Tag: pubmed

J Sleep Res. 2022 May 21:e13592. doi: 10.1111/jsr.13592. Online ahead of print.

ABSTRACT

Hypoglossal nerve stimulation is an established treatment option for obstructive sleep apnea in selected patients. A unilateral hypoglossal nerve stimulation system was approved a decade ago, yet the physiological effect of unilateral hypoglossal stimulation on bilateral tongue motion remains unclear. This study examined how electrode configuration, stimulation cuff position, or body mass index influenced the contralateral genioglossus electromyography (EMG) signal. Twenty-nine patients underwent three EMG recordings in a polysomnographic setting after being implanted with a unilateral hypoglossal nerve stimulator for at least 6 months. The ratio of EMG signals between the ipsi- and contralateral sides was evaluated. No difference in EMG signals was demonstrated based on electrode configurations, stimulation-cuff position, body-mass-index, or sleep apnea severity, even in patients with right tongue protrusion only. Our findings may be explained by a significant level of cross-innervation and by a smaller and less variable circumferential electric field than expected based on prior biophysical models. A patient’s individual anatomy needs to be considered during therapy titration in order to achieve an optimal response.

PMID:35596592 | DOI:10.1111/jsr.13592

Expert Rev Clin Pharmacol. 2022 May 20. doi: 10.1080/17512433.2022.2081151. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have found potential benefits of vitamin D in relieving pain, while the results from randomized controlled trials of vitamin D for fibromyalgia have been promising. We conducted a systematic review and meta-analysis to evaluate the efficacy of vitamin D in the treatment of fibromyalgia.

RESEARCH DESIGN AND METHODS: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched. The language used was limited to English. We selected only randomized controlled studies that reported vitamin D versus placebo-controlled cure for fibromyalgia. After extracting valid data, a meta-analysis was performed using Stata version 12.0. The major outcome in the pooled analysis was the Fibromyalgia Impact Questionnaire and Visual Analogue Scale (VAS) changes in fibromyalgia patients before and after treatment. The pooled effects were analyzed as mean differences and 95% confidence intervals.

RESULTS: : Five studies including 315 participants were identified. These studies found that vitamin D was effective in reducing Fibromyalgia Impact Questionnaire scores compared with that in the control group, with significant differences (weighted mean difference = -7.82, 95% confidence interval: -12.05 to -3.59, P < 0.001). However, there was no statistical difference in VAS between the two groups (weighted mean difference = -0.60, 95% confidence interval: -1.38 to 0.17, P > 0.05).

CONCLUSIONS: Data from randomized controlled studies suggest that vitamin D supplementation may be an effective fibromyalgia therapeutic approach.

PMID:35596576 | DOI:10.1080/17512433.2022.2081151

Acta Psychiatr Scand. 2022 May 20. doi: 10.1111/acps.13457. Online ahead of print.

ABSTRACT

OBJECTIVE: Little is known about the economic value of clinical interventions for delirium. This review aims to synthesise and appraise available economic evidence, including resource use, costs, and cost-effectiveness of interventions for reducing, preventing, and treating delirium.

METHODS: Systematic review of published and grey literature on full and partial economic evaluations. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

RESULTS: Fourteen economic evaluations (43% full, 57% partial) across nine multicomponent and nonpharmacological intervention types met inclusion criteria. The intervention costs ranged between US$386-$553 per person in inpatient settings. Multicomponent delirium prevention intervention and the Hospital Elder Life Program (HELP) reported statistically significant cost savings or cost offsets somewhere else in the health system. Cost savings related to inpatient, outpatient, and out-of-pocket costs ranged between $194-$6022 per person . The average CHEERS score was 74% (±SD 10%).

CONCLUSION: Evidence on a joint distribution of costs and outcomes of delirium interventions was limited, varied and of generally low quality. Directed expansion of health economics towards the evaluation of delirium care is necessary to ensure effective implementation that meets patients’ needs and is cost-effective in achieving similar or better outcomes for the same or lower cost.

PMID:35596552 | DOI:10.1111/acps.13457

Thyroid. 2022 May 20. doi: 10.1089/thy.2022.0083. Online ahead of print.

ABSTRACT

OBJECTIVES: Thyroid autoimmunity is common in pregnant women and associated with thyroid dysfunction and adverse obstetric outcomes. Most studies focus on thyroid peroxidase autoantibodies (TPOAbs) assessed by negative-positive dichotomy and rarely take into account thyroglobulin autoantibodies (TgAbs). This study aimed at determining the association of TPOAbs and TgAbs, respectively and interdependently, with maternal thyroid function.

METHODS: This was a meta-analysis of individual participant cross-sectional data from 20 cohorts in the Consortium on Thyroid and Pregnancy. Women with multiple pregnancy, pregnancy by assisted reproductive technology, history of thyroid disease or use of thyroid interfering medication were excluded. Associations of (log2) TPOAbs and TgAbs (with/without mutual adjustment) with cohort-specific z-scores of (log2) thyroid stimulating hormone (TSH), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), total thyroxine (TT4) or T3:T4 ratio were evaluated in a linear mixed model.

RESULTS: In total, 51,138 women participated (51,094 had TPOAb-data and 27,874 TgAb-data). Isolated TPOAb-positivity was present in 4.1% (95% confidence interval(CI):3.0-5.2), isolated TgAb-positivity in 4.8% (95%CI:2.9-6.6), and positivity for both antibodies in 4.7% (95%CI:3.1-6.3). Compared to antibody-negative women, TSH was higher in women with isolated TPOAb-positivity (z-score increment 0.40, 95% confidence interval(CI):0.16-0.64) and TgAb-positivity (0.21,95%CI:0.10-0.32), but highest in those positive for both antibodies (0.54,95%CI:0.36-0.71). There was a dose-response effect of higher TPOAb and TgAb concentrations with higher TSH (TSH z-score increment for TPOAbs 0.12,95%CI:0.09-0.15, TgAbs 0.08,95%CI:0.02-0.15)). When adjusting analyses for the other antibody, only the association of TPOAbs remained statistically significant. Higher TPOAb concentration was associated with lower FT4 (p<0.001) and higher T3:T4 ratio (0.09, 95%CI:0.03-0.14), however, the association with FT4 was not significant when adjusting for TgAbs (p=0.16).

CONCLUSIONS: This individual participant data meta-analysis demonstrated an increase in TSH with isolated TPOAb-positivity and TgAb-positivity, respectively, which was amplified for individuals positive for both antibodies. There was a dose-dependent association of TPOAbs, but not TgAbs, with TSH when adjusting for the other antibody. This supports current practice of using TPOAbs in initial laboratory testing of pregnant women suspected of autoimmune thyroid disease. However, studies on the differences between TPOAb- and TgAb-positive women are needed to fully understand the spectrum of phenotypes.

PMID:35596568 | DOI:10.1089/thy.2022.0083

Inquiry. 2022 Jan-Dec;59:469580221102202. doi: 10.1177/00469580221102202.

ABSTRACT

Background and Aim: Alternative treatments for respiratory disorders attempt to prevent or relieve symptoms and enhance functions. Furthermore, substantial evidence shows that several herbal medicines have been clinically effective against respiratory disorders. Thus this study assesses the Saudi students’ use, beliefs, and practices related to herbal and dietary supplements for the possible prevention of respiratory infections. Methods: A cross-sectional web-based survey was designed using Google Forms to collect the data from the healthcare and non-healthcare students currently pursuing their courses at King Saud University, Riyadh, Saudi Arabia. The data was collected over 4 months, from November 2021 to February 2022, using convenience sampling with a 25-item questionnaire. A statistical package for social sciences, SPSS 26, was used to analyze the data. Results: A total of 274 participants responded to the study. The mean age of the respondents was 21.9 ± 3.08 (mean (SD)). The prevalence of herbal medicine (HM) was found to be 62.7% (n = 172). Around 48.5% (n = 133) of the respondents occasionally used some form of HM during the period of an illness associated with a respiratory infection. About 66% of the respondents agreed that using HMs prevents or controls respiratory symptoms and strengthens immunity. A majority (75.2%) of the respondents agreed that ginger extract possesses antiviral and immunity-boosting properties, followed by garlic extract (59.5%), cinnamon (39.4%), and lemongrass (38.3%). In addition, between 37% and 45.6% of the respondents agreed that vitamin C and vitamin D intake helps in boosting immunity and reducing the likelihood of developing respiratory infections. The overall mean of the positive beliefs and practice score was 9.6 (range 0-14). The mean positive beliefs and practice scores were significantly higher for males (11.4 ± 3.2) compared to females (8.6 ± 3.6) (P < .001). The numbers were not significantly different regardless of the source of information (9.6 ± 3.5), respondents being in health colleges (8.9 ± 4.1) or non-health colleges (9.8 ± 3.7), them being previously or currently infected (9.7 ± 3.8), the absence of infection (9.7 ± 3.8), or the respondents possessing a history of chronic diseases (10.5 ± 3.9) or not (9.5 ± 3.7) (P > .05). Conclusions: This study found a relatively high prevalence of herbal and dietary supplements’ use, positive beliefs, and practices to strengthen one’s immunity against respiratory symptoms.

PMID:35596542 | DOI:10.1177/00469580221102202

Stat Med. 2022 May 20. doi: 10.1002/sim.9443. Online ahead of print.

ABSTRACT

This article extends the semiparametric mixed model for longitudinal censored data with Gaussian errors by considering the Student’s t$$ t $$ -distribution. This model allows us to consider a flexible, functional dependence of an outcome variable over the covariates using nonparametric regression. Moreover, the proposed model takes into account the correlation between observations by using random effects. Penalized likelihood equations are applied to derive the maximum likelihood estimates that appear to be robust against outlying observations with respect to the Mahalanobis distance. We estimate nonparametric functions using smoothing splines under an EM-type algorithm framework. Finally, the proposed approach’s performance is evaluated through extensive simulation studies and an application to two datasets from acquired immunodeficiency syndrome clinical trials.

PMID:35596519 | DOI:10.1002/sim.9443

Musculoskeletal Care. 2022 May 20. doi: 10.1002/msc.1644. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this systematic review was to assess the reproducibility of exercise therapy used in clinical trials for chronic neck pain (CNP) based on reported items from the Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT) checklists.

METHODS: Two researchers systematically searched, screened, and selected trials that assessed exercise therapy for CNP between 2000 and 2021 from PubMed, CINAHL, and Ovid Medline. Included studies were published in English, and study participants experienced neck pain for longer than 3 months. Thoroughness of reporting of exercise therapy was assessed using the TIDierR and CERT checklists. Methodological quality of each study was screened with the Revised Cochrane Risk of Bias Tool. Data analysis was performed for descriptive and correlational statistics.

RESULTS: Sixty-three clinical trials using exercise therapy for treatment of CNP met the inclusion criteria. No study reported all TIDieR or CERT items. The mean number of items reported was 5.44 (SD 2.40, range of 1-11) on the TIDieR, and 8.27 (SD 4.14, range of 0-17) for the CERT. Risk of bias was high for 30 studies (47.6%), somewhat concerning for 20 studies (31.7%), and low for 13 studies (21.7%). Higher risk of bias was associated with a lower number of TIDieR and CERT items reported.

DISCUSSION & CONCLUSION: The majority of exercise therapy trials for CNP lack proper reporting, limiting reproducibility of the interventions in real world clinical practice and follow-on research. After checklists were published, reporting did not improve.

PMID:35596275 | DOI:10.1002/msc.1644

Nurs Health Sci. 2022 May 20. doi: 10.1111/nhs.12953. Online ahead of print.

ABSTRACT

This descriptive-predictive, cross-sectional study aimed to explore organizational commitment and to determine the predictability of years of experience, level of education, position, perceived organizational support, and work-life balance on each component of organizational commitment. The participants included 234 nurses who were randomly selected from four general hospitals in the Republic of the Union of Myanmar. The research instruments included a demographic data form, the Organizational Commitment Scale, the Survey of Perceived Organizational Support, and the Work-Life Balance Scale. The data were analyzed using descriptive statistics and stepwise multiple regression. The results revealed that the nurses perceived the three components of organizational commitment at a moderate level. Years of experience, position, perceived organizational support, and work-life balance explained 38.0% of the total variance for affective commitment, 28.3% for continuance commitment, and 35.9% for normative commitment. The findings of this study can inform administrators and policymakers regarding the development of strategies to improve organizational commitment among nurses based on four predictors. This article is protected by copyright. All rights reserved.

PMID:35596260 | DOI:10.1111/nhs.12953

Int J Health Policy Manag. 2022 May 17. doi: 10.34172/ijhpm.2022.5783. Online ahead of print.

ABSTRACT

BACKGROUND: The association between timing of integrated home palliative care (IHPC) enrolment and emergency department (ED) visits is still under debate, and no studies investigated the effect of the timing of IHPC enrolment on ED visits, according to their level of emergency. This study aimed to investigate the impact of the timing of IHPC enrolment on different acuity ED visits.

METHODS: A retrospective, pre-/post-intervention study was conducted from 2013 to 2019 in Italy. Analyses were stratified by IHPC duration (short ≤30 days; medium 31-90 days; long >90 days) and triage tags (white/green: low level of emergency visit; yellow/red: medium-to-high level). The impact of the timing of IHPC enrolment was evaluated in two ways: incidence rate ratios (IRRs) of ED visits were determined (1) before and after IHPC enrolment in each group and (2) post-IHPC among groups.

RESULTS: A cohort of 17 983 patients was analysed. Patients enrolled early in the IHPC programme had a significantly lower incidence rate of ED visits than the pre-enrolment period (IRR=0.65). The incidence rates of white/green and yellow/red ED visits were significantly lower post-IHPC enrolment for patients enrolled early (IRR=0.63 and 0.67, respectively). All results were statistically significant (P<.001). Comparing the IHPC groups after enrolment versus the short group, medium and long IHPC groups had a significant reduction of ED visits (IRR=0.37, IRR=0.14 respectively), showing a relation between the timing of IHPC enrolment and the incidence of ED visits. A similar trend was observed after accounting for triage tags of ED visits.

CONCLUSION: The timing of IHPC enrolment is related with a variation of the incidence of ED visits. Early IHPC enrolment is related to a high significant reduction of ED visits when compared to the 90-day pre-IHPC enrolment period and to late IHPC enrolment, accounting for both low-level and medium-to-high level emergency ED visits.

PMID:35596272 | DOI:10.34172/ijhpm.2022.5783

Stat Med. 2022 May 20. doi: 10.1002/sim.9441. Online ahead of print.

ABSTRACT

With the increasing importance of predictive modeling in health research comes the need for methods to rigorously assess predictive accuracy. We consider the problem of evaluating the accuracy of predictive models for nominal outcomes when outcome data are coarsened at random. We first consider the problem in the context of a multinomial response modeled by polytomous logistic regression. Attention is then directed to the motivating setting in which class membership corresponds to the state occupied in a multistate disease process at a time horizon of interest. Here, class (state) membership may be unknown at the time horizon since disease processes are under intermittent observation. We propose a novel extension to the polytomous discrimination index to address this and evaluate the predictive accuracy of an intensity-based model in the context of a study involving patients with arthritis from a registry at the University of Toronto Centre for Prognosis Studies in Rheumatic Diseases.

PMID:35596238 | DOI:10.1002/sim.9441