Tag: nevin manimala

J Pediatr Orthop B. 2021 Sep 17. doi: 10.1097/BPB.0000000000000916. Online ahead of print.

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, many aspects of healthcare have been hindered. The primary aim of this study was to identify what the impact of COVID-19 was on the delivery of outpatient care for children with congenital talipes equinovarus deformity (CTEV) at a large tertiary hospital in the UK. This study reviewed the patients who commenced their Ponseti treatment between March and September 2020, representing the cohort who received hands-on care during the first wave of the COVID-19 pandemic. Equivalent 6-month periods were searched in 2019 and 2018 as control cohorts. This study included a total of 45 children (72 affected feet) presenting for treatment of clubfoot. Twenty-three babies were seen with CTEV in 2020. For the same time period in 2018 and 2019, 11 babies were treated each year. The distance commuted to by families was higher in 2020 compared to 2019 and 2018, although the difference did not reach statistical significance (P = 0.301). Treatment with Ponseti casting was commenced at a mean age of 52 days, with no statistically significant differences between cohorts (P = 0.758). Using strict precautions, the Ponseti service at a large tertiary hospital in the UK grew in size and successfully provided treatment for children presenting with CTEV during the first wave of the COVID-19 pandemic. This study has shown that with careful protocols in place, children with CTEV can be treated successfully during times of pandemic, thereby reducing the post-pandemic burden of older children requiring treatment.

PMID:34545852 | DOI:10.1097/BPB.0000000000000916

Stud Health Technol Inform. 2021 Sep 21;283:69-77. doi: 10.3233/SHTI210543.

ABSTRACT

Optimizing the utilization of radiology departments is one of the primary objectives for many hospitals. To support this, a solution has been developed, which at first transforms the export of different Radiological Information Systems (RIS) into the data format of a clinical data warehouse (CDW). Additional features, like for example the time between the creation of a radiologic request and the finalization of the diagnosis for the created images, can then be defined using a simple interface and are calculated and saved in the CDW as well. Finally, the query language of the CDW can be used to create custom reports with all the RIS data including the calculated features and export them into the standard formats Excel and CSV. The solution has been successfully tested with data from two German hospitals.

PMID:34545821 | DOI:10.3233/SHTI210543

Stud Health Technol Inform. 2021 Sep 21;283:78-85. doi: 10.3233/SHTI210544.

ABSTRACT

About 30 million people suffer from a rare disease in Europe. Those affected face a variety of problems. These include the lack of information and difficult access to scientific knowledge for physicians. For a higher visibility of rare diseases and high-quality research, effective documentation and use of data are essential. The aim of this work is to optimize the processing, use and accessibility of data on rare diseases and thus increase the added value from existing information. While dashboards are already being used to visualize clinical data, it is unclear what requirements are prevalent for rare diseases and how these can be implemented with available development tools so that a highly accepted dashboard can be designed. For this purpose, based on an analysis of the current situation and a requirements analysis, a prototype dashboard for the visualization of up-to-date key figures on rare diseases was developed at the University Hospital Carl Gustav Carus in Dresden. The development was based on the user-centered design process in order to achieve a high-level user-friendliness. The requirements analysis identified parameters that stakeholders wanted to see, focusing primarily on statistical analyses. The dashboard handles the automated calculation of statistics as well as their preparation and provision. The evaluations showed the prototypical dashboard would be considered valuable and used by potential users. This work demonstrates that stakeholders are interested in access to prepared information and exemplifies a way to implement it. The dashboard can increase the usage of existing information in terms of a higher accessibility and thus improve the knowledge about rare diseases.

PMID:34545822 | DOI:10.3233/SHTI210544

BJPsych Open. 2021 Sep 21;7(5):e174. doi: 10.1192/bjo.2021.993.

ABSTRACT

BACKGROUND: Electronic health records (EHRs) are a significant contributor to physicians’ low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure.

AIMS: The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions.

METHOD: Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics.

RESULTS: Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day.

CONCLUSIONS: EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.

PMID:34545781 | DOI:10.1192/bjo.2021.993

Stud Health Technol Inform. 2021 Sep 21;283:12-19. doi: 10.3233/SHTI210535.

ABSTRACT

The primary intention of any scientific work is to share the gained knowledge and to contribute to the knowledge and progress in the scientific domain. The wide range of journals and conferences, each with specific submission requirements, can be difficult to navigate, especially for young scientists without extensive experience. But a suitable publication strategy can be helpful, especially at the beginning of a scientific career. Using the annual conference of the German Association for Medical Informatics, Biometry and Epidemiology (GMDS) e.V. as an example, this editorial highlights fundamental differences, advantages and disadvantages, as well as assistance in selecting the right form of submission.

PMID:34545815 | DOI:10.3233/SHTI210535

Exp Clin Transplant. 2021 Sep;19(9):910-913. doi: 10.6002/ect.2021.0231.

ABSTRACT

OBJECTIVES: Tacrolimus has a narrow therapeutic window, and lack of adherence to the therapeutic regimen is a main risk factor for acute graft rejection; hence, the prolonged-release formulation was created. A high intrapatient variability for tacrolimus trough levels has been associated with worse graft outcomes; therefore, we investigated the correlation between the tacrolimus variation coefficient and the development of biopsy-proven acute graft rejection in kidney transplant patients with typical maintenance immunosuppression versus the prolonged-release formulation.

MATERIALS AND METHODS: This was a single-center observational retrospective study that included all adult kidney transplants from deceased donors between January 2011 and December 2014 for which the transplant recipients were given maintenance therapy with tacrolimus prolonged-release formulation (Advagraf). The overall tacrolimus variation coefficient was calculated for the follow-up period from transplant until December 2019. Biopsy-proven acute graft rejection results were collected throughout follow-up. Statistical analysis was performed with SPSS software.

RESULTS: The study was composed of 147 patients with a mean follow-up time of 60.4 ± 15 months. The mean age of the patients was 47.5 ± 11.9 years and 67.3% were men. Of these 147 patients, 29 had at least 1 episode of acute graft rejection during follow-up. There was a significant correlation between patients with a higher tacrolimus variation coefficient and the presence of biopsy-proven acute graft rejection. Receiver operating characteristic curves were used to determine an intrapatient variability cutoff point of 28.3% for tacrolimus. Younger patients were also more likely than older patients to develop acute graft rejection in our sample.

CONCLUSIONS: High intrapatient variability of tacrolimus trough levels is a risk factor for acute graft rejection in kidney transplant patients.

PMID:34545776 | DOI:10.6002/ect.2021.0231

J Craniofac Surg. 2021 Sep 20. doi: 10.1097/SCS.0000000000008180. Online ahead of print.

ABSTRACT

Various recent developments, including legislation in 2014 banning healthcare discrimination against gender minorities, have contributed to expanding insurance coverage for gender-affirming care, which includes facial gender confirmation surgery (FGCS). Increasing evidence suggests FGCS improves quality-of-life outcomes, but literature evaluating FGCS patient demographics, surgical risk factors, procedures, and complications is limited. Therefore, the authors conducted a study of a national surgical database from 2005 to 2019 attempting to fill in these literature gaps. Statistics were used to assess temporal trends after 2014. A total of 203 FGCS cases were identified, with the earliest occurring in 2013. Case volume increased annually from 2015-2019. The average patient age was 34.0 years and racial demographics largely mirrored national estimates for the transgender/non-binary population. Obesity (20.7%) and hypertension (3.9%) were the only patient co-morbidities, although a relatively high proportion were underweight (5.4%). The majority of cases were outpatient procedures (66.5%) conducted by either plastic surgery (38.9%) or otolaryngology (61.1%). Comparing FGCSs by anatomic site, the proportion of tracheal procedures decreased between 2015-17 and 2018-19 (25.6% vs. 10.7%, P = 0.0002) whereas the proportion of brow/forehead reconstructions increased (32.6% versus 63.1%, P = 0.0005). These changes coincided with an increase in mean operative time (168.6 minutes versus 260.0, P = 0.0002). Complications were rare (3.9%), and the most common was surgical site infection (3.4%), a previously unreported outcome in the FGCS literature. Overall, FGCS patients are mostly young healthy individuals from diverse racial/ethnic backgrounds, and they have few surgical complications. The increasing volume and complexity of FGCSs may be a result of expanding insurance coverage for previously unaffordable procedures.

PMID:34545054 | DOI:10.1097/SCS.0000000000008180

Med Sci Monit. 2021 Sep 21;27:e932674. doi: 10.12659/MSM.932674.

ABSTRACT

BACKGROUND The aim of this study was to compare the clinical efficacy and postoperative recovery between uterine artery embolization (UAE) and infrarenal aortic balloon occlusion (IABO) in planned cesarean sections for placenta accreta spectrum disorders. MATERIAL AND METHODS A retrospective analysis using the clinical data of 62 patients with placenta previa combined with placenta accreta for planned cesarean between January 2014 and December 2019 was performed at the First People’s Hospital in Lianyungang. Thirty-five cases undergoing UAE during cesarean section were defined as group A, while the other 27 cases undergoing IABO were defined as group B. Intraoperative and postoperative parameters including intraoperative blood loss, blood transfusion volume, radiation duration, radiation dose, hysterectomy rate, operation duration, Intensive Care Unit hospitalization, complications, and neonatal outcomes as well as the maternal recovery during follow-up were compared between the 2 groups. RESULTS Intraoperative blood loss, transfusion volume, radiation time, radiation dose, hysterectomy rate, duration of surgery, Intensive Care Unit admission, and complications were higher in group A than group B, with differences being statistically significant (P<0.05). There were no significant differences in birth weight, 1-min Apgar score, neonatal asphyxia rate, admission to Neonatal Intensive Care Unit, breastfeeding time, duration of postpartum lochia, and data related to menstruation between the 2 groups (P>0.05). CONCLUSIONS IABO, which was more effective than UAE in cesarean section of patients with placenta accreta spectrum, could be further applied in treatment.

PMID:34545059 | DOI:10.12659/MSM.932674

J Craniofac Surg. 2021 Sep 20. doi: 10.1097/SCS.0000000000008188. Online ahead of print.

ABSTRACT

BACKGROUND: Craniosynostosis, a malformation caused by premature closure of one or more cranial sutures, is a rare congenital disability usually of unknown cause; however, it is often associated with assisted reproductive technology. Given the increasing prevalence of craniosynostosis and the use of the in vitro fertilization (IVF) method, the authors evaluated the association between IVF and the prevalence of craniosynostosis.

METHODS: This retrospective study reviewed records of patients with nonsyndromic craniosynostosis who underwent surgery in Mofid Hospital, a tertiary children’s hospital affiliated to Shahid Beheshti University of Medical Sciences, between 2010 and 2019.

RESULTS: A total of 200 patients aged one month to 7 years old, were evaluated. Out of 200 patients, 43% were plagiocephalic, 39% trigonocephalic, 8.5% scaphocephalic, 8% brachiocephalic, and 1.5% were mixed. Nine (4.5%) patients had received clomiphene citrate. Eight (4%) mothers had become pregnant under IVF, and they all had used clomiphene citrate for ovulation stimulation. No use of artificial insemination was reported. Of the eight patients whose mother had become pregnant through IVF, three were trigonocephalic, and five were plagiocephalic.

CONCLUSIONS: Without a control group, we are not able report the statistical results confirming or denying a link between craniosynostosis and infertility treatment. However, 4% prevalence of IVF use among craniosynostosis patients is significant. Further studies with a broader statistical community are suggested in this regard.

PMID:34545049 | DOI:10.1097/SCS.0000000000008188

J Craniofac Surg. 2021 Sep 20. doi: 10.1097/SCS.0000000000008182. Online ahead of print.

ABSTRACT

BACKGROUND: Cone beam computerized computed tomography (CBCT) has been widely indicated in dental implant procedure. The first step that the doctors should perform in local hospitals is to use orthopantomography for surgical planning to avoid and limit the risk of complications. As a result, determining the magnification amount of orthopantomography to achieve a precise diagnosis is clinically important. This study investigated the difference in measurement of the mental foramen (MF) position before dental surgery using 2 views of CBCT.

MATERIALS AND METHODS: Cone beam computed tomography scan was performed for 100 patients who required implant placement. In the panoramic and three-dimensional views of CBCT, the vertical distance between the margin of the mandible and the lower border of MF, and the horizontal distance between the mandibular symphysis and the mesial anterior border of MF were calculated. The differences between the 2 views were compared using Wilcoxon-rank U test with P value ≤ 0.05 considered statistically significant.

RESULTS: The findings of this study showed a substantial statistical difference in the horizontal distance for the dentate patients in panoramic and three-dimensional views (22.7 ± 3.04 versus 21.1 ± 1.6), (22.5 ± 2.4 versus 20.9 ± 1.5) and left side (22.4 ± 2.8 versus 21.2 ± 1.6), (22.4 ± 2.8 versus 20.6 ± 1.4) of both genders. Concerning the vertical distance, a significant difference was also observed in the dentate (12.1 ± 2.1 versus 11.1 ± 1.4), (10.6 ± 1.4 versus 9.6 ± 1.3) and left side of the jaw (11.6 ± 1.95 versus 10.9 ± 1.2), (10.5 ± 1.2 versus 9.96 ± 1.4) for both genders in both views. In the edentulous and right side of the jaw, however no statistical difference was observed between male and female patients in terms of horizontal and vertical measurements.

PMID:34545052 | DOI:10.1097/SCS.0000000000008182