Tag: pubmed

JAMA Netw Open. 2022 Mar 1;5(3):e225026. doi: 10.1001/jamanetworkopen.2022.5026.

ABSTRACT

IMPORTANCE: Nearly 30% of individuals with gestational diabetes (GDM) do not achieve glycemic control with lifestyle modification alone and require medication treatment. Oral agents, such as glyburide, have several advantages over insulin for the treatment of GDM, including greater patient acceptance; however, the effectiveness of glyburide for the treatment of GDM remains controversial.

OBJECTIVE: To compare the perinatal and neonatal outcomes associated with glyburide vs insulin using causal inference methods in a clinical setting with information on glycemic control.

DESIGN, SETTING, AND PARTICIPANTS: The population-based cohort study included patients with GDM who required medication treatment from 2007 to 2017 in Kaiser Permanente Northern California. Machine learning and rigorous casual inference methods with time-varying exposures were used to evaluate associations of exposure to glyburide vs insulin with perinatal outcomes. Data analysis was conducted from March 2018 to July 2017.

EXPOSURES: Time-varying exposure to glyburide vs insulin during pregnancy.

MAIN OUTCOMES AND MEASURES: Outcomes evaluated separately included neonatal hypoglycemia, jaundice, shoulder dystocia, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, size-for-gestational age, and cesarean delivery. Inverse probability weighting (IPW) estimation was used to separately compare perinatal outcomes between those initiating glyburide and insulin. This approach was combined with Super Learning for propensity score estimation to account for both baseline and time-dependent confounding in both per-protocol (primary) and intention-to-treat (secondary) analyses to evaluate sustained exposure to the same therapy.

RESULTS: From 2007 to 2017, 11 321 patients with GDM (mean [SD] age, 32.9 [4.9] years) initiated glyburide or insulin during pregnancy. In multivariate models, the risk of neonatal respiratory distress was 2.03 (95% CI, 0.13-3.92) per 100 births lower and the risk of NICU admission was 3.32 (95% CI, 0.20-6.45) per 100 births lower after continuous exposure to glyburide compared with insulin. There were no statistically significant differences in glyburide vs insulin initiation in risk for neonatal hypoglycemia (0.85 [95% CI, -1.17 to 2.86] per 100 births), jaundice (0.02 [95% CI, -1.46 to 1.51] per 100 births), shoulder dystocia (-1.05 [95% CI, -2.71 to 0.62] per 100 births), or large-for-gestational age categories (-2.75 [95% CI, -6.31 to 0.80] per 100 births).

CONCLUSIONS AND RELEVANCE: Using data from a clinical setting and contemporary causal inference methods, our findings do not provide evidence of a difference in the outcomes examined between patients with GDM initiating glyburide compared with those initiating insulin.

PMID:35357451 | DOI:10.1001/jamanetworkopen.2022.5026

JAMA Otolaryngol Head Neck Surg. 2022 Mar 31. doi: 10.1001/jamaoto.2022.0167. Online ahead of print.

ABSTRACT

IMPORTANCE: Individuals with persistent unilateral vestibular deficits experience loss of quality of life and increased risk of falling, and they have few well-supported options for effective treatment.

OBJECTIVES: To evaluate whether vestibular retraining using computerized dynamic posturography is associated with reduced participant-reported disability for patients with an objectively assessed unilateral peripheral vestibular deficit and to assess the feasibility of conducting a randomized clinical trial of vestibular retraining using computerized dynamic posturography.

DESIGN, SETTING, AND PARTICIPANTS: This single-group cohort study was conducted from April 29 to July 23, 2021, in a tertiary neurotology clinic among 13 individuals with a stable unilateral vestibular deficit present for more than 6 months, confirmed with videonystagmography and vestibular evoked myogenic potential testing. Statistical analysis was performed from July 7, 2021, to January 25, 2022.

INTERVENTIONS: Twelve twice-weekly sessions of posturography-assisted vestibular retraining with prescribed weight shifting tasks guided by an interactive display.

MAIN OUTCOMES AND MEASURES: Change in scores on the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence (ABC) Scale, and the Falls Efficacy Scale-International (FES-I), which participants completed before and after retraining to measure their perception of their disability. They also completed posturography measurements. Secondary outcomes included tolerability of the intervention and rate of completion of the full protocol.

RESULTS: A total of 13 participants (8 men [62%]; median age, 51 years [range, 18-67 years]) were enrolled. All 13 participants completed the intervention and all follow-up. After treatment, the median changes in scores were -16 points (95% CI, -20 to 2) for the DHI, -9 (95% CI, -14 to 1) for the FES-I, and 11.9 (95% CI, 0-17.3) for the ABC Scale. Eight participants (62%) improved by greater than the minimum clinically important difference (MCID) for the DHI, whereas 4 (31%) exceeded the MCID for the ABC Scale, and 3 (23%) exceeded the MCID for the FES-I. Participants with moderate to severe disability at baseline (n = 7) had a larger magnitude of improvement in DHI scores than those with mild disability (n = 6) (-18 [95% CI, -78 to 2] vs -1 [95% CI, -8 to 16]). Six of the 7 patients (86%) with moderate to severe disability improved by greater than the MCID for DHI, wherease 4 of 7 patients (57%) improved by greater than the MCID for the ABC Scale, and 3 of 7 patients (43%) improved by greater than the MCID for the FES-I.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that computerized, dynamic posturography-assisted retraining was associated with clinically meaningful improvements in participant-reported disability among those with stable unilateral vestibular deficit and moderate to severe disability. Further studies should compare posturography-assisted vestibular retraining with conventional physical therapy rehabilitation techniques.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04875013.

PMID:35357406 | DOI:10.1001/jamaoto.2022.0167

BJS Open. 2022 Mar 8;6(2):zrac014. doi: 10.1093/bjsopen/zrac014.

ABSTRACT

BACKGROUND: As the outcome of modern colorectal cancer (CRC) surgery has significantly improved over the years, however, renewed and adequate risk stratification for mortality is important to identify high-risk patients. This population-based study was conducted to analyse postoperative outcomes in patients with CRC and to create a risk model for 30-day mortality.

METHODS: Data from the Dutch Colorectal Audit were used to assess differences in postoperative outcomes (30-day mortality, hospital stay, blood transfusion, postoperative complications) in patients with CRC treated from 2009 to 2017. Time trends were analysed. Clinical variables were retrieved (including stage, age, sex, BMI, ASA grade, tumour location, timing, surgical approach) and a prediction model with multivariable regression was computed for 30-day mortality using data from 2009 to 2014. The predictive performance of the model was tested among a validation cohort of patients treated between 2015 and 2017.

RESULTS: The prediction model was obtained using data from 51 484 patients and the validation cohort consisted of 32 926 patients. Trends of decreased length of postoperative hospital stay and blood transfusions were found over the years. In stage I-III, postoperative complications declined from 34.3 per cent to 29.0 per cent (P < 0.001) over time, whereas in stage IV complications increased from 35.6 per cent to 39.5 per cent (P = 0.010). Mortality decreased in stage I-III from 3.0 per cent to 1.4 per cent (P < 0.001) and in stage IV from 7.6 per cent to 2.9 per cent (P < 0.001). Eight factors, including stage, age, sex, BMI, ASA grade, tumour location, timing, and surgical approach were included in a 30-day mortality prediction model. The results on the validation cohort documented a concordance C statistic of 0.82 (95 per cent c.i. 0.80 to 0.83) for the prediction model, indicating good discriminative ability.

CONCLUSION: Postoperative outcome improved in all stages of CRC surgery in the Netherlands. The developed model accurately predicts postoperative mortality risk and is clinically valuable for decision-making.

PMID:35357416 | DOI:10.1093/bjsopen/zrac014

JAMA Otolaryngol Head Neck Surg. 2022 Mar 31. doi: 10.1001/jamaoto.2022.0162. Online ahead of print.

NO ABSTRACT

PMID:35357398 | DOI:10.1001/jamaoto.2022.0162

J Pediatr Orthop B. 2022 Mar 31:BPB.0000000000000972. doi: 10.1097/BPB.0000000000000972. Online ahead of print.

ABSTRACT

YouTube is an increasingly accessible platform for families to obtain health information from; however, it is unregulated. The aim of this article was to assess the quality, reliability and accuracy of YouTube videos related to three common pediatric hip conditions: development dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease. YouTube was searched using a variety of keyword combinations. Videos were analysed using Journal of the American Medical Association, Global Quality Score and condition-specific scores created specifically for this study. Video duration and the number of views were also recorded. In total 120 videos were analysed, 40 for each of DDH, SCFE and Perthes disease. YouTube videos from physicians and academic institutions/hospitals are of significantly higher quality, reliability and accuracy than videos from patients, nonphysicians and commercial outlets. The higher quality for physician videos is associated with significantly longer video. Differences between the three pediatric orthopaedic conditions were not statistically significant. Videos of higher quality may be used as an adjunctive tool to strengthen clinical consultation. Parents and caregivers should be guided to videos from academic institutions or hospitals as a way of improving health literacy.

PMID:35357371 | DOI:10.1097/BPB.0000000000000972

Medicine (Baltimore). 2022 Mar 25;101(12):e29142. doi: 10.1097/MD.0000000000029142.

ABSTRACT

Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients’ information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.

PMID:35357356 | DOI:10.1097/MD.0000000000029142

Menopause. 2022 Jan 14;29(4):460-464. doi: 10.1097/GME.0000000000001936.

ABSTRACT

OBJECTIVE: To compare the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness and intraocular pressure in reproductive age and postmenopausal women.

METHODS: The study included 94 eyes of 47 reproductive age women (Group 1) and 94 eyes of 47 postmenopausal women (Group 2). In all women, RNFL and GCC thicknesses were measured by optical coherence tomography. Intraocular pressure levels were measured by Goldmann applanation tonometry. Generalized linear mixed models were conducted to test the differences between groups. Age- and body mass index (BMI)-adjusted partial correlation analysis was used to examine the associations between parameters.

RESULTS: There was a statistically significant difference in age and BMI between the two groups (P<0.001, P<0.001, respectively). There was no difference in all RNFL and GCC values between the reproductive age and postmenopausal women. The duration of postmenopause versus average, superior hemisphere, and superior values of RNFL and superior and inferior values of GCC were positively correlated with statistical significance in age- and BMI-adjusted partial correlation coefficient tests (r = 0.254, P = 0.017; r = 0.303, P = 0.004; r = 0.317, P = 0.003; r = 0.301, P = 0.004; r = 0.313, P = 0.003; r = 0.271, P = 0.011, with 95% confidence, respectively).

CONCLUSIONS: In this study, there was no significant difference in all RNFL and GCC values between the reproductive age and postmenopausal women after adjusting for age and BMI. However, we observed that a long postmenopausal period was associated with higher RNFL and GCC values.

PMID:35357368 | DOI:10.1097/GME.0000000000001936

Medicine (Baltimore). 2022 Mar 25;101(12):e29060. doi: 10.1097/MD.0000000000029060.

ABSTRACT

BACKGROUND: Although primary microvascular angina (PMVA) can be diagnosed clinically, the etiology and pathophysiology of PMVA remain unclear. The effects of conventional clinical medications (aspirin, statins, and nitrates) are unsatisfactory, and PMVA can lead to serious cardiovascular events. The present study was designed to analyze the correlation between the load perfusion cardiovascular magnetic resonance imaging (CMR) results and the Streptococcus sanguinis(S sanguinis) count and the correlations between the S sanguinis count in oral cavity subgingival plaque and changes in the plasma levels of platelet alpha-granule membrane glycoprotein 140 (GMP-140), fibrinopeptide A (FPA), von Willebrand factor (vWF), and homocysteine (Hcy) in patients with PMVA after increased anti-infective treatment of the oral cavity. This study also discusses the pathogenesis of PMVA from this perspective. The differences in the S sanguinis count in oral cavity subgingival plaque and oral health status between healthy people and PMVA patients will be compared, and the correlation between the oral cavity health status and disease in PMVA patients will be analyzed.

METHODS: The present randomized controlled trial with a parallel control group will be conducted in 68 PMVA patients diagnosed by the in-patient cardiology department. The selected patients will be randomly divided into 2 groups, one receiving routine drug treatment and the other a combination of anti-infective treatments. The normal control group will comprise 30 healthy people with no infectious oral cavity disease matched by age and sex. We will conduct CMR, and the presence of S sanguinis in subgingival plaques will be used to determine the bacterial count in PMVA patients. Blood samples will also be collected to determine the levels of GMP-140, FPA, vWF, and Hcy. S sanguinis in the subgingival plaque of PMVA patients will be further analyzed after increasing the oral cavity anti-infective treatment; the resulting changes and their correlations with changes in GMP-140, FPA, vWF, and Hcy levels will be assessed. Additionally, the differences in the S sanguinis count and the oral cavity health status of oral cavity dental plaque between healthy people and PMVA patients will be determined, and the correlation between the oral cavity conditions and PMVA will be analyzed. The relationship between the perfusion CMR results and the oral cavity S sanguinis count of PMVA patients, and the potential pathogenesis, will be explored. We will use the SPSS19.0 statistical software package to analyze the data. The measurements will be expressed as means±standard deviation. Student t test will be used for intergroup comparisons, a relative number description will be used for the count data, and the chi-square test will be used for intergroup comparisons. Multivariate logistic regression will be performed to identify associations. A P value < .05 will be considered significant.

DISCUSSION: In this study, the correlation between the perfusion CMR results and the S sanguinis count in oral cavity subgingival plaque of PMVA patients will be analyzed. Changes in the levels of GMP-140, FPA, vWF, and Hcy of PMVA patients after receiving increased oral cavity anti-infective treatment will be explored, and the difference in the S sanguinis count in oral cavity subgingival plaque and the oral cavity health status between healthy people and PMVA patients will be compared.

ATRIAL REGISTRATION: Chinese Clinical Trial Registry, (http://www.chictr.org.cn/showprojen.aspx?proj=45091).

PMID:35357350 | DOI:10.1097/MD.0000000000029060

J Pediatr Orthop B. 2022 Mar 31:BPB.0000000000000971. doi: 10.1097/BPB.0000000000000971. Online ahead of print.

ABSTRACT

Lockdowns due to COVID-19 increased known risk factors for nonaccidental trauma (NAT), including economic instability and parental stress. We sought to evaluate potential changes in the frequency and types of fractures associated with NAT during the COVID-19 pandemic. A retrospective cross-sectional study was conducted using de-identified data obtained from the IBM Watson Health Explorys Cohort Discovery database. Systematized Nomenclature of Medicine-Clinical Terms were used to query the database for victims of NAT in 2019 and 2020. Within this cohort of patients, we then identified those who were also diagnosed with a fracture within 21 days of the NAT event. Demographic data were compared between 2019 and 2020 where possible using chi-squared testing, and relative risks for various fracture diagnoses were calculated with 95% confidence intervals. There were 9500 records overall of pediatric NAT in 2019 compared to 9350 in 2020. Of those, in 2019 550 were associated with a diagnosis of fracture versus 570 in 2020. The relative risk of fracture due to NAT in 2020 when compared to 2019 was not significantly higher [relative risk, 1.05 (95% confidence interval, 0.94-1.17)]. The relative risk for each category of fracture diagnosis in 2020 was slightly higher, but not to a statistically significant degree. Despite increasing known risk factors, the frequency of NAT remained unchanged as the result of the COVID-19 pandemic. We also did not identify significant changes in the risk of fracture due to NAT, nor any changes in the associated types of fractures.

PMID:35357345 | DOI:10.1097/BPB.0000000000000971

JMIR Form Res. 2022 Mar 12. doi: 10.2196/35764. Online ahead of print.

ABSTRACT

BACKGROUND: Latinos are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic.

OBJECTIVE: 1) to implement and evaluate a crowdsourcing open contest to solicit a name for a COVID-19 social marketing campaign for Latinos in Maryland; and 2) to conduct a thematic analysis of submitted entries to guide campaign messaging.

METHODS: To assess the level of community engagement in this crowdsourcing open contest, we conducted descriptive statistics of entries and votes, and demographics of participants. Submitted text was analyzed through inductive thematic analysis.

RESULTS: We received 74 entries within a brief 2-week period. The top 10 entries were chosen by community judges and the winner was decided by popular vote. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We used these themes to directly inform our social marketing intervention and found that ads based on these themes became the highest performing.

CONCLUSIONS: Crowdsourcing open contests are an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by healthcare disparities such as Latino communities. Thematic analysis of contest entries can be a valuable strategy to inform the development of social marketing campaign materials.

PMID:35357317 | DOI:10.2196/35764