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World Journal of Surgical Oncology Jun 2024Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy forwhich survival is hampered by late diagnosis, complex responses to treatment, and poor...
BACKGROUND
Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy forwhich survival is hampered by late diagnosis, complex responses to treatment, and poor prognosis. Accurate prognostic tools are crucial for optimizing treatment strategies and improving patient outcomes. This study aimed to develop and validate a nomogram based on the Surveillance, Epidemiology, and End Results (SEER) database to predict cancer-specific survival (CSS) in patients with SBA and compare it to traditional American Joint Committee on Cancer (AJCC) staging.
METHODS
We analyzed data from 2,064 patients diagnosed with SBA between 2010 and 2020 from the SEER database. Patients were randomly assigned to training and validation cohorts (7:3 ratio). Kaplan‒Meier survival analysis, Cox multivariate regression, and nomograms were constructed for analysis of 3-year and 5-year CSS. The performance of the nomograms was evaluated using Harrell's concordance index (C-index), the area under the receiver operating characteristic (ROC) curve, calibration curves, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
RESULTS
Multivariate Cox regression identified sex, age at diagnosis, marital status, tumor site, pathological grade, T stage, N stage, M stage, surgery, retrieval of regional lymph nodes (RORLN), and chemotherapy as independent covariates associated with CSS. In both the training and validation cohorts, the developed nomograms demonstrated superior performance to that of the AJCC staging system, with C-indices of 0.764 and 0.759, respectively. The area under the curve (AUC) values obtained by ROC analysis for 3-year and 5-year CSS prediction significantly surpassed those of the AJCC model. The nomograms were validated using calibration and decision curves, confirming their clinical utility and superior predictive accuracy. The NRI and IDI indicated the enhanced predictive capability of the nomogram model.
CONCLUSION
The SEER-based nomogram offers a significantly superior ability to predict CSS in SBA patients, supporting its potential application in clinical decision-making and personalized approaches to managing SBA to improve survival outcomes.
Topics: Humans; Nomograms; Male; Female; SEER Program; Adenocarcinoma; Middle Aged; Survival Rate; Aged; Intestinal Neoplasms; Prognosis; Follow-Up Studies; Neoplasm Staging; Intestine, Small; ROC Curve; Adult; Retrospective Studies
PubMed: 38849854
DOI: 10.1186/s12957-024-03438-x -
BMC Medical Informatics and Decision... Jun 2024Learning of burn patient assessment is very important, but heart-breaking for nursing students. This study aimed to compare the effects of feedback lecture method with a... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Comparison of the effects of burn assessment mission game with feedback lecture on nursing students' knowledge and skills in the burn patients' assessment: a randomized clinical trial.
BACKGROUND
Learning of burn patient assessment is very important, but heart-breaking for nursing students. This study aimed to compare the effects of feedback lecture method with a serious game (BAM Game) on nursing students' knowledge and skills in the assessment of burn patients.
METHOD
In this randomized controlled clinical trial, 42 nursing students in their 5th semester at Mashhad University of Medical Sciences School of Nursing and Midwifery, were randomly assigned to intervention (BAM game, available for two weeks) and control (feedback lecture method presented in two 90-minute sessions) groups. Two weeks after the intervention, all students were evaluated for their knowledge (using knowledge assessment test) and skills (using an Objective Structured Clinical Examination). Statistical analysis involved independent t-test, Fisher's exact test, analysis of covariance (ANCOVA), and univariable and multivariable ordinal logistic regression models.
RESULTS
Following the intervention, the skill scores were 16.4 (SD 2.2) for the intervention group and 11.8 (SD 3.8) for the control group. Similarly, the knowledge scores were 17.4 (SD 2.2) for the intervention group and 14.7 (SD 2.6) for the control group. Both differences were statistically significant (P < .001). These differences remained significant even after adjusting for various factors such as age, gender, marital status, residence, university entrance exam rank, and annual GPA (P < .05). Furthermore, the BAM game group showed significantly higher skills rank than the feedback lecture group across most stations (eight of ten) (P < .05) in the univariable analysis. Multivariable analysis also revealed a significantly higher skills score across most stations even after adjusting for the mentioned factors (P < .05). These results suggest that the BAM game group had higher skills scores over a range of 1.5 to 3.9 compared to the feedback lecture group.
CONCLUSIONS
This study demonstrated that nursing students who participated in the BAM game group exhibited superior performance in knowledge acquisition and skill development, compared to those in the control group. These results underscore a significant enhancement in educational outcomes for students involved with the BAM game, confirming its utility as a potent and effective pedagogical instrument within the realm of nursing education.
TRIAL REGISTRATION
Iranian Registry of Clinical Trials: IRCT20220410054483N1, Registration date: 18/04/2022.
Topics: Humans; Female; Students, Nursing; Clinical Competence; Male; Young Adult; Burns; Adult; Educational Measurement; Health Knowledge, Attitudes, Practice; Education, Nursing
PubMed: 38840136
DOI: 10.1186/s12911-024-02558-4 -
Journal of Family Medicine and Primary... Apr 2024In diabetes mellitus (DM) patients, obtaining a good night's sleep is crucial for maintaining body caloric intake, controlling insulin levels, and reducing the...
INTRODUCTION
In diabetes mellitus (DM) patients, obtaining a good night's sleep is crucial for maintaining body caloric intake, controlling insulin levels, and reducing the likelihood of engaging in unhealthy behavior. Patients with poor sleep quality may experience impaired glycemia, playing a significant role in the development of chronic complications. This study aims to explore the effects of DM complications on sleep quality among Saudi Arabian patients.
PATIENT AND METHODS
This is a cross-sectional study conducted among patients with diabetes. A self-administered, validated questionnaire translated into Arabic was distributed among diabetic patients using an online survey. The questionnaire includes sociodemographic characteristics (i.e. age, gender, marital status, etc.), the medical history of the patients, and a questionnaire about sleep quality.
RESULTS
Out of 4171 patients involved, 52.7% were females and 27.7% were aged between 40 and 60 years old. The prevalence of patients with perceived poor sleep quality was 24.1%. Significant predictors of poor sleep quality were the gender female, having social stressors, comorbid sleep disorders, associated comorbidities, increasing HbA1c levels, being overweight/obese, and diabetes complications. Furthermore, sleep disturbance, taking sleep medications, daytime sleepiness, and having bad dreams during sleep were also identified as prognostic factors for poor sleep quality.
CONCLUSION
The subjective poor sleep quality of patients with diabetes was 24.1%. Poor sleep quality was significantly demonstrated by females who were having social stressors, comorbid sleep disorders, comorbidities, uncontrolled HbA1c levels, elevated BMI levels, and complications of diabetes. However, regular physical activity and adequate sleep were estimated to be the protective factors against poor sleep quality. Further research is needed to establish the effect of sleep quality among patients with DM.
PubMed: 38827724
DOI: 10.4103/jfmpc.jfmpc_473_23 -
PloS One 2024Type 2 diabetes mellitus is highly prevalent in the Arab Gulf countries. Despite this, limited culturally-adapted lifestyle intervention studies have been conducted in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Type 2 diabetes mellitus is highly prevalent in the Arab Gulf countries. Despite this, limited culturally-adapted lifestyle intervention studies have been conducted in this region.
METHODS
In this culturally adapted 12-month cluster randomized trial, 382 patients with type 2 diabetes, aged 20-70 years were recruited from 6 public healthcare centers (3 interventions and 3 controls) in Al Ain, United Arab Emirates. The primary outcome of this study was a change in hemoglobin A1c (HbA1c). The secondary outcomes were Body Mass Index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, dietary intake, and physical activity levels. A diet and physical activity intervention, guided by the social cognitive theory, was delivered individually and in group format to the intervention group. The control group continued receiving only their usual diabetes management care. The data were collected at baseline and 1 year after participation.
RESULTS
The mean baseline HbA1c levels of the control and the intervention groups were 7.45 ± 0.11% and 7.81 ± 0.11%, respectively. At the end of the 12-month intervention, there was no significant difference in the changes of mean HbA1c between the intervention and the control groups. On the other hand, BMI and daily caloric intake were significantly decreased in the intervention compared to the control group by 1.18 kg/m2 (95% CI: -1.78 - -0.60) and 246 kcal (95% CI: -419.52 - -77.21), respectively, after controlling for age, gender, education, marital status, duration since diabetes diagnosis, diabetes treatment, treatment clinic, and baseline values. Sitting time during the week-end was significantly lower, difference 52.53 minutes (95% CI: 93.93 - -11.14).
CONCLUSIONS
This community-based lifestyle intervention for patients with baseline HbA1c <8% did not result in a significant decrease of HbA1c but reduced caloric intake, body weight, and weekend inactivity after controlling for the covariates.
TRIAL REGISTRATION
This trial was registered on February 11, 2020 with Clinicaltrials.gov (NCT04264793).
Topics: Humans; Diabetes Mellitus, Type 2; Middle Aged; Male; Female; Exercise; Adult; Glycated Hemoglobin; Aged; Diet; United Arab Emirates; Body Mass Index; Young Adult; Life Style
PubMed: 38820345
DOI: 10.1371/journal.pone.0304639 -
Frontiers in Endocrinology 2024This study represented the inaugural effort to develop predictive survival nomograms for metastatic soft tissue sarcoma (mSTS) patients in the era of immune checkpoint...
BACKGROUND
This study represented the inaugural effort to develop predictive survival nomograms for metastatic soft tissue sarcoma (mSTS) patients in the era of immune checkpoint inhibitors.
METHOD
From the Surveillance, Epidemiology, and End Results (SEER) program database, we extracted 3078 eligible patients with mSTS between 2016 and 2022. Kaplan-Meier survival analysis, univariate and multivariable Cox analyses, and univariate and multivariable logistic analyses were conducted. Subsequently, predictive nomograms were constructed. Clinical effectiveness was validated using the area under the curve (AUC), calibration curve, and decision curve analysis (DCA) methods.
RESULTS
We used the SEER database to include 3078 eligible patients with mSTS between 2016 and 2022. All the eligible patients were randomly allocated in a ratio of 6:4 and stratified into a training group (n = 1846) and a validation group (n = 1232). In the multivariate Cox analysis, age, race, marital status, pathological grade, histologic subtype, surgery, and chemotherapy were identified as independent prognostic factors. These factors were used to construct the nomogram to predict the 1-, 3-, and 5-year OS of mSTS patients. The C-index for the training cohort and the validation cohort was 0.722(95% confidence interval [CI]: 0.708-0.736), and 0.716(95% CI: 0.698-0.734), respectively. The calibration curves for 1-, 3-, and 5-year OS probability demonstrated excellent calibration between the predicted and the actual survival. The AUC values of the nomogram at 1-, 3-, and 5-year were 0.785, 0.767, and 0.757 in the training cohort, 0.773, 0.754, and 0.751 in the validation cohort, respectively. Furthermore, DCA indicated the favorable clinical utility of the nomogram in both cohorts. The risk stratification system was constructed using the established nomogram, which enhanced prediction accuracy, aided clinicians in identifying high-risk patients and informing treatment decisions.
CONCLUSION
This study marked the inaugural effort in constructing predictive survival nomograms mSTS patients in the era of immune checkpoint inhibitors. The robustly constructed nomograms, alongside actual outcomes, offered valuable insights to inform follow-up management strategies.
Topics: Humans; Nomograms; Sarcoma; Male; Female; Middle Aged; Prognosis; SEER Program; Aged; Adult; Survival Rate; Neoplasm Metastasis
PubMed: 38803474
DOI: 10.3389/fendo.2024.1371910 -
International Journal of Public Health 2024Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering... (Review)
Review
OBJECTIVES
Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence.
METHODS
Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups.
RESULTS
A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship.
CONCLUSION
Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.
Topics: Humans; Breast Neoplasms; Female; Exercise; Randomized Controlled Trials as Topic; Social Class; Socioeconomic Factors; Patient Compliance
PubMed: 38784387
DOI: 10.3389/ijph.2024.1607002 -
AIDS Research and Therapy May 2024Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to...
BACKGROUND
Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to describe factors independently associated with viral load non-suppression among adolescents living with HIV (ALHIV) on ART in the Tanga region.
METHODS
We conducted a retrospective study of routinely collected data from ALHIV on ART from October 2018 to April 2022. We extracted data from the Care and Treatment Clinics form number 2 (CTC2) database that included age, sex, BMI, World Health Organization HIV clinical disease stage, marital status, ART duration, viral load suppression, facility level, and Dolutegravir (DTG)-based regimen. We did descriptive analysis using frequencies to describe the study participants' socio-demographic and clinical characteristics. The Cox proportional hazard regression model was used to identify factors associated with viral load non-suppression (VLS). Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. A total of 4735 ALHIV on ART were extracted from CTC2, then 2485 were excluded (2186 missed viral load results, 246 were lost to follow-up, and 53 deaths).
RESULTS
2250 ALHIV on ART were tested for viral load, of whom 2216 (98.62%) adolescents were on first-line ART, and 2024 (89.96%) participants were virally suppressed, while 226 (10.04%) were virally non-suppressed. In addition, 2131 (94.71%) of participants were using a DTG-based regimen; of them, 1969 (92.40%) were virally suppressed. Not using a DTG-based regimen (HR: 9.36, 95% CI 3.41-15.31) and dispensary facility level (HR: 3.61, 95% CI 1.44-7.03) were independently associated with increased hazard for viral load non-suppression. In addition, adolescents aged between 15 and 19 years are less likely to be virally suppressed (HR: 0.55, 95% CI 0.30-0.99).
CONCLUSIONS
The dispensary facility level and not using a DTG-based regimen were significantly associated with viral load non-suppression. HIV intervention strategies should ensure a DTG-based regimen utilization in all adolescents living with HIV, and techniques used by higher-level health facilities should be disseminated to lower-level facilities.
Topics: Humans; Adolescent; Tanzania; Female; Viral Load; Retrospective Studies; Male; HIV Infections; Anti-HIV Agents; Young Adult; Pyridones; Oxazines; Heterocyclic Compounds, 3-Ring; Proportional Hazards Models; Piperazines
PubMed: 38778318
DOI: 10.1186/s12981-024-00622-7 -
BMC Infectious Diseases May 2024As is known, CD4 cell count is a significant parameter predicting HIV progression, opportunistic infections and death in HIV-infected individuals, as well was an...
BACKGROUND
As is known, CD4 cell count is a significant parameter predicting HIV progression, opportunistic infections and death in HIV-infected individuals, as well was an important indicator for initiating antiretroviral therapy (ART). In China's National Free Antiretroviral Treatment Program, people with HIV (PWH) on ART can receive a CD4 count test at least once every six months. Importantly, the baseline CD4 count (before ART initiation) is significantly correlated with ART and even prognosis, but the influence of the peak CD4 cell count on ART and/or clinical outcomes is still unknown.
METHODS
A retrospective study was conducted among 7965 PWH who received ART from October 2003 to September 2022 at Yunnan Infectious Disease Hospital. Clinical features and laboratory data were collected and analyzed by Chi-square test, univariate and multivariate Cox regression analysis. After elimination of confounding variables, multivariate Cox regression analysis was performed to identify survival-related factors.
RESULTS
Of a total of 7965 PWH in the ART treatment cohort who met the inclusion and exclusion criteria, 7939 were finally included in the subsequent analyses. First, it was found that the proportion of clinical variables, including sex, age distribution, interval from diagnosis to ART initiation, marital status, and others, was significantly different between the living and dead groups (P < 0.05). Impressively, significantly more PWH had the higher level of baseline, peak and recent CD4 cell counts in the living group compared to those in the dead group. Due to multicollinearity effect, after excluding confounders, the following factors were found to be significantly associated with mortality by multivariate Cox regression analysis: (1) male sex (hazard ratio (HR) = 1.268 [1.032, 1.559]; P = 0.024); (2) time from HIV confirmation to ART initiation ≥ 6 months (HR = 1.962 [1.631, 2.360]; P < 0.001); (3) peak CD4 cell count: Peak CD4 < 100cells/µL group (HR = 16.093 [12.041, 21.508]; P < 0.001), 100cells/µL ≤ x < 200cells/µL group (HR = 7.904 [6.148, 10.160]; P < 0.001), 200cells/µL ≤ x < 350cells/µL group (HR = 3.166 [2.519, 3.980]; P < 0.001), 350cells/µL ≤ x < 500cells/µL group (HR = 1.668 [1.291, 2.155]; P < 0.001).
CONCLUSION
Interestingly, patients in male, time from HIV confirmation to ART initiation ≥ 6 months, or peak CD4 count < 500 cells/µl had inferior clinical outcomes, in other word, a lower peak CD4 cell count significantly increased the risk of death, and peak CD4 cell was independent in predicting the overall survival of PWH. It is important to promote "early diagnosis and treatment of HIV" and regularly monitor CD4 levels in HIV/AIDS to evaluate the efficacy of ART and immune reconstitution, and optimize the ART regimen in time to further reduce the mortality of PWH.
Topics: Humans; Retrospective Studies; Male; HIV Infections; Female; Adult; CD4 Lymphocyte Count; Middle Aged; China; Anti-HIV Agents; Treatment Outcome; Young Adult; Antiretroviral Therapy, Highly Active
PubMed: 38778273
DOI: 10.1186/s12879-024-09406-w -
PloS One 2024Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response but there is little research on patient characteristics that moderate the effectiveness of antidepressants. This study examined potential moderators of response to antidepressant treatment.
METHODS
The PANDA trial investigated the clinical effectiveness of sertraline (n = 326) compared with placebo (n = 329) in primary care patients with depressive symptoms. We investigated 11 potential moderators of treatment effect (age, employment, suicidal ideation, marital status, financial difficulty, education, social support, family history of depression, life events, health and past antidepressant use). Using multiple linear regression, we investigated the appropriate interaction term for each of these potential moderators with treatment as allocated.
RESULTS
Family history of depression was the only variable with weak evidence of effect modification (p-value for interaction = 0.048), such that those with no family history of depression may have greater benefit from antidepressant treatment. We found no evidence of effect modification (p-value for interactions≥0.29) by any of the other ten variables.
CONCLUSION
Evidence for treatment moderators was extremely limited, supporting an approach of continuing discuss antidepressant treatment with all patients presenting with moderate to severe depressive symptoms.
Topics: Humans; Sertraline; Male; Antidepressive Agents; Female; Primary Health Care; Depression; Middle Aged; Adult; Treatment Outcome; Aged; Data Analysis; Secondary Data Analysis
PubMed: 38722970
DOI: 10.1371/journal.pone.0300366 -
Frontiers in Public Health 2024The COVID-19 pandemic has presented new challenges to adhering to ART, and its influence on adherence and related factors has not been thoroughly studied. This study...
Adherence to antiretroviral therapy and determining factors in adults living with HIV receiving services at public health facilities amidst the COVID-19 crisis in Bahir Dar city, Northwest Ethiopia.
BACKGROUND
The COVID-19 pandemic has presented new challenges to adhering to ART, and its influence on adherence and related factors has not been thoroughly studied. This study examines ART adherence and its associated factors during the COVID-19 pandemic.
METHODS
A cross-sectional study was conducted on HIV-positive individuals receiving care and treatment in public health facilities. A total of 612 participants were selected using a multi-stage sampling procedure. Data were collected through interviewer-administered questionnaires and chart reviews. We used Epi-data for data entry and Stata for data analysis.
RESULTS
Good adherence to antiretroviral therapy in this study was 76.5% (95% CI, 72.9, 79.7). Divorced marital status (AOR = 0.45,95%CI:0.22,0.90), regular follow-up (AOR = 3.01,95%CI:1.81,5.01), adherence counseling and information in the context of COVID-19 pandemic (AOR = 2.57,95%CI:1.63,4.08), and knowledge about ART (AOR = 1.81,95%CI:1.11,2.94) were significantly associated with adherence to antiretroviral therapy.
CONCLUSION
The observed adherence rate in this study was lower than the World Health Organization recommendation and previous studies. The study highlighted the importance of addressing adherence to ART among HIV-positive adults during the COVID-19 pandemic and other upcoming emerging and reemerging outbreaks. Strategies to improve adherence should consider factors such as marital status, regular follow-up, provision of counseling and information, and enhancing knowledge about ART.
Topics: Humans; Ethiopia; Cross-Sectional Studies; Male; Female; Adult; HIV Infections; COVID-19; Medication Adherence; Middle Aged; Surveys and Questionnaires; Young Adult; Anti-Retroviral Agents; SARS-CoV-2; Anti-HIV Agents; Adolescent
PubMed: 38721541
DOI: 10.3389/fpubh.2024.1380055