Tag: pubmed

JAMA Netw Open. 2024 Jun 3;7(6):e2414329. doi: 10.1001/jamanetworkopen.2024.14329.

ABSTRACT

IMPORTANCE: Adverse patient events are inevitable in surgical practice.

OBJECTIVES: To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient.

DESIGN, SETTING, AND PARTICIPANTS: In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system.

MAIN OUTCOMES AND MEASURES: The personal impact of adverse patient events, current coping mechanisms, and desired forms of support.

RESULTS: Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing.

CONCLUSIONS AND RELEVANCE: In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.

PMID:38829617 | DOI:10.1001/jamanetworkopen.2024.14329

Eur Arch Otorhinolaryngol. 2024 Jun 3. doi: 10.1007/s00405-024-08753-3. Online ahead of print.

ABSTRACT

BACKGROUND: Histopathological analysis often shows close resection margins after surgical removal of tongue squamous cell carcinoma (TSCC). This study aimed to investigate the agreement between intraoperative 3D ultrasound (US) margin assessment and postoperative histopathology of resected TSCC.

METHODS: In this study, ten patients were prospectively included. Three fiducial cannulas were inserted into the specimen. To acquire a motorized 3D US volume, the resected specimen was submerged in saline, after which images were acquired while the probe moved over the specimen. The US volumes were annotated twice: (1) automatically and (2) manually, with the automatic segmentation as initialization. After standardized histopathological processing, all hematoxylin-eosin whole slide images (WSI) were included for analysis. Corresponding US images were found based on the known WSI spacing and fiducials. Blinded observers measured the tumor thickness and the margin in the caudal, deep, and cranial directions on every slide. The anterior and posterior margin was measured per specimen.

RESULTS: The mean difference in all measurements between manually segmented US and histopathology was 2.34 (SD: ±3.34) mm, and Spearman’s rank correlation coefficient was 0.733 (p < 0.001). The smallest mean difference was in the tumor thickness with 0.80 (SD: ±2.44) mm and a correlation of 0.836 (p < 0.001). Limitations were observed in the caudal region, where no correlation was found.

CONCLUSION: This study shows that 3D US and histopathology have a moderate to strong statistically significant correlation (r = 0.733; p < 0.001) and a mean difference between the modalities of 2.3 mm (95%CI: -4.2; 8.9). Future research should focus on patient outcomes regarding resection margins.

PMID:38829555 | DOI:10.1007/s00405-024-08753-3

Lasers Med Sci. 2024 Jun 3;39(1):148. doi: 10.1007/s10103-024-04096-x.

ABSTRACT

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808 nm, 250 mW, 23s continuous, 0.5 cm², 11.5 J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve’s pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24 h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar’s test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26 min, while the sham laser group experienced 134.44 ± 21.8 min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

PMID:38829548 | DOI:10.1007/s10103-024-04096-x

Adipocyte. 2024 Dec;13(1):2360037. doi: 10.1080/21623945.2024.2360037. Epub 2024 Jun 3.

ABSTRACT

As a mechanically condensed product of Coleman fat, extracellular matrix/stromal vascular fraction gel (ECM/SVF-gel) eliminates adipocytes, concentrates SVF cells, and improves fat graft retention. This study aims to compare SVF cell composition between Coleman fat and ECM/SVF-gel. Matched Coleman fat and ECM/SVF-gel of 28 healthy women were subjected to RNA-seq, followed by functional enrichment and cell-type-specific enrichment analyses, and deconvolution of SVF cell subsets, reconstructing SVF cell composition in the transcriptome level. ECM/SVF-gels had 9 upregulated and 73 downregulated differentially expressed genes (DEGs). Downregulated DEGs were mainly associated with inflammatory and immune responses, and enriched in fat macrophages. M2 macrophages, resting CD4⁺ memory T cells, M1 macrophages, resting mast cells, and M0 macrophages ranked in the top five most prevalent immune cells in the two groups. The proportions of the principal non-immune cells (e.g., adipose-derived stem cells, pericytes, preadipocytes, microvascular endothelial cells) had no statistical differences between the two groups. Our findings reveal ECM/SVF-gels share the same dominant immune cells beneficial to fat graft survival with Coleman fat, but exhibiting obvious losses of immune cells (especially macrophages), while non-immune cells necessary for adipose regeneration might have no significant loss in ECM/SVF-gels and their biological effects could be markedly enhanced by the ECM/SVF-gel’s condensed nature.

PMID:38829527 | DOI:10.1080/21623945.2024.2360037

Skeletal Radiol. 2024 Jun 3. doi: 10.1007/s00256-024-04717-0. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study is to analyze changes in the utilization of MRA of the hip and shoulder at a large tertiary care academic medical center during a period of significant technological advancements over the last 20 years.

MATERIALS AND METHODS: This retrospective cross-sectional analysis identified MRA of the hip and shoulder performed at our institution over a 20-year period (2/2003-2/2023) in relation to the total number of MR hip and shoulder examinations during the same period. Patient characteristics and referring provider demographic information were extracted. Descriptive statistics and trend analysis were performed.

RESULTS: The total number of MRIs of the hip and shoulder increased overall, with small dips in 2020 and 2022. MRA of the hip increased significantly over the first 10 years of the study period (p = 0.0005), while MRA of the shoulder did not change significantly (p = 0.33). The proportion of both MRA of the hip and shoulder declined over the last 10 years (hip, p = 0.0056; shoulder, p = 0.0017). Over the same period, there was significant increase in the proportion of examinations performed at 3 Tesla versus 1.5 (p < 0.0001).

CONCLUSION: Overall, there was a downward trend in MR shoulder and hip arthrogram utilization in the second half of this 20-year study period. However, utilization varied somewhat by referring specialties and credentials. These changes are likely reflective of both improvements in image quality and evolving practice recommendations. Awareness of such trends may be valuable in ensuring appropriate patient care, as well as for anticipating the needs of a musculoskeletal radiology practice.

PMID:38829525 | DOI:10.1007/s00256-024-04717-0

Matern Child Health J. 2024 Jun 3. doi: 10.1007/s10995-024-03948-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Gestational diabetes commonly occurs during pregnancy and increases lifetime risk of type 2 diabetes following pregnancy. Engaging in physical activity postnatally can reduce this subsequent risk. Interventions aiming to increase physical activity after gestational diabetes may not address the wide range of post-pregnancy barriers. A socio-ecological approach highlights the need to include multi-level factors such as social, community and organisational factors. The aim of the review was to map intervention components to prevent type 2 diabetes after gestational diabetes using the socio-ecological model as a framework and investigate how physical activity changes align with different intervention components utilised.

METHODS: Eligible studies included any study type within 5 years of a gestational diabetes diagnosis and targeted physical activity. A systematic search of MEDLINE, Cochrane Library, Web of Science, CINAHL Complete, and Scopus was conducted in October 2022. Results were categorised based on whether findings demonstrated no increases, non-statistically significant increases or statistically significant increases in physical activity.

RESULTS: Forty-eight studies were included (37 different interventions). Thirty-eight studies were assessed as “adequate” quality, only two studies were “good” quality, and the remaining were limited quality. Mixed physical activity outcomes were observed across components used at the intrapersonal level, with components across other levels of the socio-ecological model showing more increases in physical activity. Intervention components within the social and organisational levels, for example childcare provision, providing group-based sessions and offering remote delivery, were more often present in interventions with physical activity increases.

CONCLUSIONS FOR PRACTICE: Future interventions targeting physical activity after gestational diabetes should aim to include social and organisational-level components in their intervention design. This systematic review was registered in PROSPERO (ID: CRD42021272044).

PMID:38829517 | DOI:10.1007/s10995-024-03948-w

Environ Sci Pollut Res Int. 2024 May 30. doi: 10.1007/s11356-024-33810-z. Online ahead of print.

ABSTRACT

Significant investigations were performed on the use and impact on physical properties along with mechanical strength of the recycled and reused e-glass waste powder. However, it has been modeled how recycled display e-waste glass may affect the characteristics and qualities of dune sand mortar. This study investigates the long-term feasibility of using recycled display e-glass waste as a partial substitute for dune sand at varying percentages (5%, 10%, 15%, and 20%). The main focus is on evaluating its effectiveness in radiation shielding, strength properties, and durability for long-term development under the heating environmental process. Statistical analyses, including analysis of variance, are used to assess the significance of factors and their interactions on these characteristics. Additionally, a regression equation derived from the model offers insights into the quantitative relationship between the factors and properties. The results of the experiments led to the conclusion that the most effective proportion of e-glass waste to include in mortar is 20%, with the weight of dune sand. Including e-glass waste, they significantly increased the five characteristics of the mortar, making it suitable for high-strength mortar applications continue up to 68 MPa. The ANOVA model used in this study was trained using the same experimental research design and was critical in predicting the properties of the mortar. The model produced an accurate result with an R² value greater than 0.99. E-glass replacements exhibit remarkable radiation shielding, characterized by pozzolanic activity and superior internal bonding due to its compact texture, contributing to enhanced long-term strength.

PMID:38829500 | DOI:10.1007/s11356-024-33810-z

Drugs Real World Outcomes. 2024 Jun 3. doi: 10.1007/s40801-024-00431-4. Online ahead of print.

ABSTRACT

BACKGROUND: Levetiracetam is an anti-seizure medication (ASM) with an established safety profile. However, a potential safety signal of hypokalemia following levetiracetam use was published in the World Health Organization newsletter.

OBJECTIVE: To investigate the possible causal association between the use of levetiracetam and the development of hypokalemia.

METHOD: This was a new-user, active-comparator retrospective cohort study using Real-world Evidence Research Network data at the Saudi Food and Drug Authority from 2016 to 2022. Adults (≥ 18 years old) with an incident prescription for either levetiracetam or carbamazepine were followed for up to 6 months from the prescription date. Hypokalemia was ascertained by using diagnostic code (i.e., E87.6) or by serum potassium level below 3.5 mmol/L. A Cox proportional hazards model, adjusted with stabilized inverse probability of treatment weight, was fitted to compare the hazard of hypokalemia between levetiracetam and carbamazepine exposed patients.

RESULTS: A total of 8,982 patients entered the study cohort. The incidence rate of hypokalemia was 303 cases per 10,000 patient-years in the levetiracetam-exposed cohort compared to 57 cases per 10,000 patient-years among carbamazepine users. Compared to carbamazepine users, patients exposed to levetiracetam had an adjusted hazard ratio related to induced hypokalemia of 1.99 (95% confidence interval, 0.88-4.49). Results of sensitivity analyses were comparable to the main analysis.

CONCLUSION: The hazard ratio for hypokalemia with the use of levetiracetam versus carbamazepine was statistically comparable. However, the potential association between levetiracetam use and hypokalemia cannot be ruled out given the elevated hazard ratios from the main and sensitivity analyses. Further studies may provide a more precise assessment of this association.

PMID:38829496 | DOI:10.1007/s40801-024-00431-4

Psychometrika. 2024 Jun 3. doi: 10.1007/s11336-024-09977-2. Online ahead of print.

ABSTRACT

The deployment of statistical models-such as those used in item response theory-necessitates the use of indices that are informative about the degree to which a given model is appropriate for a specific data context. We introduce the InterModel Vigorish (IMV) as an index that can be used to quantify accuracy for models of dichotomous item responses based on the improvement across two sets of predictions (i.e., predictions from two item response models or predictions from a single such model relative to prediction based on the mean). This index has a range of desirable features: It can be used for the comparison of non-nested models and its values are highly portable and generalizable. We use this fact to compare predictive performance across a variety of simulated data contexts and also demonstrate qualitative differences in behavior between the IMV and other common indices (e.g., the AIC and RMSEA). We also illustrate the utility of the IMV in empirical applications with data from 89 dichotomous item response datasets. These empirical applications help illustrate how the IMV can be used in practice and substantiate our claims regarding various aspects of model performance. These findings indicate that the IMV may be a useful indicator in psychometrics, especially as it allows for easy comparison of predictions across a variety of contexts.

PMID:38829495 | DOI:10.1007/s11336-024-09977-2

Biol Trace Elem Res. 2024 Jun 3. doi: 10.1007/s12011-024-04253-x. Online ahead of print.

ABSTRACT

The prevalence of diabetes has reached alarming levels in India, making it essential to understand the concentration of nutritional-trace elements (Fe, Cu, Zn, Cr. and Se) in blood samples from diabetic adults. In this study, 208 whole blood samples from diabetic (n = 104) and non-diabetic (n = 104) adults across various age groups were analyzed using total reflection X-ray fluorescence (TXRF) spectroscopy with a sample dilution method. Statistical analysis was performed to assess descriptive statistics and determine a significant correlation between elemental concentrations in the blood samples of diabetic and non-diabetic adults. The mean concentration of nutritional-related trace elements in diabetic blood was as follows: Fe (46 ± 5) > Zn (1.28 ± 0.14) > Cu (0.10 ± 0.01) > Cr (0.05 ± 0.004) > Se (0.013 ± 0.001) in mg/L, respectively. Additionally, this study investigated the influence of nutrition-related trace element concentrations across various age groups such as 25-40 years (young adults), 41-55 years (middle-aged adults), and 56-70 years (older adults). In this investigation, Zn (p < 0.001) and Cr (p < 0.05) concentrations differed significantly between diabetic and non-diabetic adults aged 56-70 years. These findings will help us to understand age-dependent changes in element concentrations, clarify their role in diabetes, and improve risk factor management associated with diabetes.

PMID:38829478 | DOI:10.1007/s12011-024-04253-x