Tag: pubmed

Medicine (Baltimore). 2023 Jun 30;102(26):e34219. doi: 10.1097/MD.0000000000034219.

ABSTRACT

Little is known about differences in the therapeutic efficacy of denosumab in subjects with and without rheumatoid arthritis (RA). This study compares the changes in bone mineral density (BMD) between RA patients and controls without RA who had been treated with denosumab for 2 years for postmenopausal osteoporosis. A total of 82 RA patients and 64 controls were enrolled, who were refractory to selective estrogen receptor modulators (SERMs) or bisphosphonates and completed the treatment of denosumab 60 mg for 2 years. The efficacy of denosumab in RA patients and controls was assessed using areal BMD (aBMD) and T-score of the lumbar spine, femur neck, and total hip. A general linear model with repeated measures analysis of variance was used to determine differences in aBMD and T-score between 2 study groups. No significant differences in percent changes in aBMD and T-scores by denosumab treatment for 2 years at the lumbar spine, femur neck, and total hip were evident between RA patients and controls (P > .05 of all), except T-score of the total hip (P = .034). Denosumab treatment equally increased aBMD at the lumbar spine and T-scores at the lumbar spine and total hip between RA patients and controls without statistical differences, but RA patients showed less improvement in aBMD at the femur neck (ptime*group = 0.032) and T-scores at the femur neck and total hip than controls (ptime*group = 0.004 of both). Changes in aBMD and T-scores after denosumab treatment in RA patients were not affected by previous use of bisphosphonates or SERMs. Differences of T-score at the femur neck among previous bisphosphonate users and aBMD and T-score at the femur neck and T-scores at the total hip were evident. This study revealed that 2 years of denosumab treatment in female RA patients achieved comparable efficacy on BMD to controls at the lumbar spine, but showed somewhat insufficient improvement at the femur neck and total hip.

PMID:37390268 | DOI:10.1097/MD.0000000000034219

J Strength Cond Res. 2023 Jun 30. doi: 10.1519/JSC.0000000000004377. Online ahead of print.

ABSTRACT

Lis, R, Szymanski, DJ, Qiao, M, and Crotin, RL. An exploratory investigation into the impact of bilateral and unilateral jump characteristics on ground reaction force applications in baseball pitching. J Strength Cond Res XX(X): 000-000, 2022-Jump tests are effective, valid, and reliable in examining lower-body power that can influence ground reaction forces (GRFs) in baseball pitching. Relationships between drive and stride leg GRFs and fastball velocities while pitching from the wind-up and stretch were evaluated for performance influences across the following conditions: (a) lower-body GRFs from unilateral countermovement jumps (UCMJ) and bilateral countermovement jumps (BCMJ) and (b) BCMJ and drive and stride leg UCMJ height. Nineteen Division I collegiate baseball pitchers (age; 19.9 ± 1.5 years, height; 1.86 ± 0.06 m, body mass; 90.7 ± 13.8 kg) completed BCMJ and UCMJ tests and threw four-seam fastballs from a pitching mound with 2 embedded force plates. Three moderate associations (r ≥ 0.47) were statistically significant (p < 0.05) for BCMJ and UCMJ heights to pitching GRFs. Stride leg UCMJ height was significantly greater than drive leg UCMJ height, p < 0.01, η2 = 0.34. Wind-up and stretch GRFs were statistically similar. Fastball velocities showed a statistically significant association that was moderately high with wind-up and stretch stride leg anterior-posterior GRFs (r ≥ 0.65, p < 0.01). Collegiate pitchers jumped significantly higher with their stride leg, and the sum of vertical unilateral jump height of both legs was significantly greater (27%) than BCMJ height to indicate greater single-leg dominance in jumping. Although stride leg height was higher, improving stride leg jumping performance may be functionally more important in producing greater momentum into foot strike that has the potential to increase fastball velocity.

PMID:37389938 | DOI:10.1519/JSC.0000000000004377

J Med Internet Res. 2023 Jun 30;25:e47391. doi: 10.2196/47391.

ABSTRACT

BACKGROUND: Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth because of cervical spine elongation, affecting the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches, known as Erb-Duchenne palsy. The least common lesion is when all nerve roots are affected (C5-T1), which has the worst prognosis. Virtual reality (VR) is commonly used in neurological rehabilitation for the evaluation and treatment of physical deficits.

OBJECTIVE: This systematic review aims to assess the efficacy of VR in the rehabilitation of upper limb function in patients with OBP.

METHODS: A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines in several scientific databases-PubMed, Web of Science, PEDro, Cochrane, MEDLINE, Scopus, and CINAHL-without language or date restrictions and including articles published up to April 2023. The inclusion criteria were established according to the population, intervention, comparison, outcome, and study (PICOS) design framework: children aged <18 years diagnosed with OBP, VR therapy used in addition to conventional therapy or isolated, VR therapy compared with conventional therapy, outcomes related to OBP rehabilitation therapy, and randomized controlled trials (RCTs). The PEDro scale was used to assess the methodological quality of the RCTs, and the Cochrane Collaboration tool was used to assess the risk of bias. The Review Manager statistical software (version 5.4; The Cochrane Collaboration) was used to conduct the meta-analysis. The results were synthesized through information extraction and presented in tables and forest plots.

RESULTS: In total, 5 RCTs were included in this systematic review, with 3 (60%) providing information for the meta-analysis. A total of 138 participants were analyzed. All the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed no favorable results for all outcomes except for the hand-to-mouth subtest of the Mallet scoring system (functional activity; standardized mean difference -0.97, 95% CI -1.67 to -0.27; P=.007).

CONCLUSIONS: The evidence for the use of VR therapy for upper limb rehabilitation outcomes in patients with OBP was insufficient to support its efficacy and strongly recommend its use. Nevertheless, scientific literature supports the use of VR technologies for rehabilitation as it provides several advantages, such as enhancing the patient’s motivation, providing direct feedback, and focusing the patient’s attention during the intervention. Thus, the use of VR for upper limb rehabilitation in patients with OBP is still in its first stages. Small sample sizes; limited long-term analysis; lack of testing of different doses; and absence of International Classification of Functioning, Disability, and Health-related outcomes were present in the included RCTs, so further research is needed to fully understand the potential of VR technologies as a therapeutic approach for patients with OBP.

TRIAL REGISTRATION: PROSPERO CRD42022314264; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=314264.

PMID:37389922 | DOI:10.2196/47391

J Med Internet Res. 2023 Jun 30;25:e45974. doi: 10.2196/45974.

ABSTRACT

BACKGROUND: Patient portals not only provide patients with access to electronic health records (EHRs) and other digital health services, such as prescription renewals, but they can also improve patients’ self-management, engagement with health care professionals (HCPs), and care processes. However, these benefits depend on patients’ willingness to use patient portals and, ultimately, their experiences with the usefulness and ease of use of the portals.

OBJECTIVE: This study aimed to investigate the perceived usability of a national patient portal and the relationship of patients’ very positive and very negative experiences with perceived usability. The study was aimed to be the first step in developing an approach for benchmarking the usability of patient portals in different countries.

METHODS: Data were collected through a web-based survey of the My Kanta patient portal’s logged-in patient users in Finland from January 24, 2022, to February 14, 2022. Respondents were asked to rate the usability of the patient portal, and the ratings were used to calculate approximations of the System Usability Scale (SUS) score. Open-ended questions asked the patients about their positive and negative experiences with the patient portal. The statistical analysis included multivariate regression, and the experience narratives were analyzed using inductive content analysis.

RESULTS: Of the 1,262,708 logged-in patient users, 4719 responded to the survey, giving a response rate of 0.37%. The patient portal’s usability was rated as good, with a mean SUS score of 74.3 (SD 14.0). Reporting a very positive experience with the portal was positively associated with perceived usability (β=.51; P<.001), whereas reporting a very negative experience was negatively associated with perceived usability (β=-1.28; P<.001). These variables explained 23% of the variation in perceived usability. The information provided and a lack of information were the most common positive and negative experiences. Furthermore, specific functionalities, such as prescription renewal and the ease of using the patient portal, were often mentioned as very positive experiences. The patients also mentioned negative emotions, such as anger and frustration, as part of their very negative experiences.

CONCLUSIONS: The study offers empirical evidence about the significant role of individual experiences when patients are evaluating the usability of patient portals. The results suggest that positive and negative experiences provide relevant information that can be used for improving the patient portal’s usability. Usability should be improved so that patients receive information efficiently, easily, and quickly. Respondents would also appreciate interactive features in the patient portal.

PMID:37389909 | DOI:10.2196/45974

J Med Internet Res. 2023 Jun 30;25:e47343. doi: 10.2196/47343.

ABSTRACT

BACKGROUND: Web-based short-form videos are increasingly popular for disseminating fire and burn prevention information, but their content quality is unknown.

OBJECTIVE: We aimed to systematically assess the characteristics, content quality, and public impact of web-based short-form videos offering primary and secondary (first aid) prevention recommendations for fires and burns in China between 2018 and 2021.

METHODS: We retrieved short-form videos offering both primary and secondary (first aid) information to prevent fire and burn injuries published on the 3 most popular web-based short-form video platforms in China: TikTok, Kwai, and Bilibili. To assess video content quality, we calculated the proportion of short-form videos that included information on each of the 15 recommendations for burn prevention education from the World Health Organization (WHO; P₁) and that correctly disseminated each recommendation (P₂). High P₁ and P₂ indicated better content quality. To assess their public impact, we calculated the median (IQR) of 3 indicators: the number of comments, likes, and saves as a favorite by viewers. Chi-square test, trend chi-square test, and Kruskal-Wallis H test examined differences in indicators across the 3 platforms, years, content, and time duration of videos and between videos disseminating correct versus incorrect information.

RESULTS: Overall, 1459 eligible short-form videos were included. The number of short-form videos increased by 16 times between 2018 and 2021. Of them, 93.97% (n=1371) were about secondary prevention (first aid) and 86.02% (n=1255) lasted <2 minutes. The proportion of short-form videos including each of the 15 WHO recommendations ranged from 0% to 77.86% (n=1136). Recommendations 8, 13, and 11 had the highest proportions (n=1136, 77.86%; n=827, 56.68%; and n=801, 54.9%, respectively), whereas recommendations 3 and 5 were never mentioned. Among the short-form videos that included the WHO recommendations, recommendations 1, 2, 4, 6, 9, and 12 were always disseminated correctly, but the other 9 recommendations were correctly disseminated in 59.11% (120/203) to 98.68% (1121/1136) of videos. The proportion of short-form videos including and correctly disseminating the WHO recommendations varied across platforms and years. The public impact of short videos varied greatly across videos, with a median (IQR) of 5 (0-34) comments, 62 (7-841) likes, and 4 (0-27) saves as a favorite. Short-form videos disseminating correct recommendations had larger public impact than those disseminating either partially correct or incorrect knowledge (median 5 vs 4 comments, 68 vs 51 likes, and 5 vs 3 saves as a favorite, respectively; all P<.05).

CONCLUSIONS: Despite the rapid increase in the number of web-based short-form videos about fire and burn prevention available in China, their content quality and public impact were generally low. Systematic efforts are recommended to improve the content quality and public impact of short-form videos on injury prevention topics such as fire and burn prevention.

PMID:37389906 | DOI:10.2196/47343

JMIR Res Protoc. 2023 Jun 30;12:e46810. doi: 10.2196/46810.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has reiterated the need for cohesive, collective, and deliberate societal efforts to address inherent inefficiencies in our health systems and overcome decision-making gaps using real-time data analytics. To achieve this, decision makers need independent and secure digital health platforms that engage citizens ethically to obtain big data, analyze and convert big data into real-time evidence, and finally, visualize this evidence to inform rapid decision-making.

OBJECTIVE: The objective of this study is to develop replicable and scalable jurisdiction-specific digital health dashboards for rapid decision-making to ethically monitor, mitigate, and manage public health crises via systems integration beyond health care.

METHODS: The primary approach in the development of the digital health dashboard was the use of global digital citizen science to tackle pandemics like COVID-19. The first step in the development process was to establish an 8-member Citizen Scientist Advisory Council via Digital Epidemiology and Population Health Laboratory’s community partnerships. Based on the consultation with the council, three critical needs of citizens were prioritized: (1) management of household risk of COVID-19, (2) facilitation of food security, and (3) understanding citizen accessibility of public services. Thereafter, a progressive web application (PWA) was developed to provide daily services that address these needs. The big data generated from citizen access to these PWA services are set up to be anonymized, aggregated, and linked to the digital health dashboard for decision-making, that is, the dashboard displays anonymized and aggregated data obtained from citizen devices via the PWA. The digital health dashboard and the PWA are hosted on the Amazon Elastic Compute Cloud server. The digital health dashboard’s interactive statistical navigation was designed using the Microsoft Power Business Intelligence tool, which creates a secure connection with the Amazon Relational Database server to regularly update the visualization of jurisdiction-specific, anonymized, and aggregated data.

RESULTS: The development process resulted in a replicable and scalable digital health dashboard for decision-making. The big data relayed to the dashboard in real time reflect usage of the PWA that provides households the ability to manage their risk of COVID-19, request food when in need, and report difficulties and issues in accessing public services. The dashboard also provides (1) delegated community alert system to manage risks in real time, (2) bidirectional engagement system that allows decision makers to respond to citizen queries, and (3) delegated access that provides enhanced dashboard security.

CONCLUSIONS: Digital health dashboards for decision-making can transform public health policy by prioritizing the needs of citizens as well as decision makers to enable rapid decision-making. Digital health dashboards provide decision makers the ability to directly communicate with citizens to mitigate and manage existing and emerging public health crises, a paradigm-changing approach, that is, inverting innovation by prioritizing community needs, and advancing digital health for equity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/46810.

PMID:37389905 | DOI:10.2196/46810

ERJ Open Res. 2023 Jun 23:00181-2023. doi: 10.1183/23120541.00181-2023. Online ahead of print.

ABSTRACT

BACKGROUND: Prone positioning (PP) is routinely used among patients with COVID-19 requiring mechanical ventilation (MV). However, its utility among spontaneously breathing patients is still debated.

METHODS: In an open-label randomised controlled trial, we enrolled patients hospitalised with mild COVID-19 pneumonia, whose PaO2/FiO2 ratio (P/F) was >200 mmHg and who did not require MV or Continuous Positive Airway Pressure (CPAP) at hospital admission. Patients were randomised 1:1 to PP on top of standard of care (intervention group) versus standard of care only (controls). The primary composite outcome included death, MV, CPAP and P/F <200 mmHg; secondary outcomes were oxygen weaning and hospital discharge.

RESULTS: Sixty-one subjects were enrolled, 29 adjudicated to PP and 32 to the control group. By day 28, 24/61 (39.3%) patients met the primary outcome: 16 because of P/F ratio <200 mmHg, 5 CPAP and 3 MV. Three patients died. Using an intention-to-treat approach, 15/29 patients in PP group versus 9/32 controls met the primary outcome, corresponding to a significantly higher risk of progression among those randomised to PP (HR 2.38 [95%CI 1.04-5.43]; p=0.040). Using an as-treated approach, which included in the intervention group only patients who maintained PP for ≥3 h·day^-1, no significant differences were found between the two groups (HR 1.77; [95%CI 0.79-3.94]; p=0.165). Also, we did not find any statistically significant difference in terms of time to oxygen weaning or hospital discharge between study arms, in any of the analyses conducted.

CONCLUSIONS: We observed no clinical benefit from PP among spontaneously breathing patients with COVID-19 pneumonia requiring conventional oxygen therapy.

PMID:37389899 | PMC:PMC10291725 | DOI:10.1183/23120541.00181-2023

Ann Surg. 2023 Jul 3. doi: 10.1097/SLA.0000000000005984. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the relationship between distressing symptoms and changes in disability after major surgery and determine whether this relationship differs according to the timing of surgery (nonelective vs. elective), sex, multimorbidity, and socioeconomic disadvantage.

SUMMARY BACKGROUND DATA: Major surgery is a common and serious health event that has pronounced deleterious effects on both distressing symptoms and functional outcomes in older persons.

METHODS: From a cohort of 754 community-living persons, aged 70 or older, 392 admissions for major surgery were identified from 283 participants who were discharged from the hospital. The occurrence of 15 distressing symptoms and disability in 13 activities were assessed monthly for up to 6 months after major surgery.

RESULTS: Over the 6-month follow-up period, each unit increase in the number of distressing symptoms was associated with a 6.4% increase in the number of disabilities (adjusted rate ratio [RR]: 1.064; 95% CI: 1.053, 1.074). The corresponding increases were 4.0% (adjusted RR: 1.040; 95% CI: 1.030, 1.050) and 8.3% (adjusted RR: 1.083; 95% CI: 1.066, 1.101) for nonelective and elective surgeries. Based on exposure to multiple (i.e., 2 or more) distressing symptoms, the adjusted rate ratios (95% CI) were 1.43 (1.35, 1.50), 1.24 (1.17, 1.31), and 1.61 (1.48, 1.75) for all, nonelective, and elective surgeries. Statistically significant associations were observed for each of the other subgroups with the exception of individual-level socioeconomic disadvantage for number of distressing symptoms.

CONCLUSIONS: Distressing symptoms are independently associated with worsening disability, providing a potential target for improving functional outcomes after major surgery.

PMID:37389893 | DOI:10.1097/SLA.0000000000005984

Ann Surg. 2023 Jul 3. doi: 10.1097/SLA.0000000000005983. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize hospital-level professional networks of physicians caring for older trauma patients as a function of trauma patient age distribution.

SUMMARY BACKGROUND DATA: The causal factors associated with between-hospital variation in geriatric trauma outcomes are poorly understood. Variation in physician practice patterns reflected by differences in professional networks might contribute to hospital-level differences in outcomes for older trauma patients.

METHODS: This is a population-based, cross-sectional study of injured older adults (age ≥65) and their physicians from January 1, 2014-December 31, 2015, using Healthcare Cost and Utilization Project inpatient data and Medicare claims from 158 hospitals in Florida. We used social network analyses to characterize hospitals in terms of network density, cohesion, small-worldness, and heterogeneity, then used bivariate statistics to assess the relationship between network characteristics and hospital-level proportion of trauma patients who were age ≥65.

RESULTS: We identified 107,713 older trauma patients and 169,282 patient-physician dyads. The hospital-level proportion of trauma patients who were age ≥65 ranged from 21.5% to 89.1%. Network density, cohesion, and small-worldness in physician networks were positively correlated with hospital geriatric trauma proportions (R=0.29, P<0.001; R =0.16, P=0.048; and R =0.19, P<0.001, respectively). Network heterogeneity was negatively correlated with geriatric trauma proportion (R=0.40, P<0.001).

CONCLUSIONS: Characteristics of professional networks among physicians caring for injured older adults are associated with the hospital-level proportion of trauma patients who are older, indicating differences in practice patterns at hospitals with older trauma populations. Associations between inter-specialty collaboration and patient outcomes should be explored as an opportunity to improve treatment of injured older adults.

PMID:37389887 | DOI:10.1097/SLA.0000000000005983

JAMA Netw Open. 2023 Jun 1;6(6):e2317255. doi: 10.1001/jamanetworkopen.2023.17255.

ABSTRACT

IMPORTANCE: The value to payers of robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) when compared with open radical cystectomy (ORC) for patients with bladder cancer is unclear.

OBJECTIVES: To compare the cost-effectiveness of iRARC with that of ORC.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used individual patient data from a randomized clinical trial at 9 surgical centers in the United Kingdom. Patients with nonmetastatic bladder cancer were recruited from March 20, 2017, to January 29, 2020. The analysis used a health service perspective and a 90-day time horizon, with supplementary analyses exploring patient benefits up to 1 year. Deterministic and probabilistic sensitivity analyses were undertaken. Data were analyzed from January 13, 2022, to March 10, 2023.

INTERVENTIONS: Patients were randomized to receive either iRARC (n = 169) or ORC (n = 169).

MAIN OUTCOMES AND MEASURES: Costs of surgery were calculated using surgery timings and equipment costs, with other hospital data based on counts of activity. Quality-adjusted life-years were calculated from European Quality of Life 5-Dimension 5-Level instrument responses. Prespecified subgroup analyses were undertaken based on patient characteristics and type of diversion.

RESULTS: A total of 305 patients with available outcome data were included in the analysis, with a mean (SD) age of 68.3 (8.1) years, and of whom 241 (79.0%) were men. Robot-assisted radical cystectomy was associated with statistically significant reductions in admissions to intensive therapy (6.35% [95% CI, 0.42%-12.28%]), and readmissions to hospital (14.56% [95% CI, 5.00%-24.11%]), but increases in theater time (31.35 [95% CI, 13.67-49.02] minutes). The additional cost of iRARC per patient was £1124 (95% CI, -£576 to £2824 [US $1622 (95% CI, -$831 to $4075)]) with an associated gain in quality-adjusted life-years of 0.01124 (95% CI, 0.00391-0.01857). The incremental cost-effectiveness ratio was £100 008 (US $144 312) per quality-adjusted life-year gained. Robot-assisted radical cystectomy had a much higher probability of being cost-effective for subgroups defined by age, tumor stage, and performance status.

CONCLUSIONS AND RELEVANCE: In this economic evaluation of surgery for patients with bladder cancer, iRARC reduced short-term morbidity and some associated costs. While the resulting cost-effectiveness ratio was in excess of thresholds used by many publicly funded health systems, patient subgroups were identified for which iRARC had a high probability of being cost-effective.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03049410.

PMID:37389878 | DOI:10.1001/jamanetworkopen.2023.17255