Category: Statistics

Ann Afr Med. 2024 Oct 23. doi: 10.4103/aam.aam_145_21. Online ahead of print.

ABSTRACT

OBJECTIVES: The novel SARS-CoV-2 outbreak disrupted businesses globally and created fears in the general public and among health-care professionals. Almost universally, considerations about the coronavirus pandemic and its effects became priority in the daily operations of businesses, leaving hitherto pressing concerns in the back stage. Early in the pandemic, the management of University of Benin Teaching Hospital set up a Business Continuity Team which undertook an evaluation of the perceptions of mid-level hospital managers about their departments’ and units’ risks and vulnerabilities in the face of the ongoing pandemic.

METHODS: A modified International Labour Organization (ILO) risk profile self-assessment tool which focused on “people,” “processes,” “profits,” and “partnerships” was used to assess mid-level managers’ perceptions of their respective departments’ and units’ risks and vulnerabilities, consequent on the COVID-19 pandemic. Responses were obtained from heads of departments and units using an online survey. Final scores were divided into terciles (three equal groups) in respect of perceived risks and adverse outcomes of the COVID-19 pandemic. Scores in the lower tercile were grouped as low risk/vulnerability, the middle group of scores as medium risk/vulnerability, and scores in the upper tercile as high risk/vulnerability.

RESULTS: Responses were obtained from 35 (49.3%) of the 71 clinical and nonclinical departments and units in the hospital. Fifteen of these (42.9%) were clinical. Nineteen (54.2%) departments were assessed to be at high risk/vulnerability, 9 (47.4%) of which were clinical. Twelve (34.3%) departments were assessed to be at medium risk/vulnerability – 4 (33.3%) of them, clinical. No department was assessed to be at low risk. The highest risk ratings were in the domains of “profits” and “partnerships:” 54 (84.4%) mid-level managers assessed their departments and units to be at high risk of the negative impacts of the coronavirus pandemic with respect to “profits” and 51 (79.7%) with respect to “partnerships.”

CONCLUSION: Mid-level managers in clinical and nonclinical departments and units assessed their departments and units to be at medium and high risk of the negative impacts of the COVID-19 pandemic, using the ILO’s modified tool. Our findings enabled the management of the hospital and the Business Continuity Team to address the specific areas of concerns that were highlighted, develop contingency plans, and frame risk communication during the pandemic, with a view to fostering increased sense of safety in the workforce. This approach to risk assessment is repeatable, and we recommended it to other hospitals in Africa.

PMID:39440533 | DOI:10.4103/aam.aam_145_21

Ann Afr Med. 2024 Oct 23. doi: 10.4103/aam.aam_160_23. Online ahead of print.

ABSTRACT

BACKGROUND: Inguinal hernia repair is a common surgical procedure, with laparoscopic techniques offering advantages over open surgery. The extended Totally Extraperitoneal (eTEP) technique provides a larger working space compared to the traditional Totally Extraperitoneal (TEP) approach, potentially improving outcomes.

MATERIAL AND METHODS: A prospective study was conducted comparing eTEP and TEP techniques for inguinal hernia repair at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. Forty patients (20 in each group) aged 15-65 with uncomplicated inguinal hernias were included. Surgical procedures were performed based on patient preference. Data on surgical duration, pain scores, hospital stay, and complications were collected and analyzed using statistical methods.

RESULTS: eTEP surgery had a significantly shorter mean duration (48.70 ± 7.505 minutes) compared to TEP surgery (74.20 ± 7.78 minutes; P = 0.00). Patients undergoing eTEP experienced lower mean pain scores (3.75 ± 0.55) compared to those undergoing TEP (5.15 ± 0.745; P = 0.00). Hospital stay following eTEP surgery was shorter (1.70 ± 0.657 days) than following TEP surgery (3.65 ± 1.137 days; P = 0.00). eTEP had lower incidences of hematoma and surgical emphysema but higher seroma complications. TEP surgeries were associated with more post-operative complications and a higher likelihood of requiring conversion to open surgery.

DISCUSSION: The eTEP technique offers several advantages over TEP, including shorter surgical duration, less post-operative pain, and shorter hospital stays. However, TEP had more complications related to seroma. Individual patient factors and surgeon experience should guide the choice of technique.

CONCLUSION: The eTEP technique appears to be a promising option for inguinal hernia repair, offering advantages over TEP in terms of surgical outcomes. However, further studies are needed to evaluate long-term outcomes and complication rates comprehensively.

PMID:39440530 | DOI:10.4103/aam.aam_160_23

Epidemiol Infect. 2024 Oct 23;152:e131. doi: 10.1017/S0950268824001365.

ABSTRACT

Inappropriate antibiotic use is a key driver of antibiotic resistance and one that can be mitigated through stewardship. A better understanding of current prescribing practices is needed to develop successful stewardship efforts. This study aims to identify factors that are associated with human cases of enteric illness receiving an antibiotic prescription. Cases of laboratory-confirmed enteric illness reported to the FoodNet Canada surveillance system between 2015 and 2019 were the subjects of this study. Laboratory data were combined with self-reported data collected from an enhanced case questionnaire that included demographic data, illness duration and symptoms, and antibiotic prescribing. The data were used to build univariable logistic regression models and a multivariable logistic regression model to explore what factors were associated with a case receiving an antibiotic prescription. The final multivariable model identified several factors as being significantly associated with cases being prescribed an antibiotic. Some of the identified associations indicate that current antibiotic prescribing practices include a substantial level of inappropriate use. This study provides evidence that antibiotic stewardship initiatives targeting infectious diarrhoea are needed to optimize antibiotic use and combat the rise of antibiotic resistance.

PMID:39440529 | DOI:10.1017/S0950268824001365

Adv Sci (Weinh). 2024 Oct 23:e2410041. doi: 10.1002/advs.202410041. Online ahead of print.

ABSTRACT

The application of quantum-dot light-emitting diodes (QLEDs) is hindered by efficiency roll-off at high current densities. Factors contributing to this roll-off include Auger recombination, electric field-induced quenching, Joule heating, and electron leakage into the hole transport layer. However, a method to quantitatively attribute the contribution of each factor to roll-off has not yet been available, leaving the primary cause of roll-off unidentified. This work addresses this gap using electrically pumped transient absorption spectroscopy, which measures the accumulated electrons and electric field in quantum dots (QDs). This study also introduces a method to quantify electron leakage in QLEDs using this spectroscopic technique. Based on the spectroscopic experimental results, the contribution of each factor to roll-off is quantified. A green QLED with a peak external quantum efficiency (EQE) of 26.8% is studied as an example. The EQE declines to 20.5% at a current density of 354 mA cm^-2, where field-induced quenching accounts for 5% of the efficiency roll-off, and electron leakage contributes 95%. Contributions from Auger recombination and heat-induced quenching are negligible. This work demonstrates strong correlations between roll-off and electron leakage amplitude using statistical data obtained in multiple QLEDs, confirming that electron leakage is the primary factor in EQE roll-off.

PMID:39440522 | DOI:10.1002/advs.202410041

Infect Control Hosp Epidemiol. 2024 Oct 23:1-5. doi: 10.1017/ice.2024.157. Online ahead of print.

ABSTRACT

OBJECTIVE: Assess healthcare workers’ (HCW) attitudes toward universal masking, and gowns and gloves used as part of transmission-based precautions.

DESIGN: Cross-sectional survey.

SETTING: Academic, tertiary care medical center in Baltimore, Maryland.

PARTICIPANTS: HCW who work in patient care areas and have contact with patients.

METHODS: In May 2023, a 15-question web-based survey was distributed by the hospital’s communications team via email. The survey contained questions to assess HCW perceptions of universal masking policies prior to the availability of COVID-19 vaccines and at the time of the survey, and the use of gowns and gloves for transmission-based precautions. Descriptive statistics were used to summarize data. Differences in agreement with universal masking over time, level of agreement with gown and glove policies, and with all PPE types across respondent characteristics were assessed.

RESULTS: 257 eligible respondents completed the survey. Nurses and patient care technicians (43%) and providers (17%) were the most commonly reported roles. Agreement with universal mask use decreased from 84% early in the pandemic to 55% at the time of the survey. 70% and 72% of HCW agreed masks protect themselves and others, respectively. 63% expressed any level of annoyance with mask wearing, the most often due to communication challenges or physical discomfort. 75% agreed with gown use for antibiotic-resistant bacteria compared with 90% for glove use.

CONCLUSIONS: The majority of HCW agree with the use of PPE to prevent pathogen transmission in the healthcare setting. Agreement with universal mask use for patient care shifted during the COVID-19 pandemic.

PMID:39440514 | DOI:10.1017/ice.2024.157

Acta Orthop Belg. 2024 Jun;90(2):335-342. doi: 10.52628/90.2.11791.

ABSTRACT

Main reasons for prolonged hospital stay after total knee arthroplasty (TKA) are postoperative nausea and vomiting (PONV) and pain. Having a positive effect on both PONV and pain, perioperative administration of corticosteroids might improve rehabilitation and reduce length of hospital stay (LOS) after TKA. Aim of this review is to determine the effect of different corticosteroid dosages on PONV, pain, and LOS in TKA. A systematic search for articles comparing dosage effects of corticosteroids regarding PONV, pain, and LOS after primary unilateral TKA was conducted using EMBASE, PubMed publisher, MEDLINE, Cochrane, Google scholar, and Web-of-Science for articles published from inception to March 17, 2022. 16 studies were included involving 2352 TKA procedures. Most studies showed reduced pain scores in corticosteroid groups and some described better pain reduction in high-dose groups. All studies showed reduced PONV in the corticosteroid groups. LOS was similar in most studies comparing placebo and perioperative corticosteroids. Only one study reported increased infection rates and intramuscular venous thrombosis in the corticosteroid group. Concluding, current literature on corticosteroids use in TKA is highly variable in type, dosage, and timing of administering medication. Overall, corticosteroids mostly reduce pain and PONV with limited effects on LOS after TKA. Only minimal statistically significant and clinically relevant benefits were found in perioperative high-dose corticosteroids compared to low-dose. Given the short follow-up in most studies, it is not possible to evaluate safety of high-dose corticosteroids.

PMID:39440510 | DOI:10.52628/90.2.11791

Acta Orthop Belg. 2024 Jun;90(2):293-302. doi: 10.52628/90.2.10403.

ABSTRACT

INTRODUCTION: In 2019, the French College of Orthopaedic and Traumatology (CFCOT) made the AOTrauma course entitled “Basic Principles of Fracture Treatment” mandatory for all orthopaedic residents during the first year of their educational program i.e. during the SOCLE phase (common base phase). The objective of the evaluation was to determine which factors influenced the results of the practical work, according to the characteristics of the students and their experiences in laparoscopy or in arthroscopy in the operating theatre or on the simulator for arthroscopy.

MATERIAL AND METHODS: In 2019 a total of 121 residents were included, corresponding to the full promotion. They filled out a preliminary questionnaire giving information on their general characteristics. Eight different workshops were evaluated. The grading of skills was as follows: “A” for “acquired”, “B” for “in progress” and “C” for “not acquired”. The data was collected on a computerized spreadsheet. The statistical analysis used the Welch test, the Chi2 test and the Fisher test.

RESULTS: The average “A” percentage across all workshops was 87.8%. Factors predictive of a good result were experience in laparoscopy as the main operator (p = 0.014) and male sex (p = 0.014). We observed that the residents who had not performed arthroscopy in clinical practice had done more training on simulators than the others (p = 0.044). Residents who had performed at least one arthroscopy as a main operator were predominantly female (p < 0.001).

DISCUSSION: The interest of this study lies in the novelty of the analysis of the results of a whole promotion of residents in the SOCLE phase in osteosynthesis simulation.

CONCLUSION: This novel evaluation deserves to be repeated by refining the evaluation tools before and during the course. It allowed us to know the weak points of the students during the simulated learning.

PMID:39440506 | DOI:10.52628/90.2.10403

Acta Orthop Belg. 2024 Jun;90(2):279-285. doi: 10.52628/90.2.9907.

ABSTRACT

This current study compares the clinical and radiological outcomes of femoral neck fractures in young adults treated with either cannulated screws (CS) or proximal femoral locking plates (PFLP). We conducted a retrospective study in patients aged 18 to 60 years with femoral neck fractures and investigated medical records between January 2005 and December 2016. Patients were divided into two groups based on implants, screw and plate, used for fixation assigned. In addition, two groups were compared for their complications and functional outcomes, which were assessed with Harris Hip Score (HHS) and Parker Palmer mobility scores. Sixty-nine of 104 patients met the inclusion criteria. Forty patients were treated with cannulated screws, while 29 were treated with a proximal femoral locking plate. The two groups were comparable in terms of their perioperative variables. The overall complication rate (screw group, n = 10; plate group, n = 14) and non-union rate were significantly high in the plate group (p < 0.05). Other complications did not show statistically significant differences. The screw group had better functional outcomes than the plate group, where only the Parker-Palmer mobility score comparison was significant (p < 0.05). Poor reduction quality and Pauwels’ type III fractures were statistically associated with high complication rates regardless of the implants used (p < 0.05). Although PFLP showed better outcomes in biomechanical studies than CSs, we observed poorer clinical results. Therefore, although some of our results appeared to be statistically significant, reduction quality should also be considered.

PMID:39440504 | DOI:10.52628/90.2.9907

Acta Orthop Belg. 2024 Jun;90(2):271-277. doi: 10.52628/90.2.11928.

ABSTRACT

The purpose of the current study is to determine which variables influence the onset of chronic regional pain syndrome (CRPS) following Sanders type 1 calcaneal fractures, which are treated conservatively, and to discover how Vitamin C (VC) supplementation, which is often mentioned in the literature, affects the outcomes of these fractures. The study incorporated individuals who had a Sanders type 1 fracture that was both closed and non-displaced and were treated with conventional plaster. The current study retrospectively reviewed medical records to gather demographic data, duration of immobilization, smoking habits, administration of VC supplementation, and presence of diabetes mellitus (DM). The Budapest criteria were employed to make the clinical diagnosis of CRPS. The study cohort comprised 258 (75.9%) males and 82 (24.1%) females aged between 18 and 90 years who had sustained Sanders type 1 calcaneal fractures and were managed non-operatively. CRPS was detected in 42 (12.4%) of the 340 subjects. CRPS patients had a statistically higher immobilization duration than those without CRPS (p<0.05). Smoking and DM were more common among patients with CRPS (p<0.05) and CRPS patients had a much lower rate of VC consumption (4.8%) (p<0.05). The current study is the first to examine risk variables for CRPS after calcaneal fractures. Long periods of immobility, female gender, and lack of VC supplementation increase the risk of CRPS. CRPS also increases with diabetes and smoking.

PMID:39440503 | DOI:10.52628/90.2.11928

Acta Orthop Belg. 2024 Jun;90(2):261-269. doi: 10.52628/90.2.12271.

ABSTRACT

Osteotomies to correct hallux valgus are usually secured using metal implants. Their main disadvantage is the need for a repeat surgery for removal of implanted material. Bioresorbable implants would make it possible to overcome this complication. Few studies analyse the results of using bioresorbable pins. The primary objective of this study is to compare hallux valgus correction radiographic results with the use of two types of bioresorbable pins. The secondary objectives are to screen for possible complications related to the use of these bioresorbable pins. This is a descriptive, retrospective, single-centre study carried out between May 2018 and May 2022 in the orthopaedic surgery department of the Centre Chirurgical Emile Gallé at the CHRU in Nancy (France). The study involved 105 hallux valgus (98 patients) operated on by open double metatarsal and phalangeal osteotomy. Osteotomies were stabilised with resorbable polylactic acid (PLLA) pins (Arthrex® TRIM-IT® drill pin) in 57 cases (53 patients), and with resorbable polylactic acid-polyglycolic acid copolymer (PGLA) pins (Bioretec® ActivaPins®) in 48 cases (45 patients). The efficacy of hallux valgus correction was analysed in terms of changes in preoperative and postoperative radiographic parameters at 1 and 6 months on a weight-bearing foot. Descriptive statistics were used to describe the demographic and radiological parameters of each group. The mean age was 59.7 years (range 25-81 years) in the PLLA group and 56 years (range 23-78 years) in the PGLA group. The mean preoperative HVA was 30° (range 15-63°) in the PLLA group and 30.8° (range 15-57°) in the PGLA group. The mean preoperative IMA was 14.4° (range 7-30°) in the PLLA group and 13.8° (range 7-20°) in the PGLA group. There was a statistically significant correction of hallux valgus in the PLLA (p=5.24 X 10-15 ) and PGLA (p=3.56 X 10-13 ) groups. The mean correction for the hallux valgus angle was 13° in the PLLA group and 12° in the PGLA group. There was no statistically significant difference in hallux valgus correction between the PLLA and PGLA groups, particularly in terms of hallux valgus severity. There was no radiological or clinical complication in the groups related to bioresorbable pins. The use of bioresorbable pins allows effective stabilisation of osteotomies to correct hallux valgus. There was no significant difference in correction between PLLA and PGLA implants, regardless of the severity of the hallux valgus. We did not observe any obvious clinical or radiological complications related to their use. The use of bioresorbable osteosynthesis material in forefoot surgery seems to offer interesting advantages, providing patients with safer and less invasive treatment solutions.

PMID:39440502 | DOI:10.52628/90.2.12271