Tag: pubmed

BMJ Open. 2023 Oct 31;13(10):e074440. doi: 10.1136/bmjopen-2023-074440.

ABSTRACT

OBJECTIVES: We aimed to explore the psychometric properties of the first known online asynchronous multiple mini-interview (MMI) designed for fairness with subgroup analyses by key characteristics, usability and acceptability.

DESIGN: Cross-discipline multimethod evaluation.

SETTING: One UK University.

PARTICIPANTS: Applicants to nursing, midwifery and paramedic science undergraduate programmes during 2021-2022.

PRIMARY, SECONDARY OUTCOME MEASURES: Psychometric properties (internal consistency, construct validity, dimensionality) were assessed using Cronbach’s alpha (α), parallel analysis (PA), Schmid-Leiman transformation and ordinal confirmatory factor analysis (CFA). Usability and acceptability were evaluated using descriptive statistics and conventional content analysis.

METHODS: The system was configured in a seven question 4 min MMI. Applicants’ videorecorded their answers which were later assessed by interviewers and scores summed. Applicants and interviewers completed online evaluation questionnaires.

RESULTS: Performance data from 712 applicants determined good-excellent reliability for the asynchronous MMI (mean α 0.72) with similar results across subgroups (gender, age, disability/support needs, UK/non-UK). PA and factor analysis results suggested there were seven factors relating to the MMI questions with an underlying general factor that explained the variance in observed candidate responses. A CFA testing a seven-factor hierarchical model showed an excellent fit to the data (Confirmatory Fit Index=0.99), Tucker Lewis Index=0.99, root mean square error (RMSE) =0.034). Applicants (n=210) viewed the flexibility, relaxed environment and cost savings advantageous. Interviewers (n=65) reported the system to be intuitive, flexible with >70% time saved compared with face-to-face interviews. Reduced personal communication was cited as the principal disadvantage.

CONCLUSIONS: We found that the asynchronous MMI was reliable, time-efficient, fair and acceptable and building fairness in was lost-cost. These novel, insights are applicable across health professions selection internationally informing the future configuration of online interviews to ensure workforces represent the societies they serve.

PMID:37907294 | DOI:10.1136/bmjopen-2023-074440

J Neurointerv Surg. 2023 Oct 31:jnis-2023-020850. doi: 10.1136/jnis-2023-020850. Online ahead of print.

ABSTRACT

BACKGROUND: Infarct growth on multimodal imaging is a common lead outcome in phase 2 proof-of-concept and dose-optimization neuroprotective agent stroke trials. However, the effect size in infarct growth reduction that correlates with clinically meaningful differences in clinical global disability outcomes has not been well delineated.

METHODS: A systematic literature search identified all endovascular thrombectomy randomized trials reporting magnitude of treatment effect on both infarct growth reduction and increase in functional independence (modified Rankin Scale (mRS) 0-2). Data aggregation determined the size of infarct growth reductions salient to four types of clinically meaningful effect sizes of increase in functional independence: (1) the minimal clinically important difference (MCID)-outcome specific; (2) the MCID-practice changing; (3) the realistic target difference; and (4) the reasonable comparability effect size.

RESULTS: A systematic search identified four trials enrolling 612 imaged participants. Across the trials, the amount of functional independence (mRS 0-2) increase associated with each 1 mL reduction in infarct growth was mean 2.3±0.6%. An infarct growth reduction of 0.57 mL correlated with the mRS 0-2 increase MCID of 1.3%. Infarct growth reductions of 2.27 mL, 4.35 mL, and 6.53 mL correlated with realistic effect and reasonable comparability effects sizes of mRS 0-2 increases of 5%, 10%, and 15%, respectively.

CONCLUSION: In formal meta-analysis of randomized treatment trials, every 1 mL reduction in infarct growth was associated with a 2.3% increase in functional independence (mRS 0-2) at 3 months. This conversion factor can inform selection of infarct growth effect size targets for phase 2 trials of neuroprotective agents.

PMID:37907282 | DOI:10.1136/jnis-2023-020850

J Neurol Surg A Cent Eur Neurosurg. 2023 Oct 31. doi: 10.1055/a-2201-8370. Online ahead of print.

ABSTRACT

BACKGROUND: Pituitary adenoma (PA) is a common intracranial endocrine cancer, but no precise target has been found for the effective prediction and treatment of PA.

METHODS: qRT‒PCR analysis showed that circMFN2 could affect the expression of miR-146a-3p in PA samples. Moreover, we used Western blotting to evaluate the expression levels of TRAF6 and NF-κB markers. The EdU assay, scratch wound-healing assay, and matrigel invasion assay were performed to assess the potential function of this pathway in PA cells. Based on the bioinformatics analysis including KEGG, GO analysis and microarray analysis, we evaluated the efficacy of circMFN2 as a potential biomarker for diagnosing PA, and we aimed to determine it mechanism of action in PA cells.

RESULTS: Our findings indicate that there is a significant increase in the expression of circMFN2 in tissues, serum, and exosomes in the invasive group compared to the non-invasive and normal groups. Furthermore, this difference was statistically significant both preoperatively and postoperatively. To clarify its function, we downregulated this gene, and the experimental results suggested that the motility and proliferative capacity were reduced in vitro. In addition, rescue assays showed that miR-146a-3p could successfully reverse the inhibitory effect of circMFN2 knockdown on motility and proliferation in PA cells. Moreover, down-regulation of circMFN2 and miR-146a-3p significantly changed the expression of TRAF6 and NF-κB.

CONCLUSION: This study identified that circMFN2 regulates miR-146a-3p to promote adenoma development partially via the TRAF6/NF-κB pathway and may be a potential therapeutic target for pituitary adenoma.

PMID:37907264 | DOI:10.1055/a-2201-8370

Int J Gynecol Cancer. 2023 Oct 31:ijgc-2023-004945. doi: 10.1136/ijgc-2023-004945. Online ahead of print.

ABSTRACT

INTRODUCTION: Sertoli-Leydig cell tumors are rare tumors of the ovary. Moderate and poorly differentiated tumors can metastasize and have a poor outcome. A pathogenic variant in DICER1 is associated with an increased risk of developing these tumors along with other clinical phenotypes. We aimed to describe a national cohort of all Sertoli-Leydig cell tumors with regard to clinicopathological characteristics and frequency of DICER1 pathogenic variants.

METHODS: In May 2018, all patients registered from January 1997 to December 2017 with the Systematized Nomenclature of Medicine code M86310 (Sertoli-Leydig cell tumor) were obtained from the Danish National Pathology Registry. Validation of the diagnosis depended on comments in the reports that two pathologists validated the initial diagnosis or revision of the pathology at another facility. We performed descriptive statistics to describe baseline characteristics, and cancer related survival was calculated using Kaplan-Meier analysis followed by a log rank test for differences between variables RESULTS: 41 women with Sertoli-Leydig cell tumors were identified. Median age was 41 years (range 6-79). The stages according to the International Federation of Gynecology and Obstetrics (FIGO) were: stage I, 85% (n=35), stage II, 2% (n=1), stage III, 5% (n=2), and stage IV, 7% (n=3). The 5 year cancer related survival was 100% for patients with localized disease (stages I-II) and 0% in advanced tumor stages (stages III-IV). Histological differentiation grade of the tumors was well differentiated in 29% (n=12), moderately differentiated in 56% (n=23), and poorly differentiated in 15% (n=6), and the 5 year cancer related survival was 100%, 96%, and 33%, respectively, according to grade. All patients underwent surgery. Twenty-two patients had fertility sparing surgery and four of these had given birth at the time of follow-up. Analysis of DICER1 was performed in eight women. Four carried a pathogenic variant. Four patients received adjuvant chemotherapy, three because of advanced tumor stage, and one because of a poorly differentiated Sertoli-Leydig cell tumor.

CONCLUSION: The prognosis for women with Sertoli-Leydig cell tumors with localized disease is excellent. Women with advanced stages (III-IV) have a poor prognosis, regardless of adjuvant chemotherapy. Fertility sparing surgery seems to be a viable option for localized Sertoli-Leydig cell tumors. DICER1 screening was rarely performed in previous cohorts and concomitant organ screening programs are topics for discussion.

PMID:37907261 | DOI:10.1136/ijgc-2023-004945

Ann Rheum Dis. 2023 Oct 31:ard-2023-224571. doi: 10.1136/ard-2023-224571. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to describe the data structure and harmonisation process, explore data quality and define characteristics, treatment, and outcomes of patients across six federated antineutrophil cytoplasmic antibody-associated vasculitis (AAV) registries.

METHODS: Through creation of the vasculitis-specific Findable, Accessible, Interoperable, Reusable, VASCulitis ontology, we harmonised the registries and enabled semantic interoperability. We assessed data quality across the domains of uniqueness, consistency, completeness and correctness. Aggregated data were retrieved using the semantic query language SPARQL Protocol and Resource Description Framework Query Language (SPARQL) and outcome rates were assessed through random effects meta-analysis.

RESULTS: A total of 5282 cases of AAV were identified. Uniqueness and data-type consistency were 100% across all assessed variables. Completeness and correctness varied from 49%-100% to 60%-100%, respectively. There were 2754 (52.1%) cases classified as granulomatosis with polyangiitis (GPA), 1580 (29.9%) as microscopic polyangiitis and 937 (17.7%) as eosinophilic GPA. The pattern of organ involvement included: lung in 3281 (65.1%), ear-nose-throat in 2860 (56.7%) and kidney in 2534 (50.2%). Intravenous cyclophosphamide was used as remission induction therapy in 982 (50.7%), rituximab in 505 (17.7%) and pulsed intravenous glucocorticoid use was highly variable (11%-91%). Overall mortality and incidence rates of end-stage kidney disease were 28.8 (95% CI 19.7 to 42.2) and 24.8 (95% CI 19.7 to 31.1) per 1000 patient-years, respectively.

CONCLUSIONS: In the largest reported AAV cohort-study, we federated patient registries using semantic web technologies and highlighted concerns about data quality. The comparison of patient characteristics, treatment and outcomes was hampered by heterogeneous recruitment settings.

PMID:37907255 | DOI:10.1136/ard-2023-224571

BMJ Support Palliat Care. 2023 Oct 31:spcare-2023-004633. doi: 10.1136/spcare-2023-004633. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to implement training to increase the perineal care knowledge of relatives caring for incontinent palliative care patients and to examine the effectiveness of this training.

METHODS: This study was designed as a pretest-post-test randomised controlled trial. The study included 84 relatives of patients with incontinence (experimental group, n=42; control group, n=42). The experimental group was given one-on-one face-to-face training on perineal care for patients with incontinence, while the control group was given training through a brochure. Data were collected using a personal information form and the Perineal Care Knowledge Test. The Wilcoxon signed-rank and Mann-Whitney U tests were used for statistical analysis.

RESULTS: The difference between the pretest and post-test scores of the experimental group was found to be statistically significant (p<0.05), while the difference between the pretest and post-test scores of the control group was not significant (p>0.05). The post-test scores of the experimental group were higher than those of the control group (p<0.05).

CONCLUSIONS: It was found that one-on-one face-to-face perineal care training was a more effective method for increasing the perineal care knowledge of patients’ relatives than brochures.

PMID:37907251 | DOI:10.1136/spcare-2023-004633

Ann Rehabil Med. 2023 Oct;47(5):393-402. doi: 10.5535/arm.23058. Epub 2023 Oct 12.

ABSTRACT

OBJECTIVE: : To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients.

METHODS: : Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer.

RESULTS: : Wilcoxon signed rank test revealed a significant reduction (p<0.001) in total RSDI values from 71.08±1.13 pretest to 47.14±1.15 posttest for group A, while it decreased from 70.64±1.20 pretreatment to 31.76±1.04 posttreatment for group B; furthermore, Mann-Whitney U-test revealed a significant difference (p<0.001) in total RSDI values between both groups when comparing the change of the pre-post data values, it was 23.94±0.95 for group A and 38.88±0.67 for group B. The independent t-test revealed a highly statistically significant increase (p<0.001) in the PPT values in the experimental group compared to the control group.

CONCLUSION: : The physiotherapy program which included pulsed ultrasound therapy, sinus manual drainage technique, and self-sinus massage technique in conjunction with conventional medical treatment was more beneficial for enhancing the quality of life and PPT than traditional medical treatment alone in CRS patients.

PMID:37907231 | DOI:10.5535/arm.23058

Ann Rehabil Med. 2023 Oct;47(5):377-384. doi: 10.5535/arm.23110. Epub 2023 Oct 4.

ABSTRACT

OBJECTIVE: : To demonstrate the association between the physical and functional characteristics of individuals with spinal cord injury (SCI) and suicidality, an area of research that is less understood than the association with demographic, social, and psychological characteristics.

METHODS: : A retrospective cross-sectional study was conducted with 259 patients with SCI admitted for rehabilitation at the National Rehabilitation Center, Seoul, between January 2019 and December 2021. Demographic, SCI-related, physical, and functional data were collected from their medical records. Suicide risk was assessed using the Mini International Neuropsychiatric Interview.

RESULTS: : The 259 participants had an average age of 49.1 years, and 75.7% were male. The analysis revealed a statistically significant negative correlation between age and suicidality. No significant differences were found for sex, education, occupation, or SCI-related factors. Lower upper extremity motor score (UEMS) was significantly associated with higher suicide risk. Regarding functional factors, the inability to perform independent rolling, come to sit, wheelchair propelling, and self-driving were associated with increased suicidality. In the multiple linear regression analysis, lower UEMS, limited shoulder joint motion, upper extremity spasticity, and dependent wheelchair propulsion were predictors of higher suicide risk.

CONCLUSION: : This study highlights the associations among physical status, functional dependency, and suicide risk in individuals with SCI. These findings emphasize the need to address psychological aspects and physical and functional factors in the management of individuals with SCI who are at a high risk of suicide.

PMID:37907229 | DOI:10.5535/arm.23110

Ann Rehabil Med. 2023 Oct;47(5):348-357. doi: 10.5535/arm.23090. Epub 2023 Oct 27.

ABSTRACT

OBJECTIVE: : To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty.

METHODS: : A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected.

RESULTS: : Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07-0.94; p=0.80, I²=0%).

CONCLUSION: : This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty.

PMID:37907226 | DOI:10.5535/arm.23090

Ann Rehabil Med. 2023 Oct;47(5):318-325. doi: 10.5535/arm.23050. Epub 2023 Oct 31.

ABSTRACT

Cardiovascular disease (CVD) poses a significant health challenge globally, including in Korea, due to its status as a leading cause of death and its impact on cardiopulmonary function. Cardiac rehabilitation (CR) is a well-established program that not only aids in restoring cardiopulmonary function, but also improves physical and social conditions. The benefits of CR are widely recognized, and it is implemented globally. While the effectiveness of CR has been proven in Korea, it is underutilized. This fact sheet summarizes the current status of CR in Korea, including the prevalence of CVD, the clinical practice guidelines for CR programs, and the challenges of implementing CR in Korea.

PMID:37907223 | DOI:10.5535/arm.23050