Tag: pubmed

Ear Hear. 2021 Nov 30. doi: 10.1097/AUD.0000000000001176. Online ahead of print.

ABSTRACT

OBJECTIVES: This study identified an association between cholesteatoma and progressive sensorineural hearing loss using a large pediatric longitudinal audiologic dataset. Cholesteatoma is a potential sequela of chronic otitis media with effusion, a commonly observed auditory pathology that can contribute to hearing loss in children. The purpose of this report is to (i) describe the process of identifying the association between cholesteatoma and progressive sensorineural hearing loss in a large pediatric dataset and (ii) describe the audiologic data acquired over time in patients identified with cholesteatoma-associated progressive sensorineural hearing loss.

DESIGN: Records of patients included in the Audiologic and Genetics Database (n = 175,215 patients) were examined using specified criteria defining progressive hearing loss. A linear regression model examined the log frequency of all diagnostic codes in the electronic health record assigned to patients for a progressive hearing loss cohort compared with a stable hearing loss group. Based on findings from the linear regression analysis, longitudinal audiometric air (AC) and bone conduction (BC) thresholds were extracted for groups of subjects with cholesteatoma-associated progressive (n = 58 subjects) and stable (n = 55 subjects) hearing loss to further analyze changes in hearing over time.

RESULTS: The linear regression analyses identified that diagnostic codes for cholesteatoma were associated with progressive sensorineural hearing loss in children. The longitudinal audiometric data demonstrated within-subject changes in masked BC sensitivity consistent with progressive sensorineural hearing loss in children diagnosed with cholesteatoma. Additional analyses showed that mastoidectomy surgeries did not appear to contribute to the observed progressive hearing loss and that a high number of cholesteatoma patients with progressive hearing loss had normal-hearing thresholds at their first test.

CONCLUSIONS: The statistical analyses demonstrated an association between cholesteatoma and pediatric progressive sensorineural hearing loss. These findings inform clinical management by suggesting that children with cholesteatoma diagnoses may be at increased risk for progressive sensorineural hearing loss and should receive continued monitoring even after a normal masked BC baseline has been established.

PMID:34860720 | DOI:10.1097/AUD.0000000000001176

Ear Hear. 2021 Nov 23. doi: 10.1097/AUD.0000000000001158. Online ahead of print.

ABSTRACT

OBJECTIVES: About 15% of U.S. adults report speech perception difficulties despite showing normal audiograms. Recent research suggests that genetic factors might influence the phenotypic spectrum of speech perception difficulties. The primary objective of the present study was to describe a conceptual framework of a deep phenotyping method, referred to as AudioChipping, for deconstructing and quantifying complex audiometric phenotypes.

DESIGN: In a sample of 70 females 18 to 35 years of age with normal audiograms (from 250 to 8000 Hz), the study measured behavioral hearing thresholds (250 to 16,000 Hz), distortion product otoacoustic emissions (1000 to 16,000 Hz), click-evoked auditory brainstem responses (ABR), complex ABR (cABR), QuickSIN, dichotic digit test score, loudness discomfort level, and noise exposure background. The speech perception difficulties were evaluated using the Speech, Spatial, and Quality of Hearing Scale-12-item version (SSQ). A multiple linear regression model was used to determine the relationship between SSQ scores and audiometric measures. Participants were categorized into three groups (i.e., high, mid, and low) using the SSQ scores before performing the clustering analysis. Audiometric measures were normalized and standardized before performing unsupervised k-means clustering to generate AudioChip.

RESULTS: The results showed that SSQ and noise exposure background exhibited a significant negative correlation. ABR wave I amplitude, cABR offset latency, cABR response morphology, and loudness discomfort level were significant predictors for SSQ scores. These predictors explained about 18% of the variance in the SSQ score. The k-means clustering was used to split the participants into three major groups; one of these clusters revealed 53% of participants with low SSQ.

CONCLUSIONS: Our study highlighted the relationship between SSQ and auditory coding precision in the auditory brainstem in normal-hearing young females. AudioChip was useful in delineating and quantifying internal homogeneity and heterogeneity in audiometric measures among individuals with a range of SSQ scores. AudioChip could help identify the genotype-phenotype relationship, document longitudinal changes in auditory phenotypes, and pair individuals in case-control groups for the genetic association analysis.

PMID:34860719 | DOI:10.1097/AUD.0000000000001158

Rev Esp Anestesiol Reanim (Engl Ed). 2021 Nov 29:S2341-1929(21)00167-0. doi: 10.1016/j.redare.2021.02.005. Online ahead of print.

ABSTRACT

OBJECTIVES: Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia.

MATERIALS AND METHODS: A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12 h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID.

RESULTS: There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12 h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P = .014) and ID (P = .040) but more fresh frozen plasma than group ID (P = .0002).

CONCLUSIONS: Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.

PMID:34857506 | DOI:10.1016/j.redare.2021.02.005

J Med Imaging Radiat Sci. 2021 Nov 19:S1939-8654(21)00245-9. doi: 10.1016/j.jmir.2021.11.002. Online ahead of print.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has had significant impact on clinical radiography educational activities including teaching, research, and clinical placement. The study aimed to investigate the impact of the COVID-19 pandemic on clinical radiography education in a low-resource setting from the perspectives of students and educators.

METHODS: A cross-sectional online survey was conducted between December 2020 and March 2021. Participants included student radiographers and educators from six clinical radiography training institutions in Ghana. Conventional descriptive statistics, frequency, and thematic text analysis were undertaken.

RESULTS: 291 valid responses were received involving 277 students and 14 educators. Most of the respondents, predominantly students did not find the online platforms for learning user-friendly. Key challenges to clinical radiography training during the pandemic included poor internet connectivity (73.8%), inadequate time for academic discussions (50.9%), and the reluctance of health facilities to accept students for clinical placement (51%). Challenges with data collection and the provision of supervision were issues associated with research activities.

DISCUSSION: The findings suggest the COVID-19 pandemic has had significant impact on clinical radiography education in Ghana and other countries of similar resource availability.

CONCLUSION: Clinical radiography training institutions need to customize approaches to education. Adopting blended learning approaches as well as the use of simulation to augment practical placement opportunities are new modes of instruction that will maximize learning experience.

PMID:34857497 | DOI:10.1016/j.jmir.2021.11.002

An Pediatr (Engl Ed). 2021 Nov 29:S2341-2879(21)00186-1. doi: 10.1016/j.anpede.2021.06.009. Online ahead of print.

ABSTRACT

INTRODUCTION: About 0.2-6.1% of newborns in the developed world have been conceived by assisted reproductive techniques (ART). Higher rate of major and minor malformations have been described in this population, but the multiple possible confounders associated make it difficult to establish a direct causal relationship and the specific factors involved.

MATERIAL AND METHODS: To determine the risk of these malformations in our population, a collaborative prospective controlled cohort study was designed. We collected the specific ART-data related to the clinical gestation of women treated in a period of 2 years in the Reproduction Unit from a Spanish public tertiary-level hospital. 231 out of 267 newborns of these gestation (88%) participated in the study and were assessed by a pediatrician with expertise in Clinical Genetics and Dysmorphology at 12-20 and 26-40 months of age. At the same time a controlled group of children naturally conceived (NC) was selected according to the following criteria: the next NC newborn belonging to the same group of maternal and gestational age, and type of gestation (single or multiple). 230 controls were chosen and 208 participated in the study (90%).

RESULTS: Major malformations were presented in 7.8% of the ART-children and 7.2% of the controls, without founding statistically differences between groups. However, differences were found in the risk of some minor malformations such as capillary malformations and pigmentary lesions, higher in the ART-group. A recurrent pattern of craneofacial anomalies was also unexpectedly detected.

CONCLUSIONS: In spite of the high rate of major congenital malformations detected, there were no differences between groups. Thus, our results suggest that ART may affect the normal embryonic development but in a milder way than other confounding factors do. The facial phenotype identified has not previously been described, either the higher risk of capillary malformations and pigmentary lesions. More studies are needed to confirm this association.

PMID:34857501 | DOI:10.1016/j.anpede.2021.06.009

Pain Manag Nurs. 2021 Nov 29:S1524-9042(21)00224-1. doi: 10.1016/j.pmn.2021.10.006. Online ahead of print.

ABSTRACT

BACKGROUND: Substance use seems to be higher among populations with chronic pain.

AIM: The aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men.

METHOD: Linear and logistic regression analyses were carried out using data from the 2015-2016 adults’ version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men).

RESULTS: Disabling chronic pain was statistically associated with higher tobacco consumption among men (β = -30.0, 95% confidenct interval [CI] -59.5 to -0.60; t = -2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: β = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: β = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs.

CONCLUSIONS: Chronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.

PMID:34857475 | DOI:10.1016/j.pmn.2021.10.006

Res Social Adm Pharm. 2021 Nov 27:S1551-7411(21)00383-1. doi: 10.1016/j.sapharm.2021.11.011. Online ahead of print.

ABSTRACT

BACKGROUND: The perceived service quality scale (pSQS) is a patient-reported experience measure (PREM) previously developed for measuring perceived service quality (pSQ) in community pharmacies. While measuring pSQ is feasible, further psychometric evaluation of the pSQS is warranted. In addition, the length of the 20-item pSQS may lead to fatigue among patients. It remains to be determined whether a short form of the pSQS has acceptable psychometric properties.

OBJECTIVES: The aim of this study was to psychometrically test the pSQS with a specific focus on making scoring recommendations and developing a short form pSQS with acceptable psychometric properties.

METHODS: Participants were recruited either in community pharmacies or via an online panel to complete a questionnaire including the pSQS. Confirmatory factor analyses (CFA) were conducted using robust statistics, including tests of factorial invariance. Alternative models were tested including a bifactor model. Spearman’s correlation was used to conduct test-retest analyses on responses obtained one month apart.

RESULTS: Data were analysed from 319 participants recruited in-store and 303 participants recruited online, 86 participants providing test-retest reliability. Tests of factorial invariance indicated that the pSQS is stable across settings. The most parsimonious and best-fitting solution was obtained with a 19-item bifactor model with 5 factors plus a “general” factor. Factor scores obtained from the “general” factor explained sufficient variance and are unlikely to be excessively biased in regression models. A short-form 6-item scale (pSQ-SF6) demonstrated acceptable psychometric properties and similar predictive capacity to the original pSQS for patient loyalty intentions. Test-retest analyses indicated acceptable reliability for pSQS and PSQ-SF6.

CONCLUSION: This study confirms that the pSQS has acceptable psychometric properties including temporal stability. It is recommended that a 19-item pSQS be used to obtain a comprehensive overview of patients’ pSQ. The short-form pSQ-SF6 is suitable as a community pharmacy PREM.

PMID:34857482 | DOI:10.1016/j.sapharm.2021.11.011

Acad Radiol. 2021 Nov 29:S1076-6332(21)00529-8. doi: 10.1016/j.acra.2021.11.003. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients.

MATERIALS AND METHODS: The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups’ trends and differences between the lactating and cancer cohorts were statistically assessed.

RESULTS: CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001).

CONCLUSION: BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.

PMID:34857455 | DOI:10.1016/j.acra.2021.11.003

J Cardiol. 2021 Nov 29:S0914-5087(21)00316-6. doi: 10.1016/j.jjcc.2021.11.006. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical risk assessment with quantitative formal risk scores may add to intuitive physician risk assessment and are advised by the international guidelines for the management of acute coronary syndrome (ACS) patients. Most previous studies have used the binary regression/classification approach (dead/alive) for long-term mortality post-ACS, without considering the time-to-event as in survival analysis. The use of machine learning (ML)-based survival models has yet to be validated. The primary objective was to compare survival prediction performance of 1-year mortality following ACS of two newly developed ML-based models [random survival forest (RSF) and deep learning (DeepSurv)] with the traditional Cox-proportional hazard (CPH) model. The secondary objective was external validation of the findings.

METHODS: This was a retrospective, supervised learning data mining study based on the Acute Coronary Syndrome Israeli Survey (ACSIS) and the Myocardial Ischemia National Audit Project (MINAP). The ACSIS data were divided to train/test in a 70/30 fashion. Next, the models were externally validated on the MINAP data. Harrell’s C-index, inverse probability of censoring weighting (IPCW), and the Brier-score were used for models’ performance comparison.

RESULTS: RSF performed best among the three models, with Harrell’s C-index on training and testing sets reaching 0.953 and 0.924 respectively, followed by CPH multivariate selected model (0.805/0.849), CPH Univariate selected model (0.828/0.806), DeepSurv model (0.801/0.804), and the traditional CPH model (0.826/0.738). The RSF model also had the highest performance on the validation data set with 0.811 for Harrell’s C-index, 0.844 for IPCW, and 0.093 for Brier score. The CPH model performance on the validation set had C-index range between 0.689 to 0.790, 0.713 to 0.826 for IPCW, and 0.094 to 0.103 Brier score.

CONCLUSIONS: RSF survival predictions for long-term mortality post-ACS show improved model performance compared with the classic statistical method. This may benefit patients by allowing better risk stratification and tailored therapy, however further prospective evaluations are required.

PMID:34857429 | DOI:10.1016/j.jjcc.2021.11.006

J Voice. 2021 Nov 29:S0892-1997(21)00366-0. doi: 10.1016/j.jvoice.2021.11.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Voice is the one of the sexual maturation characteristics that differs between boys and girls. Voice analysis is a non-invasive diagnostic tool and well-tolerated by children. Our aim is to investigate the capability of MDVP to predict precocious puberty (PP). To our knowledge, this is the only study to assess the voice parameters in the diagnosis of PP.

MATERIAL AND METHODS: The data of PP and control group were retrospectively reviewed. Voice parameters including fundamental frequency, jitter, shimmer and harmonic-to-noise ratio (HNR), age, and gender of subjects were noted. ROC curve was performed to the statistically significant parameters after double group comparisons and cut-off values were defined. 2 × 2 table were created and compared between the groups.

RESULTS: A total of 54 children comprising 32 subjects (8 boys and 24 girls) in the PP group and 22 (10 boys and 12 girls) in the control group were included, and the mean age of girls were 8.17 and 7.92 years, and those of the boys were 8.83 and 7.90, respectively. Jitter and HNR values were statistically significant in the girls but not in boys between the 2 groups (P = 0.013, P = 0.032, respectively). The cut-off points were 1.31 for jitter, 6.39 for HNR. Univariate analysis according to cut-off values of jitter and HNR revealed a statistically significant difference between the 2 groups (P = 0.004, OR: 8.80 [1.26- 61,15] and P = 0.012, OR: 5.00 [1.27-19.68], respectively).

CONCLUSIONS: Our findings suggest that, along with an evaluation of other secondary sexual maturation characteristics, voice analysis may be used by pediatric endocrinologists and otolaryngologists to diagnose PP in girls but not in boys.

PMID:34857449 | DOI:10.1016/j.jvoice.2021.11.001