Patterns of sedentary behavior among older women with urinary incontinence and urinary symptoms: a scoping review.

BACKGROUND: Independent of physical activity, sedentary behavior has emerged as a significant risk factor for health. Particularly, older adults spent as high as 13 h daily on sedentary activities, which account for 98% of their awake times. Although there is growing evidence revealing the potential association between sedentary behavior and urinary incontinence (UI) across populations of different ages, the relationship between sedentary behavior and urinary symptoms in older women, who are twice as likely to have UI than older men, has not been reviewed. This scoping review aimed to synthesize available evidence of the relationship between sedentary behavior and urinary symptoms in noninstitutionalized older women. METHODS: Six electronic databases (PubMed, Web of Science, SPORTDiscus, Ovid Nursing Database, EMBASE, and MEDLINE) were searched from their inception to April 2023. Observational and experimental studies that measured sedentary behavior using objective and/or self-reported methods in older women aged 60 + years having any type of UI, with English full texts available, were included. Relevant data, including sedentary patterns (types, definitions, measurements, and daily patterns) and UI types were tabulated. A narrative synthesis of the findings was also conducted. RESULTS: A total of seven studies (n = 1,822) were included for review and reporting. Objective measurement showed that older women with UI were engaged in > 8 h sedentary activities daily (493.3-509.4 min/day), which accounted for 73% of their awake times. The duration of self-reported sedentary behavior was lower than the time measured objectively, and the average weekday sitting time was 300-380 min/day. With or without adjustment for confounding factors (e.g., age and number of vaginal deliveries), the daily proportion of sedentary time and average duration of sedentary bouts were positively associated with the prevalence of urgency UI. Notably, sedentary patients with UI were more likely to have lower urinary tract symptoms, including bothersome incontinence, to use incontinence products, and to have nocturia episodes, than their age-matched counterparts who were less sedentary. CONCLUSION: Our findings suggest a potential relationship between sedentary behavior and UI in older women, but the causality of the relationship remains unclear. To further inform the clinical role of sedentary behavior in the context of UI, a greater number of rigorous studies with a prospective study design is urgently needed.

Clinical and onychoscopic features of histopathologically proven onychopapillomas and literature update.

BACKGROUND: Onychopapilloma is a benign tumor of the distal nail matrix and proximal nail bed with heterogeneous clinical presentations. It poses a diagnostic challenge because it could mimic subungual malignancies and inflammatory conditions. Clinical, onychoscopic, and histopathological clues play critical roles in diagnosis. METHODS: We performed a retrospective chart review of onychopapilloma cases collected over 10 years, and characterized the clinical, onychoscopic, and histopathological features of onychopapilloma at an academic institution. RESULTS: We obtained 17 biopsy-confirmed cases of onychopapilloma. Among our cases, we found manifestation of onychopapilloma as longitudinal erythronychia, longitudinal leukonychia, yellow-brown chromonychia, and longitudinal melanonychia. Long longitudinal or short splinter hemorrhages may be present. Distal fissuring with V-shaped notch, subungual keratotic mass, and onycholysis are other discernable features. Histopathological features include papillomatosis, epidermal hyperplasia, acanthosis of the distal nail bed, premature keratinization, matrix metaplasia, hyperkeratosis, and splinter hemorrhages; histopathological signs of malignancy were not observed in any of our cases. CONCLUSIONS: Onychopapilloma has polymorphic clinical and morphological features. Onychoscopic and histopathological studies are important to help exclude malignant mimickers. Consider onychopapilloma in the differential diagnoses of a monodactylous longitudinal streak in the nail, especially on the left thumb of an adult female.

Terminology and descriptions of navigation and related practices for children with neurodisability and their families: a scoping review.

BACKGROUND: Children with neurodisability (ND) represent a significant population with a demonstrated need for coordinated support. Patient navigation has a primary focus on: facilitating access to and connection amongst fragmented systems; as well as the provision of educational and emotional support. Given the distinct needs of children with ND and their families, programs built upon such core concepts could be of great benefit. The diversity of terminology encompassing navigation-related concepts and activities (e.g., care coordination, case management, family support), however, presents challenges to both practice and research. This scoping review examined the terminology and descriptions provided within published articles on navigation-type models for children with ND and their families. METHODS: The scoping review was conducted according to the Joanna Briggs Institute methodology. A preliminary search was completed on PubMed (NCBI), MEDLINE (Ovid) and CINAHL (EBSCO) to identify initial search terms, upon which a full search strategy was developed and executed in MEDLINE (Ovid) and CINAHL (EBSCO). After screening records according to our inclusion and exclusion criteria, a full-text review of relevant articles was conducted and data extracted using a researcher-developed tool. Under close supervision by the research team, study selection was primarily performed by one author. RESULTS: Of the 2597 papers identified, 33 were included in the final review. From the included papers, a total of 49 terms were extracted, 20 of which were unique. Across the diversity of terminology observed, articles provided detailed and rich descriptions characterized by four central domains, namely: (i) what navigation-related resources, supports and services aim to facilitate and (ii) provide; (iii) descriptions of their intended outcomes; as well as (iv) guiding principles. CONCLUSIONS: This scoping review addresses a gap in our knowledge related to the specification of patient navigation and related supports as applied to the specific context of children with ND and their families. Given the particular needs of this population, we propose an empirically-informed integrative model that synthesizes the findings from this scoping review. We suggest that this framework can be used as a guide to the mindful characterization of how supports aiming to connect children and families to needed service are termed and described within future research and in practice.

Design-Based Approaches to Causal Replication Studies.

Recent interest in promoting replication efforts assumes that there is well-established methodological guidance for designing and implementing these studies. However, no such consensus exists in the methodology literature. This article addresses these challenges by describing design-based approaches for planning systematic replication studies. Our general approach is derived from the Causal Replication Framework (CRF), which formalizes the assumptions under which replication success can be expected. The assumptions may be understood broadly as replication design requirements and individual study design requirements. Replication failure occurs when one or more CRF assumptions are violated. In design-based approaches to replication, CRF assumptions are systematically tested to evaluate the replicability of effects, as well as to identify sources of effect variation when replication failure is observed. The paper describes research designs for replication and demonstrates how multiple designs may be combined in systematic replication efforts, as well as how diagnostic measures may be used to assess the extent to which CRF assumptions are met in field settings.

Body site distribution of pediatric-onset morphea and association with extracutaneous manifestations.

BACKGROUND: The distribution of pediatric-onset morphea and site-based likelihood for extracutaneous complications has not been well characterized. OBJECTIVE: To characterize the lesional distribution of pediatric-onset morphea and to determine the sites with the highest association of extracutaneous manifestations. METHODS: A retrospective cross-sectional study was performed. Using clinical photographs, morphea lesions were mapped onto body diagrams using customized software. RESULTS: A total of 823 patients with 2522 lesions were included. Lesions were more frequent on the superior (vs inferior) anterior aspect of the head and extensor (vs flexor) extremities. Linear morphea lesions were more likely on the head and neck, whereas plaque and generalized morphea lesions were more likely on the trunk. Musculoskeletal complications were more likely with lesions on the extensor (vs flexor) extremity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.4), whereas neurologic manifestations were more likely with lesions on the anterior (vs posterior) (OR, 2.8; 95% CI, 1.7-4.6) and superior (vs inferior) aspect of the head (OR, 2.3; 95% CI, 1.6-3.4). LIMITATIONS: Retrospective nature and the inclusion of only patients with clinical photographs. CONCLUSION: The distribution of pediatric-onset morphea is not random and varies with body site and within individual body sites. The risk stratification of extracutaneous manifestations by body site may inform decisions about screening for extracutaneous manifestations, although prospective studies are needed.

Establishing a Hybrid Wound and Ostomy Continuing Education Program.

Wound and ostomy nurses receive specialty training and certification to provide care in abdominal stomas, ostomies, wounds, fistulas, and pressure injuries. The eight existing nationwide programs in 2011 were inadequate to meet increasing patient population demands. We developed an innovative nondegree, postbaccalaureate continuing wound and ostomy education program using a hybrid design. The program integrated interactive online classes with intensive onsite classes and skills training. The program has been granted seven-year accreditation; student evaluations have been positive.

Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modeling approach.

OBJECTIVE: Previous validation studies of the Chalder Fatigue Scale (CFS) suffer methodological shortcomings. The present study aimed to re-evaluate its psychometric properties using exploratory structural equation modeling (ESEM). METHODS: A Chinese sample of 1259 community-dwelling residents completed the 11-item Chinese CFS and a variety of health measures (anxiety, depression, exhaustion, sleep disturbance, and quality of life). In addition to traditional confirmatory factor analysis, ESEM was performed to assess the fit of two- and three-factor models using robust maximum likelihood estimation and oblique geomin rotation. Convergent validity of the CFS was examined via associations with five covariates (gender, age, exercise, perceived health, and life event) and the health measures in the ESEM model. RESULTS: The ESEM models displayed a superior fit to confirmatory factor models. The three-factor ESEM model showed a satisfactory model fit to the data but not for the two-factor model. The three factors were physical fatigue (three items, α = .800), low energy (four items, α = .821), and mental fatigue (four items, α = .861). The factors exhibited convergent validity with the model covariates and health measures. CONCLUSION: The results demonstrate the satisfactory reliability and convergent validity for the three-factor structure of the CFS as a valid measure of fatigue symptoms in the general population. Future psychometric studies could adopt the ESEM approach as a practical alternative to traditional confirmatory factor analysis.

Distinct conformational transition patterns of noncoding 7SK snRNA and HIV TAR RNAs upon Tat binding.

Noncoding 7SK snRNA is believed to play an important role in the recruitment of P-TEFb by viral protein Tat to stimulate HIV processive transcription. Because HIV-2 TAR RNA and 7SK both evolved to feature a dinucleotide bulge region, compared to the trinucleotide bulge for HIV-1 TAR, ultrafast time-resolved fluorescence spectroscopy has been used to probe the conformational landscape of HIV-2 TAR and 7SK-SL4 RNA to monitor the conformational changes upon Tat binding. Our studies demonstrate that both HIV-1/2 TAR and 7SK-SL4 sample heterogeneous ensembles in the free state and undergo distinct conformational transitions upon Tat binding. These findings provide exquisite knowledge on the conformational complexity and intricate mechanism of molecular recognition and pave the way for drug design and discovery that incorporate dynamics information.

A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression.

BACKGROUND: Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation (DCEAS), a novel brain stimulation therapy in patients with major depression, postpartum depression and obsessive-compulsive disorder. The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors (SSRIs) in patients with post-stroke depression (PSD). METHODS: In a single-blind, randomized controlled trial, 43 patients with PSD were randomly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture (n = 23), or sham (non-invasive cranial electroacupuncture, n-CEA) plus SSRI plus body electroacupuncture (n = 20) for 3 sessions per week over 4 weeks. Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), the Clinical Global Impression - Severity scale (CGI-S) and Barthel Index (BI), a measure used to evaluate movement ability associated with daily self-caring activity. RESULTS: DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA, but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS. Incidence of adverse events was not different in the two groups. CONCLUSIONS: These results indicate that DCEAS could be effective in reducing stroke patients' depressive symptoms. Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients. A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke. TRIAL REGISTRATION: http://www.clinicaltrials.gov, NCT01174394.

Heel response to external pressure: is it the same in healthy community-dwelling adults and in hip surgery patients?

PURPOSE: The purpose of the study was to determine whether the interface pressure created when the heel is in contact with the bed surface reduced healthy adults' heel oxygen delivery (transcutaneous oxygen [TcO2]) and raised heel skin temperature. We also determined whether there was a hyperemic response to pressure relief on 3 consecutive days, and compared data from healthy adults to that from hip surgery patients. DESIGN: A 1-group, prospective, repeated-measures design guided data collection and analysis. SUBJECTS AND SETTINGS: Eighteen subjects were age (±5 years) and gender-matched with a previous study on hip surgery patients. The mean age of study participants was 57.3 ± 15.75 (mean ± SD) years and half were men (n = 9). METHODS: Oxygen and temperature sensors were placed on the plantar surface of each foot, close to the heels. Measures were taken when the heels were (1) suspended above the bed surface (preload), (2) on the bed surface for 15 minutes (loading), and (3) again suspended above the bed surface for 15 minutes (unloading).Repeated measures analysis of variance was used to analyze the data. RESULTS: When compared with preload, both loading and unloading on all 3 days resulted in a statistically significant bilateral reduction in heel TcO2 (P < .001) and a bilateral increase in heel skin temperature (P = .001). There was a significant bilateral heel hyperemic response (during the first 3 minutes of immediate heel unloading) on all 3 days. There were significant changes in heel TcO2 (P = .008) and heel skin temperature (P < .001) in both legs when pressure was relieved. The hyperemic response was not apparent in the operative leg in our prior hip surgery group. When comparing one of the legs of the healthy adults with the operative leg of the prior hip surgery patients, heel TcO2 in both groups decreased (P < .001) while heel skin temperature increased during both loading and unloading in all 3 days (P < .001). CONCLUSION: Heel TcO2 fell while heel skin temperature increased with both the application and removal of external pressure in healthy adults. The fall in TcO2 and the rise in heel skin temperature were also apparent in the operative leg of the hip surgery group. The brief period of hyperemia, measured by abrupt changes in heel TcO2 and heel skin temperature, was present only in healthy subjects. This raises the question of whether heel pressure ulcer development is related to a blunted hyperemic response in subjects with hip surgery. Further studies are needed that explore the effects of varying the duration of pressure on the hyperemic response as a strategy to understand heel pressure ulcer prevention. Since heel TcO2 fell in both groups after a brief pressure application of 15 minutes, nurses should keep heels off-load at all times to ensure adequate heel skin oxygenation.

Integrating Patient Preferences with Guideline-Based Care in Neurogenic Lower Urinary Tract Dysfunction After Spinal Cord Injury.

Individual and social factors are important for clinical decision-making in patients with neurogenic bladder secondary to spinal cord injury (SCI). These factors include the availability of caregivers, social infrastructure, and personal preferences, which all can drive bladder management decisions. These elements can be overlooked in clinical decision-making; therefore, there is a need to elicit and prioritize patient preferences and values into neurogenic bladder care to facilitate personalized bladder management choices. For the purposes of this article, we review the role of guideline-based care and shared decision-making in the SCI population with neurogenic lower urinary tract dysfunction.

Drug-related problems associated with direct oral anticoagulants: an observational cross-sectional study of medical record review by pharmacists in a large teaching hospital.

Background: Prescribing DOACs presents with challenges in the elderly and patients with renal and hepatic impairment. To mitigate safety risks, pharmacists have a role in detection, prevention, and resolution of DOAC-associated drug-related problems (DRPs). Objectives: To identify the types of DOAC-associated DRPs in patients on DOAC therapy and factors that predispose patients to DOAC-associated DRPs. Methods: An observational cross-sectional study was conducted in SGH from January 1, 2017, to May 31, 2019, on patients prescribed with a DOAC (rivaroxaban, dabigatran, and apixaban). Data were electronically extracted for patient demographics, clinical characteristics, and details of DOAC-related DRPs identified by pharmacists. Matching of DRP group to non-DRP group at a ratio of 1:2 based on gender, race, and DOAC was performed. The DRP group included patients with detected DRPs while non-DRP group included patients without them. Descriptive analysis was used to summarize patient characteristics and types of DOAC-associated DRPs. In the matched population, conditional logistic regression was used to calculate unadjusted (UOR) and adjusted odds (AOR) ratio to detect association of DOAC-associated DRPs with age, renal function, ≥2 comorbidities, and DOAC indication (atrial fibrillation [AF] vs venous thromboembolism). Results: A total of 8432 patients prescribed DOACs were analyzed, which consisted of 827 (9.8%) and 7602 (90.2%) patients with DRPs and no DRPs, respectively. The top DOAC-associated DRP was inappropriate drug regimen (n = 487, 60.1%). After matching, 2403 patients were analyzed, consisting of 801 patients from DRP group and 1602 from non-DRP group. Factors associated with DOAC-associated DRPs were statistically significant for renal function at creatinine clearance (CrCl) of >30 to 50 mL/min/1.73 m2 (AOR: 1.42; 95% CI: 1.14-1.76; P = .002), 15 to 30 mL/min/1.73 m2 (OR: 1.94; 95% CI: 1.42-2.66; P < .001), and <15 mL/min/1.73m2 (OR: 2.35; 95% CI: 1.13-4.88; P = .022), respectively, compared with a CrCl of >50 mL/min/1.73 m2 and DOAC indication for AF (AOR: 1.84; 95% CI: 1.47-2.30; P < .001) compared with venous thromboembolism. Conclusion: Inappropriate drug regimen was the most common DOAC-associated DRP. Impaired renal function and patients with AF increased the likelihood of DOAC-associated DRPs.

Empirical variability in the calibration of slope-based eccentric photorefraction.

Refraction estimates from eccentric infrared (IR) photorefraction depend critically on the calibration of luminance slopes in the pupil. While the intersubject variability of this calibration has been estimated, there is no systematic evaluation of its intrasubject variability. This study determined the within subject inter- and intra-session repeatability of this calibration factor and the optimum range of lenses needed to derive this value. Relative calibrations for the MCS PowerRefractor and a customized photorefractor were estimated twice within one session or across two sessions by placing trial lenses before one eye covered with an IR transmitting filter. The data were subsequently resampled with various lens combinations to determine the impact of lens power range on the calibration estimates. Mean (±1.96 SD) calibration slopes were 0.99±0.39 for North Americans with the MCS PowerRefractor (relative to its built-in value) and 0.65±0.25 Ls/D and 0.40±0.09 Ls/D for Indians and North Americans with the custom photorefractor, respectively. The ±95% limits of agreement of intrasubject variability ranged from ±0.39 to ±0.56 for the MCS PowerRefractor and ±0.03 Ls/D to ±0.04 Ls/D for the custom photorefractor. The mean differences within and across sessions were not significantly different from zero (p>0.38 for all). The combined intersubject and intrasubject variability of calibration is therefore about ±40% of the mean value, implying that significant errors in individual refraction/accommodation estimates may arise if a group-average calibration is used. Protocols containing both plus and minus lenses had calibration slopes closest to the gold-standard protocol, suggesting that they may provide the best estimate of the calibration factor compared to those containing either plus or minus lenses.

Correspondence measures for assessing replication success.

Given recent evidence challenging the replicability of results in the social and behavioral sciences, critical questions have been raised about appropriate measures for determining replication success in comparing effect estimates across studies. At issue is the fact that conclusions about replication success often depend on the measure used for evaluating correspondence in results. Despite the importance of choosing an appropriate measure, there is still no widespread agreement about which measures should be used. This article addresses these questions by describing formally the most commonly used measures for assessing replication success, and by comparing their performance in different contexts according to their replication probabilities-that is, the probability of obtaining replication success given study-specific settings. The measures may be characterized broadly as conclusion-based approaches, which assess the congruence of two independent studies' conclusions about the presence of an effect, and distance-based approaches, which test for a significant difference or equivalence of two effect estimates. We also introduce a new measure for assessing replication success called the correspondence test, which combines a difference and equivalence test in the same framework. To help researchers plan prospective replication efforts, we provide closed formulas for power calculations that can be used to determine the minimum detectable effect size (and thus, sample sizes) for each study so that a predetermined minimum replication probability can be achieved. Finally, we use a replication data set from the Open Science Collaboration (2015) to demonstrate the extent to which conclusions about replication success depend on the correspondence measure selected. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The validity of causal claims with repeated measures designs: A within-study comparison evaluation of differences-in-differences and the comparative interrupted time series.

Modern policies are commonly evaluated not with randomized experiments but with repeated measures designs like difference-in-differences (DID) and the comparative interrupted time series (CITS). The key benefit of these designs is that they control for unobserved confounders that are fixed over time. However, DID and CITS designs only result in unbiased impact estimates when the model assumptions are consistent with the data at hand. In this paper, we empirically test whether the assumptions of repeated measures designs are met in field settings. Using a within-study comparison design, we compare experimental estimates of the impact of patient-directed care on medical expenditures to non-experimental DID and CITS estimates for the same target population and outcome. Our data come from a multi-site experiment that includes participants receiving Medicaid in Arkansas, Florida, and New Jersey. We present summary measures of repeated measures bias across three states, four comparison groups, two model specifications, and two outcomes. We find that, on average, bias resulting from repeated measures designs are very close to zero (less than 0.01 standard deviations; SDs). Further, we find that comparison groups which have pre-treatment trends that are visibly parallel to the treatment group result in less bias than those with visibly divergent trends. However, CITS models that control for baseline trends produced slightly more bias and were less precise than DID models that only control for baseline means. Overall, we offer optimistic evidence in favor of repeated measures designs when randomization is not feasible.

Moving away from mannitol infusion for partial nephrectomy: has this altered renal function?

In recent years, research has questioned the theorized renal-protective value of mannitol infusion during partial nephrectomy. This study considers whether the cessation of routine mannitol administration has shown any benefit or detriment to patients in the contemporary era. We retrospectively reviewed a multi-institution database for an association between mannitol administration and subsequent renal function during follow-up. These patients were assessed for de novo stage III chronic kidney disease (CKD III) and followed with estimated glomerular filtration rate (eGFR). Statistical analysis included Mann-Whitney-U and Chi-squared tests for comparing baseline and perioperative variables with postoperative outcomes. eGFR changes were evaluated with a mixed-effects linear regression model. Nine hundred and fifteen patients were identified whose operative reports or surgeons' treatment algorithms explicitly described whether or not mannitol was administered. 667 (73%) did not receive mannitol. There were no differences in demographics, age, Charlson comorbidity index, nephrometry score, tumor size, grading, or baseline eGFR from those who received mannitol. Ischemia time and operative time appeared slightly longer with mannitol use. Patients were followed for a median of 5 months (IQR 0.5-19 months), during which mannitol use was associated with an increase in de novo CKD III (14% v. 9%, p = 0.041) and minimally worsened median eGFR on final follow-up (72.82 v. 76.06, p = 0.039). Our analysis of partial nephrectomy patients indicates that mannitol administration likely confers no short- or long-term renal benefit. Mannitol may be used at the surgeon's discretion, but if it prolongs surgery time or ischemia time, it may in fact be detrimental to outcomes.

An efficient approach to estimate the risk of coronary artery disease for people living with HIV using machine-learning-based retinal image analysis.

BACKGROUND: People living with HIV (PLWH) have increased risks of non-communicable diseases, especially cardiovascular diseases. Current HIV clinical management guidelines recommend regular cardiovascular risk screening, but the risk equation models are not specific for PLWH. Better tools are needed to assess cardiovascular risk among PLWH accurately. METHODS: We performed a prospective study to determine the performance of automatic retinal image analysis in assessing coronary artery disease (CAD) in PLWH. We enrolled PLWH with ≥1 cardiovascular risk factor. All participants had computerized tomography (CT) coronary angiogram and digital fundus photographs. The primary outcome was coronary atherosclerosis; secondary outcomes included obstructive CAD. In addition, we compared the performances of three models (traditional cardiovascular risk factors alone; retinal characteristics alone; and both traditional and retinal characteristics) by comparing the area under the curve (AUC) of receiver operating characteristic curves. RESULTS: Among the 115 participants included in the analyses, with a mean age of 54 years, 89% were male, 95% had undetectable HIV RNA, 45% had hypertension, 40% had diabetes, 45% had dyslipidemia, and 55% had obesity, 71 (61.7%) had coronary atherosclerosis, and 23 (20.0%) had obstructive CAD. The machine-learning models, including retinal characteristics with and without traditional cardiovascular risk factors, had AUC of 0.987 and 0.979, respectively and had significantly better performance than the model including traditional cardiovascular risk factors alone (AUC 0.746) in assessing coronary artery disease atherosclerosis. The sensitivity and specificity for risk of coronary atherosclerosis in the combined model were 93.0% and 93.2%, respectively. For the assessment of obstructive CAD, models using retinal characteristics alone (AUC 0.986) or in combination with traditional risk factors (AUC 0.991) performed significantly better than traditional risk factors alone (AUC 0.777). The sensitivity and specificity for risk of obstructive CAD in the combined model were 95.7% and 97.8%, respectively. CONCLUSION: In this cohort of Asian PLWH at risk of cardiovascular diseases, retinal characteristics, either alone or combined with traditional risk factors, had superior performance in assessing coronary atherosclerosis and obstructive CAD. SUMMARY: People living with HIV in an Asian cohort with risk factors for cardiovascular disease had a high prevalence of coronary artery disease (CAD). A machine-learning-based retinal image analysis could increase the accuracy in assessing the risk of coronary atherosclerosis and obstructive CAD.

A descriptive study of percutaneous injuries in National Healthcare Group POLYCLINICS dental clinics in Singapore from 2014 to 2020.

INTRODUCTION: All dental staff face risk of percutaneous injuries (PCI)s. Blood-borne diseases may be transmitted to staff via contaminated sharp instruments. Hence there are significant impacts on staff when PCIs occur. Though a PCI is an occupational hazard, it is preventable. AIM: This study aims to identify factors associated with PCIs among dental staff by evaluating the circumstances and staff designations involved. METHODS: PCIs were reported through an electronic incident reporting system from 2014 to 2020. Reports involved their nature and extent. Statistical analysis was carried out to find associations between factors such as injury site, type of instrument and staff designation. RESULTS: A total of 63 PCIs were included in this study. The type of instrument was found to be significantly associated with staff designation (p = 0.04, p < 0.05) with significantly more dental burs causing injury in dentists and more injuries caused by 'other instruments' in health attendants (p = 0.0083). Majority of PCIs occurred in dentists, then dental assistants and health attendants. Staff designation was significantly associated with the instance where PCIs occurred (p < 0.001). Dentists and dental assistants were more likely to sustain injuries during a dental procedure than before procedure and after procedure (p = 0.0167). The mean incidence of PCIs among our dentists was 15.6/100. CONCLUSIONS: All dental staff are at risk of PCIs however dentists sustain the highest number of PCIs. Needles, dental burs and metal matrices are the top three instruments. Targeted interventions might help prevent/reduce PCIs.

Add-on Rehmannia-6-Based Chinese Medicine in Type 2 Diabetes and CKD: A Multicenter Randomized Controlled Trial.

BACKGROUND: Diabetes is the leading cause of CKD and kidney failure. We assessed the real-world effectiveness of Rehmannia-6-based Chinese medicine treatment, the most used Chinese medicine formulation, on the change in eGFR and albuminuria in patients with diabetes and CKD with severely increased albuminuria. METHODS: In this randomized, assessor-blind, standard care-controlled, parallel, multicenter trial, 148 adult patients from outpatient clinics with type 2 diabetes, an eGFR of 30-90 ml/min per 1.73 m 2 , and a urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g were randomized 1:1 to a 48-week add-on protocolized Chinese medicine treatment program (using Rehmannia-6-based formulations in the granule form taken orally) or standard care alone. Primary outcomes were the slope of change in eGFR and UACR between baseline and end point (48 weeks after randomization) in the intention-to-treat population. Secondary outcomes included safety and the change in biochemistry, biomarkers, and concomitant drug use. RESULTS: The mean age, eGFR, and UACR were 65 years, 56.7 ml/min per 1.73 m 2 , and 753 mg/g, respectively. Ninety-five percent ( n =141) of end point primary outcome measures were retrievable. For eGFR, the estimated slope of change was -2.0 (95% confidence interval [CI], -0.1 to -3.9) and -4.7 (95% CI, -2.9 to -6.5) ml/min per 1.73 m 2 in participants treated with add-on Chinese medicine or standard care alone, resulting in a 2.7 ml/min per 1.73 m 2 per year (95% CI, 0.1 to 5.3; P = 0.04) less decline with Chinese medicine. For UACR, the estimated proportion in the slope of change was 0.88 (95% CI, 0.75 to 1.02) and 0.99 (95% CI, 0.85 to 1.14) in participants treated with add-on Chinese medicine or standard care alone, respectively. The intergroup proportional difference (0.89, 11% slower increment in add-on Chinese medicine, 95% CI, 0.72 to 1.10; P = 0.28) did not reach statistical significance. Eighty-five adverse events were recorded from 50 participants (add-on Chinese medicine versus control: 22 [31%] versus 28 [36%]). CONCLUSIONS: Rehmannia-6-based Chinese medicine treatment stabilized eGFR on top of standard care alone after 48 weeks in patients with type 2 diabetes, stage 2-3 CKD, and severely increased albuminuria. CLINICAL TRIAL REGISTRY: Semi-individualized Chinese Medicine Treatment as an Adjuvant Management for Diabetic Nephropathy (SCHEMATIC), NCT02488252 .