Tag: nevin manimala

Risk Anal. 2021 Jun 19. doi: 10.1111/risa.13772. Online ahead of print.

ABSTRACT

Structured expert judgment (SEJ) is a method for obtaining estimates of uncertain quantities from groups of experts in a structured way designed to minimize the pervasive cognitive frailties of unstructured approaches. When the number of quantities required is large, the burden on the groups of experts is heavy, and resource constraints may mean that eliciting all the quantities of interest is impossible. Partial elicitations can be complemented with imputation methods for the remaining, unelicited quantities. In the case where the quantities of interest are conditional probability distributions, the natural relationship between the quantities can be exploited to impute missing probabilities. Here we test the Bayesian intelligence interpolation method and its variations for Bayesian network conditional probability tables, called “InterBeta.” We compare the various outputs of InterBeta on two cases where conditional probability tables were elicited from groups of experts. We show that interpolated values are in good agreement with experts’ values and give guidance on how InterBeta could be used to good effect to reduce expert burden in SEJ exercises.

PMID:34146431 | DOI:10.1111/risa.13772

Pharmacoepidemiol Drug Saf. 2021 Jun 19. doi: 10.1002/pds.5310. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to analyse the epidemiology of polypharmacy in hospital psychiatry. Another aim was to investigate predictors of the number of drugs taken and the associated risks of drug-drug interactions and potentially inappropriate medications in the elderly.

METHODS: Daily prescription data were obtained from a pharmacovigilance project sponsored by the Innovations Funds of the German Federal Joint Committee.

RESULTS: The study included 47 071 inpatient hospital cases from 8 different study centers. The mean number of different drugs during the entire stay was 6.1 (psychotropic drugs = 2.7; others = 3.4). The mean number of drugs per day was 3.8 (psychotropic drugs = 1.6; others = 2.2). One third of cases received at least five different drugs per day on average during their hospital stay (polypharmacy). Fifty-one percent of patients received more than one psychotropic drug simultaneously. Hospital cases with polypharmacy were 18 years older (p < 0.001), more likely to be female (52% versus 40%, p < 0.001) and had more comorbidities (5 versus 2, p < 0.001) than hospital cases without polypharmacy. The risks of drug-drug interactions (OR = 3.7; 95% CI = 3.5-3.9) and potentially inappropriate medication use in the elderly (OR = 2.2; CI = 1.9-2.5) substantially increased in patients that received polypharmacy.

CONCLUSION: Polypharmacy is frequent in clinical care. The number of used drugs is a proven risk factor of adverse drug reactions due to drug-drug interactions and potentially inappropriate medication use in the elderly. The potential interactions and the specific pharmacokinetics and -dynamics of older patients should always be considered when multiple drugs are used.

PMID:34146372 | DOI:10.1002/pds.5310

Haemophilia. 2021 Jun 19. doi: 10.1111/hae.14360. Online ahead of print.

ABSTRACT

INTRODUCTION: Haemophilia research has traditionally focused on patients diagnosed with haemophilia and although research priorities are rapidly changing, there is still a lot more we need to understand about the experiences and psychosocial issues facing women who are diagnosed as carriers of haemophilia (Haemophilia, https://doi.org/10.1111/hae.14043). One study noted that the understanding of carriers’ experience of bleeding by healthcare professionals is limited and that many women have had negative experiences of healthcare (Haemophilia, 17, 2011, 237). The carrier population does not typically receive much support for themselves as individuals as they are often not registered at Haemophilia Centres in their own right.

AIM: This study aimed to look at the emotional wellbeing of carriers in more detail.

METHOD: This was initially investigated through the use of focus groups and individual interviews with 16 participants (Stage 1) and then widening the study using an online questionnaire battery developed from the themes identified from these interviews (Stage 2). The questionnaire battery was completed by 226 participants.

RESULTS: Descriptive statistics are reported on the endorsement of themes identified in Stage 1 and around participants’ experiences of their carriership and healthcare. Results demonstrated that the participants have had a number of difficulties with accessing helpful information and support during key times in their lives, for example, at diagnosis and when deciding whether to start a family. They also showed that although participants endorsing a higher number of bleeding symptoms scored statistically significantly higher in measures of depression, anxiety and negative affect, this difference was not clinically significant.

CONCLUSION: These results lend support to the growing evidence base that women who are carriers of haemophilia have a distinct set of (currently unmet) needs that need assessing and treating.

PMID:34146374 | DOI:10.1111/hae.14360

J Community Psychol. 2021 Jun 19. doi: 10.1002/jcop.22637. Online ahead of print.

ABSTRACT

Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.

PMID:34146356 | DOI:10.1002/jcop.22637

Aust Endod J. 2021 Jun 19. doi: 10.1111/aej.12539. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis was sought to assess whether intentional foraminal enlargement (IFE) is responsible for extrusion of a larger quantity of debris from extracted human teeth with fully formed apexes. Following the recommendations of Preferred Reporting Items for Systematic Review and Meta-Analysis – PRISMA, electronic and manual searches were performed to identify studies that evaluated the extrusion of debris, comparing different apical limits of instrumentation (with/without IFE). The quality of the studies selected was evaluated, and statistical analysis was conducted. To perform the meta-analysis, just 3 papers could be used. The heterogeneity was high, however; there was no statistically significant difference in relation to the extrusion of debris in teeth either submitted or not submitted to IFE. The general risk of bias was moderate. In conclusion, IFE is not responsible for extrusion of a larger quantity of debris from extracted human teeth with fully formed apexes.

PMID:34146366 | DOI:10.1111/aej.12539

Oral Dis. 2021 Jun 19. doi: 10.1111/odi.13942. Online ahead of print.

ABSTRACT

OBJECTIVE: To survey the frequency and pattern of family history for non-syndromic orofacial clefts (NSOFC). Initial hypothesis: more complex forms have a higher frequency of positive family history.

MATERIALS AND METHODS: A retrospective study was carried with 2,668 subjects with three different types of clefts (CL Group (cleft lip), CLP Group (cleft lip and palate), and CP group (cleft palate)); family history information was collected. The Chi-square (X² ) and Z-test were used.

RESULTS: A positive family history was found in 31% of the sample. The CLP group had highest percentage and highest proportion of affected relatives, being these factors statistically significant when compared to the CP group. Comparisons between the CLP Male and CL Male with CP Male were statistically significant. First-degree kinship was the most frequently found. Additionally.

CONCLUSIONS: The initial hypothesis was confirmed, subjects with CLP had the highest percentage of positive family history, the highest proportion of affected relatives and had more affected relatives in comparison with CP. It is more common to find affected relatives in the CLP Male and CL Male groups when compared with CP Male. CLP and CP groups present a pattern of occurrence of the type of cleft in the family.

PMID:34146367 | DOI:10.1111/odi.13942

MMW Fortschr Med. 2021 Jun;163(Suppl 2):28-35. doi: 10.1007/s15006-021-9713-1.

ABSTRACT

The steady development of the antiretroviral therapy (ART) has led to a significant change in the demands on the quality of care. There are different regional challenges.It is a non-interventional, bicentric correlation study in the form of a retrospective data analysis including data of 43 HIV-positive patients in Greifswald and 1669 in Berlin. All variables were evaluated with R. Statistical significance was assumed at a p-value of ≤ 0.05.The immunological parameters showed a significantly lower CD4+ T-lymphocyte cell count in patients from Greifswald compared to those from Berlin (B: 516/μl blood; G: 266/μl blood; p < 0.001). The supply of ART was > 80% (B: 153/184 [83.15%]; G: 36/41 [87.8%]; p = 0.64) in both cohorts and led to a permanent (> than 4 quarters) drop of the viral load below the detection limit in 115/184 [62.25%] patients in Berlin and 23/41 [56.09%] patients in Greifswald (p = 0.008).This study has shown that the quality of care for HIV-infected patients in both urban and rural areas is of a high standard and carried out in accordance with the guidelines.

PMID:34146315 | DOI:10.1007/s15006-021-9713-1

J Eur Acad Dermatol Venereol. 2021 Jun 19. doi: 10.1111/jdv.17464. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic sun damage in the background is common in pigmented actinic keratoses and Bowen’s disease (pAK/BD). While explainable artificial intelligence (AI) demonstrated increased background attention for pAK/BD, humans frequently miss this clue in dermatoscopic images because they tend to focus on the lesion.

AIM: To analyze whether perilesional sun damage is a robust diagnostic clue for pAK/BD and if teaching this clue to dermatoscopy users improves their diagnostic accuracy.

METHODS: We assessed the interrater agreement and the frequency of perilesional sun damage in 220 dermatoscopic images and conducted a reader study with 124 dermatoscopy users. The readers were randomly assigned to one of two online tutorials; one tutorial pointed to perilesional sun damage as a clue to pAK/BD (group A) the other did not (group B). In both groups we compared the frequencies of correct diagnoses before and after receiving the tutorial.

RESULTS: The frequency of perilesional sun damage was higher in pAK/BD than in other types of pigmented skin lesions and interrater agreement was good (kappa=0.675). The diagnostic accuracy for pAK/BD improved in both groups of readers (group A: +16.1%, 95%-CI:9.5-22.7; group B: +13.1%; 95%-CI:7.1-19.0; p for both <0.001), but the overall accuracy improved only in group A from 59.1% (95%-CI:55.0-63.1) to 63.5% (95%-CI:59.5-67.6); p=0.002).

CONCLUSION: Perilesional sun-damage is a good clue to differentiate pAK/BD from other pigmented skin lesions in dermatoscopic images, which could be useful for teledermatology. Knowledge of this clue improves the accuracy of dermatoscopy users, which demonstrates that insights from explainable AI can be used to train humans.

PMID:34146354 | DOI:10.1111/jdv.17464

Endocrine. 2021 Jun 19. doi: 10.1007/s12020-021-02797-9. Online ahead of print.

ABSTRACT

PURPOSE: Thyroid Bethesda classification system provides 6 diagnostic categories, the first being a sample deemed non-diagnostic or insufficient and requiring a subsequent second biopsy. Our objective was to evaluate differences in non-diagnostic fine needle aspiration (FNA) of thyroid nodules conducted with a 23-gauge(G) needle vs. those conducted with a 25 G needle.

METHODS: Data from 298 aspiration procedures using either 23 G or 25 G needles were collected, including cytological findings, ultrasound characteristics and patient demographics. The samples were classified as diagnostic or non-diagnostic according to final cytology.

RESULTS: There was no statistically significant difference between the 25 G and 23 G needles in terms of non-diagnostic rates (35.7%, 31.9%; p = 0.494). Nodules defined as cystic had higher non-diagnostic rates (p < 0.05). Older patients as well as cystic nodules were associated with a higher non-diagnostic rate (OR = 1.018, p = 0.047, OR = 13.533, p = 0.0001, respectively), while nodule size was associated with lower non-diagnostic rates (OR = 0.747, p = 0.017).

CONCLUSIONS: The use of 25 G needle did not produce a lower non-diagnostic rate when compared to 23 G needle. Larger nodules might increase diagnostic rates, while older patients and cystic nodules are prone to inadequate samples. Patients and caregivers should be aware that FNA of small or cystic nodules as well as nodules in older patients may result in a higher non-diagnostic rate. Further research comparing other needles gauges should be conducted.

PMID:34146249 | DOI:10.1007/s12020-021-02797-9

Eur Arch Paediatr Dent. 2021 Jun 19. doi: 10.1007/s40368-021-00641-2. Online ahead of print.

ABSTRACT

PURPOSE: Pulpectomy may be indicated in restorable primary teeth exhibiting irreversible pulpitis or pulpal necrosis. The purpose of this study was to compare the cleaning and shaping efficacy of NiTi systems (Reciproc^® Blue and MTwo^®) with manual stainless-steel instrumentation in primary molars using micro-CT analysis.

METHODS: Fifty-seven maxillary second primary molars were scanned using micro-CT. Teeth with three divergent roots were divided randomly (n = 15) according to instrument type (K file, MTwo®, and Reciproc® Blue). Teeth with root fusion were instrumented manually as a separate group (n = 12). Pre- and post-instrumentation micro-CT images were superimposed, and the instrumentation area (IA) and procedural complications were recorded.

RESULTS: No statistically significant differences in IA between file systems was observed in the non-fused teeth. The mean IA of fused roots was significantly lower than in the non-fused distobuccal (p = 0.003) and palatal (p < 0.001) roots. The root segment had a significant effect on IA (p < 0.001) and the highest mean IA was observed in the apical third. Manual instrumentation had fewer procedural complications compared with rotary systems.

CONCLUSION: No differences were determined in the cleaning and shaping effectiveness of all systems in non-fused teeth. Uninstrumented areas (> 60%) occurred in both non-fused and fused primary teeth with fewer procedural complications observed after manual instrumentation.

PMID:34146251 | DOI:10.1007/s40368-021-00641-2