Tag: nevin manimala

Dermatol Surg. 2021 Apr 27. doi: 10.1097/DSS.0000000000003062. Online ahead of print.

ABSTRACT

BACKGROUND: The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery.

OBJECTIVE: Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand.

MATERIALS AND METHODS: United States national and state-based Google search data for “Mohs surgery” and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends.

RESULTS: Search volume for “Mohs surgery” and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between “Mohs surgery” search volume and new COVID-19 deaths on a national and state-based level.

CONCLUSION: Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.

PMID:33927090 | DOI:10.1097/DSS.0000000000003062

Curr Opin Urol. 2021 Apr 28. doi: 10.1097/MOU.0000000000000884. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Artificial intelligence has become popular in medical applications, specifically as a clinical support tool for computer-aided diagnosis. These tools are typically employed on medical data (i.e., image, molecular data, clinical variables, etc.) and used the statistical and machine-learning methods to measure the model performance. In this review, we summarized and discussed the most recent radiomic pipeline used for clinical analysis.

RECENT FINDINGS: Currently, limited management of cancers benefits from artificial intelligence, mostly related to a computer-aided diagnosis that avoids a biopsy analysis that presents additional risks and costs. Most artificial intelligence tools are based on imaging features, known as radiomic analysis that can be refined into predictive models in noninvasively acquired imaging data. This review explores the progress of artificial intelligence-based radiomic tools for clinical applications with a brief description of necessary technical steps. Explaining new radiomic approaches based on deep-learning techniques will explain how the new radiomic models (deep radiomic analysis) can benefit from deep convolutional neural networks and be applied on limited data sets.

SUMMARY: To consider the radiomic algorithms, further investigations are recommended to involve deep learning in radiomic models with additional validation steps on various cancer types.

PMID:33927099 | DOI:10.1097/MOU.0000000000000884

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Mar 28;46(3):272-277. doi: 10.11817/j.issn.1672-7347.2021.190378.

ABSTRACT

OBJECTIVES: To explore the risk factors for femoral neck fracture in elderly population.

METHODS: A total of 124 elderly patients (≥60 years old) in hospital for trauma were enrolled, including 71 patients (57%) with femoral neck fracture and 53 non-femoral neck fracture patients (43%). All patients’ age, gender, body mass index (BMI), bone mineral density (BMD), thigh length and average circumference were collected. Single factor analysis and multivariate logistic regression analysis were performed to explore whether the above factors were risk factors for femoral neck fracture.

RESULTS: Single factor analysis showed that the age, gender, BMI, BMD, thigh length, and average thigh circumference between the 2 groups were statistically different (all P<0.05), and multi-factor logistic regression analysis showed that age, gender, BMI, BMD, thigh length, and average thigh circumference were influencing factors for femoral neck fracture in elderly population (all P<0.05).

CONCLUSIONS: Older age, female, lower BMI index (low body weight), lower BMD (osteoporosis), longer thigh length, and lower average circumference are risk factors for femoral neck fracture in the elderly population.

PMID:33927074 | DOI:10.11817/j.issn.1672-7347.2021.190378

BMJ Mil Health. 2021 Apr 29:bmjmilitary-2021-001783. doi: 10.1136/bmjmilitary-2021-001783. Online ahead of print.

ABSTRACT

INTRODUCTION: The conflicts in Iraq and Afghanistan resulted in large numbers of personnel sustaining extremity injuries. In the context of polytrauma, partial hand amputation is often unrecorded. The aim of this work was to quantify the burden of upper limb (UL) amputation at any level occurring concurrently with a major (ankle and proximal) lower limb (LL) amputation. Knowledge of this cohort could aid in prosthetic modification to further improve quality of life outcomes in a population with dexterity loss.

METHOD: A trauma database search was undertaken for all UK military LL amputees from the conflicts in Iraq and Afghanistan. A manual search method was employed to identify from the major LL amputees those who had a concurrent UL amputation at any level (including isolated finger amputation). Demographics, level of amputation, and injury profile data were recorded.

RESULTS: Sixty-eight individuals were identified; the most prevalent population was bilateral LL with a unilateral UL amputation (60%). Most UL amputations were partial hand (75%). The was no statistically significant difference between left or right side (p=0.13). On the left side, correlation was found between amputation of the thumb and third digit (rho=0.34; p=0.005) not seen on the right.

CONCLUSION: We have determined the rate of UL amputation at any level, in combination with LL amputation as a result of blast injury. Knowledge of these combinations enables further research to support anecdotal evidence that there is a need for tailored prosthetics in the context of potential dexterity loss making donning and doffing problematic.

PMID:33927000 | DOI:10.1136/bmjmilitary-2021-001783

Int J Med Educ. 2021 Apr 29;12:76-83. doi: 10.5116/ijme.606a.f16c.

ABSTRACT

OBJECTIVES: We aimed to explore empathy, moral competencies, callous traits, and temperament in a sample of medical students. Furthermore, we aimed to investigate differences in our variables across the 1st and 5th years of medical education and possible correlations between them.

METHODS: This was a cross-sectional study with 138 medical students. We resorted to self-reported instruments that were given at the end of classes: Barrett-Lennard Relational Inventory, Temperament Evaluation of Memphis, Pisa and San Diego Auto-questionnaire, Inventory of Callous-Unemotional Traits, and Moral Competence Test. For the statistical analysis, we resorted to descriptive and inferential statistics, using non-parametric tests when data didn’t follow a normal distribution.

RESULTS: We found no statistical difference between empathy scores in 1st (N=104, Mean=41.42, SD=22.48) and 5th year students (N=34, Mean=37.35, SD=23.35), t₍₁₃₆₎=0.908, p=0.366. Callous traits were negatively correlated with empathy (r₍₁₃₆₎=-0.444, p=0.000) and no correlation between moral competences and empathy (r₍₉₆₎=0.029, p=0.779) was observed. We found a negative correlation between empathy and cyclothymic, anxious and irritable temperaments (r₍₁₃₆₎=-0.334, p=0.000, r₍₁₃₆₎=-0.281, p=0.001, r₍₁₃₆₎=-0.400, p=0.000).

CONCLUSIONS: Our scores corroborate previous evidence that medical students are empathic, have good moral standards and low callous traits. We saw no differences in empathy scores between the two years and future studies could explore the particulars of medical curriculums impacting this variable. In our study, empathy was negatively correlated with callous traits and linked with specific temperaments. Considering these variables at admission to medical school as well as preserving and improving them in medical education might offer better standards of care.

PMID:33927064 | DOI:10.5116/ijme.606a.f16c

BMJ Open. 2021 Apr 29;11(4):e049093. doi: 10.1136/bmjopen-2021-049093.

ABSTRACT

OBJECTIVES: Randomised controlled trials conducted using cohorts and routinely collected data, including registries, electronic health records and administrative databases, are increasingly used in healthcare intervention research. A Consolidated Standards of Reporting Trials (CONSORT) statement extension for trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE) has been developed with the goal of improving reporting quality. This article describes the processes and methods used to develop the extension and decisions made to arrive at the final checklist.

METHODS: The development process involved five stages: (1) identification of the need for a reporting guideline and project launch; (2) conduct of a scoping review to identify possible modifications to CONSORT 2010 checklist items and possible new extension items; (3) a three-round modified Delphi study involving key stakeholders to gather feedback on the checklist; (4) a consensus meeting to finalise items to be included in the extension, followed by stakeholder piloting of the checklist; and (5) publication, dissemination and implementation of the final checklist.

RESULTS: 27 items were initially developed and rated in Delphi round 1, 13 items were rated in round 2 and 11 items were rated in round 3. Response rates for the Delphi study were 92 of 125 (74%) invited participants in round 1, 77 of 92 (84%) round 1 completers in round 2 and 62 of 77 (81%) round 2 completers in round 3. Twenty-seven members of the project team representing a variety of stakeholder groups attended the in-person consensus meeting. The final checklist includes five new items and eight modified items. The extension Explanation & Elaboration document further clarifies aspects that are important to report.

CONCLUSION: Uptake of CONSORT-ROUTINE and accompanying Explanation & Elaboration document will improve conduct of trials, as well as the transparency and completeness of reporting of trials conducted using cohorts and routinely collected data.

PMID:33926985 | DOI:10.1136/bmjopen-2021-049093

J Neurosci. 2021 Apr 29:JN-RM-1932-20. doi: 10.1523/JNEUROSCI.1932-20.2021. Online ahead of print.

ABSTRACT

Forrest Gump or Matrix? Preference-based decisions are subjective and entail self-reflection. However, these self-related features are unaccounted for by known neural mechanisms of valuation and choice. Self-related processes have been linked to a basic interoceptive biological mechanism, the neural monitoring of heartbeats, in particular in ventromedial prefrontal cortex (vmPFC), a region also involved in value encoding. We thus hypothesized a functional coupling between the neural monitoring of heartbeats and the precision of value encoding in vmPFC. Human participants of both sexes were presented with pairs of movie titles. They indicated either which movie they preferred, or performed a control objective visual discrimination that did not require self-reflection. Using magnetoencephalography, we measured heartbeat-evoked responses (HERs) before option presentation, and confirmed that HERs in vmPFC were larger when preparing to the subjective, self-related task. We retrieved the expected cortical value network during choice with time-resolved statistical modeling. Crucially, we show that larger HERs before option presentation are followed by stronger value encoding during choice in vmPFC. This effect is independent of overall vmPFC baseline activity. The neural interaction between HERs and value encoding predicted preference-based choice consistency over time, accounting for both inter-individual differences and trial-to-trial fluctuations within individuals. Neither cardiac activity nor arousal fluctuations could account for any of the effects. HERs did not interact with the encoding of perceptual evidence in the discrimination task. Our results show that the self-reflection underlying preference-based decisions involves HERs, and that HER integration to subjective value encoding in vmPFC contributes to preference stability.SIGNIFICANCE STATEMENT:Deciding whether you prefer Forrest Gump or Matrix is based on subjective values, which only you, the decision-maker, can estimate and compare, by asking yourself. Yet, how self-reflection is biologically implemented and its contribution to subjective valuation are not known. We show that in ventromedial prefrontal cortex, the neural response to heartbeats, an interoceptive self-related process, influences the cortical representation of subjective value. The neural interaction between the cortical monitoring of heartbeats and value encoding predicts choice consistency, i.e. whether you consistently prefer Forrest Gump over Matrix over time. Our results pave the way for the quantification of self-related processes in decision making and may shed new light on the relationship between maladaptive decisions and impaired interoception.

PMID:33926998 | DOI:10.1523/JNEUROSCI.1932-20.2021

Eur Respir J. 2021 Apr 29:2004047. doi: 10.1183/13993003.04047-2020. Online ahead of print.

ABSTRACT

Four-metre gait speed (4MGS) is a simple physical performance measure and surrogate marker of frailty that is associated with adverse outcomes in older adults. We aimed to assess the ability of 4MGS to predict prognosis in patients hospitalised with acute exacerbations of COPD (AECOPD).213 participants hospitalised with AECOPD (52% male, mean age and FEV₁, 72 years and 35% predicted) were enrolled. 4MGS and baseline demographics were recorded at hospital discharge. All-cause readmission and mortality were collected for 1 y after discharge, and multivariable Cox-proportional hazards regression were performed. Kaplan-Meier and Competing risk analysis was conducted comparing time to all-cause readmission and mortality between 4MGS quartiles.111 participants (52%) were readmitted, and 35 (16%) died during the follow-up period. 4MGS was associated with all-cause readmission, with an adjusted subdistribution hazard ratio of 0.868 (95% CI 0.797-0.945; p=0.001) per 0.1 m·s^-1 increase in gait speed, and with all-cause mortality with an adjusted subdistribution hazard ratio of 0.747 (95% CI: 0.622-0.898; p=0.002) per 0.1 m·s^-1 increase in gait speed. Readmission and mortality models incorporating 4MGS had higher discrimination than age or FEV₁% predicted alone, with areas under the receiver operator characteristic curves of 0.73 and 0.80 respectively. Kaplan-Meier and Competing Risk curves demonstrated that those in slower gait speed quartiles had reduced time to readmission and mortality (log rank both p<0.001).4MGS provides a simple means of identifying at-risk patients with COPD at hospital discharge. This provides valuable information to plan post-discharge care and support.

PMID:33926974 | DOI:10.1183/13993003.04047-2020

BMJ Open. 2021 Apr 29;11(4):e044472. doi: 10.1136/bmjopen-2020-044472.

ABSTRACT

OBJECTIVES: To assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.

DESIGN: Systematic review.

DATA SOURCES: DAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.

ELIGIBILITY CRITERIA: DAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I-III.

DATA EXTRACTION AND SYNTHESIS: After the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.

RESULTS: In total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.

CONCLUSIONS: Both instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

PMID:33926980 | DOI:10.1136/bmjopen-2020-044472

BMJ Open. 2021 Apr 29;11(4):e044569. doi: 10.1136/bmjopen-2020-044569.

ABSTRACT

INTRODUCTION: Despite available pharmacological and psychological treatments, remission rates for bipolar disorder remain relatively low. Current research implicates the experience of childhood trauma as a potential moderator of poor treatment outcomes among individuals with bipolar disorder. To date, the evidence reporting the influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder has not been systematically reviewed.

METHOD AND ANALYSIS: MEDLINE Complete, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials will be searched to identify randomised and nonrandomised studies of pharmacological and/or psychological interventions for bipolar disorder, which also assessed childhood trauma. To be eligible for inclusion, studies must have been conducted with adolescents or adults (≥10 years). Data will be screened and extracted by two independent reviewers. The methodological quality of the included studies will be assessed with the Cochrane Collaboration’s Risk of Bias tool and the Newcastle-Ottawa Scale. If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I² statistics.

ETHICS AND DISSEMINATION: This systematic review will use only previously published data. Therefore, ethical approval is not required. The results will be written in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, published in peer-reviewed journals and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER: CRD42020201891.

PMID:33926981 | DOI:10.1136/bmjopen-2020-044569