Category: Statistics

Foot Ankle Surg. 2023 Jan 18:S1268-7731(23)00010-3. doi: 10.1016/j.fas.2023.01.009. Online ahead of print.

ABSTRACT

BACKGROUND: Various conservative treatment methods can be administered in the early stages of plantar fasciitis (PF). The aim of the treatment is to enable the patient to return to the physical activity as soon as possible.

AIM: In this study it was aimed to compare efficacies of Extracorporeal Shockwave Therapy (ESWT) and Low-Level Laser Therapy (LLLT) on patients with PF.

DESIGN: A local prospective cross-sectional study SETTING: Department of Physical Medicine and Rehabilitation Outpatient Clinic of Sakarya University, Faculty of Medicine POPULATION: Patients aged 18-70 years, having ongoing heel pain for at least 3 months, and not using oral and/or parenteral corticosteroids in the last 6 months.

METHODS: A total of 40 patients with PF included in the current study. Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), American Orthopedic Foot and Ankle Association Score (AOFAS) and Foot Function Index (FFI) questionnaire were performed for all patients. ESWT and LLLT groups comprised of 22 (55%) and 18 (45%) patients, respectively.

RESULTS: We found significant improvements in scores based on the VAS, RMS, AOFAS, FFI in patients with PF and it was sustained for 3 months (p = 0.001, for all scores). While decrease in scores based on the VAS and FFI in LLLT group was statistically more significant compared to ESWT group (p = 0.014, p = 0.013), there was statistically less significant decrease in scores on the AOFAS in LLLT group than that of ESWT group (p = 0.032).

CONCLUSIONS: The results of this study indicated significant improvements in terms of pain, functional status and daily life activities following the administration of either of the treatments. Furthermore, LLLT was found to be significantly more effective for alleviating pain than ESWT in the treatment of PF.

PMID:36737392 | DOI:10.1016/j.fas.2023.01.009

J Craniomaxillofac Surg. 2023 Jan 28:S1010-5182(23)00021-5. doi: 10.1016/j.jcms.2023.01.013. Online ahead of print.

ABSTRACT

The aim of this study was to assess patient satisfaction relating to inpatient stays. In this prospective observational study, adult patients with oncological (oral cancer, medication-related osteonecrosis of the jaw) and non-oncological (mandibular fracture) diagnoses, and who had undergone surgery, were contacted 4 weeks after discharge. Two validated questionnaires were used: EORTC QLQ-C30 for quality of life and IN-PATSAT32 for patient satisfaction. For quality of life, the mandibular fracture group had a lower impairment of physical functioning (M = 83.59, SD = 24.44; p = 0.029) in comparison with both other groups (M = 68.84, SD = 26.24; M = 59.33, SD = 24.43, for oral cancer and osteonecrosis, respectively). Regarding patient satisfaction, patients with oral cancer were slightly more satisfied with doctors’ availability (M = 48.91, SD = 24.11; p = 0.583) compared with the other groups (M = 36.54, SD = 19.11; M = 46.67, SD = 20.86, for mandibular fracture and ostenecrosis, respectively). Patients with an unplanned inpatient stay following an acute event tended to be less satisfied than patients with a planned inpatient stay. Within the limitations of the study it seems that knowledge of these influencing external factors and their effects can support physicians and nursing staff in providing improved patient care.

PMID:36737378 | DOI:10.1016/j.jcms.2023.01.013

Physiol Meas. 2023 Feb 3. doi: 10.1088/1361-6579/acb8fe. Online ahead of print.

ABSTRACT

OBJECTIVE: The quantitative assessment of Parkinsonian tremor, e.g., (0, 1, 2, 3, 4) according to the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, is crucial for treating Parkinson’s disease. However, the tremor amplitude constantly fluctuates due to environmental and psychological effects on the patient. In clinical practice, clinicians assess the tremor severity over a period of time, whereas manual tremor labeling relies on the clinician’s physician experience. Therefore, automatic tremor quantification based on wearable inertial sensors and machine learning algorithms is affected by the manual labels of clinicians. In this study, an automatic modification method for the labels judged by clinicians is presented to improve Parkinsonian tremor quantitation.

APPROACH: For the severe overlapping of dynamic feature range between different severities, an outlier modification algorithm (PCA-IQR) based on the combination of principal component analysis (PCA) and interquartile range (IQR) statistic rule is proposed to learn the blurred borders between different severity scores, thereby optimizing the labels. Afterward, according to the modified feature vectors, a support vector machine (SVM) with a radial basis function (RBF) kernel is proposed to classify the tremor severity. The classifier models of SVM with RBF kernel, k-nearest neighbors (KNN), and SVM with the linear kernel are compared.

MAIN RESULTS: Experimental results show that the proposed method has high classification performance and excellent model generalization ability for tremor quantitation (accuracy: 97.93%, precision: 97.96%, sensitivity: 97.93%, F1-score: 97.94%).

SIGNIFICANCE: The proposed method may not only provide valuable assistance (digital biomarkers) for clinicians to assess the tremor severity accurately, but also provides self-monitoring for patients at home and improve the assessment skills of clinicians.

PMID:36735971 | DOI:10.1088/1361-6579/acb8fe

Phys Med Biol. 2023 Feb 3. doi: 10.1088/1361-6560/acb8fc. Online ahead of print.

ABSTRACT

OBJECTIVE: Organ deformation models have the potential to improve delivery and reduce toxicity of radiotherapy, but existing data-driven motion models are based on either patient-specific or population data. We propose to combine population and patient-specific data using a Bayesian framework. Our goal is to accurately predict individual motion patterns while using fewer scans than previous models.

APPROACH: We have derived and evaluated two Bayesian deformation models. The models were applied retrospectively to the rectal wall from a cohort of prostate cancer patients. These patients had repeat CT scans evenly acquired throughout radiotherapy. Each model was used to create coverage probability matrices (CPMs). The spatial correlations between these estimated CPMs and the ground truth, derived from independent scans of the same patient, were calculated.\ Main results: Spatial correlation with ground truth were significantly higher for the Bayesian deformation models than both patient-specific and population-derived models with 1, 2 or 3 patient-specific scans as input. Statistical motion simulations indicate that this result will also hold for more than 3 scans. \ Significance: The improvement over previous models means that fewer scans per patient are needed to achieve accurate deformation predictions. The models have applications in robust radiotherapy planning and evaluation, among others.

PMID:36735964 | DOI:10.1088/1361-6560/acb8fc

Int Nurs Rev. 2023 Feb 3. doi: 10.1111/inr.12821. Online ahead of print.

ABSTRACT

AIM: To determine the effect of male nursing students’ voluntary activities on their image in society.

BACKGROUND: The role of voluntary nursing services in enhancing the visibility of nursing in society can also contribute to enhancing the image of male nurses in society.

METHODS: This study employed a one-group, quasi-experimental pre-post analysis design. It was carried out between September 2020 and June 2021 in the pedestrian zone, which is one of the main streets of Bartın in Turkey. Using a convenience sampling approach, tradesmen aged 18 and over operating in commercial enterprises (n = 81) were asked to participate in the study. Information form and Nursing Image Scale were used to collect the research data. Results from the paired sample t test were utilized to analyse the study’s data using the intervention of ‘men nursing students’ voluntary activities’.

RESULTS: The total Nursing Image Scale score of the participants was statistically considerably greater after the intervention than the pre-intervention score. Based on the paired sample t test results, it was observed that the participants obtained higher scores after the intervention than before in the gender sub-dimension as well as all other sub-dimensions of the Nursing Image Scale, and these results were statistically significant.

CONCLUSION: According to the findings of the study, volunteering by male nursing students improved both the profession of nursing and the perception of men in nursing in society.

IMPLICATIONS FOR NURSING/HEALTH POLICY: This study suggested that male nursing students’ voluntary activities could be one of the strategies to overcome the nursing shortage due to its enhancing effect on the profession of nursing and the perception of men in nursing in society.

PMID:36735939 | DOI:10.1111/inr.12821

JMIR Mhealth Uhealth. 2023 Feb 2. doi: 10.2196/44316. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have risen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied.

OBJECTIVE: The aim of the present study was to assess the impact of urban and rural residencies on engagement and clinical outcomes after a multimodal DCP for MSK pain.

METHODS: The study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area (RUCA) code, and grouped into rural and urban cohorts. Their engagement, as well as clinical outcome changes from baseline to program-end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, body mass index, employment status and pain acuity. Outcomes included engagement, self-reported pain, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was considered for pain.

RESULTS: Patients from urban and rural residencies across all the U.S. participated in the program (N= 9992). A 73.8% completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes without inter-group statistical significance, including pain, mental health and work productivity. The percentage of patients meeting the MCID was similar in both groups (urban: 67%, rural: 68.7%, P=.24).

CONCLUSIONS: This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction and completion rates were noted in both groups, as well as significant improvements in clinical outcomes.

CLINICALTRIAL: ClinicalTrials.gov NCT04092946.

PMID:36735933 | DOI:10.2196/44316

Ann Am Thorac Soc. 2023 Feb 3. doi: 10.1513/AnnalsATS.202208-738OC. Online ahead of print.

ABSTRACT

RATIONALE: Clear definition of optimal positive airway pressure therapy usage in patients with obstructive sleep apnea is not possible due to scarce data on the relationship between usage hours and major clinical outcomes.

OBJECTIVE: To investigate the dose-response relationship between positive airway pressure usage and healthcare resource utilization, and determine the minimum device usage required for benefit.

METHODS: A linked data set combined de-identified payer-sourced administrative medical/pharmacy claims data from >100 US health plans and individual patient positive airway pressure usage data. Eligible adults (age ≥18 years) had a new obstructive sleep apnea diagnosis between June 2014 and April 2018. All received positive airway pressure therapy (AirSense™ 10; ResMed) with claims data for ≥1 year before, and 2 years after, device setup. Healthcare resource utilization was determined based on the number of all-cause hospitalizations and emergency room visits over 3, 12 and 24 months after positive airway pressure initiation.

RESULTS: Data from 179,188 patients showed a clear dose-response relationship between daily positive airway pressure usage and healthcare utilization. Minimum device usage required for benefit was 1-3 h/night. There was a statistically significant decrease in hospitalizations and ER visits at all time points (all p<0.0001) with increasing PAP usage. Each additional h/night of usage decreased hospitalizations/emergency room visits by 5-10%/5-7%.

CONCLUSIONS: These data provide compelling evidence for a dose-response relationship between positive airway pressure usage and healthcare utilization, with benefits seen even when usage is as low as 1-2 h/night.

PMID:36735928 | DOI:10.1513/AnnalsATS.202208-738OC

Epidemiology. 2023 Feb 6. doi: 10.1097/EDE.0000000000001600. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid-related mortality is an important public health problem in the United States. Incidence estimates rely on death certificate data generated by health care providers and medical examiners. Opioid overdoses may be underreported when other causes of death appear plausible. We applied physician-elicited death certificate bias parameters to quantitative bias analyses assessing potential age-related differential misclassification in U.S. opioid-related mortality estimates.

METHODS: We obtained cause-of-death data (U.S., 2017) from the National Center for Health Statistics and calculated crude opioid-related outpatient death counts by age category (25-54, 55-64, 65+). We elicited beliefs from 10 primary care physicians on sensitivity of opioid-related death classification from death certificates. We summarized elicited sensitivity estimates, calculated plausible specificity values, and applied resulting parameters in a probabilistic bias analysis.

RESULTS: Physicians estimated wide sensitivity ranges for classification of opioid-related mortality by death certificates, with lower estimated sensitivities among older age groups. Probabilistic bias analyses adjusting for physician-estimated misclassification indicated 3.1 times more (95% uncertainty interval: 1.2 – 23.5) opioid-related deaths than the observed death count in the 65+ age group. All age groups had substantial increases in bias-adjusted death counts.

CONCLUSIONS: We developed and implemented a feasible method of eliciting physician expert opinion on bias parameters for sensitivity of a medical record-based death indicator and applied findings in quantitative bias analyses adjusting for differential misclassification. Our findings are consistent with the hypothesis that opioid-related mortality rates may be substantially underestimated, particularly among older adults, due to misclassification in cause-of-death data from death certificates.

PMID:36735892 | DOI:10.1097/EDE.0000000000001600

Acta Medica (Hradec Kralove). 2022;65(3):99-104. doi: 10.14712/18059694.2022.25.

ABSTRACT

OBJECTIVE: The aim of this study was to compare the visual assessment of tooth shade with the measurement using intraoral scanner (IOS) and spectrophotometer devices.

METHODOLOGY: The colour for a single unit implant supported crown was measured visually, using IOS, and spectrophotometer. The results of the digital methods were compared with the visual measurement.

RESULTS: A complete colour match with the visual measurement was in 42.9% of cases for IOS, and in 33.3% of cases for spectrophotometry. The match in the colour value, hue, and chroma were in 61.9%, 95.2%, and 66.7% of cases, respectively, for the IOS; and in 61.9%, 61.9%, and 66.7% of cases, respectively, for the spectrophotometry. The differences between the IOS and spectrophotometry were not statistically significant.

CONCLUSIONS: The most reliable method for tooth colour selection is the visual measurement by an experienced dentist. IOS and spectrophotometer can be used as an alternative method, however in both cases they should be verified using visual measurement.

PMID:36735887 | DOI:10.14712/18059694.2022.25

Acta Medica (Hradec Kralove). 2022;65(3):75-82. doi: 10.14712/18059694.2022.22.

ABSTRACT

INTRODUCTION: To date, there is not generally accepted and universal indicator of activity, and functional integrity of the small intestine in patients with coeliac disease. The aim of our study was to investigate whether serum concentrations of the non-essential amino acids citrulline and ornithine might have this function.

METHODS: We examined serum citrulline and ornithine concentrations in a subgroup of patients with proven coeliac disease and healthy controls (blood donors).

RESULTS: A total of 94 patients with coeliac disease (29 men, mean age 53 ± 18 years; 65 women, mean age 44 ± 14 years) and 35 healthy controls (blood donors) in whom coeliac disease was serologically excluded (10 men, mean age 51 ± 14 years; 25 women, mean age 46 ± 12 years) were included in the study. Significantly lower concentrations of serum ornithine were found in patients with coeliac disease (mean 65 ± 3 μmol/L; median 63 μmol/L, IQR 34 μmol/L, p < 0.001). No statistically nor clinically significant differences were found in the citrulline concentrations between the study and control group.

CONCLUSIONS: Serum ornithine (but not citrulline) may be useful for assessing the functional status of the small intestine in uncomplicated coeliac disease. Further studies involving more detailed analysis of dietary and metabolic changes in patients will be needed to reach definitive conclusions.

PMID:36735884 | DOI:10.14712/18059694.2022.22