Tag: pubmed

BMJ. 2024 Jun 5;385:e079329. doi: 10.1136/bmj-2024-079329.

ABSTRACT

OBJECTIVES: To evaluate whether providing family physicians with feedback on their antibiotic prescribing compared with that of their peers reduces antibiotic prescriptions. To also identify effects on antibiotic prescribing from case-mix adjusted feedback reports and messages emphasising antibiotic associated harms.

DESIGN: Pragmatic, factorial randomised controlled trial.

SETTING: Primary care physicians in Ontario, Canada PARTICIPANTS: All primary care physicians were randomly assigned a group if they were eligible and actively prescribing antibiotics to patients 65 years or older. Physicians were excluded if had already volunteered to receive antibiotic prescribing feedback from another agency, or had opted out of the trial.

INTERVENTION: A letter was mailed in January 2022 to physicians with peer comparison antibiotic prescribing feedback compared with the control group who did not receive a letter (4:1 allocation). The intervention group was further randomised in a 2×2 factorial trial to evaluate case-mix adjusted versus unadjusted comparators, and emphasis, or not, on harms of antibiotics.

MAIN OUTCOME MEASURES: Antibiotic prescribing rate per 1000 patient visits for patients 65 years or older six months after intervention. Analysis was in the modified intention-to-treat population using Poisson regression.

RESULTS: 5046 physicians were included and analysed: 1005 in control group and 4041 in intervention group (1016 case-mix adjusted data and harms messaging, 1006 with case-mix adjusted data and no harms messaging, 1006 unadjusted data and harms messaging, and 1013 unadjusted data and no harms messaging). At six months, mean antibiotic prescribing rate was 59.4 (standard deviation 42.0) in the control group and 56.0 (39.2) in the intervention group (relative rate 0.95 (95% confidence interval 0.94 to 0.96). Unnecessary antibiotic prescribing (0.89 (0.86 to 0.92)), prolonged duration prescriptions defined as more than seven days (0.85 (0.83 to 0.87)), and broad spectrum prescribing (0.94 (0.92 to 0.95)) were also significantly lower in the intervention group compared with the control group. Results were consistent at 12 months post intervention. No significant effect was seen for including emphasis on harms messaging. A small increase in antibiotic prescribing with case-mix adjusted reports was noted (1.01 (1.00 to 1.03)).

CONCLUSIONS: Peer comparison audit and feedback letters significantly reduced overall antibiotic prescribing with no benefit of case-mix adjustment or harms messaging. Antibiotic prescribing audit and feedback is a scalable and effective intervention and should be a routine quality improvement initiative in primary care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04594200.

PMID:38839101 | DOI:10.1136/bmj-2024-079329

J Oral Implantol. 2024 Jun 1;50(3):266-276. doi: 10.1563/aaid-joi-D-22-00096.

ABSTRACT

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CDs) or implant-retained mandibular overdentures (IODs), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CDs and IODs are the 2 leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, “Is patient satisfaction and quality of life affected by the type of prostheses and provider?” A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the University of Kentucky College of Dentistry from 2014 to 2016 with at least 1 year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients’ oral health-related quality of life, including questions related to the edentulous patients’ satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study’s findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IODs had lower physical pain, limitations, and disability scores than males with CD. However, females with IODs reported more significant concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IODs and identified significance in outcomes by gender. These findings guide prosthodontic practitioners’ patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

PMID:38839070 | DOI:10.1563/aaid-joi-D-22-00096

Int J Numer Method Biomed Eng. 2024 Jun 5:e3837. doi: 10.1002/cnm.3837. Online ahead of print.

ABSTRACT

The mechanisms behind intracranial aneurysm formation and rupture are not fully understood, with factors such as location, patient demographics, and hemodynamics playing a role. Additionally, the significance of anatomical features like blebs in ruptures is debated. This highlights the necessity for comprehensive research that combines patient-specific risk factors with a detailed analysis of local hemodynamic characteristics at bleb and rupture sites. Our study analyzed 359 intracranial aneurysms from 268 patients, reconstructing patient-specific models for hemodynamic simulations based on 3D rotational angiographic images and intraoperative videos. We identified aneurysm subregions and delineated rupture sites, characterizing blebs and their regional overlap, employing statistical comparisons across demographics, and other risk factors. This work identifies patterns in aneurysm rupture sites, predominantly at the dome, with variations across patient demographics. Hypertensive and anterior communicating artery (ACom) aneurysms showed specific rupture patterns and bleb associations, indicating two pathways: high-flow in ACom with thin blebs at impingement sites and low-flow, oscillatory conditions in middle cerebral artery (MCA) aneurysms fostering thick blebs. Bleb characteristics varied with gender, age, and smoking, linking rupture risks to hemodynamic factors and patient profiles. These insights enhance understanding of the hemodynamic mechanisms leading to rupture events. This analysis elucidates the role of localized hemodynamics in intracranial aneurysm rupture, challenging the emphasis on location by revealing how flow variations influence stability and risk. We identify two pathways to wall failure-high-flow and low-flow conditions-highlighting the complexity of aneurysm behavior. Additionally, this research advances our knowledge of how inherent patient-specific characteristics impact these processes, which need further investigation.

PMID:38839043 | DOI:10.1002/cnm.3837

Eur J Obstet Gynecol Reprod Biol. 2024 Jun 3;299:72-77. doi: 10.1016/j.ejogrb.2024.06.001. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, the integration ofArtificial intelligence (AI) into various fields of medicine including Gynaecology, has shown promising potential. Surgical treatment of fibroid is myomectomy if uterine preservation and fertility are the primary aims. AI usage begins with the involvement of LLM (Large Language Model) from the point when a patient visits a gynecologist, from identifying signs and symptoms to reaching a diagnosis, providing treatment plans, and patient counseling.

OBJECTIVE: Use of AI (ChatGPT versus Google Bard) in the surgical management of fibroid.

STUDY DESIGN: Identifyingthe patient’s problems using LLMs like ChatGPT and Google Bard and giving a treatment optionin 8 clinical scenarios of fibroid. Data entry was done using M.S. Excel and was statistically analyzed using Statistical Package for Social Sciences (SPSS Version 26) for M.S. Windows 2010. All results were presented in tabular form. Data were analyzed using nonparametric tests Chi-square tests or Fisher exact test.pvalues < 0.05 were considered statistically significant. The sensitivity of both techniques was calculated. We have used Cohen’s Kappa to know the degree of agreement.

RESULTS: We found that on the first attempt, ChatGPT gave general answers in 62.5 % of cases and specific answers in 37.5 % of cases. ChatGPT showed improved sensitivity on successive prompts 37.5 % to 62.5 % on the third prompt. Google Bard could not identify the clinical question in 50 % of cases and gave incorrect answers in 12.5 % of cases (p = 0.04). Google Bard showed the same sensitivity of 25 % on all prompts.

CONCLUSION: AI helps to reduce the time to diagnose and plan a treatment strategy for fibroid and acts as a powerful tool in the hands of a gynecologist. However, the usage of AI by patients for self-treatment is to be avoided and should be used only for education and counseling about fibroids.

PMID:38838389 | DOI:10.1016/j.ejogrb.2024.06.001

Eur J Obstet Gynecol Reprod Biol. 2024 Jun 1;299:62-70. doi: 10.1016/j.ejogrb.2024.05.044. Online ahead of print.

ABSTRACT

OBJECTIVE: The influence of hypertensive disorders of pregnancy (HDP) on left atrial (LA) mechanics assessed by speckle tracking echocardiography (STE) has been poorly investigated. Accordingly, we performed a meta-analysis to summarize the main findings of STE studies who measured LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain in HDP women.

STUDY DESIGN: All echocardiographic studies assessing LA strain parameters in HDP women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LASr, LAScd and LASct) were pooled as standardized mean difference (SMD) comparing HDP group with healthy controls. The overall SMDs of LASr, LAScd and LASct were calculated using the random-effect model.

RESULTS: The full-texts of 8 studies with 566 HDP women and 420 healthy pregnant women were analyzed. Average LASr (34.3 ± 6.4 vs 42.7 ± 5.3 %, P = 0.01) and LAScd (23.4 ± 6.3 vs 32.5 ± 6.0 %, P < 0.001) were significantly lower in HDP women than controls, whereas LASct (-13.0 ± 5.4 vs -13.7 ± 4.5 %, P = 0.18) was similar in the two groups of women. Substantial heterogeneity was detected among the studies evaluating LASr (I² = 94.3 %), LAScd (I² = 64.9 %) and LASct (I² = 86.4 %). SMDs were large and statistically significant for LASr (-1.70, 95 %CI -2.34,-1.06, P < 0.001) and LAScd (-1.35, 95 %CI -1.69,-1.00, P < 0.001), small and not statistically significant for LASct (-0.11, 95 %CI -0.60,0.39, P = 0.678) assessment. Egger’s test gave P-values of 0.10, 0.34 and 0.75 for LASr, LAScd and LASct measurement respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LASr and its components (all P < 0.05).

CONCLUSIONS: HDPs are independently associated with LASr impairment in pregnancy. STE allows to identify, among HDP women, those who might benefit from a more aggressive antihypertensive treatment and/or a closer clinical follow-up, aimed at reducing the risk of adverse maternal outcome and cardiovascular complications later in life.

PMID:38838388 | DOI:10.1016/j.ejogrb.2024.05.044

J Pediatr Nurs. 2024 Jun 4;78:1-6. doi: 10.1016/j.pedn.2024.05.028. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the variables that affect early adolescents’ parents’ digital self-efficacy and digital parenting awareness.

DESIGN AND METHODS: A cross-sectional study was conducted between May and June 2022, with a sample of 2402 parents. Data were collected using a Parent Information Form, Digital Parenting Awareness Scale, and Digital Parenting Self-Efficacy Scale. The data were analysed using independent t-tests, Pearson correlations, and one-way ANOVA analysis.

RESULTS: All parents have internet access at home and on their phones, and they all use the internet. The average daily internet usage time is 4.48 ± 2.09 h. A positive correlation was found between the average scores of parents’ digital literacy (r = -0.111; p < 0.001) and digital communication (r = 0.089; p < 0.001). It was determined that the average digital communication subscale score of parents with a primary school degree was higher than that of parents with a university degree or higher (F = 2.783, p = 0.040). It was found that there was no statistical correlation between the amount of time parents spend on the internet daily and their total score and subscale scores of digital self-efficacy (p > 0.05).

CONCLUSION: This study’s results demonstrate that parents are proficient in digital security, digital literacy, and digital communication. Additionally, there is a significant correlation between digital literacy, digital communication, and digital parenting awareness.

PRACTICE IMPLICATIONS: The study results could guide the development of future interventions to enhance parents’ awareness and competence in digital safety and the use of digital tools.

PMID:38838381 | DOI:10.1016/j.pedn.2024.05.028

J Craniofac Surg. 2024 Jun 3. doi: 10.1097/SCS.0000000000010340. Online ahead of print.

ABSTRACT

INTRODUCTION: Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world’s fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation.

METHODS: The authors performed a retrospective chart review on all patients who received cleft lip and palate repair by a single surgeon in 40 separate surgical camps at Edna Adan University Hospital in Hargeisa, Somaliland, between 2011 and 2024. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. Descriptive statistical analysis was performed.

RESULTS: A total of 767 patients (495 male, 64.5%) received 787 surgical procedures. The average age of primary surgery was 73.7 months. The most common chief complaint was left cleft lip with cleft palate (316, 41.2%). Males received primary surgery 19.2 months later than did females (73.7 and 54.6 mo, respectively, P<0.001). Patients residing in Hargeisa received their initial procedure an average of 17.8 months younger than those who lived elsewhere in Somaliland (62.9 and 80.7 mo, respectively, P=0.004).

CONCLUSIONS: In this severely economically depressed region, patients received treatment at ages that lagged far beyond recommended guidelines. Our finding of earlier treatment for females than males is rare in the literature and likely relates to cultural sex expectations. Patients from rural locations were especially vulnerable to receiving delayed treatment. Further efforts to decrease the burden of craniofacial deformities in Somaliland should be pursued in earnest.

PMID:38838366 | DOI:10.1097/SCS.0000000000010340

J Phys Chem Lett. 2024 Jun 5:6222-6229. doi: 10.1021/acs.jpclett.4c01401. Online ahead of print.

ABSTRACT

Unimolecular decay of the formaldehyde oxide (CH₂OO) Criegee intermediate proceeds via a 1,3 ring-closure pathway to dioxirane and subsequent rearrangement and/or dissociation to many products including hydroxyl (OH) radicals that are detected. Vibrational activation of jet-cooled CH₂OO with two quanta of CH stretch (17-18 kcal mol^-1) leads to unimolecular decay at an energy significantly below the transition state barrier of 19.46 ± 0.25 kcal mol^-1, refined utilizing a high-level electronic structure method HEAT-345(Q)_Λ. The observed unimolecular decay rate of 1.6 ± 0.4 × 10⁶ s^-1 is 2 orders of magnitude slower than that predicted by statistical unimolecular reaction theory using several different models for quantum mechanical tunneling. The nonstatistical behavior originates from excitation of a CH stretch vibration that is orthogonal to the heavy atom motions along the reaction coordinate and slow intramolecular vibrational energy redistribution due to the sparse density of states.

PMID:38838341 | DOI:10.1021/acs.jpclett.4c01401

J Med Internet Res. 2024 Jun 5;26:e51418. doi: 10.2196/51418.

ABSTRACT

BACKGROUND: Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners.

OBJECTIVE: This study aims to quantitatively synthesize evidence of the between- and within-group effectiveness of social media for dissemination of research evidence to health and social care practitioners. It also compared effectiveness between different social media platforms, formats, and strategies.

METHODS: We searched electronic databases for articles in English that were published between January 1, 2010, and January 10, 2023, and that evaluated social media interventions for disseminating research evidence to qualified, postregistration health and social care practitioners in measures of reach, engagement, direct dissemination, or impact. Screening, data extraction, and risk of bias assessments were carried out by at least 2 independent reviewers. Meta-analyses of standardized pooled effects were carried out for between- and within-group effectiveness of social media and comparisons between platforms, formats, and strategies. Certainty of evidence for outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework.

RESULTS: In total, 50 mixed-quality articles that were heterogeneous in design and outcome were included (n=9, 18% were randomized controlled trials [RCTs]). Reach (measured in number of practitioners, impressions, or post views) was reported in 26 studies. Engagement (measured in likes or post interactions) was evaluated in 21 studies. Direct dissemination (measured in link clicks, article views, downloads, or altmetric attention score) was analyzed in 23 studies (8 RCTs). Impact (measured in citations or measures of thinking and practice) was reported in 13 studies. Included studies almost universally indicated effects in favor of social media interventions, although effect sizes varied. Cumulative evidence indicated moderate certainty of large and moderate between-group effects of social media interventions on direct dissemination (standardized mean difference [SMD] 0.88; P=.02) and impact (SMD 0.76; P<.001). After social media interventions, cumulative evidence showed moderate certainty of large within-group effects on reach (SMD 1.99; P<.001), engagement (SMD 3.74; P<.001), and direct dissemination (SMD 0.82; P=.004) and low certainty of a small within-group effect on impacting thinking or practice (SMD 0.45; P=.02). There was also evidence for the effectiveness of using multiple social media platforms (including Twitter, subsequently rebranded X; and Facebook), images (particularly infographics), and intensive social media strategies with frequent, daily posts and involving influential others. No included studies tested the dissemination of research evidence to social care practitioners.

CONCLUSIONS: Social media was effective for disseminating research evidence to health care practitioners. More intense social media campaigns using specific platforms, formats, and strategies may be more effective than less intense interventions. Implications include recommendations for effective dissemination of research evidence to health care practitioners and further RCTs in this field, particularly investigating the dissemination of social care research.

TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022378793; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378793.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/45684.

PMID:38838330 | DOI:10.2196/51418

JMIR Public Health Surveill. 2024 Jun 5;10:e51323. doi: 10.2196/51323.

ABSTRACT

BACKGROUND: We have previously demonstrated that opioid prescribing increased by 127% between 1998 and 2016. New policies aimed at tackling this increasing trend have been recommended by public health bodies, and there is some evidence that progress is being made.

OBJECTIVE: We sought to extend our previous work and develop a data-driven approach to identify general practices and clinical commissioning groups (CCGs) whose prescribing data suggest that interventions to reduce the prescribing of opioids may have been successfully implemented.

METHODS: We analyzed 5 years of prescribing data (December 2014 to November 2019) for 3 opioid prescribing measures-total opioid prescribing as oral morphine equivalent per 1000 registered population, the number of high-dose opioids prescribed per 1000 registered population, and the number of high-dose opioids as a percentage of total opioids prescribed. Using a data-driven approach, we applied a modified version of our change detection Python library to identify reductions in these measures over time, which may be consistent with the successful implementation of an intervention to reduce opioid prescribing. This analysis was carried out for general practices and CCGs, and organizations were ranked according to the change in prescribing rate.

RESULTS: We identified a reduction in total opioid prescribing in 94 (49.2%) out of 191 CCGs, with a median reduction of 15.1 (IQR 11.8-18.7; range 9.0-32.8) in total oral morphine equivalence per 1000 patients. We present data for the 3 CCGs and practices demonstrating the biggest reduction in opioid prescribing for each of the 3 opioid prescribing measures. We observed a 40% proportional drop (8.9% absolute reduction) in the regular prescribing of high-dose opioids (measured as a percentage of regular opioids) in the highest-ranked CCG (North Tyneside); a 99% drop in this same measure was found in several practices (44%-95% absolute reduction). Decile plots demonstrate that CCGs exhibiting large reductions in opioid prescribing do so via slow and gradual reductions over a long period of time (typically over a period of 2 years); in contrast, practices exhibiting large reductions do so rapidly over a much shorter period of time.

CONCLUSIONS: By applying 1 of our existing analysis tools to a national data set, we were able to identify rapid and maintained changes in opioid prescribing within practices and CCGs and rank organizations by the magnitude of reduction. Highly ranked organizations are candidates for further qualitative research into intervention design and implementation.

PMID:38838327 | DOI:10.2196/51323