340880 research outputs found
Sort by
AI-Assisted Image Recognition of Cervical Spine Vertebrae in Dynamic X-Ray Recordings
No full textBackground: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. This analysis calculates the relative rotation between vertebral segments to determine the sequence in which they contribute to extension, demonstrating a mean sensitivity of 90% and specificity of 85%. However, the extensive time that is required limits its applicability. This study investigated the feasibility of implementing a deep-learning model to analyze qualitative cervical motion. Methods: A U-Net architecture was implemented as 2D and 2D+t models. Dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to assess the performance of the models. Intraclass Correlation Coefficient (ICC) was used to compare the relative rotation of individual vertebrae and segments to the ground truth. Results: IoU ranged from 0.37 to 0.74 and DSC ranged from 0.53 to 0.80. The ICC scores for relative rotation ranged from 0.62 to 0.96 for individual vertebrae and from 0.28 to 0.72 for vertebral segments. For segments, 2D+t models presented higher ICC scores compared to 2D models. Conclusions: This study showed the feasibility of implementing deep-learning models to analyze qualitative cervical motion in dynamic X-ray recordings. Future research should focus on improving model segmentation by enhancing recording contrast and applying post-processing methods. Improved segmentation accuracy will enable routine use of the analysis of motion patterns in clinical research. The absence or presence of a motion pattern, or identification of new patterns has the potential to aid in clinical decision-making
Rethinking causal inference for recurring exposures:The incremental propensity score approach with lavaan
No full textScholars are often interested in evaluating the causal effects of a recurring exposure (e.g., family violence) on behavioral and psychological outcomes. However, causal inference of recurring exposures is challenging. Conventional analytic approaches target causal quantities lacking practical relevance, such as mandating everyone to uniformly always be exposed or unexposed to family violence. Estimation further relies on everyone having a non-zero probability of being either exposed or unexposed at each occurrence, which is frequently unrealistic when past exposures perfectly predict future exposures. In this paper, we introduce a novel approach from the causal inference literature for drawing causal conclusions about recurring exposures: the incremental propensity score intervention (IPSI). IPSI frames causal questions more realistically by assessing how changing the propensity of a recurring exposure may influence an outcome. To facilitate the adoption of IPSI for recurring exposures, we develop an estimation procedure using lavaan, a widely used structural equation modeling software in R. We demonstrate the application of IPSI with a real-world dataset investigating the impact of recurring family violence on adolescent depression. IPSI requires fewer assumptions than existing approaches while offering more meaningful insights into the causal effects of recurring exposures
Near-fatal saddle pulmonary embolism following chemoradiotherapy and brachytherapy for locally advanced cervical cancer:A case series
No full textPurpose: Women with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy are at increased risk of venous thromboembolic events. Case presentation: This case series reported three women, who experienced near-fatal saddle pulmonary embolisms shortly after undergoing high-dose-rate brachytherapy for locally advanced cervical cancer. In one patient, pulmonary saddle embolism led to hypovolemic shock due to intra-abdominal hemorrhage post-resuscitation, necessitating emergency decompressive laparotomy. Another case was complicated by neurological symptoms consistent with a stuttering stroke, following mechanical pulmonary thrombectomy. Conclusions: Pulmonary embolism represents a severe complication of chemoradiotherapy and brachytherapy. Given the high morbidity and mortality rates associated with this condition, routine thromboprophylaxis may be warranted
Telehealth as a Care Solution for Homebound People:Systematic Review and Meta-Analysis of Healthcare Utilization, Quality of Life, and Well-Being Outcomes
No full textHomebound individuals residing in community settings with severe health conditions and disabilities could arguably benefit from telehealth interventions. However, the effectiveness of telehealth compared to in-person care remains underexplored, considering the diversity of these groups. This systematic review and meta-analysis aimed to evaluate the effectiveness of telehealth in reducing healthcare utilization and improving health-related quality of life (HRQOL) and well-being in homebound populations. Adhering and expanding on a published protocol, we conducted comprehensive search across multiple databases: MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, LILACS, and the Web of Science, with no restrictions on language or publication date, and experimental and quasiexperimental studies considered. Eleven independent reviewers were responsible for study selection, and three for data extraction. The methodological quality of the included studies was assessed using JBI checklists. A meta-analysis was then performed using Stata software, which reported standardized mean differences (SMDs) as the effect measure, with the quality of evidence evaluated using the GRADE approach. From an initial screening of 3289 articles, ten studies met our inclusion criteria, with eight suitable for meta-analysis. These studies encompassed data from 2245 participants. Our findings revealed that telehealth interventions significantly reduced healthcare utilization (SMD: -0.49; 95% CI: -0.76 to -0.22; p < 0.01, GRADE: low certainty), significantly enhanced HRQOL (SMD: 0.18; 95% CI: 0.01 to 0.35; p = 0.04, GRADE: moderate certainty), and significantly improved well-being (SMD: -0.31; 95% CI: -0.47 to -0.15; p < 0.01, GRADE: moderate certainty) compared to in-person care. Thus, telehealth emerges as a viable alternative to conventional care, significantly reducing healthcare utilization and enhancing both HRQOL and well-being for homebound people. These findings underscore the potential of telehealth to mitigate healthcare disparities and emphasize the need for accessible, equitable telehealth services codeveloped with end users and relevant stakeholders to save resources and maximize health outcomes for vulnerable populations in community settings
Qualitative Analysis of the Content and Quality of Best Possible Self Narratives:Identifying Factors that Contribute to its Efficacy in Increasing State Optimism and Positive Affect
No full textThis study explored how Best Possible Self (BPS) and control (Typical Day: TD) narratives qualitatively differ from each other and whether the content and quality of the BPS narratives predict BPS effectiveness in increasing state optimism and positive affect. In total, 111 BPS and 108 TD narratives from prior studies were digitalized. First, linguistic analysis examined differences in word use. Second, BPS narratives were rated and compared, regarding their content (i.e., number of goals/wishes within 10 domains: family, love life, career, education, leisure, social life, social involvement, personal growth, physical health and materialism) and quality (i.e., effort, concreteness, and creativity). Results demonstrated that BPS narratives differ from TD narratives, with BPS narratives containing more future orientated words, positive words, the pronoun we, and words that relate to money, family life, and professional life. Furthermore, regarding the content and quality, results indicated that although various predictors of BPS efficacy were examined, only BPS narratives with more words indicative of daily activities, usage of the pronoun we and description of more materialistic goals predicted the effectiveness of the BPSexercise. This may suggest that the manner in which something is written (i.e., positive), might be more important than the actual content itself. This research highlights narrative features and offers insights to enhance the efficacy of BPS manipulation, benefiting researchers utilizing the BPS framework and may contribute to the broader advancement of positive psychological interventions
Preliminary data on the oncological safety of autologous fat transfer (AFT) for total breast reconstruction from the BREAST trial
No full textBackground: Total breast reconstruction via autologous fat transfer (AFT) improves the quality of life compared to implant-based reconstruction (IBR). Hypotheses are that AFT may affect oncologic outcomes. As predetermined in the study protocol, we present the loco-regional recurrence data from the BREAST trial. Methods: This prospective cohort study is based on participants from the BREAST trial, comparing AFT to IBR after mastectomy. Patients were randomised 1:1 to AFT or IBR. Oncological follow-up, including clinical exams and imaging, was conducted annually for five years post-reconstruction in the intervention group. Data on demographics, tumour characteristics, and treatment details of the first tumour were collected from medical records and national pathology databases. Primary outcome for analysis was loco-regional breast cancer recurrence (LRR). Results: In total, 77 patients were included in the AFT arm and 86 in the control arm. Time from breast cancer diagnosis to first AFT exposure was considered control time to minimise immortal time bias. Eight patients in the AFT group and 5 in the control group experienced loco-regional recurrence. This was not significantly different (hazard ratio 1.74 (95% CI: 0.56 – 5.44, p = 0.341) in comparison to control. After adjustment for confounders, the difference remained non-significant. Conclusion: Per study protocol, loco-regional recurrence in the BREAST trial was analysed: no significant difference was observed between AFT-reconstruction and IBR-reconstruction. This study was underpowered for oncological endpoints, the population was too heterogeneous, and not all participants received recommended oncological care
The risk for residual AIS/CIN3+ after the first conservative surgical procedure for cervical adenocarcinoma in situ – A Dutch retrospective cohort study
No full textIntroduction: Conservative treatment options for cervical adenocarcinoma in situ (AIS) include a large loop excision of the transformation zone (LLETZ) and cold-knife conisation (CKC). Since each subsequent intervention might have adverse effects, this study aimed to 1) describe the risk of residual AIS, cervical intraepithelial neoplasia (CIN) grade 3, and cervical cancer (combined AIS/CIN3+) after the first surgical procedure and 2) develop a prediction model for residual AIS/CIN3+. Methods: AIS/CIN3+ incidence was assessed in Dutch patients with AIS who underwent a LLETZ or CKC between 1990 and 2021. The discriminative performance (area-under-the-curve, AUC) for AIS/CIN3+ was compared between a prediction model including four prognostic variables (margin status, age, type of surgical procedure, history of CIN) and a prediction model based on surgical margins only. Results: 4115 patients were eligible, including 2363 patients (57.4 %) treated by LLETZ and 1752 patients (42.6 %) treated by CKC. Of the 3585 patients with known follow-up, 549 patients (15.3 %) were diagnosed with residual AIS/CIN3+, of which 409 of 2152 patients after LLETZ (19 %) and 140 of 1433 patients after CKC (9.3 %) (p < 0.001). The discriminative performance of the prediction model including four prognostic variables was higher (AUC = 0.80, 95 %CI0.78–0.82) than predictions based on surgical margins only (AUC = 0.74, 95 %CI:0.71–0.76). By applying the prediction model, the number of retreatments after unclear margins could decrease by 15.2 %. Conclusion: The prediction model developed in this study enables better quantitative assessment of the risk for residual AIS/CIN3+ after the first conservative surgical procedure for AIS compared to surgical margins only. This model could be used to guide decisions on re-excision in patients with AIS
Adherence and response to supervised home-based exercise prehabilitation of unfit patients scheduled for pancreatic surgery
No full textIntroduction: Exercise prehabilitation yields promising results in major surgery, including pancreatic surgery. Whereas most prehabilitation studies focus on effectiveness, objectively assessed adherence data supporting feasibility of preoperative physical exercise programs are scarce. This study aimed to assess participation rate, adherence, and effectiveness of a partly supervised, home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery. Material and methods: In this prospective multicentre study, thirty unfit patients (oxygen uptake [VO<inf>2</inf>] at ventilatory anaerobic threshold [VAT] =13 mL/kg/min and/or VO<inf>2</inf> at peak exercise [VO<inf>2</inf>peak] =18 mL/kg/min) participated in a four-week home-based exercise prehabilitation program consisting of three personalized high-intensity interval training sessions per week on a remotely monitored cycle ergometer. The primary outcome was program feasibility, defined as participation rates and adherence to frequency, intensity, and time of each training session. Secondary outcomes were individual responses to the program. Results: Participation rate was 63.8 % (30/47 eligible patients, median age 71 years [IQR 65–76], 16 females, 80 % malignancy). Five patients (16.6 %) dropped out. Overall adherence to the number of training sessions was 91.1 %. Adherence to frequency and intensity diminished during the second half of the program. Nevertheless, aerobic capacity improved (VO<inf>2</inf>peak+12.4 %, p < 0.001; VO<inf>2</inf> at the VAT +16.3 %, p = 0.002). Ultimately, twenty patients underwent surgery, without mortality but with major complications in 25.0 %. Conclusions: Objective assessment of adherence to a 4-week partly supervised home-based exercise prehabilitation program by unfit patients scheduled for pancreatic surgery was high, suggesting that even suboptimal execution of a training program still improves aerobic capacity, especially in the least fit patients. Trial registration: ClinicalTrials.gov identifier NCT05496777
WERF Endometriosis Phenome and Biobanking Harmonisation Project for Experimental Models in Endometriosis Research (EPHect-EM-Organoids):endometrial organoids as an emerging technology for endometriosis research
No full textThe aetiology of endometriosis remains poorly understood. In vitro model systems provide the opportunity to identify the mechanisms driving disease pathogenesis using human cells. Three-dimensional models, particularly organoid systems, have revolutionized how we study epithelial biology and are powerful tools for modelling endometriosis. As an emerging model system, it is important to define protocols and identify the remaining challenges surrounding endometrial organoid culture to increase reproducibility and scientific rigour in endometriosis research. The World Endometriosis Research Foundation (WERF) established an international working group comprised of experts using in vitro approaches for the study of endometriosis. This working group harmonized protocols and documentation of existing and emerging organoid systems to maximize comparison and replication across the field and guide specific research hypotheses testing. This evaluation of organoid protocols, limitations, challenges, and alternative approaches assessed both published and grey literature papers across several disciplines pertinent to endometriosis research. Recommendations for protocol and documentation harmonization are presented, and we created the first-ever decision tree diagram to guide and facilitate the selection of existing models best suited for specific areas of endometriosis research. Rigorous and systematic assessment of emerging organoid systems, recognizing the inferential strengths and limitations of these approaches, is vital for endometriosis research. This comprehensive review of the benefits, limitations, and utilization of organoid models, as well as the consequent integration of protocols and documentation, will contribute to the scientific knowledge base by maximizing the reproducibility, comparability, and interpretation of research studies in endometriosis. Additionally, these newly developed protocols and documentation should serve as a resource for, and facilitate collaboration between, endometriosis investigators using organoids in their research methods