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Deep-learning image-reconstruction algorithm for dual-energy CT angiography with reduced iodine dose: preliminary results

Clin Radiol. 2021 Nov 12:S0009-9260(21)00511-0. doi: 10.1016/j.crad.2021.10.014. Online ahead of print.

ABSTRACT

AIM: To evaluate the computed tomography (CT) attenuation values, background noise, arterial depiction, and image quality in whole-body dual-energy CT angiography (DECTA) at 40 keV with a reduced iodine dose using deep-learning image reconstruction (DLIR) and compare them with hybrid iterative reconstruction (IR).

MATERIAL AND METHODS: Whole-body DECTA with a reduced iodine dose (200 mg iodine/kg) was performed in 22 patients, and DECTA data at 1.25-mm section thickness with 50% overlap were reconstructed at 40 keV using 40% adaptive statistical iterative reconstruction with Veo (hybrid-IR group), and DLIR at medium and high levels (DLIR-M and DLIR-H groups). The CT attenuation values of the thoracic and abdominal aortas and iliac artery and background noise were measured. Arterial depiction and image quality on axial, multiplanar reformatted (MPR), and volume-rendered (VR) images were assessed by two readers. Quantitative and qualitative parameters were compared between the hybrid-IR, DLIR-M, and DLIR-H groups.

RESULTS: The vascular CT attenuation values were almost comparable between the three groups (p=0.013-0.97), but the background noise was significantly lower in the DLIR-H group than in the hybrid-IR and DLIR-M groups (p<0.001). The arterial depictions on axial and MPR images and in almost all arteries on VR images were comparable (p=0.14-1). The image quality of axial, MPR, and VR images was significantly better in the DLIR-H group (p<0.001-0.015).

CONCLUSION: DLIR significantly reduced background noise and improved image quality in DECTA at 40 keV compared with hybrid-IR, while maintaining the arterial depiction in almost all arteries.

PMID:34782114 | DOI:10.1016/j.crad.2021.10.014

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Evaluating the effects of a Therapeutic Day Rehabilitation program and inclusion of gardening in an Australian Rural Community Health Service

Aust J Prim Health. 2021 Nov 16. doi: 10.1071/PY20294. Online ahead of print.

ABSTRACT

Therapeutic day rehabilitation (TDR) is a non-residential intensive structured program designed for individuals recovering from substance misuse. A weekly afternoon of therapeutic gardening was a new incentive initiated in a TDR program at one Australian community health service, designed to give participants the opportunity to spend time outdoors connecting with nature and each other. The aim of this study was to explore perceptions of participants enrolled in this program by employing a convergent parallel mixed-method design using qualitative individual, semi-structured interviews (n = 14) and longitudinal quantitative quality of life (QOL) data at three different intervals (n = 17). The analysis of the quantitative data showed that there was a statistically significant increase in the participants’ QOL scores in three of four domains (physical health, psychological, social relationships) when comparing baseline and post completion of the TDR. These observed changes were maintained at the 4-week follow up. The key findings from the semi-structured interviews include positive effects for participants on social connectivity, structure and achievement, understanding of recovery and relaxation from contact with nature. This study shows that a combination of TDR and therapeutic gardening can improve participants’ physical health, psychological health and social relationships.

PMID:34782059 | DOI:10.1071/PY20294

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Ondansetron and metoclopramide as second-line antiemetics in women with nausea and vomiting in pregnancy: the EMPOWER pilot factorial RCT

Health Technol Assess. 2021 Nov;25(63):1-116. doi: 10.3310/hta25630.

ABSTRACT

BACKGROUND: Around one-third of pregnant women suffer from moderate to severe nausea and vomiting, causing physical and emotional distress and reducing their quality of life. There is no cure for nausea and vomiting in pregnancy. Management focuses on relieving symptoms and preventing morbidity, and often requires antiemetic therapy. National guidelines make recommendations about first-, second- and third-line antiemetic therapies, although care varies in different hospitals and women report feeling unsupported, dissatisfied and depressed.

OBJECTIVES: To determine whether or not, in addition to intravenous rehydration, ondansetron compared with no ondansetron and metoclopramide compared with no metoclopramide reduced the rate of treatment failure up to 10 days after drug initiation; improved symptom severity at 2, 5 and 10 days after drug initiation; improved quality of life at 10 days after drug initiation; and had an acceptable side effect and safety profile. To estimate the incremental cost per treatment failure avoided and the net monetary benefits from the perspectives of the NHS and women.

DESIGN: This was a multicentre, double-dummy, randomised, double-blinded, dummy-controlled 2 × 2 factorial trial (with an internal pilot phase), with qualitative and health economic evaluations.

PARTICIPANTS: Thirty-three patients (who were < 17 weeks pregnant and who attended hospital with nausea and vomiting after little or no improvement with first-line antiemetic medication) who attended 12 secondary care NHS trusts in England, 22 health-care professionals and 21 women participated in the qualitative evaluation.

INTERVENTIONS: Participants were randomly allocated to one of four treatment groups (1 : 1 : 1: 1 ratio): (1) metoclopramide and dummy ondansetron; (2) ondansetron and dummy metoclopramide; (3) metoclopramide and ondansetron; or (4) double dummy. Trial medication was initially given intravenously and then continued orally once women were able to tolerate oral fluids for a maximum of 10 days of treatment.

MAIN OUTCOME MEASURES: The primary end point was the number of participants who experienced treatment failure, which was defined as the need for further treatment because symptoms had worsened between 12 hours and 10 days post treatment. The main economic outcomes were incremental cost per additional successful treatment and incremental net benefit.

RESULTS: Of the 592 patients screened, 122 were considered eligible and 33 were recruited into the internal pilot (metoclopramide and dummy ondansetron, n = 8; ondansetron and dummy metoclopramide, n = 8; metoclopramide and ondansetron, n = 8; double dummy, n = 9). Owing to slow recruitment, the trial did not progress beyond the pilot. Fifteen out of 30 evaluable participants experienced treatment failure. No statistical analyses were performed. The main reason for ineligibility was prior treatment with trial drugs, reflecting an unpredicted change in prescribing practice at several points along the care pathway. The qualitative evaluation identified the requirements of the study protocol, in relation to guidelines on anti-sickness drugs, and the diversity of pathways to care as key hurdles to recruitment while the role of research staff was a key enabler. No important adverse events or side effects were reported.

LIMITATIONS: The pilot trial failed to achieve the recruitment target owing to unforeseen changes in the provision of care.

CONCLUSIONS: The trial was unable to provide evidence to support clinician decisions about the best choice of second-line antiemetic for nausea and vomiting in pregnancy.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN16924692 and EudraCT 2017-001651-31.

FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 63. See the NIHR Journals Library website for further project information.

PMID:34782054 | DOI:10.3310/hta25630

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STI testing among young people attending music festivals in New South Wales, Australia: exploring the client segmentation concept in the ‘Down to Test’ program

Sex Health. 2021 Nov 16. doi: 10.1071/SH21101. Online ahead of print.

ABSTRACT

BACKGROUND: The ‘Down to Test (DTT)’ campaign is a sexually transmissible infection (STI) social marketing intervention delivered through outdoor music festival activations and supported by digital media communications in New South Wales, Australia. This paper investigates whether and how the tailored messages reached the intended audience.

METHODS: Data was collected through three annual rounds of online surveys post campaign exposure, targeting young people (aged 15-29years) attending 14 music festivals in NSW from October 2017 to March 2020. Descriptive statistics, principal component analysis and multivariable logic regression were applied to identify the key client segment and factors associated with a strong intention for future STI screening.

RESULTS: Of the 10044 participants with a valid urine specimen submitted, 261 (2.8%) tested positive for chlamydia. Altogether, 1776 participants (median age=22) self-completed the evaluation surveys online with more being female (73.4%) than male (26.2%). Participants were mostly Australian-born (89.5%), heterosexual (82.6%) and the majority being sexually active (96.7%). Rates of self-reported lifetime STI testing (70.4%) and intention for future STI screening (‘definitely yes’ in the next 12months, 39.0%) were also high. The most significant factor associated with future intention for STI testing is the Sexual Experience and Perception Factor (adjusted odds ratio [AOR]=2.02; 95%CI 1.76-2.32; P<0.001), followed by the Sexual Beliefs and Attitudes Factor (AOR=1.14; 95% CI 1.01-1.30; P<0.05).

CONCLUSIONS: The NSW state-wide DTT campaign has largely reached sexually active youth who are attentive to sexual health promotion messages and contributed to enhanced STI screening in a fun and peer-supportive environment.

PMID:34782058 | DOI:10.1071/SH21101

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Effect of Intramuscular Dexmedetomidine Administration Before Extubation on Post-Extubation Haemodynamics, Postoperative Sedation, and Analgesic Requirements: A Double Blind Placebo Controlled Study

Asian J Anesthesiol. 2021 Sep 1;59(3):102-110. doi: 10.6859/aja.202109_59(3).0004.

ABSTRACT

BACKGROUND: Dexmedetomidine, an α2-adrenoreceptor agonist has been successfully used for attenuating stress response to laryngoscopy. The present study was designed to evaluate the effects of intramuscular dexmedetomidine 30 minutes before extubation on hemodynamic response in patients undergoing laminectomy for prolapsed intervertebral disc (PIVD) under endotracheal intubation and general anesthesia.

METHODS: Present double-blinded randomized placebo-controlled study, included 100 patients from either sex with American Society of Anesthesiologists grades I and II and age from 18 to 60 years undergoing laminectomy for PIVD under general anesthesia. Patients were randomly divided into two groups of 50 each based on computer generated random numbers. The study group received dexmedetomidine (2.0 μg/ kg, i.m.) in 2.5 mL saline, and the control group received normal saline (placebo, i.m.) 2.5 mL. Drugs had been administered 30 minutes before anticipated time of extubation intramuscularly at the deltoid region. Comparison of continuous variables between two groups was done by using student’s unpaired t-test. Categorical data were analyzed by using chi-square test and Fischer Exact test as applicable.

RESULTS: Heart rate was found to be significantly lower in the study group, 15 minutes before extubation (P = 0.003), during and after extubation (P < 0.0001). The systolic and diastolic blood pressure was significantly lower in the study group during and after extubation (P < 0.05). Cough was significantly lower in the study group during extubation. No significant difference was observed in other complications (respiratory stridor, incidence of laryngospasm or bronchospasm and reintubation) between the two groups. Pain score at 5 minutes, 2 hours, and 4 hours post-extubation was significantly lower in the study group (P < 0.01). P-value < 0.05 was considered statistically significant.

CONCLUSIONS: Dexmedetomidine provides haemodynamic stability during extubation and post-extubation. It also provides post-operative calmness and reduces analgesic requirement and post-extubation complications.

PMID:34781421 | DOI:10.6859/aja.202109_59(3).0004

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Use of Homeopathic Arnica montana 30cH for Postoperative Analgesia in Female Dogs Undergoing Elective Ovariohysterectomy

Homeopathy. 2021 Nov 15. doi: 10.1055/s-0041-1732352. Online ahead of print.

ABSTRACT

BACKGROUND: Ovariohysterectomy (OH) is one of the most frequent elective surgical procedures in routine veterinary practice. Arnica montana is a well-known medicine in phytotherapy, with proven analgesic, anti-inflammatory, antiseptic, healing, antioxidant and immunomodulatory activity. However, there is still a shortage of studies on the action and effects of the homeopathic formulation of the medicine on animals. The aim of this study was to evaluate analgesia with Arnica montana 30cH during the postoperative period after elective OH.

METHODS: Thirty healthy female dogs, aged 1 to 3 years, weighing 7 to 14 kg, were selected at the Veterinary Hospital in Campo Mourão, Paraná, Brazil. The dogs underwent the surgical procedure with an anaesthetic protocol and analgesia that had the aim of maintaining the patient’s wellbeing. After the procedure, they were randomly divided into three groups of 10. One group received Arnica montana 30cH; another received 5% hydroalcoholic solution; and the third group, 0.9% NaCl saline solution. All animals received four drops of the respective solution sublingually and under blinded conditions, every 10 minutes for 1 hour, after the inhalational anaesthetic had been withdrawn. The Glasgow Composite Measure Pain Scale was used to analyse the effect of therapy. Analysis of variance (ANOVA) followed by the Tukey test was used to evaluate the test data. Statistical differences were deemed significant when p ≤0.05.

RESULTS: The Arnica montana 30cH group maintained analgesia on average for 17.8 ± 3.6 hours, whilst the hydroalcoholic solution group did so for 5.1 ± 1.2 hours and the saline solution group for 4.1 ± 0.9 hours (p ≤0.05).

CONCLUSION: These data demonstrate that Arnica montana 30cH presented a more significant analgesic effect than the control groups, thus indicating its potential for postoperative analgesia in dogs undergoing OH.

PMID:34781409 | DOI:10.1055/s-0041-1732352

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Tissue Engineered Skeletal Muscle Model of Rheumatoid Arthritis Using Human Primary Skeletal Muscle Cells

J Tissue Eng Regen Med. 2021 Nov 15. doi: 10.1002/term.3266. Online ahead of print.

ABSTRACT

Rheumatoid arthritis (RA) is a chronic inflammatory disease primarily targeting the joints. Autoreactive immune cells involved in RA affect other tissues, including skeletal muscle. Patients with RA experience diminished physical function, limited mobility, reduced muscle function, chronic pain, and increased mortality. To explore the impact of RA on skeletal muscle, we engineered electrically responsive, contractile human skeletal muscle constructs (myobundles) using primary skeletal muscle cells isolated from the vastus lateralis muscle of 11 RA patients (aged 57-74) and 10 aged healthy donors (aged 55-76), as well as from the hamstring muscle of 6 young healthy donors (less than 18 years of age) as a benchmark. Since all patients were receiving treatment for the disease, RA disease activity was mild. In 2D culture, RA myoblast purity, growth rate, and senescence were not statistically different than aged controls; however, RA myoblast purity showed greater variance compared to controls. Surprisingly, in 3D culture, contractile force production by RA myobundles was greater compared to aged controls. In support of this finding, assessment of RA myofiber maturation showed increased area of sarcomeric α-actinin expression over time compared to aged controls. Furthermore, a linear regression test indicated a positive correlation between sarcomeric α-actinin protein levels and tetanus force production in RA and controls. Our findings suggest that medications prescribed to RA patients may maintain-or even enhance-muscle function, and this effect is retained and observed in in vitro culture. Future studies regarding the effects of RA therapeutics on RA skeletal muscle, in vivo and in vitro, are warranted. This article is protected by copyright. All rights reserved.

PMID:34781416 | DOI:10.1002/term.3266

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Sexual Self-esteem in Trans*People: Development of a New Questionnaire and Clinical Evaluation

Psychother Psychosom Med Psychol. 2021 Nov 15. doi: 10.1055/a-1658-0977. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: Our purpose was to develop a new instrument for the assessment of sexual self-esteem in German and to examine its psychometric properties. Subsequently, we aimed to investigate sexual self-esteem in trans*people.

METHODS: The construction and validation of the sexual self-esteem scale was realized in a sample of the general population (N=426; Study 1, online) based on confirmatory factor analysis and statistical item analysis. We then investigated an outpatient sample of trans*people (N=85; study 2) to compare sexual self-esteem with the population sample and to examine the associations between sexual self-esteem, body experience, and psychological and psychosomatic distress.

RESULTS: An acceptable model fit and good internal consistency for the final unidimensional 8-item solution of the sexual self-esteem scale (SSES) were confirmed. Sexual self-esteem was moderately associated with global self-esteem in the population sample. Trans*people showed a significantly lower sexual self-esteem compared to the normal population. Results also revealed the expected associations with body experience, but no association with psychological and psychosomatic distress.

CONCLUSION: The SSES is the first German-language and gender-neutral instrument to assess sexual self-esteem and provides good psychometric properties. It appears promising for monitoring the course and success of the transition treatment of trans*people as well as for its application in couples and sexual therapy.

PMID:34781378 | DOI:10.1055/a-1658-0977

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Proposal of a Basic Documentation for Child, Adolescent and Family Psychosomatics Based on a Synopsis of Basic Documentations for Children, Adolescents and Adults

Psychother Psychosom Med Psychol. 2021 Nov 15. doi: 10.1055/a-1635-6630. Online ahead of print.

ABSTRACT

In psychiatry, psychosomatics and psychotherapy, basic documentation (BaDo) is used as a quality assurance tool. For the field of child, adolescent and family psychosomatics, there is no uniform BaDo that can be used across facilities and care areas. The aim of the study was to propose a catalog of characteristics for the context of psychosomatic treatment of children and adolescents on the basis of a synoptic comparison of established BaDos METHODS: In the context of a qualitative document analysis, BaDo items from the children/youth and adult sector were evaluated in content analysis along a category system. The resulting aspects were then classified according to age and multidisciplinary content and evaluated with regard to their child/youth specificity. Descriptive statistical analysis of the results was performed RESULTS: Aspects of the categories Family Anamnesis and Biographical Anamnesis specified a BaDo for children and adolescents. For BaDos from the psychosomatic field, a record of pre-treatments was accentuated across age groups. The recording of socio-demographic data had to be adapted conceptually to the age-related needs of children and adolescents. CONCLUSION: On the basis of an empirical approach, a modular BaDo for child, youth and family psychosomatics could be formulated that enables institutional, sectoral and interdisciplinary evaluations. In a next step, the instrument should be evaluated in an application study and be consented to on a broad level.

PMID:34781379 | DOI:10.1055/a-1635-6630

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Impact of Complex Wounds on Health-Related Quality of Life: A Descriptive Study

J Wound Ostomy Continence Nurs. 2021 Nov-Dec 01;48(6):504-509. doi: 10.1097/WON.0000000000000824.

ABSTRACT

PURPOSE: To describe health-related quality of life (HRQoL) using the Wound-Quality of Life (Wound-QoL) questionnaire for those individuals referred to an academic medical center wound clinic.

DESIGN: Prospective, descriptive study.

SUBJECTS AND SETTING: One hundred eleven participants receiving care in an academic medical center wound clinic in the Southeastern United States. The sample comprised 67 males (60.4%) and 44 females (39.6%) with wounds of 6 major etiologies.

METHODS: From June 2019 through May 2020, a convenience sample of 111 individuals completed the Wound-QoL questionnaire at the initial visit to the wound clinic. The Wound-QoL questionnaire is a valid and reliable tool consisting of 17 questions related to wound-QoL measured on a 5-point Likert scale, ranging from 0 (not at all affected) to 4 (very much affected). The questions are assigned to the 3 subscales: “body,” “psyche,” and “everyday life.” The Wound-QoL individual items, subscales, and the total wound score (TWS) were calculated as mean values of the item scores, ranging from 0 to 4, where higher values correspond to decreased HRQoL. The TWS is defined as the sum of the 17 item responses, with values ranging from 0 to 68. Descriptive and parametric statistics were used to analyze the data from the Wound-QoL questionnaire.

RESULTS: The mean TWS was approximately 3 points higher for Whites (n = 84) than for Blacks (n = 27) (32.42, SD = 17.96 vs 29.51, SD = 19.39), but this difference was not significant (P = .473). An independent-samples t test of TWS versus sex was not significant (P = .446). The TWS by age category was significant (P = .015), showing differences in mean scores based on age category. We found that the youngest (ages 17-39 years) and oldest (ages 70-98 years) participants were less bothered by their wounds in almost all respects than those in the middle age range (ages 40-69 years). The individual item means varied between 0.84 and 2.72, out of a possible range of 0 to 4. The highest means were for items on the emotional subscale with means from 1.93 to 2.72. Analysis of variance was used to examine the TWS and the 3 subscales over the 6 wound types; none were found to be significant (TWS: P = .454, body: P = .722, psyche: P = .452, everyday life: P = .087).

CONCLUSION: Wound-QoL questionnaire scores indicated that the greatest impact of a wound on HRQoL was on the emotional subscale. These 4 items are related to the individual expressing worry, fear, unhappiness, or frustration with wound healing. The Wound-QoL questionnaire may be used to evaluate the impact the wound has on the individual’s HRQoL.

PMID:34781305 | DOI:10.1097/WON.0000000000000824