Tag: pubmed

Stat Med. 2022 Jun 8. doi: 10.1002/sim.9427. Online ahead of print.

ABSTRACT

Routinely-collected health data can be employed to emulate a target trial when randomized trial data are not available. Patients within provider-based clusters likely exert and share influence on each other’s treatment preferences and subsequent health outcomes and this is known as dissemination or spillover. Extending a framework to replicate an idealized two-stage randomized trial using routinely-collected health data, an evaluation of disseminated effects within provider-based clusters is possible. In this article, we propose a novel application of causal inference methods for dissemination to retrospective cohort studies in administrative claims data and evaluate the impact of the normality of the random effects distribution for the cluster-level propensity score on estimation of the causal parameters. An extensive simulation study was conducted to study the robustness of the methods under different distributions of the random effects. We applied these methods to evaluate baseline prescription for medications for opioid use disorder among a cohort of patients diagnosed with opioid use disorder and adjust for baseline confounders using information obtained from an administrative claims database. We discuss future research directions in this setting to better address unmeasured confounding in the presence of disseminated effects.

PMID:35673849 | DOI:10.1002/sim.9427

Rom J Morphol Embryol. 2021 Oct-Dec;62(4):1069-1075. doi: 10.47162/RJME.62.4.21.

ABSTRACT

The World Health Organization (WHO) estimates that one of five persons develops a cancer form during their lives. Out of the total of malignant cancer forms known up to the present, the statistics currently place breast cancer on the first rank at European level, as a type of neoplasm registered and treated with a standard protocol through the medical programs approved within public policies. The cost for the treatment of this type of oncological disease is enormous; for this reason, the state should manifest a direct interest for the prevention, early diagnose and investments in the research of mammary neoplasm. The coherence of national and European policies is achieved on a regular basis, subject to changes in Community legislation and the approval of European Commission (EC) documents that design unified approaches. This year, the emergence of the Europe’s Beating Cancer Plan, launched in 2021, has taken on the objective of investing in research and innovation, with a focus on the development of digital technologies that will increase expertise in genomics, onco-radiology, and digital health. The article analyzes the secondary data and empirical research collected at national and European level with the aim of highlighting the significant differences between public policies in Romania and France and identifying the pillars on which a national strategy similar to a functional European model can be built.

PMID:35673828 | DOI:10.47162/RJME.62.4.21

Rom J Morphol Embryol. 2021 Oct-Dec;62(4):991-1000. doi: 10.47162/RJME.62.4.11.

ABSTRACT

PURPOSE: Our retrospective study on 27 patients with a large mean macular hole diameter (MH-D) of 480.08±78.62 μm evaluates the usefulness of combining the current internal limiting membrane (ILM) inverted-flap surgical technique with silicone oil tamponade, which has been associated with the classical technique of ILM peeling.

RESULTS: Functional results: mean visual acuity (VA) improved to 0.89±0.11 logMar (logarithm of the minimum angle of resolution, at one month), 0.67±0.03 logMar (at three months), 0.52±0.04 logMar (at six months), 0.42±0.15 logMar (at one year) postoperative (final VA), with statistical linkage between preoperative VA and final VA (two-sample t-test, p=0.007), mean MH-D and final VA (regression analysis, p=0.003). We compared the results by MH size (Group A ≤400 μm – eight eyes and Group B >400 μm – 19 eyes), finding statistical variance (Bonett & Levene methods). Group A presented a final VA of 0.21±0.12 logMar, while Group B had 0.51±0.17 logMar. Successful closure was noted in 25 (92.59%) cases, with Group A having complete closure and external limiting membrane (ELM) restoration with ellipsoid zone (EZ) regeneration in six cases. Group B had successful closure in 17 (89.47%) cases with ELM restoration in 16 cases and EZ regeneration in seven (38.88%) cases, with reintervention in two cases. Restoration of the ELM was correlated [Pearson’s correlation coefficient (PCC) of 0.999, p=0.022] with successful closure, with overall restoration obtained in 24 (88.88%) cases and EZ regeneration in 13 (48.14%) cases.

CONCLUSIONS: ILM inverted-flap technique with silicone oil tamponade had favorable functional and anatomical outcomes. ELM restoration was associated with successful MH closure.

PMID:35673818 | DOI:10.47162/RJME.62.4.11

Rom J Morphol Embryol. 2021 Oct-Dec;62(4):1045-1050. doi: 10.47162/RJME.62.4.17.

ABSTRACT

Agenesis of permanent maxillary and mandibular canines is very rare; one to all four can be missing, isolated or in association with other missing teeth or with dental morphology abnormalities. Such cases can present functional, esthetic, and psychological problems, since the canine’s role in functional occlusion and in obtaining an aesthetic smile is crucial. Frequently, the canine’s absence from the arch is caused by impaction; its congenital absence is extremely rare in patients with no associated syndrome. The aim of this paper was to present a very rare case of a non-syndromic Romanian adult female patient with a unilateral permanent maxillary missing canine, in association with peg-shaped maxillary lateral permanent incisors, which can have a genetic cause, since the same morphological abnormality was present in her father and her younger sister, who also presented a rare situation of bilateral upper transposition between the canines and lateral incisors. The association of a permanent maxillary canine hypodontia with bilateral “peg laterals” and transposition between the maxillary canine and the peg-shaped lateral incisors is also rare as a family character in healthy patients. Future statistical studies are necessary to establish the incidence of permanent maxillary canine agenesis in Romanian population. Also, the article includes a detailed literature review of reported cases of agenesis of permanent maxillary canines.

PMID:35673824 | DOI:10.47162/RJME.62.4.17

Rom J Morphol Embryol. 2021 Oct-Dec;62(4):971-979. doi: 10.47162/RJME.62.4.09.

ABSTRACT

BACKGROUND AND AIM: Colonic serrated lesions are premalignant lesions, using an alternative malignization pathway, including multiple genetic and epigenetic alterations, as: mismatch repair deficiency due to MutL homolog 1 (MLH1) promoter methylation, tumor protein p53 (TP53) mutations, activating mutations of v-Raf murine sarcoma viral oncogene homolog B (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS). Our study aims to evaluate MLH1, BRAF and p53 immunohistochemical (IHC) status in sessile serrated lesions (SSLs), with and without dysplasia.

MATERIALS AND METHODS: This is a retrospective case-control study including 20 SSLs with dysplasia and 20 SSLs without dysplasia (matching sex and age). IHC expression of MLH1, BRAF and p53 was evaluated as the percent of nuclear loss of MLH1, cytoplasmic positivity of BRAF and nuclear positivity of p53. Data concerning age, sex, localization of the lesion, dysplasia and IHC results were statistically processed using Microsoft Excel.

RESULTS: We had very polymorphous patterns of IHC expression for BRAF, MLH1 and p53, especially in the dysplastic group. Thus, two patients were BRAF+∕MLH1-∕p53+, three were BRAF+∕MLH1-∕p53-, one was BRAF+∕MLH1+∕p53- and six were BRAF+∕MLH1+∕p53+. Dysplastic lesions without BRAF mutation exhibited the following phenotype: one case BRAF-∕MLH1-∕p53+, four BRAF-∕MLH1-∕p53- and three BRAF-∕MLH1+∕p53+. In the control group (SSLs without dysplasia), there was a more homogenous distribution of cases: eight cases BRAF+∕MLH1+∕p53-, seven BRAF-∕MLH1+∕p53-, one BRAF-∕MLH1-∕p53+, two BRAF-∕MLH1-∕p53- and two BRAF-∕MLH1+∕p53+.

CONCLUSIONS: There are more routes on the serrated pathway, with different mutations and time of acquisition of each genetic or epigenetic lesion with the same morphological result. These lesions should be stratified according to their risk to poor outcome and their need to further surveillance.

PMID:35673816 | DOI:10.47162/RJME.62.4.09

Rom J Morphol Embryol. 2021 Oct-Dec;62(4):939-949. doi: 10.47162/RJME.62.4.06.

ABSTRACT

BACKGROUND: Nephroblastoma is the most common renal malignancy in children kidney. They are highly heterogeneous tumors with challenging imagistic and histopathological (HP) differential diagnosis. Imaging is critical for understanding local anatomy, staging and for planning surgical approach.

PURPOSE: To determine whether HP staging can be successfully predicted by the imagistic staging using computed tomography. Also, we find it important to make a brief review of the imagistic, HP and immunohistochemical differential diagnosis of nephroblastoma, considering that a correct diagnosis is essential for an appropriate therapeutic strategy in all stages.

PATIENTS, MATERIALS AND METHODS: We present a retrospective study of the medical dossiers of 22 patients that underwent surgery at our Center between 2014 and 2020. We provided descriptive data and compared imagistic and HP staging using a Mann-Whitney U-test. An up-to-date literature review was also done.

RESULTS: We found that imagistic staging tends to under- or over-stage at similar rates and that the difference between the two staging systems is statistically significant. Immunohistochemistry is necessary for establishing the correct diagnosis, especially in cases with one predominant HP pattern.

CONCLUSIONS: HP and imagistic staging are not yet sufficiently similar for successfully predict the former via imagistic means.

PMID:35673813 | DOI:10.47162/RJME.62.4.06

Eur J Oral Sci. 2022 Jun 7:e12873. doi: 10.1111/eos.12873. Online ahead of print.

ABSTRACT

This study aimed to evaluate carbon nanotubes-hydroxyapatite nanocomposites as bioactive titanium implant coats and to assess the effect of near-infrared radiation on these nanocomposites. Carbon nanotubes were acid-functionalized, and hydroxyapatite was prepared by the wet-chemical precipitation method. Both precursors were used to prepare the carbon nanotubes-hydroxyapatite nanocomposites in two concentrations of hydroxyapatite (0.5 and 1 wt.%). The formed nanocomposites were characterized and used to coat silanized titanium discs and cylinders. Half the specimens of each group were radiated by near-infrared laser, then wettability and shear bond strength were tested for all specimens. Bioactivity was tested by monitoring the formation of calcium phosphate compounds after soaking in simulated body fluid. A significant increase in wettability and bond strength was found in the radiated coats compared to the non-radiated ones with the 1% hydroxyapatite group showing the highest values followed by 0.5% hydroxyapatite then the carbon nanotubes group. The two-way ANOVA test showed that both the difference in material and the laser treatment have had a statistically significant contribution to the increase in wettability and bond strength. The radiated groups also contributed to the formation of more calcium phosphate crystals of larger sizes and higher degrees of crystallinity.

PMID:35673772 | DOI:10.1111/eos.12873

J Health Organ Manag. 2022 Jun 7;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-03-2022-0088.

ABSTRACT

PURPOSE: Building leadership skills among faculty in academic medicine is essential, yet professional development programs focused on leadership are not always attentive to the needs of faculty on diverse career pathways or at differing career stages-nor are they often rigorously assessed. Evaluations commonly focus on participant satisfaction and short-term learning but not behavior change and institutional impact, which are difficult to assess but arguably more meaningful. Given the substantial time and money invested in these programs, more rigorous evaluation is critical.

DESIGN/METHODOLOGY/APPROACH: The authors evaluated an intensive, shared leadership-focused training program for early-career and mid-career faculty, offered by the University of Pittsburgh’s School of Medicine over the course of a year. They administered a pre/post-program assessment of confidence in key skill areas, and conducted semi-structured interviews with 21 participants between 1-4 years after program completion.

FINDINGS: Participants in both programs showed statistically significant improvement (p < 0.001) on every item measured in the pre/post-test. Analysis of the interviews revealed indications of substantial behavior change as well as institutional impact. The evaluation also suggested particular benefits for female professionals.

ORIGINALITY/VALUE: The authors conducted a long-term assessment of leadership training focused on career pathway and career stage and found that it (a) prompted both positive behavioral change and institutional impact and (b) suggested benefits for female faculty in particular, which could potentially help to eliminate gender-based disparities in leadership in academic medical centers.

PMID:35673769 | DOI:10.1108/JHOM-03-2022-0088

J Obstet Gynaecol. 2022 Jun 7:1-11. doi: 10.1080/01443615.2022.2071604. Online ahead of print.

ABSTRACT

Dropout of infertility treatments is a common phenomenon and many patients avoid continuing infertility treatments. Determining the total rate of treatment dropout, and related factors was the objective of the present systematic review and meta-analysis study. We performed an electronic literature search in Web of Science, Scopus, Embase, Cinhal, ProQuest and Medline databases and a manual search in Google scholar by using a set of Standard keywords. We included descriptive studies in English or Persian, from August 2000 to 2019. Finally, we extracted data of 25 papers for systematic review and 11 papers for meta-analysis. Data analysed by RevMan software. The results of the meta-analysis analysed by the random-effects model and studies heterogeneity analysed using the I2 calculation index. We tried to control high heterogeneity (because of the small amounts of p value and chi-square and large amount of I2) with statistical methods such as subgroup analysis and using random-effects model. The results showed that factors related to treatment, psychological and demographic/personal factors are the most common factors for dropout. It seems that educational and supportive programs on psychological, financial, therapeutic, demographic and personal factors can play an important role in reducing the incidence of infertility treatment’s drop out before completing the course of treatment.

PMID:35672872 | DOI:10.1080/01443615.2022.2071604

BMC Rheumatol. 2022 Jun 8;6(1):31. doi: 10.1186/s41927-022-00263-1.

ABSTRACT

OBJECTIVES: To determine the effect of omega-three supplementation with fish oil on serum urate, weight and body mass index (BMI) in people with gout.

METHODS: A pilot 6-month, randomized, open-label clinical trial was undertaken in people with gout with serum urate ≥ 0.36 mmol/l. Forty participants were randomized to receive 6.2 g omega-3 fish oil daily or no fish oil for 24 weeks. Blood was obtained monthly for serum urate and red cell EPA (20:5n-3) DHA (22:6n-3) were measured using a blood spot collection system.

RESULTS: There was no statistically significant difference in the mean (SEM) decrease in serum urate between baseline and week 24 between randomized groups: fish oil – 0.021 (0.02) mmol/l versus control – 0.006 (0.02) mmol/l. There was no significant difference in change in weight or BMI between baseline and week 24 between randomized groups. There was a statistically significant correlation between red cell omega-three concentrations and the total number of flares per participant between week 12 and week 24; total omega-three r = – 0.75 (p ≤ 0.001), EPA r = – 0.75 (p ≤ 0.001) and DHA r = -0.76 (p ≤ 0.001). In the omega-three fish oil group four participants reported gastrointestinal adverse effects definitely or probably related to the omega-three supplementation.

CONCLUSIONS: The lack of untoward effect of omega three fish oil supplementation on serum urate and BMI together with the relationship between higher omega-three concentrations and lower gout flares supports the development of further adequately powered clinical trials to determine the role of omega-three supplements as prophylaxis against gout flares in people starting urate lowering therapy. Clinical trial registration ACTRN12617000539336p Registered 13/04/2017.

PMID:35672866 | DOI:10.1186/s41927-022-00263-1