Sci. 2021 Oct 15. doi: 10.1002/pro.4205. Online ahead of print.

ABSTRACT

The antibody repertoires of individuals and groups have been used to explore disease states, understand vaccine responses and drive therapeutic development. The arrival of B-cell receptor repertoire sequencing has enabled researchers to get a snapshot of these antibody repertoires and as more data is generated, increasingly in depth studies are possible. However, most publicly available data only exists as raw FASTQ files, making the data hard to access, process and compare. The Observed Antibody Space (OAS) database was created in 2018 to offer clean, annotated and translated repertoire data. In this paper we describe an update to OAS that has been driven by the increasing volume of data and the appearance of paired (VH/VL) sequence data. OAS is now accessible via a new web server, with standardised search parameters and a new sequence-based search option. The new database provides both nucleotides and amino acids for every sequence, with additional sequence annotations to make the data MiAIRR-compliant, and comments on potential problems with the sequence. OAS now contains 25 new studies, including SARS-CoV-2 data and paired sequencing data. The new database is accessible at http://opig.stats.ox.ac.uk/webapps/oas/ and all data is freely available for download. This article is protected by copyright. All rights reserved.

PMID:34655133 | DOI:10.1002/pro.4205

Health Econ. 2021 Oct 15. doi: 10.1002/hec.4442. Online ahead of print.

ABSTRACT

In light of skilled-labor shortage, the effect of a change in the wage of nurses on their labor supply is intensely discussed in recent literature. Using extensive data of German 14- to 15-year-olds, I analyze the role of the beliefs about a nurse’s wage in the decision to become one. To estimate a partial effect, I select controls and their functional form using post-double-selection, which is a data-driven selection method based on regression shrinkage. Highlighting the importance of wages at the extensive margin of labor supply, the wage beliefs play a positive and statistically significant role. Although information is publicly available, educational choices knowingly suffer from misinformation. I find that especially those who do not become a nurse understate the wage. The results lead to two important policy implications. First, increasing the wage may help to overcome the shortage observed in many countries. Second, providing more information on the (relative) wage may be a successful strategy to attract more individuals into this profession. To assess the sensitivity of the results regarding omitted variable bias, I apply a novel approach. It turns out that potential unobserved confounders would have to be strong to overrule the conclusions.

PMID:34655140 | DOI:10.1002/hec.4442

Int J Health Plann Manage. 2021 Oct 15. doi: 10.1002/hpm.3365. Online ahead of print.

ABSTRACT

BACKGROUND: Case-based payment has extensively been adopted to replace the fee-for-service payment in China. This paper aims to assess the impacts of case-based payment reform on the providers’ behaviour using cataract surgery as an example.

METHODS: A total of 400 cataract inpatients were sampled in a tertiary hospital. Data analysis consisted of descriptive statistics, Wilcoxon rank-sum test and Chi-square test.

RESULTS: The number of routine preoperative laboratory tests and drugs significantly declined after the case-based payment reform (p < 0.001). Healthcare providers significantly reduced the use frequency of systemic glucocorticoids (GCs) and antibiotics, adjuvant drugs, multiple antibiotic eye drops, generic drugs in cataract surgery after reform (p < 0.001), and they reduced non-ophthalmic medications after reform (p < 0.01). Notably, all patients were prescribed GC eye drops, antibiotic eye drops, and original drugs in both groups. Moreover, the preoperative, postoperative, and total length of stay (LOS) declined after the reform (p < 0.001). Nonetheless, no significant difference was noted in the care quality between the two group.

CONCLUSION: The case-based payment reform decreased the intensity of care by reducing unnecessary drugs and retaining necessary drugs on cataract surgery. Besides, the LOS was shortened. Further, an impaired care quality was not witnessed, however, cost-shifting warrants further attention.

PMID:34655114 | DOI:10.1002/hpm.3365

J Vet Intern Med. 2021 Oct 15. doi: 10.1111/jvim.16279. Online ahead of print.

ABSTRACT

BACKGROUND: The term big kidney-little kidney syndrome in cats has been used for many years, but the definitions are not consistent and relevant research is limited.

OBJECTIVE: To determine the factors that differ between normal and BKLK cats, as well as to develop models for predicting the 30-day survival of cats with ureteral obstruction (UO).

ANIMALS: Sixteen healthy cats and 64 cats with BKLK.

METHODS: Retrospective study. To define BKLK by reference to data from clinically healthy cats. The demographic and clinicopathological data among groups were statistically analyzed.

RESULTS: Big kidney-little kidney syndrome cats had higher blood urea nitrogen (BUN) (median [interquartile range] 69 [28-162] vs 21 [19-24] mg/dL, P < .001), creatinine (5.6 [1.9-13.3] vs 1.3 [1.05-1.40] mg/dL, P < .001), and white blood cells (10 800 [7700-17 500] vs 6500 [4875-9350] /μL, P < .001) and lower hematocrit (32.8 [27.1-38.4] vs 39.1 [38.1-40.4]%, P < .001), urine specific gravity (1.011 [1.009-1.016] vs 1.049 [1.044-1.057], P < .001) and pH (5.88 [5.49-6.44] vs 6.68 [6.00-7.18], P = .001) compared to the control cats. A lower body temperature (BT; 38.1 [37.9-38.2] vs 38.7 [38.3-39.2]°C, P = .009), higher BUN (189 [150-252] vs 91 [36-170] mg/dL, P = .04), and creatinine (15.4 [13.3-17.4] vs 9.0 [3.1-14.2] mg/dL, P = .03) were found among the UO cats that were not 30-day survivors. A combination of BUN, phosphorus, and BT can predict 30-day survival among UO cats with an area under receiver operating characteristic curve of 0.863. (P = .01).

CONCLUSION: An increase in the length difference between kidneys can indicate UO, but cannot predict outcome for BKLK cats.

PMID:34655128 | DOI:10.1111/jvim.16279