Tag: pubmed

J Magn Reson Imaging. 2022 Feb 8. doi: 10.1002/jmri.28105. Online ahead of print.

ABSTRACT

BACKGROUND: Localized regions of left-right image intensity asymmetry (LRIA) were incidentally observed on T₂ -weighted (T₂ -w) and T₁ -weighted (T₁ -w) diagnostic magnetic resonance imaging (MRI) images. Suspicion of herpes encephalitis resulted in unnecessary follow-up imaging. A nonbiological imaging artifact that can lead to diagnostic uncertainty was identified.

PURPOSE: To investigate whether systematic LRIA exist for a range of scanner models and to determine if LRIA can introduce diagnostic uncertainty.

STUDY TYPE: A retrospective study using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) data base.

SUBJECTS: One thousand seven hundred fifty-three (median age: 72, males/females: 878/875) unique participants with longitudinal data were included.

FIELD STRENGTH: 3T.

SEQUENCES: T₁ -w three-dimensional inversion-recovery spoiled gradient-echo (IR-SPGR) or magnetization-prepared rapid gradient-echo (MP-RAGE) and T₂ -w fluid-attenuated inversion recovery (FLAIR) long tau fast spin echo inversion recovery (LT-FSE-IR). Only General Electric, Philips, and Siemens’ product sequences were used.

ASSESSMENT: LRIA was calculated as the left-right percent difference with respect to the mean intensity from automated anatomical atlas segmented regions. Three neuroradiologists with 37 (**), 32 (**), and 3 (**) years of experience rated the clinical impact of 30 T₂ -w three-dimensional FLAIR exams with LRIA to determine the diagnostic uncertainty. Statistical comparisons between retrospective intensity normalized T₁ m and original T₁ -w images were made.

STATISTICAL TESTS: For each image type, a linear mixed effects model was fit using LRIA scores from all scanners, regions, and participants as the outcome and age and sex as predictors. Statistical significance was defined as having a P-value <0.05.

RESULTS: LRIA scores were significantly different from zero on most scanners. All clinicians were uncertain or recommended definite diagnostic follow-up in 62.5% of cases with LRIA >10%. Individuals with acute brain pathology or focal neurologic deficits are not enrolled in ADNI; therefore, focal signal abnormalities were considered false positives.

DATA CONCLUSION: LRIA is system specific, systematic, creates diagnostic uncertainty, and impacts IR-SPGR, MP-RAGE, and LT-FSE-IR product sequences.

LEVEL OF EVIDENCE: 2 Technical Efficacy Stage: 3.

PMID:35133061 | DOI:10.1002/jmri.28105

Ophthalmic Physiol Opt. 2022 Feb 8. doi: 10.1111/opo.12950. Online ahead of print.

ABSTRACT

PURPOSE: Longitudinal changes in priority rehabilitation needs, vision-related activity limitation and importance of visual goals were evaluated in a sample of people with a visual impairment over a year following entry to low vision rehabilitation services in England.

METHODS: Participants were adults with newly registered visual impairment within Leicestershire. Priority scores, indicating the level of rehabilitative need, were determined from the importance and difficulty scores of the 48 goals of the Participation and Activity Inventory (PAI). Rasch analysis of the difficulty and importance scores examined activity limitation and importance separately. PAI outcome measures were assessed on entry to rehabilitation services and at 4 and 12 months thereafter.

RESULTS: Forty-eight participants (mean age 74.2, SD 14.1 years) completed three visits. Overall, there was a statistically significant reduction in the perceived need for rehabilitation over time (p < 0.001, η_p² = 0.29), driven by reduced perceived difficulty (p < 0.001, η_p² = 0.32) but stable importance (p = 0.73) of goals, with most change occurring between baseline and 4 months. PAI goals with greatest rehabilitative need at study entry were reading, mobility and writing, and these remained of highest priority over time. The greatest priority score decrease was for the goal ‘Hobbies and crafts’. The largest decrease in importance was for ‘Mobility outdoors’, whereas ‘Relationship with loved ones’ increased most.

CONCLUSIONS: Despite a decline in the perceived need for rehabilitation over the study period, there remains a need for continued support and intervention at 12 months following registration with rehabilitation services, particularly for the key goals of reading, writing and mobility. Early identification and support for individuals’ important but difficult goals could prevent such goals being relinquished. Goals concerning relationships and communication became more important over time, indicating that re-evaluation of needs at follow-up is necessary to inform ongoing service provision.

PMID:35133019 | DOI:10.1111/opo.12950

Med Pr. 2022 Feb 8:143109. doi: 10.13075/mp.5893.01002. Online ahead of print.

ABSTRACT

BACKGROUND: The study concerned workplace mobbing, a phenomenon affecting about 3-20% of the Polish population. The aim of the article is to distinguish the manifestations of mobbing, to study the coexistence of mobbing manifestations, and to search for the relationships between the symptoms of mobbing, reactions to mobbing and methods of dealing with mobbing used by victims.

MATERIAL AND METHODS: Information on the above variables was obtained using a questionnaire on mobbing, risk factors, and responses to mobbing. The questionnaire was completed by 781 people (women: 66%, men: 34%). The average age of the respondents was 29 years. The current statistical analysis included: distinguishing the manifestations of mobbing by means of a confirmatory factor analysis, studying the coexistence of mobbing manifestations by means of a cluster analysis, and detecting the relationships between mobbing manifestations, reactions to mobbing and ways of dealing with it based on the system of structural equations.

RESULTS: The results of the research revealed 3 categories of relationships: a co-occurrence of mobbing manifestations, a relationship of mobbing manifestations with reactions to mobbing, and a relationship of mobbing reactions with methods of dealing with mobbing.

CONCLUSIONS: Mobbing was found in 22% of the examined group. The study revealed the existence of 5 clusters of mobbing manifestations (i.e., subgroups of respondents characterized by experiencing at least 1 of the mobbing manifestations). In the most numerous clusters in which the symptoms of mobbing were diagnosed, unfriendly working conditions prevailed. In the context of mobbing, people were found to more often react with passivity or with using interpersonal coping methods. However, they rarely turned to institutions for help or used aggression against the mobber. Med Pr. 2022;73(1).

PMID:35132973 | DOI:10.13075/mp.5893.01002

Int J Cancer. 2022 Feb 8. doi: 10.1002/ijc.33959. Online ahead of print.

ABSTRACT

Cyclin-dependent-kinase-4/6 inhibitor (CDKi) plus endocrine therapy (ET) is standard of care for patients with advanced hormone receptor (HR)-positive, HER2-negative breast cancer (BC). The Breast Medical Oncology database at MD Anderson Cancer Center (MDACC) was analyzed to assess effectiveness of the CDKi palbociclib plus ET compared to ET alone. From a total of 5402 advanced HR+ HER2- BC patients referred to MDACC between 1997 and 2020, we identified eligible patients who received palbociclib in combination with first- (n=778) and second-line (n=410) ET. We further identified “control” patients who received ET alone in the first- (n=2452) and second-line (n=1183) settings. Propensity score matching analysis was conducted to balance baseline demographic and clinical characteristics between palbociclib and control cohorts to assess the effect of palbociclib treatment on progression-free survival (PFS) and overall survival (OS). For propensity-matched-cohort in the first-line setting (n=708), palbociclib group had significantly longer median PFS (17.4 vs. 11.1 months; p<0.0001) compared to controls. Median OS (44.3 vs. 40.2 months) did not show a statistically significant benefit in the first line setting. However, in the second-line setting, with 380 propensity-matched-cohort, the palbociclib group had significantly longer PFS (10 vs 5 months, p<0.0001) as well as OS (33 vs 24 months; p < 0.022), compared to controls. We conclude that in this single center analysis of a large cohort of metastatic HR+ HER2- BC patients, palbociclib in combination with ET was associated with improved PFS in both first- and second-line settings and OS in the second-line setting compared with ET alone cohort.

PMID:35133007 | DOI:10.1002/ijc.33959

Br J Neurosurg. 2022 Feb 8:1-6. doi: 10.1080/02688697.2022.2034741. Online ahead of print.

ABSTRACT

PURPOSE: Sagittal imbalance is common in degenerative and congenital spinal diseases. Some studies have examined spinal deformities in the spina bifida. However, sagittal spinopelvic parameters in tethered cord syndrome (TCS) and split cord malformation (SCM) have been poorly evaluated in the literature. In this study, we investigated sagittal spinopelvic differences in TCS due to fatty filum terminale and SCM patients.

MATERIAL AND METHODS: A total of 78 patients with spina bifida occulta (30 SCM and 48 TCS due to fatty filum terminale) were included in the study. Radiological images of these patients were retrospectively evaluated. We evaluated the pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 pelvic angle, lumbar lordosis (LL), thoracic kyphosis, thoracolumbar alignment, and change in those parameters with age.

RESULTS: Correlation coefficients between age and LL, T1 pelvic angle, and the SVA in patients with TCS due to fatty filum terminale were statistically significant. In addition, correlation coefficients between age and LL and the SVA in patients with SCM were statistically significant. Notably, LL was increased at a statistically significant level with age in patients with TCS and SCM.

CONCLUSION: Improved knowledge of spinal balance parameters in patients with TCS and SCM may be helpful in understanding the clinical course of these pathologies, and provide information regarding the success of surgery at the follow-up period.

PMID:35132932 | DOI:10.1080/02688697.2022.2034741

Med Teach. 2022 Feb 8:1-7. doi: 10.1080/0142159X.2022.2033189. Online ahead of print.

ABSTRACT

BACKGROUND: Repeated application of foundational science (FS) during medical reasoning results in encapsulation of knowledge needed to develop clinical expertise. Despite proven benefit of educating learners using a FS framework to anchor clinical decision making, how FS is integrated on clinical rotations has not been well characterized. This study examines how and when FS discussion occurs on internal medicine teaching rounds.

MATERIAL AND METHODS: We performed a convergent mixed method study. Six internal medicine teams at a quaternary hospital were observed during rounds and team members interviewed. Transcripts were analyzed using thematic analysis. Descriptive statistics provided a summary of the observations.

RESULTS: Our study revealed that rounds used a teacher-centered model where FS knowledge was transmitted as pearls external to the clinical context. FS content arose primarily when the patient was complex. Barriers preventing FS discussion were lack of time and perceived lack of personal FS knowledge.

CONCLUSION: Our study describes scenarios that commonly elicit discussion of FS on inpatient medicine rounds highlighting a ‘transmission’ model of FS knowledge. We suggest a learner-centered model that engages students in the practice of integrating FS into clinical reasoning.

PMID:35132917 | DOI:10.1080/0142159X.2022.2033189

Ann Med. 2022 Dec;54(1):484-494. doi: 10.1080/07853890.2022.2032820.

ABSTRACT

BACKGROUND: Novice nurses’ responsibilities are greater than what their actual level of competence can cope with. This can cause increased levels of stress, which many studies have shown is a factor resulting in reduced self-esteem, which affects not only the well-being of nurses but also the quality of care provided.

AIMS: To investigate the relationship between the self-assessment of nursing competencies and self-esteem among novice nurses and the moderation role of the sociodemographic variables and intention to leave the nursing profession on this relationship.

MATERIAL AND METHODS: A correlational cross-sectional study was performed using an online questionnaire. The study was conducted between July and October 2019 among 122 novice nurses. The study tool consisted of the Rosenberg Self-Esteem Scale, the Nurse Professional Competence Scale-Short Version, and metrics. Calculations were performed using SPSS Statistics, version 25. To approach research questions hierarchical multiple regression was performed.

RESULTS: The self-esteem level of novice nurses have been identified as low. Novice nurses who declared their willingness to leave their profession had a higher level of self-esteem than nurses who did not declare this willingness. The highest-rated competencies were in the fields of nursing care and value-based nursing care, while the lowest were in the areas of development, leadership, and the organisation of nursing care. Correlations between postgraduate education and competencies in the majority subscales were revealed. The results showed a negative correlation between self-esteem and all subscales of the competence scale. Seniority and postgraduate education were important moderators in the relationship between some competence subscales and self-esteem.

CONCLUSION: Novice nurses present a low level of self-esteem. Nurses with a higher competence level showed lower self-esteem. Developing competencies at the beginning of one’s nursing practice, which is crucial for patients’ outcomes, should be accompanied by the strengthening of novice nurses’ self-esteem.KEY MESSAGESNovice nurses with a higher level of self-esteem more often declared their willingness to leave their profession.The results showed a negative correlation between self-esteem and all subscales of the competence scale.Seniority and postgraduate education are important moderators in the relationship between some competence subscales and self-esteem.

PMID:35132927 | DOI:10.1080/07853890.2022.2032820

Global Spine J. 2022 Feb 8:21925682211053593. doi: 10.1177/21925682211053593. Online ahead of print.

ABSTRACT

STUDY DESIGN: Level III retrospective database study.

OBJECTIVES: The purpose of this study is to determine if machine learning algorithms are effective in predicting unplanned intubation following anterior cervical discectomy and fusion (ACDF).

METHODS: The National Surgical Quality Initiative Program (NSQIP) was queried to select patients who had undergone ACDF. Machine learning analysis was conducted in Python and multivariate regression analysis was conducted in R. C-Statistics area under the curve (AUC) and prediction accuracy were used to measure the classifier’s effectiveness in distinguishing cases.

RESULTS: In total, 54 502 patients met the study criteria. Of these patients, .51% underwent an unplanned re-intubation. Machine learning algorithms accurately classified between 72%-100% of the test cases with AUC values of between .52-.77. Multivariable regression indicated that the number of levels fused, male sex, COPD, American Society of Anesthesiologists (ASA) > 2, increased operating time, Age > 65, pre-operative weight loss, dialysis, and disseminated cancer were associated with increased risk of unplanned intubation.

CONCLUSIONS: The models presented here achieved high accuracy in predicting risk factors for re-intubation following ACDF surgery. Machine learning analysis may be useful in identifying patients who are at a higher risk of unplanned post-operative re-intubation and their treatment plans can be modified to prophylactically prevent respiratory compromise and consequently unplanned re-intubation.

PMID:35132907 | DOI:10.1177/21925682211053593

Hand (N Y). 2022 Feb 8:15589447211073829. doi: 10.1177/15589447211073829. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to determine the occurrence of patients undergoing primary trigger finger release (TFR) that underwent ulnar superficialis slip resection (USSR) for decompression and to determine which digit was most commonly affected.

METHODS: A retrospective chart review was conducted of all cases of open TFR performed by a single surgeon. The following data were obtained: age, sex, laterality, affected digit, and consideration for USSR. All patients failed nonoperative treatment of at least 1 steroid injection. The occurrence of patients who underwent TFR and USSR and which digit(s) most commonly underwent USSR were determined. The average patient age that underwent USSR, frequency by sex, and relative occurrence of USSR in each digit were computed. Statistical calculations were conducted using χ² analysis (P < .05).

RESULTS: A total of 911 primary open TFRs were performed in 631 patients over a 16-year period. A total of 20 TFRs in 20 patients underwent USSR (2.2%). The long finger was the most commonly affected digit (40%) that required simple decompression. Within all USSR cases, the long finger was the most commonly affected digit. The index finger was the second most affected (30%), and there were no cases in the small finger.

CONCLUSIONS: This study determined the occurrence of primary TFR cases that underwent USSR, with the long finger being the most commonly affected digit. Surgeons may consider this additional procedure to perform a larger decompression than simple A1 pulley release alone.

PMID:35132886 | DOI:10.1177/15589447211073829

J Oncol Pharm Pract. 2022 Feb 8:10781552221078934. doi: 10.1177/10781552221078934. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy.

PATIENTS AND METHODS: Patients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs.

RESULTS: Of 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium (p < 0.05), it was not clinically significant. A total of 226 ADRs were documented. Anaemia was the most frequently occurred ADR (14%) and Capecitabine caused the highest number of ADRs. Assessments of causality showed that the majority of cases are “possible” (63%). In evaluating the severity of ADRs, 99% ADRs were “mild” and 61% of ADRs were “probably” preventable. Upon assessing the DDIs, 82% of the prescriptions had “no known interaction”.

CONCLUSION: Metronomic chemotherapy in geriatric cancer patients exhibited grade 1 toxicity for haemoglobin. Anemia was the most common ADRs. The majority of cases were “possible” in causality, “mild” in severity, and “probably” preventable. The majority of the prescriptions have no known DDIs.

PMID:35132888 | DOI:10.1177/10781552221078934