Tag: pubmed

Genetics. 2023 Jun 27:iyad119. doi: 10.1093/genetics/iyad119. Online ahead of print.

ABSTRACT

When quantitative longitudinal traits are risk factors for disease progression and subject to random biological variation, joint model analysis of time-to-event and longitudinal traits can effectively identify direct and/or indirect genetic association of single nucleotide polymorphisms (SNPs) with time-to-event. We present a joint model that integrates: i) a multivariate linear mixed model describing trajectories of multiple longitudinal traits as a function of time, SNP effects, and subject-specific random effects, and ii) a frailty Cox survival model that depends on SNPs, longitudinal trajectory effects, and subject-specific frailty accounting for dependence among multiple time-to-event traits. Motivated by complex genetic architecture of type 1 diabetes complications (T1DC) observed in the Diabetes Control and Complications Trial (DCCT), we implement a two-stage approach to inference with bootstrap joint covariance estimation and develop a hypothesis testing procedure to classify direct and/or indirect SNP association with each time-to-event trait. By realistic simulation study, we show that joint modelling of two time-to-T1DC (retinopathy, nephropathy) and two longitudinal risk factors (HbA1c, systolic blood pressure) reduces estimation bias in genetic effects and improves classification accuracy of direct and/or indirect SNP associations, compared to methods that ignore within-subject risk factor variability and dependence among longitudinal and time-to-event traits. Through DCCT data analysis, we demonstrate feasibility for candidate SNP modelling, and quantify effects of sample size and Winner’s curse bias on classification for two SNPs identified as having indirect associations with time-to-T1DC traits. Joint analysis of multiple longitudinal and multiple time-to-event traits provides insight into complex trait architecture.

PMID:37369448 | DOI:10.1093/genetics/iyad119

Can J Surg. 2023 Jun 27;66(3):E310-E320. doi: 10.1503/cjs.017020. Print 2023 May-Jun.

ABSTRACT

BACKGROUND: Women with low-grade ovarian serous carcinoma (LGSC) benefit from surgical treatment; however, the role of chemotherapy is controversial. We examined an international database through the Ovarian Cancer Association Consortium to identify factors that affect survival in LGSC.

METHODS: We performed a retrospective cohort analysis of patients with LGSC who had had primary surgery and had overall survival data available. We performed univariate and multivariate analyses of progression-free survival and overall survival, and generated Kaplan-Meier survival curves.

RESULTS: Of the 707 patients with LGSC, 680 (96.2%) had available overall survival data. The patients’ median age overall was 54 years. Of the 659 patients with International Federation of Obstetrics and Gynecology stage data, 156 (23.7%) had stage I disease, 64 (9.7%) had stage II, 395 (59.9%) had stage III, and 44 (6.7%) had stage IV. Of the 377 patients with surgical data, 200 (53.0%) had no visible residual disease. Of the 361 patients with chemotherapy data, 330 (91.4%) received first-line platinum-based chemotherapy. The median follow-up duration was 5.0 years. The median progression-free survival and overall survival were 43.2 months and 110.4 months, respectively. Multivariate analysis indicated a statistically significant impact of stage and residual disease on progression-free survival and overall survival. Platinum-based chemotherapy was not associated with a survival advantage.

CONCLUSION: This multicentre analysis indicates that complete surgical cytoreduction to no visible residual disease has the most impact on improved survival in LGSC. This finding could immediately inform and change practice.

PMID:37369443 | DOI:10.1503/cjs.017020

BMJ Open. 2023 Jun 26;13(6):e067432. doi: 10.1136/bmjopen-2022-067432.

ABSTRACT

OBJECTIVES: Studies have suggested contradictory results on the relationship between chronic obstructive pulmonary disease (COPD) and periodontal disease (PD). The aim of this study was to determine whether PD increased the risk of COPD and COPD-related clinical events.

DESIGN: A systematic review and meta-analysis.

DATA SOURCES: PubMed, Ovid EMBASE and Ovid CENTRAL were searched from inception to 22 February 2023.

ELIGIBILITY CRITERIA FOR STUDIES: We included trials and observational studies evaluating association of PD with the risk of COPD or COPD-related events (exacerbation and mortality), with statistical adjustment for smoking.

DATA EXTRACTION AND SYNTHESIS: Two investigators independently extracted data from selected studies using a standardised Excel file. Quality of studies was evaluated using the Newcastle-Ottawa Scale. OR with 95% CI was pooled in a random-effect model with inverse variance method.

RESULTS: 22 observational studies with 51 704 participants were included. Pooled analysis of 18 studies suggested that PD was weakly associated with the risk of COPD (OR: 1.20, 95% CI 1.09 to 1.32). However, in stratified and subgroup analyses, with strict adjustment for smoking, PD no longer related to the risk of COPD (adjusting for smoking intensity: OR: 1.14, 95% CI 0.86 to 1.51; smokers only: OR: 1.46, 95% CI 0.92 to 2.31; never smokers only: OR: 0.93, 95% CI 0.72 to 1.21). Moreover, PD did not increase the risk of COPD-related exacerbation or mortality (OR: 1.18, 95% CI 0.71 to 1.97) in the pooled result of four studies.

CONCLUSIONS: This study demonstrates PD confers no risk for COPD and COPD-related events when strictly adjusted by smoking. Large-scale prospective cohort studies with control of potential confounding factors are warranted to validate the present findings.

PMID:37369414 | DOI:10.1136/bmjopen-2022-067432

BMJ Open. 2023 Jun 27;13(6):e069957. doi: 10.1136/bmjopen-2022-069957.

ABSTRACT

OBJECTIVES: Delirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes.

DESIGN: Prospective randomised controlled trial.

SETTING: Single centre, conducted at the neurosurgical department of the Erasmus Medical Center, Rotterdam, the Netherlands.

PARTICIPANTS: Adult patients undergoing craniotomy were eligible.

INTERVENTIONS: Patients in the intervention group received preferred recorded music before, during and after the operation until day 3 after surgery. Patients in the control group were treated according to standard of clinical care.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was presence or absence of postoperative delirium within the first 5 postoperative days measured with the Delirium Observation Screening Scale (DOSS) and, in case of a daily mean score of 3 or higher, a psychiatric evaluation with the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Secondary outcomes included anxiety, heart rate variability (HRV), depth of anaesthesia, delirium severity and duration, postoperative complications, length of stay and location of discharge.

RESULTS: We enrolled 189 patients (music=95, control=94) from July 2020 through September 2021. Delirium, as assessed by the DOSS, was less common in the music (n=11, 11.6%) than in the control group (n=21, 22.3%, OR:0.49, p=0.048). However, after DSM-5 confirmation, differences in delirium were not significant (4.2% vs 7.4%, OR:0.47, p=0.342). Moreover, music increased the HRV (root mean square of successive differences between normal heartbeats, p=0.012). All other secondary outcomes were not different between groups.

CONCLUSION: Our results support the efficacy of music in reducing the incidence of delirium after craniotomy, as found with DOSS but not after DSM-5 confirmation, substantiated by the effect of music on preoperative autonomic tone. Delirium screening tools should be validated and the long-term implications should be evaluated after craniotomy.

TRIAL REGISTRATION NUMBER: Trialregister.nl: NL8503 and ClinicalTrials.gov: NCT04649450.

PMID:37369412 | DOI:10.1136/bmjopen-2022-069957

BMJ Open. 2023 Jun 26;13(6):e068559. doi: 10.1136/bmjopen-2022-068559.

ABSTRACT

OBJECTIVES: This meta-analysis aimed to systematically evaluate the efficacy of acupuncture in treating postsurgical gastroparesis syndrome (PGS) after thoracic or abdominal surgery.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Twelve databases (PubMed, Embase, Cochrane Library Cochrane Central Register of Controlled Trials (CENTRAL), Medline (Ovid) (from 1946), Web of Science, EBSCO, Scopus, Open Grey, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP) and China Biology Medicine disc (CBM)) and three registration websites (WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Chinese Clinical Trial Registry (ChiCTR)) were searched from the inception to September 2022, and citations of the included literature were screened.

ELIGIBILITY CRITERIA: All randomised controlled trials addressing invasive acupuncture for PGS.

DATA EXTRACTION AND SYNTHESIS: Key information on the included studies was extracted by two reviewers independently. Risk ratio (RR) with 95% CI was used for categorical data, and mean difference with 95% CI for continuous data. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Outcomes were conducted with trial sequential analysis (TSA).

RESULTS: Fifteen studies with 759 patients met the inclusion criteria. Subgroup analyses revealed that compared with the drug group, the drug and acupuncture group had a greater positive effect on the total effective rate (TER) (nine trials, n=427; RR=1.20; 95% CI 1.08 to 1.32; P-heterogeneity=0.20, I²=28%, p=0.0004) and the recovery rate (RCR) (six trials, n = 294; RR = 1.61; 95% CI 1.30 to 1.98; P-heterogeneity=0.29, I²=19%, p<0.0001) of PGS after abdominal surgery. However, acupuncture showed no significant advantages in terms of the TER after thoracic surgery (one trial, p=0.13) or thoracic/abdominal surgery-related PGS (two trials, n = 115; RR=1.18; 95% CI 0.89 to 1.57; P-heterogeneity=0.08, I²=67%, p=0.24) and the RCR after thoracic/abdominal surgery (two trials, n=115; RR=1.40; 95% CI 0.97 to 2.01; P-heterogeneity=0.96, I²=0%, p=0.07). The quality of evidence for TER and RCR was moderate certainty. Only one study reported an acupuncture-related adverse event, in the form of mild local subcutaneous haemorrhage and pain that recovered spontaneously. TSA indicated that outcomes reached a necessary effect size except for clinical symptom score.

CONCLUSION: Based on subgroup analysis, compared with the drug treatment, acupuncture combined drug has significant advantages in the treatment of PGS associated with abdominal surgery, but not with thoracic surgery.

PROSPERO REGISTRATION NUMBER: CRD42022299189.

PMID:37369406 | DOI:10.1136/bmjopen-2022-068559

BMJ Open. 2023 Jun 26;13(6):e070482. doi: 10.1136/bmjopen-2022-070482.

ABSTRACT

OBJECTIVES: Maximising the impact of community-based programmes requires understanding how supply of, and demand for, the intervention interact at the point of delivery.

DESIGN: Post-hoc analysis from a large-scale community health worker (CHW) study designed to increase the uptake of malaria diagnostic testing.

SETTING: Respondents were identified during a household survey in western Kenya between July 2016 and April 2017.

PARTICIPANTS: Household members with fever in the last 4 weeks were interviewed at 12 and 18 months post-implementation. We collected monthly testing data from 244 participating CHWs and conducted semistructured interviews with a random sample of 70 CHWs.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was diagnostic testing before treatment for a recent fever. The secondary outcomes were receiving a test from a CHW and tests done per month by each CHW.

RESULTS: 55% (n=948 of 1738) reported having a malaria diagnostic test for their recent illness, of which 38.4% were tested by a CHW. Being aware of a local CHW (adjusted OR=1.50, 95% CI: 1.10 to 2.04) and belonging to the wealthiest households (vs least wealthy) were associated with higher testing (adjusted OR=1.53, 95% CI: 1.14 to 2.06). Wealthier households were less likely to receive their test from a CHW compared with poorer households (adjusted OR=0.32, 95% CI: 0.17 to 0.62). Confidence in artemether-lumefantrine to cure malaria (adjusted OR=2.75, 95% CI: 1.54 to 4.92) and perceived accuracy of a malaria rapid diagnostic test (adjusted OR=2.43, 95% CI: 1.12 to 5.27) were positively associated with testing by a CHW. Specific CHW attributes were associated with performing a higher monthly number of tests including formal employment, serving more than 50 households (vs <50) and serving areas with a higher test positivity. On demand side, confidence of the respondent in a test performed by a CHW was strongly associated with seeking a test from a CHW.

CONCLUSION: Scale-up of community-based malaria testing is feasible and effective in increasing uptake among the poorest households. To maximise impact, it is important to recognise factors that may restrict delivery and demand for such services.

TRIAL REGISTRATION NUMBER: NCT02461628; Post-results.

PMID:37369403 | DOI:10.1136/bmjopen-2022-070482

Int J Med Inform. 2023 Jun 23;177:105134. doi: 10.1016/j.ijmedinf.2023.105134. Online ahead of print.

ABSTRACT

BACKGROUND: The search for valid information was one of the main challenges encountered during the COVID-19 pandemic, which resulted in the development of several online alternatives.

OBJECTIVES: To describe the development of a computational solution to interact with users of different levels of digital literacy on topics related to COVID-19 and to map the correlations between user behavior and events and news that occurred throughout the pandemic.

METHOD: CoronaAI, a chatbot based on Google’s Dialogflow technology, was developed at a public university in Brazil and made available on WhatsApp. The dataset with users’ interactions with the chatbot comprises approximately 7,000 hits recorded throughout eleven months of CoronaAI usage.

RESULTS: CoronaAI was widely accessed by users in search of valuable and updated information on COVID-19, including checking the veracity of possible fake news about the spread of cases, deaths, symptoms, tests and protocols, among others. The mapping of users’ behavior revealed that as the number of cases and deaths increased and as COVID-19 became closer, users showed a greater need for information applicable to self-care compared to following the statistical data. In addition, they showed that the constant updating of this technology may contribute to public health by enhancing general information on the pandemic and at the individual level by clarifying specific doubts about COVID-19.

CONCLUSION: Our findings reinforce the potential usefulness of chatbot technology to resolve a wide spectrum of citizens’ doubts about COVID-19, acting as a cost-effective tool against the parallel pandemic of misinformation and fake news.

PMID:37369153 | DOI:10.1016/j.ijmedinf.2023.105134

Int J Nurs Stud. 2023 Jun 12;145:104545. doi: 10.1016/j.ijnurstu.2023.104545. Online ahead of print.

ABSTRACT

BACKGROUND: Pressure injury risk assessment tools have several well-known limitations. As a result, new methods of assessing risk are emerging, including the use of sub-epidermal moisture measurement to detect localized edema.

AIMS: To assess the daily variation in sacral sub-epidermal moisture measurement over five days and establish if age and prophylactic sacral dressing use influenced these measurements.

METHODS: As part of a larger randomized controlled trial of the use of prophylactic sacral dressings, a longitudinal observational substudy was undertaken in hospitalized medical and surgical adult patients at risk of pressure injury. The substudy was conducted in consecutively recruited patients from 20 May 2021 to 9 November 2022. Using the SEM 200 (Bruin Biometrics LLC), daily sacral sub-epidermal measurements for up to five days were completed. Two measurements were generated, the most recent sub-epidermal moisture measurement and, after at least three measurements, a delta value, the difference between the highest and lowest values. The delta measurement was the outcome, with a delta of ≥0.60 considered abnormal, increasing the risk of pressure injury development. A mixed analysis of covariance was undertaken to determine if there was any change in delta measurements over the five days and to determine if age and sacral prophylactic dressing use influenced sub-epidermal moisture delta measurement.

RESULTS: A total of 392 participants were included in this study; 160 (40.8%) patients had completed five consecutive days of sacral sub-epidermal moisture delta measurements. In total, 1324 delta measurements were undertaken across the five study days. In total, 325 of 392 patients (82.9%) had experienced one or more abnormal delta. Furthermore, 191 (48.7%) and 96 (24.5%) of patients experienced abnormal deltas for two or more and three or more consecutive days. There was no statistically significant variation in sacral sub-epidermal moisture delta measurements over time; increasing age and prophylactic dressing use did not influence sub-epidermal moisture deltas over the five days.

CONCLUSION: If only one abnormal delta was used as a trigger, about 83% of patients would have received additional pressure injury prevention strategies. But, if a more nuanced approach to responding to abnormal deltas is taken, between 25 and 50% of patients may receive additional pressure injury prevention, representing a more time and resource efficient approach.

TWEETABLE ABSTRACT: Sub-epidermal moisture delta measurements did not vary over 5 days; increasing age and prophylactic dressing use did not influence these measurements.

PMID:37369147 | DOI:10.1016/j.ijnurstu.2023.104545

Am J Respir Crit Care Med. 2023 Jun 27. doi: 10.1164/rccm.202302-0289OC. Online ahead of print.

ABSTRACT

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a prevalent and burdensome condition in low- and middle-income countries (LMICs). Challenges to better care include more effective diagnosis, and access to affordable interventions. There are no previous reports describing therapeutic needs in LMIC populations with COPD identified through screening.

OBJECTIVE: To describe unmet therapeutic need in screening-detected COPD in LMIC settings.

METHODS: We compared interventions recommended by the international ‘GOLD’ COPD strategy document, with that received, in 1000 people with COPD identified by population screening at three LMIC sites in Nepal, Peru and Uganda. We calculated costs using data on the availability and affordability of medicines.

MEASUREMENT AND MAIN RESULTS: The greatest unmet need for non-pharmacological interventions was for education and vaccinations (applicable to all), pulmonary rehabilitation (49%), smoking cessation (30%) and advice on biomass smoke exposure (26%). 95% of cases were previously undiagnosed and few were receiving therapy (4.5% had short-acting beta-agonists). Only three of 47 people (6%) with a previous COPD diagnosis had access to drugs consistent with recommendations. None of those with more severe COPD were accessing appropriate maintenance inhalers. Even when available, maintenance treatments were unaffordable with 30 days of treatment more than a low-skilled workers’ daily average wage.

CONCLUSION: We found significant missed opportunity to reduce the burden of COPD in LMIC settings, with most cases undiagnosed. Whilst there is unmet need in developing novel therapies, in LMICs where the burden is greatest, better diagnosis together with access to affordable interventions could translate to immediate benefit. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

PMID:37369142 | DOI:10.1164/rccm.202302-0289OC

Aust Health Rev. 2023 Jun 28. doi: 10.1071/AH23060. Online ahead of print.

ABSTRACT

ObjectivesTo assess whether compliance with the nationally endorsed Optimal Care Pathways is evident in 75% of patients treated with curative intent treatment and if this compliance was impacted by the COVID-19 pandemic (hereinafter COVID-19).MethodsThis retrospective study included patients undergoing curative treatment with radiotherapy in head and neck (HN), breast, lung and gastrointestinal malignancies between January 2019 and June 2021 in a single NSW outer metropolitan cancer service. For care delivered within the remit of cancer services, the primary outcome measure was the proportion of patients whose treatment complied with the Optimal Care Pathways recommended time frame. Secondary outcome measures included evaluating the effect of COVID-19 on the proportion of patients being treated within the recommended time frame.ResultsThere were n = 733 eligible patients across the five tumour streams with the majority being breast cancer patients comprising 65% (n = 479) of the cohort, followed by HN cancer patients (n = 125, 17%). None of the tumour subsites abided by the 75% compliance rate. Oesophageal cancer patients had the lowest compliance rate of 4% (P < 0.001), with a similarly low compliance rate for rectal cancer patients at 33% (P = 0.002). None of the hypothesis tests to assess for detriment in treatment time during COVID-19 were statistically significant (P > 0.05).ConclusionDespite the availability of best practice guidelines, there is limited compliance throughout all cancer subtypes, which has not been negatively influenced by COVID-19. Improved awareness of the Optimal Care Pathways, and implementation of the associated infrastructure and systems, are required to support compliance.

PMID:37369140 | DOI:10.1071/AH23060