Tag: pubmed

Echocardiography. 2022 Mar 27. doi: 10.1111/echo.15345. Online ahead of print.

ABSTRACT

BACKGROUND: Little data exist regarding interreader variability of diastolic measurements and their application by the 2016 American Society of Echocardiography left ventricular (LV) diastolic function guidelines.

METHODS: Volunteers (n = 49) were recruited from an outpatient cardiology practice. The presence and grade of diastology dysfunction (DD) was determined by the 2016 LV diastology guideline algorithm. We determined the mean, standard deviation, coefficient of variation, and intraclass correlation coefficient (ICC) for each measurement and Fleiss K-statistic to define differences in grading DD. We determined predictors associated with disagreement of DD grade using odds ratios.

RESULTS: The mean LVEF was 56%, LAVI 32 ml/m² , and peak TR velocity was 2.3 m/s. The ICC for mitral inflow and tissue Doppler velocities were >.90, for LV volumes were .80-.86, and for LA volume was .56. The Fleiss K-value for the agreement of the presence of DD was .68 and for DD grade was .59. Variables with increased odds of disagreement were (1) at least one reader considering a TR signal uninterpretable (OR 12.0; 95% CI 1.3-109.6), (2) at least one reader assessing both LVEF 50%-55% and LAVI 29-39 ml/m² (OR 9.3; 95% CI 1.0-87), and (3) at least one reader assessing LVEF 50-55% (OR 3.8; 95% CI 1.1-13.4).

CONCLUSIONS: Using the 2016 ASE/EACVI diastology guidelines, we found excellent interrater reliability of Doppler measurements, moderate-good interrater reliability of volumetric measurements, and moderate-good but not excellent agreement for diastology grade.

PMID:35342988 | DOI:10.1111/echo.15345

J Oral Rehabil. 2022 Mar 28. doi: 10.1111/joor.13320. Online ahead of print.

ABSTRACT

BACKGROUND: Conflicting results exist between somatosensory profiles of patients with temporomandibular myalgia (TMDm). The objective of this review was to examine whether adults with TMDm show altered responses to dynamic quantitative sensory tests compared with healthy controls.

METHODS: We searched five electronic databases for studies, excluding those without suitable controls or where TMDm was associated with confounding non-musculoskeletal disorders. Risk of bias was assessed with the SIGN case-control study checklist. Findings were structured around dynamic quantitative sensory tests and their localization. Where possible, we performed meta-analysis with a random inverse variance model to compare patients with TMDm and healthy controls. Statistical heterogeneity was estimated with Chi² test and inconsistency index, I².

RESULTS: We extracted data from 23 studies comprising 1284 adults with chronic TMDm and 2791 healthy controls. Risk of bias was assessed as high for 20 studies. Mechanical temporal summation, the most studied phenomenon (14 studies), is increased in the upper limb of patients with TMDm (SMD = .43; 95% CI: .11 to .75; p = .0001) but not in the jaw area (p = .09) or in the cervical area (p = .29). Very little evidence for altered thermal temporal summation (five studies), conditioned pain modulation (seven studies), exercise-induced hypoalgesia (two studies), placebo analgesia (two studies), stress-induced hypoalgesia (one study) and offset analgesia (one study) was found.

DISCUSSION: A major limitation of this review was the risk of bias of included studies. Future studies would benefit from following methodological guidelines and consideration of confounding factors.

PMID:35342987 | DOI:10.1111/joor.13320

Med Phys. 2022 Mar 27. doi: 10.1002/mp.15625. Online ahead of print.

ABSTRACT

PURPOSE: The unpredictable interplay between dynamic proton therapy delivery and target motion in the thorax can lead to severe dose distortions. A fraction-wise four-dimensional (4D) dose reconstruction workflow allows for the assessment of the applied dose after patient treatment while considering the actual beam delivery sequence extracted from machine log files, the recorded breathing pattern and the geometric information from a 4D computed tomography scan (4DCT). Such an algorithm capable of accounting for amplitude-sorted 4DCTs was implemented and its accuracy as well as its sensitivity to input parameter variations was experimentally evaluated.

METHODS: An anthropomorphic thorax phantom with a movable insert containing a target surrogate and a radiochromic film was irradiated with a monoenergetic field for various 1D target motion forms (sin, sin4) and peak-to-peak amplitudes (5/10/15/20/30 mm). The measured characteristic film dose distributions were compared to the respective sections in the 4D reconstructed doses using a 2D γ-analysis (3mm, 3%); γ-pass rates were derived for different dose grid resolutions (1mm/3mm) and deformable image registrations (DIR, automatic/manual) applied during the 4D dose reconstruction process. In an additional analysis, the sensitivity of reconstructed dose distributions against potential asynchronous timing of the motion and machine log files was investigated for both a monoenergetic field and more realistic 4D robustly optimized fields by artificially introduced offsets of ± 1/5/25/50/250 ms. The resulting dose distributions with asynchronized log files were compared to those with synchronized log files by means of a 3D γ-analysis (1mm, 1%) and the evaluation of absolute dose differences.

RESULTS: The induced characteristic interplay patterns on the films were well reproduced by the 4D dose reconstruction with 2D γ-pass rates ≥95% for almost all cases with motion magnitudes ≤15 mm. In general, the 2D γ-pass rates showed a significant decrease for larger motion amplitudes and increase when using a finer dose grid resolution but were not affected by the choice of motion form (sin, sin4). There was also a trend, though not statistically significant, towards the manually defined DIR for better quality of the reconstructed dose distributions in the area imaged by the film. The 4D dose reconstruction results for the monoenergetic as well as the 4D robustly optimized fields were robust against small asynchronies between motion and machine log files of up to 5 ms, which is in the order of potential network latencies.

CONCLUSIONS: We have implemented a 4D log file-based proton dose reconstruction that accounts for amplitude-sorted 4DCTs. Its accuracy was proven to be clinically acceptable for target motion magnitudes of up to 15 mm. Particular attention should be paid to the synchronization of the log file generating systems as the reconstructed dose distribution may vary with log file asynchronies larger than those caused by realistic network delays. This article is protected by copyright. All rights reserved.

PMID:35342943 | DOI:10.1002/mp.15625

Muscle Nerve. 2022 Mar 27. doi: 10.1002/mus.27539. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients experience recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China.

METHODS: This retrospective study enrolled patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome (MFS). We evaluated clinical characteristics, cerebrospinal fluid (CSF) parameters, serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS.

RESULTS: Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P<0.001), whereas FT3 levels were higher in the monophasic GBS group (P=0.022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), and Hughes Functional Grading Scale (HFGS) at nadir were statistically significant between monophasic GBS patients and RGBS patients (P<0.05). The multivariate regression analysis revealed that antecedent illness, AIDP and high TSH were independent risk factors for RGBS. Our ROC curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87uIU/mL.

DISCUSSION: Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.

PMID:35342963 | DOI:10.1002/mus.27539

Eur J Clin Invest. 2022 Mar 28:e13782. doi: 10.1111/eci.13782. Online ahead of print.

ABSTRACT

There are no widely accepted, quantitative definitions for the end of a pandemic like COVID-19. The end of the pandemic due to a new virus and the transition to endemicity may be defined based on a high proportion of the global population having some immunity from natural infection or vaccination. Other considerations include diminished death toll, diminished pressure on health systems, reduced actual and perceived personal risk, removal of restrictive measures, and diminished public attention. A threshold of 70% of the global population having being vaccinated or infected was probably already reached in the second half of 2021. Endemicity may still show major spikes of infections and seasonality, but typically less clinical burden, although some locations are still hit more than others. Death toll and ICU occupancy figures are also consistent with a transition to endemicity by end 2021/early 2022. Personal risk for the vast majority of the global population was already very small by end 2021, but perceived risk may still be grossly over-estimated. Restrictive measures of high stringency have persisted in many countries by early 2022. The gargantuan attention in news media, social media, and even scientific circles should be tempered. Public health officials need to declare the end of the pandemic. Mid- and long-term consequences of epidemic waves and of adopted measures on health, society, economy, civilization, and democracy may perpetuate a pandemic legacy long after the pandemic itself has ended.

PMID:35342941 | DOI:10.1111/eci.13782

J Am Coll Emerg Physicians Open. 2022 Mar 17;3(2):e12705. doi: 10.1002/emp2.12705. eCollection 2022 Apr.

ABSTRACT

OBJECTIVE: Physician Orders for Life-Sustaining Treatment (POLST) forms exist in some form in all 50 states. This study evaluates emergency medical service (EMS) practitioners interpretation of the POLST in cardiopulmonary arrest.

METHODS: This study used a prospective convenience sample of California Bay Area EMS practitioners who reviewed 6 fictional scenarios of patients in cardiopulmonary arrest and accompanying California POLST forms. Based on the cases and POLST, EMS practitioners identified patient preference for “attempt resuscitation,” “do not attempt resuscitation/DNR,” or “unsure” and subsequently selected medical interventions (ie, chest compressions, defibrillation, and so on). They also rated their confidence in POLST use and interpretation.

RESULTS: In scenarios of cardiopulmonary arrest and POLST that indicated do not resuscitate (DNR)/do not attempt resuscitation (DNAR) and full treatment, only 45%-65% of EMS practitioners correctly identified the patient as DNR/DNAR. EMS practitioners were more likely to interpret the POLST correctly in scenarios where patients were DNR/DNAR but indicated selective treatment (86%; 168/196) or comfort-focused treatment (86%; 169/196). In cardiopulmonary arrest scenarios where the patient was correctly identified as DNR/DNAR, EMS practitioners frequently selected defibrillation, advanced airway, or epinephrine as appropriate treatment. For all 6 scenarios, there was no statistical difference in response selection with level of training (emergency medical technician/paramedics) or type of EMS personnel (fire based/private).

CONCLUSION: The POLST is a powerful tool to convey medical treatment preferences; however, there is significant variation in the interpretation and application by EMS practitioners. To improve the POLST effectiveness, the authors suggest more EMS input into POLST development, concise language that defines resuscitation, and more EMS education about clinical application.

PMID:35342899 | PMC:PMC8931303 | DOI:10.1002/emp2.12705

Perspect Behav Sci. 2021 May 13;45(1):259-294. doi: 10.1007/s40614-021-00289-9. eCollection 2022 Mar.

ABSTRACT

Multiple quantitative methods for single-case experimental design data have been applied to multiple-baseline, withdrawal, and reversal designs. The advanced data analytic techniques historically applied to single-case design data are primarily applicable to designs that involve clear sequential phases such as repeated measurement during baseline and treatment phases, but these techniques may not be valid for alternating treatment design (ATD) data where two or more treatments are rapidly alternated. Some recently proposed data analytic techniques applicable to ATD are reviewed. For ATDs with random assignment of condition ordering, the Edgington’s randomization test is one type of inferential statistical technique that can complement descriptive data analytic techniques for comparing data paths and for assessing the consistency of effects across blocks in which different conditions are being compared. In addition, several recently developed graphical representations are presented, alongside the commonly used time series line graph. The quantitative and graphical data analytic techniques are illustrated with two previously published data sets. Apart from discussing the potential advantages provided by each of these data analytic techniques, barriers to applying them are reduced by disseminating open access software to quantify or graph data from ATDs.

PMID:35342876 | PMC:PMC8894511 | DOI:10.1007/s40614-021-00289-9

Lancet Reg Health Eur. 2022 Mar 22;15:100344. doi: 10.1016/j.lanepe.2022.100344. eCollection 2022 Apr.

NO ABSTRACT

PMID:35342893 | PMC:PMC8943426 | DOI:10.1016/j.lanepe.2022.100344

Perspect Behav Sci. 2021 May 24;45(1):53-75. doi: 10.1007/s40614-021-00290-2. eCollection 2022 Mar.

ABSTRACT

Functional analysis (FA) is an integral component of behavioral assessment and treatment given that clinicians design behavioral treatments based on FA results. Unfortunately, the interrater reliability of FA data interpretation by visual analysis can be inconsistent, potentially leading to ineffective treatment implementation. Hall et al. (2020) recently developed automated nonparametric statistical analysis (ANSA) to facilitate the interpretation of FA data and Kranak et al. (2021) subsequently extended and validated ANSA by applying it to unpublished clinical data. The results of both Hall et al. and Kranak et al. support ANSA as an emerging statistical supplement for interpreting FA data. In the present article, we show how ANSA can be applied to interpret FA data collected in clinical settings in multielement and pairwise designs. We provide a detailed overview of the calculations involved, how to use ANSA in practice, and recommendations for its implementation. A free web-based application is available at https://ansa.shinyapps.io/ansa/.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40614-021-00290-2.

PMID:35342875 | PMC:PMC8894515 | DOI:10.1007/s40614-021-00290-2

Perspect Behav Sci. 2021 Sep 1;45(1):13-35. doi: 10.1007/s40614-021-00304-z. eCollection 2022 Mar.

ABSTRACT

This study investigated the power of two-level hierarchical linear modeling (HLM) to explain variability in intervention effectiveness between participants in context of single-case experimental design (SCED) research. HLM is a flexible technique that allows the inclusion of participant characteristics (e.g., age, gender, and disability types) as moderators, and as such supplements visual analysis findings. First, this study empirically investigated the power to estimate intervention and moderator effects using Monte Carlo simulation techniques. The results indicate that larger values for the true effects and the number of participants resulted in a higher power. The more moderators added to the model, the more participants needed to detect the effects with sufficient power (i.e., power ≥.80). When a model includes three moderators, at least 20 participants are required to capture the intervention effect and moderator effects with sufficient power. For that same condition, but only including one moderator, seven participants are sufficient. Specific recommendations for designing a SCED study with sufficient power to estimate intervention and moderator effects were provided. Second, this study introduced a newly developed user-friendly point and click Shiny tool, PowerSCED. This tool assists applied SCED researchers in designing a SCED study that has sufficient power to detect intervention and moderator effects. To end, the use of HLM with the inclusion of moderators was demonstrated using two previously published SCED studies in the journal School Psychology Quarterly.

PMID:35342874 | PMC:PMC8894540 | DOI:10.1007/s40614-021-00304-z