Tag: pubmed

PLoS One. 2024 Jul 8;19(7):e0297019. doi: 10.1371/journal.pone.0297019. eCollection 2024.

ABSTRACT

Previous observational studies have indicated that social influences, such as arising from herding-like behaviour, can contribute to medical errors. In this study, we experimentally examined whether general practitioners (GPs) would follow incorrect prescription recommendations from fellow GP or specialists. To investigate this, we conducted an online survey with 475 GPs practicing in England that included two case vignettes. Case vignette 1 focused on sleeping tablets, and case vignette 2 was centred around antibiotics. The vignettes were presented in random order, and within each vignette, study participants were assigned to one of three experimental conditions: control condition (lacking peer recommendation), fellow GP condition (including a recommendation from a fellow GP not aligned with best practice clinical guidelines), or specialist condition (including a recommendation from a specialist not aligned with best practice clinical guidelines). The primary outcome measure was the proportion of GPs who prescribed medication that deviated from best practice clinical guidelines. We found that, in both case vignettes, the percentage of respondents prescribing such medication was highest in those assigned to the specialist condition, followed by those assigned to the control condition. It was lowest in those assigned to the fellow GP condition (case vignette 1: 73.8% vs. 55.6% vs. 36.6% and case vignette 2: 24.0% vs. 12.4% vs. 10.1%). In the case of vignette 1, the difference between the fellow GP condition and the control condition is statistically significant, suggesting that GPs are less likely to prescribe sleeping tablets when recommended by a fellow GP. This implies that GPs are more inclined to prescribe non-guideline-recommended medication when advised by specialists. This study is the first to experimentally demonstrate that physician herding behaviour can result in prescription errors. Future research could extend this inquiry to diverse contexts, including diagnosis.

PMID:38976681 | DOI:10.1371/journal.pone.0297019

PLoS Comput Biol. 2024 Jul 8;20(7):e1011791. doi: 10.1371/journal.pcbi.1011791. Online ahead of print.

ABSTRACT

Psychological and neuroscientific research over the past two decades has shown that the Bayesian causal inference (BCI) is a potential unifying theory that can account for a wide range of perceptual and sensorimotor processes in humans. Therefore, we introduce the BCI Toolbox, a statistical and analytical tool in Python, enabling researchers to conveniently perform quantitative modeling and analysis of behavioral data. Additionally, we describe the algorithm of the BCI model and test its stability and reliability via parameter recovery. The present BCI toolbox offers a robust platform for BCI model implementation as well as a hands-on tool for learning and understanding the model, facilitating its widespread use and enabling researchers to delve into the data to uncover underlying cognitive mechanisms.

PMID:38976678 | DOI:10.1371/journal.pcbi.1011791

Clin Transl Gastroenterol. 2024 Jul 1. doi: 10.14309/ctg.0000000000000738. Online ahead of print.

ABSTRACT

BACKGROUND: Stricture is a common complication in Crohn’s disease (CD). Accurate identification of strictures that poorly respond to biologic therapy is essential for making optimal therapeutic decisions. This study aimed to determine the association between ultrasound characteristics of strictures and their therapeutic outcomes.

METHODS: Consecutive CD patients with symptomatic strictures scheduled for biologic therapy were retrospectively recruited at a tertiary hospital. Baseline intestinal ultrasound was conducted to assess stricture characteristics, including bowel wall thickness, length, stratification, vascularity, and creeping fat wrapping angle. Patients were followed-up for a minimum of one year, during which long-term outcomes including surgery, steroid-free clinical remission, and mucosal healing were recorded. Statistical analyses were performed.

RESULTS: A total of 43 patients were enrolled. Strictures were located in the ileocecal region (39.5%), colon (37.2%), anastomosis (20.9%), and small intestine (2.3%). The median follow-up time was 17 months (IQR 7-25), with 27 (62.8%) patients undergoing surgery. On multivariant analysis, creeping fat wrapping angle > 180° (OR 6.2, 95% CI 1.1-41.1) and a high Limberg score (OR 2.3, 95% CI 1.4-6.0) were independent predictors of surgery, with an area under the curve of 0.771 (95% CI: 0.602-0.940), accuracy of 83.7%, sensitivity of 96.3%, and specificity of 62.5%. On Cox survival analysis, creeping fat > 180° was significantly associated with surgery (HR, 5.2; 95% CI, 1.2-21.8; P=0.03). Additionally, creeping fat was significantly associated with steroid-free clinical remission (P=0.015) and mucosal healing (P=0.06).

CONCLUSION: Intestinal ultrasound characteristics can predict outcomes in patients with stricturing Crohn’s disease who undertook biologic therapy.

PMID:38976327 | DOI:10.14309/ctg.0000000000000738

Clin Transl Gastroenterol. 2024 Jul 1. doi: 10.14309/ctg.0000000000000732. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact of pregnancy on the development of pouchitis in women who have undergone total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC) is poorly understood.

METHODS: This was a retrospective study of women with UC who underwent TPC with IPAA and subsequently became pregnant at Mount Sinai Hospital. The primary outcome was acute pouchitis during pregnancy or the post-partum period defined as symptoms of increased stool frequency and urgency treated with antibiotics.

RESULTS: A total of 44 women with 63 pregnancies and complete data were identified. Acute pouchitis occurred in 14 (22.2%) pregnancies in 12 women, and in the post-partum period of 10 (15.9%) pregnancies in 9 women. Acute pouchitis occurred more frequently in women with a prior history of acute pouchitis immediately before, during, or after pregnancy.

CONCLUSIONS: Acute pouchitis was common during pregnancy and the post-partum period, likely due to microbial shifts. Although not statistically significant, these results provide insight into the impact of pregnancy on the risk of pouchitis and establish the framework for pre-conception counseling that focuses on prevention and management of pouchitis during pregnancy.

PMID:38976322 | DOI:10.14309/ctg.0000000000000732

JMIR Form Res. 2024 Jul 8;8:e58063. doi: 10.2196/58063.

ABSTRACT

BACKGROUND: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV.

OBJECTIVE: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development.

METHODS: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants’ willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19).

RESULTS: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up.

CONCLUSIONS: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.

PMID:38976321 | DOI:10.2196/58063

J Glaucoma. 2024 Jul 1. doi: 10.1097/IJG.0000000000002455. Online ahead of print.

ABSTRACT

PRECIS: Among 1,861 adults with ocular hypertension or mild or moderate primary open-angle glaucoma, those with Medicaid or no insurance had a statistically significantly lower likelihood of receiving laser trabeculoplasty compared with those with other insurance.

PURPOSE: To determine whether social determinants of health are associated with undergoing treatment with laser trabeculoplasty (LTP) among individuals with ocular hypertension (OHT) or mild or moderate primary open angle glaucoma (POAG).

METHODS: In this cross-sectional study, we included patients with OHT or mild or moderate POAG from the National Institutes of Health All of Us Research Program, a diverse US nationwide dataset. Logistic regression was performed to study the association between LTP treatment status and seven covariates (diagnosis severity, age, gender, race/ethnicity, income, insurance status, and education).

RESULTS: 1,861 subjects were included (median age of 72 y). In univariable logistic regression, diagnosis severity, older age, higher income, and insurance (non-Medicaid) were associated with LTP treatment. On multivariable logistic regression models, those with mild POAG (OR, 3.49; 95% CI [2.12-5.87]) and moderate POAG (OR, 7.15 [4.49-11.8]) were still more likely than OHT patients to have received LTP. Moreover, compared with participants with Medicaid or no insurance, participants with other insurance (e.g. employer provided, Medicare) were still more likely to have received LTP (OR, 2.24 [1.08-5.29]). There was no significant difference in the LTP treatment likelihood based on race/ethnicity.

CONCLUSIONS: After controlling for confounders, the likelihood of receiving LTP appears to be driven primarily by insurance rather than income or race/ethnicity. Potential reasons for decreased utilization of LTP among Medicaid patients include higher rates of declining the procedure, or LTP may have been offered less frequently due to Medicaid’s lower levels of reimbursement and longer reimbursement delays.

PMID:38976304 | DOI:10.1097/IJG.0000000000002455

JAMA Pediatr. 2024 Jul 8. doi: 10.1001/jamapediatrics.2024.1991. Online ahead of print.

ABSTRACT

IMPORTANCE: Since the COVID-19 pandemic, emergency department boarding of youth with mental health concerns has increased.

OBJECTIVE: To summarize characteristics (including gender, age, race, ethnicity, insurance, diagnosis, and barriers to placement) of youth who boarded in emergency departments while awaiting inpatient psychiatric care and to test for racial, ethnic, and gender disparities in boarding lengths and inpatient admission rates after boarding. Secondarily, to assess whether statewide demand for inpatient psychiatric care correlated with individual outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis included administrative data collected from May 2020 to June 2022 and represented a statewide study of Massachusetts. All youth aged 5 to 17 years who boarded in Massachusetts emergency departments for 3 or more midnights while awaiting inpatient psychiatric care were included.

EXPOSURE: Boarding for 3 or more midnights while awaiting inpatient psychiatric care.

MAIN OUTCOMES AND MEASURES: Emergency department boarding length (number of midnights) and whether inpatient care was received after boarding. Statistical analyses performed included logistic and gamma regressions; assessed gender, racial, and ethnic disparities; and correlations between statewide demand for psychiatric care and boarding outcomes.

RESULTS: A total of 4942 boarding episodes were identified: 2648 (54%) for cisgender females, 1958 (40%) for cisgender males, and 336 (7%) for transgender or nonbinary youth. A total of 1337 youth (27%) were younger than 13 years. Depression was the most common diagnosis (2138 [43%]). A total of 2748 episodes (56%) resulted in inpatient admission, and 171 transgender and nonbinary youth (51%) received inpatient care compared with 1558 cisgender females (59%; adjusted difference: -9.1 percentage points; 95% CI, -14.7 to -3.6 percentage points). Transgender or nonbinary youth boarded for a mean (SD) of 10.4 (8.3) midnights compared with 8.6 (6.9) midnights for cisgender females (adjusted difference: 2.2 midnights; 95% CI, 1.2-3.2 midnights). Fewer Black youth were admitted than White youth (382 [51%] and 1231 [56%], respectively; adjusted difference: -4.3 percentage points; 95% CI, -8.4 to -0.2 percentage points). For every additional 100 youth boarding statewide on the day of assessment, the percentage of youth admitted was 19.4 percentage points lower (95% CI, -23.6% to -15.2%) and boarding times were 3.0 midnights longer (95% CI, 2.4-3.7 midnights).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, almost one-half of 3 or more midnight boarding episodes did not result in admission, highlighting a need to understand the effects of boarding without admission. Gender and racial disparities were identified, suggesting the need for targeted resources to reduce boarding and promote equitable access to care.

PMID:38976283 | DOI:10.1001/jamapediatrics.2024.1991

Clin Neuropharmacol. 2024 Jun 24. doi: 10.1097/WNF.0000000000000602. Online ahead of print.

ABSTRACT

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurobehavioral disorder in school-aged children. Although there are several drug treatment options, some patients do not have adequate therapeutic responses to conventional medications or experience considerable adverse effects. Citicoline is an endogenous molecule that has beneficial effects on attention, impulsivity, and memory and is a potential treatment for ADHD. This study aimed to evaluate the effect of citicoline in pediatric patients diagnosed with ADHD.

METHODS: This randomized, crossover, double-blind, placebo-controlled clinical trial included with patients aged 7-12 years diagnosed with ADHD.

RESULTS: As a result, no statistically significant difference was noted between the use of citicoline and placebo in the evaluated parameters. The treatment had no adverse effects.

CONCLUSIONS: Citicoline seems to be a safe molecule to be administered in the pediatric age group. Further studies are required to assess the therapeutic potential of citicoline in ADHD.

PMID:38976279 | DOI:10.1097/WNF.0000000000000602

JAMA Netw Open. 2024 Jul 1;7(7):e2419229. doi: 10.1001/jamanetworkopen.2024.19229.

NO ABSTRACT

PMID:38976273 | DOI:10.1001/jamanetworkopen.2024.19229

JAMA Netw Open. 2024 Jul 1;7(7):e2419268. doi: 10.1001/jamanetworkopen.2024.19268.

ABSTRACT

IMPORTANCE: A nonadjuvanted bivalent respiratory syncytial virus (RSV) prefusion F (RSVpreF [Pfizer]) protein subunit vaccine was newly approved and recommended for pregnant individuals at 32 0/7 to 36 6/7 weeks’ gestation during the 2023 to 2024 RSV season; however, clinical vaccine data are lacking.

OBJECTIVE: To evaluate the association between prenatal RSV vaccination status and perinatal outcomes among patients who delivered during the vaccination season.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational cohort study was conducted at 2 New York City hospitals within 1 health care system among patients who gave birth to singleton gestations at 32 weeks’ gestation or later from September 22, 2023, to January 31, 2024.

EXPOSURE: Prenatal RSV vaccination with the RSVpreF vaccine captured from the health system’s electronic health records.

MAIN OUTCOME AND MEASURES: The primary outcome is preterm birth (PTB), defined as less than 37 weeks’ gestation. Secondary outcomes included hypertensive disorders of pregnancy (HDP), stillbirth, small-for-gestational age birth weight, neonatal intensive care unit (NICU) admission, neonatal respiratory distress with NICU admission, neonatal jaundice or hyperbilirubinemia, neonatal hypoglycemia, and neonatal sepsis. Logistic regression models were used to estimate odds ratios (ORs), and multivariable logistic regression models and time-dependent covariate Cox regression models were performed.

RESULTS: Of 2973 pregnant individuals (median [IQR] age, 34.9 [32.4-37.7] years), 1026 (34.5%) received prenatal RSVpreF vaccination. Fifteen patients inappropriately received the vaccine at 37 weeks’ gestation or later and were included in the nonvaccinated group. During the study period, 60 patients who had evidence of prenatal vaccination (5.9%) experienced PTB vs 131 of those who did not (6.7%). Prenatal vaccination was not associated with an increased risk for PTB after adjusting for potential confounders (adjusted OR, 0.87; 95% CI, 0.62-1.20) and addressing immortal time bias (hazard ratio [HR], 0.93; 95% CI, 0.64-1.34). There were no significant differences in pregnancy and neonatal outcomes based on vaccination status in the logistic regression models, but an increased risk of HDP in the time-dependent model was seen (HR, 1.43; 95% CI, 1.16-1.77).

CONCLUSIONS AND RELEVANCE: In this cohort study of pregnant individuals who delivered at 32 weeks’ gestation or later, the RSVpreF vaccine was not associated with an increased risk of PTB and perinatal outcomes. These data support the safety of prenatal RSVpreF vaccination, but further investigation into the risk of HDP is warranted.

PMID:38976271 | DOI:10.1001/jamanetworkopen.2024.19268