Category: Statistics

Adv Med Educ Pract. 2023 Aug 4;14:845-857. doi: 10.2147/AMEP.S417649. eCollection 2023.

ABSTRACT

OBJECTIVE: The purpose of this study was to examine the application of faculty to stimulate the critical thinking and deep analysis of their students through instructional practice including lecture design, assessment structure, and assignment instructions.

METHODS: Faculty from multiple different health colleges at Saudi Arabia were asked to respond to survey items about the activities they use in their classrooms with regards to designing lectures, assessment structures, and instructional assignments. A correlation analysis was performed to determine if the level of applied critical thinking and deep analysis that is stimulated by faculty members were statistically related between designing lectures, assessment structure, and instructional assignments. An analysis of variance (ANOVA) was also performed to determine if there were significant differences based on the demographic characteristics of the participants and level of applied critical thinking and deep analysis.

RESULTS: A correlational analysis revealed that the mean score for designing lectures was 67.276, following by a mean score of 65.233 for instructional assignment and 64.688 for assessment structure. The result of the ANOVA showed that there was a significant difference in the perceptions of the participants between designing lectures, assessment structure, and instructional assignment (p<0.05).

CONCLUSION: The participants applied critical thinking and deep analysis when they design their lectures more than assessments and instructional assignments. They had the flexibility to stimulate critical thinking during the lecture activities. In contrast, this flexibility was limited when they were structuring the assessment as they had instructions to consider and were required to provide a rubric with unified key answer which is a mandatory requirement from the assessment department. This is due to the nature of high level of critical thinking answers that lead to high subjectivity in student responses.

PMID:37560610 | PMC:PMC10408665 | DOI:10.2147/AMEP.S417649

Surg Neurol Int. 2023 Jul 7;14:235. doi: 10.25259/SNI_409_2023. eCollection 2023.

ABSTRACT

BACKGROUND: Continuous electroencephalograms (cEEGs) are often used in the neurosurgical intensive care unit (NSICU) to detect subclinical seizures (SCSs) in patients with altered mental status (AMS). This retrospective study evaluated the efficacy of this approach for improving patient outcomes.

METHODS: We reviewed the records of 100 patients admitted to the NSICU between 2015 and 2020 who underwent continous electroencephalograms (cEEG) during workup of unexplained AMS. Patient outcomes were classified as positive (discharged), neutral (transfer of care), or negative (dead). Incidence of SCSs on cEEG and association with patient outcomes was analyzed with Chi-square analysis and relative risk (RR).

RESULTS: For the 99 included patients, median age was 62 years and 43% were female. About 15.2% had a known or newly diagnosed brain tumor. Outcomes were positive in 22 patients, neutral in four, and negative in 73. SCSs were detected in 15 patients, of whom 12 died, two were discharged, and one whose care was transferred. Chi-square association between SCS and outcome (P = 0.59) and RR of death associated with SCS diagnosis (1.1) was not significant.

CONCLUSION: We found a lower incidence of SCSs (15.2%) than reported in the literature. In the absence of clinically evident seizures, continous cEEGs performed in the NSICU to determine the etiology of AMS did not yield an improvement in patient outcomes, and patients diagnosed and treated for SCS did not have statistically decreased risk of death. In summary, electroencephalogram monitoring for SCS is important but should not delay diagnosis and treatment of other, potentially life-threating etiologies of AMS.

PMID:37560585 | PMC:PMC10408650 | DOI:10.25259/SNI_409_2023

Interdiscip Perspect Infect Dis. 2023 Aug 1;2023:1035113. doi: 10.1155/2023/1035113. eCollection 2023.

ABSTRACT

BACKGROUND: Bacterial urinary tract infections are important public health problems in children. This study was conducted to identify the bacterial agents of urinary tract infections and antibiogram patterns in children.

METHODS: A hospital-based cross-sectional study including 220 children was carried out between November 15, 2021, and March 10, 2022. Simple random sampling was used to enroll participants. The sociodemographic and clinically pertinent information was gathered using a semi-structured questionnaire. Every participant in the study who was ≤15 years old gave clean-catch midstream urine. Urine samples were inoculated onto a cystine lactose electrolyte-deficient agar using a calibrated inoculating loop with a 0.001 ml capacity and then incubated aerobically for 24 hours at 37°C. Subculturing for significant bacteriuria was done on MacConkey and blood agar. Gram staining, biochemical assays, and colony characteristics were used for bacterial identification. The disc diffusion method developed by Kirby and Bauer was used for antimicrobial susceptibility testing. SPSS software version 25 was used for data entry and analysis. To find the risk factors, bivariate and multivariate logistic regression analyses were performed. An association was deemed statistically significant if the p value at the 95 percent confidence interval was less than 0.05.

RESULTS: In this study, the majority (50.5%) of the study participants were males. The mean age of the study participants was 6 ± 0.91 years. It was found that 31.8% of children had urinary tract infections. The most prevalent urinary pathogens among the isolates were E. coli (27.1%) and S. aureus (18.6%). Approximately 56% of the participants were infected with multidrug-resistant pathogens. Additionally, compared to children who have never had a urinary tract infection, children with a history of infection had 1.04 (95 percent confidence interval (CI): 0.39, 2.75) times higher risk of infection.

CONCLUSION: This study has shown an alarming increase in the prevalence of pediatric urinary tract infections which warrants further investigation into multidrug-resistant bacterial infection.

PMID:37560543 | PMC:PMC10409584 | DOI:10.1155/2023/1035113

Circ J. 2023 Aug 9. doi: 10.1253/circj.CJ-23-0318. Online ahead of print.

ABSTRACT

BACKGROUND: The HELT-E₂S₂score, which assigns 1 point to Hypertension, Elderly aged 75-84 years, Low body mass index <18.5 kg/m², and Type of atrial fibrillation (AF: persistent/permanent), and 2 points to Extreme Elderly aged ≥85 years and previous Stroke, has been proposed as a new risk stratification for strokes in Japanese AF patients, but has not yet undergone external validation.Methods and Results: We evaluated the prognostic performance of the HELT-E₂S₂score for stroke risk stratification using 2 large-scale registries in Japanese AF patients (n=7,020). During 23,241 person-years of follow-up (mean follow-up 1,208±450 days), 287 ischemic stroke events occurred. The C-statistic using the HELT-E₂S₂score was 0.661 (95% confidence interval [CI], 0.629-0.692), which was numerically higher than with the CHADS₂score (0.644, 95% CI 0.613-0.675; P=0.15 vs. HELT-E₂S₂) or CHA₂DS₂-VASc score (0.650, 95% CI, 0.619-0.680; P=0.37 vs. HELT-E₂S₂). In the SAKURA AF Registry, the C-statistic of the HELT-E₂S₂score was consistently higher than the CHADS₂and CHA₂DS₂-VASc scores across all 3 types of facilities comprising university hospitals, general hospitals, and clinics. However, in the RAFFINE Study, its superiority was only observed in general hospitals.

CONCLUSIONS: The HELT-E₂S₂score demonstrated potential value for risk stratification, particularly in a super-aged society such as Japan. However, its superiority over the CHADS₂or CHA₂DS₂-VASc scores may vary across different hospital settings.

PMID:37558457 | DOI:10.1253/circj.CJ-23-0318

BMJ Open. 2023 Aug 9;13(8):e069308. doi: 10.1136/bmjopen-2022-069308.

ABSTRACT

INTRODUCTION: Armed conflicts have significant negative impacts on the entire healthcare system in general and HIV care system in particular. Sub-Saharan Africa is suffering from a disproportionate double burden of armed conflict and HIV infection. Nevertheless, the impact of the armed conflict on the HIV treatment outcomes in conflict settings in sub-Saharan Africa has not been thoroughly and systematically synthesised. This protocol outlines a review that aims to summarise the available evidence on the impact of armed conflict on HIV treatment outcomes in sub-Saharan Africa.

METHODS AND ANALYSIS: A systematic review of all quantitative studies that assess the impact of armed conflicts on HIV treatment outcomes will be conducted. The systematic search will start with a preliminary search of Google Scholar, followed by implementation of the full search strategy across five databases (MEDLINE, PubMed, CINAHL, SCOPUS and Web of Science) and the screening of titles and abstracts then relevant full texts. Bibliographies will be reviewed to identify additional relevant studies. We will include studies conducted in sub-Saharan Africa that were published in English between 1 January 2002 and 31 December 2022. Methodological validity of the included studies will be assessed using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument. Data will be extracted using standardised JBI instruments and analysed through narrative synthesis, and meta-analyses and regression. Heterogeneity will be assessed using I² and Χ² tests.

ETHICS AND DISSEMINATION: Since this study will not involve gathering primary data, formal ethical approval is not required. Journal publications, conference presentations and a media release will be used to share the study findings.

PROSPERO REGISTRATION NUMBER: CRD42022361924.

PMID:37558447 | DOI:10.1136/bmjopen-2022-069308

BMJ Open. 2023 Aug 9;13(8):e066644. doi: 10.1136/bmjopen-2022-066644.

ABSTRACT

INTRODUCTION: Indian Council of Medical Research (ICMR), New Delhi has established a nationwide registry ‘Indian Registry for Venous Thromoembolism Disorder (i-RegVeD)’ for real-time analytics of sociodemographic profile of patients, disease patterns, management strategies, treatment choices and outcomes of patients with venous thromboemobolism (VTE). The purpose is to generate evidence on VTE in order to fill the gaps in the knowledge of the disease across various demographic regions.

METHODS AND ANALYSIS: This prospective hospital-based registry will be a continuous data collection process on the occurrence and characteristics of VTE from the 16 hospital sites pan India. This process would include obtaining clinical profiles, risk factors, diagnostic tests, treatment and outcome information of patients collected from medical records through an active method of data abstraction and data capture mechanism guided by an online web-based tool.

ETHICS AND DISSEMINATION: At centralised programme management unit, the study protocol was approved by the Institutional Ethics Committees (IEC) named ICMR-Central Ethics Committee on Human Research and similarly each of the participating site has obtained the ethical approval by their respective IECs. The results from this study will be disseminated publicly on the study website (https://iregved.icmr.org.in) as well as through scientific meetings and publications.

PMID:37558443 | DOI:10.1136/bmjopen-2022-066644

BMJ Open. 2023 Aug 9;13(8):e071971. doi: 10.1136/bmjopen-2023-071971.

ABSTRACT

OBJECTIVE: The study assessed COVID-19 era-related e-learning cyberchondria, internet addiction and anxiety-related symptomatology among nursing students. The relationships, predictors and differences between the studied concepts were measured.

DESIGN: In 2021, a quantitative cross-sectional research design using a web survey with a sample size of 333 nursing students yielded a response rate of 70%.

RESULTS: Nursing students had a moderate level of cyberchondria, low to moderate internet addiction, a moderate to severe level of anxiety and depression, and a normal stress level. Demographic characteristics, cyberchondria, internet addiction and anxiety-related symptomatology were significantly correlated. Grade point average, age, type of organisation where the students were trained and level of education were significant predictors of the studied variables. Significant differences in the studied concepts were found based on the sample’s characteristics such as gender, type of organisations or universities where the students were trained or studied, and age.

CONCLUSION: Cyberchondria, internet addiction, depression, anxiety and stress symptomatology are troublesome. Higher education organisations might benefit from examining the variables of interest and investigating the relations between internet addiction and depression and anxiety symptomatology among nursing students. Such research will aid in tailoring treatments to assist vulnerable students by targeting counselling and educational efforts toward building a future generation of nurses with reduced cyberchondria, internet addiction and anxiety-related symptomatology.

PMID:37558438 | DOI:10.1136/bmjopen-2023-071971

BMJ Open. 2023 Aug 9;13(8):e074256. doi: 10.1136/bmjopen-2023-074256.

ABSTRACT

INTRODUCTION: Heart failure (HF) as a long-term clinical syndrome is associated with inadequate self-care behaviours, a feeling of uncertainty and frequent hospitalisation. In recent years, empowerment has evolved for improving chronic disease management. Nevertheless, there is a lack of studies investigating remote care interventions such as a tele-empowerment programme in patients with HF. Therefore, this protocol proposes a randomised controlled trial which aims to evaluate the effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission in patients with HF.

METHODS AND ANALYSIS: The study is a double-arm and parallel-group randomised controlled trial in which a 10-week intervention, including 6 weeks of a comprehensive tele-empowerment programme and 4 weeks of follow-up, will be compared with usual care. A total of 96 eligible patients with HF will be recruited and randomly assigned to the intervention or control group. The patients in the intervention group will join virtual groups and receive the five-step tele-empowerment programme through the internet. The primary outcomes include self-care behaviours and uncertainty which will be measured with valid instruments at baseline and 10th week. The secondary outcome is the number of patients’ hospital readmissions and will be assessed at the end of the study. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests including two-sample t-tests, Χ², analysis of covariance or linear regression will be performed. In addition, standardised intervention effect sizes will be calculated for each outcome.

ETHICS AND DISSEMINATION: The trial has been approved by the Research Ethics Committee of School of Nursing and Midwifery & Rehabilitation at Tehran University of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: Iranian Registry of Clinical Trials (IRCT20100725004443N30).

PMID:37558436 | DOI:10.1136/bmjopen-2023-074256

Heart. 2023 Aug 9:heartjnl-2023-322830. doi: 10.1136/heartjnl-2023-322830. Online ahead of print.

ABSTRACT

OBJECTIVE: The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision.

METHODS: New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score).

FINDINGS: In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell’s c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified.

CONCLUSION: We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.

PMID:37558394 | DOI:10.1136/heartjnl-2023-322830

Lancet Planet Health. 2023 Aug;7(8):e694-e705. doi: 10.1016/S2542-5196(23)00143-2.

ABSTRACT

BACKGROUND: The global spatiotemporal pattern of mortality risk and burden attributable to tropical cyclones is unclear. We aimed to evaluate the global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019.

METHODS: The wind speed associated with cyclones from 1980 to 2019 was estimated globally through a parametric wind field model at a grid resolution of 0·5° × 0·5°. A total of 341 locations with daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day (a day with maximum sustained wind speed associated with cyclones ≥17·5 m/s) during the study period were included. A conditional quasi-Poisson regression with distributed lag non-linear model was applied to assess the tropical cyclone-mortality association. A meta-regression model was fitted to evaluate potential contributing factors and estimate grid cell-specific tropical cyclone effects.

FINDINGS: Tropical cyclone exposure was associated with an overall 6% (95% CI 4-8) increase in mortality in the first 2 weeks following exposure. Globally, an estimate of 97 430 excess deaths (95% empirical CI [eCI] 71 651-126 438) per decade were observed over the 2 weeks following exposure to tropical cyclones, accounting for 20·7 (95% eCI 15·2-26·9) excess deaths per 100 000 residents (excess death rate) and 3·3 (95% eCI 2·4-4·3) excess deaths per 1000 deaths (excess death ratio) over 1980-2019. The mortality burden exhibited substantial temporal and spatial variation. East Asia and south Asia had the highest number of excess deaths during 1980-2019: 28 744 (95% eCI 16 863-42 188) and 27 267 (21 157-34 058) excess deaths per decade, respectively. In contrast, the regions with the highest excess death ratios and rates were southeast Asia and Latin America and the Caribbean. From 1980-99 to 2000-19, marked increases in tropical cyclone-related excess death numbers were observed globally, especially for Latin America and the Caribbean and south Asia. Grid cell-level and country-level results revealed further heterogeneous spatiotemporal patterns such as the high and increasing tropical cyclone-related mortality burden in Caribbean countries or regions.

INTERPRETATION: Globally, short-term exposure to tropical cyclones was associated with a significant mortality burden, with highly heterogeneous spatiotemporal patterns. In-depth exploration of tropical cyclone epidemiology for those countries and regions estimated to have the highest and increasing tropical cyclone-related mortality burdens is urgently needed to help inform the development of targeted actions against the increasing adverse health impacts of tropical cyclones under a changing climate.

FUNDING: Australian Research Council and Australian National Health and Medical Research Council.

PMID:37558350 | DOI:10.1016/S2542-5196(23)00143-2