Tag: pubmed

Int J Lang Commun Disord. 2021 Sep 14. doi: 10.1111/1460-6984.12670. Online ahead of print.

ABSTRACT

BACKGROUND: Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students’ development of skills in clinical practice with people who stutter.

AIMS: (1) To evaluate students’ clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students’ performance.

METHODS & PROCEDURES: Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students’ clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored.

OUTCOMES & RESULTS: Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency.

CONCLUSIONS & IMPLICATIONS: This study identified that students’ clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students’ clinical skills in stuttering management, further exploration of reliability is required.

WHAT THIS PAPER ADDS: What is already known on this subject Within speech-language pathology, simulation-based learning is a teaching approach used in university clinical programme curricula. Simulation-based learning is used as an opportunity for students to gain specific clinical skills, particularly if clinical experiences are readily not available. Research in speech-language pathology has revealed that students value simulation because it provides a safe learning environment. What this study adds to existing knowledge There are fewer opportunities for students to gain clinical experience in the management of stuttering in adults. This study explored students’ clinical skill development within a stuttering simulation-based learning programme. Additionally, it detailed the development and preliminary investigation of validity of the SPIRS-Stuttering, an assessment tool used in a simulation-based learning environment. What are the potential or actual clinical implications of this work? Students’ clinical skills in the assessment and management of stuttering in adults, as measured by the SPIRS-Stuttering, improved during participation in the stuttering simulation-based learning programme. Further investigation of validity of the SPIRS-Stuttering tool is required to confidently measure students’ performance. The stuttering simulation-based learning programme can be used to provide students with an opportunity to develop their clinical skills in stuttering, a practice area in speech-language pathology that is not always available to students.

PMID:34519389 | DOI:10.1111/1460-6984.12670

Pediatr Blood Cancer. 2021 Sep 14:e29342. doi: 10.1002/pbc.29342. Online ahead of print.

ABSTRACT

BACKGROUND: Integratedbehavioral health models have been proposed as care delivery approaches to mitigate mental health disparities in primary care settings. However, these models have not yet been widely adopted or evaluated in pediatric oncology medical homes.

METHODS: We conducted a retrospective cohort study of 394 children with newly diagnosed cancer at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center (DF/BCH) from April 2013 to January 2017. Baseline sociodemographic characteristics and psychiatry utilization outcomes at 12 months following diagnosis were abstracted from the medical record. The severity of household material hardship (HMH), a concrete poverty exposure, at diagnosis and race/ethnicity were characterized by parent report using the Psychosocial Assessment Tool 2.0 (PAT). Associations between sociodemographic characteristics and receipt of psychiatry consultation were assessed with multivariable logistic regression models.

RESULTS: Among 394 children, 29% received a psychiatric consultation within 12 months postdiagnosis. Of these, 88% received a new psychiatric diagnosis, 76% received a psychopharmacologic recommendation, and 62% received a new behavioral intervention recommendation. In multivariable logistic regression adjusting for age, cancer diagnosis, and PAT total score, there was no statistically significant association between HMH severity or household income and psychiatry utilization. Children who identified as racial/ethnic minorities were significantly less likely to receive a psychiatry consultation (OR = 0.48, 95% CI = 0.27-0.84).

CONCLUSIONS: In a pediatric oncology medical home with an integrated behavioral health model, socioeconomic status was not associated with disparate psychiatry utilization. However, there remained a profound racial/ethnic disparity in psychiatry utilization, highlighting the need for additional research and care delivery intervention.

PMID:34519425 | DOI:10.1002/pbc.29342

Clin Infect Dis. 2021 Sep 14:ciab787. doi: 10.1093/cid/ciab787. Online ahead of print.

ABSTRACT

BACKGROUND: Annual mass drug administration (MDA) using praziquantel is the cornerstone of schistosomiasis morbidity control, but is not sufficient to interrupt transmission. We implemented a cluster-randomized trial to compare the effectiveness of four different intervention packages to interrupt transmission of Schistosoma haematobium in a seasonal transmission setting of Côte d’Ivoire.

METHODS: Sixty-four localities with a S. haematobium prevalence in school children aged 13-14 years above 4% were randomly assigned to one of four intervention arms over a 3-year period: (1) the current standard strategy consisting of annual MDA before peak of transmission; (2) annual MDA after peak of transmission; (3) biannual MDA; and (4) standard MDA combined with snail control. The primary outcome was prevalence and intensity of S. haematobium infection in children aged 9-12 years 1 year after the final intervention, using urine filtration performed by experienced microscopists.

RESULTS: By study end, we observed the lowest S. haematobium prevalence in the biannual MDA, compared to the standard treatment arm (0.6% vs. 7.5%; odds ratio [OR] = 0.07, 95% confidence interval [CI] = 0.02 to 0.24). The prevalence in arms 2 and 4 was about 3.5%, which was not statistically significantly different from the standard strategy (both ORs 0.4, 95% CI = 0.1 to ~1.8). New cases of infection were still observed in all arms at study end.

CONCLUSIONS: Biannual MDA was the only regimen that outperformed the standard treatment. All strategies resulted in decreased prevalence of infection, however none of them was able to interrupt transmission of S. haematobium within a 3-year period.

PMID:34519344 | DOI:10.1093/cid/ciab787

Hum Brain Mapp. 2021 Sep 14. doi: 10.1002/hbm.25577. Online ahead of print.

ABSTRACT

Many key findings in neuroimaging studies involve similarities between brain maps, but statistical methods used to measure these findings have varied. Current state-of-the-art methods involve comparing observed group-level brain maps (after averaging intensities at each image location across multiple subjects) against spatial null models of these group-level maps. However, these methods typically make strong and potentially unrealistic statistical assumptions, such as covariance stationarity. To address these issues, in this article we propose using subject-level data and a classical permutation testing framework to test and assess similarities between brain maps. Our method is comparable to traditional permutation tests in that it involves randomly permuting subjects to generate a null distribution of intermodal correspondence statistics, which we compare to an observed statistic to estimate a p-value. We apply and compare our method in simulated and real neuroimaging data from the Philadelphia Neurodevelopmental Cohort. We show that our method performs well for detecting relationships between modalities known to be strongly related (cortical thickness and sulcal depth), and it is conservative when an association would not be expected (cortical thickness and activation on the n-back working memory task). Notably, our method is the most flexible and reliable for localizing intermodal relationships within subregions of the brain and allows for generalizable statistical inference.

PMID:34519385 | DOI:10.1002/hbm.25577

J Child Lang. 2021 Sep 14:1-13. doi: 10.1017/S0305000921000532. Online ahead of print.

ABSTRACT

Children learn words in ambiguous situations, where multiple objects can potentially be referents for a new word. Yet, researchers debate whether children maintain a single word-object hypothesis – and revise it if falsified by later information – or whether children establish a network of word-object associations whose relative strengths are modulated with experience. To address this issue, we presented 4- to 12-year-old children with sets of mutual exclusivity (fast-mapping) trials: offering them with obvious initial hypotheses (that the novel object is the referent for the novel word). We observe that children aged six years and above, despite showing a novelty bias and retaining this novel word – novel object association, also formed an association between the novel word and the name-known object, thereby suggesting that older children attend to more than one word-object association, in a manner similar to associative learning. We discuss our findings in the context of competing theoretical accounts related to word learning.

PMID:34519266 | DOI:10.1017/S0305000921000532

Eur J Endocrinol. 2021 Sep 1:EJE-21-0351.R2. doi: 10.1530/EJE-21-0351. Online ahead of print.

ABSTRACT

Objective Female patients treated with alkylating agents in childhood are at risk for ovarian impairment. We aimed at describing the pattern of residual ovarian function in a cohort of survivors of hematological malignancies and/or hematopoietic stem cell transplantation (HSCT) and assessing the relationship between Cyclophosphamide Equivalent Dose (CED) and Anti-Müllerian Hormone (AMH). Design and methods Gonadal health was clinically and biochemically assessed in 124 post-menarchal survivors who underwent treatment for pediatric hematological malignancies and/or HSCT between 1992 and 2019. Results Overt “premature ovarian insufficiency” (POI) was detected in 72.1% and 3.7% of transplanted and non-transplanted patients, respectively; milder “diminished ovarian reserve” (DOR) in 16.3% and 22.2%. In non-transplanted patients, increasing CED values were associated with lower AMH-SDS (p 0.04), with the threshold of 7200 g/m2 being the best discriminator between DOR/POI and normal ovarian function (AUC: 0.75 on ROC analysis) and with an observed decrease of 0.14 AMH-SDS for each CED increase of 1 gr/m2. In addition, age at diagnosis ≥10 years played a detrimental role on ovarian reserve (p 0.003). In the HSCT group, irradiation was associated with a statistically significant reduction in AMH-SDS (p 0.04). Conclusions In non-transplanted patients, CED ≥ 7200 mg/m2 was associated with a DOR, while younger age at diagnosis played a protective role on ovarian reserve. As a result of the data collected, we propose a systematic algorithm to assess iatrogenic gonadal impairment in young female patients exposed to chemo-radiotherapy in childhood for hematological disorders.

PMID:34519276 | DOI:10.1530/EJE-21-0351

Global Spine J. 2021 Sep 14:21925682211041048. doi: 10.1177/21925682211041048. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cross-sectional study.

OBJECTIVE: To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period.

METHODS: The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff’s main allegations, and arbitration outcomes.

RESULTS: A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff’s favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant’s favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability.

CONCLUSION: The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.

PMID:34519250 | DOI:10.1177/21925682211041048

Cochlear Implants Int. 2021 Sep 14:1-11. doi: 10.1080/14670100.2021.1973208. Online ahead of print.

ABSTRACT

OBJECTIVE: There is still a lack in precise postoperative evaluation of the cochlea because of strong artifacts. This study aimed to improve accuracy of postoperative two-turn (2TL) and cochlear duct length (CDL) measurements by applying flat-panel volume computed tomography (fpVCT), secondary reconstruction (fpVCT_SECO) and three-dimensional curved multiplanar reconstruction.

METHODS: First, 10 temporal bone specimens with or without electrode were measured in multi-slice computed tomography (MSCT), fpVCT and fpVCT_SECO and compared to high-resolution micro-CT scans. Later, pre- and postoperative scans of 10 patients were analyzed in a clinical setting.

RESULTS: Concerning 2TL, no statistically significant difference was observed between implanted fpVCT_SECO and nonimplanted micro-CT in 10 temporal bone specimens. In contrast, there was a significant discrepancy for CDL (difference: -0.7 mm, P = 0.004). Nevertheless, there were no clinically unacceptable errors (±1.5 mm). These results could be confirmed in a clinical setting. Using fpVCT_SECO, CDL was slightly underestimated postoperatively (difference: -0.5 mm, P = 0.002) but without any clinically unacceptable errors.

CONCLUSION: fpVCT_SECO can be successfully applied for a precise measurement of the cochlear lengths pre- and postoperatively. However, users must be aware of a slight systematic underestimation of CDL postoperatively. These results may help to refine electrode selection and frequency mapping.

PMID:34519256 | DOI:10.1080/14670100.2021.1973208

Global Spine J. 2021 Sep 14:21925682211025501. doi: 10.1177/21925682211025501. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective database study.

OBJECTIVES: To compare the accuracy and safety of 2 types of a computer-assisted navigation system for percutaneous pedicle screw placement during endoscopic lumbar interbody fusion.

METHODS: From May 2019 to January 2020, data of 56 patients who underwent Endo-LIF with a robot-assisted system and with an electromagnetic navigation system were compared. The pedicles in all patients were subjected to postoperative CT scan to assess screw correction by measuring the perpendicular distance between the pedicle cortical wall and the screw surface. The registration and matching time, guide-wire insertion time, the entire surgery time, and X-ray exposure time were recorded.

RESULTS: In the robot-assisted group, 25 cases with 100 percutaneous pedicle screws were included, and the excellent and good rate was 95%. In the electromagnetic navigation group, 31 cases with 124 screws were included, and the excellent rate was 97.6%. There was no statistical difference between the two groups (P > 0.05). The registration time and the total time for the surgery also showed no statistical differences (P > 0.05). The main difference between the two groups was the guide-wire insertion time and the X-ray exposure time (P < 0.05).

CONCLUSIONS: Both electromagnetic navigation and robot-assisted are safe and efficient for percutaneous pedicle screw placement. Electromagnetic navigation system has obvious advantages over robot-assisted in terms of faster guide-wire placement and less X-ray exposure. Robot-assisted for percutaneous pedicle screw placement offers a preoperative planning system and a stable registration system, with obvious drawbacks of a strict training curve.

PMID:34519243 | DOI:10.1177/21925682211025501

Am Surg. 2021 Sep 14:31348211041555. doi: 10.1177/00031348211041555. Online ahead of print.

ABSTRACT

BACKGROUND: Low colorectal anastomoses carry a high anastomotic leak (AL) rate (up to 20%) and thus are commonly diverted. Much less is known about mid-to-high colorectal anastomosis, which carries a leak rate of 2-4%. The objective of this study was to determine our AL rate after mid-to-high colorectal anastomosis and associated risk factors.

METHODS: A single center retrospective cohort study of patients undergoing left colonic resections with mid-to-high colorectal anastomosis (≥7 cm from the anal verge) from January 2008 to October 2017 was utilized. Main outcome, AL, defined as clinical suspicion supported by radiological or intraoperative findings, was calculated and risk factors assessed using multivariable logistic regression analysis.

RESULTS: 977 patients were included; 487 (49.9%) were male, with a mean age of 59.8 (+/-12.1) years. Mean BMI was 27.5 (+/-5.5) kg/m². Diverticular disease (67.5%), malignancy (17.4%), and inflammatory bowel disease (2.2%) were the main indications for resection. Mean length of stay was 6.7 (+/-4.5) days. 455 (46.8%) colonic resections were performed by laparoscopy, 283 (29.1%) by hand assisted surgery, 219 (22.5%) by laparotomy, and 16 (1.6%) by robotics. Majority of patients had complete donuts (99.6%) and a negative air leak test (97.7%). 149 patients (15.3%) underwent construction of a diverting stoma. The overall AL rate was 2.1% (n = 20). Increased BMI (>30 kg/m²), P = .02, was an independent risk factor for AL and a trend observed for positive air leak tests (P = .05), with other factors failing to achieve statistical significance.

CONCLUSIONS: Patients with mid-to-high colorectal anastomosis have a 2% AL risk. Increased BMI was a risk factor for AL.

PMID:34519249 | DOI:10.1177/00031348211041555