Tag: pubmed

BMJ Glob Health. 2024 May 14;9(5):e014367. doi: 10.1136/bmjgh-2023-014367.

ABSTRACT

INTRODUCTION: There are no published data on the long-term impact of invasive group B Streptococcus disease (iGBS) on economic costs or health-related quality of life (HRQoL) in low-income and middle-income countries. We assessed the impact of iGBS on healthcare utilisation, costs and HRQoL in Argentina, India, Kenya, Mozambique and South Africa.

METHODS: Inpatient and outpatient visits, out-of-pocket (OOP) healthcare payments in the 12 months before study enrolment, and health-state utility of children and caregivers (using the EuroQol 5-Dimensions-3-Level) were collected from iGBS survivors and an unexposed cohort matched on site, age at recruitment and sex. We used logistic or Poisson regression for analysing healthcare utilisation and zero-inflated gamma regression models for family and health system costs. For HRQoL, we used a zero-inflated beta model of disutility pooled data.

RESULTS: 161 iGBS-exposed and 439 unexposed children and young adults (age 1-20) were included in the analysis. Compared with unexposed participants, iGBS was associated with increased odds of any healthcare utilisation in India (adjusted OR 11.2, 95% CI 2.9 to 43.1) and Mozambique (6.8, 95% CI 2.2 to 21.1) and more frequent healthcare visits (adjusted incidence rate ratio (IRR) for India 1.7 (95% CI 1.4 to 2.2) and for Mozambique 6.0 (95% CI 3.2 to 11.2)). iGBS was also associated with more frequent days in inpatient care in India (adjusted IRR 4.0 (95% CI 2.3 to 6.8) and Kenya 6.4 (95% CI 2.9 to 14.3)). OOP payments were higher in the iGBS cohort in India (adjusted mean: Int$682.22 (95% CI Int$364.28 to Int$1000.16) vs Int$133.95 (95% CI Int$72.83 to Int$195.06)) and Argentina (Int$244.86 (95% CI Int$47.38 to Int$442.33) vs Int$52.38 (95% CI Int$-1.39 to Int$106.1)). For all remaining sites, differences were in the same direction but not statistically significant for almost all outcomes. Health-state disutility was higher in iGBS survivors (0.08, 0.04-0.13 vs 0.06, 0.02-0.10).

CONCLUSION: The iGBS health and economic burden may persist for years after acute disease. Larger studies are needed for more robust estimates to inform the cost-effectiveness of iGBS prevention.

PMID:38749511 | DOI:10.1136/bmjgh-2023-014367

Endoscopy. 2024 May 15. doi: 10.1055/a-2328-2844. Online ahead of print.

ABSTRACT

BACKGROUND AND STUDY AIM: Computer-aided detection (CADe) has been developed to improve detection during colonoscopy. After initial reports of high efficacy, there has been an increasing recognition of variability in the effectiveness of CADe systems. The aim of this study was to evaluate a CADe system (PENTAX Medical, Tokyo, Japan) in a varied colonoscopy population.

PATIENTS AND METHODS: A multicenter, randomized trial was conducted at 7 hospitals (both university and non-university) in Europe and Canada. Participants referred for diagnostic, non-iFOBT screening, or surveillance colonoscopy were randomized (1:1) to undergo CADe-assisted or conventional colonoscopy (CC) by experienced endoscopists. Participants with insufficient bowel preparation were excluded from the analysis. Primary outcome was adenoma detection rate (ADR). Secondary outcomes included adenomas per colonoscopy (APC) and sessile serrated lesions per colonoscopy (SSLPC).

RESULTS: In total, 581 participants were enrolled, of which 497 were included in the final analysis: 250 in the CADe-arm and 247 in the CC-arm. Surveillance was the indication in 202/497 (40.6%) colonoscopies, diagnostic in 199/497 (40.0%), and non-iFOBT screening in 96/497 (19.3%). Overall, ADR (38.4% vs. 37.7%; p=0.43) and APC (0.66 vs. 0.66; p=0.97) were similar between CADe and CC. SSLPC was increased (0.30 vs. 0.19; p=0.049) in the CADe-arm vs. CC.

CONCLUSIONS: In this study conducted by experienced endoscopists, CADe did not result in a statistically significant increase in ADR. However, the ADR of our control group substantially surpassed our sample size assumptions, increasing the risk of an underpowered trial. (Trialsearch.who.int:NL9135).

PMID:38749482 | DOI:10.1055/a-2328-2844

Dtsch Med Wochenschr. 2024 May;149(11):638-645. doi: 10.1055/a-2160-5397. Epub 2024 May 15.

ABSTRACT

The diagnosis and treatment of malignant lymphoma is rapidly advancing, offering hope but also highlighting inherent limitations. Technological breakthroughs in sequencing technologies enable more precise subtyping and risk stratification. For example, in diffuse large B-cell lymphoma (DLBCL), exome sequencing revealed molecular subtypes. Understanding these subtypes sheds light on lymphomagenesis and prognosis, and may provide targets for tailored therapies. Additionally, tumor-derived cell-free DNA (ctDNA) detected in blood plasma allows for genotyping, risk stratification, and measurement of minimal residual disease (MRD). Current studies often examine drug effectiveness through “all-comer” approaches or in transcriptionally defined subtypes. Molecular agnostic studies increasingly focus on clinically defined high-risk patients (e.g., using the IPI) to better demonstrate the statistical significance of therapy effects. Improved patient selection can enhance the cost-effectiveness of modern, often expensive, therapies.

PMID:38749440 | DOI:10.1055/a-2160-5397

JMIR Form Res. 2024 May 15;8:e56198. doi: 10.2196/56198.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at higher risk of mental health problems due to widespread hetero- and cisnormativity, including negative public attitudes toward the LGBTQ+ community. In addition to combating social exclusion at the societal level, strengthening the coping abilities of young LGBTQ+ people is an important goal.

OBJECTIVE: In this transdiagnostic feasibility study, we tested a 6-week internet intervention program designed to increase the ability of nonclinical LGBTQ+ participants to cope with adverse events in their daily lives. The program was based on acceptance and commitment therapy principles.

METHODS: The program consists of 6 web-based modules and low-intensity assistance for homework provided by a single care provider asynchronously. The design was a single-group assignment of 15 self-identified LGB community members who agreed to participate in an open trial with a single group (pre- and postintervention design).

RESULTS: Before starting the program, participants found the intervention credible and expressed high satisfaction at the end of the intervention. Treatment adherence, operationalized by the percentage of completed homework assignments (32/36, 88%) was also high. When we compared participants’ pre- and postintervention scores, we found a significant decrease in clinical symptoms of depression (Cohen d=0.44, 90% CI 0.09-0.80), social phobia (d=0.39, 90% CI 0.07-0.72), and posttraumatic stress disorder (d=0.30, 90% CI 0.04-0.55). There was also a significant improvement in the level of self-acceptance and behavioral effectiveness (d=0.64, 90% CI 0.28-0.99) and a significant decrease in the tendency to avoid negative internal experiences (d=0.38, 90% CI 0.09-0.66). The level of general anxiety disorder (P=.11; d=0.29, 90% CI -0.10 to 0.68) and alcohol consumption (P=.35; d=-0.06, 90% CI -0.31 to 0.19) were the only 2 outcomes for which the results were not statistically significant.

CONCLUSIONS: The proposed web-based acceptance and commitment therapy program, designed to help LGBTQ+ participants better manage emotional difficulties and become more resilient, represents a promising therapeutic tool. The program could be further tested with more participants to ensure its efficacy and effectiveness.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05514964; https://clinicaltrials.gov/study/NCT05514964.

PMID:38749024 | DOI:10.2196/56198

Appl Neuropsychol Child. 2024 May 15:1-9. doi: 10.1080/21622965.2024.2353089. Online ahead of print.

ABSTRACT

The present study was conducted with the aim of investigating the effect of exergames in improving the motor memory and inhibitory control of children with executive functions disorder. Children, selected by simple random method were divided into two groups: experimental (n = 16) and control (n = 16). Circle drawing task, and The Serial Reaction Time Task were used to collect and analyze data. The current study is a randomized control trial (RCT) type of research with a two-group pretest, post-test, and follow up -test design in terms of the purpose of applied research and the method of data collection. T-test results for the differences in post- test mean scores between the two groups in motor memory and inhibitory control showed that the treatment group outperformed the control group. There were statistical differences between pre and post measures in favor of post test, and between pre and follow up measures in favor of follow up test, but no statistical differences between post and follow up test. This study demonstrates that it is possible to enhance motor memory and inhibitory control of children with executive functions disorder using exergames intervention.

PMID:38749023 | DOI:10.1080/21622965.2024.2353089

AIDS Care. 2024 May 15:1-14. doi: 10.1080/09540121.2024.2354225. Online ahead of print.

ABSTRACT

The objectives were to assess the self-efficacy and consistent condom use by people living with HIV (PLHIV). A cross-sectional, comparative study was carried out in outpatient clinics in Ceará State, Brazil, with a sample of 190 PLHIV, 95 serodiscordant and 95 seroconcordant. Interviews were conducted using the Socio-Demographic, Clinical, Epidemiological and Vulnerability Form and the Condom Use Self-Efficacy Scale. Descriptive analysis, associations between variables, odds ratio and 95% confidence interval were determined. P < 0.05 was considered statistically significant. Of the sample, 43.1% consistently used condoms (50.5% serodiscordant and 35.7% seroconcordant). Serodiscordant PLHIV without guidance on HIV prevention (P = 0.027) and without access to testing (P = 0.002) had lower self-efficacy and 11.5 times more chances for inconsistent condom use (P = 0.006), while those satisfied with follow-up in health were less likely to use condoms inconsistently (P = 0.011). We conclude that there is low consistent use of condoms among PLHIV, which increases the risk of HIV transmission and the acquisition of other sexually transmitted infections. Consistent condom use was greater among serodiscordant individuals, although there was no difference in self-efficacy in condom use between the groups.

PMID:38749020 | DOI:10.1080/09540121.2024.2354225

Gynecol Endocrinol. 2024 May 6;40(1):2352133. doi: 10.1080/09513590.2024.2352133. Epub 2024 May 15.

ABSTRACT

OBJECTIVES: Progestin-primed ovarian stimulation (PPOS) is an efficient controlled ovarian stimulation (COS) method. The study explored the pregnancy outcomes between PPOS and antagonist ovarian stimulation protocol (GnRH-ant) in infertile patients with poor ovarian response (POR).

METHODS: This retrospective study included patients with POR who underwent COS at the Reproductive Medical Center of Shanxi Maternal and Child Health Hospital from January 2021 to April 2022. The cycles were grouped as the GnRH-ant group and the PPOS group. The primary outcome was the clinical pregnancy rate; the secondary outcomes included the biochemical pregnancy abortion rate and live birth rate.

RESULTS: Frozen embryo transfer was used in all cycles in this study. The cycles were divided into the GnRH-ant (n = 236 cycles) and PPOS (n = 273 cycles) groups. Age, BMI, type of infertility, infertility duration, FSH, LH, PRL, E2, T, P, and the number of cycles in the hospital were similar between the two groups (all p > 0.05). No statistically significant differences were observed in the clinical pregnancy rate (primary outcome, 32.71% vs. 43.90%, p = 0.082), total Gn dose, total Gn days, ART mode (IVF or ICSI), AFC, MII follicles, 2PN embryos, fertility, cycle cancelation rate, biochemical pregnancy rate, abortion rate, or live birth rate between the two groups (all p > 0.05). The PPOS group exhibited a higher rate of high-quality embryos than the GnRH-ant group (50.12% vs. 42.90%, p = 0.045).

CONCLUSIONS: The PPOS protocol was comparable to the GnRH-ant protocol regarding induction parameters and cycle cancelation, biochemical pregnancy, clinical pregnancy, and abortion rates but might be associated with a higher proportion of high-quality embryos.

PMID:38749017 | DOI:10.1080/09513590.2024.2352133

Interdiscip Cardiovasc Thorac Surg. 2024 May 15:ivae097. doi: 10.1093/icvts/ivae097. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore whether portable budesonide-formoterol powder inhalation can ameliorate cough symptoms and improve pulmonary function recovery in patients who underwent thoracoscopic lung surgery.

METHODS: Clinical data of patients who underwent thoracoscopic pulmonary resection at Henan Provincial People’s Hospital between December 2022 and May 2023 were extracted. To evaluate the impact of continuous post-operative use of portable budesonide-formoterol powder inhalation, patients were divided into two groups: the control group and the case group. Next, we compared the Leicester cough score and pulmonary function indexes of the patients before surgery, one month and six month after the operation.

RESULTS: A total of 188 cases were included, and the baseline demographic characteristics of both groups were well-balanced. The internal consistency of the LCQ-MC scale, as indicated by Cronbach’s α coefficients, were all greater than 0.8, and there was no significant difference in LCQ-MC scores between the two groups before the operation (Z=-1.173, P=0.241). Postoperatively, the LCQ-MC score in the case group was significantly higher than that in the control group (18.66 vs. 16.79, P<0.01), with a notable statistically significant difference in the reduction of LCQ-MC scores between the two groups (1.32 vs. 3.30, P<0.01). Analysis of lung function revealed that patients in the case group exhibited significant improvements in FEV1/FVC, FVC, FEV1, PEF, MMEF75/25, MVV, DLCO and the RV/TLC indexes compared to the control group (P<0.01).

CONCLUSIONS: Portable budesonide-formoterol powder inhalation can alleviate cough symptoms and promote pulmonary function recovery in patients following thoracoscopic lung surgery.

PMID:38748992 | DOI:10.1093/icvts/ivae097

J Am Med Inform Assoc. 2024 May 15:ocae121. doi: 10.1093/jamia/ocae121. Online ahead of print.

ABSTRACT

OBJECTIVE: Present a general framework providing high-level guidance to developers of computable algorithms for identifying patients with specific clinical conditions (phenotypes) through a variety of approaches, including but not limited to machine learning and natural language processing methods to incorporate rich electronic health record data.

MATERIALS/METHODS: Drawing on extensive prior phenotyping experiences and insights derived from three algorithm development projects conducted specifically for this purpose, our team with expertise in clinical medicine, statistics, informatics, pharmacoepidemiology, and healthcare data science methods conceptualized stages of development and corresponding sets of principles, strategies, and practical guidelines for improving the algorithm development process.

RESULTS: We propose five stages of algorithm development and corresponding principles, strategies, and guidelines: 1) assessing fitness-for-purpose, 2) creating gold standard data, 3) feature engineering, 4) model development, and 5) model evaluation.

DISCUSSION/CONCLUSION: This framework is intended to provide practical guidance and serve as a basis for future elaboration and extension.

PMID:38748991 | DOI:10.1093/jamia/ocae121

Braz J Cardiovasc Surg. 2024 May 15;39(4):e20230154. doi: 10.21470/1678-9741-2023-0154.

ABSTRACT

INTRODUCTION: It is not yet clear whether cardiac surgery by mini-incision (minimally invasive cardiac surgery [MICS]) is overall less painful than the conventional approach by full sternotomy (FS). A meta-analysis is necessary to investigate polled results on this topic.

METHODS: PubMed®/MEDLINE, Cochrane CENTRAL, Latin American and Caribbean Health Sciences Literature (or LILACS), and Scientific Electronic Library Online (or SciELO) were searched for all clinical trials, reported until 2022, comparing FS with MICS in coronary artery bypass grafting (CABG), mitral valve surgery (MVS), and aortic valve replacement (AVR), and postoperative pain outcome was analyzed. Main summary measures were the method of standardized mean differences (SMD) with a 95% confidence interval (CI) and P-values (considered statistically significant when < 0.05).

RESULTS: In AVR, the general estimate of postoperative pain effect favored MICS (SMD 0.87 [95% CI 0.04 to 1.71], P=0.04). However, in the sensitivity analysis, there was no difference between the groups (SMD 0.70 [95% CI -0.69 to 2.09], P=0.32). For MVS, it was not possible to perform a meta-analysis with the included studies, because they had different methodologies. In CABG, the general estimate of the effect of postoperative pain did not favor any of the approaches (SMD -0.40 [95% CI -1.07 to 0.26], P=0.23), which was confirmed by sensitivity analysis (SMD -0.02 [95% CI -0.71 to 0.67], P=0.95).

CONCLUSION: MICS was not globally less painful than the FS approach. It seems that postoperative pain is more related to the degree of tissue retraction than to the size of the incision.

PMID:38748974 | DOI:10.21470/1678-9741-2023-0154