Tag: pubmed

J Neurosurg. 2024 May 10:1-9. doi: 10.3171/2024.2.JNS232832. Online ahead of print.

ABSTRACT

OBJECTIVE: Neurosurgery subinternships are a critical portion of the medical student application to neurosurgery residency programs, allowing programs to assess the student’s clinical knowledge, interpersonal skills, work ethic, and character. Despite how critical these auditions are, many students have a poor understanding of expectations prior to beginning these subinternships. Thomas Jefferson University hosted a combined in-person and virtual boot camp session open to all medical students interested in neurosurgery. The authors sought to determine the effectiveness of this inaugural course.

METHODS: A total of 304 registered participants were sent a survey assessing their attitudes toward neurosurgery subinternships, beliefs about their abilities, and their comfort with various neurosurgical skills. All participants were sent a postsession survey composed of the same questions. The mean scores for responses to pre- and postsession survey questions were recorded based on graduating year and by medical school type (US allopathic [US MD], US osteopathic [US DO], or foreign degree/international medical graduate [IMG]). Differences in means between pre- and postsession survey responses were analyzed using the Student t-test, and statistical significance was set at p < 0.05.

RESULTS: A total of 112 presession surveys and 64 postsession surveys were completed, yielding a presession survey response rate of 36.8% and a postsession survey response rate of 21.1%. Seventy-five percent of the postsession survey respondents attended virtually, and 25% were in-person. US MD, US DO, and IMG attendees demonstrated a significantly increased understanding of the expectations of a neurosurgery subintern (p < 0.001). All students had significantly increased confidence in their ability to succeed as subinterns (US MD students and IMGs p < 0.001, US DO students p < 0.05). Regarding procedural confidence, US MD students had increased confidence in craniotomies and cranial plating (p < 0.001). When comparing responses by graduation year, students in the classes of 2024 and 2025 (rising 4th-year and rising 3rd-year medical students, respectively) demonstrated significantly increased understanding of expectations and confidence in their ability to succeed (< 0.001). Seventy-five percent of our postsession survey respondents attended virtually, and 25% were in-person. The in-person cohort had greater improvements in comfort with procedures such as craniotomies, cranial plating, and extraventricular drain placement (in-person vs Zoom mean differences: craniotomies and cranial plating, -2.29, extraventricular drain placement, -2.31) (p < 0.05).

CONCLUSIONS: The boot camp successfully delineated the expectations of neurosurgery subinterns and enhanced the attendees’ confidence in their abilities. The authors concluded that a hybrid virtual and in-person format is beneficial and feasible in increasing accessibility to information about neurosurgery subinternships.

PMID:38728756 | DOI:10.3171/2024.2.JNS232832

J Neurosurg. 2024 May 10:1-11. doi: 10.3171/2024.2.JNS232744. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to develop and validate a predictive nomogram model for long-term rebleeding events in patients with hemorrhagic moyamoya disease (HMMD).

METHODS: In total, 554 patients with HMMD from the Fifth Medical Center of the Chinese PLA General Hospital (5-PLAGH cohort) were included and randomly divided into training (390 patients) and internal validation (164 patients) sets. An independent cohort from the First Medical Center and Eighth Medical Center of Chinese PLA General Hospital (the 1-PLAGH and 8-PLAGH cohort) was used for external validation (133 patients). Univariate Cox regression analysis and least absolute shrinkage and selection operator (LASSO) regression algorithm were used to identify significant factors associated with rebleeding, which were used to develop a nomogram for predicting 5- and 10-year rebleeding.

RESULTS: Intraventricular hemorrhage was the most common type of cerebral hemorrhage (39.0% of patients in the 5-PLAGH cohort and 42.9% of the 1-PLAGH and 8-PLAGH cohort). During the mean ± SD follow-up period of 10.4 ± 2.9 years, 91 (16.4%) patients had rebleeding events in the 5-PLAGH cohort. The rebleeding rates were 12.3% (68 patients) at 5 years and 14.8% (82 patients) at 10 years. Rebleeding events were observed in 72 patients (14.3%) in the encephaloduroarteriosynangiosis (EDAS) surgery group, whereas 19 patients (37.3%) experienced rebleeding events in the conservative treatment group. This difference was statistically significant (p < 0.001). We selected 4 predictors (age at onset, number of episodes of bleeding, posterior circulation involvement, and EDAS surgery) for nomogram development. The concordance index (C-index) values of the nomograms of the training cohort, internal validation cohort, and the external validation cohort were 0.767 (95% CI 0.704-0.830), 0.814 (95% CI 0.694-0.934), and 0.718 (95% CI 0.661-0.775), respectively. The nomogram at 5 years exhibited a sensitivity of 48.1% and specificity of 87.5%. The positive and negative predictive values were 38.2% and 91.3%, respectively. The nomogram at 10 years exhibited a sensitivity of 47.1% and specificity of 89.1%. The positive and negative predictive values were 48.5% and 88.5%, respectively.

CONCLUSIONS: EDAS may prevent rebleeding events and improve long-term clinical outcomes in patients with HMMD. The nomogram accurately predicted rebleeding events and assisted clinicians in identifying high-risk patients and devising individual treatments. Simultaneously, comprehensive and ongoing monitoring should be implemented for specific patients with HMMD throughout their entire lifespan.

PMID:38728755 | DOI:10.3171/2024.2.JNS232744

Phys Rev Lett. 2024 Apr 26;132(17):171401. doi: 10.1103/PhysRevLett.132.171401.

ABSTRACT

Rapidly rotating bodies moving in curved space-time experience the so-called spin-curvature force, which becomes important for the motion of compact objects in gravitational-wave inspirals. As a first approximation, this effect is captured in the motion of a spinning test particle. We solve the equations motion of a spinning particle to leading order in spin in arbitrary static and spherically symmetric space-times in terms of one-dimensional closed-form integrals. This solves the problem and proves its integrability in a wide range of modified gravities and near exotic compact objects. Then, by specializing to the case of bound orbits in Schwarzschild space-time, we demonstrate how to express the solution in the form of Jacobi elliptic functions.

PMID:38728722 | DOI:10.1103/PhysRevLett.132.171401

Phys Rev Lett. 2024 Apr 26;132(17):170402. doi: 10.1103/PhysRevLett.132.170402.

ABSTRACT

Quantum systems are unavoidably open to their surrounding degrees of freedom. The theory of open quantum systems is thus crucial to understanding the fluctuations, dissipation, and decoherence of a quantum system of interest. Typically, the bath is modeled as an ensemble of harmonic oscillators, which yields Gaussian statistics of the bath influence on the quantum systems. However, there are also phenomena in which the bath consists of two-state systems, spins, or anharmonic oscillators; therefore, the non-Gaussian properties of the bath become important. Nevertheless, a theoretical framework to describe quantum systems under the influence of such non-Gaussian baths is not well established. Here, we develop a theory to describe quantum dissipative systems affected by Poisson noise properties of the bath, because the Lévi-Itô decomposition theorem asserts that Poisson noise is fundamental in describing arbitrary white noise beyond Gaussian properties. We introduce a quantum bath model that allows for the consistent description of dissipative quantum systems. The obtained master equation reveals non-Gaussian bath effects in the white noise regime, and provides an essential step toward describing open quantum dynamics under the influence of generic baths.

PMID:38728715 | DOI:10.1103/PhysRevLett.132.170402

JMIR Ment Health. 2024 May 10;11:e54007. doi: 10.2196/54007.

ABSTRACT

BACKGROUND: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care.

OBJECTIVE: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health.

METHODS: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ² tests. We analyzed interview data using thematic analysis.

RESULTS: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care).

CONCLUSIONS: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA’s Collect-Share-Act model of MBC.

PMID:38728684 | DOI:10.2196/54007

JMIR Public Health Surveill. 2024 May 10;10:e46029. doi: 10.2196/46029.

ABSTRACT

BACKGROUND: The COVID-19 pandemic impacted mental health and health care systems worldwide.

OBJECTIVE: This study examined the COVID-19 pandemic’s impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures.

METHODS: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age.

RESULTS: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions.

CONCLUSIONS: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences.

PMID:38728683 | DOI:10.2196/46029

Med Care. 2024 Jun 1;62(6):423-430. doi: 10.1097/MLR.0000000000002003. Epub 2024 Apr 10.

ABSTRACT

OBJECTIVE: Fragmented readmissions, when admission and readmission occur at different hospitals, are associated with increased charges compared with nonfragmented readmissions. We assessed if hospital participation in health information exchange (HIE) was associated with differences in total charges in fragmented readmissions.

DATA SOURCE: Medicare Fee-for-Service Data, 2018.

STUDY DESIGN: We used generalized linear models with hospital referral region and readmission month fixed effects to assess relationships between information sharing (same HIE, different HIEs, and no HIE available) and total charges of 30-day readmissions among fragmented readmissions; analyses were adjusted for patient-level clinical/demographic characteristics and hospital-level characteristics.

DATA EXTRACTION METHODS: We included beneficiaries with a hospitalization for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, syncope, urinary tract infection, dehydration, or behavioral issues with a 30-day readmission for any reason.

PRINCIPAL FINDINGS: In all, 279,729 admission-readmission pairs were included, 27% of which were fragmented (n=75,438); average charges of fragmented readmissions were $64,897-$71,606. Compared with fragmented readmissions where no HIE was available, the average marginal effects of same-HIE and different-HIE admission-readmission pairs were -$2329.55 (95% CI: -7333.73, 2674.62) and -$3905.20 (95% CI: -7592.85, -307.54), respectively. While the average marginal effects of different-HIE pairs were lower than those for no-HIE fragmented readmissions, the average marginal effects of same-HIE and different-HIE pairs were not significantly different from each other.

CONCLUSIONS: There were no statistical differences in charges between fragmented readmissions to hospitals that share an HIE or that do not share an HIE compared with hospitals with no HIE available.

PMID:38728681 | DOI:10.1097/MLR.0000000000002003

Med Care. 2024 Jun 1;62(6):416-422. doi: 10.1097/MLR.0000000000002001. Epub 2024 Apr 12.

ABSTRACT

BACKGROUND: HCAHPS’ 2008 initial public reporting, 2012 inclusion in the Hospital Value-Based Purchasing Program (HVBP), and 2015 inclusion in Hospital Star Ratings were intended to improve patient experiences.

OBJECTIVES: Characterize pre-COVID-19 (2008-2019) trends in hospital consumer assessment of healthcare providers and systems (HCAHPS) scores.

RESEARCH DESIGN: Describe HCAHPS score trends overall, by phase: (1) initial public reporting period (2008-2013), (2) first 2 years of HVBP (2013-2015), and (3) initial HCAHPS Star Ratings reporting (2015-2019); and by hospital characteristics (HCAHPS decile, ownership, size, teaching affiliation, and urban/rural).

SUBJECTS: A total of 3909 HCAHPS-participating US hospitals.

MEASURES: HCAHPS summary score (HCAHPS-SS) and 9 measures.

RESULTS: The mean 2007-2019 HCAHPS-SS improvement in most-positive-category (“top-box”) responses was +5.2 percentage points/pp across all hospitals (where differences of 5pp, 3pp, and 1pp are “large,” “medium,” and “small”). Improvement rate was largest in phase 1 (+0.8/pp/year vs. +0.2pp/year and +0.1pp/year for phases 2 and 3, respectively). Improvement was largest for Overall Rating of Hospital (+8.5pp), Discharge Information (+7.3pp), and Nurse Communication (+6.5pp), smallest for Doctor Communication (+0.8pp). Some measures improved notably through phases 2 and 3 (Nurse Communication, Staff Responsiveness, Overall Rating of Hospital), but others slowed or reversed in Phase 3 (Communication about Medicines, Quietness). Bottom-decile hospitals improved more than other hospitals for all measures.

CONCLUSIONS: All HCAHPS measures improved rapidly 2008-2013, especially among low-performing (bottom-decile) hospitals, narrowing the range of performance and improving scores overall. This initial improvement may reflect widespread, general quality improvement (QI) efforts in lower-performing hospitals. Subsequent slower improvement following the introduction of HVBP and Star Ratings may have reflected targeted, resource-intensive QI in higher-performing hospitals.

PMID:38728680 | DOI:10.1097/MLR.0000000000002001

Med Care. 2024 Jun 1;62(6):404-415. doi: 10.1097/MLR.0000000000002002. Epub 2024 Apr 26.

ABSTRACT

RESEARCH DESIGN: Community-engaged qualitative study using inductive thematic analysis of semistructured interviews.

OBJECTIVE: To understand Latine immigrants’ recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization.

BACKGROUND: Decreased health care utilization among immigrants due to punitive immigration policies (ie, the “chilling effect”) has been well-documented among Latine birthing people both pre and postnatally.

PATIENTS AND METHODS: Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants’ pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants.

RESULTS: Participants’ recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants’ rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants’ rights to health care. Participants also suggested training non-medical office staff in the use of interpreters.

CONCLUSION: Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants’ suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.

PMID:38728679 | DOI:10.1097/MLR.0000000000002002

Med Care. 2024 Jun 1;62(6):380-387. doi: 10.1097/MLR.0000000000002005. Epub 2024 Apr 26.

ABSTRACT

BACKGROUND: Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake.

OBJECTIVE: To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States.

DESIGN: A cross-sectional study.

SETTING: 2021 National Health Interview Survey (Q2-Q4).

SUBJECTS: In all, 21,532 adults aged≥18 were included in the study.

MEASURES: Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates.

RESULTS: In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio [AOR] 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses.

LIMITATIONS: Receipt of COVID-19 vaccination was self-reported.

CONCLUSIONS: Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.

PMID:38728678 | DOI:10.1097/MLR.0000000000002005