Tag: pubmed

Biom J. 2022 Feb 3. doi: 10.1002/bimj.202100077. Online ahead of print.

ABSTRACT

The wide-scale adoption of electronic health records (EHRs) provides extensive information to support precision medicine and personalized health care. In addition to structured EHRs, we leverage free-text clinical information extraction (IE) techniques to estimate optimal dynamic treatment regimes (DTRs), a sequence of decision rules that dictate how to individualize treatments to patients based on treatment and covariate history. The proposed IE of patient characteristics closely resembles “The clinical Text Analysis and Knowledge Extraction System” and employs named entity recognition, boundary detection, and negation annotation. It also utilizes regular expressions to extract numerical information. Combining the proposed IE with optimal DTR estimation, we extract derived patient characteristics and use tree-based reinforcement learning (T-RL) to estimate multistage optimal DTRs. IE significantly improved the estimation in counterfactual outcome models compared to using structured EHR data alone, which often include incomplete data, data entry errors, and other potentially unobserved risk factors. Moreover, including IE in optimal DTR estimation provides larger study cohorts and a broader pool of candidate tailoring variables. We demonstrate the performance of our proposed method via simulations and an application using clinical records to guide blood pressure control treatments among critically ill patients with severe acute hypertension. This joint estimation approach improves the accuracy of identifying the optimal treatment sequence by 14-24% compared to traditional inference without using IE, based on our simulations over various scenarios. In the blood pressure control application, we successfully extracted significant blood pressure predictors that are unobserved or partially missing from structured EHR.

PMID:35112726 | DOI:10.1002/bimj.202100077

J Clin Sleep Med. 2022 Feb 4. doi: 10.5664/jcsm.9930. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Chronic pain is associated with insomnia. The objective of this clinical study is to compare the efficacy and safety of different prescribed doses of zopiclone and clonidine; for the management of insomnia in patients with chronic pain.

METHODS: A prospective observational crossover study of 160 consenting adult patients who underwent pain management. For insomnia treatment, each patient ingested different prescribed doses of zopiclone or clonidine on alternate nights. Each patient used a special validated sleep diary to collect data including pain score, sleep scores, sleep duration, sleep medication dose, and adverse effects. Each patient completed the diary for 3 continuous weeks. Pain was measured using the numeric pain rating scale. Sleep score was measured using the Likert sleep scale. A change in the pain or sleep scores by 2-points was considered significant. Of the 160 study participants, 150 (93.8%) completed the study successfully; and their data were analyzed. Data were analyzed with IBM SPSS Statistics 25 (IBM Corp, Armonk, NY); using Student’s t-test, ANOVA, Pearson Chi-square test, and regression analysis. P-value <0.05 was considered significant.

RESULTS: Pain score was lower with clonidine than zopiclone (p=0.025). Time to fall asleep was shorter with clonidine than zopiclone (p=0.001). Feeling rested on waking in the morning was better with clonidine than zopiclone (p=0.015). Overall sleep quality was better with clonidine than zopiclone (p=0.015). Total Likert sleep score was better with clonidine than zopiclone (p=0.005). Total sleep duration was better with clonidine than zopiclone (p=0.013). Adverse effects were commoner with zopiclone; including collapse, fall, confusion, amnesia, mood disorder, hallucination, nightmare, nocturnal restlessness, locomotor dysfunction, hunger, nausea and headache. Minor adverse effect of dry mouth was commoner with clonidine.

CONCLUSIONS: Clonidine is significantly better than zopiclone regarding sleep quality, analgesia, tolerability profile, and patient safety. Further studies will be beneficial to compare clonidine with other insomnia medications.

PMID:35112665 | DOI:10.5664/jcsm.9930

Rev Esc Enferm USP. 2022 Jan 28;56:e20210249. doi: 10.1590/1980-220X-REEUSP-2021-0249. eCollection 2022.

ABSTRACT

OBJECTIVE: To identify factors related to tissue complications resulting from insulin therapy.

METHOD: This is a descriptive, cross-sectional study carried out in a capital of northeastern Brazil. A semi-structured form and an observation guide were applied to assess the performance of insulin preparation and administration techniques. Descriptive statistics, association test, and multivariate logistic regression were used for data analysis.

RESULTS: Most participants were female (74.2%), aged between 51 and 70 years (50.0%), and had nine to eleven years of education (36.7%). The presence of some type of local complication in 73.5% of the participants and the failure to rotate the injection sites in 82.3% are highlighted. Being single/widowed and not rotating insulin application sites were related to local complications and increased the chances of their occurrence by 3.51 and 6.70 times, respectively.

CONCLUSION: Marital status and nonrotation of injection site were related to the increased chances of tissue complications resulting from insulin therapy.

PMID:35112702 | DOI:10.1590/1980-220X-REEUSP-2021-0249

Curr Med Res Opin. 2022 Feb 3:1-14. doi: 10.1080/03007995.2022.2037847. Online ahead of print.

ABSTRACT

BACKGROUND: Histamine 2 receptor antagonists (H2RA) are amongst the most entrenched antacid therapies available including over-the-counter. They have an excellent safety profile including no known teratogenic risk. Fracture risk is generally recognized with chronic proton pump inhibitor (PPI) therapy in adults and children although the related mechanism is poorly understood. The analogous risk in H2RAs, including in children, is unclear. We studied the fracture risk and characteristics among hospitalized pediatric patients exposed to H2RA compared to an untreated cohort.

METHODS: The Pediatric Health Information System (PHIS) multicenter database was queried for hospital encounters of children aged 6 months – 15.5 years and between 7/2016 – 8/2017. Patients with comorbidities and medications including PPI that predispose for fractures were excluded from the cohort and a propensity matched control was identified. The subjects and controls were followed for 2 years for hospitalization with a fracture diagnoses.

RESULTS: Our cohort included 3,526 patients with exposure to H2RA and matched controls. Fractures were reported in 1% of patients (67) with no statistical difference between the groups. Upper, then lower extremity fractures were the most common in both groups. Axial skeleton fractures were the least frequently encountered fractures among both groups.

CONCLUSION: H2RA exposure is not associated with an increased risk of fracture in hospitalized children exposed to H2RA when compared with a matched untreated cohort, further studies are needed to determine if long-term exposure to H2RA may be associated with fracture risk in both those with and without comorbidities or on fracture predisposing medication.What is known Histamine-2-receptor antagonists (H2RA) are amongst the most widely used acid suppression therapy in children.H2RA therapy is regarded as safe in children including infants.Fracture risk associated with proton pump inhibitor (PPI) therapy in children has not been adequately studied in children.What is new The incidence of fractures in children aged 6 months through 15.5 years followed for 2 years after H2RA therapy was not increased when compared to a matched controlUse of H2RA therapy is safer than PPI therapy with respect to fracture risk in children with no other risk factors.Further studies are needed to assess the association of long-term exposure to H2RA with fracture risk in children without predisposing risk for fracture.

PMID:35112645 | DOI:10.1080/03007995.2022.2037847

Acta Otolaryngol. 2022 Feb 3:1-4. doi: 10.1080/00016489.2022.2030880. Online ahead of print.

ABSTRACT

Background: Malignant neoplasms (MNs) in the head and neck are occasionally hidden in deep neck infections (DNIs) that require emergency treatment, which potentially leads to delayed diagnosis of MNs.Objectives: This study aimed to identify predictive factors that can prevent delays in diagnosing MNs in patients with DNIs.Methods: We retrospectively analysed data from 83 patients admitted to our hospital who were diagnosed with DNIs.Results: Four patients (4.8%) had DNIs veiling MNs in the head and neck. Statistical analyses revealed a significant association (p = .0481) of platelet to albumin ratio (PAR; ≥ 98.9 × 10³) with hidden MNs in DNIs. Furthermore, concomitant cervical lymphadenopathy, especially multiple lymphadenopathies and excluding abscesses, was higher in patients with DNIs veiling MNs (p = .0142 and p = .0023, respectively).Conclusions and Significance: The PAR, which can be easily measured and readily detected, was a potential predictive factor. Moreover, performing fine-needle aspiration for lymphadenopathies could help diagnose hidden MNs in DNIs.

PMID:35112650 | DOI:10.1080/00016489.2022.2030880

Scand J Clin Lab Invest. 2022 Feb 3:1-7. doi: 10.1080/00365513.2022.2034038. Online ahead of print.

ABSTRACT

BACKGROUND: Viscoelastic tests (rotational thromboelastometry, ROTEM^®), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.

METHODS: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM^® implementation.

RESULTS: Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p = .026) during the perioperative period. In the group monitored with ROTEM^®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p = .002), fresh frozen plasma (9.8% vs 3.8%, p = .008), prothrombin complex concentrate administration (0.9% vs 0.3%, p = .599) and activated recombinant factor VII (0.3% vs 0.0%, p = .603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p = .530) and fibrinogen concentrate (0.9% vs 3.5%, p = .066), tranexamic acid (0.0% vs 0.6%, p = .370) and protamine administration (0.6% vs 0.9%, p = .908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p = .813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p = .037), surgical reexploration (6.0% vs 2.9%, p = .035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p = .026).

CONCLUSIONS: The monitoring of hemostasis by ROTEM^® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.

PMID:35112642 | DOI:10.1080/00365513.2022.2034038

Ann Saudi Med. 2022 Jan-Feb;42(1):1-7. doi: 10.5144/0256-4947.2022.1. Epub 2022 Feb 3.

ABSTRACT

BACKGROUND: Taxes on tobacco products that increase the price and target demand-reduction have been shown to be an efficient means of reducing tobacco consumption. A new policy introduced in 2017 has increased the price of a 20-cigarette pack of the most popular brand to 27.50 SAR (7.33 USD) with the tax portion being 68.09%, which is within the yardstick recommended by the World Bank.

OBJECTIVE: Assess impact of taxes on cigarette consumption.

DESIGN: Retrospective econometric analysis.

MAIN OUTCOMES MEASURES: The annual importation of cigarettes containing tobacco (commodity code 24022000) in metric tons (as a proxy measure of consumption).

METHODS: An econometric analysis of cigarette prices and consumption was performed using the methods of the World Bank Economics of Tobacco Toolkit. The impact was assessed statistically through price elasticity of cigarette demand. The study used yearly data for the period 2013-2019 to compare the price elasticity of demand according to the change in price. Cigarette consumption was equated to cigarette imports (dependent variable), and correlation with the cigarette price, income, education, and unemployment was assessed as independent variables of interest.

RESULTS: Annual importation of cigarettes declined by 27.41% for the period 2013-2019 after the imposition of ad valorem and value-added taxes in 2017 and 2018, respectively. The price of a pack of cigarettes increased by 115.1% from 2016 to 2018. The per capita consumption was inversely correlated with price *P=.0003285, r=-0.969). The inverse correlation between income and per capita consumption was also statistically significant (P=.025, r=-0.816). Education did not correlate with per capita consumption (P=.740, r=-0.155), but unemployment was inversely correlated (P=.008, r=-0.884). From 2016 to 2018, the price elasticity of demand became negative with respect to income as recommended by the World Health Organization. The price elasticity of demand reached -0.07, -0.8, -0.93 in 2016, 2017, 2018, respectively.

CONCLUSION: The modification of tax policy in 2017 has resulted in a decrease in both cigarette affordability and consumption. An additional 42.67% increase in the price, or pack price of 35.81 SAR (9.54 USD) might offset the increase in individual income noted in 2019 and maintain the decreased affordability.

LIMITATIONS: The lack of more granular data on cigarette sales and more reliable data on prevalence.

CONFLICT OF INTEREST: None.

PMID:35112589 | DOI:10.5144/0256-4947.2022.1

Ann Saudi Med. 2022 Jan-Feb;42(1):8-16. doi: 10.5144/0256-4947.2022.8. Epub 2022 Feb 3.

ABSTRACT

BACKGROUND: Postoperative pulmonary complications in patients who undergo open heart surgery are serious life-threatening conditions. Few studies have investigated the potentially beneficial effects of preoperative physiotherapy in patients undergoing cardiac surgery.

OBJECTIVES: Assess the effects of preoperative chest physiotherapy on oxygenation and lung function in patients undergoing open heart surgery.

DESIGN: Randomized, controlled.

SETTING: University hospital.

PATIENTS AND METHODS: Patients with planned open heart surgery were randomly allocated into an intervention group of patients who underwent a preoperative home chest physiotherapy program for one week in addition to the traditional postoperative program and a control group who underwent only the traditional postoperative program. Lung function was assessed daily from the day before surgery until the seventh postoperative day.

MAIN OUTCOME MEASURES: Differences in measures of respiratory function and oxygen saturation. Length of postoperative hospital stay was a secondary outcome.

SAMPLE SIZE: 100 patients (46 in intervention group, 54 in control group).

RESULTS: Postoperative improvements in lung function and oxygen saturation in the intervention group were statistically significant compared with the control group. The intervention group also had a statistically significant shorter hospital stay (P<.01).

CONCLUSION: Preoperative chest physiotherapy is effective in improving respiratory function following open heart surgery.

LIMITATIONS: Relatively small number of patients.

CONFLICT OF INTEREST: None.

REGISTRATION: ClinicalTrials.gov (NCT04665024).

PMID:35112592 | DOI:10.5144/0256-4947.2022.8

Behav Modif. 2022 Feb 3:1454455211073738. doi: 10.1177/01454455211073738. Online ahead of print.

ABSTRACT

Mindfulness-based programs are a promising intervention modality for reducing disruptive behavior, and Soles of the Feet (SOF) is one program that teaches internal awareness of personal events (e.g., unpleasant emotions) and a self-regulation strategy to decrease disruptive behaviors. This study conducted a meta-analysis of single-case research design (SCRD) studies that implemented SOF to decrease disruptive behaviors. Existing SOF studies were evaluated using high-quality SCRD standards, resulting in 15 studies included in the analysis (49 participants; mean age 23.12 years (SD = 15.87); highly heterogeneous backgrounds). Studies were analyzed to calculate effect sizes using Tau-U, an innovative non-parametric statistical approach for estimating effect sizes in SCRD studies. The aggregated weighted Tau-U effect size of SOF across all studies was -0.87. Moderator analyses indicated SOF’s effectiveness was robust across participant characteristics and delivery formats. This meta-analysis suggests that SOF is a moderately effective evidence-based practice for reducing disruptive behavior.

PMID:35112575 | DOI:10.1177/01454455211073738

Ideggyogy Sz. 2022 Jan 30;75(1-02):51-59. doi: 10.18071/isz.75.0051.

ABSTRACT

BACKGROUND AND PURPOSE: Oxidative stress has been associated as an essential contributor to the development of neurodegenerative diseases. Recent developments in the field of Parkinson’s Disease (PD) pathophysiology have led to a renewed interest in this field. As an antioxidant, uric acid (UA) has arisen as a potential neuroprotectant. Higher concentrations of UA are linked to reducing the risk of the development of the disease and preventing its progression. However, the expositions are unsatisfactory because the outcomes of these reports have not been consistent. This study is set out to assess the association of whether lower UA concentrations increased the PD risk by investigating its relationship with patients’ demographic and clinical data, and to determine whether previous studies are compatible with the Turkish-sampled population. Furthermore, we aimed to determine UA’s probability of being an early-stage diagnostic marker.

METHODS: A total of 305 patients and 100 healthy controls were included. Serum UA levels of patients and controls were compared with clinical features. We classified the patients into three motor subtypes and determined the disease severity by modified Hoehn&Yahr Staging Scale (mH&Y) and Unified Parkinson’s Disease Rating Scale (UPDRS). Standardized Mini-Mental State Examination (MMSE-TR) was assessed for cognition.

RESULTS: There were not any significant differences of age and sex between patients and controls (p=0.030, p=0.132). The mean UA was 5.06±1.33 mg/dL in patients and 5.46±1.44 in controls, and a statistical significance was detected (p=0.022). The mean MMSE-TR were 24.83±4.35 in patients and 27.09±2.13 in controls, and statictical significance was revealed (p=0.001). The mean duration of the disease was 6.31±4.16 years, mean UPDRS scores were 59.74±22.33, and mH&Y scores were 2.29±0.91. In binary comparisons, patients with tremor-dominant motor subtype had lower UA concentrations than controls (p=0.014). ROC curve analysis revealed UA’s cut-off as ≤9.15, the specificity was 99.3, the sensitivity was 10.0, and the area under the curve was 0.576 (p<0.005). Regression analysis revealed age as an independent risk factor on UA values. Oxidative stress might be a factor in the development of PD, and UA may be a possible prospective protecting factor in the clinical course of the disease. However, it does not affect the severity.

CONCLUSION: Our results support that lower uric acid concentrations are associated with PD; however, it is not a powerful indicator for predicting PD risk. As we reveal more about UA and its effect in further investigations, its significant role will become well-defined.

PMID:35112521 | DOI:10.18071/isz.75.0051