Tag: pubmed

Female Pelvic Med Reconstr Surg. 2022 Mar 1. doi: 10.1097/SPV.0000000000001142. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to investigate the clinical utility of estimated levator ani subtended volume (eLASV) as a prospective preoperative biomarker for prediction of surgical outcomes.

STUDY DESIGN: This is a prospective case-control pilot study. Patients were recruited and gave consent between January 2018 and December 2020. Surgical failure was defined by composite score. The eLASV was calculated for each patient based on a previously published algorithm. Descriptive statistics, Fisher exact test, log-binomial regression, area under a receiver operating characteristics, Bland-Altman plot, Lin coefficient, and κ coefficient were all performed for analysis.

RESULTS: Fifty-one patients gave consent, 31 completed preoperative magnetic resonance imaging, 27 underwent surgery (uterosacral ligament suspension), and 19 followed up for 1-year examination. Five patients (26.3%) were defined as surgical failure with median eLASV volume of 57.0 (interquartile range, 50.1-66.2). Fourteen patients (73.7%) were defined as surgical success with median eLASV of 28.2 (interquartile range, 17.2-24.3). Eighty percent of the surgical failure group (4/5) had elevated volume of eLASV, where only 14.3% of the success group (2/14) had an elevated volume (P = 0.0173). No confounders were found and unadjusted log-binomial regression suggested that patients with a high eLASV were 8.7 (95% confidence interval, 1.2-61.9) times more likely to experience surgical failure compared with those with low eLASV. The c-statistic (area under a receiver operating characteristics) was high at 0.829 along with Lin concordance coefficient of 0.949 (95% confidence interval, 0.891-0.977) for continuous data between the 2 interrater observer teams.

CONCLUSIONS: In this small prospective pilot study, patients with elevated eLASV on a preoperative pelvic magnetic resonance imaging were associated with an increased risk for surgical failure at 1 year regardless of age, body mass index, stage, or parity.CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT03534830.

PMID:35234178 | DOI:10.1097/SPV.0000000000001142

J Nurs Care Qual. 2022 Feb 28. doi: 10.1097/NCQ.0000000000000622. Online ahead of print.

ABSTRACT

BACKGROUND: Nicotine causes significant morbidity and mortality. Many adults who want to quit using nicotine may not be receiving adequate support from their primary care providers. If used properly, the 5As nicotine cessation guidelines may help patients address their nicotine use.

LOCAL PROBLEM: Smokers screened for tobacco use at a primary care clinic were not consistently offered evidence-based interventions using the 5As at each primary care encounter.

METHODS: The 5As framework was presented to providers via PowerPoint presentation and printed materials. Provider and patient behaviors were measured using data from pre- and postintervention chart reviews.

RESULTS: There was a statistically significant postintervention increase in the proportion of smokers who received the 5As components (P < .001). Patients’ nicotine use decreased post-intervention.

CONCLUSION: Results suggest that the intervention increased providers’ knowledge and use of the 5As, which helped patients reduce their nicotine use.

PMID:35234174 | DOI:10.1097/NCQ.0000000000000622

Crit Care Med. 2022 Mar 2. doi: 10.1097/CCM.0000000000005517. Online ahead of print.

ABSTRACT

OBJECTIVE: As data science and artificial intelligence continue to rapidly gain traction, the publication of freely available ICU datasets has become invaluable to propel data-driven clinical research. In this guide for clinicians and researchers, we aim to: 1) systematically search and identify all publicly available adult clinical ICU datasets, 2) compare their characteristics, data quality, and richness and critically appraise their strengths and weaknesses, and 3) provide researchers with suggestions, which datasets are appropriate for answering their clinical question.

DATA SOURCES: A systematic search was performed in Pubmed, ArXiv, MedRxiv, and BioRxiv.

STUDY SELECTION: We selected all studies that reported on publicly available adult patient-level intensive care datasets.

DATA EXTRACTION: A total of four publicly available, adult, critical care, patient-level databases were included (Amsterdam University Medical Center data base [AmsterdamUMCdb], eICU Collaborative Research Database eICU CRD], High time-resolution intensive care unit dataset [HiRID], and Medical Information Mart for Intensive Care-IV). Databases were compared using a priori defined categories, including demographics, patient characteristics, and data richness. The study protocol and search strategy were prospectively registered.

DATA SYNTHESIS: Four ICU databases fulfilled all criteria for inclusion and were queried using SQL (PostgreSQL version 12; PostgreSQL Global Development Group) and analyzed using R (R Foundation for Statistical Computing, Vienna, Austria). The number of unique patient admissions varied between 23,106 (AmsterdamUMCdb) and 200,859 (eICU-CRD). Frequency of laboratory values and vital signs was highest in HiRID, for example, 5.2 (±3.4) lactate values per day and 29.7 (±10.2) systolic blood pressure values per hour. Treatment intensity varied with vasopressor and ventilatory support in 69.0% and 83.0% of patients in AmsterdamUMCdb versus 12.0% and 21.0% in eICU-CRD, respectively. ICU mortality ranged from 5.5% in eICU-CRD to 9.9% in AmsterdamUMCdb.

CONCLUSIONS: We identified four publicly available adult clinical ICU datasets. Sample size, severity of illness, treatment intensity, and frequency of reported parameters differ markedly between the databases. This should guide clinicians and researchers which databases to best answer their clinical questions.

PMID:35234175 | DOI:10.1097/CCM.0000000000005517

J Musculoskelet Neuronal Interact. 2022 Mar 1;22(1):52-61.

ABSTRACT

OBJECTIVES: To compare ultrasonography (USG) parameters of deep abdominal muscles (transversus abdominis-TrA, internal obliques-IO) between women with and without chronic neck pain (CNP).

METHODS: Women with CNP (n=18; mean-age=37.7 years; mean-BMI=22.7 kg/m²) and asymptomatic individuals (n=18; mean-age=36.1 years; mean-BMI=21.8 kg/m²) participated in the study. The activation of the deep neck flexors (ADNF) was measured using cranio-cervical flexion test. Muscle thickness, changes in thickness (ΔT), and contraction ratio (CR) of deep abdominal muscles were evaluated by ultrasonography device in two conditions: standard-protocol and during ADNF. For each condition, ultrasound image of abdominal muscles was captured at rest and during abdominal draw-in manoeuvre (ADIM).

RESULTS: Comparative statistics revealed no significant difference between groups regarding ultrasonography parameters in the standard-protocol (p>0.05). Besides, there was no difference in the CR of TrA and IO between groups in the two conditions. However, women with CNP showed less muscle thickness of TrAADIM during ADNF than the asymptomatic participants (p<0.05). The CNP group also had decreased ΔT of TrA(ADIM-rest) during ADNF compared to the asymptomatic group (p<0.05).

CONCLUSIONS: The ultrasonography parameters of TrA suggest that motor control in the lumbar region is altered in women with CNP. The combination of cervical stabilization exercises with ADIM can be a novel strategy in the treatment of CNP.

PMID:35234159

J Nurs Care Qual. 2022 Feb 28. doi: 10.1097/NCQ.0000000000000620. Online ahead of print.

ABSTRACT

BACKGROUND: Intensive care outreach nurses (ICONs) can reduce deterioration and death of patients in hospitals.

PURPOSE: Evaluate outcomes associated with implementation of the ICON role across 4 UAE hospitals.

METHODS: Trend analyses and χ2 tests were used to measure changes before ICON program, during ICON year 1, ICON year 2, when the service coverage extended 24/7, and until the end of 2019.

RESULTS: From year 1 to year 2, failures to escalate decreased from a rate of 14.8 to 5.6 episodes per 1000 admissions for all sites combined (P < .001). The cardiac arrest rate went from 4.04 to 1.42 per 1000 admissions in year 2 and continued downward to 0.72 per 1000 (P < .001). Transfer from ward or readmission to intensive care unit/high dependency unit varied by site, although there was a statistically significant trend for all hospitals combined.

CONCLUSION: The ICON role contributed to fewer failure to escalate incidents and lower cardiac arrest rates.

PMID:35234173 | DOI:10.1097/NCQ.0000000000000620

Acta Crystallogr D Struct Biol. 2022 Mar 1;78(Pt 3):268-277. doi: 10.1107/S2059798321013425. Epub 2022 Feb 18.

ABSTRACT

One often observes small but measurable differences in the diffraction data measured from different crystals of a single protein. These differences might reflect structural differences in the protein and may reveal the natural dynamism of the molecule in solution. Partitioning these mixed-state data into single-state clusters is a critical step that could extract information about the dynamic behavior of proteins from hundreds or thousands of single-crystal data sets. Mixed-state data can be obtained deliberately (through intentional perturbation) or inadvertently (while attempting to measure highly redundant single-crystal data). To the extent that different states adopt different molecular structures, one expects to observe differences in the crystals; each of the polystates will create a polymorph of the crystals. After mixed-state diffraction data have been measured, deliberately or inadvertently, the challenge is to sort the data into clusters that may represent relevant biological polystates. Here, this problem is addressed using a simple multi-factor clustering approach that classifies each data set using independent observables, thereby assigning each data set to the correct location in conformational space. This procedure is illustrated using two independent observables, unit-cell parameters and intensities, to cluster mixed-state data from chymotrypsinogen (ChTg) crystals. It is observed that the data populate an arc of the reaction trajectory as ChTg is converted into chymotrypsin.

PMID:35234141 | DOI:10.1107/S2059798321013425

Radiography (Lond). 2022 Feb 26:S1078-8174(22)00010-4. doi: 10.1016/j.radi.2022.02.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Little research has focused on the accuracy of gonad shield placement, especially by students. While studies have investigated the presence of gonad shields they do not aim to measure accuracy but only look at repeatability. This study aimed to establish students’ knowledge of gonad shields and their accuracy in placing it.

METHODS: Following an invitation email and informed consent, students completed a 7-question questionnaire and placed a gonad shield on a Pixi full body adult phantom (male configuration). The phantom was x-rayed and images were assessed for gonad shield positioning in terms of obscuring bony anatomy, correct orientation and distance from a “gold standard” position.

RESULTS: 36% of images displayed shields covering bony anatomy while 16% of shields were incorrectly orientated. All shields incorrectly orientated also covered bony anatomy. Statistical significance was seen between incorrect shield orientation and the obscuring of bony anatomy (p = 0.01). Dispersion of positioning error measurements ranged from -6.80 mm (better placed than the “gold standard”) to 62.35 mm inferiorly, with an average 28.22 mm inferiorly.

CONCLUSION: The average misplacement of 28.22 mm suggests participants placed the gonad shielding lower than necessary to avoid obscuring bony anatomy. The 36% of misplaced shields, while lower than in previous studies, is still a significant number of radiographs that would require repeats.

IMPLICATIONS FOR PRACTICE: Given the associated difficulties surrounding gonad shields and their placement, this study supports previous research suggesting that the benefit of using gonad shielding is questionable.

PMID:35232660 | DOI:10.1016/j.radi.2022.02.001

J Surg Educ. 2022 Feb 27:S1931-7204(22)00019-8. doi: 10.1016/j.jsurg.2022.02.004. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the strength of the association between medical school ranking and orthopedic surgery residency ranking using the current cohort of orthopedic surgery residents.

DESIGN: We obtained a list of accredited programs from Doximity for orthopedic surgery residency programs and U.S. News & World Report for medical schools. Each orthopedic surgery residency program webpage was evaluated for the presence of an orthopedic surgery residency roster. For each resident, the medical school attended, allopathic or osteopathic degree, and year of post-graduate training was recorded. Orthopedic surgery residency programs and medical schools were assigned to one of four tiers for each based on their respective ranking. Descriptive statistics, Chi squared tests and Pearson residuals were used to analyze the association of orthopedic surgery residency tier and medical school tier. Post-hoc pairwise comparisons were performed utilizing the Bonferroni correction to account for 16 tests, correcting the significance level to p = 0.003.

SETTING: 187 orthopedic surgery residency program webpages.

PARTICIPANTS: 4123 orthopedic surgery residents.

RESULTS: There was a significant association between medical school tier and orthopedic surgery residency tier (X² [9] = 1214.78, p < 0.001). The post-hoc residual values were statistically significant for 75% (12/16) of tests performed. The majority of Tier 1 orthopedic surgery residents 50.5% (800/1585) attended a Tier 1 medical school. The strongest positive association exists between Tier 1 medical students attending Tier 1 residencies (residual = 23.978, p < 0.001). The strongest negative association with Tier 4 residencies was with Tier 1 medical schools (residual= -15.656, p< 0.001).

CONCLUSIONS: Medical school ranking is an important consideration for prospective orthopedic surgery applicants and may become more important with less objective measures of academic performance such as United States Medical Licensing Examination Step 1.

LEVEL OF EVIDENCE: Observational.

PMID:35232692 | DOI:10.1016/j.jsurg.2022.02.004

Hepatobiliary Pancreat Dis Int. 2022 Feb 23:S1499-3872(22)00012-1. doi: 10.1016/j.hbpd.2022.02.004. Online ahead of print.

ABSTRACT

BACKGROUND: Hepato-pancreatico-biliary (HPB) patients experience significant risk of preoperative frailty. Studies assessing preventative prehabilitation in HPB populations are limited. This systematic review and meta-analysis evaluates outcomes for HPB patients treated with exercise prehabilitation.

DATA SOURCES: A comprehensive search of MEDLINE (via Ovid), Embase (Ovid), Scopus, Web of Science Core Collection, Cochrane Library (Wiley), ProQuest Dissertations, Theses Global, and Google Scholar was conducted with review and extraction following PRISMA guidelines. Included studies evaluated more than 5 adult HPB patients undergoing ≥ 7-day exercise prehabilitation. The primary outcome was postoperative length of stay (LOS); secondary outcomes included complications, mortality, physical performance, and quality of life.

RESULTS: We evaluated 1778 titles and abstracts and selected 6 (randomized controlled trial, n = 3; prospective cohort, n = 1; retrospective cohort, n = 2) that included 957 patients. Of those, 536 patients (56.0%) underwent exercise prehabilitation and 421 (44.0%) received standard care. Patients in both groups were similar with regards to important demographic factors. Prehabilitation was associated with a 5.20-day LOS reduction (P = 0.03); when outliers were removed, LOS reduction decreased to 1.85 days and was non-statistically significant (P = 0.34). Postoperative complications (OR = 0.70; 95% CI: 0.39 to 1.26; P = 0.23), major complications (OR = 0.83; 95% CI: 0.60 to 1.14; P = 0.24), and mortality (OR = 0.67; 95% CI: 0.17 to 2.70; P = 0.57) were similar. Prehabilitation was associated with improved strength, cardiopulmonary function, quality of life, and alleviated sarcopenia.

CONCLUSIONS: Exercise prehabilitation may reduce LOS and morbidity following HPB surgery. Studies with well-defined exercise regimens are needed to optimize exercise prehabilitation outcomes.

PMID:35232658 | DOI:10.1016/j.hbpd.2022.02.004

Auris Nasus Larynx. 2022 Feb 26:S0385-8146(22)00038-4. doi: 10.1016/j.anl.2022.02.006. Online ahead of print.

ABSTRACT

OBJECTIVE: Real-world outcomes and prognostic factors in Japanese patients receiving nivolumab therapy for recurrent or metastatic head and neck carcinoma (RMHNC) with an observation period of 1 year have been previously reported. The 1-year follow-up data have been subsequently accumulated, and the long-term real-world outcomes have been analyzed. This study aimed to investigate the 2-year long-term outcomes and prognostic factors associated with the response to nivolumab.

METHODS: This was a multi-institutional retrospective study. In total, 88 RMHNC Japanese patients with squamous cell carcinoma who received nivolumab between May 2017 and May 2018 were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and best overall response (BOR) were evaluated. Univariate and multivariable analyses were performed to identify the prognostic factors.

RESULTS: The median follow-up periods for monitoring OS and PFS were 73.1 and 48.1 weeks, respectively. The median OS was 74.1 weeks, and the 2-year survival rate was 33.4%. The median PFS was 18.5 weeks, and the 2-year PFS rate was 22.5%. The BOR rate was 10.2%, 19.3%, 25.0%, and 44.3% in patients who achieved complete response, partial response, stable disease, and progressive disease (PD), respectively. Among the 88 patients with RMHNC, a total of 40 immune-related adverse events (irAEs) were reported in 30 patients. Four patients continued nivolumab, while 84 patients discontinued nivolumab at the data cut-off date. The most common reason for discontinuation was PD in 61 patients, irAEs in 14 patients, and patients’ wishes in 7 patients. Of the 61 patients who discontinued nivolumab because of PD, 28 patients received subsequent treatment. Statistical analyses revealed radiotherapy history, performance status, platinum-refractory carcinoma, irAEs, age, and post-nivolumab treatment as the important prognostic factors associated with OS in patients with RMHNC, and the magnitude of BOR was significantly associated with OS. Additionally, patients with subsequent treatment, including molecular targeted therapy and/or chemotherapy, had significantly prolonged OS compared to patients without subsequent treatment in cases with nivolumab discontinuation because of PD.

CONCLUSION: These findings could be a useful guide for future treatment strategies for head and neck carcinoma. Considering the limitations of our cohort, further larger-scale studies with long-term follow-up are needed to substantiate the results of this study.

PMID:35232636 | DOI:10.1016/j.anl.2022.02.006