Tag: pubmed

BMJ Qual Saf. 2023 Jul 6:bmjqs-2022-015832. doi: 10.1136/bmjqs-2022-015832. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier.

DESIGN: Staggered difference-in-difference panel event study allowing for differential effects across intervention cohorts.

SETTING: All English National Health Service (NHS) acute hospital sites.

PARTICIPANTS: All 1 410 427 NHS patients aged 75+ with high frailty risk who had an emergency hospital admission to acute, general or geriatric medicine departments between 1 January 2012 and 31 March 2019.

INTERVENTION: Membership of the AFN, a quality improvement collaborative designed to support acute hospitals in England deliver evidence-based care for older people with frailty. 66 hospital sites joined the AFN in six sequential cohorts, the first starting in January 2015, the sixth in May 2018. Usual care was delivered in the remaining 248 control sites.

MAIN OUTCOME MEASURES: Length of hospital stay, in-hospital mortality, institutionalisation, hospital readmission.

RESULTS: No significant effects of AFN membership were found for any of the four outcomes nor were there significant effects for any individual cohort.

CONCLUSIONS: To realise its aims, the AFN might need to develop better resourced intervention and implementation strategies.

PMID:37414555 | DOI:10.1136/bmjqs-2022-015832

J Neurol Neurosurg Psychiatry. 2023 Jul 6:jnnp-2023-331499. doi: 10.1136/jnnp-2023-331499. Online ahead of print.

ABSTRACT

BACKGROUND: Simultaneous comparisons of multiple disease-modifying therapies for relapsing-remitting multiple sclerosis (RRMS) over an extended follow-up are lacking. Here we emulate a randomised trial simultaneously comparing the effectiveness of six commonly used therapies over 5 years.

METHODS: Data from 74 centres in 35 countries were sourced from MSBase. For each patient, the first eligible intervention was analysed, censoring at change/discontinuation of treatment. The compared interventions included natalizumab, fingolimod, dimethyl fumarate, teriflunomide, interferon beta, glatiramer acetate and no treatment. Marginal structural Cox models (MSMs) were used to estimate the average treatment effects (ATEs) and the average treatment effects among the treated (ATT), rebalancing the compared groups at 6-monthly intervals on age, sex, birth-year, pregnancy status, treatment, relapses, disease duration, disability and disease course. The outcomes analysed were incidence of relapses, 12-month confirmed disability worsening and improvement.

RESULTS: 23 236 eligible patients were diagnosed with RRMS or clinically isolated syndrome. Compared with glatiramer acetate (reference), several therapies showed a superior ATE in reducing relapses: natalizumab (HR=0.44, 95% CI=0.40 to 0.50), fingolimod (HR=0.60, 95% CI=0.54 to 0.66) and dimethyl fumarate (HR=0.78, 95% CI=0.66 to 0.92). Further, natalizumab (HR=0.43, 95% CI=0.32 to 0.56) showed a superior ATE in reducing disability worsening and in disability improvement (HR=1.32, 95% CI=1.08 to 1.60). The pairwise ATT comparisons also showed superior effects of natalizumab followed by fingolimod on relapses and disability.

CONCLUSIONS: The effectiveness of natalizumab and fingolimod in active RRMS is superior to dimethyl fumarate, teriflunomide, glatiramer acetate and interferon beta. This study demonstrates the utility of MSM in emulating trials to compare clinical effectiveness among multiple interventions simultaneously.

PMID:37414534 | DOI:10.1136/jnnp-2023-331499

Br J Ophthalmol. 2023 Jul 6:bjo-2023-323282. doi: 10.1136/bjo-2023-323282. Online ahead of print.

ABSTRACT

PURPOSE: To determine the surgical outcomes using navigation-guided transcaruncular orbital optic canal decompression (NGTcOCD) and investigate the relationship between visual prognosis. visual evoked potential (VEP), association with DeLano type of optic canal and Onodi cells in patients with indirect traumatic optic neuropathy (TON).

DESIGN: Prospective observational.

METHODS: Fifty-two consecutive patients with indirect TON unresponsive to steroid therapy were divided into three groups where Group I comprised of cases with optic canal fracture who underwent NGTcOCD, Group II without optic canal fracture who underwent NGTcOCD and Group III, no-decompression group who chose not to undergo NGTcOCD. An improvement in visual acuity (VA) at 1 week, 3 months and 1 year and amplitude and latency of VEP at 1 year were considered as primary and secondary outcomes, respectively.

RESULTS: The mean VA improved from 2.55±0.67 and 2.62±0.56 LogMAR at presentation to 2.03±0.96 and 2.33±0.72 LogMAR at final follow-up among Group I and Group II patients, respectively (p<0.001 and p=0.01). Statistically significant improvement observed among both the Groups in VEP amplitude (p=<0.01) and among Group II in VEP latency (p<0.01). Both Group I and Group II patients have better outcomes than patients in no-decompression group. VA at presentation and Type 1 DeLano optic canal were observed as significant prognostic factors.

CONCLUSIONS: NGTcOCD serves as a minimally invasive transcaruncular route to the optic canal which enables ophthalmologists to perform decompression from the anterior-most orbital end under direct visualisation. Patients with indirect TON with or without optic canal fracture and unresponsive to steroid therapy when managed with NGTcOCD have shown comparable and superior outcomes.

PMID:37414533 | DOI:10.1136/bjo-2023-323282

Heart. 2023 Jul 6:heartjnl-2022-322315. doi: 10.1136/heartjnl-2022-322315. Online ahead of print.

ABSTRACT

OBJECTIVE: We sought to investigate prevalence, incidence and prognostic implications of permanent pacemaker (PPM) implantation in patients with cardiac amyloidosis (CA), thereby identifying the predictors of time to PPM implantation.

METHODS: Seven hundred eighty-seven patients with CA (602 men, median age 74 years, 571 transthyretin amyloidosis (ATTR), 216 light-chain amyloidosis (AL)) evaluated at two European referral centres were retrospectively included. Clinical, laboratory and instrumental data were analysed. The associations between PPM implantation and mortality, heart failure (HF) or a composite endpoint of mortality, cardiac transplantation and HF were analysed.

RESULTS: 81 (10.3%) patients had a PPM before initial evaluation. Over a median follow-up time of 21.7 months (IQR 9.6-45.2), 81 (10.3%) additional patients (18 with AL (22.2%) and 63 with ATTR (77.8%)) underwent PPM implantation with a median time to implantation of 15.6 months (IQR 4.2-40), complete atrioventricular block was the most common indication (49.4%). Independent predictors of PPM implantation were QRS duration (HR 1.03, 95% CI 1.02 to 1.03, p<0.001) and interventricular septum (IVS) thickness (HR 1.1, 95% CI 1.03 to 1.17, p=0.003). The model to estimate the probability of PPM at 12 months and containing both factors showed a C-statistic of 0.71 and a calibration of slope of 0.98.

CONCLUSIONS: Conduction system disease requiring PPM is a common complication in CA that affects up to 20.6% of patients. QRS duration and IVS thickness are independently associated with PPM implantation. A PPM implantation at 12 months model was devised and validated to identify patients with CA at higher risk of requiring a PPM and who require closer follow-up.

PMID:37414523 | DOI:10.1136/heartjnl-2022-322315

Clin Ther. 2023 Jun;45(6):589-598. doi: 10.1016/j.clinthera.2023.04.002.

ABSTRACT

PURPOSE: Cannabis use during adolescence can have harmful consequences, including poor educational outcomes, neurocognitive defects, and an increased risk of addiction to other drugs, such as tobacco, alcohol, and opioids. Perceived family and social network cannabis use is a risk factor for use among adolescents. It is not currently known whether there is an association between perceived family/social network cannabis use and adolescent cannabis use in the context of legalization. The purpose of this study was to examine associations between adolescent perceptions of parent, sibling, and best friend medical and/or recreational cannabis use and adolescents’ own use and whether the association changed pre-legalization and post-legalization in Massachusetts.

METHODS: We analyzed responses from surveys administered to students at 2 high schools in Massachusetts before legalization in 2016 (wave 1) and after legalization but before the start of regulated retail cannabis sales in 2018 (wave 2). We used χ² tests and multiple logistic regression to examine associations between adolescent perception of parent, sibling, and best friend use and adolescent past 30-day cannabis use before and after legalization.

FINDINGS: In this sample, no statistically significant differences were found in the prevalence of past 30-day cannabis use before and after legalization among adolescents. There was an increase in the proportion of adolescents who reported any perceived parent cannabis use from before to after legalization (18% before legalization to 24% after legalization; P = 0.018). Perceived parent, sibling, and best friend medical and recreational cannabis use were all associated with an increased odds of adolescent use, with the highest increase in odds found for perceived best friend use (adjusted odds ratio, 17.2; 95% CI, 12.4-24.0).

IMPLICATIONS: Adolescent perceptions of their parents as cannabis users increased after legalization, even before state-regulated retails sales began. Parent, sibling, and best friend cannabis use is each independently associated with increased odds of adolescent’s own use. These findings from 1 Massachusetts district should be explored in larger and more representative populations and motivate additional attention to interventions that consider family and friend influences when seeking to address adolescent cannabis use.

PMID:37414509 | DOI:10.1016/j.clinthera.2023.04.002

Clin Ther. 2023 Jun;45(6):562-577. doi: 10.1016/j.clinthera.2023.04.003.

ABSTRACT

BACKGROUND: Mental and other physical health concerns and substance use disorder are common and co-occurring events experienced by US veterans. Treatment with medicinal cannabis is a potential alternative to unwanted medication use for veterans, but more clinical and epidemiologic research is needed to understand the risks and benefits.

METHODS: Data were collected from a cross-sectional, self-reported, anonymous survey asking US veterans about their health conditions, medical treatments, demographics, and medicinal cannabis use along with its self-reported effectiveness. In addition to descriptive statistics, logistic regression models were run to examine correlates of the use of cannabis as a substitution for prescription or over-the-counter medications.

FINDINGS: A total of 510 veterans of US military service participated in the survey, which was administered between March 3 and December 31, 2019. The participants reported experiencing a variety of mental and other physical health conditions. Primary health conditions reported included chronic pain (196; 38%), PTSD (131; 26%), anxiety (47; 9%), and depression (26; 5%). Most participants (343; 67%) reported using cannabis daily. Many reported using cannabis to reduce the use of over-the-counter medications (151; 30%) including antidepressants (130; 25%), anti-inflammatories (89; 17%), and other prescription medications. Additionally, 463 veterans (91% of respondents) reported that medical cannabis helped them to experience a greater quality of life and 105 (21%) reported using fewer opioids as a result of their medical cannabis use. Veterans who were Black, who were female, who served in active combat, and who were living with chronic pain were more likely to report a desire to reduce the number of prescription medications they were taking (odds ratios = 2.92, 2.29, 1.79, and 2.30, respectively). Women and individuals who used cannabis daily were more likely to report active use of cannabis to reduce prescription medication use (odds ratios = 3.05 and 2.26).

IMPLICATIONS: Medicinal cannabis use was reported to improve quality of life and reduce unwanted medication use by many of the study participants. The present findings indicate that medicinal cannabis can potentially play a harm-reduction role, helping veterans to use fewer pharmaceutical medications and other substances. Clinicians should be mindful of the potential associations between race, sex, and combat experience and the intentions for and frequency of medicinal cannabis use.

PMID:37414507 | DOI:10.1016/j.clinthera.2023.04.003

Br J Sports Med. 2023 Jul 6:bjsports-2023-106948. doi: 10.1136/bjsports-2023-106948. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy.

METHODS: We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively registered three-armed, randomised, single-blinded superiority trial. Patients were randomly allocated to PA (n=62), PA plus self-dosed lower limb heavy-slow resistance training consisting of heel raises (PAX) (n=59), or PAX plus an ultrasound-guided injection of 1 mL triamcinolone 20 mg/mL (PAXI) (n=59). The primary outcome was changed in the pain domain of the Foot Health Status Questionnaire (ranging from 0 ‘worst’ to 100 ‘best’) from baseline to the 12-week follow-up. The minimal important difference in the pain domain is 14.1 points. The outcome was collected at baseline and at 4, 12, 26, and 52 weeks.

RESULTS: The primary analysis found a statistically significant difference between PA and PAXI after 12 weeks favouring PAXI (adjusted mean difference: -9.1 (95% CI -16.8 to -1.3; p=0.023)) and over 52 weeks (adjusted mean difference: -5.2 (95% CI -10.4 to -0.1; p=0.045)). At no follow-up did the mean difference between groups exceed the pre-specified minimal important difference. No statistically significant difference was found between PAX and PAXI or between PA and PAX at any time.

CONCLUSION: No clinically relevant between-group differences were found after 12 weeks. The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise.

TRIAL REGISTRATION NUMBER: NCT03804008.

PMID:37414460 | DOI:10.1136/bjsports-2023-106948

AJNR Am J Neuroradiol. 2023 Jul 6. doi: 10.3174/ajnr.A7923. Online ahead of print.

ABSTRACT

BACKGROUND: Platelet function testing has been proposed to better adjust individualized antiplatelet treatment for patients undergoing endovascular treatment for intracranial aneurysms. Its clinical significance needs to be comprehensively evaluated.

PURPOSE: Our aim was to evaluate the impact of platelet function testing-guided versus standard antiplatelet treatment in patients receiving endovascular treatment for intracranial aneurysms.

DATA SOURCES: PubMed, EMBASE, and the Cochrane Library of clinical trials were searched from inception until March 2023.

STUDY SELECTION: Eleven studies comprising 6199 patients were included.

DATA ANALYSIS: ORs with 95% CIs were calculated using random effects models.

DATA SYNTHESIS: The platelet function testing-guided group was associated with a decreased rate of symptomatic thromboembolic events (OR = 0.57; 95% CI, 0.42-0.76; I² = 26%). No significant difference was found in asymptomatic thromboembolic events (OR = 1.07; 95% CI, 0.39-2.94; I² = 48%), hemorrhagic events (OR = 0.71; 95% CI, 0.42-1.19; I² = 34%), intracranial hemorrhagic events (OR = 0.61; 95% CI, 0.03-10.79; I² = 62%), morbidity (OR = 0.53; 95% CI, 0.05-5.72; I² = 86%), and mortality (OR = 1.96; 95% CI, 0.64-5.97; I² = 0%) between the 2 groups. Subgroup analysis suggested that platelet function testing-guided therapy may contribute to fewer symptomatic thromboembolic events in patients who received stent-assisted coiling (OR = 0.43; 95% CI, 0.18-1.02; I² = 43%) or a combination of stent-assisted and flow-diverter stent placement (OR = 0.61; 95% CI, 0.36-1.02; I² = 0%) or who changed from clopidogrel to other thienopyridines (OR = 0.64; 95% CI, 0.40-1.02; I² = 18%), though the difference did not reach statistical significance.

LIMITATIONS: Heterogeneous endovascular treatment methods and adjusted antiplatelet regimens were limitations.

CONCLUSIONS: Platelet function testing-guided antiplatelet strategy significantly reduced the incidence of symptomatic thromboembolic events without any increase in the hemorrhagic events for patients undergoing endovascular treatment for intracranial aneurysms.

PMID:37414457 | DOI:10.3174/ajnr.A7923

AJNR Am J Neuroradiol. 2023 Jul 6. doi: 10.3174/ajnr.A7935. Online ahead of print.

ABSTRACT

BACKGROUND: Transophthalmic artery embolization of intracranial meningiomas is thought to be associated with a high complication risk.

PURPOSE: With advances in endovascular techniques, we systematically reviewed the current literature to improve our understanding of the safety and efficacy of transophthalmic artery embolization of intracranial meningiomas.

DATA SOURCES: We performed a systematic search using PubMed from inception until August 3, 2022.

STUDY SELECTION: Twelve studies with 28 patients with intracranial meningiomas embolized through the transophthalmic artery were included.

DATA ANALYSIS: Baseline and technical characteristics and clinical and safety outcomes were collected. No statistical analysis was conducted.

DATA SYNTHESIS: The average age of 27 patients was 49.5 (SD, 13) years. Eighteen (69%) meningiomas were located in the anterior cranial fossa, and 8 (31%), in the sphenoid ridge/wing. Polyvinyl alcohol particles were most commonly (n = 8, 31%) used to preoperatively embolize meningiomas, followed by n-BCA in 6 (23%), Onyx in 6 (23%), Gelfoam in 5 (19%), and coils in 1 patient (4%). Complete embolization of the target meningioma feeders was reported in 8 (47%) of 17 patients; partial embolization, in 6 (32%); and suboptimal embolization, in 3 (18%). The endovascular complication rate was 16% (4 of 25), which included visual impairment in 3 (12%) patients.

LIMITATIONS: Selection and publication biases were limitations.

CONCLUSIONS: Transophthalmic artery embolization of intracranial meningiomas is feasible but is associated with a non-negligible complication rate.

PMID:37414456 | DOI:10.3174/ajnr.A7935

AJNR Am J Neuroradiol. 2023 Jul 6. doi: 10.3174/ajnr.A7937. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Automatic brain parcellation is typically performed on dedicated MR imaging sequences, which require valuable examination time. In this study, a 3D MR imaging quantification sequence to retrieve R₁ and R₂ relaxation rates and proton density maps was used to synthesize a T1-weighted image stack for brain volume measurement, thereby combining image data for multiple purposes. The repeatability and reproducibility of using the conventional and synthetic input data were evaluated.

MATERIALS AND METHODS: Twelve subjects with a mean age of 54 years were scanned twice at 1.5T and 3T with 3D-QALAS and a conventionally acquired T1-weighted sequence. Using SyMRI, we converted the R₁, R₂, and proton density maps into synthetic T1-weighted images. Both the conventional T1-weighted and the synthetic 3D-T1-weighted inversion recovery images were processed for brain parcellation by NeuroQuant. Bland-Altman statistics were used to correlate the volumes of 12 brain structures. The coefficient of variation was used to evaluate the repeatability.

RESULTS: A high correlation with medians of 0.97 for 1.5T and 0.92 for 3T was found. A high repeatability was shown with a median coefficient of variation of 1.2% for both T1-weighted and synthetic 3D-T1-weighted inversion recovery at 1.5T, and 1.5% for T1-weighted imaging and 4.4% for synthetic 3D-T1-weighted inversion recovery at 3T. However, significant biases were observed between the methods and field strengths.

CONCLUSIONS: It is possible to perform MR imaging quantification of R₁, R₂, and proton density maps to synthesize a 3D-T1-weighted image stack, which can be used for automatic brain parcellation. Synthetic parameter settings should be reinvestigated to reduce the observed bias.

PMID:37414454 | DOI:10.3174/ajnr.A7937