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Quality Analysis of Measurement Properties of Patient-Reported Outcome Measures for Vitiligo and of the Studies Assessing Them: A Systematic Review
No full textEvaluating measurement properties (MPs) of Patient Reported Outcome Measures (PROMs) in vitiligo is essential for evidence-based recommendations and identifying research gaps. This study assesses the quality of PROMs used in vitiligo. A systematic search of PubMed, Embase, and the Cochrane Library (up to 20 February 2024) included studies on PROM analysis or development, excluding those validating other tools. Quality assessments followed the COSMIN guidelines. PROMs with the highest number MPs rated sufficient (supported by moderate/high Quality of Evidence [QoE]) were reported per construct category, and information related to content validity specifically was provided. Forty articles on 24 PROMs (=161 MP studies) were analyzed. In the QoL group, the VIT, VLQI, VIP-FS, and ViPPO had the highest number of MPs rated sufficient (n = 3). For severity-related constructs, the Self-Assessment Vitiligo Extent Score (SA-VES) had the most MPs rated sufficient (n = 3). For treatment-related PROMs, the BMQ had the highest number MPs rated sufficient (n = 2). Content validity was limitedly assessed in 12 different PROMs. Comprehensive MP assessment and further validation of vitiligo PROMs are necessary to make definitive conclusions. These systematic reviews are registered at PROSPERO (CRD42020216338). Only English publications were included, which may limit the scope. Additionally, systematic searches conducted by different reviewers in consecutive updates may introduce subjectivity
Skeletal Muscle Ultrasound Radiomics and Machine Learning for the Earlier Detection of Type 2 Diabetes Mellitus
No full textBackground: Studies have demonstrated that a qualitatively and quantitatively assessed hyperechoic deltoid muscle on ultrasound (US) was accurate for the earlier detection of type 2 diabetes (T2D). We aim to demonstrate the utility of automated skeletal muscle US radiomics and machine learning for the earlier detection of T2D and prediabetes (PreD) as a supplement to traditional hemoglobin A1c (HbA1c) testing.
Methods: A sample of 1191 patients who underwent shoulder US was collected with five cohorts: 171 “normal” (without T2D), 69 “screening” (negative pre-US, but positive HbA1c post-US), 190 “risk” (negative, but clinically high-risk and referred for HbA1c), 365 with “PreD” (pre-US), and 396 with “diabetes” (pre-US). Analysis was performed on deltoid muscle US images. Automatic detection identified the deltoid region of interest. Radiomics features, race, age, and body mass index were input to a gradient-boosted decision tree model to predict if the patient was either low-risk or moderate/high-risk for T2D.
Results: Combining selected radiomics and clinical features resulted in a mean area under the receiver operating characteristic (AUROC) of 0.86 with 71% sensitivity and 96% specificity. In a subgroup of only patients with obesity, combining radiomics and clinical features achieved an AUROC of 0.92 with 82% sensitivity and 95% specificity.
Conclusion: US radiomics and machine learning yielded promising results for the detection of T2D using skeletal muscle. Given the increasing use of shoulder US and the increasingly high number of undiagnosed patients with T2D, skeletal muscle US and radiomics analysis has the potential to serve as a supplemental noninvasive screening tool for the opportunistic earlier detection of T2D and PreD
Functional Outcomes for Elderly Patients After ORIF for Distal Femur Fractures Are Similar to Outcomes for Patients After Primary Total Knee Arthroplasty
No full textBACKGROUND: The long-term clinical outcomes after open reduction and internal fixation (ORIF) for distal femoral fractures, both native and peri-prosthetic, are not yet well established in the literature.
MATERIALS AND METHODS: We used the clinically validated Western Ontario and McMaster Universities Arthritis Index (WOMAC) score to make the functional outcomes after ORIF comparable with the well-characterized results achieved after total knee arthroplasty (TKA) for osteoarthritis. After long-term clinical follow-up and prospectively collected WOMAC scores were obtained, pain, stiffness, and function were evaluated for 68 elderly patients with distal femur fractures (34 periprosthetic, 34 native; median follow-up time, 2.43 years).
RESULTS: Although pain and stiffness scores were significantly lower than those achieved after TKA, functional and total WOMAC scores were similar. Pain and function continued to improve with greater time to follow-up. Although 32% (22/68) of patients had a return to the operating room (3 for infection, 11 for nonunion, and 7 for implant prominence), total WOMAC scores at long-term follow-up were not different for the patients who returned to the operating room. Although stiffness may persist for some patients, the functional outcomes after this procedure are similar to outcomes for patients after primary TKA. The rate of fracture-related re-operations was 32%, but was not associated with poor clinical outcomes.
CONCLUSION: The 91% rate of good to excellent outcomes seen in our cohort suggests ORIF is likely to provide a favorable result for distal femur fractures, both native and periprosthetic, among elderly patients
From mechanism to medicine: The progress and potential of epigenetics in osteoarthritis
No full textOBJECTIVE: Osteoarthritis (OA) is a chronic, degenerative disease of the articular joints. The disease presents an enormous clinical and economic burden globally, due in part to the lack of disease modifying therapies. For over a decade, OA researchers have been working to determine epigenetic mechanisms underlying the disease to better understand pathology, identify biomarkers of progression, and pinpoint novel targets for therapeutic intervention.
DESIGN: This article presents a summary of the 3rd International Workshop on the Epigenetics of Osteoarthritis held in Toronto, Ontario, Canada, in September 2024. The purpose of this meeting was to gather the international community to discuss the status of OA epigenetic research and share expertise on innovative techniques for future.
RESULTS: Since the two previous meetings, there has been increasing adoption of advanced single-cell and spatial sequencing technologies and bioinfomatic analyses. Furthermore, investigations of multiple joint tissues has highlighted the shifting paradigm from OA as a cartilage centric disease to the consideration of all joint tissues.
CONCLUSIONS: The workshop provided a unique opportunity for early-career researchers to expand their network, and for all participants to discuss new or improved approaches to advance the field, including international consortia and data sharing. The highlights and outcomes from this OA epigenetics workshop are described in this report
Osteoporosis screening in the mammography setting via digital wrist tomosynthesis
No full textUNLABELLED: Adherence to osteoporosis screening guidelines could be considerably higher if offered at the time of routine mammography using the same imaging modality. We found that forearm density measurements using a breast imaging system provides density information with excellent diagnostic capability for osteoporosis and osteopenia status determined by hip and spine DXA.
PURPOSE: Adherence to osteoporosis screening guidelines via bone mineral density (BMD) measurements with dual-energy x-ray absorptiometry (DXA) is low. Since adherence to breast cancer screening is quite high, it was suggested that the rate of osteoporosis screening can be improved if wrist imaging were performed at the time of breast screening using the very same equipment.
METHODS: Digital wrist tomosynthesis (DWT) imaging was performed in 150 women using a 3D mammography system and BMD was measured from both 3D tomosynthesis and synthesized 2D images. In addition, standard DXA based BMD measurements were performed at the hip, spine, and forearm sites. We examined the extent to which DWT-derived ultradistal radius BMD correlates with DXA based BMD measurements, evaluated DWT measurement precision errors, and determined the accuracy of DWT in diagnosing low bone mass and osteoporosis in vivo.
RESULTS: DWT BMD strongly correlated with DXA-derived ultradistal radius BMD (R2 up to 0.814) and discriminated osteoporosis (AUC up to 0.978) and osteopenia (AUC up to 0.938) by ultradistal T-score with low in vivo precision errors (0.91-2.3%). BMD derived from 3D DWT BMD performed comparably to forearm DXA BMD in the diagnosis of osteopenia (AUC up to 0.916) and osteoporosis (AUC up to 0.946) determined by hip and spine DXA.
CONCLUSIONS: DWT can be readily implemented in mammography settings with similar diagnostic accuracy to DXA, has the potential to increase adherence to osteoporosis screening recommendations, and offers a convenient means to measure bone density within the highly accessible breast screening environment
Comparison of fluorescence in situ hybridization and cytology for the accurate detection of malignant biliary strictures, with emphasis on unusual results
No full textINTRODUCTION: Biliary brushing cytology is the standard diagnostic approach for evaluating biliary strictures, but it has low sensitivity and a high rate of atypical diagnoses. Fluorescence in situ hybridization (FISH) has become an increasingly valuable adjunct to cytology. Therefore, the aim of this retrospective quality improvement study was to evaluate the relative diagnostic performance of traditional cytology and FISH for correctly determining malignant versus benign biliary strictures from biliary brushing samples and to evaluate whether adding FISH to the diagnostic pipeline improves diagnostic accuracy over relying on cytology alone.
MATERIALS AND METHODS: We conducted a retrospective study of biliary brushing and FISH results in patients evaluated for biliary strictures between April 2019 and March 2023.
RESULTS: A total of 228 specimens were retrieved. For cytology results: 151 negative, 55 atypical, 6 suspicious, and 16 positive. For FISH results: 105 negative, 71 equivocal, and 52 positive. When calculating performance measures, cytology atypical and FISH equivocal were excluded; cytology suspicious was considered positive. The sensitivity and specificity of cytology were 45.8% and 100%, respectively. The sensitivity and specificity of FISH were 84.2% and 96.0%, respectively.
CONCLUSIONS: Our findings indicate that FISH exhibits considerably higher diagnostic sensitivity than routine cytology in identifying malignant biliary strictures. Furthermore, combining cytology with FISH may provide a more comprehensive diagnostic approach, reducing the likelihood of false-negative results. However, positive and equivocal FISH results should be interpreted carefully and considered alongside more specific cytology findings to minimize the risk of false-positive diagnoses
Choose your own adventure: Perception of gamification in continuing pharmacy education
No full textBACKGROUND: Literature detailing the implementation of gamification strategies, including \u27choose your own adventure\u27 (CYOA) patient cases, in continuing professional development within the pharmacy profession is limited. CYOA-style activities have had positive impacts on student cohorts. This report details attendees\u27 perceptions of a continuing pharmacy education presentation at a national pharmacy conference that utilized gamification for content delivery.
EDUCATIONAL ACTIVITY: An educational session was developed to use gamification to teach important concepts in the management of asthma. Presenters worked together to create \u27choose your own adventure\u27 (CYOA) activities as the gamification style for the session. Learning intentions were set for both cases based on important clinical considerations for pharmacists. A mixed methods approach was utilized to provide a descriptive evaluation of the CYOA educational session based on attendees\u27 feedback. A survey was developed by the session moderators and distributed to attendees at the end of the session. A qualitative analysis was also conducted to analyze open-ended response questions within the end of session survey and the standardized session evaluation.
EVALUATION FINDINGS: A total of 227 evaluations were submitted. Ninety-eight percent of respondents agreed or strongly agreed they would recommend the activity to a friend or colleague and were satisfied with the educational content and format of the activity.
ANALYSIS OF EDUCATIONAL ACTIVITY: Incorporating gamification techniques, such as CYOA, into continuing pharmacy education presents a valuable opportunity for practitioners
Obtaining a Probability Sample of a Pregnancy Cohort of Births: A Review of the Problem and a Practical Solution.
No full textThe Michigan Archive for Research on Child Health (MARCH) study produced a probability sample of Michigan births between 2017 and 2023, with data collection beginning at first prenatal visit and continuing up to age 4. Birth certificate data were used to create a sampling frame of hospitals and associated obstetric clinics, from which a probability-proportional-size sample of 10 hospitals was drawn. Close to 100 pregnancies were then recruited in clinics serving each sampled hospital, yielding a probability sample of 1,021 births. This sample was supplemented with 109 births from a certainty selection of a Flint, MI hospital, for a total sample of 1,130. The resulting response rate was high, with 100% of sampled hospitals and 65% of sampled clinics participating. Comparing the resulting sample with all 2017-2023 Michigan births showed close correspondence with respect to birth outcomes (birthweight, gestational age, Apgar scores, gestational diabetes) and mothers\u27 demographics (age, race, education, marital status), with underrepresentation of Hispanic ethnicity and overrepresentation of reported smoking. Given the recent failures of two major prospective birth cohorts (the US National Childrens\u27 Study and the UK Life Study), our work shows a way forward for representative pre- and post-natal studies of births
An optimal design framework for lasso sign recovery
No full textSupersaturated designs investigate more factors than there are runs and are often constructed under a criterion measuring a design\u27s proximity to an unattainable orthogonal design. The most popular analysis identifies active factors by inspecting the solution path of a penalized estimator, such as the lasso. Recent criteria encouraging positive correlations between factors have been shown to produce designs with more definitive solution paths so long as the active factors have positive effects. Two open problems affecting the understanding and practicality of supersaturated designs are: (1) do optimal designs under existing criteria maximize support recovery probability across an estimator\u27s solution path and (2) why do designs with positively correlated columns produce more definitive solution paths when the active factors have positive sign effects? To answer these questions, we develop criteria maximizing the lasso\u27s sign recovery probability. We prove that an orthogonal design is an ideal structure when the signs of the active factors are unknown, and a design with constant, small, positive correlations is ideal when the signs are assumed known. A computationally efficient design search algorithm is proposed that first filters through optimal designs under new heuristic criteria to select the one that maximizes the lasso sign recovery probability
An Unexpected Twist: Sigmoid Volvulus Complicated by Peritoneal Metastases
No full textSigmoid volvulus is the mechanical torsion of the sigmoid colon, its mesentery, and blood supply around itself, resulting in luminal obstruction and colonic ischemia. Initial management typically involves endoscopic detorsion; however, patients with peritonitis or who fail endoscopic therapy warrant surgical intervention. This case illustrates the rare presentation of recurrent sigmoid volvulus, which was refractory to endoscopic detorsion due to complications of peritoneal metastases, which tethered the sigmoid into a torsed position, ultimately requiring surgical resection. This report emphasizes the need for tailored, collaborative approaches to managing sigmoid volvulus in patients with underlying malignancy