Tag: pubmed

Int J Surg. 2023 Nov 23. doi: 10.1097/JS9.0000000000000924. Online ahead of print.

ABSTRACT

BACKGROUND: This study employs a meta-analytic approach to investigate the impact of robotic-assisted partial nephrectomy, with and without near-infrared fluorescence imaging (NIRF-RAPN vs S-RAPN), on patients’ perioperative outcomes and postoperative changes in renal function.

MATERIALS AND METHODS: We conducted a comprehensive and rigorous systematic review and cumulative meta-analysis of primary outcomes following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines, and Risk-of-Bias Tool (RoB2). To ensure a thorough search, we systematically searched five major databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, from databases’ inception to April 2023.

RESULTS: No significant differences were found between the two groups in terms of age (P=0.19), right side (P=0.54), BMI (P=0.39), complexity score (P=0.89), tumor size (P = 0.88), operating time (P = 0.39), estimated blood loss (P = 0.47), length of stay (P = 0.87), complications (P = 0.20), transfusion (P = 0.36), and positive margins (P = 0.38). However, it is noteworthy that the NIRF-RAPN group exhibited significant reductions in warm ischemia time (P=0.001), the percentage change in estimated glomerular filtration rate at discharge (P=0.01) compared to the S-RAPN group.

CONCLUSION: This meta-analysis provides evidence that the group undergoing NIRF-RAPN showed a statistically significant protective effect on the estimated glomerular filtration rate (eGFR).

PMID:38000056 | DOI:10.1097/JS9.0000000000000924

Int J Surg. 2023 Nov 23. doi: 10.1097/JS9.0000000000000879. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to compare the differences in quality of life (QOL) and overall survival (OS) between DPPHR and PD during long-term follow-up. Duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD) have been shown to be effective in alleviating symptoms and controlling malignancies, but there is ongoing debate over whether DPPHR has an advantage over PD in terms of long-term benefits.

METHOD: We searched the PubMed, Cochrane, Embase, and Web of Science databases for relevant studies comparing DPPHR and PD published before 1 May 2023. This study was registered with PROSPERO. Randomised controlled trials and non-randomised studies were included. The Mantel-Haenszel model and inverse variance method were used as statistical approaches for data synthesis. Subgroup analyses were conducted to evaluate the heterogeneity of the results. The primary outcome was the global QOL score, measured using the QLQ-C30 system.

RESULTS: We analysed ten studies involving 976 patients (456 DPPHR and 520 PD). The global QOL score did not differ significantly between the DPPHR and PD groups (standard mean difference [SMD] 0.21, 95% confidence interval [CI] [-0.05, 0.46], P=0.109, I2=70%); however, the OS time of patients with DPPHR was significantly improved (HR 0.59, 95% CI [0.44, 0.77], P<0.001, I2=0%). The follow-up length may be an important source of heterogeneity. Studies with follow-up length between two to seven years showed better global QOL for DPPHR than for PD (SMD 0.43, 95% CI [0.23, 0.64], P<0.001, I2=0%). There were no significant differences between the two groups in any of the functional scales of the QLQ-C30 system (all P>0.05). On the symptom scale, patients in the DPPHR group had lower scores for fatigue, nausea and vomiting, loss of appetite, insomnia, and diarrhoea than those in the PD group (all P<0.05).

CONCLUSION: There were no significant differences in global QOL scores between the two surgeries; however, DPPHR had advantages over PD in terms of safer perioperative outcomes, lower long-term symptom scores, and longer OS times. Therefore, DPPHR should be recommended over PD for the treatment of benign pancreatic diseases and low-grade malignant tumours.

PMID:38000055 | DOI:10.1097/JS9.0000000000000879

Int J Biostat. 2023 Nov 27. doi: 10.1515/ijb-2023-0052. Online ahead of print.

ABSTRACT

Model-based component-wise gradient boosting is a popular tool for data-driven variable selection. In order to improve its prediction and selection qualities even further, several modifications of the original algorithm have been developed, that mainly focus on different stopping criteria, leaving the actual variable selection mechanism untouched. We investigate different prediction-based mechanisms for the variable selection step in model-based component-wise gradient boosting. These approaches include Akaikes Information Criterion (AIC) as well as a selection rule relying on the component-wise test error computed via cross-validation. We implemented the AIC and cross-validation routines for Generalized Linear Models and evaluated them regarding their variable selection properties and predictive performance. An extensive simulation study revealed improved selection properties whereas the prediction error could be lowered in a real world application with age-standardized COVID-19 incidence rates.

PMID:38000054 | DOI:10.1515/ijb-2023-0052

Int J Nurs Educ Scholarsh. 2023 Nov 24;20(1). doi: 10.1515/ijnes-2023-0017. eCollection 2023 Jan 1.

ABSTRACT

OBJECTIVES: This study aimed to investigate the level of perceived competence and explore the predictors of competence in nursing students at graduation.

METHODS: This cross-sectional study was conducted with students at the point of graduation (n=239). A sociodemographic form and three different scales assessing students’ competence, self-efficacy, and self-reflection and insight were used to collect data. Visual Analog Scale (VAS) was used to assess students’ satisfaction (i.e., the role as nursing students in the nursing program), job-related stress (i.e., perceived stress related to nursing program), and coping behaviors. The data were analyzed using descriptive statistics and hierarchical linear regression.

RESULTS: The mean scores of perceived competence, self-reflection, insight, and self-efficacy were 5.25 ± 0.96 (range: 1-7), 54.51 ± 7.83 (range: 12-96), 33.36 ± 5.40 (range: 8-48), 84.13 ± 12.27 (range: 0-100), respectively. Self-efficacy was the most significant associated factor of the entire group of variables in competence.

CONCLUSIONS: Scores of perceived competence of students were optimistic. Self-efficacy was the most important factor affecting competence; that is, the greater the self-efficacy, the better the perceived competence.

PMID:38000005 | DOI:10.1515/ijnes-2023-0017

J Asthma. 2023 Nov 24:1-19. doi: 10.1080/02770903.2023.2288317. Online ahead of print.

ABSTRACT

Objective: We aim to assess the risk factors of uncontrolled asthma in children and adolescents. Method: A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to July 17, 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the Odds Ratio (OR) and the corresponding 95% confidence interval (CI). We also used a narrative approach where it was not feasible to quantitatively assess the outcome. Results: Ten observational studies were used to conduct this systematic review and meta-analysis. A quantitative analysis of five factors was done. Pooled analysis showed a statistically significant risk of uncontrolled asthma in association with past hypersensitivity reactions (SMD = 1.51 (1.16, 1.98); p = 0.002; I2 = 84%) and incomplete controller adherence (SMD = 3.15 (1.83, 5.41); p < 0.0001; I2 = 94%). While non-significant relation was seen in parental asthma (SMD = 1.23 (0.98, 1.55); p = 0.07; I2 = 15%), oral corticosteroid use (SMD = 0.99 (0.72, 1.36); p = 0.96; I2 = 81%) and education of caregivers (SMD = 0.99 (0.72, 1.36); p = 0.96; I2 = 81%). Some other factors were also discussed qualitatively. Conclusion: Our study shows that some significant risk factors might cause uncontrolled asthma in children and adolescents like past hypersensitivity reactions and incomplete controller adherence.

PMID:37999990 | DOI:10.1080/02770903.2023.2288317

J Asthma. 2023 Nov 24:1-21. doi: 10.1080/02770903.2023.2288325. Online ahead of print.

ABSTRACT

INTRODUCTION: Asthma is the most common chronic disease among children. The management of asthma in children requires ongoing effort and is heavily dependent on the effectiveness of family management. This study aimed to evaluate the validity and reliability of the Family Management Scale for Children with Asthma (FMSCA) by adapting it to Turkish.

METHODS: This methodological research comprised 293 parents between December 2020 and May 2021. Inclusion criteria were having a child with a diagnosis of asthma for more than 6 months, being literate, and not having problems in communication. FMSCA was examined for language, content and construct validity. Internal consistency was calculated using Cronbach’s α coefficient, item-total correlation, and test-retest equivalence. Ethical principles were adhered to.

RESULTS: The content validity index scores of the items in the FMSCA ranged from 0.90 to 1.0. The Kaiser-Meyer-Olkin value was determined to be 0.965 and the Bartlett’s Test of Sphericity value was χ² = 18296.335 (p ≤ 0.001). Many indices were used to examine the fit of the FMSCA model. Of these, the χ^2/SD value was determined to be 1.61. The total FMSCA Cronbach α coefficient was 0.981. The relationship between the test-retest results was statistically significant, high, and positive (p <0.05).

CONCLUSION: FMSCA is a valid and reliable tool that can be used to objectively evaluate family management in families with children with asthma and to determine the effectiveness of interventions.

PMID:37999987 | DOI:10.1080/02770903.2023.2288325

JMIR Med Educ. 2023 Nov 24;9:e49013. doi: 10.2196/49013.

ABSTRACT

BACKGROUND: UK medical graduates can apply for specialty training after completing a 2-year internship (foundation training). Postfoundation training application requirements vary depending on specialty but fundamentally require key skills such as teaching, research, and leadership.

OBJECTIVE: This study investigated whether medical student demographics impact their self-reported familiarity with the Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP).

METHODS: This was a cross-sectional study using a Bristol Online Survey. We invited all UK medical students to answer a range of questions about their demographics. Students were then asked to rank their familiarity with PFTPs and PFAP on a scale of 1 to 5 (1=least familiar and 5=most familiar). The responses were collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata (version 17.1; StataCorp) using chi-square tests.

RESULTS: A total of 850 students from 31 UK medical schools took part. There was a significant difference between gender and self-reported familiarity with PFTPs (P<.001) and PFAP (P<.001), with male students expressing higher familiarity. Similarly, there was a difference between ethnicity and self-reported familiarity with PFTPs (P=.02) and PFAP (P<.001), with White students more likely to express higher familiarity than their Black, Asian, or Mixed Ethnic counterparts. Lastly, there was an overall difference between medical background and age and self-reported familiarity with PFTPs and PFAP (all P<.001), with students from medical backgrounds and older students being more likely to express higher familiarity.

CONCLUSIONS: The impact of gender, ethnicity, age, and medical background on students’ self-reported familiarity with PFTPs and PFAP is significant. Further studies are required to evaluate the impact of these factors on tested knowledge of PFTPs and PFAP and whether this impacts the success rate of postfoundation applications.

PMID:37999951 | DOI:10.2196/49013

J Med Internet Res. 2023 Nov 24;25:e43034. doi: 10.2196/43034.

ABSTRACT

BACKGROUND: Nonspecific low back pain (LBP) is a leading contributor to disability worldwide, and its socioeconomic burden is substantial. Self-management support is an important recommendation in clinical guidelines for the physiotherapy treatment of patients with LBP and may support cost-effective management. However, providing adequate individually tailored self-management support is difficult. The integration of web-based applications into face-to-face care (ie, blended care) seems promising to optimize tailored treatment and enhance patients’ self-management and, consequently, may reduce LBP-related costs.

OBJECTIVE: We aimed to evaluate the long-term effectiveness and cost-effectiveness of stratified blended physiotherapy (e-Exercise LBP) compared with face-to-face physiotherapy in patients with nonspecific LBP.

METHODS: An economic evaluation was conducted alongside a prospective, multicenter, cluster randomized controlled trial in primary care physiotherapy. Patients with nonspecific LBP were treated with either stratified blended physiotherapy (e-Exercise LBP) (n=104) or face-to-face physiotherapy (n=104). The content of both interventions was based on the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the STarT Back Screening Tool. The primary clinical outcome was physical functioning (Oswestry Disability Index version 2.1a). For the economic evaluation, quality-adjusted life years (QALYs; EQ-5D-5L) and physical functioning were the primary outcomes. Secondary clinical outcomes included fear avoidance beliefs and self-reported adherence. Costs were measured from societal and health care perspectives using self-report questionnaires. Effectiveness was estimated using linear mixed models. Seemingly unrelated regression analyses were conducted to estimate total cost and effect differences for the economic evaluation.

RESULTS: Neither clinically relevant nor statistically substantial differences were found between stratified blended physiotherapy and face-to-face physiotherapy regarding physical functioning (mean difference [MD] -1.1, 95% CI -3.9 to 1.7) and QALYs (MD 0.026, 95% CI -0.020 to 0.072) over 12 months. Regarding the secondary outcomes, fear avoidance beliefs showed a statistically significant improvement in favor of stratified blended physiotherapy (MD -4.3, 95% CI -7.3 to -1.3). Societal and health care costs were higher for stratified blended physiotherapy than for face-to-face physiotherapy, but the differences were not statistically significant (societal: €972 [US $1027], 95% CI -€1090 to €3264 [US -$1151 to $3448]; health care: €73 [US $77], 95% CI -€59 to €225 [US -$62 to $238]). Among the disaggregated cost categories, only unpaid productivity costs were significantly higher for stratified blended physiotherapy. From both perspectives, a considerable amount of money must be paid per additional QALY or 1-point improvement in physical functioning to reach a relatively low to moderate probability (ie, 0.23-0.81) of stratified blended physiotherapy being cost-effective compared with face-to-face physiotherapy.

CONCLUSIONS: The stratified blended physiotherapy intervention e-Exercise LBP is neither more effective for improving physical functioning nor more cost-effective from societal or health care perspectives compared with face-to-face physiotherapy for patients with nonspecific LBP.

TRIAL REGISTRATION: ISRCTN 94074203; https://www.isrctn.com/ISRCTN94074203.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12891-020-3174-z.

PMID:37999947 | DOI:10.2196/43034

JMIR Diabetes. 2023 Nov 24;8:e49113. doi: 10.2196/49113.

ABSTRACT

BACKGROUND: Over the past few decades, diabetes has become a serious public health concern worldwide, particularly in Bangladesh. The advancement of artificial intelligence can be reaped in the prediction of blood glucose levels for better health management. However, the practical validity of machine learning (ML) techniques for predicting health parameters using data from low- and middle-income countries, such as Bangladesh, is very low. Specifically, Bangladesh lacks research using ML techniques to predict blood glucose levels based on basic noninvasive clinical measurements and dietary and sociodemographic information.

OBJECTIVE: To formulate strategies for public health planning and the control of diabetes, this study aimed to develop a personalized ML model that predicts the blood glucose level of urban corporate workers in Bangladesh.

METHODS: Based on the basic noninvasive health checkup test results, dietary information, and sociodemographic characteristics of 271 employees of the Bangladeshi Grameen Bank complex, 5 well-known ML models, namely, linear regression, boosted decision tree regression, neural network, decision forest regression, and Bayesian linear regression, were used to predict blood glucose levels. Continuous blood glucose data were used in this study to train the model, which then used the trained data to predict new blood glucose values.

RESULTS: Boosted decision tree regression demonstrated the greatest predictive performance of all evaluated models (root mean squared error=2.30). This means that, on average, our model’s predicted blood glucose level deviated from the actual blood glucose level by around 2.30 mg/dL. The mean blood glucose value of the population studied was 128.02 mg/dL (SD 56.92), indicating a borderline result for the majority of the samples (normal value: 140 mg/dL). This suggests that the individuals should be monitoring their blood glucose levels regularly.

CONCLUSIONS: This ML-enabled web application for blood glucose prediction helps individuals to self-monitor their health condition. The application was developed with communities in remote areas of low- and middle-income countries, such as Bangladesh, in mind. These areas typically lack health facilities and have an insufficient number of qualified doctors and nurses. The web-based application is a simple, practical, and effective solution that can be adopted by the community. Use of the web application can save money on medical expenses, time, and health management expenses. The created system also aids in achieving the Sustainable Development Goals, particularly in ensuring that everyone in the community enjoys good health and well-being and lowering total morbidity and mortality.

PMID:37999944 | DOI:10.2196/49113

Clin Chem Lab Med. 2023 Nov 24. doi: 10.1515/cclm-2023-0312. Online ahead of print.

ABSTRACT

OBJECTIVES: Blood microsampling, particularly dried blood spots (DBSs), is an attractive minimally-invasive approach that is well suited for home sampling and predictive medicine associated with longitudinal follow-up of the elderly. However, in vitro diagnostic quantification of biomarkers from DBS poses a major challenge. Clinical mass spectrometry can reliably quantify blood proteins in various research projects. Our goal here was to use mass spectrometry of DBS in a real-world clinical setting and compared it to the standard immunoassay method. We also sought to correlate DBS mass spectrometry measurements with clinical indices.

METHODS: A clinical trial of diagnostic equivalence was conducted to compare conventional venous samples quantified by immunoassay and DBSs quantified by mass spectrometry in an elderly population. We assayed three protein biomarkers of nutritional and inflammatory status: prealbumin (transthyretin), C-reactive protein, and transferrin.

RESULTS: The analysis of DBSs showed satisfactory variability and low detection limits. Statistical analysis confirmed that the two methods give comparable results at clinical levels of accuracy. In conclusion, we demonstrated, in a real-life setting, that DBSs can be used to measure prealbumin, CRP and transferrin, which are commonly used markers of nutritional status and inflammation in the elderly. However, there was no correlation with patient frailty for these proteins.

CONCLUSIONS: Early detection and regular monitoring of nutritional and inflammatory problems using DBS appear to be clinically feasible. This could help resolve major public health challenges in the elderly for whom frailty leads to serious risks of health complications.

PMID:37999931 | DOI:10.1515/cclm-2023-0312