Objective Lumbar puncture (LP) is a diagnostic procedure that accesses the spinal subarachnoid space to measure the opening pressure of the cerebrospinal fluid (CSF) and obtain samples of CSF for analysis. Although commonly performed, LPs are associated with the risk of morbidity and mortality. In addition, thrombocytopenia is thought to increase the risk of LP complications, particularly spinal bleeds. This study compares rates of complications among patients who received LPs with and without thrombocytopenia in hopes of establishing more evidence-based platelet thresholds for an LP. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective propensity score-matched analysis of clinical outcomes of two cohorts of patients who underwent LPs - those with thrombocytopenia (defined as a platelet level of 10,000-50,000 platelets {plts}/μL) and those without thrombocytopenia. The outcomes of interest were the new occurrence of subdural hematoma, epidural hematoma, subarachnoid hemorrhage, receipt of a blood patch, new onset of paralysis, and requirement of spinal decompression. Results The risk of developing a spinal bleed following an LP was 1.496% (42 of 2,808) for the cohort with thrombocytopenia versus 1.09% (31 of 2,843) for the cohort without thrombocytopenia. The risk difference, risk ratio, and odds ratio of patients from these two cohorts experiencing a spinal bleed following an LP were insignificant at 0.05. The risk of receiving a blood patch following an LP was 7.844% for those with thrombocytopenia compared to 1.421% for those without thrombocytopenia. The odds ratio of receiving a blood patch between the two cohorts was 5.906, significant to the 0.05 level (95% CI: 4.213-8.279). There was no significant difference in the cohorts’ risk of developing paralysis or requiring spinal decompression following an LP. Conclusion In support of recent findings against conventional platelet count thresholds prior to LP, it was observed in the present study that the incidence of post-LP spinal bleeding in the 30 days after LP is not associated with platelet counts below the guideline threshold of 50,000 plts/μL. Patients with thrombocytopenia are also not significantly more likely to require spinal decompression or develop new onset paralysis. However, thrombocytopenia is associated with a significantly increased likelihood of receiving a blood patch following an LP.
Objectives There is evidence that teaching gardening skills to new gardeners may improve a range of health behaviors related to cardiovascular disease (CVD) prevention. Little is known about how participation in these programs may influence nutrition knowledge and values. The present study was a qualitative assessment of participant perceptions of learning during a 20-week, 10 session, Zoom-based gardening intervention. Methods Semi-structured interviews were conducted after the intervention was complete. Participants (n = 26) were asked what they learned about nutrition during the program and how it impacted their nutrition-related attitudes and values. Interviews were recorded and transcribed verbatim. A codebook was established and data were coded and managed in Nvivo 1.5.2. Once coded, major themes were identified along with illustrative quotes. Results Participants had a mean age of 50 years and were majority white (83%). The following 3 themes emerged from the interviews: 1) Gaining an awareness of how to transform the eating environment: “For me to be reminded of reading nutrition labels on packages, the food plate, and trying to shoot for the goal of fruits and vegetables helped me immensely. I try to take the time to shop for things that are healthy, like grains, a variety of fruits and vegetables, especially whole foods.” 2) Applying gardening and cooking skills to create healthy habits: “I definitely feel confident in my ability to grow a wider variety of vegetables in my garden and know that they're good. Like the kale is something I never grew before. And I was so surprised by how many uses I have for it. And the zucchini, I was able to make it sauteed, baked, grilled… So I definitely incorporate more diverse vegetables.” 3) Transforming experiences that changed values: “I think that I'm only going to use the store to buy frozen fruits and vegetables, and take more initiative to build connections with the farmers in my area. Conclusions Our results suggest that participation in gardening, nutrition, and cooking intervention produced a meaningful impact on learning. Participants established a new connection to food and nutrition and felt that they physically transformed their eating environments and acquired new habits. Funding Sources None.
Objectives Despite increasing evidence that gardening is an effective mental health intervention, the nuances of its psychological effects are not well understood. Using a mixed methods design, this study examines the potential mechanisms through which gardening may impact depression. Methods A pilot study involved community participants near Hershey, PA (N = 30), who participated in an online, group, Zoom-based 20-week gardening intervention program. Synchronous sessions provided education in the areas of gardening, nutrition, and cooking skills. Participants’ depression levels were quantified using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys at the baseline and follow up. The quantitative data were analyzed with paired t-tests. Semi-structured interviews were conducted at the end of the intervention. Data were recorded, transcribed verbatim, and a codebook was established. Data were managed in NVivo and organized into the three themes presented in this report. Results Twenty-nine participants completed PROMIS at both timepoints. The cohort had a mean age of 49.9 years, majority white (83.3%) and living in a house (86.7%). Compared to baseline, at follow up, there was a statistically significant improvement in the PROMIS depression score (50.5 v. 47.4, p = 0.02). In interviews, participants reported that learning to garden improved their happiness (“[gardening] just makes me so happy”), sense of accomplishment (“I did harvest three cucumbers, which was the first time ever in my life”), and self-worth (“everybody's like wow, where'd you get that tomato? […] that was like an excellent feeling, because I grew that tomato”). Conclusions This study highlights three potential mechanisms through which gardening may improve mental health outcomes: feelings of happiness, sense of accomplishment, and self-worth. Since unhappiness, sense of failure and worthlessness are key metrics of the PROMIS depression scale, future studies should consider the potential of gardening as a public health intervention to improve mental health outcomes. Funding Sources This study was funded by the Penn State Department of Family and Community Medicine pilot study grant program (PI: SV).
Background First implemented in the 1950s, telemedicine is a rapidly evolving tool for healthcare systems around the world. Technological advancement and increasing access to information technology have made the implementation of telemedicine more feasible. Recent provisions by healthcare governing bodies have increased reimbursement for and the use of telemedicine globally. We have done a literature review to find out the pros and cons of adopting telemedicine. Main body Telemedicine is found to offer many benefits to conventional, in-person healthcare encounters for both patients and providers: decreased travel cost and time, decreased time spent in waiting rooms, decreased risk of transmission of communicable diseases, decreased overall encounter time consumption, increased convenience, and more. Telemedicine also facilitates seamless transitions of care between healthcare teams, connects isolated people groups with healthcare providers, and helps address regional healthcare infrastructure and provider shortages by connecting patients with healthcare teams from any location. Drawbacks specific to telemedicine include the lack of accessibility and advancement of imaging technology required to replace in-person physical examinations, nonuniversal access to the required devices and networks across the general patient population, and the risk of technical difficulties such as network connection disruptions. Conclusion Telemedicine helps bridging the gap of distance by connecting patients in remote locations with the physicians. This has also become vital in the time pandemic.
INTRODUCTION Many non-small cell lung cancer (NSCLC) patients eventually develop brain metastases (BM). Reliable risk stratification with predictive algorithms can lead to early intervention. Here, we evaluated the performance of published BM risk-stratification algorithms using an independent cohort of NSCLC patients. METHODS We evaluated statistical models predicting BM in NSCLC by systematically reviewing relevant studies and testing them on an independent cohort of NSCLC patients in electronic medical records (2011-2020) from Penn State Health. Patient data was randomly split into 70% training and 30% testing for modeling using L1-regularized logistic regression, and we assessed the models' performance using ROC analyses. RESULTS Out of 1,643 publications, 22 met our criteria, and 12 of those studies (527,258 patients) included variables consistently available in patient charts. Our validation cohort included 1,699 NSCLC patients, with a median age at diagnosis of 68 and 20.4% developing BM. Among feasible models, Zhang 2021 had the highest performance in our cohort (AUROC [95% CI]: 0.89 [0.85-0.93]) and was comprised of the following predictors: age at diagnosis; surgical, chemotherapy, and radiation status; T and N stage; histological grade; and number of organs with metastases. Within our independent cohort, logistic regression revealed that the most informative predictors were the number of organs with metastases (OR [95% CI]: 3.25 [2.70, 3.92]), age at NSCLC diagnosis (OR [95% CI]: 0.98 [0.96, 0.99]), N-stage 1 at diagnosis (OR [95% CI]: 1.83 [1.08, 3.11]), and non-carcinoid or -carcinoma histology (OR [95% CI]: 0.29 [0.10, 0.84]). CONCLUSION Our robust approach, including systematic review and one of the largest-to-date independent institutional datasets, proposes a clinically feasible, novel algorithm for stratifying NSCLC patients based on risk of developing BM. This work can inform pragmatic screening and surveillance guidelines to facilitate early detection of BM in NSCLC patients.
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