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Asian Spine Journal Jun 2024Retrospective cohort study.
STUDY DESIGN
Retrospective cohort study.
PURPOSE
To investigate the long-term clinical and radiological outcomes of selective fusion for rotatory olisthesis (RO) in degenerative lumbar scoliosis (DLS).
OVERVIEW OF LITERATURE
DLS is often associated with RO, and selective fusion of RO is a common surgical treatment option. However, the clinical and radiological outcomes remain controversial.
METHODS
A cohort of 54 consecutive patients with DLS and RO was included in the study. All the included patients underwent selective RO fusion and at least 2 years of follow-up. They were divided into two groups: group 1 with a curve <30° and group 2 with a curve ≥30°. The clinical outcomes were evaluated by the Oswestry Disability Index (ODI) and Numerical Rating Scale. The radiological assessment included RO location, offset and subluxated-disc orientation, Cobb angle, and coronal as well as sagittal alignments.
RESULTS
The offset value was greater in group 2 than in group 1 (13.4±4.7 mm vs. 9.3±3.5 mm, p<0.001). The subluxated disc was mainly oriented to the concave side in group 2 (15/21) but to the convex side in group 1 (20/33) (p =0.022). Group 2 had a higher rate of postoperative adjacent RO than group 1 (14/21 vs. 1/33, p<0.001). The ODI was comparable between both groups preoperatively but higher at the final follow-up in group 2 (34.9±9.5) than in group 1 (24.4±6.2). In the multiple logistic regression analysis, the thoracolumbar/lumbar curve was identified as the risk factor for postoperative adjacent RO (odds ratio, 1.400; p=0.007). The receiver operating characteristic analysis verified it with an area under the curve of 0.960 (p<0.001).
CONCLUSIONS
The clinical and radiological outcomes were maintained well in group 1 but not in group 2. Selective RO fusion in DLS with a lumbar curve <30° is a rational option. However, it should be avoided in those with a lumbar curve >30° because of a higher complication rate and a worse clinical outcome at the final follow-up.
PubMed: 38917856
DOI: 10.31616/asj.2023.0365 -
Severe complex neglected infantile Blount disease acute correction by Ilizarov frame: A case report.International Journal of Surgery Case... Jun 2024Blount disease is a disorder causing three proportions of deformity, including varus deformity, procurvatum deformity, and internal tibial rotational deformity. The...
INTRODUCTION
Blount disease is a disorder causing three proportions of deformity, including varus deformity, procurvatum deformity, and internal tibial rotational deformity. The standardized treatment remains controversial despite extensive reviews. The application of Ilizarov external fixators for circumspect corrections is established. The SCARE 2023 criteria have been followed in reporting the case report.
CASE PRESENTATION
We present the case of a nine-year-old girl who's complaining about bowing on both of her knees. From the examination, we found that the metaphyseodiaphyseal angle of both knees was 50 degrees. On the right knee, there is 125 degrees of procurvatum deformity and 115 degrees of deformity on the left knee. After performing deformity correction with the Ilizarov application, there's clinical improvement in the patient.
CLINICAL DISCUSSION
Some experts advise using physeal distraction to manage the deformity in order to achieve correction. The limited popularity of physeal distraction technique may be attributed to the risks of premature closure of the growth plate that we manage to avoid. The Ilizarov frame provides maximum adjustability for aligning all planes, making it suitable for treating severe deformities. Secure fixation, improved patient mobility, being able to assess patient alignment in a functional standing position, and precision.
CONCLUSION
Acute correction and fixation using circular frames as a treatment option for Blount disease show positive outcomes without any significant complications.
PubMed: 38917699
DOI: 10.1016/j.ijscr.2024.109909 -
JMIR Formative Research Jun 2024Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and...
BACKGROUND
Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision.
OBJECTIVE
The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD.
METHODS
An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10% of the panelists deemed the criteria as "not important" or "not important at all" and >60% "important" or "very important."
RESULTS
In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains-background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages.
CONCLUSIONS
This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges.
PubMed: 38917454
DOI: 10.2196/56241 -
Microbiology Spectrum Jun 2024The microbial ecosystem of women undergoes enormous changes during pregnancy and the perinatal period. Little is known about the extent of changes in the maternal...
UNLABELLED
The microbial ecosystem of women undergoes enormous changes during pregnancy and the perinatal period. Little is known about the extent of changes in the maternal microbiome beyond the vaginal cavity and its recovery after birth. In this study, we followed pregnant women [maternal prepartum (mpre), = 30] into the postpartum period [1 month postpartum, maternal postpartum (mpost), = 30]. We profiled their oral, urinary, and vaginal microbiome; archaeome; mycobiome; and urinary metabolome and compared them with those of nonpregnant (np) women ( = 29). Overall, pregnancy status (np, mpre, and mpost) had a smaller effect on the microbiomes than body site, but massive transitions were observed for the oral and urogenital (vaginal and urinary) microbiomes. While the oral microbiome fluctuates during pregnancy but stabilizes rapidly within the first month postpartum, the urogenital microbiome is characterized by a major remodeling caused by a massive loss of and thus a shift from Vaginal Community State Type (CST) I (40% of women) to CST IV (85% of women). The urinary metabolome rapidly reached an np-like composition after delivery, apart from lactose and oxaloacetic acid, which were elevated during active lactation. Fungal and archaeal profiles were indicative of pregnancy status. signatures were found mainly in np women, and showed an opposite behavior in the oral cavity (increased) and vagina (decreased) during pregnancy. Our findings suggest that the massive remodeling of the maternal microbiome and metabolome needs more attention and that potential interventions could be envisioned to optimize recovery and avoid long-term effects on maternal health and subsequent pregnancies.
IMPORTANCE
The perinatal microbiome is of specific interest for the health of the mother and infant. We therefore investigate the dynamics of the female microbiome from nonpregnant over prepartum to the postpartum period in urine and the oral and vaginal cavities. A specific focus of this study is put not only on the bacterial part of the microbiome but also on the underinvestigated contribution of fungi and archaea. To our knowledge, we present the first study highlighting those aspects. Our findings suggest that the massive remodeling of the maternal microbiome and metabolome needs more attention and that potential interventions could be envisioned to optimize recovery and avoid long-term effects on maternal health and subsequent pregnancies.
PubMed: 38917430
DOI: 10.1128/spectrum.00147-24 -
Neurology(R) Neuroimmunology &... Sep 2024Encephalitis with anti-N-methyl-d-aspartate receptor antibodies (anti-NMDARe) is a rare disorder characterized by cognitive impairment, psychosis, seizures, and abnormal...
OBJECTIVES
Encephalitis with anti-N-methyl-d-aspartate receptor antibodies (anti-NMDARe) is a rare disorder characterized by cognitive impairment, psychosis, seizures, and abnormal movements. Abnormal behaviors during REM sleep have not been described in anti-NMDARe.
METHODS
Patients were monitored by video-polysomnography on a first night followed by multiple sleep latency tests and 18 hours of bed rest.
RESULTS
Two patients with anti-NMDARe developed during the acute and postacute phase parasomnias including REM sleep behavior disorder and continuous finalistic quiet gesturing during a mixed N2/R sleep. The parasomnia disorder was improved by gabapentin and clonazepam.
DISCUSSION
Video-polysomnography avoids misdiagnosing these parasomnia behaviors for seizure or movement disorders and allows adequate treatment.
Topics: Humans; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Female; Adult; Male; Polysomnography; REM Sleep Parasomnias; REM Sleep Behavior Disorder; Parasomnias; Sleep, Slow-Wave; Clonazepam
PubMed: 38917379
DOI: 10.1212/NXI.0000000000200203 -
PloS One 2024This study aims to enhance the post-training evaluation of the annual performance agreement (APA) training organized by the Bangladesh Public Administration Training...
This study aims to enhance the post-training evaluation of the annual performance agreement (APA) training organized by the Bangladesh Public Administration Training Centre (BPATC), the apex training institute for civil servants. Utilizing fuzzy-set qualitative comparative analysis (fsQCA) and artificial neural network (ANN) techniques within Kirkpatrick's four-stage model framework, data were collected from a self-administered questionnaire survey of 71 in-service civil servants who participated in the APA training program. This study employs an asymmetric, non-linear model analyzed through a configurational approach and ANN to explore interrelationships among the four Kirkpatrick levels namely, reaction, learning, behavior, and results. Findings indicate that trainees were satisfied across all levels, identifying a non-linear relationship among these levels in post-training evaluation process. The research highlights that "learning skills" are most significant in the APA post-training evaluation, followed by behavior, results, and reaction. Theoretically, this research advances Kirkpatrick's model and adds to the literature on public service post-training evaluation. Practically, it recommends prioritizing strategies that address cognitive barriers to enhance training effectiveness. This study's innovative approach lies in its concurrent use of fsQCA and ANN methods to analyze the success or failure of APA-related trainees, offering alternative pathways to desired outcomes and contrasting traditional quantitative methods that provide a single solution. The findings have practical implications for public service training institutions and bureaucratic policymakers involved in capacity development, guiding the creation of more effective in-service training courses for public officials. The methodology and analysis can be applied in other contexts, allowing bureaucratic policymakers to replicate these findings in their learning institutes to identify unique configurations that lead to successful or unsuccessful training outcomes, adopt effective strategies, and avoid detrimental ones.
Topics: Humans; Neural Networks, Computer; Bangladesh; Surveys and Questionnaires; Male; Female; Adult; Learning
PubMed: 38917194
DOI: 10.1371/journal.pone.0305916 -
PloS One 2024Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical... (Observational Study)
Observational Study
BACKGROUND
Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical cancer risk, we must reassess our screening strategies. We analyzed Danish HPV-vaccinated women's outcomes after the first screening test at age 23.
METHODS AND FINDINGS
Our study was embedded in Danish routine cytology-based screening. We conducted an observational study and included women born in 1994, offered the 4-valent HPV vaccine at age 14, and subsequently invited to screening at age 23. Cervical cytology was used for diagnostics and clinical management. Residual material was HPV tested with Cobas® 4800/6800. The most severe histology diagnosis within 795 days of screening was found through linkage with the Danish National Pathology Register. We calculated the number of women undergoing follow-up (repeated testing and/or colposcopy) per detected cervical intraepithelial neoplasia (CIN2+). A total of 6021 women were screened; 92% were HPV-vaccinated; 12% had abnormal cytology; 35% were high-risk HPV-positive, including 0.9% HPV16/18 positive, and 20% had follow-up. In women that were cytology-abnormal and HPV-positive (Cyt+/HPV+), 610 (98.5%) had been followed up, and 138 CIN2+ cases were diagnosed, resulting in 4.4 (95% CI 3.9-5.2) women undergoing follow-up per detected CIN2+. In contrast to recommendations, 182 (12.2%) cytology-normal and HPV-positive (Cyt-/HPV+) women were followed up within 795 days, and 8 CIN2+ cases were found, resulting in 22.8 (95% CI 13.3-59.3) women undergoing follow-up per detected CIN2+.
CONCLUSION
Overall, HPV prevalence was high in HPV-vaccinated women, but HPV16/18 had largely disappeared. In the large group of cytology-normal and HPV-positive women, 23 had been followed up per detected CIN2+ case. Our data indicated that primary HPV screening of young HPV-vaccinated women would require very effective triage methods to avoid an excessive follow-up burden.
TRIAL REGISTRATION
Trial registration number: NCT0304955.
Topics: Humans; Female; Denmark; Papillomavirus Vaccines; Uterine Cervical Neoplasms; Papillomavirus Infections; Early Detection of Cancer; Young Adult; Cohort Studies; Uterine Cervical Dysplasia; Adult; Adolescent; Vaccination; Human papillomavirus 18; Mass Screening
PubMed: 38917143
DOI: 10.1371/journal.pone.0306044 -
PloS One 2024Antibiotic self-medication is one of the common causes of antibiotic resistance of bacterial organisms. The COVID-19 pandemic introduced a new paradigm shift and...
BACKGROUND
Antibiotic self-medication is one of the common causes of antibiotic resistance of bacterial organisms. The COVID-19 pandemic introduced a new paradigm shift and significantly influenced healthcare behaviors, including an increase in antibiotic self-medication, which contributes to antibiotic resistance. This study was aimed at determining the prevalence of antibiotic self-medication and the possible associated factors during the peak of the COVID-19 pandemic among adult residents of Tema in Ghana from April to July 2021.
METHODS
Using a cross-sectional design, 400 adults were randomly selected and surveyed using a researcher-assisted questionnaire. Data were analyzed with IBM® SPSS® Statistics Version 22.0, considering associations significant at a 95% confidence interval (p < 0.05).
RESULTS
Of the 400 respondents, (76%) 304 had practiced antibiotic self-medication within the previous 12 months during the COVID-19 pandemic. Significant factors associated with antibiotic self-medication included gender, age, marital status, education, occupation, and National Health Insurance Scheme subscription. Convenience and avoiding long hospital queues were primary non-medical reasons for antibiotic self-medication, while previous successful experience, easy access to antibiotics, treating symptoms, prophylaxis, and fear of hospital infection were the medical reasons for antibiotic self-medication. Commonly self-administered antibiotics were azithromycin (34%), amoxicillin/clavulanic acid (22%), and metronidazole (16%) for perceived respiratory tract and gastrointestinal tract infections.
CONCLUSIONS
The high prevalence of antibiotic self-medication observed during the COVID-19 pandemic underscores the need for enhanced public education and stricter enforcement of regulations governing antibiotic sales. The non-medical and medical factors of convenience, avoiding long hospital queues, previous successful experience, easy access to antibiotics, treating symptoms, prophylaxis, and fear of hospital infection which motivated antibiotic self-medication practices require the implementation of antimicrobial stewardship interventions.
Topics: Humans; Self Medication; Male; Female; Adult; Cross-Sectional Studies; COVID-19; Anti-Bacterial Agents; Middle Aged; Ghana; Young Adult; SARS-CoV-2; Surveys and Questionnaires; Pandemics; Aged; Adolescent
PubMed: 38917123
DOI: 10.1371/journal.pone.0305602 -
Reumatismo Jun 2024Recognized since antiquity, gout is still a relevant pathology with rising prevalence and incidence. This study aims to assess the reference accuracy in journal articles...
Recognized since antiquity, gout is still a relevant pathology with rising prevalence and incidence. This study aims to assess the reference accuracy in journal articles mentioning the early use of the word 'gout'. Specifically, it investigates whether the term was indeed coined in the 13th century by the Dominican monk Randolphus of Bocking, as widely believed. Several historical sources in their original Latin were consulted to test the hypothesis of literary mentions predating Randolphus of Bocking's description. At the same time, biomedical articles spanning the last two decades were perused using specific keywords in different combinations to determine the accuracy level of references related to the earliest use of the word 'gout'. The results showed that several biomedical publications wrongly ascribed the origin of the word 'gout' to Randolphus of Bocking. Indeed, various texts predate his mention by many years. In particular, gutta, the Latin word used to indicate a host of rheumatological conditions including gout, is recorded as early as the 10th century in a biography dedicated to the martyred nun Saint Wiborada of St. Gall. Written by Swiss monks between AD 960 and 963, this text should be regarded as containing the earliest known adoption of the word. For this reason, scholars should now avoid quoting Randolph of Bocking's description as the first use of the word 'gout' in Western literature.
Topics: Gout; History, Medieval; Humans; Terminology as Topic
PubMed: 38916161
DOI: 10.4081/reumatismo.2024.1704 -
Journal of Primary Care & Community... 2024Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing...
Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms.
BACKGROUND
Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For interventions to be successful, it is important to influence "behavioral mechanisms" such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36 months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed.
METHOD
Participants (n = 962) with overweight and prediabetes who had achieved ≥8% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol.
RESULTS
There was no increase in the participants' self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions.
CONCLUSIONS
The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.
Topics: Humans; Diabetes Mellitus, Type 2; Prediabetic State; Male; Female; Middle Aged; Self Efficacy; Life Style; Aged; Adult; Stress, Psychological; Exercise; Program Evaluation; Affect; Risk Reduction Behavior; Primary Health Care; Overweight
PubMed: 38916158
DOI: 10.1177/21501319241248223