Tag: pubmed

Radiol Oncol. 2024 Nov 28;58(4):501-508. doi: 10.2478/raon-2024-0060. eCollection 2024 Dec 1.

ABSTRACT

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) is a prerequisite for targeted prostate biopsy. The aim of our study was to evaluate the performance and learning curve of the mpMRI-transrectal ultrasound (TRUS) software image fusion (MRI-TRUS fusion) biopsy (BX) process in the first year after its introduction in our urology department.

PATIENTS AND METHODS: MRI-TRUS fusion BX was performed in 293 patients with at least one Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion. The proportion of patients and lesions with positive histopathologic result for prostate cancer (PCa) was analyzed. The learning curve for MRI-TRUS fusion BX was assessed at institutional and individual level. Positive BX lesions were further analyzed by PIRADS and Gleason scores.

RESULTS: The proportion of patients with positive histopathologic results for targeted BX, systematic BX, and combined BX was 53.9%, 47.9%, and 63.5%, respectively. The chi-square test for the proportion of PCa positive patients showed no significant difference between the time-based patient groups at the institutional level and no significant difference between individual urologists. PIRADS score (p < 0.001), total PSA concentration (p = 0.05), prostate volume (p < 0.001) and number of cores per lesion (p = 0.034) were significant predictors of a positive histopathologic result in a lesion-based analysis. Clinically significant PCa (csPCa) was confirmed in 34.7% of the 412 BX lesions and 76.4% of the 187 positive PCa lesions.

CONCLUSIONS: MRI-TRUS fusion targeted BX significantly improves the overall rate of PCa detection compared with systematic BX alone. No steep learning curve was observed in our urologists. The proportion of lesions with clinically insignificant PCa was low, limiting overdiagnosis of PCa.

PMID:39608006 | DOI:10.2478/raon-2024-0060

JMIR Form Res. 2024 Nov 28;8:e63262. doi: 10.2196/63262.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike.

OBJECTIVE: The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health.

METHODS: We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool’s capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users’ monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention.

RESULTS: Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants’ (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants’ response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants’ mental health deteriorated during the intervention.

CONCLUSIONS: The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context.

PMID:39608005 | DOI:10.2196/63262

J Med Internet Res. 2024 Nov 28;26:e53320. doi: 10.2196/53320.

ABSTRACT

BACKGROUND: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients’ access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated.

OBJECTIVE: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas.

METHODS: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions.

RESULTS: The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor’s degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P≥.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth.

CONCLUSIONS: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted.

PMID:39608002 | DOI:10.2196/53320

J Med Internet Res. 2024 Nov 28;26:e53932. doi: 10.2196/53932.

ABSTRACT

BACKGROUND: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs.

OBJECTIVE: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA’s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands).

METHODS: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user.

RESULTS: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37% (n=292 vs n=213) in users and 64% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3% (67/804) were female and 41.4% (333/804) were aged ≥75 years, compared with 4.3% (840/19,583) and 49% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5%; nonusers: 4936/19,583, 25.2%), highly disabled (users: 387/804, 48.1%; nonusers: 9246/19,583, 47.2%), and low-income (users: 165/804, 20.5%; nonusers: 3941/19,583, 20.1%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95% CI 1.29-2.24) and lower for older veterans (aged ≥75 years; 0.33, 95% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95% CI 1.00-1.42; P=.046).

CONCLUSIONS: The VA’s Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings.

PMID:39607997 | DOI:10.2196/53932

J Pediatr Psychol. 2024 Nov 28:jsae097. doi: 10.1093/jpepsy/jsae097. Online ahead of print.

ABSTRACT

OBJECTIVES: Anxiety disorders affect 20%-50% of youth with chronic medical conditions (CMCs) and can interfere with medical care and treatment outcomes. Psychological therapies are typically designed for youth without CMCs; thus, this systematic review (Open Science Framework preregistration osf.io/a52nd/) assesses the effect of psychological therapies on anxiety, functional impairment and health-related quality of life (HRQOL) in this unique population.

METHODS: We included randomized controlled trials of psychological therapies vs. any comparator for youth (ages 24 and younger) with CMCs that assessed child anxiety. We excluded studies of adults and those not in English. Medline, Embase, PsycInfo, and CENTRAL databases were searched, studies were screened using COVIDENCE software, and meta-analysis was undertaken in R. Study quality was assessed using the Cochrane Risk of Bias tool, version 2. Quality of evidence was assessed using the GRADE system.

RESULTS: Thirty-three studies with 2676 participants (ages 5-21 years) were included in the meta-analysis. Nearly all had at least some risk of bias. Overall, psychological interventions resulted in lower anxiety (Hedges’ g = -0.48 [-0.71; -0.25]), but did not have a significant effect on functional impairment or HRQOL. Based on the GRADE criteria, we have moderate confidence in these results. Treatments with higher risk of bias and those with live therapist components had greater effects on anxiety.

CONCLUSIONS: Psychological interventions may be effective for improving anxiety for children and youth with CMCs, particularly those with a live therapist. More high-quality studies are needed to understand what components produce the best outcomes for patients.

PMID:39607990 | DOI:10.1093/jpepsy/jsae097

Braz J Cardiovasc Surg. 2024 Nov 28;e20230254(e20230254). doi: 10.21470/1678-9741-2023-0254.

ABSTRACT

OBJECTIVE: To compare the efficacy of isolated off-pump coronary artery bypass grafting (OPCABG) and of coronary artery bypass grafting (CABG) plus mitral valve plasty (MVP) in treating coronary heart disease with moderate ischemic mitral regurgitation to find a better surgical method.

METHODS: Clinical data of 822 patients diagnosed with coronary heart disease and moderate ischemic mitral regurgitation were analyzed retrospectively. Patients were divided into the OPCABG and CABG+MVP groups according to surgical methods. Baseline data of both groups were corrected, and clinical efficacy of the two surgical methods was analyzed and compared using the propensity score inverse probability of treatment weighting (IPTW) method.

RESULTS: There were no significant differences in the use of mammary artery grafts, number of grafts, and blood product consumption between the two groups (P>0.05) after IPTW. However, the CABG+MVP group had a significantly longer operation time than the OPCABG group (4.13 ± 0.85 hours vs. 5.65 ± 1.02 hours, P<0.001). No statistically significant differences in postoperative major adverse cardiac and cerebrovascular events were observed between the two groups. However, the intra-aortic balloon pump rate was higher in the CABG+MVP group than in the OPCABG group (12.3% vs. 25.0%, P=0.012). Although CABG+MVP can improve ischemic mitral regurgitation significantly (95.4% vs. 81.2%, P<0.001), there were no significant differences in the cumulative survival rate and the incidence of major adverse cardiac and cerebrovascular events between the groups (P>0.05) after IPTW.

CONCLUSION: CABG+MVP may not provide more advantage in patients with coronary heart disease and moderate ischemic mitral regurgitation.

PMID:39607971 | DOI:10.21470/1678-9741-2023-0254

N Z Med J. 2024 Nov 29;137(1606):107-109. doi: 10.26635/6965.6701.

ABSTRACT

Disruption to the circadian clock has impacts on health and wellbeing, including impaired immune function and wound healing. It is plausible that the timing of surgical procedures could impact the body’s response to trauma and susceptibility to infections. Using the Health Quality & Safety Commission data on surgical site infections (SSI) we sought to investigate any possible time of day effects on the incidents of recorded infections. All recorded data from June 2017 to July 2021 were extracted for cardiac and orthopaedic operations in New Zealand. The incidence of SSI was calculated for each 4-hour bin of time across the day. There was a total of 87,034 cases in the analysis, of which 1,327 (1.5%) had an infection. Univariately, there was a significant time of day effect, with operations after 8 pm being 3.91 times more likely to have an infection (p<0.001), and operations between 4 pm and 8 pm being 0.71 times more likely (p=0.03) to have an infection compared to operations conducted between 12 pm and 4 pm. However, when age, acuity and American Society of Anesthesiologists score were included in the model, there were no differences in the rate of infection by time of day. This preliminary work suggests that surgical time of day does not significantly impact incidence of surgical infection when other variables are controlled for. However, this work has not considered other factors that may also be important. We plan to link the SSI data with the National Minimum Dataset to investigate these other factors and conduct a more comprehensive analysis.

PMID:39607969 | DOI:10.26635/6965.6701

N Z Med J. 2024 Nov 29;137(1606):73-91.

ABSTRACT

AIM: Mental wellbeing has been one of the most prominent health concerns in Aotearoa New Zealand and has only been exacerbated by the COVID-19 pandemic. Here we explored factors associated with anxiety and happiness in a mid-pandemic climate in Aotearoa.

METHODS: Analyses were performed on the anxiety and happiness scores from the wellbeing survey in December 2020 (Statistics NZ Tatauranga Aotearoa; 30,000 responders contacted for the Household Labour Force Survey). Correlations and general linear models were used to identify significant predictor variables related to anxiety and happiness scores.

RESULTS: A number of factors correlated with both anxiety and happiness, including loneliness, physical health, family wellbeing, financial wellbeing, age and gender. After controlling for many ethnically stratified social burdens, Māori and Pacific populations demonstrated higher levels of happiness. Discrimination was only associated with anxiety, while generalised trust, trust in the police and in the health system all related to happiness.

CONCLUSION: Anxiety and happiness in a mid-pandemic environment shared many related variables spanning physical, social and financial domains. Additionally, anxiety was associated with greater levels of discrimination, and happiness with trust in public services. Here we provide a window into the state of mental wellbeing in Aotearoa during a global health crisis.

PMID:39607965

N Z Med J. 2024 Nov 29;137(1606):63-72. doi: 10.26635/6965.6562.

ABSTRACT

AIM: New Zealand’s Ministry of Health sets three quality metrics for inpatient stroke care: admission to an organised stroke unit within 24 hours (target 80%), appropriate use of reperfusion therapy (target 12% for ischemic stroke) and transfer to rehabilitation services within 7 days (target 80%). Our aim was to evaluate a large Auckland tertiary hospital’s performance against these indicators.

METHODS: A retrospective study of 200 consecutive stroke patients admitted between April 4 and August 1, 2021, was conducted.

RESULTS: Fifty percent (100/200) of patients were admitted to the stroke unit within 24 hours. Sixteen point six percent (27/183) of ischaemic stroke patients received reperfusion therapy. Twenty-four point five percent (49/200) were transferred to rehabilitation services, of which 40.8% (20/49) were within 7 days of presentation. Patients were less likely to be admitted to the stroke unit within 24 hours if not admitted by the stroke service, if admitted out-of-hours or if suffering an inpatient stroke. Timely admission to the stroke unit was associated with receipt of reperfusion therapy, shorter time to inpatient rehabilitation transfer and shorter duration of admission. Patients with inpatient stroke were less likely to be discharged in a timely manner (adjusted hazard ratio [HR] 0.19; 95% CI 0.07-0.50). All-cause mortality during a hospitalisation episode with a stroke diagnosis was likely to occur early in the admission (adjusted HR 1.82; 95% CI 1.01-3.32).

CONCLUSIONS: The hospital met the reperfusion therapy target but fell short on timely stroke unit admission and rehabilitation transfer. An after-hours effect on stroke unit admission was observed, previously undocumented in New Zealand.

PMID:39607964 | DOI:10.26635/6965.6562

N Z Med J. 2024 Nov 29;137(1606):22-39. doi: 10.26635/6965.6654.

ABSTRACT

AIM: The study explored whether the reported experience of primary healthcare differs for survey respondents in Aotearoa New Zealand who self-report having a mental health (MH) condition in comparison with those who do not.

METHOD: Responses to the New Zealand Health Quality & Safety Commission’s adult primary care patient experience survey received from August 2020 to May 2022 were analysed. Comparative analysis of patient-reported experience measures were completed to contrast experiences reported by those with and without a MH condition, with results stratified by ethnicity (Māori/non-Māori), age group and gender. Age/gender-standardised estimates for proportions of positive responses to each question were developed for each group alongside standardised risk differences.

RESULTS: Our sample comprised 201,650 responses, with 21% reporting a current diagnosed MH condition. While most respondents reported positive experiences of primary healthcare, we found a consistent pattern of fewer positive experiences for those with MH conditions across dimensions of care quality, age and gender groups. When responses were separated by ethnicity, this difference was amplified among Māori.

CONCLUSION: This analysis adds to the increasing body of evidence that experience of MH conditions is associated with worse healthcare experiences. It demonstrates that data are available in Aotearoa New Zealand to routinely monitor and report on primary care experiences for this group. Interventions to improve healthcare should focus on care for Māori with MH conditions as a priority.

PMID:39607961 | DOI:10.26635/6965.6654