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Journal of General Internal Medicine Jun 2024Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs)....
BACKGROUND
Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known.
OBJECTIVE
To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes.
DESIGN
Pragmatic cluster randomized trial.
PARTICIPANTS
A total of 1060 adults with type 2 diabetes in 22 primary care practices.
INTERVENTIONS
Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors).
MAIN MEASURES
Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models.
KEY RESULTS
Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions.
CONCLUSIONS
Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order.
NIH TRIAL REGISTRY NUMBER
NCT03590041.
PubMed: 38943014
DOI: 10.1007/s11606-024-08868-7 -
Journal of Human Hypertension Jun 2024National and international hypertension guidelines recommend that adults with young-onset hypertension (aged <40 years at diagnosis) are reviewed by a hypertension... (Review)
Review
National and international hypertension guidelines recommend that adults with young-onset hypertension (aged <40 years at diagnosis) are reviewed by a hypertension specialist to exclude secondary causes of hypertension and optimise therapeutic regimens. A recent survey among UK secondary care hypertension specialist physicians highlighted variations in the investigation of such patients. In this position statement, the British and Irish Hypertension Society seek to provide clinicians with a practical approach to the investigation and management of adults with young-onset hypertension. We aim to ensure that individuals receive consistent and high-quality care across the UK and Ireland, to highlight gaps in the current evidence, and to identify important future research questions.
PubMed: 38942895
DOI: 10.1038/s41371-024-00922-5 -
Scientific Reports Jun 2024In tuberculosis (TB), chest radiography (CXR) patterns are highly variable, mimicking pneumonia and many other diseases. This study aims to evaluate the efficacy of...
In tuberculosis (TB), chest radiography (CXR) patterns are highly variable, mimicking pneumonia and many other diseases. This study aims to evaluate the efficacy of Google teachable machine, a deep neural network-based image classification tool, to develop algorithm for predicting TB probability of CXRs. The training dataset included 348 TB CXRs and 3806 normal CXRs for training TB detection. We also collected 1150 abnormal CXRs and 627 normal CXRs for training abnormality detection. For external validation, we collected 250 CXRs from our hospital. We also compared the accuracy of the algorithm to five pulmonologists and radiological reports. In external validation, the AI algorithm showed areas under the curve (AUC) of 0.951 and 0.975 in validation dataset 1 and 2. The accuracy of the pulmonologists on validation dataset 2 showed AUC range of 0.936-0.995. When abnormal CXRs other than TB were added, AUC decreased in both human readers (0.843-0.888) and AI algorithm (0.828). When combine human readers with AI algorithm, the AUC further increased to 0.862-0.885. The TB CXR AI algorithm developed by using Google teachable machine in this study is effective, with the accuracy close to experienced clinical physicians, and may be helpful for detecting tuberculosis by CXR.
Topics: Humans; Deep Learning; Tuberculosis, Pulmonary; Radiography, Thoracic; Algorithms; Female; Male; Middle Aged; Adult; Area Under Curve
PubMed: 38942819
DOI: 10.1038/s41598-024-65703-z -
The Journal of Prosthetic Dentistry Jun 2024While the presence of a ferrule has been reported to be essential for post-and-core restorations, many extensively damaged teeth lack complete ferrules. The outcome of...
STATEMENT OF PROBLEM
While the presence of a ferrule has been reported to be essential for post-and-core restorations, many extensively damaged teeth lack complete ferrules. The outcome of post-and-core restorations for these teeth remains uncertain.
PURPOSE
The purpose of this retrospective clinical study was to assess the outcome of cast alloy post-and-cores and knife-edged crowns for the restoration of teeth lacking complete ferrules.
MATERIAL AND METHODS
A total of 106 participants with endodontically treated teeth with 2 or fewer walls with ferrules who had received cast precious metal alloy post-and-cores along with knife-edged crowns between 2013 and 2022 were recalled for a clinical examination. The minimum follow-up time was 5 months after restoration, and restoration failure and the periodontal status difference between restored teeth and reference teeth were determined. Kaplan-Meier analysis was performed to obtain success curves. The influence of age, sex, jaw position, tooth type, and antagonistic dentition upon the success function was analyzed with the log-rank or Breslow test (α=.05).
RESULTS
A total of 100 participants with 130 restorations were studied. The success rate of the restorations was 93.85% in a mean ±standard deviation period of 48.3 ±26.1 months. The estimated 5-year cumulative success probability was 91.61%. No significant effect on the success of restorations was found regarding age, sex, jaw position, tooth type, or antagonistic dentition (P>.05). The main failure types were post debonding, root fracture, and apical periodontitis. No statistical difference in tooth mobility (Z=-1.265, P=.206) was found between the restored and the reference teeth, but the plaque index and calculus index of the restored teeth were significantly lower than of the reference teeth (Z=-7.216, P<.001; Z=-7.044, P<.001). Teeth that had received cast post-and-cores and knife-edged crowns were found to have no significant correlation with periodontal disease (χ²=1.131, P=.288) or bleeding on probing (χ²=3.436, P=.064).
CONCLUSIONS
The clinical outcomes for the restoration of teeth with 2 or fewer walls with ferrules using cast precious metal alloy post-and-cores and knife-edged crowns were favorable, exhibiting a high 5-year cumulative success probability and no increased periodontal health risk.
PubMed: 38942716
DOI: 10.1016/j.prosdent.2024.05.015 -
International Dental Journal Jun 2024To assess oral health-related knowledge, attitude, and practices (KAP) of patients with diabetes mellitus (DM) attending public diabetic clinics in Dar es Salaam,...
AIM
To assess oral health-related knowledge, attitude, and practices (KAP) of patients with diabetes mellitus (DM) attending public diabetic clinics in Dar es Salaam, Tanzania.
METHODOLOGY
This study involved adult patients diagnosed with DM. A questionnaire with questions related to oral health KAP was used. Data analysis was done using SPSS software v26. Multivariate regression analysis was utilized for response analysis. An alpha of less than 0.05 was considered to indicate statistical significance.
RESULTS
Participants with good levels of KAP related to oral health comprised 51.0%, 82.3%, and 20.6%, respectively. The odds of good oral health knowledge among participants were almost 2 folds higher in participants with high education levels and 7 folds higher in those who had been referred to a dentist by a physician. Participants with good oral health knowledge had 5.5 times higher odds of having a good attitude. The participants with high education levels were almost 3 times more likely to have good practice.
CONCLUSION
About half of the patients with DM have good oral health-related knowledge. A majority have good compliance towards oral health, but only a limited number have good oral health-related practices. The level of education and previous referrals to dental professionals were found to be predictors of good knowledge regarding dental health.
PubMed: 38942616
DOI: 10.1016/j.identj.2024.06.006 -
Journal of the American Board of Family... Jun 2024The 2022 Centers for Disease Control's "Clinical Practice Guidelines for Prescribing Opioids for Pain in United States" called for attention and action toward reducing...
BACKGROUND
The 2022 Centers for Disease Control's "Clinical Practice Guidelines for Prescribing Opioids for Pain in United States" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients' race and sex.
METHODS
We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired test to compare changes in mean MME's and logistic regression to determine associations between patient characteristics and MME changes.
RESULTS
Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, . Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME's at baseline compared with their White men counterparts, .
DISCUSSION
Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.
PubMed: 38942449
DOI: 10.3122/jabfm.2023.230220R2 -
Journal of Vascular Surgery Jun 2024Given changes in intervention guidelines and the growing popularity of endovascular treatment for aortic aneurysms, we examined the trends in admissions and repairs of...
BACKGROUND
Given changes in intervention guidelines and the growing popularity of endovascular treatment for aortic aneurysms, we examined the trends in admissions and repairs of abdominal aortic aneurysms (AAA), thoracoabdominal aortic aneurysms (TAAA), and thoracic aortic aneurysms (TAA).
METHODS
We identified all patients admitted with ruptured aortic aneurysms and intact aortic aneurysms repaired in the Nationwide Inpatient Sample (NIS) between 2004-2019. We then examined the utilization of open, endovascular, and complex endovascular repair (OAR,EVAR,cEVAR) for each aortic aneurysm location (AAA,TAAA,TAA), alongside their resulting in-hospital mortality, over time. cEVAR included branched, fenestrated, and physician modified endograft.
RESULTS
715,570 patients were identified with AAA (87% Intact-Repairs, 13% Rupture-Admissions). Both intact AAA repairs and ruptured AAA admissions decreased significantly between 2004 and 2019 (intact 41,060-34,215,p<.01; ruptured 7,175-4,625,p=.02). Out of all AAA repairs done in a given year, the use of EVAR increased (2004-2019: intact 45%-66%,p<.01; ruptured 10%-55%,p<.01) as well as cEVAR (2010-2019: intact 0%-23%,p<.01; ruptured 0%-14%,p<.01). Mortality after EVAR of intact AAAs decreased significantly by 29% (2004-2019, 0.73%-0.52%,p<.01) while mortality after OAR increased significantly by 16% (2004-2019, 4.4%-5.1%,p<.01). In the study, 27,443 patients were identified with TAAA (80% Intact, 20% Ruptured). In the same period, intact TAAA repairs trended upwards (2004-2019 1,435-1,640,p=.055) and cEVAR became the most common approach (2004-2019, 3.8%-72%,p=.055). 141,651 patients were identified with ascending, arch, or descending TAA (90% Intact, 10% Ruptured). Intact TAA repairs increased significantly (2004-2019 4,380-10,855,p<.01). From 2017-2019, the mortality after OAR of descending TAAs increased and mortality after TEVAR decreased (2017-2019: OAR 1.6%-3.1%; TEVAR 5.2%-3.8%).
CONCLUSION
Both intact AAA repairs and ruptured AAA admissions significantly decreased between 2004 and 2019. The use of endovascular techniques for the repair of all aortic aneurysm locations, both intact and ruptured, increased over the past two decades. Most recently in 2019, 89% of intact AAAs repairs, infrarenal through suprarenal, were endovascular (EVAR or cEVAR, respectively). cEVAR alone has risen to 23% of intact AAA repairs in 2019, from 0% a decade earlier. In this period of innovation, with many new options to repair aortic aneurysms while maintaining arterial branches, endovascular repair is now used for the majority of all intact aortic aneurysm repairs. Long-term data are needed to evaluate the durability of these procedures.
PubMed: 38942397
DOI: 10.1016/j.jvs.2024.06.165 -
The Journal of Pediatrics Jun 2024
PubMed: 38942356
DOI: 10.1016/j.jpeds.2024.114173 -
Regulatory Toxicology and Pharmacology... Jun 2024Depressive disorders are one of the most common mental disorders globally and progress in treating these disorders has been hampered, in part, by a lack of suitable... (Review)
Review
Depressive disorders are one of the most common mental disorders globally and progress in treating these disorders has been hampered, in part, by a lack of suitable nonclinical efficacy tests. Two common tests used in nonclinical efficacy studies of antidepressants-the forced swim test (FST) and tail suspension test (TST)-have come under criticism in recent years for their inconsistency and lack of validity, yet they continue to be used in the pharmaceutical industry. In this review, we provide a rationale for why international pharmaceutical regulatory and guidance agencies should begin issuing direction on methods for non-clinical efficacy testing that traditionally use the FST and TST, particularly considering that some regulators, such as those in the U.S. and E.U., allow the authorization of clinical trials to proceed without requiring tests in animals. The area of antidepressant drug discovery represents an important opportunity for reducing the attrition of psychiatric drugs, harmonizing regulatory requirements, and reducing animal use. Specific recommendations for the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) have been provided.
PubMed: 38942190
DOI: 10.1016/j.yrtph.2024.105666 -
The Journal of Thoracic and... Jun 2024The objective of this study was to examine representation of women on CT journal editorial boards over the past two decades to identify changes over time compared to...
OBJECTIVE
The objective of this study was to examine representation of women on CT journal editorial boards over the past two decades to identify changes over time compared to women CT surgeon and trainee representation, and to highlight additional opportunities for improvement.
METHODS
The editorial boards of two high impact CT journals were reviewed from 2000 to 2023. Data on editorial board positions including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared to publicly available information from the Association of American Medical Colleges (AAMC) on physician specialty by sex.
RESULTS
Of 3,460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (n=1/45) of editor-in-chief positions, 13.2% (n=78/592) of senior editor positions, 11.5% (n=33/287) of feature editor positions, and 8.3% (n=221/2,663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (p=0.01). Overall, editorial board representation increased at a mean ± standard deviation rate of 0.7%±1.3% per year, not significantly different from the growth of practicing women CT surgeons at 0.3%±0.5% per year (p=0.584).
DISCUSSION
Representation of women on CT journal editorial boards has increased commensurate with the increasing proportion of practicing women CT surgeons, though remains at 16%. Work remains to continue the recruitment of women to CT surgery as well as to identify the key elements that can support them in positions of leadership.
PubMed: 38942139
DOI: 10.1016/j.jtcvs.2024.06.015