Main Outcome measuresThe Research Articles

Reliability and validity of the L test in people with multiple sclerosis

ObjectivesFunctional mobility is an essential factor affecting the activities of daily living in people with multiple sclerosis (PwMS). The L test is a comprehensive assessment tool for functional mobility that incorporates sit-to-stand, transfers and bidirectional turning. The purpose of this study was to determine the psychometric properties of the L test in PwMS. DesignCross-sectional study. ParticipantsThirty-four PwMS [Expanded Disability Status Scale (EDSS) score 0 to 5] and 34 healthy controls were included in this study. Main outcome measuresThe L test was administered along with the timed up and go (TUG) test, 10-m walk test (10-MWT), 6-minute walk test (6-MWT), timed 360 degree turn test, and EDSS by the same rater. Fall history was recorded to categorize PwMS with and without a history of falls. The L test was repeated after 1 week to determine test–retest reliability. ResultsThe L test showed excellent test–retest reliability (intraclass correlation coefficient 0.995). The minimum detectable change for the L test time was 1.4 seconds. The L test demonstrated significant positive correlations with the TUG test, timed 360 degree turn test and EDSS score, and significant negative correlations with the 10-MWT and 6-MWT (P < 0.001). Significant differences in the L test times were found between PwMS and healthy controls, and between PwMS with a history of falls and those without a history of falls (P < 0.05). The cut-off time of 14.7 seconds on the L test was found to best discriminate between PwMS and healthy people, while 16.4 seconds was found to best discriminate between PwMS with a history of falls and those without a history of falls. ConclusionThe L test is a reliable and valid tool for the assessment of functional mobility in PwMS. Clinical Trial Registration numberNCT05641714. Contribution of the Paper•The L test has excellent test–retest reliability and validity in PwMS.•The L test can provide insight into functional mobility, with high scores (long completion times) warranting further specific assessment of underlying components (turning, walking, etc.) that may contribute to the longer completion times.•The L test demonstrates a more comprehensive mobility assessment using an L-shaped pathway.

Costs of Transfer From Nontrauma to Trauma Centers Among Patients With Minor Injuries

ImportanceNearly half the patients transferred from nontrauma centers to trauma centers have minor injuries, yet trauma center care is not associated with a difference in morality among patients with minor injuries. Consequently, reducing the frequency of such transfers has been postulated as a method to improve resource allocation. Currently, the economic implications of these transfers are not well understood.ObjectiveTo estimate health care costs associated with the transfer of patients with minor injuries from nontrauma to trauma centers.Design, Setting, and ParticipantsThis retrospective, population-based cohort study was conducted from April 1, 2009, to March 31, 2020, in Ontario, Canada. Participants included individuals aged 16 years or older who were transferred to a trauma center after presenting to a nontrauma center with a minor injury (survival &amp;amp;gt;24 hours, Injury Severity Score [ISS] &amp;amp;lt;16, and absence of an American College of Surgeons–defined critical injury). Statistical analysis was conducted from March 2022 to June 2024.Main Outcomes and MeasuresThe main outcome was total health care costs within 30 days of injury, standardized to 2015 Canadian dollars (CAD$). Propensity scoring was used to match transferred patients with controls admitted to nontrauma centers. Negative binomial models were used to estimate differences in costs between transferred patients and matched controls.ResultsOf the 14 557 patients with minor injuries transferred to a trauma center (mean [SD] age, 48.1 [20.9] years; 5367 female patients [36.9%]; median ISS, 4 [IQR, 2-5]), 12 652 (86.9%) were matched with a control. Thirty days after injury, mean health care costs among transferred patients were CAD$13 540 (95% CI, CAD$13 319-CAD$13 765), a 6.5% (95% CI, 4.4%-8.5%) increase relative to controls (CAD$12 719 [95% CI, CAD$12 582-CAD$12 857]). Half the transferred patients (54.9% [7994 of 14 557]) were admitted, while the remainder were discharged after evaluation in the trauma center emergency department. Among patients admitted to a trauma center, mean 30-day costs were CAD$19 602 (95% CI, CAD$19 294-CAD$19 915), a 54.6% (95% CI, 51.5%-57.8%) increase relative to controls.Conclusions and RelevanceThis cohort study of patients with minor injuries transferred from nontrauma centers to trauma centers found that the transfer of these patients was associated with increased costs to the health care system. Given the high prevalence of such transfers, these findings suggest that the development of systems to support the care of patients with minor injuries at their local hospitals is essential to the sustainability of trauma systems.

Ultra-low dose estradiol and dydrogesterone for the treatment of menopausal symptoms in a pooled, multi-ethnic population

ObjectivesEvidence suggests ethnicity-specific differences in postmenopausal symptoms, highlighting the need for therapies that are efficacious across different ethnicities. We evaluated the efficacy of an ultra-low dose combination of 0.5 mg estradiol and 0.25 mg dydrogesterone (E 0.5 mg/D 2.5 mg) in alleviating vasomotor symptoms across a multi-ethnic population. Study designData from two controlled trials were pooled to form a dataset of 583 postmenopausal women from across Europe and China. Participants were randomized to receive treatment with E 0.5 mg/D 2.5 mg or placebo for 12 weeks. Main outcome measuresThe main efficacy variable was absolute change in the number of hot flushes from baseline to end of treatment. Health-related quality of life and safety were also assessed. ResultsChange in the number of hot flushes per day was greater with E 0.5 mg/D 2.5 mg versus placebo (mean difference − 1.5, 95 % confidence interval − 2.1, −1.0; p < 0.001). Participants treated with E 0.5 mg/D 2.5 mg reported improvement in health-related quality of life (including psychological symptoms, vaginal dryness), and high amenorrhea rates. Combined E 0.5 mg/D 2.5 mg was well tolerated: there were no differences between groups in the percentage of participants with at least one serious adverse event or treatment-emergent serious adverse events. Analysis of change in body weight indicated no differences between groups. ConclusionsThis pooled analysis demonstrates the consistent efficacy of E 0.5 mg/D 2.5 mg in the treatment of menopause-related symptoms across a multi-ethnic population of postmenopausal women.

Rescue ICSI Improved Cumulative Live Birth Rate for Cycles with Second Polar Body Extrusion Rate

ObjectiveTo determine the indications for early rescue intracytoplasmic sperm injection (ICSI) application. DesignA retrospective cohort study SubjectsThe study included 19,808 patients who underwent conventional in vitro fertilization (IVF) or rescue ICSI for their first cycles between February 2017 and December 2021. ExposureRescue ICSI cycles constituted the study group, where oocytes that had not extruded the second polar body 4-6 hours after insemination were rescued by ICSI. The control group consisted of conventional IVF cycles with no interventions to rescue oocytes without the second polar body. Generalized additive models (GAMs) were constructed to describe the relationship between the second polar body extrusion rate and cumulative live birth rate in conventional IVF and rescue ICSI cycles, respectively. The cutoff value of the second polar body extrusion rate guiding rescue ICSI application was determined from the intersection point of GAMs. Maternal age range applicable to rescue ICSI was further analyzed using the same method. Clinical outcomes were compared between conventional IVF and rescue ICSI cycles across different second polar body extrusion rate and maternal age subgroups. Main outcome measuresThe second polar body extrusion rate and maternal age range for rescue ICSI application, normal fertilization rate, and cumulative live birth rate. ResultsGAMs showed that the cutoff value for the second polar body extrusion rate about rescue ICSI application was 50%. When the rate <50%, normal fertilization rate and cumulative live birth rate (63.7% vs. 46.1%, OR: 1.609, 95% CI: 1.276-2.030) were significantly higher in rescue ICSI cycles than conventional IVF cycles. When the rate ≥50%, rescue ICSI cycles had similar normal fertilization rate and cumulative live birth rate compared to conventional IVF cycles. Further analysis on maternal age in cycles with second polar body extrusion rate <50% released that rescue ICSI cycles showed a higher cumulative live birth rate (67.7% vs. 48.3%, OR: 1.732, 95% CI: 1.361-2.202) than conventional IVF cycles for women aged < 38 years. ConclusionIVF cycles with second polar body extrusion rate <50% in women aged < 38 years was applicable to early rescue ICSI.

Effectiveness of a Just-In-Time Adaptive App to Increase Daily Steps: An RCT

IntroductionAddressing the public health problem of physical inactivity, this study evaluates “SNapp”, a just-in-time adaptive app intervention to promote walking through dynamically tailored coaching content. It assesses SNapp's impact on daily steps and how users’ perceptions regarding ease of use and usefulness moderated its effectiveness. Study designSNapp was evaluated in an RCT from February 2021 to May 2022. Analyses were conducted in November 2022. Setting/participants176 adults (76% female, mean age of 56 years) were randomized to a control group receiving a step counter app (n = 89) or an intervention group receiving the app plus coaching content (n = 87). InterventionSNapp's coaching content encompasses individually tailored feedback on step counts and advice to engage in more walking, taking preferences regarding behavior change techniques into account. Additionally, SNapp provides contextualized content calling attention to suitable walking locations in the user's environment. Main outcome measuresThe primary outcome was daily step count as recorded by the step counter app. User perceptions regarding ease of use and usefulness were assessed via survey at 3-month follow-up. ResultsMixed models indicated that the intervention did not significantly impact step counts on average over time (B = -202.30, 95% CI = -889.7, 485.1), with the coefficient indicating that the intervention group walked fewer steps per day on average, though this difference was not statistically significant. Perceived ease of use did not moderate the intervention effect (B group x perceived ease of use = 38.60, 90% CI = -276.5, 353.7). Perceived usefulness significantly moderated the intervention effect (B group x perceived usefulness = 344.38, 90% CI = 40.4, 648.3). ConclusionsSNapp increased steps only in users who deemed the app useful, underscoring the importance of user perceptions in app-based interventions. Trial registrationThis trial was preregistered in the Dutch Trial Register (NL7064).

Vitreopapillary Findings in Nonarteritic Ischemic Optic Neuropathy versus Healthy Eyes: A Clinical and OCT Comparison

PurposeTo study the vitreopapillary interface in non‐arteritic ischemic optic neuropathy (NAION) for features that may predispose to optic nerve perfusion defects. DesignCase-control study. Participants and ControlsPatients with NAION (Study group) were compared with healthy non‐NAION patients with crowded discs (Control group I) and non-crowded optic discs (Control group II). MethodsThe vitreopapillary interface was studied in 32 eyes with NAION using high-resolution OCT scans. Results were compared with two control groups consisting of age, sex, and refraction‐matched non‐NAION individuals with crowded optic discs (Control Group I: 31 eyes) and non-crowded optic discs (Control Group II: 32 eyes). Main Outcome MeasuresThe incidence of total posterior vitreous detachment (PVD), vitreopapillary and vitreovascular attachments, and epipapillary membranes. ResultsThe rate of PVD over the macula was similar among groups (NAION: 62.5%, Control I: 61.3%, and Control II: 65.6%, p=0.93) while the posterior hyaloid remained attached to the crowded discs at a significantly higher rate (NAION: 81.2%, Control I: 83.9% and Control II: 43.7%, p=0.0005). A higher rate of focal vitreopapillary attachments on crowded discs than on non-crowded discs was noted (NAION: 72.2%, crowded control I: 58.7%, and non-crowded control II: 19.1%, p=0.007). Vitreovascular attachments (NAION: 69%, crowded control I: 3% vs non-crowded control II: 6%, p=0.00001) and dense epipapillary membranes were observed in NAION eyes. ConclusionsCrowded discs may have stronger vitreopapillary attachments. A close relationship of these attachments with optic nerve vessels may lead to the transmission of strong tractional forces by a syneretic vitreous gel, especially after macular PVD. This transduced mechanical force may contort the vessel wall and disrupt the blood flow in NAION.

Evaluating the Effectiveness of Transtibial Prosthetic Socket Shape Design Using Artificial Intelligence: A Clinical Comparison With Traditional Plaster Cast Socket Designs

ObjectiveTo investigate the feasibility of creating an artificial intelligence (AI) algorithm to enhance prosthetic socket shapes for transtibial prostheses, aiming for a less operator-dependent, standardized approach. DesignThe study comprised 2 phases: first, developing an AI algorithm in a cross-sectional study to predict prosthetic socket shapes. Second, testing the AI-predicted digitally measured and standardized designed (DMSD) prosthetic socket against a manually measured and designed (MMD) prosthetic socket in a 2-week within-subject cross-sectional study. SettingThe study was done at the rehabilitation department of the Radboud University Medical Center in Nijmegen, the Netherlands. ParticipantsThe AI algorithm was developed using retrospective data from 116 patients from a Dutch orthopedic company, OIM Orthopedie, and tested on 10 randomly selected participants from Papenburg Orthopedie. InterventionsUtilization of an AI algorithm to enhance the shape of a transtibial prosthetic socket. Main Outcome MeasuresThe algorithm was optimized to minimize the error in the test set. Participants’ socket comfort score and fitting ratings from an independent physiotherapist and prosthetist were collected. ResultsPredicted prosthetic shapes deviated by 2.51 mm from the actual designs. In total, 8 of 10 DMSD and all 10 MMD-prosthetic sockets were satisfactory for home testing. Participants rated DMSD-prosthetic sockets at 7.1 ± 2.2 (n=8) and MMD-prosthetic sockets at 6.6 ± 1.2 (n=10) on average. ConclusionsThe study demonstrates promising results for using an AI algorithm in prosthetic socket design, but long-term effectiveness and refinement for improved comfort and fit in more deviant cases are necessary.

The Physical Home Food Environment in Relation to Children’s Diet Quality and Cardiometabolic Health

BackgroundHome food availability has been identified as an important influence on dietary intake. Less is known about the relationship between the physical home food environment (HFE) and factors of cardiometabolic health in children. ObjectiveThe purpose of this study was to explore the relationship between the physical HFE and diet quality and factors of cardiometabolic health (eg, weight and blood biomarkers). DesignThis was a cross-sectional secondary analysis with 1 or more children per household. Participants/settingThis study included 44 children aged 6 to 12 years from 29 households in the Newark, DE area between August 2020 and August 2021. Main outcome measuresThe Home Food Inventory provides an obesogenic score (ie, score indicative of the presence of energy-dense foods) for the overall HFE and HFE subcategories scores; body mass index z-scores were calculated using measured height and weight; diet quality was measured using the Healthy Eating Index 2020 (HEI-2020) total scores; and cardiometabolic biomarkers were obtained from serum blood samples. Statistical analyses performedUnadjusted and adjusted linear mixed model regressions were used to test the association between the physical HFE and each of the outcome variables: body mass index z scores, HEI-2020 total scores, and cardiometabolic biomarkers. HFE subcategories (eg, fruits and vegetables) were also examined with each outcome using linear mixed model regression. ResultsMean ± SD age of the children was 9.5 ± 1.9 years, 61.4% were female, 59.1% identified as White, and 90.9% were non-Hispanic. Obesogenic score was significantly associated with body mass index z scores (β = .03, P = .029), but not HEI-2020 total scores or cardiometabolic biomarkers. As HFE fruits and vegetables subcategory increased, HEI-2020 total scores significantly increased (β = .73, P = .005) and total cholesterol (β = –1.54, P = .014) and low-density lipoprotein cholesterol levels (β = –1.31, P = .010) significantly decreased. Increased availability of sweet and salty snack food and availability of sugar-sweetened beverages was associated with increased fasting blood glucose (β = 0.65, P = .033) and insulin levels (β = 5.60, P = .035) respectively. ConclusionsThere is evidence of a relationship between the subcategories of the physical HFE and cardiometabolic factors. Future interventions are needed to understand whether altering the overall HFE or specific subcategories within the HFE can improve cardiometabolic health.

Usefulness and Safety of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Promoting Exercise Therapy in Patients With Chronic Knee Pain: A Randomized Controlled Trial

ObjectiveTo investigate the effect of transcutaneous electrical nerve stimulation (TENS) in reducing barriers to the implementation of exercise therapy and promoting exercise therapy, focusing on physical activity (PA). DesignA single-center, participant-blinded, randomized controlled trial with a pre-post design. SettingOrthopedic clinic at a single institution,. ParticipantsParticipants (N=63, aged ≥50y) who had knee pain for ≥3 months were randomly assigned to the TENS (N=21), exercise (N=23), or combined (N=19) groups. InterventionsParticipants were provided with 4 weeks of intervention: the TENS group using a wearable TENS device, exercise group performing designated exercises, and combined group performing activities from the TENS and exercise groups. Main Outcome MeasuresThe primary outcome measure was PA. The secondary outcome measures were 6-minute walk test (6MWT); timed Up and Go (TUG) test; stair climbing; knee pain using the visual analog scale at 6MWT, TUG test, and stair climbing; and patient-reported changes in knee pain over time. ResultsAt pre- and postintervention, light-intensity PA time (minutes per day) in the TENS, exercise, and combined groups was 735.62±68.82 vs 714.21±73.06 (P=.061), 733.05±103.90 vs 700.31±90.33 (P=.057), and 710.09±62.98 vs 685.22±58.35 (P=.049), respectively, with a significant decrease in the combined group. Significant improvement in knee pain and stair climbing was observed in all groups pre- and postintervention. ConclusionsThe group using TENS showed improved effects of early reduction in knee pain and when combined with exercise therapy, a reduction in time spent in light-intensity activities such as sedentary behavior. Thus, the use of TENS in combination with conventional exercise therapy has the potential to reduce psychological barriers to the introduction of exercise therapy. It also promotes and ensures the safe implementation and continuation of exercise therapy.

Socioeconomic determinants of very frequent presentations to emergency departments in New South Wales, Australia: A state wide data linkage study

ObjectivesTo describe the clinical and longitudinal patterns of presentation, and to understand the underlying socioeconomic characteristics of different modes of presentation. DesignRetrospective state-wide data linkage analysis of emergency department (ED) presentations. Patients were included if they were 18 years of age or over and presented to the ED over twenty times within any consecutive 365-day period between January 2015 and December 2020. This analysis used routinely collected data from the Emergency Department Data Collection and Admitted Patient Data Collection. The quintile of Socioeconomic Indexes for Area (SEIFA) defined by Australian Bureau of Statistics was used for equity considerations. Main outcome measuresThe main outcomes of interest included patients’ clinical presentation, demographic information and SEIFA score as represented by Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) quintiles. ResultsThere were 417,154 presentations and 5,244 patients who met the inclusion criteria. The majority of the presentations were from SEIFA groups 1 (28.2 %) and 2 (35.6 %). The most common presentations were for drug and alcohol (17.5 %), followed by abdominal pathology (11.8 %) and mental health (11.5 %). In the lowest SEIFA group, the main presenting complaints were for drug and alcohol and administrative presentations. While in the highest SEIFA group, the main presentations were for mental health then abdominal pain, followed by drug and alcohol presentations. ConclusionPatients in the lower SEIFA groups tended to be older with lower acuity presentations and were more likely to present to the same facility, more regularly. Patients in the lower SEIFA group were also more likely to present with drug and alcohol and administrative presentations while those in the higher SEIFA groups were more likely to present with mental health presentations. System wide interventions are needed to address the needs of both groups, particularly those from lower socioeconomic backgrounds, who would benefit from improved access to primary care either through access to General Practice or Urgent Care Centres.

Sustainability and cost of typical and heart-healthy dietary patterns in Australia

Study objectiveThe aim was to quantify and compare the environmental and financial impact of two diets: a heart-healthy Australian diet (HAD) and the typical Australian diet (TAD). DesignThe study involved a secondary analysis of two modelled dietary patterns used in a cross-over feeding trial. SettingThe evaluation focused on two-week (7-day cyclic) meal plans designed to meet the nutritional requirements for a reference 71-year-old male (9000 kJ) for each dietary pattern. Main outcome measuresThe environmental footprint of each dietary pattern was calculated using the Global Warming Potential (GWP*) metric, taking into account single foods, multi-ingredient foods, and mixed dishes. Prices were obtained from a large Australian supermarket. ResultsThe HAD produced 23.8 % less CO2 equivalents (CO2e) per day (2.16 kg CO2e) compared to the TAD (2.83 kg CO2e per day). Meat and discretionary foods were the primary contributors to the environmental footprint of the TAD, whereas dairy and vegetables constituted the largest contributors to the HAD footprint. However, the HAD was 51 % more expensive than the TAD. ConclusionTransitioning from a TAD to a HAD could significantly reduce CO2 emissions and with benefits for human health and the environment. Affordability will be a major barrier. Strategies to reduce costs of convenient healthy food are needed. Future studies should expand the GWP* database and consider additional environmental dimensions to comprehensively assess the impact of dietary patterns. Current findings have implications for menu planning within feeding trials and for individuals seeking to reduce their carbon footprint while adhering to heart-healthy eating guidelines.

Relationship between Neighborhood-Level Social Risk Factor Measures and Presenting Glaucoma Severity Utilizing Multilevel Modeling

PurposeThe neighborhood and built environment social determinant of health domain has several social risk factors (SRF) that are modifiable through policy efforts. We investigated the impact of neighborhood-level SRFs on presenting glaucoma severity at a tertiary eye care center. DesignA cross-sectional study from August 2012 to May 2022 in the University of Michigan (UM) electronic health record (EHR). ParticipantsPatients with a diagnosis of any open angle glaucoma with ≥1 eye care visit at the UM Kellogg Eye Center and ≥1 reliable visual field. MethodsParticipants who met inclusion criteria were identified by ICD9/10 codes (365.x/H40.x). Data extracted from the EHR included patient demographics, address, presenting mean deviation (MD), and visual field reliability. Addresses were mapped to SRF measures at the census tract, block group, and county levels. Multilevel linear regression models were used to estimate the fixed effects of each SRF on MD, after adjusting for patient-level demographic factors and a random effect for neighborhood. Interactions between each SRF measure with patient-level race and Medicaid status were tested for an additive effect on MD. Main Outcome MeasuresThe main outcome measure was the effect of SRF on presenting MD. ResultsIn total, 4428 patients were included in the analysis who were, on average, 70.3 years old (standard deviation=11.9), 52.6% self-identified as female, 75.8% self-identified as White, and 8.9% had Medicaid. The median value of presenting MD was -4.94 dB (interquartile range=-11.45 to -2.07 dB). Neighborhood differences accounted for 4.4% of the variability in presenting MD. Neighborhood-level measures, including worse area deprivation (estimate, β=-0.31 per 1-unit increase; p<0.001), increased segregation (β=-0.92 per 0.1-unit increase in Theil’s H index; p<0.001), and increased neighborhood Medicaid (β=-0.68; p<0.001) were associated with worse presenting MD. Significant interaction effects with race and Medicaid status were found in several neighborhood-level SRF measures. ConclusionsAlthough patients’ neighborhood SRF measures accounted for a minority of the variability in presenting MD, most neighborhood-level SRFs are modifiable and were associated with clinically meaningful differences in presenting MD. Policies that aim to reduce neighborhood inequities to address allocation of resources could have lasting impacts on vision outcomes.

High-Adherence Dichoptic Treatment Versus Patching in Anisometropic and Small Angle Strabismus Amblyopia: A Randomized Controlled Trial

PurposeTo compare the effectiveness and safety of a novel binocular eye-tracking-based-home-treatment (CureSight) to patching for the treatment of amblyopia. DesignProspective, masked, randomized controlled noninferiority trial. SettingMulticenter, multinational, home treatment. ParticipantsOne hundred forty-nine children 4 to < 9 years with anisometropic, small-angle strabismic, or mixed-mechanism amblyopia were randomized to either binocular treatment (n=75) or patching (n=74). InterventionsThe binocular treatment group used the CureSight system for 90 min/day, 5 days/week for 16 weeks (120 hours). The patching group received 2-hour patching 7 days/week (224 hours). Main outcome measuresThe primary outcome was the mean improvement from baseline in amblyopic eye visual acuity (VA) to week 16 in both study groups (non-inferiority of ≤0.10 logarithm of the minimum angle of resolution [logMAR]). Other outcomes included changes in stereoacuity and binocular VA from baseline to week 16. ResultsThe mean improvement from baseline at week 16 in the binocular treatment group was noninferior to patching group improvement in the modified intent-to-treat (mITT) dataset (LS mean difference between groups in improvement from baseline: 0.034 logMAR (95% CI -0.009 to 0.076)). In the per-protocol (PP) dataset, the mean improvement from baseline at week 16 in the binocular treatment group was superior to patching group improvement (LS mean difference between groups in improvement from baseline: 0.05 logMAR ([95% CI; 0.007 to 0.097]). At week 16, both groups showed significant median improvement in stereoacuity, with no significant between-group difference in the magnitude of improvement in both the mITT and the PP datasets. Binocular VA was also improved in both groups (p<0.0001). Median adherence in the mITT binocular treatment group (94.0%) was also significantly higher than in the patching group (83.9%; p=0.0038). ConclusionsBinocular, eye-tracking-based amblyopia home treatment is at least as effective as patching.

Decibel level of coughing as a predictor of extubation outcome in mechanically ventilated intensive care patients: A prospective, observational study

AimThis study aims to evaluate the feasibility and clinical utility of measuring cough decibel level as predictive markers for extubation outcomes in mechanically ventilated patients. DesignA prospective observational study. SettingThree interdisciplinary medical-surgical intensive care units across China. Main outcome measuresThe primary outcomes assessed were extubation results in patients. Secondary measures included the cough decibel level, semiquantitative cough intensity scores, and white card test results recorded prior to extubation. ResultsA total of 71 patients were included, 55 patients were in the extubation success group and 16 in the failure group. The mean age was 78(71,83) years, mainly male (73.2 %). Despite the baseline characteristics being mostly consistent across both groups, significant differences were noted in duration of mechanical ventilation, and intensive care units and hospital stay. Remarkably, the cough decibel was substantially lower in the extubation failure group compared to the other group (78.69 ± 8.23 vs 92.28 ± 7.01 dB). The Receiver Operating Characteristic curve analysis revealed that a cough decibel below 85.77 dB is the optimal threshold for predicting extubation failure, exhibiting an 80 % sensitivity and 91.67 % specificity. ConclusionThe study corroborates that the cough decibel level serves as a quantifiable metric in patients undergoing mechanical ventilation. It posits that the likelihood of extubation failure escalates when the cough decibel falls below 85.77 dB. Implications for clinical practiceQuantification of coughing capacity in decibels may be a good predictor of extubation outcome, thus offering assistance to healthcare professionals in evaluating the readiness of patients for extubation.

Short-Term Efficacy of Integrating the Easy-Flex Device With Inpatient Rehabilitation in Individuals With Total Knee Arthroplasty: Insights From a Single-Blind Randomized Controlled Trial

ObjectiveTo determine the effect of Easy-Flex as an adjunct to standard inpatient rehabilitation on clinical and functional outcomes. DesignProspective randomized controlled trial. SettingOutpatient clinic and research laboratory. ParticipantsA total of 44 patients were randomized to the Easy-Flex Group (EFG) or Control Group (CG). InterventionsA rehabilitation program averaging 50-60 minutes per day was implemented for the patients with CG. In the EFG, in addition to 30-40 minutes of exercise with the Easy-Flex, the rehabilitation program applied to the CG was integrated with reduced sets and repetitions, with an average duration of 20 minutes. All interventions were performed under the supervision of a physiotherapist during hospitalization. After discharge, both groups received the same home exercise program. Main Outcome MeasuresThe primary outcome is the flexion and extension range of motion (ROM). The secondary outcomes include the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Five Times Sit-to-Stand Test (5-TSST), 10-Meter Walking Test (10-MWT), Short Form (SF)-12v2, and Global Rating of Change scale. ResultsAfter 6 weeks, the overall group-by-time interaction for the 2 × 3 mixed-model analysis of variance was found to be significant for flexion ROM (P=.005), NPRS-rest (P=.04), NPRS-activity (P=.01), 10-MWT (P=.003), WOMAC (P=.021), and SF-12 physical component summary (PCS) (P=.032) in favor of EFG exercising with Easy-Flex in addition to standard rehabilitation. The between-group differences in favor of the EFG were −8.0° knee ROM, 1.35-1.5 points for pain intensity, and 0.12 m/s for gait speed. Furthermore, differences favoring EFG in NPRS-rest, 10-MWT speed, and SF-12 PCS were greater than the reported minimum clinically important difference. ConclusionsIncorporating Easy-Flex into standard physical therapy can be a beneficial, safe, and effective approach in clinical practice, as patients undergoing total knee arthroplasty typically prioritize improving their quality of life by reducing pain and increasing ROM.

How a population-based cohort of men estimate lifetime risk of prostate cancer in a survey before entering a prostate cancer screening trial in Sweden?

ObjectivesInvestigating men’s perceived lifetime risk of prostate cancer.DesignSurvey-based study to men invited for prostate-specific antigen (PSA) screening in the GÖTEBORG-2 trial between September 2015 and June 2020.Setting38 775 men in...

Early parenteral nutrition is associated with improved growth in very low birth weight infants: a retrospective study

ObjectiveTo assess the association between early initiation of parenteral nutrition (PN) and body growth in preterm infants with very low birth weight (VLBW).DesignCausal inference analysis with confounders preselected by causal...

Effect of gestational age on cerebral lesions in neonatal encephalopathy

ObjectiveTo determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy.DesignSecondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy.SettingFrench...

Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up of a randomised, multicentre, non-inferiority trial

ObjectiveTo assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis.DesignFive year follow-up of a randomised, multicentre, non-inferiority...

Comparison of Machine Learning Models to a Novel Score in the Identification of Patients at Low Risk for Diabetic Retinopathy

PurposeTo develop an easily applicable predictor of patients at low risk for diabetic retinopathy (DR). DesignAn experimental study on the development and validation of machine learning models and a novel retinopathy risk score to detect patients at low risk for diabetic retinopathy. SubjectsAll individuals aged 18 years or older who participated in the telemedicine retinal screening initiative through Temple University Health Systems from October 1, 2016 through December 31, 2020. The subjects must have documented evidence of their diabetes mellitus diagnosis as well as a documented hemoglobin A1C recorded in their chart within 6 months of the retinal screening photograph. MethodsThe charts of 1930 subjects (1590 evaluable) undergoing telemedicine screening for DR were reviewed, and 30 demographic and clinical parameters were collected. DR is a dichotomous variable where low risk is defined as no or mild retinopathy using the International Clinical Diabetic Retinopathy severity score. Five machine learning models (MLM) were trained to predict patients at low risk for DR using 1050 subjects and further underwent 10-fold cross validation to maximize its performance indicated by the area under the receiver operator characteristic curve (AUC). Additionally, a novel retinopathy risk score (RRS) is defined as the product of hemoglobin A1c closest to screening and years with diabetes mellitus. RRS was also applied to generate a predictive model. Main Outcome MeasuresThe performance of the trained machine learning models and the RRS model was compared using DeLong’s test. The models were further validated using a separate unseen test set of 540 subjects.The performance of the validation models were compared using DeLong’s test and chi-square tests. ResultsUsing the test set, the AUC for the RRS was not statistically different from four out of five MLM. The error rate for predicting low-risk patients using the RRS was significantly lower than the naive rate (0.097 vs 0.19; p<0.0001), and it was comparable to the error rates of the machine learning models. ConclusionThis novel retinopathy risk score is a potentially useful and easily deployable predictor of patients at low risk for DR.