Tag: pubmed

J Gen Intern Med. 2022 Oct 13. doi: 10.1007/s11606-022-07793-x. Online ahead of print.

ABSTRACT

BACKGROUND: Despite widespread adoption of state prescription drug monitoring programs (PDMPs), it is unclear how often PDMPs are accessed through an electronic health record system (EHR-PDMP integration), or whether efforts to make PDMPs easier to access and use have improved their utility.

OBJECTIVE: To produce national-level estimates on the use of PDMPs among office-based physicians and benefits associated with their use.

DESIGN: We use nationally representative survey data to produce descriptive statistics on PDMP use and associated benefits among office-based physicians in the USA.

PARTICIPANTS: 1398 office-based physicians who prescribe controlled substances.

MAIN MEASURES: We examined physician-reported ease and frequency of PDMP use, and how EHR-PDMP integration affects frequency and ease of use. Multivariate models were used to assess whether characteristics of PDMP use were related to physician-reported benefits such as reduced prescribing of controlled substances and perceived improvements in clinical decision-making.

KEY RESULTS: In 2019, two-thirds of office-based physicians in the USA reported frequent use of their state PDMP and over three-quarters reported they were easy to use. Both frequency and ease of use were positively correlated with PDMP integration status. Respondents who frequently checked their state’s PDMP were 8.7 percentage points (95% CI -.4 to 17.8) more likely to report perceived benefits and reported 2.2 (95% CI 1.54 to 2.83) more benefits. Respondents who indicated their PDMP was easy to use were 12.7 percentage points (95% CI .040 to .214) more likely to report perceived benefits and reported 0.94 (95% CI 0.26 to 1.61) more benefits.

CONCLUSIONS: Our findings suggest efforts to make PDMPs easier to access and use aided physicians in making informed clinical decisions that may not be captured by reduced prescribing alone. Efforts to further increase frequency and ease of use-including advancing a standards-based approach to PDMP and EHR data interoperability-may further increase the benefit of PDMPs.

PMID:36229762 | DOI:10.1007/s11606-022-07793-x

Bull Math Biol. 2022 Oct 13;84(11):135. doi: 10.1007/s11538-022-01090-8.

ABSTRACT

Population persistence and spatial propagation and their dependence on demography and dispersal are of great importance in spatial ecology. Many species with highly structured life cycles invade new habitats through the dispersal of organisms in their early life stages (e.g., seeds, larvae, etc.). We develop a stage-structured continuous/discrete-time hybrid model to describe the spatiotemporal dynamics of such species, in which a reaction-diffusion equation describes the random movement of dispersing individuals, while two difference equations describe the demography of sedentary individuals. We obtain a formula for the spreading speed of the population in terms of model parameters. We show that the spreading speed can be characterized as the slowest wave speed of a class of traveling wave solutions. We provide an explicit formula for the critical domain size that separates population persistence from extinction. By comparing our stage-structured model with a physically unstructured model, we find that the structured model reduces to the unstructured one in some special cases. Accordingly, the results about the spreading speed and the critical domain size for the unstructured model represent some special cases of those for the structured one. This highlights the significance of including stage structure in studying the spatial dynamics of species with complex life cycles.

PMID:36229706 | DOI:10.1007/s11538-022-01090-8

Biomech Model Mechanobiol. 2022 Oct 13. doi: 10.1007/s10237-022-01634-w. Online ahead of print.

ABSTRACT

We consider a two-dimensional biomorphoelastic model describing post-burn scar contraction. This model describes skin displacement and the development of the effective Eulerian strain in the tissue. Besides these mechanical components, signaling molecules, fibroblasts, myofibroblasts, and collagen also play a significant role in the model. We perform a sensitivity analysis for the independent parameters of the model and focus on the effects on features of the relative surface area and the total strain energy density. We conclude that the most sensitive parameters are the Poisson’s ratio, the equilibrium collagen concentration, the contraction inhibitor constant, and the myofibroblast apoptosis rate. Next to these insights, we perform a sensitivity analysis where the proliferation rates of fibroblasts and myofibroblasts are not the same. The impact of this model adaptation is significant.

PMID:36229698 | DOI:10.1007/s10237-022-01634-w

Eur J Pediatr. 2022 Oct 14. doi: 10.1007/s00431-022-04656-9. Online ahead of print.

ABSTRACT

Dysregulation of zinc (Zn) homeostasis causes a shift in the Th1/Th2 balance towards a Th2 response, which may lead to a heightened inflammatory response. Asthma is associated with an exaggerated Th2 response to antigens. This study attempts to find the association of serum Zn with the status of symptom control of asthma in children and adolescents with bronchial asthma. A total of 67 asthmatic children, diagnosed as per Global Initiative for Asthma (GINA) 2019 guidelines, were included in the study. Symptom control of asthma was assessed by Asthma Control Test (ACT) and Childhood Asthma Control Test (C-ACT) scores. Spirometry was performed on those participants who were able to perform satisfactorily. Serum Zn was analyzed using the photometric method. Participants were divided into two groups: controlled and uncontrolled groups according to ACT/C-ACT score. Mean age of the participants was 10.78 ± 3.67 years. The mean S. Zn (µg/dL) was 136.97 ± 48.37. This study found a higher mean S. Zn value in the controlled asthma group as compared to the uncontrolled group (158.06 vs 129.23, p = 0.006). At a cutoff of S. Zn (µg/dL) ≥ 126.84, it predicted controlled asthma with a sensitivity of 89% and a specificity of 55%. No significant difference was found between the mean serum Zn levels in terms of age, sex, severity, and CRP levels.

CONCLUSION: A significant difference was observed between the mean value of Zn and symptom control of asthma (p = 0.006) with a weak positive correlation between the two which was statistically significant (rho = 0.26, p = 0.031). However, low levels of zinc were not significantly associated with symptom control of asthma. Thus, we conclude that maintaining an adequate zinc level could help in achieving better control of asthma in pediatric populations.

WHAT IS KNOWN: • Zinc has a role in immunological response in the pathophysiology of immunological disorders such as bronchial asthma.

WHAT IS NEW: • This study adds a significant association of serum zinc levels with symptom control of asthma in pediatric populations. • This study also gives a cut-off value of serum zinc level which predicts adequate symptom control of asthma.

PMID:36229694 | DOI:10.1007/s00431-022-04656-9

Eur Arch Otorhinolaryngol. 2022 Oct 13. doi: 10.1007/s00405-022-07690-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the relationship of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) with voice self-assessments (The Persian version of vocal tract discomfort [VTDp] scale and non-standard hoarseness self-assessment [NHS] questionnaire).

METHODS: 223 participants (159 with and 64 without dysphonia) were asked to utter the vocal tasks namely vowels /a/ and /e/, six standard sentences, and a non-standard connected speech sample. CPP and CPPS were calculated in these three vocal tasks using the “Praat” software. The participants also asked to complete the VTDp scale and the NHS questionnaire.

RESULTS: The means of frequency and severity the VTDp and the means of NHS were statistically different between the dysphonic and normal voice groups (P < 0.05), except for tickling (P > 0.05). There was a very low significant correlation between cepstral analysis with aching and in the dysphonic group (P < 0.05). However, a very low to low significant correlation between cepstral analysis with burning, tight, aching, tickling, sore, and both frequency and severity subscales scores of the VTDp in the normal voice group (P < 0.05). Moreover, the means of the cepstral analysis did not differ significantly between all scores of the NHS in the dysphonic the normal voice groups (P > 0.05), except for 1 with 3, 4, and 5 in the dysphonic group (P < 0.05).

CONCLUSION: The cepstral analysis can provide some information about the status of vocal tract and person’s perception of his/her own voice quality.

PMID:36229669 | DOI:10.1007/s00405-022-07690-3

Langenbecks Arch Surg. 2022 Oct 14. doi: 10.1007/s00423-022-02712-4. Online ahead of print.

ABSTRACT

PURPOSE: Despite continuous improvement in minimally invasive surgery (MIS) and growing evidence for its superiority in procedures in various organ systems, a routinely application in patients with acute bowel obstruction (ABO) cannot be seen to date. Besides very general explanations for this attitude, not much is known about the decision process in a particular patient. This retrospective study aims at investigating surgeon- and patient-specific factors for or against MIS in acute bowel obstruction.

METHODS: A retrospective analysis of all patients undergoing either MIS or open surgery (OS) for ABO at a single center between 2009 and 2017 was performed. All available preoperative parameters were included in the analysis and subdivided into patient- (age, gender, BMI, previous abdominal procedures, inflammatory process, ASA score, bowel dilatation) and surgeon-specific (time of patient admission, senior surgeon performed the procedure or taught the case, availability of a surgical resident or junior doctor as assisting surgeon) factors. Statistical analysis was performed to reveal their influence on the surgeon’s decision for or against MIS.

RESULTS: Of 106 patients requiring surgical intervention, 57 were treated by OS (53.77%) and 49 by MIS (46.23%). Patients with a higher ASA score (ASA III) and a bowel width of ≥ 3.8 cm in preoperative radiologic imaging were more likely to undergo OS (p < 0.01). Also, a late admission time to the hospital (x̄ = 14.78 h) was associated with OS (p = 0.01). Concerning previous abdominal surgical interventions, patients with prior appendectomy rather were assigned to MIS (p < 0.01) whereas those with prior colectomy to OS (p < 0.01).

CONCLUSIONS: The choice of procedure in patients with bowel obstruction is a highly individualized decision. Whereas scientifically proven parameters, such as high age and BMI, had no influence on the decision process, impaired general health condition (ASA score), high bowel width, previous surgical intervention, and a late admission time influenced the decision process towards open surgery.

TRIAL REGISTRATION: Retrospectively registered with the German Clinical Trials Register: DRKS00021600.

PMID:36229667 | DOI:10.1007/s00423-022-02712-4

Strahlenther Onkol. 2022 Oct 13. doi: 10.1007/s00066-022-02008-y. Online ahead of print.

ABSTRACT

PURPOSE: To compare two left breast cancer patient cohorts (tangential vs. locoregional deep-inspiration breath-hold – DIBH treatment) with different predefined beam gating thresholds and to evaluate their impact on motion management and DIBH stability.

METHODS: An SGRT-based clinical workflow was adopted for the DIBH treatment. Intrafractional monitoring was performed by tracking both the respiratory signal and the real-time displacement between the isocenter on the daily reference surface and on the live surface (“SGRT shift”). Beam gating tolerances were 5 mm/4 mm for the SGRT shifts and 5 mm/3 mm for the gating window amplitude for breast tangential and breast + lymph nodes locoregional treatments, respectively. A total of 24 patients, 12 treated with a tangential technique and 12 with a locoregional technique, were evaluated for a total number of 684 fractions. Statistical distributions of SGRT shift and respiratory signal for each treatment fraction, for each patient treatment, and for the two population samples were generated.

RESULTS: Lateral cumulative distributions of SGRT shifts for both locoregional and tangential samples were consistent with a null shift, whereas longitudinal and vertical ones were slightly negative (mean values < 1 mm). The distribution of the percentage of beam on time with SGRT shift > 3 mm, > 4 mm, or > 5 mm was extended toward higher values for the tangential sample than for the locoregional sample. The variability in the DIBH respiration signal was significantly greater for the tangential sample.

CONCLUSION: Different beam gating thresholds for surface-guided DIBH treatment of left breast cancer can impact motion management and DIBH stability by reducing the frequency of the maximum SGRT shift and increasing respiration signal stability when tighter thresholds are adopted.

PMID:36229656 | DOI:10.1007/s00066-022-02008-y

Transplantation. 2022 Oct 13. doi: 10.1097/TP.0000000000004360. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies indicate an association between reduced absolute lymphocyte count (ALC) and cytomegalovirus (CMV) infection after solid organ transplantation and have therefore highlighted the potential of ALC as a simple tool to predict CMV infection in transplant patients. This study aimed to examine the utility of ALC as a valuable marker for CMV infection in heart transplant patients.

METHODS: Clinical information and ALC data of all adult patients who received orthotopic heart transplantation at the Medical University of Vienna between January 2004 and May 2019 were collected. We performed a multivariable Cox regression model that incorporates repeated measurements of ALC as a time-varying continuous factor in 2 ways, first as continuous logarithmic factor considering a 50% decrease of ALC levels and second as binary factor using a threshold of 610 cells/μL.

RESULTS: One hundred fifty-eight (39%) patients developed CMV infection over the course of 2 y. Patients with lymphopenia were shown to be at higher risk of developing CMV infection both in the continuous approach (HR [per 50% reduction] 1.29; confidence interval [CI], 1.09-1.53; P = 0.003) and the binary approach with a cutoff of 610 cells/μL (HR 1.74; CI, 1.20-2.51; P = 0.003).

CONCLUSIONS: This study demonstrated a strong association between reduced ALC and the development of CMV infection after heart transplantation. ALC value monitoring could provide an additional tool to assess individualized CMV risk after solid organ transplantation.

PMID:36228318 | DOI:10.1097/TP.0000000000004360

Acta Cir Bras. 2022 Oct 10;37(7):e370702. doi: 10.1590/acb370702. eCollection 2022.

ABSTRACT

PURPOSE: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control.

METHODS: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®.

RESULTS: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group.

CONCLUSIONS: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

PMID:36228297 | DOI:10.1590/acb370702

Arq Bras Cardiol. 2022 Oct 10:S0066-782X2022005017204. doi: 10.36660/abc.20220045. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary stenosis can be caused de novo atherosclerosis, in-stent restenosis, and in-stent neoatherosclerosis, three entities that develop from a diverse pathophysiological milieu.

OBJECTIVE: This study aims to investigate, using optical coherence tomography (OCT), whether or not coronary lesions related to these processes differ in their local inflammatory profile.

METHODS: Retrospective analysis of patients with diagnosed or suspected coronary lesions who had undergone OCT imaging for clinical reasons. Macrophage and intra-plaque neovascularization were assessed by OCT and used as surrogates of local inflammation. A significance level of < 0.05 was adopted as statistically significant.

RESULTS: From the 121 lesions, 74 were de novo, 29 were restenosis, and 18 were neoatherosclerosis. Neovascularization was found in 65.8% of de novo, 10.3% in restenosis, and 94.4% in neoatherosclerosis (p<0.01 for all). The volume of neovascularization was different among lesion types (950 vs. 0 vs. 6220, respectively [median values in 1000 x µm3/mm]; p<0.01 for all), which were significantly higher in neoatherosclerosis and lower in restenosis. The presence of macrophages differed among the lesions (95.9% in de novo vs. 6.9% in restenosis vs. 100% in neoatherosclerosis [p<0.01 for all]). Moreover, the intensity of macrophagic infiltration was different among lesion types (2.5 vs. 0.0 vs. 4.5, respectively [median values of macrophage score]; p<0.01 for all), significantly higher in neoatheroscleosis and lower in restenosis.

CONCLUSION: When compared using coronary OCT, de novo atherosclerosis, in-stent restenosis, and neoatherosclerosis presented markedly different inflammatory phenotypes.

PMID:36228279 | DOI:10.36660/abc.20220045