Tag: pubmed

Brain Inform. 2023 Nov 18;10(1):31. doi: 10.1186/s40708-023-00211-w.

ABSTRACT

Random Survival Forests (RSF) has recently showed better performance than statistical survival methods as Cox proportional hazard (CPH) in predicting conversion risk from mild cognitive impairment (MCI) to Alzheimer’s disease (AD). However, RSF application in real-world clinical setting is still limited due to its black-box nature.For this reason, we aimed at providing a comprehensive study of RSF explainability with SHapley Additive exPlanations (SHAP) on biomarkers of stable and progressive patients (sMCI and pMCI) from Alzheimer’s Disease Neuroimaging Initiative. We evaluated three global explanations-RSF feature importance, permutation importance and SHAP importance-and we quantitatively compared them with Rank-Biased Overlap (RBO). Moreover, we assessed whether multicollinearity among variables may perturb SHAP outcome. Lastly, we stratified pMCI test patients in high, medium and low risk grade, to investigate individual SHAP explanation of one pMCI patient per risk group.We confirmed that RSF had higher accuracy (0.890) than CPH (0.819), and its stability and robustness was demonstrated by high overlap (RBO > 90%) between feature rankings within first eight features. SHAP local explanations with and without correlated variables had no substantial difference, showing that multicollinearity did not alter the model. FDG, ABETA42 and HCI were the first important features in global explanations, with the highest contribution also in local explanation. FAQ, mPACCdigit, mPACCtrailsB and RAVLT immediate had the highest influence among all clinical and neuropsychological assessments in increasing progression risk, as particularly evident in pMCI patients’ individual explanation. In conclusion, our findings suggest that RSF represents a useful tool to support clinicians in estimating conversion-to-AD risk and that SHAP explainer boosts its clinical utility with intelligible and interpretable individual outcomes that highlights key features associated with AD prognosis.

PMID:37979033 | DOI:10.1186/s40708-023-00211-w

Eur Radiol. 2023 Nov 18. doi: 10.1007/s00330-023-10403-x. Online ahead of print.

ABSTRACT

INTRODUCTION: This study investigated the use of dual-energy spectral detector computed tomography (CT) and virtual monoenergetic imaging (VMI) reconstructions in pre-interventional transcatheter aortic valve replacement (TAVR) planning. We aimed to determine the minimum required contrast medium (CM) amount to maintain diagnostic CT imaging quality for TAVR planning.

METHODS: In this prospective clinical trial, TAVR candidates received a standardized dual-layer spectral detector CT protocol. The CM amount (Iohexol 350 mg iodine/mL, standardized flow rate 3 mL/s) was reduced systematically after 15 patients by 10 mL, starting at 60 mL (institutional standard). We evaluated standard, and 40- and 60-keV VMI reconstructions. For image quality, we measured signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and diameters in multiple vessel sections (i.e., aortic annulus: diameter, perimeter, area; aorta/arteries: minimal diameter). Mixed regression models (MRM), including interaction terms and clinical characteristics, were used for comparison.

RESULTS: Sixty consecutive patients (mean age, 79.4 ± 7.5 years; 28 females, 46.7%) were included. In pre-TAVR CT, the CM reduction to 40 mL is possible without affecting the image quality (MRM: SNR: -1.1, p = 0.726; CNR: 0.0, p = 0.999). VMI 40-keV reconstructions showed better results than standard reconstructions with significantly higher SNR (+ 6.04, p < 0.001). Reduction to 30 mL CM resulted in a significant loss of quality (MRM: SNR: -12.9, p < 0.001; CNR: -13.9, p < 0.001), regardless of the reconstruction. Across the reconstructions, we observed no differences in the metric evaluation (p > 0.914).

CONCLUSION: Among TAVR candidates undergoing pre-interventional CT at a dual-layer spectral detector system, applying 40 mL CM is sufficient to maintain diagnostic image quality. VMI 40-keV reconstructions improve the vessel attenuation and are recommended for evaluation.

CLINICAL RELEVANCE STATEMENT: Contrast medium reduction to 40 mL in pre-interventional transcatheter aortic valve replacement CT using dual-energy CT maintains image quality, while 40-keV virtual monoenergetic imaging reconstructions enhance vessel attenuation. These results offer valuable recommendations for interventional transcatheter aortic valve replacement evaluation and potentially improve nephroprotection in patients with compromised renal function.

KEY POINTS: • Patients undergoing transcatheter aortic valve replacement (TAVR), requiring pre-interventional CT, are often multimorbid with impaired renal function. • Using a spectral detector dual-layer CT, contrast medium reduction to 40 mL is feasible, maintaining diagnostic image quality. • The additional application of virtual monoenergetic image reconstructions with 40 keV improves vessel attenuation significantly in clinical practice.

PMID:37979008 | DOI:10.1007/s00330-023-10403-x

J Emerg Nurs. 2023 Nov 17:S0099-1767(23)00253-2. doi: 10.1016/j.jen.2023.10.003. Online ahead of print.

ABSTRACT

INTRODUCTION: Family members experience considerable physiological, psychological, and emotional pressure when accompanying a critically ill relative in the emergency department. The culture and context of care influence the needs of the family, and a thorough understanding of these needs by health care professionals is essential to providing patient- and family-centered care. This study aimed to compare nurses’ and family members’ perceptions of the priorities of family member needs and their satisfaction with meeting those needs in the emergency department.

METHODS: A comparative, cross-sectional descriptive study was conducted. Participants were 140 family members of patients receiving care and 122 nurses working in the emergency department in hospitals of Tabriz University of Medical Science, in Iran. The data were collected through Critical Care Family Needs Inventory-ED and analyzed with SPSS Statistics software.

RESULTS: Family members rated their care needs as significantly greater than did nurses (129.45 [31.5] vs 124.45 [24.8], P = .003). Families rated their needs as having been met significantly less than the nurses estimated (103.6 [17.6] vs 110.8 [19.61], P < .05).

DISCUSSION: The perceived importance of the patient’s family’s needs differed from the viewpoints of the patient’s family members and the nurses. In addition, emergency nurses overestimated the extent to which family members’ needs were met compared with family members. To more adequately gauge and meet the needs of family members, nurses need to acquire more knowledge about patient family needs in the emergency department.

PMID:37978980 | DOI:10.1016/j.jen.2023.10.003

Neuromodulation. 2023 Nov 16:S1094-7159(23)00751-1. doi: 10.1016/j.neurom.2023.09.005. Online ahead of print.

ABSTRACT

BACKGROUND: Ninety-Hz active-recharge spinal cord stimulation (SCS) applied at below sensory-threshold intensity, as used with fast-acting subperception therapy spinal cord stimulation, has been shown clinically to produce significant analgesia, but additional characterization is required to better understand the therapy. This preclinical study investigates the behavioral effect of multiple 90-Hz SCS variants in a rodent model of neuropathic pain, focusing on charge balance and the relationship between 90-Hz efficacy and stimulation intensity.

MATERIALS AND METHODS: Rats (n = 24) received a unilateral partial sciatic nerve ligation to induce neuropathic pain and were implanted with a quadripolar lead at T13. Mechanical hypersensitivity was assessed before, during, and after 60 minutes of SCS. After a prescreen with 50-Hz SCS 67% motor threshold ([MT], the positive control), rats underwent a randomized-crossover study including sham SCS and several 90-Hz SCS paradigms (at 40% MT or 60% MT, either using active or pseudopassive recharge) (experiment 1, n = 16). A second, identical experiment (experiment 2) was performed to supplement data with 90-Hz SCS at 20% and 80% MT (experiment 2, n = 8).

RESULTS: Experiment 1: At 40% MT, 90-Hz active-recharge SCS produced a significantly larger recovery to baseline than did 90-Hz pseudopassive SCS at both tested intensities and sham SCS. Experiment 2: Only the 90-Hz SCS active recharge at 40% MT and 50-Hz SCS positive control caused mean recovery to baseline that was statistically better than that of sham SCS.

CONCLUSIONS: The degree to which 90-Hz SCS reduced mechanical hypersensitivity during stimulation depended on the nature of charge balance, with 90-Hz active-recharge SCS generating better responses than did 90-Hz pseudopassive recharge SCS. In addition, our findings suggest that the amplitude of 90-Hz active-recharge SCS must be carefully configured for efficacy.

PMID:37978974 | DOI:10.1016/j.neurom.2023.09.005

J Perianesth Nurs. 2023 Nov 16:S1089-9472(23)00888-2. doi: 10.1016/j.jopan.2023.07.014. Online ahead of print.

ABSTRACT

PURPOSE: To implement a standardized Stir-up Regimen (deep breathing, coughing, repositioning, mobilization [moving arms/legs], assessing and managing pain and nausea) within the first 30 minutes of arrival in the postanesthesia care unit (PACU), with a goal of decreasing recovery time in the immediate postanesthesia period (Phase I).

DESIGN: A pragmatic stepped wedge cluster randomized control trial. Initially, data were collected on time in Phase I in three PACUs (control). Subsequently, the same three units were randomized to sequentially transition to the Stir-up Regimen (intervention).

METHODS: A stepped wedge cluster randomized control trial design was used to implement a standardized Stir-up Regimen in three PACUs in an academic hospital for adult patients who received at least 30 minutes of general anesthesia. The measured outcome was the PACU time in minutes from patient arrival to when the patient met Phase I discharge criteria. Differences between intervention and control groups were evaluated using a generalized mixed-effects model. Nurses were educated about the Stir-up Regimen in team huddles, in-services, video demonstrations, email notifications/reminders and reminders, and immediate feedback at the bedside. Implementation science principles were used to assess the adoption of the Stir-up Regimen through a presurvey, postsurvey and spot-check observations in all three PACUs.

FINDINGS: A total of 5,809 PACU adult patient admissions were included: control group (n = 2,860); intervention group (n = 2,949); males (n = 2,602), and females (n = 3,206). The intervention was associated with a reduction in overall mean Phase I recovery time of 4.9 minutes (95% CI: -8.4 to -1.4, P = .007). One PACU decreased time by 9.6 minutes (95% CI: -15.3 to -4.0, P < .001). The other units also reduced Phase I recovery time, but this did not reach statistical significance. The spot-check observations confirmed the intervention was adopted by the nurses, as most interventions were nurse-initiated versus patient-initiated during the first 30 minutes in PACU.

CONCLUSIONS: Standardization of a Stir-up Regimen within 30 minutes of patient PACU arrival resulted in decreased Phase I recovery time.

PMID:37978971 | DOI:10.1016/j.jopan.2023.07.014

Expert Rev Clin Pharmacol. 2023 Nov 18:1-11. doi: 10.1080/17512433.2023.2279740. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this study was to identify and determine factors associated with patients’ ophthalmic adherence in common ocular conditions from randomized clinical trials (RCT).

RESEARCH DESIGN METHODS: A univariate analysis with proportions, a bivariate analysis using polychoric correlations, and logistic regression (LR) models were used. The collected dataset was made up of records from RCT. Using three validated LR models, factors were identified and ranked based on their adjusted odds ratio and their statistical significance to adherence.

RESULTS: A total of 1,087 valid patients were included in this analysis, of which 88.96% presented adherence. All models were calibrated, had a good performance, were well specified and cost-effective using the Hosmer-Lemeshow test, metrics for class imbalance, link test approach and Akaike’s criteriums, respectively.

CONCLUSION: We identified as determinants for encouraging good ophthalmic adherence the adverse events presented, duration of the study, female sex, and older age; other determinants such as medical condition, protocol treatment, type of treatment and disease are all risk factors for adherence. Improvements in ophthalmic adherence may be achieved by focused attention to young male patients with chronic degenerative diseases such as glaucoma or ocular hypertension (especially those who need combination therapy) and developing medications with reduced side effects.

PMID:37978952 | DOI:10.1080/17512433.2023.2279740

West Afr J Med. 2023 Nov 10;40(11 Suppl 1):S30.

ABSTRACT

INTRODUCTION: Interprofessional collaboration is crucial to the optimal functioning of every health system because the complex nature of healthcare requires that health workers from different allied professions work as a team to deliver quality health to the patients. Identifying the enhancing factors and barriers to this synergy is essential to safe and efficient healthcare delivery. This study addresses this issue in Nigeria, where inter-professional rivalry is rife.

OBJECTIVE: To determine the enablers of, and barriers to, interprofessional collaboration in Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.

METHODOLOGY: The study adopted the proportionate stratified random sampling technique to recruit 266 staff of the hospital across the different health professions. Data was collected using an adapted version of the Assessment of Interprofessional Team Collaboration Scale (AITCS) and data analysis was done using the Statistical Package for Social Sciences version 23.0. The ideal scores pre-set were 4.0 for the enablers and 2.0 for the barriers. Ethical review for the study was obtained from the Ethics Review Committee of the hospital.

RESULTS: The mean score for the enablers was 4.28, and the strongest enabler of IPC identified was a climate of mutual respect, dignity, and trust among team members (4.36). On the other hand, the mean score for the barriers was 3.80, and the strongest barrier to IPC was the lack of role clarification (3.84).

CONCLUSION: The study revealed a strong level of enablers to IPC in ATBUTH. However, the barriers were above the set threshold, suggesting a significant impediment to IPC. The hospital should strengthen the identified enablers while making efforts to reduce the barriers. This type of study is also recommended for other hospitals in the country.

PMID:37978944

J Pharm Pharmacol. 2023 Nov 18:rgad110. doi: 10.1093/jpp/rgad110. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the effect of blackseed oil (BSO) single dose on prednisolone pharmacokinetics via p-gp inhibition.

METHODS: Three groups of rats (n = 5) were orally administered the vehicle, verapamil (50 mg/kg) or BSO (5 ml/kg) 15 min prior to prednisolone (5 mg/kg) administration. Blood samples were collected over 24 h and quantified. Non-compartmental analysis was employed to calculate maximum plasma concentration (Cmax), area under the curve (AUC0-last), time to reach Cmax (Tmax), apparent clearance (CL/F), and half-life (t1/2). Statistical significance was considered at p<0.05.

RESULTS: Prednisolone Cmax and AUC0-last decreased by 65% and 25% in the BSO group compared to the negative control (P < .0001, .0029, respectively) while they increased by 1.75-folds and 8-folds in verapamil group (P < .0001). Tmax was achieved at 0.16, 0.5, and 0.25 h in the negative control, verapamil, and BSO-treated groups, respectively. CL/F in the treatment group was 1.3-fold and 10-fold higher compared to the negative and positive control, respectively, whereas the t1/2 remained comparable.

CONCLUSION: Administration of BSO decreased prednisolone Cmax and AUC0-last in rats indicating that there is a herb-drug interaction; however, p-gp inhibition cannot be concluded. Patients relying on folk medicine in chronic illnesses treatment might need to avoid combining BSO with prednisolone.

PMID:37978932 | DOI:10.1093/jpp/rgad110

J Neurosurg. 2023 Nov 17:1-13. doi: 10.3171/2023.8.JNS231684. Online ahead of print.

ABSTRACT

OBJECTIVE: In the authors’ microsurgical experience, the trans-middle cerebellar peduncle (MCP) approach to the lateral and central pons has been the most common approach to brainstem cavernous malformations (BSCMs). This approach through a well-tolerated safe entry zone (SEZ) allows a wide vertical or posterior trajectory, reaching pontine lesions extending into the midbrain, medulla, and pontine tegmentum. Better understanding of the relationships among lesion location, surgical trajectory, and long-term clinical outcomes could determine areas of safe passage.

METHODS: A single-surgeon cohort study of all primary trans-MCP BSCM resections was conducted from July 1, 2017, to June 30, 2021. Preoperative and postoperative MR images were independently reviewed by 3 investigators blinded to the intervention, using a standardized rubric to define BSCM regions of interest (ROIs) involved with a lesion or microsurgical tract. Statistical testing, including the chi-square test with the Bonferroni correction, logistic regression, and structural equation modeling, was performed to analyze relationships between ROIs and clinical outcomes.

RESULTS: Thirty-one patients underwent primary trans-MCP BSCM resection during the study period. The median age was 50 years (IQR 24-49 years); 19 (61%) patients were female, and 12 (39%) were male. Seven (23%) patients had familial cavernous malformation syndromes. The median follow-up was 9 months (range 6-37 months). At the last follow-up, composite neurological outcomes were favorable: 22 (71%) patients had 0 (n = 12, 39%) or 1 (n = 10, 32%) major persistent deficit, 5 patients (16%) had 2 deficits, 2 (7%) had 3 deficits, and 1 patient each (3%) had 4 or 6 deficits. Unfavorable composite outcomes were significantly associated with lesions (OR 7.14, p = 0.04) or surgical tracts (OR 12.18, p < 0.001) extending from the superior cerebellar peduncle (SCP) into the contralateral medial midbrain. The ipsilateral dorsal pons was the most frequently implicated ROI involving a surgical tract and the development of new postoperative deficits. This region involved the rhomboid pontine territory and transgression of the pontine tegmentum (OR 7.53, p < 0.001). Structural equation modeling supported medial midbrain and pontine tegmentum transgression as the primary drivers of morbidity.

CONCLUSIONS: Trans-MCP resection is a safe and effective treatment for BSCMs, including lesions with marked superior or inferior ipsilateral extension. Two trajectories are associated with increased neurological risk: first, a superomedial trajectory to lesions extending into the midbrain that transgresses the SCP, its decussation, or both; and second, a posteromedial trajectory to lesions extending into the pontine tegmentum. The corticospinal tract, SCP, and pontine tegmentum form an invisible triangle within the pontine white matter tolerant of transgression. When the surgeon works within this triangle, most deep pontine BSCMs, including large lesions, those with contralateral or posterior extension, and others extending into the midbrain and medulla, can be resected safely with the trans-MCP approach.

PMID:37976511 | DOI:10.3171/2023.8.JNS231684

Pain Physician. 2023 Nov;26(7):E851-E857.

ABSTRACT

BACKGROUND: Complex regional pain syndrome (CRPS) is an extremely painful disorder driven primarily by inflammation.

OBJECTIVES: We hypothesized that the immunomodulatory biologic, ExoFloTM, composed of bone marrow mesenchymal stem cell-derived extracellular vesicles, could be safely administered to CRPS patients and alleviate symptoms.

STUDY DESIGN: Ten patients received 2 intravenous (IV) infusions, each containing 15 mL ExoFlo, on day one and day 4. A series of tests were performed at baseline (day 0, prior to infusion), week one, and months one, 3, and 6 after the second infusion.

SETTING: All patients were treated in one of 2 outpatient pain management clinics in Orange County, CA.

METHODS: Testing for clinical improvement included: visual analog scale of pain, brief pain inventory, 36-item short-form questionnaire, range of motion analysis, and jamar dynamometer testing.

RESULTS: No serious adverse events related to ExoFlo treatment occurred. Statistically significant improvements in pain and motion assessments occurred across the patient pool.

LIMITATIONS: This study was limited by its patient number enrolled (10), it lacked a control arm, and one patient who dropped out of the study.

CONCLUSIONS: IV delivery of ExoFlo appears safe in patients with CRPS. In addition, ExoFlo exhibited efficacy in addressing CRPS symptoms. Given the lack of effective and safe treatments available to CRPS patients, these results suggest that further studies are warranted to explore and validate this potential treatment for CRPS.

PMID:37976492