Tag: nevin manimala

J Neurointerv Surg. 2024 Aug 21:jnis-2024-022218. doi: 10.1136/jnis-2024-022218. Online ahead of print.

ABSTRACT

BACKGROUND: Across a wide range of tasks it has been shown that workers switching between different activities have ‘switching costs’ due to slower performance and increased errors. Scheduling similar cases consecutively, or ‘stacking cases’, allows an operating room (OR) team to avoid switching costs and might therefore result in increased efficiency.

OBJECTIVE: To investigate whether stacking neuroendovascular cases decreases turnover and procedure time.

METHODS: A retrospective case series was identified of 4386 endovascular cases performed by vascular neurosurgeons between 2015 and 2023 at an academic center. A ‘stacked case’ was defined as a binary variable, which counted as ‘yes’ when the preceding case was the same procedure. Primary outcomes were turnover time and procedure time.

RESULTS: Diagnostic angiograms (n=2575) and aneurysm embolizations (n=517) had a sufficient number of cases for statistical analysis.Stacked diagnostic angiograms were associated with significantly faster turnover time (7 min, P=1e-12) in a multivariate regression model. Turnover time decreased with additional stacked cases, with a 4 min reduction for a single stacked case, up to 11 min for a fifth stacked angiogram.For angiograms and aneurysm embolizations, stacked cases were associated with shorter procedure times: 4 min for angiograms (P<0.0001) and 20 min for aneurysm embolizations (P=0.0057).

CONCLUSION: This project demonstrates that stacking similar cases is associated with reduced turnover and procedure time, after controlling for other variables that affect the flow of an OR day. Stacking cases is a zero-cost intervention that offers significant efficiency gains in the OR schedule.

PMID:39168620 | DOI:10.1136/jnis-2024-022218

Occup Environ Med. 2024 Aug 21:oemed-2024-109451. doi: 10.1136/oemed-2024-109451. Online ahead of print.

ABSTRACT

Occupational infectious disease risks between men and women have often been attributed to the gendered distribution of the labour force, with limited comparative research on occupation-specific infectious disease risks. The objective of this study was to compare infectious disease risks within the same occupations by gender. A systematic review of peer-reviewed studies published between 2016 and 2021 was undertaken. To be included, studies were required to report infectious disease risks for men, women or non-binary people within the same occupation. The included studies were appraised for methodological quality. A post hoc power calculation was also conducted. 63 studies were included in the systematic review. Among high-quality studies with statistical power (9/63), there was evidence of a higher hepatitis risk for men than for women among patient-facing healthcare workers (HCWs) and a higher parasitic infection risk for men than for women among farmers (one study each). The rest of the high-quality studies (7/63) reported no difference between men and women, including for COVID-19 risk among patient-facing HCWs and physicians, hepatitis risk among swine workers, influenza risk among poultry workers, tuberculosis risk among livestock workers and toxoplasmosis risk among abattoir workers. The findings suggest that occupational infectious disease risks are similarly experienced for men and women within the same occupation with a few exceptions showing a higher risk for men. Future studies examining gender/sex differences in occupational infectious diseases need to ensure adequate sampling by gender.

PMID:39168602 | DOI:10.1136/oemed-2024-109451

Tob Control. 2024 Aug 21:tc-2024-058779. doi: 10.1136/tc-2024-058779. Online ahead of print.

ABSTRACT

INTRODUCTION: Significant progress has been made in reducing maternal exposure to tobacco smoke and subsequent adverse birth outcomes, however, reductions may require strategies that reduce the availability of tobacco retailers. In this study, we investigated the relationship between tobacco retailer density and birth outcomes across the USA and predicted the potential impact of a tobacco retailer density cap on these outcomes.

METHODS: Annual US county (n=3105), rates of preterm birth, low birth weight, small-for-gestational age, all-cause infant mortality and sudden infant death syndrome (SIDS) were calculated using National Vital Statistics System data. Tobacco retailers were identified from the National Establishment Time-Series Database. We used Poisson regression to estimate the effect of capping retailer density at 1.4 retailers per 1000 population, controlling for county demographics and air pollution, using propensity score weighting.

RESULTS: Tobacco retailer density was positively associated with most adverse birth outcomes. We estimate that a nationwide cap on tobacco retailer density, implemented in 2016, would have resulted in a reduction of 4275 (95% CI 2210 to 6392) preterm births, 6096 (95% CI 4421 to 7806) small-for-gestational-age births, 3483 (95% CI 2615 to 4378) low birthweight births, 538 (95% CI 345 to 733) all-cause infant deaths and 107 (95% CI 55 to 158) SIDS deaths in that year.

CONCLUSION: Higher rates of adverse birth outcomes were seen in counties with high tobacco retailer density compared with those with low density. These results provide further support for regulating tobacco retail density to reduce adverse health outcomes associated with tobacco use.

PMID:39168593 | DOI:10.1136/tc-2024-058779

Inj Prev. 2024 Aug 21:ip-2023-045160. doi: 10.1136/ip-2023-045160. Online ahead of print.

ABSTRACT

INTRODUCTION: Paediatric drowning is an injury associated with significant morbidity and mortality.

OBJECTIVE: The objective is to describe drowning trends, including associations with inpatient hospitalisation or fatality, in a state-wide paediatric cohort to inform prevention strategies.

METHODS: In this retrospective cohort study using the Health Services Cost Review Commission database, we used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients aged 0-19 years with an outpatient (including emergency department) or inpatient medical encounter following a non-fatal or fatal drowning event between 2016 and 2019. Descriptive statistics and logistic regression were used to summarise the data and evaluate associations with inpatient hospitalisation or fatality.

RESULTS: There were 541 medical encounters for drowning events, including 483 non-fatal outpatient encounters, 42 non-fatal inpatient encounters and 16 fatal cases. Overall, most patients were boys, 0-4 years, white and lived in urban settings. White children accounted for 66% of encounters among those aged 0-4 years, whereas non-white children accounted for 62% of visits among those aged 10-19 years. Non-white children were more likely than white children to experience a fatal drowning (OR 3.6, 95% CI: 1.2 to 11.5). Adolescents were more likely than younger children to be hospitalised (OR 3.1, 95% CI: 1.6 to 6.5) and had higher charges in outpatient (p=0.002) and inpatient settings (p=0.003).

DISCUSSION: Our study revealed high fatality rates among non-white children and high admission rates among adolescents.

PMID:39168588 | DOI:10.1136/ip-2023-045160

Am J Prev Med. 2024 Sep;67(3):471-472. doi: 10.1016/j.amepre.2024.05.002.

NO ABSTRACT

PMID:39168563 | DOI:10.1016/j.amepre.2024.05.002

Am J Prev Med. 2024 Sep;67(3):470-471. doi: 10.1016/j.amepre.2024.04.003.

NO ABSTRACT

PMID:39168562 | DOI:10.1016/j.amepre.2024.04.003

J Nucl Med. 2024 Aug 21:jnumed.124.267591. doi: 10.2967/jnumed.124.267591. Online ahead of print.

ABSTRACT

This analysis aimed to identify clinical factors associated with positivity on repeat ⁶⁸Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 ⁶⁸Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann-Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2-1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9-3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative ⁶⁸Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat ⁶⁸Ga-PSMA-11 PET/CT.

PMID:39168522 | DOI:10.2967/jnumed.124.267591

BMJ. 2024 Aug 21;386:q1758. doi: 10.1136/bmj.q1758.

NO ABSTRACT

PMID:39168508 | DOI:10.1136/bmj.q1758

BMJ. 2024 Aug 21;386:q1845. doi: 10.1136/bmj.q1845.

NO ABSTRACT

PMID:39168507 | DOI:10.1136/bmj.q1845

BMJ. 2024 Aug 21;386:e078607. doi: 10.1136/bmj-2023-078607.

ABSTRACT

OBJECTIVE: To evaluate the comparative effectiveness and acceptability of oral monotherapy using psychedelics and escitalopram in patients with depressive symptoms, considering the potential for overestimated effectiveness due to unsuccessful blinding.

DESIGN: Systematic review and Bayesian network meta-analysis.

DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, ClinicalTrial.gov, and World Health Organization’s International Clinical Trials Registry Platform from database inception to 12 October 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials on psychedelics or escitalopram in adults with depressive symptoms. Eligible randomised controlled trials of psychedelics (3,4-methylenedioxymethamphetamine (known as MDMA), lysergic acid diethylamide (known as LSD), psilocybin, or ayahuasca) required oral monotherapy with no concomitant use of antidepressants.

DATA EXTRACTION AND SYNTHESIS: The primary outcome was change in depression, measured by the 17-item Hamilton depression rating scale. The secondary outcomes were all cause discontinuation and severe adverse events. Severe adverse events were those resulting in any of a list of negative health outcomes including, death, admission to hospital, significant or persistent incapacity, congenital birth defect or abnormality, and suicide attempt. Data were pooled using a random effects model within a Bayesian framework. To avoid estimation bias, placebo responses were distinguished between psychedelic and antidepressant trials.

RESULTS: Placebo response in psychedelic trials was lower than that in antidepression trials of escitalopram (mean difference -3.90 (95% credible interval -7.10 to -0.96)). Although most psychedelics were better than placebo in psychedelic trials, only high dose psilocybin was better than placebo in antidepression trials of escitalopram (mean difference 6.45 (3.19 to 9.41)). However, the effect size (standardised mean difference) of high dose psilocybin decreased from large (0.88) to small (0.31) when the reference arm changed from placebo response in the psychedelic trials to antidepressant trials. The relative effect of high dose psilocybin was larger than escitalopram at 10 mg (4.66 (95% credible interval 1.36 to 7.74)) and 20 mg (4.69 (1.64 to 7.54)). None of the interventions was associated with higher all cause discontinuation or severe adverse events than the placebo.

CONCLUSIONS: Of the available psychedelic treatments for depressive symptoms, patients treated with high dose psilocybin showed better responses than those treated with placebo in the antidepressant trials, but the effect size was small.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023469014.

PMID:39168500 | DOI:10.1136/bmj-2023-078607