Tag: pubmed

Proc Natl Acad Sci U S A. 2022 Apr 12;119(15):e2114914119. doi: 10.1073/pnas.2114914119. Epub 2022 Apr 4.

ABSTRACT

SignificanceA large body of research in the social and behavioral sciences studies the impact of behavioral interventions (or “nudges”) on decisions. Although this work has been extremely influential, we currently lack an overarching theoretical framework for behavioral interventions that provides a systematic account of their behavioral consequences, cognitive and neurobiological mechanisms, and statistical interpretations. In this paper, we propose such a theoretical framework using the diffusion decision model, a quantitative theory of decision-making whose parameters offer a theoretically compelling characterization of choice underpinnings. Our results not only reveal insights about how context-based interventions alter behavior but also offer practitioners a model-based method for choosing between behavioral interventions based on different goals.

PMID:35377794 | DOI:10.1073/pnas.2114914119

Health Aff (Millwood). 2022 Apr;41(4):549-556. doi: 10.1377/hlthaff.2021.00440.

ABSTRACT

Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.

PMID:35377764 | DOI:10.1377/hlthaff.2021.00440

J Urol. 2022 Apr 4:101097JU0000000000002688. doi: 10.1097/JU.0000000000002688. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the incidence of 90-day complications after urethroplasty and identify factors associated with them.

METHODS: A single-institution, two-surgeon retrospective review was performed on patients undergoing urethroplasty from 08/2003-06/2020. Variables included the incidence, type and Clavien-Dindo grade of complications, patient age, individual comorbidities, comorbidity component of the Charlson comorbidity index (CCI), smoking status, obesity (BMI ≥35), bacteriuria, type of urethroplasty, stricture etiology, length, location, prior endoscopic procedures, previous urethroplasty, and pre-operative suprapubic catheterization. The primary outcome was the incidence of significant 90-day complications defined as Clavien grade ≥2. Descriptive statistics were used to summarize the results and binary logistic regression was used to examine the factors associated with 90-day complications.

RESULTS: Of the 1611 patients included in the analysis, 90-day complications (Clavien ≥2) occurred in 7.9% (128/1611) and were wound-related (3.5%), urinary tract infection (3.4%), cardiovascular (0.4%), catheter-related (0.2%), hematuria (0.1%), or retention (0.1%). On univariable binary logistic regression stricture location (p=0.04), stricture length (p=0.009), CCI (p<0.0001), prior urethroplasty (p=0.01) and bacteriuria (p=0.002) were associated with complications while age (p=0.3), etiology (p=0.2), smoking (p=0.2), obesity (p=0.3), failed endoscopic treatment (p=0.8), indwelling suprapubic catheter (p=0.7) and type of urethroplasty (p=0.09) were not. On multivariable analysis, increasing CCI (Odds Ratio 1.31, 95%CI 1.10-1.56; p=0.003), prior urethroplasty (O.R.1.86, 95%CI 1.09-3.17; p=0.02) and pre-operative bacteriuria (O.R.1.67, 95%CI 1.14-2.45; p=0.009) remained associated with 90-day complications.

CONCLUSION: Patients with increased comorbidities, prior urethroplasty and pre-operative bacteriuria are at higher risk for complications after urethroplasty and should be counselled accordingly in a shared decision-making model of care.

PMID:35377776 | DOI:10.1097/JU.0000000000002688

JCO Glob Oncol. 2022 Mar;8:e2100246. doi: 10.1200/GO.21.00246.

ABSTRACT

PURPOSE: Currently, limited information is available on care provided to breast cancer survivors in Singapore. This study aims to assess the quality of post-treatment cancer survivorship care among breast cancer survivors on the basis of compliance with international guidelines up to 5 years post-primary treatment.

METHODS: This study analyzed a cohort of 189 nonmetastatic breast cancer survivors recruited from the National Cancer Centre Singapore, Changi General Hospital, and KK Women’s and Children’s Hospital between November 2011 and September 2015. Data were retrieved from electronic medical records in 6-month intervals. Adherence to guidelines was assessed in four areas: (1) recurrent cancer surveillance, (2) monitoring and detecting late effects, (3) health care resource utilization, and (4) preventive care. Descriptive statistics, Kaplan-Meier, and regression analyses were conducted.

RESULTS: Annual surveillance mammogram adherence rates were ≥ 83% consistently. The most common new diagnosis was osteoporosis at an incidence rate of 102 (95% CI, 77.6 to 135) cases per 1,000 person-years. Overall, ≤ 10.1% of survivors had an emergency department or hospitalization visit. Oncologist services were overutilized, with a median of 6 (interquartile range: 4-10) visits in the first 6 months before reducing to a median of 2 (interquartile range: 1-3) visits biannually 3 years post-treatment. Bone mineral density test utilization rate adhered to guidelines for 92.2% of aromatase inhibitor recipients but only for 36.4% of premenopausal tamoxifen recipients.

CONCLUSION: Overall, adherence rates to surveillance and osteoporosis preventive care were high. Extensive utilization of oncologist services up to 5 years post-primary treatment could be reversed with strategies to engage and coordinate survivorship care with primary care providers, leveraging their strengths to improve adherence to health promotion and chronic disease management.

PMID:35377727 | DOI:10.1200/GO.21.00246

Ann Intern Med. 2022 Apr 5. doi: 10.7326/M21-2812. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increasing awareness of firearm-related deaths, evidence on the clinical and economic implications of nonfatal firearm injuries is limited.

OBJECTIVE: To measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their family members.

DESIGN: Cohort study.

SETTING: MarketScan Medicare and commercial claims data, 2008 to 2018.

PARTICIPANTS: 6498 survivors of firearm injuries matched to 32 490 control participants and 12 489 family members of survivors matched to 62 445 control participants.

INTERVENTION: Exposure to nonfatal firearm injury as a survivor or family member of a survivor.

MEASUREMENTS: Changes in health care spending, use, and morbidity from preinjury through 1 year postinjury relative to control participants, on average and by type and severity of firearm injury.

RESULTS: After nonfatal firearm injury, medical spending increased $2495 per person per month (402%) and cost sharing increased $102 per person per month (176%) among survivors relative to control participants (P < 0.001) in the first year after injury, driven by an increase in the first month of $25 554 (4122%) in spending and $1112 (1917%) in cost sharing per survivor (P < 0.001). All categories of health care use increased relative to the control group. Survivors had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders after firearm injury relative to control participants (P < 0.001), accompanied by increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants (P = 0.003). These overall clinical and economic changes were driven by intentional firearm injuries and more severe firearm injuries.

LIMITATION: Precision of diagnostic codes and generalizability to other patient populations, including Medicaid and uninsured patients.

CONCLUSION: In survivors, nonfatal firearm injuries led to increases in psychiatric disorders, substance use disorders, and pain diagnoses, alongside substantial increases in health care spending and use. In addition, mental health worsened among family members.

PRIMARY FUNDING SOURCE: National Institutes of Health.

PMID:35377713 | DOI:10.7326/M21-2812

Neuropsychology. 2022 Apr 4. doi: 10.1037/neu0000809. Online ahead of print.

ABSTRACT

OBJECTIVE: Cognitive impairment is common among individuals with Parkinson’s disease (PD). Intraindividual variability (IIV) is a measure of variability across multiple tasks of cognitive functioning. Due to the limited amount of research, particularly among individuals with PD, IIV has been an underutilized metric of cognitive functioning both in research and clinical practice. Previous research demonstrated that individuals with PD have greater variability in cognitive performance relative to controls, and that IIV is predictive of future cognitive impairments. The aim of this study is to investigate the association between baseline IIV and change in cortical and subcortical volumes among individuals with PD.

METHOD: The present study used data from 80 newly diagnosed PD patients who were part of a longitudinal cohort study (Parkinson progression marker initiative [PPMI]). Participants completed neuropsychological measures and underwent T1 structural magnetic resonance imaging (MRI) at baseline and the first annual follow-up. Neuropsychological tests assessed attention, processing speed, visuospatial functioning, verbal fluency learning, and memory. T1 scans were processed using standard Freesurfer protocols for extraction of regional volumes.

RESULTS: Greater IIV at baseline was predictive of change in cortical volume in posterior temporal/parietal regions over the 1-year period. Baseline IIV predicted cortical volume changes above and beyond the main effect of motor severity and the baseline statistical mean/global cognition score.

CONCLUSION: Our results provide initial evidence that IIV is a marker of longitudinal cortical volume loss. Evidence is building that IIV is a sensitive marker of cognitive impairment and the underlying neurodegeneration among individuals with PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35377683 | DOI:10.1037/neu0000809

Personal Disord. 2022 Apr 4. doi: 10.1037/per0000560. Online ahead of print.

ABSTRACT

Maternal borderline personality disorder (BPD) symptoms have been found to relate to parenting difficulties that subsequently predict children’s maladjustment. One specific area of difficulty for mothers with BPD symptoms surrounds responses to infant distress. Based in mentalization theories of BPD, the current study tested the relation between BPD symptom severity and maternal accuracy in predicting infant distress. Infant biological sex was also tested as a moderator. Participants included 101 mothers, varying in self-reported BPD symptom severity, and their 12- to 23-month-old infants. At a laboratory visit, mothers responded to structured questions about their predictions for infant distress behaviors in fear- and anger-eliciting tasks, which were then observed. Maternal accuracy represented the statistical association between maternal predictions and infant distress behaviors. Maternal accuracy did not differ between infant fear and anger. For male infants, mothers’ higher BPD symptom severity related to lower accuracy across fear and anger contexts. For female infants, BPD symptom severity did not influence maternal accuracy. Results are discussed in relation to existing theories of emotional disruption in the relationships between mothers with BPD symptoms and their infants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35377691 | DOI:10.1037/per0000560

Arch Orthop Trauma Surg. 2022 Apr 4. doi: 10.1007/s00402-022-04419-z. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrent hip dislocation after multiple revision total hip arthroplasty is a severe complication. Therefore, constrained acetabular liners (CL) have been used during salvage procedures. We report our experience of constrained liners in a re-revision setting with focus on re-dislocation. We also evaluated acetabular and femoral bone loss as potential risk factor.

METHODS: Between January 2013 and December 2016, 65 patients were treated in a single institution for revision and re-revision hip arthroplasty using CL. The indication for using a CL was a high risk of re-redislocation after multiple recurrent hip dislocation including failed Dual Mobility Cups (DMC). Compromising soft tissue defects as well as severe bone defect were therefore regarded as high risks. Thirty-eight patients (77.6%) underwent a minimum of three surgical procedures before the index revision procedure. Sixteen patients (24.6%) were excluded as they were lost to follow-up, expired before minimum follow-up or refused study participation, leaving 49 patients in the analysis (75.4%). The mean follow-up was 62 months (44-74; SD = 7.7). We assessed the following potential risk factors for revision or dislocation: type of surgical setting (septic/aseptic), BMI, cup inclination angle, size of liner used and acetabular and femoral bone loss according to Paprosky classification. The primary endpoints were dislocation or repeat revision for any reason.

RESULTS: Of the 49 patients, we found an overall re-revision rate of 40.8% (20/49) and a dislocation rate of 30.6% (15/49). There were no significant differences among the surgical re-revision rate or dislocation rate as a factor of patient characteristics. In terms of bone loss, there was a trend towards higher revision rates for increasing acetabular and femoral bone loss, but without statistical significance.

CONCLUSIONS: We found the use of a constrained liner in a re-revision setting still bears a high risk of re-revision and re-dislocation. Therefore we restrained from using constrained liners in favour of Dual mobility cups. In this study there was no significant higher dislocation rate in the subgroup of periprosthetic infection. Furthermore the rigid design of a constrained liner bears the known risk of structural failure of acetabular reconstruction implants. Severe acetabular or femoral bone defects seem to have an impact on the revision rate, but not on the dislocation rate with regards to the restored offset and center of the hip. Results have to be taken into context such that the study population inherently has a predisposition for poorer outcomes. Indications should be strongly filtered for patients at high risk for recurrent hip joint dislocation including failed DMCs with only limited bone loss and moderate soft tissue defects. Our modification to the existing classification with a high inter and intraobserver reliability will make future studies more comparable regarding revisions and bone stock loss. Still further research using objective and reproducible parameters is needed to better analyze data especially in the background of complex revision hip arthroplasty.

PMID:35377048 | DOI:10.1007/s00402-022-04419-z

Biomech Model Mechanobiol. 2022 Apr 4. doi: 10.1007/s10237-022-01571-8. Online ahead of print.

ABSTRACT

Personalized computational cardiac models are considered to be a unique and powerful tool in modern cardiology, integrating the knowledge of physiology, pathology and fundamental laws of mechanics in one framework. They have the potential to improve risk prediction in cardiac patients and assist in the development of new treatments. However, in order to use these models for clinical decision support, it is important that both the impact of model parameter perturbations on the predicted quantities of interest as well as the uncertainty of parameter estimation are properly quantified, where the first task is a priori in nature (meaning independent of any specific clinical data), while the second task is carried out a posteriori (meaning after specific clinical data have been obtained). The present study addresses these challenges for a widely used constitutive law of passive myocardium (the Holzapfel-Ogden model), using global sensitivity analysis (SA) to address the first challenge, and inverse-uncertainty quantification (I-UQ) for the second challenge. The SA is carried out on a range of different input parameters to a left ventricle (LV) model, making use of computationally efficient Gaussian process (GP) surrogate models in place of the numerical forward simulator. The results of the SA are then used to inform a low-order reparametrization of the constitutive law for passive myocardium under consideration. The quality of this parameterization in the context of an inverse problem having observed noisy experimental data is then quantified with an I-UQ study, which again makes use of GP surrogate models. The I-UQ is carried out in a Bayesian manner using Markov Chain Monte Carlo, which allows for full uncertainty quantification of the material parameter estimates. Our study reveals insights into the relation between SA and I-UQ, elucidates the dependence of parameter sensitivity and estimation uncertainty on external factors, like LV cavity pressure, and sheds new light on cardio-mechanic model formulation, with particular focus on the Holzapfel-Ogden myocardial model.

PMID:35377030 | DOI:10.1007/s10237-022-01571-8

Arch Virol. 2022 Apr 2. doi: 10.1007/s00705-022-05422-w. Online ahead of print.

ABSTRACT

With the widespread use of coronavirus disease 2019 (COVID-19) vaccines, a rapid and reliable method to detect SARS-CoV-2 neutralizing antibodies (NAbs) is extremely important for monitoring vaccine effectiveness and immunity in the population. The purpose of this study was to evaluate the performance of the RapiRead™ reader and the TestNOW™ COVID-19 NAb rapid point-of-care (POC) test for quantitative measurement of antibodies against the spike protein receptor-binding domain of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) in different biological matrices compared to chemiluminescence immunoassay (CLIA) methods. Ninety-four samples were collected and analyzed using a RapiRead™ reader and TestNOW™ COVID-19 NAb kits for detecting neutralizing antibodies, and then using two CLIAs. The data were compared statistically using the Kruskal-Wallis test for more than two groups or the Mann-Whitney test for two groups. Specificity and sensitivity were evaluated using a receiver operating characteristic (ROC) curve. Good correlation was observed between the rapid lateral flow immunoassay (LFIA) test system and both CLIA methods. RapiRead™ reader/TestNOW™ COVID-19 NAb vs. Maglumi: correlation coefficient (r) = 0.728 for all patients; r = 0.841 for vaccinated patients. RapiRead™ reader/TestNOW™ COVID-19 NAb vs. Mindray: r = 0.6394 in all patients; r = 0.8724 in vaccinated patients. The time stability of the POC serological test was also assessed considering two times of reading, 12 and 14 minutes. The data revealed no significant differences. The use of a RapiRead™ reader and TestNOW™ COVID-19 NAb assay is a quantitative, rapid, and valid method for detecting SARS-CoV-2 neutralizing antibodies and could be a useful tool for screening studies of SARS-CoV-2 infection and assessing the efficacy of vaccines in a non-laboratory context.

PMID:35377034 | DOI:10.1007/s00705-022-05422-w