https://pubmed.ncbi.nlm.nih.gov/38093492
The abstract reports a methodological progress note on de-implementing low-value care by Kripalani and Norton. Low-value care refers to medical tests, treatments, or interventions that provide no net benefit to patients or even cause harm. The authors highlight the importance of understanding and addressing factors that drive the persistence of low-value care. They propose a conceptual framework that identifies drivers of low-value care at multiple levels, including the patient, provider, organizational, and policy levels. The authors also discuss potential interventions to de-implement low-value care, such as provider education, clinical decision support, and payment reforms. They call for further research to identify effective strategies to reduce low-value care and improve healthcare quality and value. The abstract highlights the importance of addressing low-value care to improve healthcare outcomes and reduce healthcare costs.
Uncategorised
https://pubmed.ncbi.nlm.nih.gov/38093491
This study aimed to evaluate the impact of two policy interventions in Finland that reduced public subsidies for private dental services. Using a realist evaluation and data from the Social Insurance Institution of Finland, the study found that the reductions to subsidies resulted in a 49% decrease in average subsidies to the private dental sector and a 26% increase in out-of-pocket prices. Additionally, 12.2% of patients left the private sector and transitioned to the public sector, which saw a 2.3% increase in dental care professionals and a 9.9% increase in the patient-to-professional ratio. The private sector lost 4.6% of its dental care professionals and increased prices by 4%. The study concludes that the policy changes had tangible effects on both the private and public sectors, with many patients transitioning to the public sector and initial evidence suggesting that the changes increased the cost to the public sector.
https://pubmed.ncbi.nlm.nih.gov/38093490
The study aimed to identify host and microbial characteristics associated with recurrent prosthetic joint infections (PJIs) in patients who underwent two-stage revision arthroplasty. The researchers compared 39 cases of recurrent-PJI, who required at least two antibiotic spacers, with 67 controls of single-PJI, who received only one antibiotic spacer. The findings suggest that McPherson host grade, polymicrobial infection, and S. aureus infection are key indicators of secondary or persistent joint infection. However, bacterial resistance did not predict infection-related arthroplasty failure. Recurrent-PJI patients had higher odds of polymicrobial infections and systemic compromise, and were more likely to harbor S. aureus. Among recurrent-PJI patients, erythromycin-resistant infections were more prevalent at the final than initial spacer, despite no erythromycin exposure.
https://pubmed.ncbi.nlm.nih.gov/38093489
This systematic review aimed to identify and evaluate mentoring programs for specialized nurses (SNs) or nurse navigators (NNs) and advanced practice nurses (APNs). Twelve articles focused on APNs were included, describing various forms of mentorship. Positive outcomes were reported for job retention, satisfaction, skills improvement, satisfaction with the program, and confidence improvement. However, there is a lack of consistency in the elements of mentoring programs. The authors recommend further research to develop systematic and theoretically underpinned mentoring programs for both APNs and SNs/NNs, using a mixed methods design for evaluation. The review provides useful insights for organizations developing and implementing mentoring programs for SNs/NNs and APNs.
https://pubmed.ncbi.nlm.nih.gov/38093488
The study, “National SIDS Trends in the United States From 2000 to 2019: A Population-Based Study on 80 Million Live Births,” investigates recent trends in Sudden Infant Death Syndrome (SIDS) in the United States, with a focus on changes over time and by sex and race.
The research was conducted using data from the Center for Disease Control and Prevention’s (CDC) “Birth Data” and “Mortality Multiple Cause” files from 2000 to 2019, analyzing 80,710,348 live births in total. The study found that the incidence of SIDS decreased from 6.3 to 3.4 per 10,000 births over the study period, with an overall incidence of 4.9 per 10,000 births (95% confidence interval [CI] = 4.4-5.3).
The study also found that male infants were at the greatest risk of SIDS, as were black and American Indian infants. Although the incidence of SIDS decreased among all sex and racial groups over time, the decline was smaller among Hispanic and American Indian infants.
In conclusion, while the overall incidence of SIDS in the United States has decreased over the past two decades, there are still disparities in SIDS rates by sex and race. Public health initiatives should continue to focus on reducing the incidence of SIDS, particularly among high-risk populations.
https://pubmed.ncbi.nlm.nih.gov/38093487
A recent study published in the journal Nutrition & Dietetics has found that a significant number of university students in Australia experience food insecurity, which is associated with poor diet quality. The study, conducted by researchers from the University of Wollongong and the University of Newcastle, found that more than half of the students (54%) who participated in the study experienced some form of food insecurity.
The researchers used the Household Food Security Survey Module to assess food insecurity among students and measured their diet quality with the Australian Recommended Food Score. They found that male students and students who do not live with their parents were at a higher risk of food insecurity.
Students who were food-insecure were more likely to use the campus food pantry, but they were less likely to use the campus community garden. The study also found that food-insecure students had significantly lower diet quality scores compared to food-secure students, with over three points difference. The difference in diet quality was particularly notable in the fruit and vegetable subscale scores.
The study highlights the urgent need for universities to implement interventions to improve the dietary intake of students who experience food insecurity. The study’s authors suggest that universities should offer programs that increase access to affordable and nutritious food on campus. They also recommend that campus-led initiatives address the barriers to using community gardens, as this could be a potential way to improve the diets of food-insecure students.
In summary, the study adds to a growing body of evidence that food insecurity is a significant issue among university students, and it underscores the need for universities to take action to address this problem. Poorest dietary quality in university students is linked with food insecurity, and hence highlights the urgent need for university-led interventions to improve students’ dietary intake.
https://pubmed.ncbi.nlm.nih.gov/38093486
A recent systematic review examined the quality and consistency of clinical practice guidelines for glaucoma suspects. The review, published in Clinical & Experimental Ophthalmology, included 20 guidelines and assessed their quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
The results showed that 80% of the guidelines had low scores (≤2 domains with scores >66%) in the AGREE II assessment, with the lowest scoring domains being applicability, editorial independence, and stakeholder involvement. There was poor agreement across guidelines on the definition of a “glaucoma suspect” or “primary open angle glaucoma (POAG) suspect,” as well as the recommendations and criteria for treatment initiation in these populations. However, there was better agreement for the definition and recommendations for treatment initiation for “primary angle closure suspects.”
The authors concluded that there is substantial room for improvement in the methodological quality of most current international clinical guidelines for glaucoma suspects. They noted that clinicians should consider this finding when using such guidelines to inform their care of glaucoma suspects. The substantial variation in the definition of a POAG suspect and recommendations for treatment initiation also highlights important gaps in the current evidence for accurate prediction of glaucoma development and treatment effectiveness in these individuals.
In summary, this systematic review found significant variations and methodological issues in the available clinical practice guidelines for glaucoma suspects. The findings highlight the need for improved guidelines and evidence-based approaches for identifying and managing glaucoma suspects.
https://pubmed.ncbi.nlm.nih.gov/38093485
A new study published in the journal Anaesthesia has investigated the use of artificial intelligence (AI) in predicting difficult videolaryngoscopy, which is a challenging and critical aspect of airway management during anesthesia. The study developed a deep learning-based facial analysis model that uses a neural network to identify patients at risk of difficult videolaryngoscopy.
The researchers collected data from 5849 patients and used several predictor variables, including medical history, bedside examination, and seven facial images. They used ResNet-18, a convolutional neural network, to recognize and extract features from the facial images. They then used different machine learning algorithms to develop predictive models.
The facial model using the Light Gradient Boosting Machine algorithm showed the highest predictive performance, with an area under the curve of 0.779 (95% CI: 0.733-0.825), a sensitivity of 0.757 (95% CI: 0.650-0.845), and a specificity of 0.721 (95% CI: 0.626-0.794). The facial model outperformed other traditional methods, such as bedside examination and multivariate scores (El-Ganzouri and Wilson), in predicting difficult videolaryngoscopy.
The study suggests that AI-based facial analysis is a feasible and accurate technique for predicting difficult videolaryngoscopy, and it has the potential to improve airway management during anesthesia. The researchers believe that their model can help anesthesiologists identify high-risk patients and take appropriate measures to ensure safe airway management.
Overall, this study highlights the potential of AI in improving clinical outcomes and patient safety in anesthesia. Further studies are needed to validate the model’s performance in different populations and settings.
https://pubmed.ncbi.nlm.nih.gov/38093484
Title: A Comparison of Real-World Data and Real-World Evidence for Regulatory Decision-Making: A Review of FDA and EMA Publications
Real-world data (RWD) and real-world evidence (RWE) are becoming increasingly important in regulatory decision-making for drug approvals. However, regulatory agencies and stakeholders may have different definitions for RWD and use different criteria to determine when analysis of such data is considered RWE.
In a recent study, researchers from the US Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services reviewed two prominent publications describing the use of RWE in drug approvals by the FDA and the European Medicines Agency (EMA). The review aimed to explore the inconsistencies and opportunities for developing a consistent understanding of the role of RWE in regulatory decision-making.
Both publications considered non-interventional (observational) studies, RWD as a comparator arm for a single-arm trial, product-related literature reviews, and RWD to support clinical trial implementation (e.g., to identify potential participants) as generating RWE. However, there were inconsistencies regarding the types of data sources and study designs that were considered as not generating RWE.
For example, there was no agreement regarding whether RWE is generated when RWD describe therapeutic contexts or are used in phase I/II interventional trials, open-label extension studies, or pharmacovigilance activities.
The findings highlight the need for a consistent understanding of the role of RWE in regulatory decision-making for drug approvals among regulatory agencies and stakeholders. The study suggests that further discussion and guidance are necessary to ensure that RWD and RWE are used appropriately and consistently in regulatory decision-making.
In conclusion, RWD and RWE play a critical role in regulatory decision-making for drug approvals. However, the lack of consistency in defining and using RWE can lead to confusion and potentially flawed decision-making. Therefore, developing a consistent understanding and guidance for the use of RWD and RWE in regulatory decision-making is crucial to ensure the safety, efficacy, and quality of approved drugs.
https://pubmed.ncbi.nlm.nih.gov/38093483
The study developed a novel multifunctional probe, [68Ga]Ga-NOTA-Cy5-R1, for noninvasive detection of PD-L1 expression in cancer. PD-L1 is a critical target for cancer immunotherapy, and its expression varies among patients. The probe showed good specificity and sensitivity to PD-L1 in vitro and in vivo. It can sensitively and specifically bind to PD-L1 positive tumors, with rapid clearance from nontarget tissues and a high signal-to-noise ratio. Moreover, [68Ga]Ga-NOTA-Cy5-R1 PET imaging can monitor the dynamic changes of PD-L1 expression in tumors, allowing for personalized cancer immunotherapy. The study suggests that this dual-modality PET/NIRF imaging probe can help direct and promote the clinical practice of ICIs therapy.