Category: Statistics

JAMA. 2024 Dec 16. doi: 10.1001/jama.2024.22975. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients of physicians with higher adenoma detection rates (ADRs) during colonoscopy have lower colorectal cancer (CRC) risk after screening colonoscopy (ie, postcolonoscopy CRC). Among physicians with an ADR above the recommended threshold, it is unknown whether improving ADR is associated with a lower incidence of CRC in their patients.

OBJECTIVE: To determine the association of improved ADR in physicians with a range of ADR values at baseline with CRC incidence among their patients.

DESIGN, SETTING, AND PARTICIPANTS: A total of 789 physicians in the Polish Colonoscopy Screening Program were studied between 2000 and 2017, with final follow-up on December 31, 2022. Joinpoint regression analyses were used to identify trends between changes in ADR and postcolonoscopy CRC incidence. Rates of CRC after colonoscopy were compared between physicians whose ADR improved and those without improvement. ADR improvement was defined as either an improvement by at least 1 ADR sextile category or remaining in the highest category.

EXPOSURE: Physician ADR.

MAIN OUTCOMES AND MEASURES: Association of improved ADR with postcolonoscopy CRC incidence.

RESULTS: Of 485 615 patients (mean [SD] age, 57 [5.41] years; 60% female), 1873 CRC diagnoses and 474 CRC-related deaths occurred during a median follow-up of 10.2 years. Among individual physicians at baseline, median (IQR) ADR was 21.8% (15.9%-28.2%) and maximum ADR was 63.0%. Joinpoint regression showed a change in CRC incidence trends at an ADR level of 26%, corresponding to a CRC incidence of 27.1 per 100 000 person-years. Patients of physicians whose ADR was less than 26% at baseline and improved during follow-up had a postcolonoscopy CRC incidence of 31.8 (95% CI, 29.5-34.3) per 100 000 person-years, compared with 40.7 (95% CI, 37.8-43.8) per 100 000 person-years for patients of physicians with an ADR of less than 26% at baseline who did not improve during follow-up (difference, 8.9/100 000 person-years [95% CI, 5.06-12.74]; P < .001). Patients of physicians whose ADR was above 26% at baseline and improved during follow-up had a postcolonoscopy CRC incidence of 23.4 (95% CI, 18.4-29.8) per 100 000 person-years, compared with 22.5 (95% CI, 18.3-27.6) for patients of physicians whose ADR was above 26% at baseline and did not improve during follow-up (difference, 0.9/100 000 person-years [95% CI, -6.46 to 8.26]; P = .80).

CONCLUSIONS AND RELEVANCE: In this observational study, improved ADR over time was statistically significantly associated with lower CRC risk in patients who underwent colonoscopy compared with absence of ADR improvement, but only among patients whose physician had a baseline ADR of less than 26%.

PMID:39680377 | DOI:10.1001/jama.2024.22975

J Vet Med Educ. 2024 Dec 16:e20240065. doi: 10.3138/jvme-2024-0065. Online ahead of print.

ABSTRACT

Remediation of preclinical course failures in the DVM program at Purdue University College of Veterinary Medicine began in 2010. We set out to understand whether some students were more likely than others to use remediation opportunities and succeed. Student demographics, undergraduate (UG) experiences, including institution attended and major studied, UG performance as measured by grade point average (uGPA), and extent of academic difficulties in DVM years 1-3 were studied at univariate levels to determine which students more often failed ≥1 courses, remediated ≥1 courses, and were successful in all remediation attempts. Among 815 students in DVM Classes 2014-2023, 157 failed ≥1 courses. Risk factors associated with failing ≥1 courses and with unsuccessful remediation were identified using multiple logistic regression analysis. Unsuccessful remediation, resulting in student’s academic attrition, was defined as not succeeding at remediation of all failed courses, including being ineligible for or not attempting remediation. Risk factors were considered statistically significant at P value <0.05. Lower uGPA, having attended a minority-serving institution, and being an underrepresented minority or an international student were associated with increased likelihood of failing ≥1 courses. However, the only factors associated with unsuccessful remediation were failing ≥3 courses in DVM years 1-3 and failing at least one course in DVM year 1. No demographic or UG educational background is associated with unsuccessful remediation. Taken together, our models suggest that being at risk of failing ≥1 courses in DVM years 1-3 did not inevitably put students at risk of attrition when remediation opportunities were provided. However, an increasing number of course failures and failures beginning in DVM year 1 increased the risk of unsuccessful remediation. Early intervention to minimize academic difficulties in DVM program may mitigate risk of student attrition.

PMID:39680375 | DOI:10.3138/jvme-2024-0065

J Neurooncol. 2024 Dec 16. doi: 10.1007/s11060-024-04888-9. Online ahead of print.

ABSTRACT

PURPOSE: Few studies have evaluated the health-related quality of life (HRQoL) of patients with diffuse low-grade glioma (LGG) during a clinical and radiological monitoring period. We report a cross sectional cohort study of HRQoL in patients with LGG and compare the results with normative population data. We then explore factors associated with HRQoL.

METHODS: We used the European Organisation for Research and Treatment of Cancer QLQ-C30, BN-20 and the Hospital Anxiety and Depression Scale (HADS) to evaluate HRQoL. Averaged QLQC30 and HADS scores were compared with scores of a normative population. A general linear model multivariate analysis of variance was used to investigate the association between HRQoL and independent factors.

RESULTS: A total of 62 patients with LGG completed HRQoL questionnaires. Compared with a normative population, LGG patients reported statistical and clinically significant lower cognitive, emotional, role and social functioning. Fatigue, anxiety, depression and sleep disturbances were frequently reported. Awake surgery and preserved high Karnofsky Performance Status were found to be independent prognostic factors for better global HRQoL, while radiotherapy was associated with worsened HRQoL.

CONCLUSION: Despite a non-therapeutic and progression free phase, LGG patients report noticeable limitations in several HRQoL subscales. Our study highlights the importance of HRQoL assessment not only at diagnosis or during active therapeutic stage. Further studies are needed to develop better adapted tools of HRQoL assessment.

PMID:39680337 | DOI:10.1007/s11060-024-04888-9

Radiol Phys Technol. 2024 Dec 16. doi: 10.1007/s12194-024-00871-1. Online ahead of print.

ABSTRACT

This study investigated the effectiveness of augmenting datasets for super-resolution processing of brain Magnetic Resonance Images (MRI) T1-weighted images (T1WIs) using deep learning. By incorporating images with different contrasts from the same subject, this study sought to improve network performance and assess its impact on image quality metrics, such as peak signal-to-noise ratio (PSNR) and structural similarity (SSIM). This retrospective study included 240 patients who underwent brain MRI. Two types of datasets were created: the Pure-Dataset group comprising T1WIs and the Mixed-Dataset group comprising T1WIs, T2-weighted images, and fluid-attenuated inversion recovery images. A U-Net-based network and an Enhanced Deep Super-Resolution network (EDSR) were trained on these datasets. Objective image quality analysis was performed using PSNR and SSIM. Statistical analyses, including paired t test and Pearson’s correlation coefficient, were conducted to evaluate the results. Augmenting datasets with images of different contrasts significantly improved training accuracy as the dataset size increased. PSNR values ranged 29.84-30.26 dB for U-Net trained on mixed datasets, and SSIM values ranged 0.9858-0.9868. Similarly, PSNR values ranged 32.34-32.64 dB for EDSR trained on mixed datasets, and SSIM values ranged 0.9941-0.9945. Significant differences in PSNR and SSIM were observed between models trained on pure and mixed datasets. Pearson’s correlation coefficient indicated a strong positive correlation between dataset size and image quality metrics. Using diverse image data obtained from the same subject can improve the performance of deep-learning models in medical image super-resolution tasks.

PMID:39680317 | DOI:10.1007/s12194-024-00871-1

Adv Ther. 2024 Dec 16. doi: 10.1007/s12325-024-03043-0. Online ahead of print.

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a profound global impact. The emergence of several variants during the pandemic has presented numerous challenges in preventing and managing this disease. The development of vaccines has played a pivotal role in controlling the pandemic, with a significant portion of the global population being vaccinated. This, along with the emergence of less virulent SARS-CoV-2 variants, has led to a reduction in the severity of COVID-19 outcomes for the overall population. Nevertheless, individuals with immunocompromising conditions continue to face challenges given their suboptimal response to vaccination and vulnerability to severe COVID-19. This expert review synthesizes recent published evidence regarding the economic and human impact of COVID-19 on such individuals. The literature suggests that rates of hospitalization, intensive care unit admission, and mechanical ventilation use were high during the pre-Omicron era, and remained high during Omicron and later, despite vaccination for this population. Moreover, studies indicated that these individuals experienced a negative impact on their mental health and health-related quality of life (HRQoL) compared to those without immunocompromising conditions, with elevated levels of anxiety, depression, and distress reported. Further, these individuals with immunocompromising conditions experienced substantial costs associated with COVID-19 and loss of income during the pandemic, though the evidence on the economic burden of COVID-19 in such individuals is limited. Generally, COVID-19 has increased healthcare resource use and costs, impaired mental health, and reduced HRQoL in those with varied immunocompromising conditions compared to both those without COVID-19 and the general population-underscoring the importance of continued real-world studies. Ongoing research is crucial to assess the ongoing burden of COVID-19 in vaccinated individuals with immunocompromising conditions who are still at risk of severe COVID-19 outcomes to ensure their needs are not disproportionately worse than the general population.

PMID:39680311 | DOI:10.1007/s12325-024-03043-0

J Relig Health. 2024 Dec 16. doi: 10.1007/s10943-024-02208-z. Online ahead of print.

ABSTRACT

This study aimed to estimate the proportion of Brazilian nurses, doctors, and psychologists who approach spirituality and religiosity (S/R) issues in professional practice. The study also explored these health professionals’ willingness to interact with patients on issues related to S/R in their clinical practice using item response theory (IRT). From a nationwide cross-sectional web survey, demographic data and the opinions of doctors, nurses, and psychologists were collected regarding aspects related to S/R. For this study, the willingness of physicians to interact with patients regarding the S/R issues scale, developed by the Network for Research Spirituality and Health and translated into Brazilian Portuguese, was used. Information was adjusted according to the IRT. Of the 1095 participants, 335 (30.6%) were nurses, 433 (39.5%), doctors, and 327 (29.9%) were psychologists. The areas of activity with the most significant representation were primary healthcare (n = 292, 26.7%) and mental health (n = 296, 27.0%). A total of 76 (22.7%) nurses, 152 (35.1%) doctors, and 112 (34.3%) psychologists often or always asked about S/R in professional practice. There was a significant difference in the frequency of approach by nurses compared to doctors (p < 0.001) and psychologists (p = 0.001). Doctors were more willing to approach S/R, with a statistically significant difference between nurses (DM – 0.72, 95% CI BCa [- 1.38 to – 0.11]) and psychologists (DM 1.44, 95% CI BCa (0.76-2.11)]. This study should encourage a more comprehensive approach to human beings, contributing to more profound research in Brazil and worldwide.

PMID:39680288 | DOI:10.1007/s10943-024-02208-z

Lifetime Data Anal. 2024 Dec 16. doi: 10.1007/s10985-024-09644-9. Online ahead of print.

ABSTRACT

Recurrent events are common in medical practice or epidemiologic studies when each subject experiences a particular event repeatedly over time. In some long-term observations of recurrent events, a terminal event such as death may exist in recurrent event data. Meanwhile, some inspected subjects will withdraw from a study for some time for various reasons and then resume, which may happen more than once. The period between the subject leaving and returning to the study is called an intermittent gap. One naive method typically ignores gaps and treats the events as usual recurrent events, which could result in misleading estimation results. In this article, we consider a semiparametric proportional rates model for recurrent event data with intermittent gaps and a terminal event. An estimation procedure is developed for the model parameters, and the asymptotic properties of the resulting estimators are established. Simulation studies demonstrate that the proposed estimators perform satisfactorily compared to the naive method that ignores gaps. A diabetes study further shows the utility of the proposed method.

PMID:39680279 | DOI:10.1007/s10985-024-09644-9

Clin Rheumatol. 2024 Dec 16. doi: 10.1007/s10067-024-07269-9. Online ahead of print.

ABSTRACT

BACKGROUND: This study sought to determine if dietary macronutrient consumption and the low-carbohydrate diet (LCD) score were linked to rheumatoid arthritis (RA).

METHODS: Participants ≥ 20 years were analyzed from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. LCD score was calculated by summing the 11 quantiles values of the percentages of energy derived from carbohydrate, protein, and fat. Weighted logistic regression, eXtreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM) models were used to explore the relationship between LCD score, dietary macronutrient intake, and RA. Propensity score matching (PSM) were applied for sensitivity analysis.

RESULTS: Ultimately, 8118 participants (RA: 499, without RA: 7619) were analyzed. After fully adjusting for confounders, a negative association was found between the LCD score and the presence of RA [OR (95% CI), 0.97 (0.96, 0.99)]. A higher LCD score was also negatively associated with a lower likelihood of RA based on a categorical model. Among macronutrients, participants in the third and fourth quartiles had significantly increased odds of RA compared with the lowest carbohydrate intake. Regarding protein intake, individuals in the highest quartile of percentage of energy from protein had a 46% lower presence of RA compared with the lowest reference group. The relative importance of the LCD score on RA was determined based on XGBoost and LightGBM models. Moreover, the association between the LCD score, dietary macronutrient intake, and RA presence remained substantial after PSM.

CONCLUSIONS: LCD score was negatively associated with odds of RA in US adults. Moreover, a correlation was found between a lower likelihood of RA and high protein, and low carbohydrate consumption. Key Points • A significant negative association was found between LCD score and RA presence. • Machine learning models revealed the LCD score was a significant predictor of the presence of RA. • Low carbohydrate intake and high protein intake were correlated with a lower odds of RA.

PMID:39680261 | DOI:10.1007/s10067-024-07269-9

Clin Exp Metastasis. 2024 Dec 16;42(1):3. doi: 10.1007/s10585-024-10322-1.

ABSTRACT

Studies conducted in the last few years have suggested a connection between clinical outcomes and the time of immune checkpoint inhibitors (ICIs) infusion. However, few data are available regarding the differences between early and late time-of-day (ToD) administration in metastatic renal cell carcinoma (mRCC) patients receiving immunotherapy and immune-based combinations. In this meta-analysis, we aimed to fully investigate the influence of timing of administration on the efficacy of mRCC immunotherapy, by comparing early ToD versus late ToD dosing in this setting. The present systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Overall Survival (OS) was measured as Hazard Ratios (HRs) and 95% confidence intervals (CIs). Our search resulted in the identification of 1429 potentially relevant reports, which were subsequently restricted to four following independent evaluation of three authors. The pooled HR for OS in RCC patients receiving early ToD versus late ToD dosing was 0.62 (95% Confidence Interval, 0.50-0.72; p < 0.001). According to our findings, a statistically significant improvement in terms of OS for mRCC patients receiving early ToD administration compared with late ToD dosing was observed, with a reduction of death by 38%. Well-designed, randomized clinical and translational trials are required to clarify this issue and to establish recommendations for personalized treatments according to ToD.

PMID:39680251 | DOI:10.1007/s10585-024-10322-1

Arch Orthop Trauma Surg. 2024 Dec 16;145(1):48. doi: 10.1007/s00402-024-05682-y.

ABSTRACT

INTRODUCTION: The effectiveness of the direct anterior approach (DAA) compared to other surgical approaches for total hip arthroplasty (THA) in patients with lumbar spine stiffness remains unclear. This systematic review and meta-analysis aimed to compare clinical outcomes, including dislocation rates and other complications, between DAA and other surgical approaches for THA in patients with lumbar spine stiffness.

MATERIALS AND METHODS: We conducted a systematic review and meta-analysis to compare the DAA with other surgical approaches (anterolateral, direct lateral, posterolateral and direct superior) in patients with lumbar spine stiffness undergoing THA. We searched PubMed, Embase, and Cochrane Central databases for cohort studies and randomized controlled trials and calculated risk ratios (RRs) with 95% confidence intervals (CIs) to assess dislocation rates.

RESULTS: This analysis included 11 non-randomized studies comprising 2505 patients, of whom 738 patients (29.4%) underwent THA via DAA. The results demonstrated that the DAA group had significantly reduced dislocation rates (RR 0.31, 95% CI 0.14-0.67, P = 0.003, I² = 0%) compared to other surgical approaches. Subgroup analysis showed significantly lower dislocation rates in DAA patients versus those undergoing the posterior approach (RR 0.22, 95% CI 0.10-0.52, P = 0.001, I² = 0%). However, there was no statistically significant difference in dislocation rates between DAA and the lateral approach (RR 0.53, 95% CI 0.19-1.47, P = 0.22, I² = 0%), although the rate was numerically lower.

CONCLUSION: The DAA was associated with lower dislocation rates compared to other surgical techniques in patients with lumbar spine stiffness undergoing THA.

PMID:39680248 | DOI:10.1007/s00402-024-05682-y