Category: Statistics

Int Wound J. 2024 Mar;21(3):e14829. doi: 10.1111/iwj.14829.

ABSTRACT

This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science, and Cochrane Library were searched for studies from their inception until September 12, 2023. Literature search, data extraction, and quality assessment were conducted independently by two researchers. The random-effects model was used to calculate the combined odds ratio (OR) and corresponding 95% confidence interval (CI) of hypertension in patients with PU; subgroup analyses were performed to explore the source of between-study heterogeneity; sensitivity analysis was used to test the robust of the combined result; and funnel plot and Egger’s test were used to assess the publication bias. Finally, a total of 19 studies with 564 716 subjects were included; the overall pooled result showed no significant association between hypertension and risk of developing PU (OR = 1.15, 95% CI = 0.90-1.47, p = 0.27); and the sensitivity analysis and publication bias analysis showed robust of the combined result. Subgroup analysis indicated a significant association between hypertension and PU when the primary disease was COVID-19 (OR = 1.73, 95% CI = 1.35-2.22, p < 0.0001). No association between hypertension and PU was seen in subgroup analysis on the patient source and study design. In sum, there is no significantly statistical association between hypertension and the occurrence of PU in most cases, while the risk of PU significantly elevates among COVID-19 patients combined with hypertension regardless of patient source and study design.

PMID:38494175 | DOI:10.1111/iwj.14829

Am J Obstet Gynecol MFM. 2024 Mar 15:101354. doi: 10.1016/j.ajogmf.2024.101354. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify evidenced-based peripartum interventions for people with a body mass index (BMI) ≥40kg/m².

DATA SOURCES: PubMed, MEDLINE, EMBASE, Cochrane, CINAHL and ClinicalTrials.gov were searched from inception to 2022 without date, publication type, or language restrictions.

STUDY ELIGIBILITY CRITERIA: Cohort and randomized controlled trials (RCT) that implemented an intervention and evaluated peripartum outcomes of people with a BMI≥40kg/m² were included. The primary outcome depended on the intervention but commonly related to wound morbidity after cesarean delivery (i.e., infection, separation, hematoma).

STUDY APPRAISAL AND SYNTHESIS METHODS: Meta-analysis was completed for interventions with at least 2 studies. Pooled risk ratios (RR) with 95% confidence intervals (CI) and heterogeneity (I² statistics) were reported.

RESULTS: Of 20,301 studies screened, 30 studies (17 cohort, 13 RCT) encompassing 10 types of interventions were included. Interventions related to delivery planning (induction of labor, planned cesarean delivery), antibiotics during labor induction or for surgical prophylaxis, six types of cesarean delivery techniques, and anticoagulation dosing after a cesarean delivery. Planned cesarean delivery compared to planned vaginal delivery did not improve outcomes based on 3 cohort studies. One cohort study compared 3g to 2g of cephazolin prophylaxis for cesarean delivery and found no differences in surgical site infections. According to 3 cohort studies and 2 RCTs, there was no improvement in outcomes with a non-low transverse skin incision. Ten studies (4 cohort, 6 RCT) met inclusion criteria for the meta-analysis. Two RCTs compared subcuticular closure with suture vs. staples after cesarean delivery and found no differences in wound morbidity within 6 weeks of cesarean delivery (n=422; RR 1.09, 95% CI [0.75-1.59], I²=9%). Prophylactic negative pressure wound therapy was compared to standard dressing in 4 cohort and 4 RCTs and found no differences in wound morbidity (cohort n=2200; RR 1.19, 95% CI [0.88-1.63], I²=66.1%) or surgical site infections (RCT n=1262; RR 0.90, 95% CI [0.63-1.29], I²=0).

CONCLUSION: Few studies address interventions in people with a BMI≥40kg/m² and most studies did not demonstrate a benefit. Either staples or suture are recommended for subcuticular closure, but available data do not support prophylactic NPWT after cesarean delivery for people with a BMI ≥40kg/m².

PMID:38494155 | DOI:10.1016/j.ajogmf.2024.101354

J Am Pharm Assoc (2003). 2024 Mar 15:102069. doi: 10.1016/j.japh.2024.102069. Online ahead of print.

ABSTRACT

BACKGROUND: Community pharmacy practice has incurred significant changes in scope of responsibility and workplace environment, particularly during the COVID-19 pandemic. The trends may impact how student pharmacists perceive community pharmacy practice and their future career opportunities.

OBJECTIVE: To determine current perceptions that student pharmacists have towards community pharmacy practice.

METHODS: A 15-item electronic, cross-sectional questionnaire was distributed to approximately 2200 student pharmacists from March to April 2023. To be included, respondents needed to be a current adult pharmacy student. The questionnaire included items about career interests, perceptions towards 12 different aspects of community pharmacy practice, and demographics. Data were analyzed primarily using descriptive statistics. A priori stratifications included interest to pursue community pharmacy according to class year and according to level of work experience.

RESULTS: A total of 146 responses were included (response rate 6.6%). A total of 101 (69.2%) respondents were women, 108 (74.0%) were white, and the mean age was 24 years. Respondents represented all four pharmacy professional years and 113 (77.4%) respondents reported current or previous work experience in community pharmacy. Most respondents were not interested in pursuing community pharmacy directly after graduation 77 (52.7%), nor as a long-term career 87 (59.6%). Student pharmacists found the most appealing aspects of community pharmacy practice to be salary/benefits, job availability and security, interactions with coworkers in the pharmacy, interactions with other medical professionals, relationships and interactions with patients, and teaching responsibilities. Student pharmacists found the work hours and schedule, business management responsibilities, navigating insurance-related tasks, and the pace of the work environment to be unappealing.

CONCLUSIONS: Student pharmacists report a low interest in pursuing community pharmacy practice. Minimizing deterrents and enhancing the appealing aspects of community pharmacy as perceived by student pharmacists may help improve recruitment and retainment, as well as improve perceptions of the practice.

PMID:38494115 | DOI:10.1016/j.japh.2024.102069

J Foot Ankle Surg. 2024 Mar 15:S1067-2516(24)00051-6. doi: 10.1053/j.jfas.2024.02.004. Online ahead of print.

ABSTRACT

Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1^st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1^st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1^st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1^st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon’s practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature. LEVEL OF CLINICAL EVIDENCE: 4, Retrospective Case Series/Cost Analysis.

PMID:38494112 | DOI:10.1053/j.jfas.2024.02.004

J Foot Ankle Surg. 2024 Mar 15:S1067-2516(24)00055-3. doi: 10.1053/j.jfas.2024.03.001. Online ahead of print.

ABSTRACT

Tibiotalocalcaneal arthrodesis has been shown in literature to have good results in regards to low complication rates and deformity correction. While previous studies have investigated functional outcomes and complication rates, no large-scale studies have looked at pain outcomes. The present study used a retrospective review of 154 extremities to analyze how a patient’s comorbidities and characteristics influence pain outcomes following a tibiotalocalcaneal arthrodesis. The present study found an average change of pain from 7.1 to 3.0 in at least a 6 month follow up. We found a diagnosis of chronic pain and tobacco use had statistically significant less pain improvement compared to patients without chronic pain or current tobacco use. We found no statistically significant difference in pain outcomes for patients with or without Charcot deformity. Lastly, we found that with older patients there was more pain improvement observed. We physicians can educate current tobacco users of the improved pain outcomes with tobacco cessation prior to surgery. We recommend a multidisciplinary approach for pain in patients with a pre-operative diagnosis of chronic pain and to educate patients on realistic postoperative pain outcomes. Level of Evidence: 3.

PMID:38494111 | DOI:10.1053/j.jfas.2024.03.001

Brain Res. 2024 Mar 15:148852. doi: 10.1016/j.brainres.2024.148852. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to examine N-acetyl aspartate (NAA)/creatine (Cr) and glutamate, glutamine, and gamma-aminobutyric acid complex (Glx)/Cr levels in patients with obsessive compulsive disorder (OCD) and healthy controls’ orbitofrontal cortex (OFC) and caudate nucleus (CN) by proton magnetic resonance spectroscopy (1H-MRS) method and to investigate their relationship with oxidative stress markers glutathione peroxidase (GPx) and superoxide dismutase (SOD).

METHODS: This study included patients with OCD (n = 25) and healthy controls (n = 25) ranging in age from 18 to 65. We used the ELISA method to evaluate serum SOD and GPx levels. Levels of NAA/Cr and Glx/Cr in the orbitofrontal cortex and caudate nucleus were measured using the 1H-MRS method.

RESULTS: Our study did not detect statistically significant differences in the orbitofrontal cortex Glx/Cr and NAA/Cr levels between the OCD patients and the control group. OCD patients exhibited a decrease in NAA/Cr levels, consistent with impaired neuronal integration, and an increase in Glx/Cr levels, consistent with hyperactivation, in the caudate nucleus compared to the control group. We observed a negative correlation between NAA/Cr levels in the caudate nucleus and the levels of SOD and GPx.

CONCLUSIONS: Our study is the first to assess CN and OFC together in OCD patients using 3 T MR, investigating the relationship between neurometabolite concentrations and oxidative stress parameters. The negative correlation we observed between NAA/Cr levels and SOD and GPx in the caudate nucleus suggests that increased oxidative stress in this brain region in OCD patients may contribute to impaired neuronal integration and functionality.

PMID:38494099 | DOI:10.1016/j.brainres.2024.148852

Magn Reson Imaging. 2024 Mar 15:S0730-725X(24)00072-9. doi: 10.1016/j.mri.2024.03.016. Online ahead of print.

ABSTRACT

Purpose To evaluate the tubular function in an alloxan-induced type 1 diabetes mellitus (DM) rabbit model measured by renal oxygenation (R2*), oxygen extraction fraction (OEF), and renal blood flow (RBF) using blood oxygenation level dependent, asymmetric spin echo, and arterial spin labeling MRI. Methods Twenty-six rabbits were randomized into the 3-day DM group (n = 13) and the 7-day DM group (n = 13). We performed pairs of multiparametric MRIs (before and after furosemide injection) at baseline and 3/7 days post-DM, and scored pathological kidney injury. We performed statistical analyses using non-parametric, chi-square, and Spearman correlation tests. Results At baseline, medullary R2* significantly decreased by 24.97% and 16.74% in the outer and inner stripes of the outer medulla (OS and IS, p = 0.006 and 0.003, respectively) after furosemide administration. While the corresponding OEF decreased by 15.91% for OS and 16.67% for IS (both p = 0.003), and no significant change in medullary RBF was observed (p > 0.05). In the 3-day DM group, the decrease of medullary R2* and OEF post-furosemide became unremarkable, suggesting tubular dysfunction. We noticed similar changes in the 7-day DM group. Correlation analysis showed pathological tubular injury score significantly correlated with medullary ∆R2* (post-furosemide – pre-furosemide difference, r = 0.82 for OS and 0.82 for IS) and ∆OEF (r = 0.82 for OS and 0.82 for IS) (p < 0.001, respectively). Conclusion: The combination of medullary OEF and R2* in response to furosemide could detect renal tubular dysfunction in early DM.

PMID:38494095 | DOI:10.1016/j.mri.2024.03.016

J Reprod Infant Psychol. 2024 Mar 17:1-16. doi: 10.1080/02646838.2024.2330662. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 pandemic characterised a unique and vulnerable social, emotional, and health environment for pregnancy, with potential long-lasting risks to maternal and child health outcomes. In women who were pregnant at the peak of COVID-19 pandemic, we investigated the association between pandemic-related concerns about pregnancy and delivery and both the parent’s (i.e. maternal parenting stress) and the infant’s (i.e. emotional-behavioral problems) outcomes 12 months after birth.

METHODS: A sample of 352 Italian pregnant women completed a web-based survey from 8 April to 4 May 2020 and a follow-up at 12 months after delivery. Maternal assessment in pregnancy covered prenatal measures for: pandemic-related concerns about pregnancy and childbirth, COVID-19 stressful events exposure, pandemic psychological stress, and mental-health symptoms (i.e. depression, anxiety). The 12 months’ assessment covered post-partum measures of social support, parenting stress and maternal reports of infants’ behavioral problems.

RESULTS: The results of the Quasi-Poisson regression models on the association between COVID-19 related influencing factors and parenting stress and infant’s behavioral problems showed that the presence of higher pandemic-related concerns about pregnancy and childbirth scores was associated with greater total and internalising behavioral problems but not with parenting stress levels.

CONCLUSION: Perinatal mother-infant health has been sensitively threatened by pandemic consequences with maternal concerns about childbirth in pregnancy being associated with 12 months’ children’s behavioral outcomes. There is a need to invest in psychological support for perinatal women throughout the transition to parenthood to protect risk conditions before they get chronic or severe and influence offspring development.

PMID:38493474 | DOI:10.1080/02646838.2024.2330662

J Cancer Res Clin Oncol. 2024 Mar 17;150(3):134. doi: 10.1007/s00432-024-05661-1.

ABSTRACT

PURPOSE: The CD47 molecule, often referred to as the “do not eat me” signal, is frequently overexpressed in tumor cells. This signaling pathway limits phagocytosis by macrophages. Our objective was to determine CD47 abundance in various soft tissue sarcomas (STS) to investigate whether it could serve as a potential evasion mechanism for tumor cells. Additionally, we aimed to assess the prognostic value of CD47 expression by examining its association with different clinicopathological factors. This study aimed to elucidate the significance of CD47 in the context of emerging anti-tumor targeting approaches.

METHODS: In this retrospective study, formalin-fixed paraffine-embedded (FFPE) tumor tissues of 55 treatment-naïve patients were evaluated by immunohistochemistry for the abundance of CD47 molecule on tumor cells. The categorization of CD47 positivity was as follows: 0 (no staining of tumor cells), 1 + (less than 1/3 of tumor area positive), 2 + (between 1/3 and 2/3 of tumor area positive), and 3 + (more than 2/3 of tumor area positive for CD47). Next, we compared CD47 abundance between different tumor grades (G1-3). We used Kaplan-Meier survival curves with log-rank test to analyze the differences in survival between patients with different CD47 expression. Moreover, we performed Cox proportional hazards regression model to evaluate the clinical significance of CD47.

RESULTS: CD47 is widely prevalent across distinct STS subtypes. More than 80% of high grade undifferentiated pleiomorphic sarcoma (UPS), 70% of myxofibrosarcoma (MFS) and more than 60% of liposarcoma (LPS) samples displayed a pattern of moderate-to-diffuse positivity. This phenomenon remains consistent regardless of the tumor grade. However, there was a tendency for higher CD47 expression levels in the G3 group compared to the combined G1 + G2 groups when all LPS, MFS, and UPS were analyzed together. No significant associations were observed between CD47 abundance, death, and metastatic status. Additionally, high CD47 expression was associated with a statistically significant increase in progression-free survival in the studied cohort of patients.

CONCLUSION: This study highlights the potential of the CD47 molecule as a promising immunotherapeutic target in STS, particularly given its elevated expression levels in diverse sarcoma types. Our data showed a notable trend linking CD47 expression to tumor grade, while also suggesting an interesting correlation between enhanced abundance of CD47 expression and a reduced hazard risk of disease progression. Although these findings shed light on different roles of CD47 in STS, further research is crucial to assess its potential in clinical settings.

PMID:38493445 | DOI:10.1007/s00432-024-05661-1

Arch Gynecol Obstet. 2024 Mar 17. doi: 10.1007/s00404-024-07460-y. Online ahead of print.

ABSTRACT

PURPOSE: Recurrence of adhesions after hysteroscopic adhesiolysis is a challenging clinical problem without a unified management approach. Therefore, we conducted a network meta-analysis that considered both direct and indirect comparisons between interventions to identify optimal strategies for preventing recurrence.

METHODS: We searched for research trials published up to July 2023 from PubMed, Embase and the Cochrane Database. We selected randomized controlled trials comparing the use of different interventions for the prevention of adhesion recurrence, with no language or regional restrictions. We used random-effects models to assess odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI). Adverse events associated with the interventions were also assessed. This study was registered on PROSPERO, CRD42023449068.

RESULTS: Data from 21 randomized controlled trials involving 2406 patients were synthesized, including interventions with balloon, amnion, platelet-rich plasma (PRP), intrauterine device (IUD), hyaluronic acid (HA), platelet-rich fibrin (PRF), and granulocyte colony-stimulating factor (G-CSF). The top 5 interventions for change in AFS scores were: PRP + Balloon (MD = 5.44; 95% CI, 2.63-8.25), Amnion + Balloon (MD = 5.08; 95% CI, 2.71-7.44), IUD + Balloon (MD = 4.89; 95% CI, 2.49-7.30), HA + Balloon (MD = 3.80; 95% CI, 1.78-5.82), and G-CSF + Balloon (MD = 3.84; 95% CI, 1.05-6.63). There were no statistically significant differences between interventions in the recurrence rate of moderate-to-severe uterine adhesions and the clinical pregnancy rate. Most interventions were safe.

CONCLUSIONS: To our knowledge, this is the most comprehensive network meta-analysis to date of interventions for preventing postoperative intrauterine adhesion recurrence. Our results indicate that PRP + Balloon seems to be the most effective approach.

PMID:38493418 | DOI:10.1007/s00404-024-07460-y