Tag: pubmed

Neurosurg Rev. 2022 May 6. doi: 10.1007/s10143-022-01802-7. Online ahead of print.

ABSTRACT

Spontaneous intracerebral hemorrhage (ICH) has an increasing incidence and a worse outcome in elderly patients. The ability to predict the functional outcome in these patients can be helpful in supporting treatment decisions and establishing prognostic expectations. We evaluated the performance of a machine learning (ML) model to predict the 6-month functional status in elderly patients with ICH leveraging the predictive value of the clinical characteristics at hospital admission. Data were extracted by a retrospective multicentric database of patients ≥ 70 years of age consecutively admitted for the management of spontaneous ICH between January 1, 2014 and December 31, 2019. Relevant demographic, clinical, and radiological variables were selected by a feature selection algorithm (Boruta) and used to build a ML model. Outcome was determined according to the Glasgow Outcome Scale (GOS) at 6 months from ICH: dead (GOS 1), poor outcome (GOS 2-3: vegetative status/severe disability), and good outcome (GOS 4-5: moderate disability/good recovery). Ten features were selected by Boruta with the following relative importance order in the ML model: Glasgow Coma Scale, Charlson Comorbidity Index, ICH score, ICH volume, pupillary status, brainstem location, age, anticoagulant/antiplatelet agents, intraventricular hemorrhage, and cerebellar location. Random forest prediction model, evaluated on the hold-out test set, achieved an AUC of 0.96 (0.94-0.98), 0.89 (0.86-0.93), and 0.93 (0.90-0.95) for dead, poor, and good outcome classes, respectively, demonstrating high discriminative ability. A random forest classifier was successfully trained and internally validated to stratify elderly patients with spontaneous ICH into prognostic subclasses. The predictive value is enhanced by the ability of ML model to identify synergy among variables.

PMID:35522333 | DOI:10.1007/s10143-022-01802-7

Skeletal Radiol. 2022 May 6. doi: 10.1007/s00256-022-04070-0. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to perform an external validation of an existing commercial AI software program (BoneView™) for the detection of acute appendicular fractures in pediatric patients.

MATERIALS AND METHODS: In our retrospective study, anonymized radiographic exams of extremities, with or without fractures, from pediatric patients (aged 2-21) were included. Three hundred exams (150 with fractures and 150 without fractures) were included, comprising 60 exams per body part (hand/wrist, elbow/upper arm, shoulder/clavicle, foot/ankle, leg/knee). The Ground Truth was defined by experienced radiologists. A deep learning algorithm interpreted the radiographs for fracture detection, and its diagnostic performance was compared against the Ground Truth, and receiver operating characteristic analysis was done. Statistical analyses included sensitivity per patient (the proportion of patients for whom all fractures were identified) and sensitivity per fracture (the proportion of fractures identified by the AI among all fractures), specificity per patient, and false-positive rate per patient.

RESULTS: There were 167 boys and 133 girls with a mean age of 10.8 years. For all fractures, sensitivity per patient (average [95% confidence interval]) was 91.3% [85.6, 95.3], specificity per patient was 90.0% [84.0,94.3], sensitivity per fracture was 92.5% [87.0, 96.2], and false-positive rate per patient in patients who had no fracture was 0.11. The patient-wise area under the curve was 0.93 for all fractures. AI diagnostic performance was consistently high across all anatomical locations and different types of fractures except for avulsion fractures (sensitivity per fracture 72.7% [39.0, 94.0]).

CONCLUSION: The BoneView™ deep learning algorithm provides high overall diagnostic performance for appendicular fracture detection in pediatric patients.

PMID:35522332 | DOI:10.1007/s00256-022-04070-0

Parasitol Res. 2022 May 6. doi: 10.1007/s00436-022-07531-6. Online ahead of print.

ABSTRACT

Malaria, helminthiasis and HIV are widespread in developing countries taking a heavy toll on pregnant women. Due to similar environmental and human factors of transmission, they co-exist. The epidemiology and pathology of these diseases have been extensively studied but data on serum cytokine profile changes which is crucial in pregnancy is limited. The aim of this study was to evaluate the co-infections and their impact on peripheral blood cytokines. Blood and stool samples were collected from recruited 18-45-year-old pregnant women in different trimesters who were apparently healthy with no obvious complications in pregnancy. Pretested questionnaires were administered for personal and socio-demographic details. Malaria parasitemia in Giemsa-stained thick blood films was examined microscopically. Stool samples were screened for helminths using Kato-Katz method. Cytokine levels of TNF-α, IFN-γ, IL-1α, IL-2, IL-4, IL-6, IL-10, IL-12p70, IL-13 and IL-17 in 121 serum samples were determined using ELISA. Data were analysed using descriptive statistics and Mann-Whitney U test at α_0.05. Relative to the single infections, there were significant reductions in IFN-γ and IL-13 in second and third trimesters respectively in those with Plasmodium and helminth co-infection. IFN-γ and IL-17 were elevated while IL-1α and IL-12p70 were reduced in co-infection of helminths and HIV. Co-infection of Plasmodium and HIV in second and third trimesters showed significant elevations in IL-1α, IL-10 and IL-17 while TNF-α, IL-4 and IL-12p70 were significantly reduced. HIV in pregnancy and its co-infection with Plasmodium resulted in significant distortions in the cytokine profile. However, helminth and its co-infection with Plasmodium or HIV produced less changes in the cytokine profile.

PMID:35522326 | DOI:10.1007/s00436-022-07531-6

Eur Arch Otorhinolaryngol. 2022 May 6. doi: 10.1007/s00405-022-07417-4. Online ahead of print.

ABSTRACT

PURPOSE: Investigating whether the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) are valid and comparable to previous unmasked measurements if the speaker wears a surgical mask or a FFP-2 mask to reduce the risk of transmitting air-borne viruses such as SARS-CoV-2.

METHODS: A convenience sample of 31 subjectively healthy participants was subjected to AVQI and ABI voice examination four times: Twice wearing no mask, once with a surgical mask and once with a FFP-2 mask as used regularly in our hospital. The order of the four mask conditions was randomized. The difference in the results between the two recordings without a mask was then compared to the differences between the recordings with each mask and one recording without a mask.

RESULTS: Sixty-two percent of the AVQI readings without a mask represented perfectly healthy voices, the largest AVQI without a mask value was 4.0. The mean absolute difference in AVQI was 0.45 between the measurements without masks, 0.48 between no mask and surgical mask and 0.51 between no mask and FFP-2 mask. The results were neither clinically nor statistically significant. For the ABI the resulting absolute differences (in the same order) were 0.48, 0.69 and 0.56, again neither clinically nor statistically different.

CONCLUSION: Based on a convenience sample of healthy or only mildly impaired voices wearing CoViD-19 protective masks does not substantially impair the results of either AVQI or ABI results.

PMID:35522325 | DOI:10.1007/s00405-022-07417-4

Knee Surg Sports Traumatol Arthrosc. 2022 May 6. doi: 10.1007/s00167-022-06975-8. Online ahead of print.

ABSTRACT

PURPOSE: Patch augmentation for large and massive rotator cuff tears (LMRCTs) has been suggested as a repair strategy that can mechanically reinforce tendons and biologically enhance healing potential. The purpose of this study was to determine whether patients who underwent patch augmentation would have lower rates of retears and superior functional outcomes.

METHODS: Patients who underwent arthroscopic rotator cuff repair (ARCR) with patch augmentation (group A) were matched by age, sex, degree of retraction, and supraspinatus muscle occupation ratio to those treated with ARCR without using a patch (group B) with a minimum follow-up of 24 months. The retear (Sugaya IV or V) rates were evaluated by magnetic resonance imaging at 3 and 12 months post-surgery. The Constant- Murley Score (CMS), Korean Shoulder Score (KSS), and University of California-Los Angeles Shoulder Rating Scale (UCLA) score were retrospectively analyzed.

RESULTS: This study included 34 patients (group A, n = 17; group B, n = 17). The mean follow-up period was 46.5 ± 17.4 months. At postoperative 1-year follow-up, group B (6 patients, 35.3%) showed higher rates of retears than group A (1 patient, 5.9%), which was statistically significant (P = 0.034). However, the postoperative CMS, KSS, and UCLA scores did not differ between the two groups at 3 months, 12 months, and the final follow-up. Additionally, the clinical outcomes of patients with retear were not significantly different from those of the healed patients in both groups.

CONCLUSION: The use of an allodermal patch for LMRCT is effective in preventing retears without complications. However, the clinical outcomes of ARCR using allodermal patch augmentation were not superior to those of only ARCR.

LEVEL OF EVIDENCE: III.

PMID:35522311 | DOI:10.1007/s00167-022-06975-8

Nervenarzt. 2022 May 6. doi: 10.1007/s00115-022-01296-0. Online ahead of print.

ABSTRACT

“Experimental case Münsterlingen: clinical trials in psychiatry, 1940-1980” is the name of the report of a control commission established by the government of the Swiss Canton Thurgau in 2016, after several articles in the press after 2012 had criticized the drug tests carried out by Roland Kuhn, the former clinical director of the cantonal mental hospital in Münsterlingen. The report discusses “fine discrepancies in everyday borderline transgressions” “from today’s viewpoint”. These borderline transgressions were seen especially in the missing, inadequate or undocumented informed consent of patients and in the usage of test substances, which varied between the (mostly) accepted or not refused intake and the camouflaged or (seldom) threatened application via injection. Thus, the report shows on the one hand, the considerable development of the normative context of treatment of mentally ill patients in the past 70 years and on the other hand, with its detailed descriptions, it can sensitize today’s therapists to the pertinent context. But most of all this is the story of Roland Kuhn, the responsible psychiatrist and the drug testing discoverer of the antidepressive effect of imipramine. This story of the discovery is judged from very differing perspectives and is thus relativized, all the way from observations of a “provincial psychiatrist” to consideration for the Nobel Prize. At the same time critically evaluated traits of Kuhn’s personality seem to have influenced the occasionally negative comments of the commission report. We should recognize, however, that with his qualitative and psychopathological individual case observations, Kuhn discovered the antidepressive effect of a test substance that as a hypothesis was verified by subsequent quantitative and statistical methods.

PMID:35522310 | DOI:10.1007/s00115-022-01296-0

Transl Vis Sci Technol. 2022 May 2;11(5):5. doi: 10.1167/tvst.11.5.5.

ABSTRACT

PURPOSE: Data postprocessing with statistical techniques that are less sensitive to noise can be used to reduce variability in visual field (VF) series. We evaluated the detection of glaucoma progression with postprocessed VF data generated with the dynamic structure-function (DSF) model and MM-estimation robust regression (MRR).

METHOD: The study included 118 glaucoma eyes with at least 15 visits selected from the Rotterdam dataset. The DSF and MRR models were each applied to observed mean deviation (MD) values from the first three visits (V1-3) to predict the MD at V4. MD at V5 was predicted with data from V1-4 and so on until the MD at V9 was predicted, creating two additional datasets: DSF-predicted and MRR-predicted. Simple linear regression was performed to assess progression at the ninth visit. Sensitivity was evaluated by adjusting for false-positive rates estimated from patients with stable glaucoma and by using longer follow-up series (12th and 15th visits) as a surrogate for progression.

RESULTS: For specificities of 80% to 100%, the DSF-predicted dataset had greater sensitivity than the observed and MRR-predicted dataset when positive rates were normalized with corresponding false-positive estimates. The DSF-predicted and observed datasets had similar sensitivity when the surrogate reference standard was applied.

CONCLUSIONS: Without compromising specificity, the use of DSF-predicted measurements to identify progression resulted in a better or similar sensitivity compared to using existing VF data.

TRANSLATIONAL RELEVANCE: The DSF model could be applied to postprocess existing visual field data, which could then be evaluated to identify patients at risk of progression.

PMID:35522306 | DOI:10.1167/tvst.11.5.5

J Cancer Res Clin Oncol. 2022 May 6. doi: 10.1007/s00432-022-04035-9. Online ahead of print.

ABSTRACT

PURPOSE: Fragmented cancer care (FC) means that patients visit multiple providers for treatment, which is common in cancer care. While FC is associated with poor health outcomes in patients with colorectal cancer (CRC) worldwide, there is still a lack of evidence in South Korea. We investigated the association between FC and 5-year morality in patients with CRC using population-based claims data.

METHODS: The study population was followed up from 2002 to 2015. Data were collected from Korea National Health Insurance claims. Participants comprised patients with CRC diagnosed with International Classification of Diseases (ICD)-10 (C18.x-C20.x) and a special claim code for cancer (V193). Data were analyzed using the Kaplan-Meier curve with a log-rank test and Cox proportional hazard model. The effect of FC on patients’ 5-year survival was examined.

RESULTS: Of 3467 patients with CRC, 20.0% had experienced FC. FC was significantly associated with an increased risk of 5-year mortality (hazard ratio 1.516, 95% confidence interval 1.274-1.804). FC was prevalent in those who had a low income level, underwent chemotherapy, did not undergo radiation therapy, and did not visit a tertiary hospital for their first treatment.

CONCLUSION: Efforts to decrease FC and integrate complex cancer care within appropriate healthcare delivery systems may improve survivorship among patients with CRC.

PMID:35522291 | DOI:10.1007/s00432-022-04035-9

JAMA Netw Open. 2022 May 2;5(5):e2210752. doi: 10.1001/jamanetworkopen.2022.10752.

ABSTRACT

IMPORTANCE: Female resident physicians are disproportionately affected by burnout, which can have serious consequences for their well-being and career trajectory. Growing evidence supports the use of professional coaching to reduce burnout in resident physicians, yet individual coaching is resource intensive and infeasible for many training programs.

OBJECTIVE: To assess whether a structured professional group-coaching program for female resident physicians would lead to decreased burnout.

DESIGN, SETTING, AND PARTICIPANTS: This pilot randomized clinical trial was conducted from January 1 to June 30, 2021, among 101 female resident physicians in graduate medical education at the University of Colorado who voluntarily enrolled in the trial after a recruitment period. Surveys were administered to participants before and after the intervention.

INTERVENTION: With the use of a computer-generated 1:1 algorithm, 50 participants were randomly assigned to the intervention group and 51 participants were randomly assigned to the control group. The intervention group was offered a 6-month, web-based group-coaching program, Better Together Physician Coaching, developed and facilitated by trained life coaches and physicians. The control group received residency training as usual, with no coaching during the study. The control group was offered the 6-month coaching program after study completion.

MAIN OUTCOMES AND MEASURES: The primary outcome of burnout was measured using the Maslach Burnout Inventory, defined by 3 Likert-type 7-point subscales: emotional exhaustion, depersonalization, and professional accomplishment. Higher scores on the emotional exhaustion and depersonalization subscales and lower scores on the professional accomplishment subscale indicate higher burnout. Secondary outcomes of impostor syndrome, self-compassion, and moral injury were assessed using the Young Impostor Syndrome Scale, Neff’s Self-Compassion Scale-Short Form, and the Moral Injury Symptom Scale-Healthcare Professionals, respectively. An intention-to-treat analysis was performed.

RESULTS: Among the 101 female residents in the study, the mean (SD) age was 29.4 (2.3) years, 96 (95.0%) identified as heterosexual, and 81 (80.2%) identified as White. There were 19 residents (18.8%) from surgical subspecialties, with a range of training levels represented. After 6 months of professional coaching, emotional exhaustion decreased in the intervention group by a mean (SE) of 3.26 (1.25) points compared with a mean (SE) increase of 1.07 (1.12) points in the control group by the end of the study (P = .01). The intervention group experienced a significant reduction in presence of impostor syndrome compared with controls (mean [SE], -1.16 [0.31] vs 0.11 [0.27] points; P = .003). Self-compassion scores increased in the intervention group by a mean (SE) of 5.55 (0.89) points compared with a mean (SE) reduction of 1.32 (0.80) points in the control group (P < .001). No statistically significant differences in depersonalization, professional accomplishment, or moral injury scores were observed. Owing to the differential follow-up response rates in the treatment groups (88.2% in the control group [45 of 51]; 68.0% in the intervention group [34 of 50]), a sensitivity analysis was performed to account for the missing outcomes, with similar findings.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, professional coaching reduced emotional exhaustion and impostor syndrome scores and increased self-compassion scores among female resident physicians.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05280964.

PMID:35522281 | DOI:10.1001/jamanetworkopen.2022.10752

JAMA Netw Open. 2022 May 2;5(5):e2210768. doi: 10.1001/jamanetworkopen.2022.10768.

ABSTRACT

IMPORTANCE: Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities.

OBJECTIVES: To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians’ perceptions of protective workplace systems.

DESIGN, SETTING, AND PARTICIPANTS: This survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022.

MAIN OUTCOMES AND MEASURES: Primary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being.

RESULTS: Of 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose “other”; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place “to a very great extent,” a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35).

CONCLUSIONS AND RELEVANCE: This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.

PMID:35522279 | DOI:10.1001/jamanetworkopen.2022.10768