Tag: pubmed

Front Med (Lausanne). 2024 Nov 21;11:1472384. doi: 10.3389/fmed.2024.1472384. eCollection 2024.

ABSTRACT

OBJECTIVE: To construct a hierarchical management system for specialist nurses based on Patricia Benner’s theory, and evaluate its implement effect, so as to provide reference for the hierarchical management of specialist nurses.

METHODS: Literature retrieval, semi-structured interview and Delphi method were conducted for initially formulation of the draft of hierarchical management system for specialist nurses. Forty-three specialist nurses and 14 nursing managers were selected for the study, using a non-randomized controlled experimental study design, and at the end of the study, the job satisfaction, job engagement, job exuberance, advice behaviors and nursing managers’ overall job satisfaction of specialist nurses were compared before and after the hierarchical management.

RESULTS: This study constructed a hierarchical management system for specialist nurses. The differences in specialist nurses’ job satisfaction, job engagement, job exuberance and constructive behaviors before and after hierarchical management were statistically significant (p < 0.05), and the differences in the nursing managers’ assessment of specialist nurses’ overall job satisfaction were statistically significant (p < 0.05).

CONCLUSION: The hierarchical management system of specialist nurses based on Patricia Benner’s theory improves the quality of hierarchical management of specialist nurses, which could improve the job satisfaction of specialist nurses. The system could provide guidance and reference for hierarchical management system of specialist nurses.

PMID:39640983 | PMC:PMC11619138 | DOI:10.3389/fmed.2024.1472384

Front Med (Lausanne). 2024 Nov 21;11:1447716. doi: 10.3389/fmed.2024.1447716. eCollection 2024.

ABSTRACT

OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of the incidence of inflammatory bowel disease-associated bronchiectasis (IBD-BE) and to explore the possible risk factors for IBD-BE, which could help to understand the pulmonary involvement in patients with IBD and to determine the global incidence of the disease.

METHODS: We searched PubMed and EMBASE databases to identify information on the prevalence of IBD-BE among IBD patients in the published literature. Information was extracted on study design, country, year, IBD-BE testing method, IBD characteristics, number of IBD-BE cases and total number of IBD patients, and factors associated with IBD-BE. We conducted meta-analyses using random-effects or fixed-effects models to estimate the prevalence of IBD-BE among IBD patients.

RESULTS: Out of a total of 682 studies, we identified 16 studies that reported prevalence. These studies used a heterogeneous approach to identify IBD-BE. In these 16 studies, there were 92,191 patients with IBD, of whom 372 cases of IBD-BE were identified. The results of the meta-analysis showed that the overall prevalence of IBD-BE in IBD derived from the use of a random effects model was 5.0% (95% CI 2.0-12.0%). In contrast, the prevalence of IBD-BE in studies using high-resolution chest computed tomography (HRCT) imaging was 12% (95% CI 4-39%) using a random-effects model. When only retrospective studies with sample sizes greater than 100 (n = 6) were considered, the prevalence was 1% (95% CI 0-1%). However, when only retrospective studies with sample sizes less than 100 were included (n = 4), the prevalence was 29% (95% CI 6-100%); in prospective studies (n = 6), the combined prevalence was 11% (95% CI 4-29%). we performed a subgroup analysis of the differences in the incidence of IBD-BE between the different studies, each of which we subgrouped by type of study, type of disease, duration of disease, and diagnostic modality, and the results showed no significance. Future studies should standardize methods to identify IBD-BE cases and investigate the natural history and clinical course given the relatively high prevalence among IBD.

CONCLUSION: In this systematic review and meta-analysis, the prevalence of IBD-BE was 12% among studies with HRCT imaging, suggesting that bronchiectasis may be an underestimated common extraintestinal manifestation of IBD. Asymptomatic patients with IBD-BE may present with abnormalities on HRCT or pulmonary function tests. Future studies should standardize methods to identify IBD-BE cases and investigate the natural history and clinical course given the relatively high prevalence among IBD.

PMID:39640979 | PMC:PMC11617167 | DOI:10.3389/fmed.2024.1447716

Front Med (Lausanne). 2024 Nov 21;11:1422163. doi: 10.3389/fmed.2024.1422163. eCollection 2024.

ABSTRACT

BACKGROUND: Genetic and genomic literacy of health professionals is of utmost importance to realize the full potential of personalized medicine. As part of a European Union project, we piloted an e-learning course on oncogenomics, primarily targeted to physicians, and we assessed both its effectiveness and users’ satisfaction.

METHODS: The course materials were developed in English according to the Problem-Based Learning method. Learning objectives, covering the basic principles of genetics and the OMICS technologies applied to oncology, were defined based on previously identified core competencies. We used a pre-test vs. post-test study design to assess knowledge improvements. Performance results by demographic and professional characteristics of participants were analyzed using univariate or multivariate statistical methods.

RESULTS: Overall, 346 Italian professionals (61% physicians, 39% biologists) successfully completed the course. Their average post-test score was almost 19% higher than the pre-test (71.6% vs. 52.9%), with no significant differences by sex. Older age (>50 years) and southern area of residence were both correlated with higher gains. The average proportion of correct answers in the final certification test after three attempts was 85% (69% at first attempt), with some differences across professional categories. Methodology, quality of content and usability of the e-learning platform were all highly rated via satisfaction questionnaire (average scores between 4 and 5, scale 1 to 5).

CONCLUSION: The pilot phase confirmed the suitability of the e-learning as a cost-effective method to improve oncogenomic literacy of health professionals. Translation into natural languages and accreditation by European or country-specific Continuing Medical Education systems will be the main incentives for wider dissemination.

PMID:39640978 | PMC:PMC11617149 | DOI:10.3389/fmed.2024.1422163

J Plast Reconstr Aesthet Surg. 2024 Nov 28;100:205-207. doi: 10.1016/j.bjps.2024.11.049. Online ahead of print.

ABSTRACT

This study aimed to evaluate the potential use of artificial dermal grafts in the lower eyelid following surgical resection of basal cell carcinoma (BCC), focusing on the degree of scar contracture. Postoperative changes were assessed using four quantitative and two qualitative parameters. Anthropometric analysis revealed no statistically significant differences across the four quantitative measures. Furthermore, no new cases of ectropion or scleral show were observed after grafting. These findings suggest that artificial dermal grafting may be a viable option following surgical excision of BCCs on the lower eyelids, without inducing significant eyelid retraction.

PMID:39637516 | DOI:10.1016/j.bjps.2024.11.049

Forensic Sci Int. 2024 Nov 28;367:112309. doi: 10.1016/j.forsciint.2024.112309. Online ahead of print.

ABSTRACT

Environmental and individualistic variables affect the rate of human decomposition in complex ways. These effects complicate the estimation of the postmortem interval (PMI) based on observed decomposition characteristics. In this work, we develop a generative probabilistic model for decomposing human remains based on PMI and a wide range of environmental and individualistic variables. This model explicitly represents the effect of each variable, including PMI, on the appearance of each decomposition characteristic, allowing for direct interpretation of model effects and enabling the use of the model for PMI inference and optimal experimental design. In addition, the probabilistic nature of the model allows for the integration of expert knowledge in the form of prior distributions. We fit this model to a diverse set of 2529 cases from the GeoFOR dataset. We demonstrate that the model accurately predicts 24 decomposition characteristics with an ROC AUC score of 0.85. Using Bayesian inference techniques, we invert the decomposition model to predict PMI as a function of the observed decomposition characteristics and environmental and individualistic variables, producing an R-squared measure of 71 %. Finally, we demonstrate how to use the fitted model to design future experiments that maximize the expected amount of new information about the mechanisms of decomposition using the Expected Information Gain formalism.

PMID:39637513 | DOI:10.1016/j.forsciint.2024.112309

Sci Total Environ. 2024 Dec 4;958:177832. doi: 10.1016/j.scitotenv.2024.177832. Online ahead of print.

ABSTRACT

In spatiotemporal trend analysis, selective inference occurs when researchers are only interested in significant trends based on a fixed threshold (α, often 0.05), without considering the total number of statistical tests performed. Using simultaneous inference in gridded data involves thousands of trend tests, one for each pixel, leading to multiple testing or multiplicity problems. Multiplicity increases the chance of false discoveries in an unknown way unless the p-values of all tests performed are appropriately considered and adjusted. This discussion paper provides a selective and non-exhaustive review of the problems of multiplicity and selective inference. We discuss some appropriate methods to cope with the inflation of spurious results and comment on some examples based on gridded data in the context of research on spatiotemporal trend analysis. In addition, we suggest some good practices in transparency to facilitate the replicability of studies. The effects of uncorrected multiplicity and selective interference can be likened to a ghostly layer over the data, projecting illusions of significance that vanish with rigorous correction methods, revealing the true statistical skeleton of the results. The basis for addressing these problems is to assume that, although it may sometimes seem counterintuitive, the reality of what we perceive as statistically significant (i.e., p-values <0.05) also depends on the number (and value) of what we perceive as non-significant (i.e., p-values ≥0.05). Indeed, in a multiplicity context, one cannot correctly decide what is statistically significant until the whole story is known. Uncorrected selective inference precisely involves ignoring part of the story.

PMID:39637466 | DOI:10.1016/j.scitotenv.2024.177832

Comput Biol Med. 2024 Dec 4;185:109479. doi: 10.1016/j.compbiomed.2024.109479. Online ahead of print.

ABSTRACT

In this study, we investigate the application of self-supervised learning via pre-trained Long Short-Term Memory (LSTM) networks for training surface electromyography pattern recognition models (sEMG-PR) using dynamic data with transitions. While labeling such data poses challenges due to the absence of ground-truth labels during transitions between classes, self-supervised pre-training offers a way to circumvent this issue. We compare the performance of LSTMs trained with either fully-supervised or self-supervised loss to a conventional non-temporal model (LDA) on two data types: segmented ramp data (lacking transition information) and continuous dynamic data inclusive of class transitions. Statistical analysis reveals that the temporal models outperform non-temporal models when trained with continuous dynamic data. Additionally, the proposed VICReg pre-trained temporal model with continuous dynamic data significantly outperformed all other models. Interestingly, when using only ramp data, the LSTM performed worse than the LDA, suggesting potential overfitting due to the absence of sufficient dynamics. This highlights the interplay between data type and model choice. Overall, this work highlights the importance of representative dynamics in training data and the potential for leveraging self-supervised approaches to enhance sEMG-PR models.

PMID:39637459 | DOI:10.1016/j.compbiomed.2024.109479

Accid Anal Prev. 2024 Dec 4;211:107850. doi: 10.1016/j.aap.2024.107850. Online ahead of print.

ABSTRACT

Conflicts between cyclists and motorized vehicles at crosswalks often lead to severe collisions. The varied behaviour of cyclists at these crossings introduces unobserved heterogeneity. Despite this, there is a notable research gap in studying the cyclist behaviour at roundabout crosswalks. To address this gap, we propose a discrete choice latent class method to capture the multi-level latent heterogeneity in cyclists’ crossing behaviour at roundabout crosswalks. Latent heterogeneity can be captured at multiple levels: site-level, interaction-level, choice-attribute level, and individual-level. This method, rooted in behavioural theory, aims to provide a deeper understanding of cyclists’ crossing decisions, enhancing safety measures at these intersections. We present an application of the proposed method to two publicly available drone datasets of naturalistic road user trajectories at roundabouts, including 8 roundabout sites that exhibit some level of similarity to minimize site heterogeneity. We capture the latent heterogeneity in the cyclists’ membership to a distinct behavioural class at two levels using these datasets: the individual level, represented by the speed of the cyclist as they enter the crosswalk, and the interaction level, defined by the presence of vehicles approaching the cyclist. Our findings align with previous studies that emphasize the significance of the initial speed variable in influencing cyclists’ subsequent behaviour and decisions. We identified two distinct classes of cyclists. We hypothesize that Class 1 cyclists, whom we refer to as passers, tend to bypass or overtake other road users at the crosswalk, especially in the absence of vehicles, prioritizing speed and efficiency. We also hypothesize that Class 2 cyclists, referred to as followers, exhibit more cautious behaviour, preferring to maintain a steady pace and avoid overtaking, particularly when vehicles are present. The proposed latent class model effectively captures this behavioural distinction, offering a more granular view of cyclists’ decision-making processes at roundabout crosswalks. A key finding is that the discrete choice model with a latent class structure outperforms the basic model without it, despite having more degrees of freedom, as it achieves a lower BIC and AIC but improved model fit statistic. This demonstrates that latent heterogeneity can be effectively captured, leading to improved predictions and outperforming the basic non-latent class model. Classifying cyclists into distinct behavioural classes not only enhances cyclist safety at crosswalks but also provides valuable insights for the development of autonomous vehicle-cyclist interactions.

PMID:39637453 | DOI:10.1016/j.aap.2024.107850

Int J Pediatr Otorhinolaryngol. 2024 Nov 30;188:112177. doi: 10.1016/j.ijporl.2024.112177. Online ahead of print.

ABSTRACT

INTRODUCTION: Allergic rhinitis (AR) within the pediatric population affects more patients than any other chronic disease. Inferior turbinate hypertrophy (ITH) is a common cause of nasal obstruction in children and is strongly associated with AR. Inferior turbinate reduction (ITR) surgery is used in patients with ITH who have failed medical management. While surgery is curative for most, there remains a subset of patients who continue to have symptoms of nasal obstruction despite ITR, which can cause discomfort and significant impacts on quality of life. Additionally, some patients with persistent disease go on to require revision surgery. The objectives in this study were to assess the impact of allergy testing results in patients undergoing ITR and evaluate if they predict long-term durability of surgical outcome.

METHODS: A retrospective chart review of patients undergoing ITR between January and December of 2015 was performed. Data pertaining to demographics, allergy testing results, surgical technique, and medical management was collected. Patients who underwent concomitant procedures at the time of ITR were excluded. Data analysis included descriptive statistics, chi-squared tests, and t-test analyses.

RESULTS: 297 patients who underwent ITR were included for data analysis. Overall, 20.9 % of patients had recurrent nasal obstruction after ITR and 5.4 % required revision surgery. Among all included patients, 37.7 % underwent allergy testing of which 53 (47.3 %) tested positive and 54 (48.2 %) tested negative; results were unknown for 5 (4.5 %) patients. In patients with positive allergy tests, 36 % had recurrent nasal obstruction and 11 % required revision surgery. In patients with negative allergy tests, 41 % had recurrent nasal obstruction and 13 % required revision surgery. There were no significant associations among those with positive and negative allergy tests and recurrence of nasal obstruction or need for revision surgery. Patients with a documented clinical diagnosis of AR were more likely to have recurrence of nasal obstruction after surgery than those without (28 % vs 12 %, p = 0.001) and were more likely to require revision surgery (9 % vs 1 %, p = 0.001).

CONCLUSIONS: ITR is a reasonable choice for the treatment of nasal obstruction in children. However, there remains a subset of patients who have recurrent nasal obstruction following initial surgery. Allergy testing results do not appear to impact the rate of recurrent nasal obstruction or the need for revision surgery. Therefore, the utility of allergy testing may have a limited benefit in the management of nasal obstruction in children. However, a clinical diagnosis of allergic rhinitis does appear to be a prognostic factor for experiencing post-operative recurrent nasal obstruction and requiring revision surgery.

PMID:39637449 | DOI:10.1016/j.ijporl.2024.112177

Early Hum Dev. 2024 Dec 3;200:106168. doi: 10.1016/j.earlhumdev.2024.106168. Online ahead of print.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) can contribute to changes in fetal cardiac structure and function, with potential implications for long-term cardiovascular health. This study focuses on assessing these cardiac adaptations in fetuses from GDM pregnancies by using the innovative Fetal Heart Quantification (Fetal HQ) technology to provide a detailed evaluation of structural and functional parameters.

METHODS: A prospective study was conducted from March 2023 to October 2024 at Xiangyang No.1 People’s Hospital, involving 382 pregnant women in their second and third trimesters, including 167 with GDM and 215 healthy controls. Fetal cardiac assessments were performed using Fetal HQ, which allows for direct measurement of cardiac deformation and function. Key parameters such as left ventricular (LV) and right ventricular (RV) dimensions, global longitudinal strain (GLS), and fractional area change (FAC) were analyzed. Maternal clinical data, including blood glucose levels and body mass index (BMI), were also collected. Statistical analyses were performed to compare the cardiac parameters between the two groups.

RESULTS: Significant differences were observed in fetal cardiac dimensions, with the GDM group exhibiting larger LV end-diastolic area (2.04 ± 0.73 cm² vs. 1.81 ± 0.69 cm², p = 0.002) and lower RV GLS (-20.1 ± 5.3 % vs. -22.6 ± 4.6 %, p = 0.000). Other functional parameters, including LV GLS and FAC, did not show significant differences between groups. Correlation analysis revealed a significant positive relationship between maternal HbA1c levels and RV FAC (r = 0.348, p = 0.036), indicating that maternal glycemic control may influence fetal cardiac function.

CONCLUSIONS: The findings suggest that GDM is associated with altered fetal cardiac morphology, particularly in the left ventricle, and impaired right ventricular function, as evidenced by reduced GLS. These results highlight the potential impact of maternal hyperglycemia on fetal cardiac development and underscore the importance of monitoring fetal cardiac health in pregnancies complicated by GDM. The use of Fetal HQ technology provides a valuable tool for early detection of cardiac dysfunction in this high-risk population.

PMID:39637448 | DOI:10.1016/j.earlhumdev.2024.106168