Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

Objectives  In this research, the authors provide a retrospective cohort study of 82 patients with suprasellar meningiomas to identify predictors of the visual outcome following surgery. We also conducted a matched retrospective case-control analysis. Methods  This retrospective cohort study included all patients who underwent craniotomy for surgical excision of suprasellar meningiomas at our institution between January 2016 and March 2022. We designed a matched case-control study for patients with and without early intradural optic canal decompression (IOCD). We also developed a machine learning model to have the best possible sensitivity for the prediction of visual recovery after surgery. Results  The visual acuity score (VAS) improved in 46.3% of our cases and decreased in 7.4% of the 82 included cases postoperatively. The VAS did not change in 46.3% of the patients after surgery. Statistically, visual complaints, optic atrophy, tuberculum sella involvement, and olfactory groove involvement were associated with lower preoperative VAS and visual field index (VFI). Only intracavernous sinus (ICS) extension and intraoperative vascular involvement were significantly associated with lower postoperative mean VAS correction. The outcome analysis revealed that the improvement in VAS and VFI after surgery was not statistically different between the groups with and without early IOCD ( p -value = 1). Conclusion  ICS extension was the only location-related factor associated with increased tumor recurrence or regrowth, which makes postoperative radiotherapy more valuable in patients with cavernous sinus extension. Our study results did not support the efficacy of early IOCD in increasing postoperative VAS and VFI.

An interdisciplinary virtual group program addressing the FINER points of chronic pain management: An exploratory analysis of functional outcomes

OBJECTIVES

Chronic pain is multifactorial and has large social and economic costs. Comprehensive pain management through an interdisciplinary approach addressing the biopsychosocial model of pain is beneficial. The purpose of this study was to assess the feasibility and functional outcomes following participation in the 8-week virtual interdisciplinary Functional Integrative Restoration (FINER) program.

DESIGN

Cohort study.

SETTING

Virtual platform (Zoom) utilized by participants and clinicians within a large academic institution.

SUBJECTS

44 individuals with chronic pain meeting study criteria who participated in the virtual FINER program from September 2021 to April 2023 were included in final analysis.

METHODS

Participants attended twice weekly seminars and group sessions focused on pain education, lifestyle medicine, integrative medicine, and psychological therapies virtually and completed pre- and post-program surveys. Outcomes included the Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). Qualitative feedback was also obtained.

RESULTS

From September 2021 to April 2023, 44 adult FINER participants with chronic low back and/or neck pain completed pre- and post-intervention surveys. We observed significant improvements in PCS, TSK, and various domains of the PROMIS-29, including pain interference, participation, physical function, and sleep, with modest effect sizes.

CONCLUSIONS

The FINER program reduced self-reported functional outcomes related to the participants' chronic pain. Positive qualitative feedback from FINER participants suggested mental and physical health benefits. Future investigation will include a larger cohort and will deploy active (patient-reported outcomes) and passive (mobility and sociability) digital measures to further characterize functional changes.

Impact of Obstructive Sleep Apnea on Diabetic Retinopathy Progression and Systemic Complications

PURPOSE

To evaluate the risk of diabetic retinopathy progression and systemic vascular events, including death, in patients with nonproliferative diabetic retinopathy (NPDR) with obstructive sleep apnea (OSA).

DESIGN

Retrospective cohort study.

METHODS

Electronic chart query using TriNetX, an electronic health records network comprising data from over 124 million patients. Patients with NPDR with and without OSA were identified. Patients were excluded if they had a history of proliferative disease (proliferative diabetic retinopathy), diabetic macular edema, or prior ocular intervention (intravitreal injection, laser, or pars plana vitrectomy). Propensity score matching was performed to control for baseline demographics and comorbidities. The rate of progression to vision-threatening complications, need for ocular intervention, and systemic events was measured at 1, 3, and 5 years.

RESULTS

A total of 11 931 patients in each group were analyzed after propensity score matching. There was an elevated risk of proliferative diabetic retinopathy in the OSA cohort at 1 (risk ratio [RR]: 1.34, P < .001), 3 (RR: 1.31, P < .001), and 5 years (RR: 1.28, P < .001). There was an elevated risk of diabetic macular edema in the OSA group at all time points: 1 (RR: 1.31, P < .001), 3 (RR: 1.19, P<.001), and 5 years (RR: 1.18, P < .001). With respect to ocular interventions, there was an increased risk of intravitreal injection in patients with OSA at 1 (RR: 1.59, P < .001), 3 (RR: 1.58, P < .001), and 5 years (RR: 1.54, P < .001), and similar trends were noted with laser photocoagulation, but not vitrectomy. Regarding systemic events, patients with NPDR with OSA had a greater risk of stroke (1 year RR: 1.80, P < .001; 3 years RR: 1.56, P < .001; and 5 years RR: 1.49, P < .001), myocardial infarction (1 year RR: 1.51, P < .001; 3 years RR: 1.46, P < .001; and 5 years RR: 1.43, P < .001), and death (1 year RR: 1.31, P < .001; 3 years RR: 1.19, P < .001; and 5 years RR: 1.15, P < .001).

CONCLUSIONS

There is an increased rate of diabetic retinopathy progression to vision-threatening complications, need for ocular intervention, and systemic complications, including death, for patients with OSA. We emphasize the need for improved screening measures of patients with NPDR and potential OSA.

Physical activity levels in patients with chronic venous insufficiency

BACKGROUND

Increasing the levels of physical activity (PA) is widely recommended for people with chronic venous insufficiency (CVI). However, studies investigating the patterns of PA and adherence to PA guidelines using objective measures are lacking.

OBJECTIVE

The primary aim was to examine the patterns of PA and adherence to PA guidelines among patients with CVI. A secondary aim was to identify whether adherence to PA recommendations differed according to patients' sociodemographic and clinical characteristics.

METHODS

This cross-sectional study included 96 patients with CVI with Clinical-Etiology-Anatomy-Pathology (CEAP) C3 to C6 (69.1% women 59 ± 11 years; 51.5% C5-C6 on CEAP classification). Objective time spent in PA was measured by a triaxial accelerometer. To examine adherence to PA guidelines, patients were grouped as meeting (or) the recommendations if they had at least 150 min/week of moderate to vigorous PA. Sociodemographic and clinic characteristics were obtained by self-report. Binary logistic regression was employed to examine whether sociodemographic and clinical characteristics were associated with adherence to PA guidelines. T-tests were employed to compare PA levels at different intensities according to patients' age.

RESULTS

Patients spent an average of 311.4 ± 91.5 min/week, 42.1 ± 28.0 min/week, and 19.8 ± 17.8 min/week in low-light PA, high-light PA, and moderate-to-vigorous PA, respectively. The proportion of patients meeting PA recommendations was 36.2%, and older patients had lower odds (OR = 0.94; 95%CI: 0.89 to 0.99). Additional analysis reinforced that by showing lower time in high-light PA (51.2 ± 30.0 min/day vs. 31.9 ± 21.8 min/day; p = .001) and moderate-to-vigorous PA (24.3 ± 15.8 min/day vs. 14.8 ± 18.8 min/day; p = .012) among older patients than their peers younger.

CONCLUSION

Our findings showed that 36,2% of CVI patients met PA recommendations, with lower odds found among older patients. Public health interventions to enhance PA engagement among CVI patients should prioritize those who are older.

Knowledge, Attitude and Practices of Areca Nut (kwai) Use among Employees of a Tertiary Health Care Institution in North-East India

OBJECTIVE

This study strives to look for the knowledge, attitudes, and practices of areca nut use among health care workers in a tertiary hospital in North-East India.

METHODS

A prospective, cross-sectional, questionnaire-based study was conducted among all health care and allied workers at a public sector teaching hospital in Meghalaya, Northeast India. A questionnaire, which was validated for content, was administered to the target population. Three domains of learned behavior towards areca nut viz. knowledge (cognitive), attitude (affective) and practice (psychomotor) were assessed. Data was analyzed using SPSS V21.0. Descriptive statistics were used.

RESULT

A total of 434 participants completed the questionnaire. Majority of the respondents [52.8% (229)] had consumed Kwai (Areca nut) in the past 12 months. Kwai was perceived to have beneficial effects by 17.9% (78) of respondents. A total of 76.3% (331), 72.8% (316) and 62.2% (210) of respondents thought that Kwai consumption caused throat, oral and esophageal cancers respectively.48.0% (110) of the respondents swallowed the kwai juice in contrast to 32.4% (69) who spit the kwai juice. 61.6% (141) Kwai chewers tried quitting, out of which 41.8% (59) managed to stay away from Kwai for more than a year but eventually ended consuming Kwai again.62.4% (143) of the respondents claimed that the children in their family/neighbor consumed Kwai.

CONCLUSION

Among our study population, the knowledge about harmful effects of areca nut is good. However, this knowledge has not translated into change in practices.

Association of 'weekend warrior' and other leisure time physical activity patterns with obesity and adiposity: A cross-sectional study

AIM

To investigate the effect of different physical activity patterns on obesity.

MATERIALS AND METHODS

Data from adults aged 17-79 years were extracted from the Hong Kong Territory-Wide Physical Fitness Survey conducted in 2011-2012 and 2021-2022. Moderate to vigorous physical activity (MVPA) patterns were collected through questionnaires and categorized as inactive (no MVPA ≥10 min), insufficiently active (<150 min MVPA/week), weekend warriors (≥150 min MVPA/week from 1 to 2 days) and regularly active (≥150 min MVPA/week from ≥3 days). The association between these activity patterns with obesity risk and body fat percentage was analysed.

RESULTS

This study included 9863 obesity data (including valid waist circumference and body mass index) and 7496 body fat data. Compared with the inactive group, the weekend warriors and regularly active individuals had lower risks of general and abdominal obesity, as well as reduced body fat. Furthermore, individuals who were insufficiently active but engaged in ≥3 days of MVPA showed significantly lower body fat and obesity risk than their inactive counterparts.

CONCLUSION

Engaging in physical activity even once or twice a week can positively impact weight control.

Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort

AIMS/HYPOTHESIS

We aimed to: (1) externally validate the five-item Hypoglycaemia Awareness Questionnaire (HypoA-Q) impaired awareness subscale (HypoA-Q IA); (2) examine how impaired awareness of hypoglycaemia (IAH) relates to the risk of severe hypoglycaemia and level 2 hypoglycaemia; and (3) identify factors associated with IAH.

METHODS

Nationwide survey of T1D Exchange registrants was conducted to collect data on demographics, 6 month severe-hypoglycaemia history, hypoglycaemia awareness status (via HypoA-Q IA, the Gold instrument and the Clarke instrument) and continuous glucose monitor (CGM) measures. The Clarke hypoglycaemia awareness factor (Clarke-HAF) was calculated to exclude severe-hypoglycaemia history items. Analyses included Cronbach's α, Spearman correlations and logistic regression.

RESULTS

Valid survey responses were collected from N=1580 adults with type 1 diabetes (median age, 44 years; 52% female participants; median HbA1c, 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop (HCL) systems; 30% had at least one severe-hypoglycaemia episode in the past 6 months. The HypoA-Q IA had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater risk of severe hypoglycaemia (p<0.001), performing comparably to the Gold instrument and the Clarke-HAF instrument. HypoA-Q IA-determined IAH was independently associated with 88% higher odds of developing severe hypoglycaemia (p<0.001) and twofold higher odds for spending ≥1% of time in level 2 hypoglycaemia (p=0.011). Higher age and longer diabetes duration were associated with higher IAH risk (p<0.001). CGM and HCL use was associated with lower IAH risk (p<0.001).

CONCLUSIONS/INTERPRETATION

The HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today's technology-oriented era. IAH was independently associated with severe hypoglycaemia and level 2 hypoglycaemia in a cohort with high prevalence of advanced diabetes technology use and HbA1c within the recommended range. CGM and HCL use was related to lower IAH risk.

Chronic pain after colorectal cancer treatment: A population-based cross-sectional study

AIMS

With the recently validated tool for estimating chronic pain after colorectal cancer surgery, the aims of this study were to calculate the prevalence and to identify predictive risk factors for chronic pain after colorectal cancer treatment.

METHOD

Clinical data from colorectal cancer patients treated between 2001 and 2014 were obtained from the Danish Colorectal Cancer Group database. In 2016, all survivors were invited to participate in a national cross-sectional questionnaire study on long-term functional outcomes, including the chronic pain questionnaire. The prevalence of chronic pain was analysed in groups based on demographic data and treatment-related factors. Multivariate logistic regression analysis was performed to determine significant predictors of chronic pain, displayed as odds ratios (OR) and 95% confidence intervals.

RESULTS

The response rate was 63.8%, representing 11 600 patients (7127 colon and 4473 rectal cancer patients). The overall prevalence of pain was 41.5%, with 15.4% having major pain. Major pain was more prevalent in rectal cancer patients than colon cancer patients (16.7% vs. 14.5%, p < 0.001). Predictors for major pain were: young age <60 years [OR 1.7 (95% CI 1.51-1.91)]; female sex [OR 1.63 (95% CI 1.46-1.82)]; an open surgical approach [OR 1.18 (95% CI 1.05-1.33)]; chemotherapy [OR 1.32 (95% CI 1.18-1.49)]; radiotherapy [OR 1.39 (95% CI 1.17-1.65)]; permanent stoma [1.56 (95% CI 1.31-1.86)]; comorbidity [OR 1.69 (95% CI 1.5-1.9)]; anastomotic leakage [OR 1.31 (95% CI 1.05-1.64)].

CONCLUSION

Chronic pain is prevalent after colorectal cancer surgery. All patients should be informed about the risks before cancer treatment, particularly those who are at an increased risk of developing major pain.

Ocular Neovascular Conversion and Systemic Bleeding Complications in Patients with Age-Related Macular Degeneration on Anticoagulants

PURPOSE

Conversion to neovascular disease in patients with non-neovascular age-related macular degeneration (AMD) initiated on direct oral anticoagulants (DOACs) compared with matched patients treated with warfarin.

DESIGN

Retrospective cohort study.

PARTICIPANTS

The study included 20 300 patients and 13 387 patients with non-neovascular AMD initiated on DOACs or warfarin, respectively, before propensity score matching (PSM).

METHODS

TriNetX was used to identify patients diagnosed with non-neovascular AMD stratified by treatment with DOACs or warfarin with at least 6 months of follow-up. Propensity score matching was performed to control for baseline demographics and medical comorbidities.

MAIN OUTCOME MEASURES

Relative risk (RR) of developing neovascular AMD, macular hemorrhage (MH), vitreous hemorrhage (VH), and requiring an ocular intervention (intravitreal anti-VEGF therapy or pars plana vitrectomy [PPV]) within 6 months and 1 year. Patients with chronic atrial fibrillation (AF) on anticoagulation were separately evaluated for the same measures within 5 years after initiating therapy.

RESULTS

Treatment with warfarin was associated with a higher risk of developing neovascular AMD at 6 months (RR, 1.24, 95% confidence interval [CI], 1.12-1.39; P < 0.001) and 1 year (RR, 1.26, 95% CI, 1.14-1.40; P < 0.001) when compared with matched patients treated with DOACs. There was an increased risk of requiring intravitreal anti-VEGF therapy (6 months: RR, 1.30; 95% CI, 1.13-1.49; P < 0.001; 1 year: RR, 1.31, 95% CI, 0.72-2.05; P < 0.001) and PPV (6 months: RR, 2.13; 95% CI, 1.16-3.94; P = 0.01; 1 year: RR, 2.29, 95% CI, 1.30-4.05; P = 0.003). Among patients with AMD and AF treated with warfarin, there was an increased risk of ocular complications (neovascular AMD: RR, 1.25; 95% CI, 1.14-1.38; P < 0.001; MH: RR, 1.86; 95% CI, 1.47-2.35; P < 0.001; VH: RR, 2.22; 95% CI, 1.51-3.26; P < 0.001) and need for intravitreal anti-VEGF therapy (RR, 1.34; 95% CI, 1.18-1.52; P < 0.001) over an extended 5-year period. There was no significant difference in the development of major systemic hemorrhagic events between the 2 cohorts over 5 years.

CONCLUSIONS

Patients with non-neovascular AMD treated with warfarin were more likely to develop neovascular disease and require ocular intervention for hemorrhagic complications when compared with matched patients initiated on DOACs.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Strength Setbacks: The Impact of Youth Sport-Related Knee Joint Injuries on Thigh Muscle Strength. A 24-Month Prospective Cohort Study

OBJECTIVE: To compare injured and uninjured limb knee extensor and flexor peak torque between youth who experienced a sport-related, traumatic knee joint injury and comparable uninjured youth, at baseline (≤4 months of injury) and semiannually for 2 years. Differences by injury type and sex were also explored. DESIGN: Prospective cohort study. METHODS: Bilateral knee extensor and flexor concentric isokinetic peak torque at 90° per second was assessed semiannually in 186 youth (106 injured, 80 controls) for 2 years. Between-group differences in strength over time were estimated with generalized estimating equations (95% confidence interval [CI]). Confounding was controlled using inverse probability weighting. Strength differences between those with anterior cruciate ligament (ACL) tears and those with non-ACL tear injuries as well as between male and female participants were explored. RESULTS: Compared to uninjured controls, injured limb knee extensor strength was lowest at baseline (-37.1 Nm; 95% CI, -45.3 to -28.9) and 6-month follow-up (-13.3 Nm; 95% CI, -20.4 to -6.2), with minimal strength gain beyond the 12-month follow-up (1.7 Nm; 95% CI, -14.3 to 17.6). Knee flexor strength of the injured limb was lowest at baseline (-24.6 Nm; 95% CI, -31.5 to -17.8), and there was minimal strength gain beyond 6 months (2.3 Nm; 95% CI, -7.7 to 12.3). The average residual deficit was similar to the knee extensors (10% to 11%) at 24 months. Exploratory analysis suggested no difference based on injury type or sex. CONCLUSION: Injured limb knee extensor and flexor weakness was present after different youth sport-related knee joint injuries. Strength deficits peaked early after injury, improved over time, and plateaued after 12 months, with lingering deficits at 24 months. Thigh muscle strength trajectory was similar across injury types and sex. J Orthop Sports Phys Ther 2025;55(2):1-11. Epub 20 December 2024. doi:10.2519/jospt.2024.12663.

Transitional implants in computer-assisted implant surgery and fixed complete-arch provisionalization: A retrospective case series

INTRODUCTION

Using mini implants as transitional implants (TIs) for complete arch implant-supported rehabilitations may overcome limitations associated with mucosa-supported surgical guides and facilitate immediate fixed provisionalization. This study aimed to assess the success of TIs in supporting surgical guides for implant placement and fixed provisional prostheses.

METHODS

Patients who received TIs between 2012 and 2023 for a complete arch implant-supported prosthesis were evaluated retrospectively. Patient demographic data, TI functionality in supporting a surgical guide and supporting a complete arch provisional prosthesis, and dates of TI placement and regular implant placement were collected. Descriptive statistics were used to determine the survival rate and success rate for TIs.

RESULTS

Twenty-six patients, 35 jaws, 136 TIs, and 216 regular implants were included. The survival rate of TIs was 74.26%; however, the use of TIs yielded success in 97% of jaws for supporting a surgical guide and a fixed complete-arch provisional prosthesis throughout the complete provisional phase. An average of 4 TIs per maxilla and 3 TIs per mandible supported surgical guides. Thirty-five provisional prostheses were placed on an average of 4 TIs in the maxilla and 3 TIs in the mandible. Thirty-four provisional prostheses were successfully supported by TIs and regular implants until final restoration delivery. The survival of regular implants placed in conjunction with the use of TIs was 98%.

CONCLUSIONS

Using TIs to support a surgical guide and provisional prosthesis may be a predictable approach with a high success rate. All surgical guides planned to be supported on TIs were successful. Despite premature loss or replacement of TIs, this approach was able to support most provisional prostheses until the regular implants could be loaded.

Relationship between academic performance, personality traits, and anxiety level among Egyptian undergraduate nursing students: a correlational research study

BACKGROUND

University students encounter a variety of challenges and stressors that have an impact on various aspects of their lives, including their personal well-being, resilience, socialization, and character development. The identification of students' personality traits and their correlation with future anxiety is crucial in determining the degree to which they possess the capacity to adjust and confront challenges.

METHODS

This cross-sectional, correlational study involved 654 students from the Faculty of Nursing at Mansoura University. Data were collected by a sociodemographic questionnaire, a Big Five Inventory questionnaire, and Zung's self-rating anxiety questionnaire. Data were analyzed using the Kolmogorov-Smirnov, Kruskal Wallis, and Mann-Whitney tests with the IBM SPSS software package, version 20.0.

RESULTS

The personality trait of openness was the most frequently observed among the participants, with a mean of 33.15 ± 7.22. A significant proportion of students76.0%, demonstrated an absence of feeling anxiety. A statistically significant relationship (P < 0.001) was detected between the personality traits of agreeableness, conscientiousness, and neuroticism and levels of anxiety. Furthermore, no significant correlation was found between anxiety and the traits of openness and extraversion.

CONCLUSIONS

This study contributes to understanding the correlation between undergraduate nursing students' academic achievement, personality traits, and anxiety levels. Thus, students must understand their personalities and highlight the importance of their psychological well-being.

Factors associated with long Covid in nursing professionals

OBJECTIVE

To analyze the association between sociodemographic variables, lifestyle and mental health habits, and long Covid in nursing professionals.

METHOD

Quantitative, observational, cross-sectional and analytical study, with 109 nursing professionals who had Covid-19 between 2020 and 2022. Data collection was carried out using an online form, with the following variables of interest: resilience, subjective well-being, age, sex, professional category, vaccination, physical activity, presence of symptoms resulting from Covid-19 infection after the acute phase of the disease and long Covid. Data were analyzed descriptively and inferentially using Poisson regression with robust variance and a significance level of 5%.

RESULTS

Male sex, high resilience, and high positive affect decrease the prevalence of long Covid by 71% (RP = 0.29), 40% (RP = 0.60) and 43% (RP = 0.57), respectively, while being in the nursing technician category increases its prevalence by 74% (RP = 1.74).

CONCLUSION

The results emphasize the importance and support the development of promotion, prevention, treatment, and rehabilitation actions for individuals with long Covid. To achieve this, multidisciplinary care, centered on the person and directed at the context and work environment is required.

Balloon-mounted versus self-expandable stent in failed neurothrombectomy: a post hoc analysis of the SAINT study

BACKGROUND

Previous studies have shown that when thrombectomy has failed, rescue intracranial stenting is associated with better clinical outcomes compared with failed reperfusion. However, comparative data regarding stent type are lacking.

OBJECTIVE

To compare the procedural and clinical outcomes of balloon-mounted stents (BMS) with those of self-expandable stents (SES).

METHODS

Retrospective analysis of a prospectively collected database from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) consortium. Patients were included if thrombectomy had failed and they then underwent rescue emergency stenting. Patients treated with SES or BMS were compared using inverse probability of treatment weighting. The primary outcome was the final reperfusion as measured by the modified Thrombolysis in Cerebral Infarction (mTICI) Scale. Safety measures included rates of symptomatic intracranial hemorrhage, procedural complications, and 90-day mortality.

RESULTS

A total of 328 patients were included. Baseline clinical and procedural characteristics were well balanced among both groups. The BMS group (n=127) had higher rates of successful reperfusion (94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 to 11.37, P=0.004) and increased likelihood of higher degree of final reperfusion on the mTICI Scale (acOR=2.06, 95% CI 1.19 to 3.57, P=0.01) than the SES group (n=201). No difference in modified Rankin Scale shift (acOR=0.98, 95% CI 0.54 to 1.79, P=0.95), rates of mRS0-2 (26% vs 36%, aOR=0.93, 95% CI 0.46 to 1.88, P=0.83) and mRS0-3 (43% vs 50%, aOR=0.92, 95% CI 0.51 to 1.66, P=0.77) at 90 days were noted. Safety measures were comparable in both groups.

CONCLUSION

The present study demonstrates higher reperfusion rates with BMS than with SES in failed thrombectomy procedures that involved rescue stenting. No differences in hemorrhagic complications or clinical outcomes were noted. Further larger controlled studies are warranted.

Endoscopic submucosal dissection for proximal colonic lesions: An effective therapeutic option

Background and study aims

Due to the greater risks of adverse events (AEs) and the lower rate of submucosal invasive cancer (SMIC), large proximal colonic polyps are frequently treated by piecemeal endoscopic mucosal resection (EMR) in the West. However, this implies the risk of surgery to radicalize non-curative endoscopic resection in case of early colorectal cancer (CRC). We evaluated procedure outcomes in patients undergoing ESD for proximal colonic lesions at risk of SMIC.

Patients and methods

All consecutive patients with lesions at risk of SMIC proximal to splenic flexure referred for ESD at a tertiary center were prospectively included from 2019 to 2021. En bloc, R0, and curative resection rates were primary outcomes, while length of hospitalization, AEs, need for surgery due to AEs, and recurrence rates were secondary outcomes.

Results

A total of 116 patients (mean age: 68.4±10.91 years; men: 69.8%) were included. En bloc, R0, and curative resection rates were 84.5%, 78.4%, and 72.4%, respectively. T1 adenocarcinoma was reported in 25% of lesions (29/116). Eleven patients (9.5%) underwent secondary surgery due to non-curative resections; residual disease was found in one patient. Most frequent AE was intra-procedural perforation (9.9%); no AE required surgery. Median follow-up was 36 months; three of 97 recurrences (3.1%) at 6 months and one of 85 recurrence (1.2%) at 36 months were reported, which were all endoscopically treated.

Conclusions

In expert hands, ESD is effective and safe for proximal colonic lesions at risk of SMIC for the favorable balance between risk of AEs and benefit of avoiding unnecessary surgery, even for early CRC.

Photon-counting detector CTA to assess intracranial stents and flow diverters: an in vivo study with ultrahigh-resolution spectral reconstructions

BACKGROUND

To define optimal parameters for the evaluation of vessel visibility in intracranial stents (ICS) and flow diverters (FD) using photon-counting detector computed tomography angiography (PCD-CTA) with spectral reconstructions.

METHODS

We retrospectively analyzed consecutive patients with implanted ICS or FD, who received a PCD-CTA between April 2023 and March 2024. Polyenergetic, virtual monoenergetic, pure lumen, and iodine reconstructions with different keV levels (40, 60, and 80) and reconstruction kernels (body vascular [Bv]48, Bv56, Bv64, Bv72, and Bv76) were evaluated by two radiologists with regions of interests and Likert scales. Reconstructions were compared in descriptive analysis.

RESULTS

In total, twelve patients with nine FDs and six ICSs were analyzed. In terms of quantitative image quality, sharper kernels as Bv64 and Bv72 yielded increased image noise and decreased signal-to-noise and contrast-to-noise ratios compared to the smoothest kernel Bv48 (p = 0.001). Among the different keV levels and kernels, readers selected the 40 keV level (p = 0.001) and sharper kernels (in the majority of cases Bv72) as the best to visualize the in-stent vessel lumen. Assessing the different spectral reconstructions virtual monoenergetic and iodine reconstructions proved to be best to evaluate in-stent vessel lumen (p = 0.001).

CONCLUSION

PCD-CTA and spectral reconstructions with sharper reconstruction kernels and a low keV level of 40 seem to be beneficial to achieve optimal image quality for the evaluation of ICS and FD. Iodine and virtual monoenergetic reconstructions were superior to pure lumen and polyenergetic reconstructions to evaluate in-stent vessel lumen.

RELEVANCE STATEMENT

PCD-CTA offers the opportunity to reduce the need for invasive angiography serving as follow-up examination after intracranial stent (ICS) or flow diverter (FD) implantation.

KEY POINTS

Neuroimaging of intracranial vessels with implanted stents and flow diverters is limited by artifacts. Twelve patients with nine flow diverters and six intracranial stents underwent photon-counting detector computed tomography angiography (PCD-CTA). In-stent vessel lumen visibility improved using sharp reconstruction kernels and a low keV level. Virtual monoenergetic and iodine reconstructions were best to evaluate in-stent vessel lumen.

Circulating Tumor DNA as a Marker of Recurrence Risk in Stage III Colorectal Cancer: The α-CORRECT Study

BACKGROUND AND OBJECTIVES

Identification of colorectal cancer (CRC) patients at high risk of recurrence could be of substantial clinical use. We evaluated the association of ctDNA status, using a tumor-informed assay, with recurrence-free survival (RFS).

METHODS

Stage III CRC patients were enrolled between 2016 and 2020. Tumor tissue and serial (every 3 months for years 1-3, biannually for years 4-5) blood samples were collected. Utilizing whole-exome sequencing and selection of 50-200 variants for tumor informed assays, ctDNA status was determined using plasma cell-free DNA.

RESULTS

Of 137 patients enrolled, 124 with 1029 ctDNA results were included in the analyses. Median follow-up was 4.8 years. Plasma ctDNA status was strongly associated with risk of recurrence during the surveillance period (hazard ratio (HR) 49.6, 95% CI: 16.6-148.3; p < 0.0001), and at the postsurgical (HR 9.6, 95% CI: 3.2-29.5) and postdefinitive therapy timepoints (HR: 16.7, 95% CI: 6.9-40.3). The estimated 3-year RFS for ctDNA positive and ctDNA negative patients were, respectively, 54.5% and 96.1% after surgery, and 18.2% and 90.0% after definitive therapy. Multivariable analysis indicated ctDNA but not CEA was strongly prognostic for recurrence.

CONCLUSIONS

Our tumor-informed ctDNA assay was strongly prognostic for recurrence in patients with stage III colorectal cancer at all timepoints.

Impact of COVID-19 vaccination on hospitalization, hospital utilization and expenditure for COVID-19: A retrospective cohort analysis of a South African private health insured population

This study quantifies the impact of COVID-19 vaccination on hospitalization for COVID-19 infection in a South African private health insurance population. This retrospective cohort study is based on the analysis of demographic and claims records for 550,332 individuals belonging to two health insurance funds between 1 March 2020 and 31 December 2022. A Cox Proportional Hazards model was used to estimate the impact of vaccination (non-vaccinated, partly vaccinated, fully vaccinated) on COVID-19 hospitalization risk; and zero-inflated negative binomial models were used to estimate the impact of vaccination on hospital utilization and hospital expenditure for COVID-19 infection, with adjustments for age, sex, comorbidities and province of residence. In comparison to the non-vaccinated, the hospitalization rate for COVID-19 was 94.51% (aHR 0.06, 95%CI 0.06, 0.07) and 93.49% (aHR 0.07, 95%CI 0.06, 0.07) lower for the partly and fully vaccinated respectively; hospital utilization was 17.70% (95% CI 24.78%, 9.95%) and 20.04% (95% CI 28.26%, 10.88%) lower; the relative risk of zero hospital days was 4.34 (95% CI 4.02, 4.68) and 18.55 (95% CI 17.12, 20.11) higher; hospital expenditure was 32.83% (95% CI 41.06%, 23.44%) and 55.29% (95% CI 61.13%, 48.57%) lower; and the relative risk of zero hospital expenditure was 4.38 (95% CI 4.06, 4.73) and 18.61 (95% CI 17.18, 20.16) higher for the partly and fully vaccinated respectively. Taken together, findings indicate that all measures of hospitalization for COVID-19 infection were significantly lower in the partly or fully vaccinated in comparison to the non-vaccinated. The use of real-world data and an aggregated level of analysis resulted in the study having several limitations. While the overall results may not be generalizable to other populations, the findings add to the evidence based on the impact of COVID-19 vaccination during the period of the pandemic.

Refining Established Practices for Research Question Definition to Foster Interdisciplinary Research Skills in a Digital Age: Consensus Study With Nominal Group Technique

BACKGROUND

The increased use of digital data in health research demands interdisciplinary collaborations to address its methodological complexities and challenges. This often entails merging the linear deductive approach of health research with the explorative iterative approach of data science. However, there is a lack of structured teaching courses and guidance on how to effectively and constructively bridge different disciplines and research approaches.

OBJECTIVE

This study aimed to provide a set of tools and recommendations designed to facilitate interdisciplinary education and collaboration. Target groups are lecturers who can use these tools to design interdisciplinary courses, supervisors who guide PhD and master's students in their interdisciplinary projects, and principal investigators who design and organize workshops to initiate and guide interdisciplinary projects.

METHODS

Our study was conducted in 3 steps: (1) developing a common terminology, (2) identifying established workflows for research question formulation, and (3) examining adaptations of existing study workflows combining methods from health research and data science. We also formulated recommendations for a pragmatic implementation of our findings. We conducted a literature search and organized 3 interdisciplinary expert workshops with researchers at the University of Zurich. For the workshops and the subsequent manuscript writing process, we adopted a consensus study methodology.

RESULTS

We developed a set of tools to facilitate interdisciplinary education and collaboration. These tools focused on 2 key dimensions- content and curriculum and methods and teaching style-and can be applied in various educational and research settings. We developed a glossary to establish a shared understanding of common terminologies and concepts. We delineated the established study workflow for research question formulation, emphasizing the "what" and the "how," while summarizing the necessary tools to facilitate the process. We propose 3 clusters of contextual and methodological adaptations to this workflow to better integrate data science practices: (1) acknowledging real-life constraints and limitations in research scope; (2) allowing more iterative, data-driven approaches to research question formulation; and (3) strengthening research quality through reproducibility principles and adherence to the findable, accessible, interoperable, and reusable (FAIR) data principles.

CONCLUSIONS

Research question formulation remains a relevant and useful research step in projects using digital data. We recommend initiating new interdisciplinary collaborations by establishing terminologies as well as using the concepts of research tasks to foster a shared understanding. Our tools and recommendations can support academic educators in training health professionals and researchers for interdisciplinary digital health projects.

Very low levels of physical activity among patients hospitalized following hip fracture surgery: a prospective cohort study

PURPOSE

The evidence supports early and intensive mobilization and physical activity for patients who are hospitalized following hip fracture. The objectives were to determine levels of physical activity among patients hospitalized following hip fracture surgery, and to explore the association between levels of physical activity and 30-day post-discharge readmission, and mortality.

MATERIALS AND METHODS

We collected data at two university hospitals in Denmark from March-June 2023. Patients were included on postoperative day (POD) 1 to 3. 24-h upright time was measured from inclusion to discharge using a thigh-worn accelerometer. 30-day readmission and mortality were verified by patient records.

RESULTS

101 patients with a mean (SD) age of 79.9(8.4) years were included. The median (IQR) 24-h upright time on POD2-6 ranged from 15(7:31) to a maximum of 34(16:67) mins. Within 30 days after discharge, 25 patients(25%) were readmitted or referred to an emergency ward and 3(3%) patients died (no clear association with upright time).

CONCLUSIONS

For patients hospitalized following hip-fracture surgery, the level of physical activity seems extremely low the first week, but it does not seem to influence the rate of readmissions. Considering evidence supporting physical activity during acute hospitalization, the low activity level in these patients calls for action.

CLINICALTRIALS.GOV-IDENTIFIER

NCT05756517.

A randomized controlled trial comparing immersive virtual reality games versus nitrous oxide for pain reduction in common outpatient procedures in pediatric surgery

BACKGROUND

Children often experience anxiety and pain during minor surgical procedures, prompting the search for effective pain management strategies beyond traditional pharmaceutical approaches. This study aims to evaluate the efficacy of virtual reality (VR) as a pain reduction method in pediatric outpatient surgical interventions compared to the standard use of nitrous oxide. The research questions explore pain reduction levels, patient preferences, enjoyment during VR use, and the time limit of the VR application.

METHODS

The study employs a randomized controlled trial design, utilizing VR technology and nitrous oxide in separate groups in 100 children at the age from 6 to 15 undergoing minor surgical procedures. Outcomes are monitored directly after the intervention and two weeks following the procedure. The primary outcome measure is the pain level, assessed using visual face and visual analog scales. Secondary outcomes are the fun and/or fear experienced during the intervention, the willingness to undergo the same procedure again (if necessary), and whether there is a time limit with the VR application compared to nitrous oxide. The study also considers adverse events and safety measures.

DISCUSSION

The study aims to address a significant research gap in pediatric pain management strategies, as it is the first randomized controlled trial designed to compare pain levels using VR versus a control group with nitrous oxide analgosedation in children undergoing minor surgical procedures. Preliminary evidence suggests VR may offer a viable alternative to traditional pain management methods, as VR technology could be an effective distraction and pain management tool for pediatric patients undergoing outpatient surgical procedures.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05510141. Registered on August 22, 2022. Virtual Reality Games in Pediatric Surgery-Full Text View-ClinicalTrials.gov.

TRIAL SPONSOR

The principal investigator, Cordula Scherer act as the Sponsor, Clinic for pediatric surgery, Inselspital, Bern University Hospital, CH 3010 Bern, Switzerland.

Virtual primary care for people living with dementia in Canada: cross-sectional surveys of patients, care partners, and family physicians

BACKGROUND

Virtual care (VC) for dementia in primary care settings is an important aspect of healthcare delivery in Canada. However, the evidence informing optimal and sustainable provision of VC for persons living with dementia (PLWD) and their care partners is scarce. The objectives of this study were to (1) describe the frequency of VC use, (2) identify characteristics of PLWD, care partners, and family physicians (FPs) that are associated with the use of VC, and (3) explore FPs' perceptions of barriers and facilitators to provide VC for PLWD and their care partners.

METHODS

The Alzheimer Society of Canada and College of Family Physicians of Canada conducted three nationwide cross-sectional surveys between October 2020 and April 2021: (1) One with PLWD, (2) one with care partners of PLWD, and (3) one with FPs. Virtual care was defined as two-way synchronous communication by telephone and/or a web camera. The prevalence of VC use among FPs, PLWD, and care partners was described. Logistic regression models were used to determine characteristics of participants (sociodemographic, urbanicity, frequency and availability of support for connecting with FPs, and FPs' practice characteristics) associated with any VC use (phone and/or video). Inductive thematic analysis of open-ended questions explored FPs' perceptions.

RESULTS

131 PLWD, 341 care partners, and 125 FPs participated. 61.2% of PLWD, 59.5% of care partners, and 77.4% of FPs reported using VC. The models for PLWD (included age and ethnicity) and care partners (included gender/sex, urbanicity, and receiving support from a family member/friend to connect with FP) were inconclusive. FPs with > 20 years in practice were less likely to provide VC (OR = 0.23, 95%CI: 0.08-0.62, p < 0.01). FPs perceived that preferences regarding virtual vs. in-person care, office/family support, technology and family presence, and remuneration for FPs influenced VC use.

CONCLUSIONS

Virtual primary dementia care uptake in Canada is substantial and mainly performed via telephone. According to FPs, physician-patient-caregiver partnerships and infrastructure for VC play key roles in using VC. Virtual care could facilitate access to primary care and minimize potential disruptions to in-person care for PLWD. Outcomes of virtual primary care for dementia need further investigation.

Prevalence of Hepatitis C Virus Among Hospitalized Patients in a Tertiary Hospital in Italy: The Basis for a National Screening Assessment Model?

Free-of-charge hepatitis C virus antibody (HCV Ab) screening in some key populations and in 1969-1989 birth cohorts have been funded in Italy as the first step in confirming diagnosis in individuals who may be unaware of their infection. The purpose of this study is to leverage existing in-hospital routine screening data to better understand the distribution of HCV. A retrospective study of hospitalized patients (PTs) tested for HCV Ab for 5 years (from January 2017 to December 2022) in San Raffaele hospital was conducted according to age categories: birth year group before 1947 (patients older than 76 years old), birth year group 1947-1968, birth year group 1969-1989, and two other groups with birth year groups 1990-2000 and 2001-2022 (with patients younger than 33 years old) using the TriNetX platform. Among the 42,805 in-hospital PTs tested, 1297 (3.03%) were HCV Ab positive. The prevalence of HCV Ab was greater in PTs over the age of 76 (5.3%), whereas it was lower in the youngest birth year cohort (2000-2022, 0.16%). Among 1297 HCV Ab positive PTs, only 198 (15.3%) were tested for the presence of HCV RNA. The birth cohort 1969-1989 had a modest seroprevalence (1.5%), yet they were the most affected age group, with 44.4% being HCV RNA positive. The in-hospital HCV screening including birth year cohort 1947-1989 could be a more valuable option compared to the screening for birth year group 1969-1989 in the general population.

RNA-seq reproducibility of Pseudomonas aeruginosa in laboratory models of cystic fibrosis

Reproducibility is a fundamental expectation in science and enables investigators to have confidence in their research findings and the ability to compare data from disparate sources, but evaluating reproducibility can be elusive. For example, generating RNA sequencing (RNA-seq) data includes multiple steps where variance can be introduced. Thus, it is unclear if RNA-seq data from different sources can be validly compared. While most studies on RNA-seq reproducibility focus on eukaryotes, we evaluate bias in bacteria using Pseudomonas aeruginosa gene expression data from five laboratory models of cystic fibrosis. We leverage a large data set that includes samples prepared in three different laboratories and paired data sets where the same sample was sequenced using at least two different sequencing pipelines. We report here that expression data are highly reproducible across laboratories. In addition, while samples sequenced with different sequencing pipelines showed significantly more variance in expression profiles than between labs, gene expression was still highly reproducible between sequencing pipelines. Further investigation of expression differences between two sequencing pipelines revealed that library preparation methods were the largest source of error, though analyses to identify the source of this variance were inconclusive. Consistent with the reproducibility of expression between sequencing pipelines, we found that different pipelines detected over 80% of the same differentially expressed genes with large expression differences between conditions. Thus, bacterial RNA-seq data from different sources can be validly compared, facilitating the ability to advance understanding of bacterial behavior and physiology using the wide array of publicly available RNA-seq data sets.IMPORTANCERNA sequencing (RNA-seq) has revolutionized biology, but many steps in RNA-seq workflows can introduce variance, potentially compromising reproducibility. While reproducibility in RNA-seq has been thoroughly investigated in eukaryotes, less is known about pipelines and workflows that introduce variance and biases in bacterial RNA-seq data. By leveraging Pseudomonas aeruginosa transcriptomes in cystic fibrosis models from different laboratories and sequenced with different sequencing pipelines, we directly assess sources of bacterial RNA-seq variance. RNA-seq data were highly reproducible, with the largest variance due to sequencing pipelines, specifically library preparation. Different sequencing pipelines detected overlapping differentially expressed genes, especially those with large expression differences between conditions. This study confirms that different approaches to preparing and sequencing bacterial RNA libraries capture comparable transcriptional profiles, supporting investigators' ability to leverage diverse RNA-seq data sets to advance their science.

Factors Associated with Participation Patterns of Young Brazilian Children with Myelomeningocele

AIMS

To describe participation patterns and identify factors associated with participation of young Brazilian children with myelomeningocele (MMC) in their home, daycare/preschool, and community settings.

METHODS

The participants were parents/caregivers of 70 children with MMC, averaging 26.7 (±17.3) months in age. Participation was measured by the Young Children's Participation and Environment Measure (YC-PEM) completed by interview. Simple and stepwise multiple linear egression models were used to examine factors associated with participation.

RESULTS

On average children participated in home activities a few times a week, community activities once a month to a few times in the last month, and daycare or preschool activities once to a few times in the past four months. Age was associated with participation frequency (R2 = 0.32; p < .0001) and number of activities (R2 = 0.27; p < .02) in daycare/preschool and in the number of activities in the community (R2 = 0.30; p < .0001). Number of environmental facilitators was associated with the desire for change in participation in daycare/preschool (R2 = 0.21; p < .04). Mobility performance was associated with children's level of involvement (R2 = 0.10; p = .006) and caregivers' desire for change in community participation (R2 = 0.11; p = .006).

CONCLUSION

Knowledge of participation and factors that influence participation can help in designing interventions to improve participation opportunities for young children with MMC.

Ergonomics and Occupational Health: Knowledge, Attitudes and Practices of Nurses in a Tertiary Hospital in Botswana

Background: Musculoskeletal disorders (MSD) are, to this day, considered one of the major occupational health risks, especially among healthcare workers. Poor working conditions, such as awkward postures, are associated with the development of MSD. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of nurses at a public tertiary hospital in Botswana relating to ergonomic principles. Methods: The researchers conducted a cross-sectional survey, using a self-administered questionnaire to collect the data. The researchers employed Stata v18 (StataCorp, USA) to perform descriptive and inferential statistics. The chi-square test was used to determine the association between knowledge levels and sociodemographic variables. p-values ≤ 0.05 were deemed statistically significant. Results: In total, 306 nurses participated in the study, and a response rate of 88.4% was achieved. The mean age was 35.5 (SD± 8.79) years. Most (69%) participants were female nurses. About 99.3% (95%CI: 97.7-99.9) of the participants were familiar with the concept of ergonomics. Only a small proportion of participants (26%) possessed high levels of knowledge, exhibited positive attitudes, and demonstrated good practices in relation to ergonomic principles, following the composite analysis. A statistically significant relationship was found to exist between sex and practice (p = 0.030) and between length of work and practice (p = 0.013). Conclusions: The KAP analysis indicated that most nurses had poor practices regarding essential ergonomic principles. These findings could inform policy development and enable employers to design prevention strategies, especially those aimed at preventing lower back pain (LBP).

Sexual identity differences in ideal cardiovascular health among cisgender adults in the All of Us Research Program

BACKGROUND

Cardiovascular health (CVH) disparities have been documented among sexual minority adults, yet prior research has focused on individual CVH metrics. We sought to examine sexual identity differences in CVH using the American Heart Association's composite measure of ideal CVH, which provides a more comprehensive assessment of future CVD risk.

METHODS

Data from the All of Us Research Program were analyzed. Sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or other. Individual CVH health metrics and cumulative ideal CVH (range 0-100) were assessed. We ran sex-stratified multiple linear regression models to estimate differences across individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. We also explored differences in CVH across racial/ethnic and age groups.

RESULTS

The sample included 11 047 cisgender adults with a mean age of 61.1 years (± 13.85); 80% were non-Hispanic White. Lesbian women, gay men, and bisexual women reported greater nicotine exposure than their heterosexual counterparts. Compared to heterosexual men, gay men (B [95% CI] = -8.95 [-14.50, -3.39]) had worse physical activity scores. Gay men also had better body mass index scores than heterosexual men (B [95% CI] = 3.21 [0.09, 6.33]). Bisexual women and men had lower cumulative ideal CVH scores than heterosexual adults. Exploratory analyses revealed several differences in individual CVH metrics and cumulative ideal CVH across racial/ethnic and age groups.

CONCLUSIONS

Clinical interventions to improve the CVH of bisexual adults are needed. Findings can inform the design of interventions that are tailored for specific subgroups of sexual minority adults.

Risk factors for overtaking, rear-end, and door crashes involving bicycles in the United Kingdom: Revisited and reanalysed

BACKGROUND AND OBJECTIVE

Relevant research has provided valuable insights into risk factors for bicycle crashes at intersections. However, few studies have focused explicitly on three common types of bicycle crashes on road segments: overtaking, rear-end, and door crashes. This study aims to identify risk factors for overtaking, rear-end, and door crashes that occur on road segments.

MATERIAL AND METHODS

We analysed British STATS19 accident records from 1991 to 2020. Using multivariate logistic regression models, we estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for multiple risk factors. The analysis included 127,637 bicycle crashes, categorised into 18,350 overtaking, 44,962 rear-end, 6,363 door, and 57,962 other crashes.

RESULTS

Significant risk factors for overtaking crashes included heavy goods vehicles (HGVs) as crash partners (AOR = 1.30, 95% CI 1.27-1.33), and elderly crash partners (AOR = 2.01, 95% CI = 1.94-2.09), and decreased risk in rural area with speed limits of 20-30 miles per hour (AOR = 0.45, 95% CI = 0.43-0.47). For rear-end crashes, noteworthy risk factors included unlit darkness (AOR = 1.49, 95% CI = 1.40-1.57) and midnight hours (AOR = 1.28, 95% CI = 1.21-1.40). Factors associated with door crashes included urban areas (AOR = 16.2, 95% CI = 13.5-19.4) and taxi or private hire cars (AOR = 1.61, 95% CI = 1.57-1.69). Our joint-effect analysis revealed additional interesting results; for example, there were elevated risks for overtaking crashes in rural areas with elderly drivers as crash partners (AOR = 2.93, 95% CI = 2.79-3.08) and with HGVs as crash partners (AOR = 2.62, 95% CI = 2.46-2.78).

CONCLUSIONS

The aforementioned risk factors remained largely unchanged since 2011, when we conducted our previous study. However, the present study concluded that the detrimental effects of certain variables became more pronounced in certain situations. For example, cyclists in rural settings exhibited an elevated risk of overtaking crashes involving HGVs as crash partners.

Meaningful Engagement as a Cornerstone for Implementing the Key Recommendations to Advance the Sexual and Reproductive Health and Rights of Women Living With HIV Across Policy, Practice, and Research in Canada

In 2022, a community-academic collaborative team published 5 key recommendations for developing a national action plan to advance the sexual and reproductive health and rights (SRHR) of women living with HIV in Canada. In 2023, a national gathering was convened to strategize implementation of the recommendations across policy, practice, and research settings. Discussions highlighted that meaningful engagement of women living with HIV (recommendation 1) is foundational to implementing the other recommendations. Meaningful engagement requires SRHR stakeholders to: actively dismantle power differentials; commit to engagement as an ongoing process; learn about regionally specific epidemiology and sociostructural forces that create and sustain vulnerability for HIV among women; invest in creating supportive infrastructure; and integrate Equity, Diversity, and Inclusion principles to call diverse groups into the conversation. This Canadian initiative demonstrates how global guidelines can be transformed into nationally tailored action plans to advance the SRHR of women living with HIV, grounded in meaningful engagement.

Preventing Severe COVID-19 with Tixagevimab-Cilgavimab in Hematological Patients Treated with Anti-CD20 Monoclonal Antibodies: An International Multicenter Study

INTRODUCTION

Despite the declining public health emergency status, COVID-19 still poses significant risks, especially for immunocompromised individuals. We aimed to evaluate the effectiveness of tixagevimab-cilgavimab (T-C) prophylaxis in preventing severe COVID-19 in patients with hematologic malignancies (HM) treated with anti-CD20 therapy during the early Omicron variant phase of the pandemic.

METHODS

The European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses (ESGREV) conducted a multicenter retrospective cohort study involving 15 centers from 5 countries. The study included 749 patients with HM treated with anti-CD20 between February 15 and June 30, 2022, comparing 215 who received T-C prophylaxis to 534 who did not.

RESULTS

The study revealed a significant reduction in the risk of COVID-19 among patients who received T-C prophylaxis compared to those who did not (11.2% vs 23.4%, p < 0.001), with hazard ratio (HR) of 0.40 (95% CI 0.26-0.63), adjusted for age, sex, vaccination status, baseline HM malignancy and type of anti-CD-20. We also demonstrated a reduction for severe-critical diseases within all study populations, 1.4% vs 5.2%, p = 0.017, HR 0.26 (95% CI 0.08-0.84).

CONCLUSION

T-C prophylaxis effectively prevented COVID-19 and severe-critical COVID-19 in patients with HM treated with anti-CD20 monoclonal antibodies during the early Omicron variant phase of the pandemic. Even though T-C is ineffective against current variants, these findings highlight the importance of additional protective measures and the continued development of monoclonal antibodies to protect immunocompromised individuals to mitigate the impact of COVID-19 and other respiratory viral diseases.

Parents' perceptions of care quality at child health centres: A cross-sectional study from Sweden

AIM

To examine parents' perceptions of care quality at child health centres. Specific objectives were to examine parents' perceptions of the care received and the subjective importance of such care. Furthermore, to examine the relationship between parents' sociodemographic characteristics and the perceptions of care quality.

DESIGN

A cross-sectional study.

METHODS

A random sample of parents of children born in Sweden in 2021 participated. Data were collected by the QPP-CHC questionnaire and analysed using descriptive and analytical statistics.

RESULTS

The response rate was 19.4%. The targeted sample size of 210 participants was reached as 584 parents responded to the questionnaire. Parents' overall ratings of care quality at child health centres indicated optimal quality with mean values >3. However, various potential improvements areas were identified as needing additional information. These included dental care (m = 2.82), allergy prevention (m = 2.25), breastfeeding (m = 2.97), sleep (m = 2.83), the child's behaviour (m = 2.47) and the child's crying (m = 2.47). Also, parents rated suboptimal quality regarding that the care was based on healthcare routines rather than parental preferences and needs (m = 2.86). Parents born outside of the Nordic countries rated higher care quality than those born in the Nordic countries, as well as parents with a non-academic education.

CONCLUSION

Parents want information based on their preferences and needs. Parent's perceptions of areas for improvement are new and important knowledge for registered nurses at child health centres.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings indicate that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres is an important component of quality work and might lead to improvements in the care quality at child health centres.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting.

IMPLICATIONS FOR POLICY AND PRACTICE

The findings of this study suggests that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres provides important knowledge which can guide further development of care quality at child health centres. The findings indicate that a family-centred approach that integrates relational and routine-oriented nursing can be a way to ensure that the care is based on parents' preferences and needs. No patient or public contribution.

Applying Large Language Models to Assess Quality of Care: Monitoring ADHD Medication Side Effects

OBJECTIVE

To assess the accuracy of a large language model (LLM) in measuring clinician adherence to practice guidelines for monitoring side effects after prescribing medications for children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Retrospective population-based cohort study of electronic health records. Cohort included children aged 6 to 11 years with ADHD diagnosis and 2 or more ADHD medication encounters (stimulants or nonstimulants prescribed) between 2015 and 2022 in a community-based primary health care network (n = 1201). To identify documentation of side effects inquiry, we trained, tested, and deployed an open-source LLM (LLaMA) on all clinical notes from ADHD-related encounters (ADHD diagnosis or ADHD medication prescription), including in-clinic/telehealth and telephone encounters (n = 15 628 notes). Model performance was assessed using holdout and deployment test sets, compared with manual medical record review.

RESULTS

The LLaMA model accurately classified notes that contained side effects inquiry (sensitivity = 87.2, specificity = 86.3, area under curve = 0.93 on holdout test set). Analyses revealed no model bias in relation to patient sex or insurance. Mean age (SD) at first prescription was 8.8 (1.6) years; characteristics were mostly similar across patients with and without documented side effects inquiry. Rates of documented side effects inquiry were lower for telephone encounters than for in-clinic/telehealth encounters (51.9% vs 73.0%, P < .001). Side effects inquiry was documented in 61.4% of encounters after stimulant prescriptions and 48.5% of encounters after nonstimulant prescriptions (P = .041).

CONCLUSIONS

Deploying an LLM on a variable set of clinical notes, including telephone notes, offered scalable measurement of quality of care and uncovered opportunities to improve psychopharmacological medication management in primary care.

Excess mortality and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality

Introduction

Excess mortality has been frequently used worldwide for summarising the COVID-19 pandemic-related burden. Estimates for France for the years 2020-2022 vary substantially from one report to another, and the year 2023 is poorly documented. The present study assessed the level of excess mortality that occurred in France between 2020 and 2023 together with the corresponding years of life lost (YLL), in order to provide a reliable, detailed and comprehensive description of the overall impact of the pandemic.

Method

This open cohort study of the whole French population analysed the 8 451 372 death occurrences reported for the years 2010-2023. A Poisson regression model was trained with years 2010-2019 for determining the age-specific and sex-specific evolution trends of mortality before the pandemic period. These trends were then used for estimating the excess mortality during the pandemic period (years 2020-2023). The life expectancies of the persons in excess mortality were used for estimating the corresponding YLL.

Results

From 2020 to 2023, the number of excess deaths (mean (95% CI) (percentage of change versus expected mortality)) was, respectively, 49 541 (48 467; 50 616) (+8.0%), 42 667 (41 410; 43 909) (+6.9%), 53 129 (51 696; 54 551) (+8.5%), and 17 355 (15 760; 18 917) (+2.8%). Corresponding YLL were 512 753 (496 029; 529 633), 583 580 (564 137; 602 747), 663 588 (641 863; 685 723), and 312 133 (288 051; 335 929). Individuals younger than 60 years old accounted for 17% of the YLL in 2020, 26% in 2021, 32% in 2022 and 50% in 2023. Men were more affected than women by both excess mortality and YLL.

Conclusion

This study highlights the long-lasting impact of the pandemic on mortality in France, with four consecutive years of excess mortality and a growing impact on people under 60, particularly men, suggesting lasting and profound disruption to the healthcare system.

Histologic parameters driving completion thyroidectomy for papillary thyroid carcinoma in a high-volume institution: A retrospective observational study

BACKGROUND

When the histological examination indicates papillary thyroid carcinoma (PTC), there is no unanimity on the need to proceed with completion thyroidectomy (CT). This study aims to assess the histologic parameters that influenced the decision to perform CT.

MATERIALS AND METHODS

This study included PTC patients who underwent thyroid lobectomy between 2019 and 2022. Group A included patients who underwent thyroid lobectomy without further treatments, whereas Group B included those who underwent CT based on histological findings. Differences in terms of histologic parameters were analyzed.

RESULTS

Group A included 291 patients (68.3 ​%), whereas Group B 135 patients (31.7 ​%). Multivariate analysis identified associations between CT and tumor size (p ​< ​0.001), aggressive variant (p ​= ​0.009), and vascular invasion (p ​< ​0.001). ROC curve analysis established a tumor size cut-off of 21 ​mm for CT. At ROC curve analysis, the cut-off number of aggressive factors required for CT was 2.

CONCLUSION

A thorough comprehensive assessment encompassing all pathological characteristics might be necessary in case of PTC with aggressive histologic features after thyroid lobectomy.

Adherence to patient blood management strategy in patients with gastrointestinal bleeding: a prospective nationwide multicenter study

INTRODUCTION

Patient blood management (PBM) adherence in clinical practice is unclear. This real-world practice study assessed the management of patients with gastrointestinal (GI) bleeding after the implementation of the PBM strategy.

METHODS

This was a nationwide multicenter and prospective study involving consecutive adults with GI bleeding between March 2019 and March 2021. Patients were examined according to hemoglobin (Hb) level at admission (<7 g/dl, n  = 93; 7-8 g/dl, n  = 47; 8-9 g/dl, n  = 61; and >9 g/dl, n  = 249). Study outcomes measures were morbidity and mortality during hospitalization and at 3- and 6-month follow-up. Appropriate anemia or iron deficiency management was considered when adherence to PBM policy was higher than 75%.

RESULTS

A total of 450 patients (57.6% men, median age: 74 years, interquartile range: 63-82) were included. Overall, 55.1% and 59.3% of patients received transfusion and iron supplementation, respectively. The rates of appropriate transfusion and iron supplementation adherence were 90.9% (range: 86.9-93.5%, P  = 0.109) and 81.8% (range: 78.5-85.1%, P  = 0.041), depending on Hb level, respectively. No associations were observed between adherence to the PBM strategy and length of stay ( P  = 0.263) or risk of further bleeding ( P  = 0.742). Patients who were transfused [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.27-0.85] and iron supplemented (HR: 0.91, 95% CI: 0.38-1.41), however, appropriately achieved a lower risk of death. Age (HR: 1.12, 95% CI: 1.12-1.25) and further bleeding (HR: 39.08, 95% CI: 4.01-181.24) were poor prognostic factors. No serious adverse events were reported.

CONCLUSIONS

In this nationwide study, there is a high level of adherence and safety of PBM for the treatment of GI bleeding. Adherence to the PBM strategy improved outcomes in patients with GI bleeding.

Long-term outcomes following the resection of screen-detected right-sided colon cancer

BACKGROUND

The relative outcomes following the resection of screen-detected right-sided colon cancer compared to symptomatic cases are unknown. In this study, short and long-term outcomes after right-sided colectomy in screen-detected colon cancer are compared with symptomatic cases, both emergency and elective.

METHODS

A prospective observational cohort study of patients, including both screen-detected and symptomatic patients (elective and emergency resections), undergoing right-sided colectomy for colon cancer (2010-2020) in a tertiary care unit was conducted. Each patient was followed up for long-term recurrence and survival.

RESULTS

A total of 909 patients (median age, 70; IQR, 58-82; male, 52%) were included (151 patients (16.6%) screen-detected; 598 (65.8%) elective and 160 (17.6%) emergency). Screen-detected patients were more likely to have T1 or T2 lesions compared to elective and emergency groups (T1: 14.6% vs. 3.8% vs. 0.6% p < 0.001; T2: 16.6% vs. 8.9% vs. 3.1% p < 0.001), but were less likely to have T3 or T4 lesions (p < 0.001), respectively. Rates of N0 were higher in the screen-detected group (68.9% vs. 63.5% vs. 41.9%, respectively; p < 0.001). 98% of the screen-detected group achieved R0 resection compared to 93.3% of elective and 79.4% of emergency patients (p < 0.001). At 5-years following resection, overall survival for the screen-detected, elective, and emergency groups were 85.4%, 75.4%, and 53.1%, respectively (p < 0.001). Recurrence at 5-year post-resection were 8%, 15.1%, and 22.5% for the screen-detected, elective, and emergency groups, respectively (p < 0.001).

DISCUSSION

When considering right-sided colon cancer alone, screen-detected cancers have a lower long-term recurrence rate, lower rates of postoperative complication, and superior survival compared to symptomatic groups following resection.

Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease

OBJECTIVE

To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD).

METHODS

This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications.

RESULTS

Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%).

CONCLUSION

CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.

Guardians of the Game: UV-Specific Skin Cancer Prevention by Coaches in Outdoor Sports

BACKGROUND

Due to the global rise in UV radiation, the prevalence of skin cancer is increasing significantly, with outdoor athletes being identified as a particularly vulnerable population group.

METHODS

This nationwide, cross-sectional study was conducted among adult coaches from the 10 largest outdoor sports associations in Germany. Their applied prevention measures and the potential for further improvement in prevention were evaluated by guideline based scores (range [0-100]). Additionally, sport-, coach-, and club-specific variables were analysed and barriers that prevent comprehensive UV prevention were identified.

RESULTS

The UV prevention practice of the 1200 participating coaches averaged 53.43 ± 16.37 [0.00-95.31], while the potential UV prevention options were assessed at a comparatively higher value of 58.82 ± 17.53 [0-100]. Notably, the proper use of sunscreen emerged as the most neglected preventive measure. Coaches identified the greatest potential for improvement in sunscreen renewal, water-resistant sun protection products and sunglasses. The study also revealed significant differences in UV protection practices between different sports, with soccer, tennis, and swimming exhibiting the most pronounced deficits. Factors such as coach qualification and experience, as well as club size and the size of training groups influenced the level of UV protection implemented. Many coaches cited various implementation obstacles such as fixed training times and resource constraints.

CONCLUSION

The study highlights specific areas for improvement in UV protection practices in outdoor sports, considering differences on sport, coach, and club levels. The significant number of active athletes in these sports underscores the public health importance of addressing UV protection in this field.

Adapting and validating the satisfaction, alertness, timing, efficiency, and duration-breast cancer (SATED-BC) scale for measuring sleep health in Spanish women treated for breast cancer

BACKGROUND

After breast cancer (BC), women may face other severe symptoms such as sleep problems. The use of simple, fast, and reliable scales is necessary in the clinic to improve patient benefits, and sleep is an important aspect to be addressed.

OBJECTIVE

This study was conducted to adapt and validate the Spanish version of the satisfaction, alertness, timing, efficiency, and duration (SATED) scale for measuring sleep health in women who have completed treatment for BC in Spain (SATED-BC).

DESIGN

Cross-sectional study.

METHODS

The adaptation process involved adding a sixth item to the SATED-BC scale: "the impact of symptoms experienced after completing breast cancer treatment on sleep" item was not considered for scoring. The SATED-BC score ranged from 0 (poorest sleep health) to 10 (best sleep health). A validation analysis was performed using the Pittsburgh Sleep Quality Index, the Consensus Sleep Diary, and actigraphy, and the results were compared with those obtained using the SATED-BC scale.

RESULTS

The SATED-BC scale was reliable in terms of its internal consistency (Cronbach's α = 0.70; McDonald's ω = 0.72), showed high intrasubject reliability (r = 0.90), and was shown to be valid for use in women who have completed treatment for breast cancer.

CONCLUSION

The SATED-BC scale is a reliable and valid tool for comprehensively evaluating sleep health in women who have completed treatment for breast cancer.

Longitudinal Identification of Pre-Lesional Tissue in Multiple Sclerosis With Advanced Diffusion MRI

BACKGROUND AND PURPOSE

Structural MRI (sMRI) is used in monitoring multiple sclerosis (MS) but lacks sensitivity in detecting clinically relevant damage to normal-appearing white matter (NAWM), that is, pre-lesional tissue, and specificity for identifying the underlying substrate of injury. In this longitudinal study, we identified pre-lesional tissue in MS patients and investigated its microstructure by modeling diffusion-weighted imaging (DWI) data using diffusion tensor imaging and neurite orientation dispersion and density imaging (NODDI).

METHODS

We enrolled 18 patients with relapsing-remitting MS (10 females, 31.92 ± 8.09 years, disease duration 0.91 ± 1.81 years) and 18 healthy controls (10 females, 31.89 ± 8.15 years). Participants underwent two sMRI and DWI sessions (baseline and follow-up) with the same protocols. Average apparent diffusion coefficient (ADC), fractional anisotropy (FA), orientation dispersion index (ODI), and neurite density index (NDI) were estimated in data-driven regions of interest: nonpersistent lesional tissue (lesional tissue at baseline, resolved at follow-up), lesions that only existed at follow-up (pre-lesional tissue at baseline, lesions at follow-up), persistent lesional tissue (lesions at baseline and follow-up), and NAWM.

RESULTS

Compared to NAWM, pre-lesional tissue showed lower ODI, and resolved lesional tissue showed higher FA and ADC and lower ODI and NDI. Over time, persistent lesional tissue showed a decrease in FA and ODI and an increase in NDI. Compared to nonpersistent lesional tissue, persistent lesional tissue showed higher ADC and lower NDI.

CONCLUSIONS

DWI and, more particularly, NODDI, can reveal the unique microstructure of persistent, resolved, and pre-lesional tissue in MS.

A longitudinal study of SARS-CoV-2 antibody seroprevalence and mitigation behaviors among college students at an Arkansas University

Objective: Assess university students' SARS-CoV-2 antibody seroprevalence and mitigation behaviors over time. Participants: Randomly selected college students (N = 344) in a predominantly rural Southern state. Methods: Participants provided blood samples and completed self-administered questionnaires at three timepoints over the academic year. Adjusted odds ratios and 95% confidence intervals were estimated from logistic regression analyses. Results: SARS-CoV-2 antibody seroprevalence was 18.2% in September 2020, 13.1% in December, and 45.5% in March 2021 (21% for those with no vaccination history). SARS-CoV-2 antibody seroprevalence was associated with large social gatherings, staying local during the summer break, symptoms of fatigue or rhinitis, Greek affiliation, attending Greek events, employment, and using social media as the primary COVID-19 information source. In March 2021, seroprevalence was associated with receiving at least one dose of a COVID-19 vaccination. Conclusion: SARS-CoV-2 seroprevalence was higher in this population of college students than previous studies. Results can assist leaders in making informed decisions as new variants threaten college campuses.

Artificial intelligence in psychiatry: A systematic review and meta-analysis of diagnostic and therapeutic efficacy

Background

Artificial Intelligence (AI) has demonstrated significant potential in transforming psychiatric care by enhancing diagnostic accuracy and therapeutic interventions. Psychiatry faces challenges like overlapping symptoms, subjective diagnostic methods, and personalized treatment requirements. AI, with its advanced data-processing capabilities, offers innovative solutions to these complexities.

Aims

This study systematically reviewed and meta-analyzed the existing literature to evaluate AI's diagnostic accuracy and therapeutic efficacy in psychiatric care, focusing on various psychiatric disorders and AI technologies.

Methods

Adhering to PRISMA guidelines, the study included a comprehensive literature search across multiple databases. Empirical studies investigating AI applications in psychiatry, such as machine learning (ML), deep learning (DL), and hybrid models, were selected based on predefined inclusion criteria. The outcomes of interest were diagnostic accuracy and therapeutic efficacy. Statistical analysis employed fixed- and random-effects models, with subgroup and sensitivity analyses exploring the impact of AI methodologies and study designs.

Results

A total of 14 studies met the inclusion criteria, representing diverse AI applications in diagnosing and treating psychiatric disorders. The pooled diagnostic accuracy was 85% (95% CI: 80%-87%), with ML models achieving the highest accuracy, followed by hybrid and DL models. For therapeutic efficacy, the pooled effect size was 84% (95% CI: 82%-86%), with ML excelling in personalized treatment plans and symptom tracking. Moderate heterogeneity was observed, reflecting variability in study designs and populations. The risk of bias assessment indicated high methodological rigor in most studies, though challenges like algorithmic biases and data quality remain.

Conclusion

AI demonstrates robust diagnostic and therapeutic capabilities in psychiatry, offering a data-driven approach to personalized mental healthcare. Future research should address ethical concerns, standardize methodologies, and explore underrepresented populations to maximize AI's transformative potential in mental health.

Association of antenatal steroid administration with neonatal morbidities among late preterm multiple gestation infants

BACKGROUND

There is limited evidence on the efficacy of antenatal steroids (ANS) among women with multiple gestations at risk of late preterm delivery.

STUDY DESIGN

This retrospective study included multiple gestation, late preterm infants (340/7-366/7 weeks' gestational age), born between January 2013 and December 2022. The primary outcome was composite respiratory outcome, defined as the need for respiratory support by 72 hours of age. Logistic and linear regressions were performed to compare the primary and secondary outcomes with and without exposure to any ANS, adjusted for gestational age, sex of infant, histologic chorioamnionitis, and intrauterine growth restriction.

RESULTS

The composite respiratory outcome was significantly lower in any ANS group compared to no ANS group (28.6% vs. 33.7%) [adjusted odds ratio 0.50, 95% CI, 0.33-0.75, p < 0.001].

CONCLUSION

In late preterm multiple gestation infants, any ANS exposure was associated with lower risk of composite respiratory outcome.

Opportunities to optimize patient experience in the in vitro fertilization (IVF) clinic and the role of genetic counselors

PURPOSE

To understand factors influencing patient satisfaction with genetics education and psychosocial support in an IVF clinic without a genetic counselor (GC), and how the role of a GC may fill gaps in care using a mixed-method cross-sectional study.

METHODS

Previous IVF patients (n = 133) completed a survey assessing satisfaction with genetics education and psychosocial support and decisional conflict about genetic testing. Kruskal-Wallis tests were used to compare satisfaction level to demographic and clinical variables. Spearman's correlation was used to analyze decisional conflict. Focus groups with 12 total participants expanded on themes identified in survey responses. Thematic analysis was performed using interpretive description.

RESULTS

Participants reported satisfaction with their genetics education experience (78.9% somewhat or extremely satisfied). Satisfaction with genetics education was associated with satisfaction with information received about genetic testing results (H = 21.3, p < 0.01) and confidence using results in future decisions (H = 9.9, p < 0.01). Participants desired thorough pre-test and post-test counseling regarding genetic testing and directive guidance. Decision conflict about genetic testing was low (mean of 22.3, range 0-100). Satisfaction with genetics education was inversely correlated with decisional conflict (rs = - 0.42, p < 0.05). In-person GC visit scored highest among proposed education methods (mean score of 84.1).

CONCLUSIONS

Patients felt satisfied with genetics education and psychosocial support provided by clinical providers. Gaps in care included misconceptions regarding genetic testing, a desire for more thorough counseling about genetic testing options, more directive guidance, and increased psychosocial support through external sources such as support groups.

The Value of P-Wave Parameters Changes in Predicting Catheter Ablation Outcomes for Paroxysmal Atrial Fibrillation

BACKGROUND

Pulmonary vein isolation (PVI) is the most promising management method for paroxysmal atrial fibrillation (PAF). The P wave in the electrocardiogram (ECG) represents atrial depolarization. This study aims to correlate P-wave parameters after PVI with outcomes.

METHODS

This single-center retrospective study included consecutive patients with first-time PVI for PAF between 2018 and 2019 and targeted pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12 leads ECGs with 1-50 hertz bandpass filter were monitored before the procedure. P-wave amplitude (PWA) and P-wave terminal force in V1 (PTFV1) Corrected P-wave duration (PWDc), and P-wave dispersion (PWDisp), were measured before and after ablation.

RESULTS

The final analysis included 180 patients, of which 130 (72%) had successful ablations and 53 (30%) had radiofrequency ablation (RF). Males comprised 71% of the patients; the mean age was 60. Demographics were similar between both arms p < 0.001. Patients with failed PVI had increased PWDc after PVI (139-146 ms, p < 0.001) compared to patients with successful PVI. PWA increased significantly after failed PVI (1.6-2 mV, p < 0.001) and successful PVI (1.6-1.8 mV, p = 0.008). PWD (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.4-4.2, p < 0.001) and PWA (HR: 1.7, 95% CI: 1.2-2.9, p = 0.03) were independently associated with PVI failure at 12 months. PWdisp and PTFV1 were not correlated with outcomes.

CONCLUSION

Increased PWDc and PWA after PVI were independently associated with failed ablation for PAF, supporting the role of P-wave parameters in predicting outcomes.

Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts

INTRODUCTION

Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique.

METHODS

This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis.

RESULTS

The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts (p < .01), with a subdistribution hazard ratio (SHR) of 0.16 (p = .010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group (p < .01) with a SHR of 0.53 (p = .017). The short-term results were similar in both groups.

CONCLUSIONS

Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG.

Physical violence and its associations: Insights from nationally representative data in India

BACKGROUND

Empowerment is vital for individuals' control over their lives but is often constrained for women in India due to deep-rooted patriarchal norms. This affects health, and resource distribution, and increases domestic violence. Domestic violence including physical, sexual, emotional, economic, and psychological abuse is a significant human rights and public health issue. Understanding the link between women's empowerment and attitudes toward physical violence is essential for addressing this problem.

OBJECTIVES

To explore the relationship between various aspects of women's empowerment and their attitudes toward the justification of physical violence in specific circumstances. The study aimed to provide insights into how empowerment can serve as a protective factor against domestic violence.

DESIGN

A cross-sectional study was conducted using the data from the National Family Health Survey-5 (NFHS-5), collected from 2019 to 2021. The study was carried out between July 2023 and March 2024.

METHODS

Data from NFHS-5, focusing on women aged 15-49 who completed the domestic violence module, were analyzed. Women's empowerment was measured through employment, asset ownership, and decision-making autonomy. The study assessed 8 indicators of employment, 12 of asset ownership, 9 of decision-making, 5 justifying physical violence, and 11 indicators of physical abuse. Frequencies, percentages, Fischer's exact test, and logistic regression were used, with significance set at p < 0.05.

RESULTS

Of 4562 women, 23 (0.7%) were employed, 3397 (74.5%) owned mobile phones, and 744 (21.9%) used them for transactions. Joint financial decisions were made by 2692 (75.2%) couples. Restrictions on meeting friends were reported by 376 (10.1%), and 431 (11.6%) had trust issues with partners. Physical violence was justified by 934 (20.5%) for neglecting children, and 3365 (90.4%) experienced partner violence. Land ownership was reported by 383 (8.4%) women. Empowered women were less likely to justify or experience violence, with mobile phone use and decision-making autonomy linked to reduced violence.

CONCLUSION

Women's empowerment through employment, asset ownership, and decision-making is associated with reduced justification and prevalence of physical violence. Despite progress, entrenched societal norms persist. Interventions should focus on economic and social empowerment, addressing cultural attitudes and promoting gender equality.

Blood Transfusion and Survival of Children, Adolescent, and Young Adult Patients with Osteosarcoma: A Multicenter Retrospective Cohort Study

Background/Objectives: Prior studies suggest that blood transfusion may adversely affect the survival of patients with cancer via transfusion-related immunomodulation. The objective of our study is to investigate the association between transfusion during neoadjuvant chemotherapy and survival in children, adolescent, and young adult (CAYA, 39 years old or younger) patients with osteosarcoma. Methods: This is a multicenter retrospective cohort study of patients between 2007 and 2022. Our primary exposure was receipt of any blood product in the neoadjuvant period (i.e., neoadjuvant transfusion). The primary outcome of interest was 3-year event-free survival (EFS) calculated using the Kaplan-Meier method, while secondary outcomes of interest included 5-year EFS and 3- and 5-year overall survival (OS). Firth multivariable logistic regression models were constructed to evaluate the adjusted association between transfusion status and 3- and 5-year EFS and OS. Results: In total, 73 patients were included in the analytic sample; among them, 34 received neoadjuvant transfusion. There was no significant difference between transfused and non-transfused groups in race, ethnicity, tumor location, stage at diagnosis, histologic response to neoadjuvant chemotherapy, and receipt of ifosfamide or radiation during initial treatment. The transfusion group included more females (p = 0.02) and lower median hemoglobin at diagnosis (p = 0.002) than the non-transfusion group. EFS and OS did not significantly vary by transfusion status or type. Conclusions: We did not observe an adjusted association between neoadjuvant transfusion and survival in CAYA patients with osteosarcoma.

Leukocyte Telomere Length as a Marker of Chronic Complications in Type 2 Diabetes Patients: A Risk Assessment Study

Telomere shortening has been linked to type 2 diabetes (T2D) and its complications. This study aims to determine whether leukocyte telomere length (LTL) could be a useful marker in predicting the onset of complications in patients suffering from T2D. Enrolled study subjects were 147 T2D patients. LTL was measured using a quantitative PCR method. Key subject's demographics and other clinical characteristics were also included. T2D patients with the shortest LTL had higher TC and non-HDL levels, compared to subjects with the longest LTL (p = 0.013). Also, T2D patients suffering from diabetic nephropathy showed significant differences in LDL levels (p = 0.023). While in the group of T2D patients with diabetic retinopathy, significant differences were observed for parameters, such as duration of diabetes (p = 0.043), HbA1c (p = 0.041), TC (p = 0.003), LDL (p = 0.015), Non-HDL (p = 0.004) and TG (p = 0.045). Logistic regression analysis confirmed a significant risk of association of TC and Non-HDL levels with LTL in the 3rd tertile LTL for the crude model adjusted for sex and age, with respective odds ratios of 0.71 (95% CI 0.56-0.91) and 0.73 (95% CI 0.58-0.91). No significant associations were found between LTL in T2D patients and the prevalence of common T2D complications. Nevertheless, a significant association was demonstrated between LTL and some markers of dyslipidemia, including in T2D patients with either diabetic nephropathy or retinopathy. Therefore, analysis of LTL in T2D patients' leukocytes demonstrates a promising potential as a marker in predicting the onset of complications in T2D. This could also help in establishing an effective treatment strategy or even prevent and delay the onset of these severe complications.