Tag: pubmed

Diagn Microbiol Infect Dis. 2024 Dec 9;111(3):116654. doi: 10.1016/j.diagmicrobio.2024.116654. Online ahead of print.

ABSTRACT

Endodontic infections include conditions such as pulp necrosis, apical periodontitis, abscesses, granulomas, and periapical cysts. Detection of pathogenic microorganisms responsible for these diseases is essential for accurate diagnosis and future therapy. Enterococcus faecalis, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were analyzed qualitatively and quantitatively using the Checkerboard methodology for DNA-DNA hybridizations as a bacterial identification tool. Clinical investigations have shown a significant frequency of these microorganisms. The present systematic review and meta-analysis aimed to determine the prevalence of E. faecalis and red complex bacteria (RCB) (P. gingivalis, T. forsythia, and T. denticola) analyzed by the Checkerboard DNA-DNA hybridization technique in endodontic infections. This systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines-electronic databases: PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar. Statistical analysis was performed using STATA V.15 software. Seventeen articles were included, of which a total of 620 samples were evaluated. Five hundred sixty-seven samples were taken from infected root canals, 34 samples from periradicular tissues, and 27 samples from periapical abscesses of infected teeth. The prevalence of E. faecalis in endodontic infections in all studies was 74 %, of P. gingivalis was 63 %, of T. forsythia 46 %, and of T. denticola 58 %. The presence of bacteria such as E. faecalis reduces the efficiency of endodontic therapy and leads to recurring infections. It is recognized that “RCB” can be identified in endodontic lesions; however, they are not usually prominent. The DNA-DNA hybridization approach is critical for identifying bacteria and detecting difficult-to-culture microorganisms, making it a helpful and cost-effective tool for directing personalized endodontic treatments.

PMID:39689402 | DOI:10.1016/j.diagmicrobio.2024.116654

Eur J Obstet Gynecol Reprod Biol. 2024 Dec 10;305:125-131. doi: 10.1016/j.ejogrb.2024.12.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Over the past decade, intrapartum ultrasound (ITU) has been in the global limelight for labour monitoring. The use of the same in clinical settings of low- and middle-income countries (LMIC’s) however, is limited. Till date, angle of progression (AOP) stands as the most studied parameter. Very few studies, most from developed countries, have shown that other ITU measurements could also hold relevance to labour and delivery. In recent times, serial ITU has also garnered some attention and could possibly be a better predictor of labour outcome.

AIMS: This study aimed to compare the predictive accuracies of AOP and head PD for vaginal delivery and to investigate whether the rate of change of serially measured AOP and head PD in the first stage is predictive of vaginal delivery.

METHODS: A prospective observational study was conducted on 90 nulliparous women between April 2023 and July 2024 at a tertiary teaching hospital in South India. Participants had singleton pregnancies in cephalic presentation between 37-40 weeks with regular contractions, and cervical dilation ≥ 3 cm. Exclusion criteria included prior LSCS and abnormal cardiotocography. Intrapartum ultrasound was performed twice, once at recruitment and 3-5 h apart, to measure AOP and PD. Statistical analysis included ROC curve plotting for diagnostic accuracy of AOP and PD in predicting vaginal delivery.

RESULTS: Of the 90 participants, 71 (78.9 %) delivered vaginally and 19 (21.1 %) had caesarean sections. AOP ≥ 120° and PD ≥ 2.7 cm at ≥ 6 cm cervical dilation showed a strong correlation with vaginal delivery, with sensitivity and specificity of 70.4 % and 94.7 %, and 63.4 % and 89.5 % respectively. Change (delta) in AOP > 10° had the highest diagnostic accuracy (81 %), with a positive predictive value of 92.2 %.

CONCLUSION: ITU offers valuable insights into labour progression. AOP and PD, particularly at cervical dilation of ≥ 6 cm, are predictive of vaginal delivery. Delta AOP serves as the most accurate predictor. Incorporating ITU into routine labour management enhances clinical decision-making, helping reduce unnecessary interventions and caesarean deliveries.

PMID:39689388 | DOI:10.1016/j.ejogrb.2024.12.014

Diabetes Metab Syndr. 2024 Dec 10;19(1):103170. doi: 10.1016/j.dsx.2024.103170. Online ahead of print.

ABSTRACT

INTRODUCTION: This study explored the effectiveness of current placenta-derived biomaterials therapies in ulcer healing in DFU compared to standard of care (SOC).

METHODS: The systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. The electronic databases of PubMed, EMBASE, and Web of Science (WoS) internet were searched for the outcome rate of complete ulcer healing. The risk of bias assessment was conducted using the tool recommended by the Cochrane Collaboration. Statistical analysis included the individual and combined result of the studies, heterogeneity test, the effect size, sensitivity analysis, and publication bias tests.

RESULTS: Twelve randomized controlled trials (RCTs) with a total of 833 patients were included in this study. This meta-analysis showed a higher rate of complete ulcer healing in groups receiving placenta-derived biomaterials therapies (OR = 6.247 [4.425, 8.819], p < 0.01, I² = 41 %) compared to control groups.

CONCLUSION: Placenta-derived biomaterials therapies have been shown to be more effective for achieving complete ulcer healing compared to current conventional treatments in DFU.

IMPLICATIONS FOR CLINICAL PRACTICE: The utilization of placenta-derived biomaterials in therapies for wound healing, particularly in chronic DFU, presents promising implications for clinical practice. These biomaterials offer a rich source of growth factors, cytokines, and extracellular matrix components, which can stimulate tissue regeneration and angiogenesis. Incorporating such therapies into clinical practice holds the potential to accelerate wound closure, reduce infection rates, and improve overall healing outcomes in people with diabetic chronic foot ulcers. Furthermore, the availability of these biomaterials can offer clinicians a readily-accessible and cost-effective alternative to traditional wound care approaches, ultimately enhancing patient care and quality of life. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

PMID:39689387 | DOI:10.1016/j.dsx.2024.103170

J Med Internet Res. 2024 Dec 17;26:e55982. doi: 10.2196/55982.

ABSTRACT

BACKGROUND: As of 2021, at least 4 out of every 5 hospitals offered patients access to clinical notes via a web-based patient portal, a number that is expected to grow because of the 21st Century Cures Act. There is limited data on how open note use may have evolved over time or which types of clinical interactions were viewed most in the outpatient setting.

OBJECTIVE: This study aims to analyze trends in outpatient open note access over time; characterize usage in terms of age, sex, and clinical interaction type; and assess the method of access to help uncover areas of improvement in patient engagement and identify further areas of research.

METHODS: A retrospective observational study was conducted at Erie County Medical Center from November 1, 2021, to December 31, 2022, to coincide with the time that open notes went live. Outpatient note access and account logs were downloaded from the portal and combined into a single dataset consisting of 18,384 note accesses by 4615 users, with column headings of the patient index, sex, age, note title that was accessed, clinical interaction type, time stamp of note creation, time stamp of access, and method of access (web vs mobile). A separate table was created with sex data for all 35,273 portal accounts. Microsoft Excel and Microsoft Power Query were used to combine and analyze the data.

RESULTS: During the study period, 4615 portal users viewed 12,150 documents for a total of 18,384 times, averaging 2.6 notes per patient viewed 4 times. Only 13.1% (4615/35,273) of all portal inpatient and outpatient registrants viewed their outpatient notes. There was a female predominance in those who viewed notes (2926/4615, 63.4%; P<.001), while 56.8% (20,047/35,273) of all portal registrants were female. Users in their 30s and 50s accessed more notes than other age groups. The ratio of mobile-to-web access of notes tended to decrease as a function of increasing age, which was not observed in those aged ≥90 years. Notes regarding COVID-19 assessments were the most accessed among all clinical interactions (4725/12,150, 38.9%). Overall, the number of users accessing notes reached a maximum of 1968 before declining to 1027 by the end of the study period.

CONCLUSIONS: Open note access was largely dominated by COVID-19 assessments, and the number of users viewing their notes has declined over time as the pandemic subsided. Furthermore, female patients and those aged in their 30s as well as 50s viewed more notes than other groups. Finally, the percentage of notes viewed via a mobile device tended to decrease as a function of increasing age, showing that web-based access of open notes is an important modality for older patients.

PMID:39689311 | DOI:10.2196/55982

J Med Internet Res. 2024 Dec 17;26:e63155. doi: 10.2196/63155.

ABSTRACT

BACKGROUND: Evaluating precision oncology outcomes requires access to real-world and clinical trial data. Access is based on consent, and consent is based on patients’ informed preferences when deciding to share their data. Decision-making is often modeled using utility theory, but a complex decision context calls for a consideration of how heuristic, intuitive thought processes interact with rational utility maximization. Data-sharing decision-making has been studied using heuristic theory, but almost no heuristic research exists in the health data context. This study explores this evidence gap, applying a qualitative approach to probe for evidence of heuristic mechanisms behind the health data-sharing preferences of those who have experienced cancer. Exploring qualitative decision-making reveals the types of heuristics used and how they are related to the process of decision-making to better understand whether consent mechanisms should consider nonrational processes to better serve patient decision-making.

OBJECTIVE: This study aimed to explore how patients with cancer use heuristics when deciding whether to share their data for research.

METHODS: The researchers conducted a focus group study of Canadians who have experienced cancer. We recruited participants through an online advertisement, screening individuals based on their ability to increase demographic diversity in the sample. We reviewed the literature on data-sharing platforms to develop a semistructured topic guide on concerns about data sharing, incentives to share, and consent and control. Focus group facilitators led the open-ended discussions about data-sharing preferences that revealed underlying heuristics. Two qualitative analysts coded transcripts using a heuristic framework developed from a review of the literature. Transcripts were analyzed for heuristic instances which were grouped according to sociocultural categories. Using thematic analysis, the analysts generated reflexive themes through norming sessions and consultations.

RESULTS: A total of 3 focus groups were held with 19 participants in total. The analysis identified 12 heuristics underlying intentions to share data. From the thematic analysis, we identified how the heuristics of social norms and community building were expressed through altruism; the recognition, reputation, and authority heuristics led to (dis)trust in certain institutions; the need for security prompted the illusion of control and transparency heuristics; and the availability and affect heuristics influenced attitudes around risk and benefit. These thematic relationships all had impacts on the participants’ intentions to share their health data.

CONCLUSIONS: The findings provide a novel qualitative understanding of how health data-sharing decisions and preferences may be based on heuristic processing. As patients consider the extent of risks and benefits, heuristic processes influence their assessment of anticipated outcomes, which may not result in rational, truly informed consent. This study shows how considering heuristic processing when designing current consent mechanisms opens up the opportunity for more meaningful and realistic interactions with the complex decision-making context.

PMID:39689309 | DOI:10.2196/63155

JMIR Public Health Surveill. 2024 Dec 17;10:e65093. doi: 10.2196/65093.

ABSTRACT

BACKGROUND: Despite the high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People’s Democratic Republic (Lao PDR), Lao health care workers (HCWs) have previously been shown to have low levels of protection against infection. Furthermore, the prevalence of hepatitis D virus (HDV), which increases disease severity in individuals infected with HBV, is not known in Lao PDR.

OBJECTIVE: This study aimed to estimate the exposure and seroprotection against HBV, as well as exposure to HDV, in Lao HCWs from 5 provinces.

METHODS: In 2020, a total of 666 HCWs aged 20 to 65 years from 5 provinces of Lao PDR were recruited, and their sera were tested by enzyme-linked immunosorbent assay to determine their HBV and HDV coinfection status.

RESULTS: HBV exposure, as indicated by the presence of anti-hepatitis B core antibodies, was 40.1% (267/666) overall and significantly higher for HCWs from Oudomxay province (21/31, 67.7%; adjusted odds ratio 3.69, 95% CI 1.68-8.12; P=.001). The prevalence of hepatitis B surface antigen was 5.4% (36/666) overall and increased with age, from 3.6% (9/248) in those aged ≤30 years to 6.8% (8/118) in those aged ≥50 years. Only 28.7% (191/666) of participants had serological indication of immunization. We could find no evidence for HDV exposure in this study.

CONCLUSIONS: The study found intermediate hepatitis B surface antigen prevalence among HCWs in Lao PDR, with no evidence of HDV coinfection. Notably, a significant proportion of HCWs remains susceptible to HBV, indicating a substantial gap in seroprotection against the disease.

PMID:39689257 | DOI:10.2196/65093

Menopause. 2024 Dec 17. doi: 10.1097/GME.0000000000002459. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of the study are to explore the range and variation in serum estradiol concentration, and to estimate the prevalence of “poor absorption” (women using licensed estradiol doses with subtherapeutic levels), in perimenopausal and postmenopausal women using transdermal estradiol in the real world.

METHODS: This is a cross-sectional analysis in a specialist menopause clinic in the UK.

RESULTS: Serum samples were obtained from 1,508 perimenopausal and postmenopausal women. A total of 61.87% were using licensed doses. The median estradiol concentration was 355.26 pmol/L (interquartile range 198.44-646.15 pmol/L). A reference interval for the whole cohort was defined as 54.62-2,050.55 pmol/L. There was substantial interindividual variation across the dose range. Variance was greater in younger women (P = 0.002) and gel users (P = 0.002). There was a trend toward greater variance in women using higher doses, but the association failed to reach statistical significance (P = 0.074). One in four women (24.84%) using the highest licensed dose had subtherapeutic levels (<200 pmol/L). Older women (≥50 y) and patch users were more likely to have low levels (odds ratio 1.77, 95% confidence interval 1.22-2.62, P = 0.003; and odds ratio 1.51, 95% confidence interval 1.18-1.95, P = 0.001, respectively).

CONCLUSIONS: The reference interval for perimenopausal and postmenopausal women using on-label and off-label doses of transdermal estradiol in the real world is wide, and there is considerable interindividual variation. The number of estradiol users with low estradiol levels (<200 pmol/L) is higher than previously recognized. Measurement of serum estradiol can be helpful to identify women who may benefit from an off-label dose. Dose customization is key to ensure that all women can reap the benefits of HT.

PMID:39689249 | DOI:10.1097/GME.0000000000002459

Menopause. 2024 Dec 17. doi: 10.1097/GME.0000000000002460. Online ahead of print.

ABSTRACT

OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) and vasomotor symptoms (VMS) are associated with increased cardiovascular disease risk. Although visceral adiposity has been linked to MASLD and VMS independently, this study aimed to evaluate associations between the two in midlife women.

METHODS: A cross-sectional study of women aged 45-60 years receiving primary care at one of four sites was conducted from March 1 through June 30, 2021. MASLD diagnosis was obtained utilizing the International Classification of Diseases, Ninth Revision and Tenth Revision codes. VMS burden was evaluated with the Menopause Rating Scale and categorized as severe/very severe versus none/mild/moderate. Logistic regression models were used to assess the association between VMS and diagnosed MASLD both univariately and after individually adjusting for several risk factors.

RESULTS: A total of 4,599 women were included in the final analysis, 304 (7%) of whom had an MASLD diagnosis. On univariate analysis, women with an MASLD diagnosis were more likely to have severe/very severe VMS (odds ratio [OR], 1.50; 95% CI, 1.08-2.08; P = 0.015). However, the association between MASLD diagnosis and severe/very severe VMS was no longer statistically significant after individually adjusting for body mass index (adjusted OR, 1.36; 95% CI, 0.97-1.92) and hypertension (adjusted OR, 1.38; 95% CI, 0.99-1.93).

CONCLUSIONS: The relationship between MASLD and VMS appears to be best explained by other variables including BMI and hypertension. Although they do not appear to be directly linked, given the prevalence of bothersome VMS in midlife women, addressing VMS may enable greater adherence to lifestyle modifications as part of MASLD management.

PMID:39689247 | DOI:10.1097/GME.0000000000002460

Cancer Nurs. 2024 Dec 18. doi: 10.1097/NCC.0000000000001413. Online ahead of print.

ABSTRACT

BACKGROUND: Unmet supportive needs are directly correlated with more frequent psychological distress, reduced quality of life, and low patient satisfaction with healthcare and indirectly connected with low compliance with treatment and increased care-related costs.

OBJECTIVE: To assess the spectrum of unmet needs among patients with cancer in Oman and identify predictors of these needs and their relationship with psychological distress and symptom burden.

METHOD: A descriptive, correlational study design was used, involving 551 patients with cancer from 2 major healthcare facilities in Muscat, Oman. Data on patients’ unmet needs were collected between January and June 2023 using the Supportive Care Needs Survey Short-Form 34.

RESULTS: Participants had a mean age of 45.8 (SD, 15.6) years, with female patients comprising 65.5% of the sample. Breast cancer was the most prevalent type of cancer. The mean unmet need score was 31.0/100 (SD, 20.1). Statistical analysis revealed significant predictors of unmet needs, including marital status, treatment type, performance status, symptom interference, and psychological distress, with the regression model explaining 26% of the variance in unmet needs.

CONCLUSIONS: Healthcare providers must regularly assess supportive needs, recognizing that they may vary across populations and are influenced by cultural factors. Additionally, individuals identified as having characteristics that predict higher levels of need should receive focused and prioritized supportive care.

IMPLICATIONS FOR PRACTICE: By adopting regular tailored assessments that address the comprehensive supportive needs of patients with cancer, clinicians can significantly enhance patients’ quality of life and optimize treatment outcomes.

PMID:39689231 | DOI:10.1097/NCC.0000000000001413

Urogynecology (Phila). 2024 Dec 18. doi: 10.1097/SPV.0000000000001622. Online ahead of print.

ABSTRACT

IMPORTANCE: Restrictive physical activity after pelvic reconstructive surgery is recommended, although the optimal duration and intensity are not standardized.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the existing literature comparing clinical outcomes for liberal postoperative physical activity versus standard of care, defined as restricted postoperative physical activity, after pelvic reconstructive surgery.

STUDY DESIGN: PubMed, CENTRAL, Scopus, Web of Science, and CINAHL databases were searched for observational and randomized studies comparing liberal postoperative physical activity and standard of care in women undergoing pelvic reconstructive surgery, reporting anatomic and functional outcomes. Statistical analysis was performed using RevMan software, presenting results as mean difference (MD) or odds ratio in a random-effects model, with 95% confidence intervals (CIs).

RESULTS: Five randomized trials, representing total n = 434, were included, with 2 studies on sling surgical procedures and 3 on prolapse surgical procedures. Data from 3 studies suggest no significant difference between liberal and standard postoperative instructions in surgical outcomes, measured by Point Ba from POP-Q assessment tool, up to 3 months follow-up (MD, -0.04; 95% CI, -0.16 to 0.07; P = 0.49). Disease-specific symptom distress, measured by Pelvic Floor Distress Inventory-20, favored the liberal approach (MD, -10.09; 95% CI, -18.33 to -1.86; P = 0.02). Other domains, including Urinary Distress Inventory-6, also showed significant improvements with liberal postoperative activities (MD, -4.29; 95% CI, -7.84 to -0.74; P = 0.02).

CONCLUSIONS: Patients with liberal postoperative physical activity recommendations in prolapse repair surgical procedures had similar short-term anatomic outcomes compared with standard restrictions, with more favorable outcomes in disease-specific symptom relief and quality of life.

PMID:39689229 | DOI:10.1097/SPV.0000000000001622