Tag: pubmed

Mar Environ Res. 2024 Jul 30;200:106663. doi: 10.1016/j.marenvres.2024.106663. Online ahead of print.

ABSTRACT

Marine Animal Forests (MAFs) form three-dimensional seascapes and provide substrate and shelter for a variety of species. We investigated the fine-scale distribution pattern of three habitat-forming species of the coastal Mediterranean MAFs: Eunicella cavolini, E. singularis and Paramuricea clavata, and assessed the influence of terrain, oceanographic, and biological factors on their distribution and the formation of MAFs in the central-northern Tyrrhenian Sea. Species presence and abundance were obtained through seafloor HD imagery and were combined with terrain and oceanographic parameters extracted from remote sensing data using distance-based linear modeling (DistLM) and generalized additive model (GAM). The three studied species occurred in all the study areas, with marked differences in their abundance and distribution across the different sites and habitat type, in relation to seafloor characteristics. Specifically, positive relationships emerged between the density of colonies and terrain parameters indicative of high seafloor complexity, such as slope and roughness, as well as the number species structuring MAFs. A clear niche separation for the three species was observed: E. cavolini and P. clavata were reported on coralligenous reefs, and in areas where the seafloor complexity may enhance hydrodynamics and transport of organic matter, while E. singularis was observed on red algal mats at shallower depths. A better understanding of the ecology of these gorgonians, as well as of the drivers determining MAFs formation, represent the first step toward the conservation of these threatened habitats which are currently poorly protected by management and conservation plans.

PMID:39102776 | DOI:10.1016/j.marenvres.2024.106663

Am J Otolaryngol. 2024 Jul 31;45(6):104445. doi: 10.1016/j.amjoto.2024.104445. Online ahead of print.

ABSTRACT

PURPOSE: This study examines the relationship between chronic cough and vagal hypersensitivity by measuring baseline esophageal motility, with interest in the upper esophageal sphincter (UES).

MATERIALS AND METHODS: Patients undergoing workup for dysphagia were assigned to a chronic cough or control group based on self-reported symptoms. Differences in demographics, medical comorbidities, and high resolution esophageal manometry findings were obtained retrospectively.

RESULTS: 62.5% of our cohort had chronic cough (30/48). There were no significant differences between the two groups with respect to sex, age, and race/ethnicity. Laryngopharyngeal reflux (LPR) was the only statistically significant predictor of CC (OR 74.04, p = 0.010). Cough patients had upper esophageal sphincter relaxation duration (734 ms) significantly longer than the non-cough patients (582 ms; p = 0.03), though both groups had similar upper esophageal mean basal pressure, mean residual pressure, relaxation time-to-nadir, and recovery time. No significant difference was found in the median intrabolus pressure and UES motility mean peak pressure between groups.

CONCLUSION: Subtle differences in high-resolution manometry between patients with and without cough suggest, in line with previous studies, baseline alterations of upper esophageal function may manifest in patients with chronic cough through an undetermined mechanism that may include underlying vagal hypersensitivity. These findings encourage further manometric study examining the relationship between UES dysfunction and chronic cough.

PMID:39102762 | DOI:10.1016/j.amjoto.2024.104445

Cancer Med. 2024 Jan;13(1):e6782. doi: 10.1002/cam4.6782. Epub 2023 Dec 22.

ABSTRACT

INTRODUCTION: Introduction: Renal cell carcinoma (RCC) is a very rare pediatric renal tumor. Robust evidence to guide treatment is lacking and knowledge on targeted therapies and immunotherapy is mainly based on adult studies. Currently, the International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG) 2016 UMBRELLA protocol recommends sunitinib for metastatic or unresectable RCC.

METHODS: This retrospective study describes the effects of tyrosine kinase inhibitors (TKI), anti-programmed cell death 1 (PD-(L)1) monoclonal antibodies, and immunotherapeutic regimens in advanced-stage and relapsed pediatric RCC.

RESULTS: Of the 31 identified patients (0-18 years) with histologically proven RCC, 3/31 presented with TNM stage I/II, 8/31 with TNM stage III, and 20/31 with TNM stage IV at diagnosis. The majority were diagnosed with translocation type RCC (MiT-RCC) (21/31) and the remaining patients mainly presented with papillary or clear-cell RCC. Treatment in a neoadjuvant or adjuvant setting, or upon relapse or progression, included mono- or combination therapy with a large variety of drugs, illustrating center specific choices in most patients. Sunitinib was often administered as first choice and predominantly resulted in stable disease (53%). Other frequently used drugs included axitinib, cabozantinib, sorafenib, and nivolumab; however, no treatment seemed more promising than sunitinib. Overall, 15/31 patients died of disease, 12/31 are alive with active disease, and only four patients had a complete response. The sample size and heterogeneity of this cohort only allowed descriptive statistical analysis.

CONCLUSION: This study provides an overview of a unique series of clinical and treatment characteristics of pediatric patients with RCC treated with targeted therapies.

PMID:39102694 | DOI:10.1002/cam4.6782

Health Expect. 2024 Feb;27(1):e13968. doi: 10.1111/hex.13968.

ABSTRACT

BACKGROUND AND CONTEXT: Involving people with lived experience of health conditions and the public (consumers) in health research is supported by policy, practice and research funding schemes. However, consumer involvement programmes in discovery-based preclinical research settings are uncommon. Few formal evaluations of these programmes are reported in the literature.

OBJECTIVE: This study aimed to evaluate an established patient and public involvement programme operating in a major Australian Discovery-Based Medical Research Institute (DBMRI) to inform programme development and the wider field.

DESIGN AND PARTICIPANTS: A multimethods programme evaluation incorporating demographic, descriptive and qualitative data obtained through consumer/researcher co-developed online surveys and semistructured virtual interviews. Programme participants (n = 111) were invited to complete an online survey seeking feedback on their experience of involvement, programme processes and perceived impacts. A purposive sample of 25 participants was interviewed. Descriptive data were analysed using explanatory statistics and qualitative data from surveys and interviews were thematically analysed.

RESULTS: This consumer involvement programme was found to be useful and meaningful for most participants, with specific examples of perceived added value. Consumers most commonly engaged with researchers to inform research development, prepare funding applications or strengthen lay communication of science. Genuine consumer-researcher interactions, relationship development and mutual respect were key elements in a positive experience for participants. Opportunities to ‘give back’, to learn and to ground research in lived experience were identified programme strengths and benefits. Developing researcher training in how to work with consumers, increasing the diversity of the consumer group membership and expanding the range of consumer activities were identified opportunities for improvement. Organisational support and adequate programme resourcing were identified as key enablers.

CONCLUSION: Discovery-based preclinical research is often viewed as being distant from clinical application; therefore, consumer involvement may be considered less relevant. However this study identified value in bringing a strong consumer voice to the discovery-based research process through a coordinated, organisation-wide approach with the potential for application in similar preclinical research settings.

PATIENT OR PUBLIC CONTRIBUTION: Four consumer partners from the DBMRI Consumer Advisory Panel were actively engaged in developing this programme evaluation. Specifically, these consumer partners co-developed and pilot-tested surveys and interview guides, reviewed and commented on project data analysis and reporting and also contributed as co-authors by editing the manuscript.

PMID:39102693 | DOI:10.1111/hex.13968

JMIR Mhealth Uhealth. 2024 Aug 5;12:e49576. doi: 10.2196/49576.

ABSTRACT

BACKGROUND: Technology has become an integral part of our everyday life, and its use to manage and study health is no exception. Romantic partners play a critical role in managing chronic health conditions as they tend to be a primary source of support.

OBJECTIVE: This study tests the feasibility of using commercial wearables to monitor couples’ unique way of communicating and supporting each other and documents the physiological correlates of interpersonal dynamics (ie, heart rate linkage).

METHODS: We analyzed 617 audio recordings of 5-minute duration (384 with concurrent heart rate data) and 527 brief self-reports collected from 11 couples in which 1 partner had type II diabetes during the course of their typical daily lives. Audio data were coded by trained raters for social support. The extent to which heart rate fluctuations were linked among couples was quantified using cross-correlations. Random-intercept multilevel models explored whether cross-correlations might differ by social contexts and exchanges.

RESULTS: Sixty percent of audio recordings captured speech between partners and partners reported personal contact with each other in 75% of self-reports. Based on the coding, social support was found in 6% of recordings, whereas at least 1 partner self-reported social support about half the time (53%). Couples, on average, showed small to moderate interconnections in their heart rate fluctuations (r=0.04-0.22). Couples also varied in the extent to which there was lagged linkage, that is, meaning that changes in one partner’s heart rate tended to precede changes in the other partner’s heart rate. Exploratory analyses showed that heart rate linkage was stronger (1) in rater-coded partner conversations (vs moments of no rater-coded partner conversations: r_diff=0.13; P=.03), (2) when partners self-reported interpersonal contact (vs moments of no self-reported interpersonal contact: r_diff=0.20; P<.001), and (3) when partners self-reported social support exchanges (vs moments of no self-reported social support exchange: r_diff=0.15; P=.004).

CONCLUSIONS: Our study provides initial evidence for the utility of using wearables to collect biopsychosocial data in couples managing a chronic health condition in daily life. Specifically, heart rate linkage might play a role in fostering chronic disease management as a couple. Insights from collecting such data could inform future technology interventions to promote healthy lifestyle engagement and adaptive chronic disease management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13685.

PMID:39102683 | DOI:10.2196/49576

Health Expect. 2024 Feb;27(1):e13945. doi: 10.1111/hex.13945.

ABSTRACT

INTRODUCTION: Value-based healthcare (VBHC) focusses on increasing value for patients. Hospitals aim to implement VBHC via value improvement (VI) teams for medical conditions. To determine the patient’s perspective on value, collective patient participation is important in these teams. We therefore evaluated the current state of patient participation in VI teams and share lessons learned.

METHODS: This mixed-methods study was conducted at seven collaborating hospitals in the Netherlands. A questionnaire (the public and patient engagement evaluation tool) was tailored to the study’s context, completed by VI team members (n = 147 from 76 different VI teams) and analysed with descriptive statistics. In addition, 30 semistructured interviews were held with VI team members and analysed through thematic analysis. Data were collected between February 2022 and January 2023 and were triangulated by mapping the quantitative results to the interview themes.

RESULTS: Thirty-eight of the 76 included VI teams reported using a form of patient participation. Many respondents (71%) indicated a lack of a clear strategy and goal for patient participation. Multiple VI team members believed that specific knowledge and skills are required for patients to participate in a VI team, but this led to concerns regarding the representativeness of participating patients. Furthermore, while patients indicated that they experienced some level of hierarchy, they also stated that they did not feel restricted hereby. Lastly, patients were satisfied with their participation and felt like equal VI team members (100%), but they did mention a lack of feedback from the VI team on their input.

CONCLUSION: The results imply the lack of full implementation of patient participation within VI teams. Guidelines should be developed that provide information on how to include a representative group of patients, which methods to use, how to evaluate the impact of patient participation, and how to give feedback to participating patients.

PATIENT AND PUBLIC CONTRIBUTION: Two patient advisors were part of the research team and attended the research team meetings. They were involved as research partners in all phases of the study, including drafting the protocol (e.g., drafting interview guides and selecting the measurement instrument), interpreting the results and writing this article.

PMID:39102682 | DOI:10.1111/hex.13945

Pancreas. 2024 Aug 6. doi: 10.1097/MPA.0000000000002396. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to investigate how preoperative chemotherapy affected the serum zinc concentrations in patients with pancreatic cancer (PC).

METHODS: Two hundreds and thirty-one patients with PC who underwent pancreatectomy at our department from 2013 to 2019 were enrolled in this study and measured for the serum zinc concentrations before pancreatectomy. Patient characteristics, course of treatment, and laboratory data were analyzed.

RESULTS: One hundred thirty-five patients underwent upfront pancreatectomy and 58 received preoperative Gemcitabine + S1 (GEM + S1) and 29 received Gemcitabine + nab-Paclitaxel (GEM + nab-PTX). Comparing the serum zinc concentrations before and after preoperative treatment, it was found to decrease after treatment with statistical difference (79.3 μg/dl vs. 68.7 μg/dl, p < 0.001). The result was consistent with the investigation for both the patients who received GEM + S1 and those who received GEM + nab-PTX (p = 0.019, p < 0.001, respectively).

CONCLUSIONS: The preoperative chemotherapy consistently reduced the serum zinc concentrations in the PC patients, regardless of their regimen such as GEM + S1 and GEM + nab-PTX. Monitoring the serum zinc concentration and appropriate zinc supplementation may be essential for PC patients undergoing preoperative chemotherapy and pancreatectomy.

PMID:39102680 | DOI:10.1097/MPA.0000000000002396

J Med Internet Res. 2024 Aug 5;26:e50749. doi: 10.2196/50749.

ABSTRACT

BACKGROUND: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women’s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021.

OBJECTIVE: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care.

METHODS: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic’s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits.

RESULTS: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available.

CONCLUSIONS: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available.

PMID:39102679 | DOI:10.2196/50749

J Med Internet Res. 2024 Aug 5;26:e57224. doi: 10.2196/57224.

ABSTRACT

BACKGROUND: Artificial intelligence-enabled clinical decision support systems (AI-CDSSs) offer potential for improving health care outcomes, but their adoption among health care practitioners remains limited.

OBJECTIVE: This meta-analysis identified predictors influencing health care practitioners’ intention to use AI-CDSSs based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Additional predictors were examined based on existing empirical evidence.

METHODS: The literature search using electronic databases, forward searches, conference programs, and personal correspondence yielded 7731 results, of which 17 (0.22%) studies met the inclusion criteria. Random-effects meta-analysis, relative weight analyses, and meta-analytic moderation and mediation analyses were used to examine the relationships between relevant predictor variables and the intention to use AI-CDSSs.

RESULTS: The meta-analysis results supported the application of the UTAUT to the context of the intention to use AI-CDSSs. The results showed that performance expectancy (r=0.66), effort expectancy (r=0.55), social influence (r=0.66), and facilitating conditions (r=0.66) were positively associated with the intention to use AI-CDSSs, in line with the predictions of the UTAUT. The meta-analysis further identified positive attitude (r=0.63), trust (r=0.73), anxiety (r=-0.41), perceived risk (r=-0.21), and innovativeness (r=0.54) as additional relevant predictors. Trust emerged as the most influential predictor overall. The results of the moderation analyses show that the relationship between social influence and use intention becomes weaker with increasing age. In addition, the relationship between effort expectancy and use intention was stronger for diagnostic AI-CDSSs than for devices that combined diagnostic and treatment recommendations. Finally, the relationship between facilitating conditions and use intention was mediated through performance and effort expectancy.

CONCLUSIONS: This meta-analysis contributes to the understanding of the predictors of intention to use AI-CDSSs based on an extended UTAUT model. More research is needed to substantiate the identified relationships and explain the observed variations in effect sizes by identifying relevant moderating factors. The research findings bear important implications for the design and implementation of training programs for health care practitioners to ease the adoption of AI-CDSSs into their practice.

PMID:39102675 | DOI:10.2196/57224

Cancer Med. 2024 Jan;13(1):e6893. doi: 10.1002/cam4.6893.

ABSTRACT

PURPOSE: Prognostic factors have been well described for osteosarcoma, but analyses evaluating the further course of long-term survivors are lacking. We used the large database of the Cooperative Osteosarcoma Study Group (COSS) to perform such an analysis.

PATIENTS AND METHODS: The COSS database 1980-04/2019 was searched for 5-year survivors of primary high-grade central osteosarcoma of the extremities or trunk. Identified patients were analyzed for their further survival outcomes, assessing potentially prognostic and predictive factors already evident at initial disease presentation and treatment as well as their disease course during the first 5 years of follow-up.

RESULTS: Two thousand and nine former eligible patients were identified (median age at initial diagnosis 15.1 (2.5-63.0) years; male vs. female 1149 (57.2%) vs. 860 (42.8%); extremities vs. trunk 1927 (95.9%) vs. 82 (4.1%); extremity primaries <1/3 vs. ≥1/3 of the involved bone 997 (67.8%) vs. 474 (32.2%) (456 unknown); localized vs. primary metastatic 1881 (93.6%) vs. 128 (6.4%); osteosarcoma as a secondary malignancy 41/2009 (2.0%)). Therapy starting by chemotherapy versus primary surgery 1860 (92.6%) versus 149 (7.4%); definitive tumor surgery by limb salvage versus ablative 1347 (67.0%) versus 659 (1 no surgery, 2 unknown); tumor response to preoperative chemotherapy documented for 1765 (94.9%) patients receiving neoadjuvant chemotherapy, good (<10% viable tumor) versus poor 1130 (64.0%) versus 635 (36.0%), local radiotherapy documented for 19 (0.9%) tumors. Recurrence during preceding 5 years no versus yes 1681 (83.7%) versus 328 (16.3%). Median follow-up starting 5 years after initial diagnosis 6.1 (0.002-32.2) years; 1815 survivors and 194 deaths. Overall survival after another 5/10/15/20 years 91.7%/88.9%/85.8%/83.4% for all patients; 97.5%/95.2%/92.4%/89.9% if in remission years 1-5 versus 62.7%/57.3%/53.0%/51.2% if recurrence year 1-5 (p < 0.001). Significant predictors of survival for all patients age at diagnosis (p = 0.038), tumor site (p = 0.030), having experienced the osteosarcoma as secondary malignancy (p < 0.001), tumor response to preoperative chemotherapy (p = 0.002). Multivariate Cox regression testing possible for 1759 (87.6%) patients with complete dataset: Having had a recurrence in years 1-5 (p < 0.001), older age at diagnosis (p = 0.009), and osteosarcoma as secondary malignancy (p = 0.013) retained significance.

DISCUSSION: Highly important predictors of death such as the extent of tumor response to chemotherapy no longer remain valid after 5-year survival. The individual history of malignancies and their outcomes seems to gain pivotal importance.

CONCLUSION: This benchmark analysis clearly defined risk factors for the further course of 5-year survivors from osteosarcoma. It argues for large disease-oriented databases as well as for very long follow-up periods. Novel findings will most likely require innovative statistical models to analyze such cohorts.

PMID:39102672 | DOI:10.1002/cam4.6893