Tag: pubmed

Alcohol Alcohol. 2024 Nov 18;60(1):agae088. doi: 10.1093/alcalc/agae088.

ABSTRACT

AIMS: Structured clinical interviewing is considered the gold standard in psychiatric diagnosis. The Diagnostic Assessment Research Tool (DART) is a novel modularized, non-copywritten, semi-structured interview; however, no studies have examined the psychometric properties of its alcohol use disorder (AUD) module. The primary aims of this study were to: (i) validate the factor structure of the DART AUD module and (ii) examine measurement invariance across several key demographic and subgroup factors.

METHODS: Participants were community members in Hamilton, Canada and Boston, USA who self-identified as making a significant AUD recovery attempt (N = 499). Internal reliability was examined via the Kuder-Richardson 20 statistic, and correlations between symptom count and drinking quantity/frequency were examined. Then, symptom-level data were included in a confirmatory factor analysis to examine model fit of a single hypothesized factor structure. Finally, measurement invariance analyses were conducted for sex, age, ethnicity (White vs. racialized), and study site.

RESULTS: This study found evidence for adequate internal reliability (rKR20 = 0.75), and symptom scores correlated with drinking quantity and frequency (r = 0.16-0.43). Confirmatory factor analysis results suggested excellent fit for the unidimensional one-factor AUD model (χ2 = 0.09, confirmatory factor index = 0.99, Tucker Lewis index = 0.99, standardized root mean square residual = 0.06, root mean square error of approximation = 0.02). Measurement invariance analyses revealed that the factor structure was equivalent between sex, age, ethnicity, and study site.

CONCLUSIONS: Findings provide strong evidence for the psychometric validity of the DART AUD module and support its use in research and clinical practice. The DART represents a credible alternative to other diagnostic interviewing tools for AUD.

PMID:39724543 | DOI:10.1093/alcalc/agae088

J Am Acad Orthop Surg. 2024 Dec 24. doi: 10.5435/JAAOS-D-24-00353. Online ahead of print.

ABSTRACT

INTRODUCTION: Gender-affirming hormone therapy (GAHT) is a cornerstone of gender-affirming care for transgender and gender diverse (TGD) patients, with a direct biological role on bone metabolism. However, a paucity of data describes how GAHT influences fracture rate over time. The study’s primary objective was to describe the 5-year all-cause fracture incidence rate (IR) among TGD patients initiating estrogen-based GAHT (E-GAHT) or testosterone-based GAHT (T-GAHT), compared with TGD patients not using GAHT (non-GAHT).

METHODS: This retrospective cohort study of TGD adults aged 18 to 65 years used insurance data from the Merative MarketScan Commercial Database (MarketScan) from January 1, 2009, to December 31, 2019. The main outcome was IR (IR with 95% confidence intervals [CIs]) of all-cause fracture after up to 5 years of follow-up. The IR ratio was estimated by comparing E-GAHT and T-GAHT groups with the non-GAHT group. Cox proportional hazards regression models estimated the hazard ratio (HR) of fracture after adjusting for age, comorbidity status using Charlson Comorbidity Index (CCI), recent fractures, and study start year.

RESULTS: Nine thousand six hundred ninety-six TGD adults (E-GAHT [n = 1,131]; T-GAHT [n = 1,046]; non-GAHT [n = 7,519]) were identified using clinical and enrollment criteria. No differences in age (mean age [SD], 33.4 [13.2] years, 30.8 [11.7] years, and 33.2 [13.6] years, respectively) and CCI (percent with CCI = 0 [%CCI = 3+]; 86.7% [2.2%], 84.9% [1.4%], and 85.3% [1.9%]) were observed by group. The fracture IR was 13.9 (95% CI, 9.1 to 18.8) for E-GAHT, 15.3 (95% CI, 10.1 to 20.4) for T-GAHT, and 19.2 (95% CI, 16.9 to 21.4) for non-GAHT. Compared with non-GAHT, the crude IR ratio and fully adjusted HR was 0.73 (95% CI, 0.51 to 1.04) and 0.71 (95% CI, 0.49 to 1.02), respectively, for E-GAHT and 0.80 (95% CI, 0.56 to 1.14) and 0.78 (95% CI, 0.55 to 1.12), respectively, for T-GAHT.

CONCLUSION: Based on United States commercial claims data, the use of GAHT was not associated with 5-year all-cause fracture IR.

LEVEL OF EVIDENCE: III.

PMID:39724520 | DOI:10.5435/JAAOS-D-24-00353

Clin Neuropsychol. 2024 Dec 26:1-15. doi: 10.1080/13854046.2024.2445269. Online ahead of print.

ABSTRACT

Objective: To determine the clinical utility of teleneuropsychology (teleNP) services in screening for cognitive concerns in a population of children and adolescents presenting with long COVID. Method: This cross-sectional study evaluated 76 pediatric patients (64% female, M_age = 13.48, SD = 2.97, range = 5 to 18 years) with long COVID referred for a neuropsychological evaluation due to persistent cognitive symptoms following their COVID infection. Of these 76 patients, 33 were tested in person, while 43 were tested via teleNP at home. Patients were administered a brief testing battery designed for use in-person or through teleNP services. Tests administered included the WASI-II (Intellectual Functioning), D-KEFS Verbal Fluency (Executive Functioning/Shifting), Oral Version of the Symbol Digit Modalities Test (Processing Speed), ChAMP List (Learning and Memory), WAIS-IV/WISC-V Digit Span (Working Memory), and TEA-Ch Score and Score DT (Sustained Auditory Attention and Divided Attention). Differences in scores between those evaluated in-person or teleNP were computed using analyses of variance and Bayesian statistics across measures. Differences in the proportion of those scoring in the below average range (< 9^th percentile) were also computed. Results: Findings revealed similar performance for patients tested in-person and patients tested by teleNP modality across measures. Conclusions: The present study provides preliminary evidence for the clinical utility of teleNP services in pediatric long COVID patients on a cognitive screening battery. These results lend support for expanding teleNP services to pediatric patients with long COVID to assess neurocognitive functioning, which is particularly important given scarcity of specialty long COVID clinics.

PMID:39723582 | DOI:10.1080/13854046.2024.2445269

J Psychosoc Oncol. 2024 Dec 26:1-15. doi: 10.1080/07347332.2024.2444276. Online ahead of print.

ABSTRACT

PURPOSE: Young adults report challenges concerning cancer–related cognitive impairment (CRCI). This study aimed to: (1) describe cognition in young adults post-cancer treatment using self-report and performance-based measures, and (2) examine associations between cognition and relevant disease-related, psychological, and lifestyle (physical activity; PA) factors.

METHODS: Forty-six young adults (M_age = 31.4 ± 5.4 years; 91.3% female) completed web-based questionnaires and neuropsychological tests; data were analyzed via descriptive statistics and bivariate correlations.

RESULTS: Most (60.9%) self-reported clinically meaningful CRCI and displayed poorer executive functioning and processing speed (but not working memory) than normative data. Disease-related factors, psychological factors, and PA had null-to-moderate (rs = -0.32-0.28), small-to-large (rs = -0.74-0.77), and trivial-to-moderate (rs = -0.16 – 0.36) correlations with cognition (respectively), with differences in magnitude between self–reported and objective cognition.

CONCLUSION: The observed correlations warrant further exploration in larger prospective studies, and trials should investigate causative mechanisms and specific PA parameters.

PMID:39723581 | DOI:10.1080/07347332.2024.2444276

Biometrics. 2024 Oct 3;80(4):ujae150. doi: 10.1093/biomtc/ujae150.

ABSTRACT

In many clinical contexts, the event of interest could occur multiple times for the same patient. Considerable advancement has been made on developing recurrent event models based on or that use biomarker information. However, less attention has been given to evaluating the prognostic accuracy of a biomarker or a composite score obtained from a fitted recurrent event-rate model. In this manuscript, we propose novel measures to characterize the prognostic accuracy of a marker measured at baseline in the presence of recurrent events. The proposed estimators are based on a semiparametric frailty model that accounts for the informativeness of a marker and unobserved heterogeneity among patients with respect to the rate of event occurrence. We investigate the asymptotic properties of the proposed accuracy estimators and demonstrate these estimators’ finite sample performance through simulation studies. The proposed estimators have minimal bias and appropriate coverage. The estimators are applied to evaluate the performance of a baseline forced expiratory volume, a measure of lung capacity, for repeated episodes of pulmonary exacerbations in patients with cystic fibrosis.

PMID:39723565 | DOI:10.1093/biomtc/ujae150

Biometrics. 2024 Oct 3;80(4):ujae154. doi: 10.1093/biomtc/ujae154.

ABSTRACT

Many trials are designed to collect outcomes at or around pre-specified times after randomization. If there is variability in the times when participants are actually assessed, this can pose a challenge to learning the effect of treatment, since not all participants have outcome assessments at the times of interest. Furthermore, observed outcome values may not be representative of all participants’ outcomes at a given time. Methods have been developed that account for some types of such irregular and informative assessment times; however, since these methods rely on untestable assumptions, sensitivity analyses are needed. We develop a sensitivity analysis methodology that is benchmarked at the explainable assessment (EA) assumption, under which assessment and outcomes at each time are related only through data collected prior to that time. Our method uses an exponential tilting assumption, governed by a sensitivity analysis parameter, that posits deviations from the EA assumption. Our inferential strategy is based on a new influence function-based, augmented inverse intensity-weighted estimator. Our approach allows for flexible semiparametric modeling of the observed data, which is separated from specification of the sensitivity parameter. We apply our method to a randomized trial of low-income individuals with uncontrolled asthma, and we illustrate implementation of our estimation procedure in detail.

PMID:39723564 | DOI:10.1093/biomtc/ujae154

ANZ J Surg. 2024 Dec 26. doi: 10.1111/ans.19372. Online ahead of print.

ABSTRACT

BACKGROUND: Over the last decade, there has been a steady increase in the number of patients diagnosed with end stage renal failure (ESRF). Renal transplant remains the best available treatment for ESRF. The aim of this study is to assess the surgical outcomes following renal transplantation in a single tertiary centre in Aotearoa New Zealand.

METHODS: A retrospective observational study was performed in Christchurch Hospital. All live-related and deceased donor adult renal transplants performed between 1 January 2009 and 1 January 2023 were included in the study. Patients were identified from the local transplant database (Proton) and data were extracted from both electronic and hardcopy records.

RESULT: There were 227 live-related and 150 deceased donor renal transplants performed over the study period. Median BMI in the study cohort was 27 kg/m². The most common aetiology of ESRF was glomerular disease. Obese (BMI 30-40 kg/m²) patients had a higher incidence of post-operative complications. Ethnicity was shown to be associated with a higher incidence of post-operative complications. This was only statistically significant in the Pacific Islander group (P = 0.013). Live-related donor graft survival was 97% at 1 year and 93% at 5 years while deceased donor graft survival was 95% at 1 year and 92% at 5 years.

CONCLUSION: This study showed that graft outcome in our cohort was comparable to international data. However, further studies are needed to assess whether specific ethnic groups are truly linked to a higher incidence of post-operative complications.

PMID:39723559 | DOI:10.1111/ans.19372

J Dance Med Sci. 2024 Dec 26:1089313X241307736. doi: 10.1177/1089313X241307736. Online ahead of print.

ABSTRACT

Introduction: As demanding as dancing en pointe is, no universal standard exists to determine when a ballet dancer is ready to advance to this next level. The goal of this study was to provide preliminarily tested and reliable guidelines for a screening tool that can be used to determine (1) if a dancer is ready for pointe, (2) reasons why a dancer may not be ready, and (3) areas for improvement to guide training and preparation. Methods: Participants: Seventeen dancers aged 9 to 17 years with a minimum 4 years of ballet and who were either possibly ready for pointe or had been in pointe class less than 3 months participated in this study. Study Design: Dancers were prospectively assessed by two physicians using the Pointe Assessment Screening Shah Edison (PASSÉ) tool for assessing pointe readiness. Interrater reliability and the relationship of individual tests to overall pointe readiness were evaluated using descriptive statistics, kappa, diagnostic metrics, and logistic regression. Setting: Private practice office; ballet studios. Results: There was 94% agreement among raters in determining overall pointe readiness, and individual tests all had significant interrater agreement ranging from 62% to 97% (P ≤ .04). Ankle plantarflexion >90° (100%), stability in grand plié (100%), and holding relevé (96%) had the highest sensitivity for overall readiness, indicating their necessity to advance to pointe. The tests with greatest specificity for identifying lack of readiness were relevé passé (72%), sauté (72%), and airplane (69%). Conclusions: This study provides preliminary testing of a reliable screening tool, the PASSÉ screen, which can be utilized to determine pointe readiness with excellent interrater agreement for the overall pass/fail and significant agreement for tests that contribute to readiness. At minimum, dancers must be able to pass the grand plié, ankle plantar flexion, and relevé tests. Also passing the sauté, relevé passé, and airplane tests indicates high likelihood of readiness.

PMID:39723557 | DOI:10.1177/1089313X241307736

ANZ J Surg. 2024 Dec 26. doi: 10.1111/ans.19359. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. With the rise of online platforms like YouTube and WebSurg, surgical videos have become popular educational tools. However, the quality of these videos varies, raising concerns about their reliability. This study evaluates the changes in the quality of laparoscopic cholecystectomy videos over two decades and compares the educational value of YouTube and WebSurg videos.

METHODS: Twenty-four videos were analyzed and divided into four groups: older YouTube, older WebSurg, newer YouTube, and newer WebSurg. Six videos from each group were selected based on relevance and popularity. Three independent surgeons assessed them using standardized scoring systems, including the JAMA Benchmark Score, Global Quality Score (GQS), LAP-VEGaS, and a new Laparoscopic Cholecystectomy-Specific Score (LAP Chole-SS). Video characteristics such as duration, uploader type, and viewer engagement were also considered. Statistical comparisons were made between the groups.

RESULTS: The analysis showed that although newer videos were longer, the difference was not statistically significant (P = 0.74). Newer videos had significantly better image quality (P < 0.001). WebSurg videos consistently outperformed YouTube videos across all evaluation criteria. WebSurg scored higher in the JAMA Benchmark (2.62 versus 1.66), GQS (3.58 versus 2.63), LAP-VEGaS (13.7 versus 6.58), and LAP Chole-SS (4.08 versus 2.33).

CONCLUSION: In conclusion, WebSurg provides higher-quality, peer-reviewed content, making it more reliable for surgical education, while YouTube offers accessibility but often lacks educational rigor.

PMID:39723551 | DOI:10.1111/ans.19359

Ann Ital Chir. 2024;95(6):1240-1248. doi: 10.62713/aic.3403.

ABSTRACT

AIM: Breast cancer is the most common cancer in women and is a leading cause of cancer-related mortality. The role of neoadjuvant therapy (NAT) in conjunction with surgical intervention is becoming increasingly prominent in the field of oncology. NAT enhance the probability of breast-conserving surgery in cases of locally advanced breast cancer and in patients with metastatic or inoperable disease.

METHODS: The study included patients who underwent surgery following neoadjuvant chemotherapy for breast cancer between 2012 and 2022. Their files were retrospectively analyzed. The following parameters were examined and statistically analyzed for patients with and without pathological complete response: age, gender, tumor size, location, stage, pathological type, grade, hormone receptor status, molecular type, and the type of surgery performed.

RESULTS: The study cohort comprised 329 patients who received NAT for breast cancer. Of the patients included in the study, 243 underwent mastectomy and 86 underwent breast-conserving surgery. A postoperative histopathologic examination revealed pathologic complete response (pCR) in 89 patients. The results of the statistical analysis indicated that certain parameters, including high grade, negative hormone receptor status, human epidermal growth factor receptor 2 (HER2) positivity, Ki-67 ≥30, and early tumor stage, were associated with higher rates of pCR following NAT.

CONCLUSIONS: The biomarkers identified in this study, including hormone receptor negativity, anatomical Tumour, Node, Metastasis (TNM) Stages 1-2 tumors, positive HER2 amplification, Ki-67 proliferation ≥30%, luminal B/HER2 (+) and HER2 (+) molecular subtypes, are crucial in predicting the likelihood of a complete response to NAT in breast cancer. The presence of these clinicopathologic biomarkers facilitates the process of therapeutic decision-making by identifying patients who are likely to achieve a complete response.

PMID:39723525 | DOI:10.62713/aic.3403