Category: Statistics

Acta Oncol. 2024 May 7;63:303-312. doi: 10.2340/1651-226X.2024.35232.

ABSTRACT

BACKGROUND AND PURPOSE: Stage at cancer diagnosis is an important predictor of cancer survival. TNM stage is constructed for anatomic solid cancer diagnoses from tumor size (T), nodal spread (N) and distant metastasis (M) and categorized in groups 0-I, II, II and IV. TNM stage is imperative in cancer diagnosis, management and control, and of high value in cancer surveillance, for example, monitoring of stage distributions. This study yields an overview of TNM availability and trends in stage distribution in the Nordic countries for future use in monitoring and epidemiologic studies.

MATERIAL AND METHODS: TNM information was acquired from the cancer registries in Denmark, Norway, Sweden, and Iceland during 2004-2016 for 26 cancer sites in the three former countries and four in Iceland. We studied availability, comparability, and distribution of TNM stage in three periods: 2004-2008, 2009-2013, and 2014-2016, applying a previously validated algorithm of ‘N0M0 for NXMX’. For cancers of colon, rectum, lung, breast, and kidney, we examined TNM stage-specific 1-year relative survival to evaluate the quality in registration of TNM between countries.

RESULTS: Denmark, Sweden, and Iceland exhibited available TNM stage proportions of 75-95% while proportions were lower in Norway. Proportions increased in Sweden over time but decreased in Denmark. One-year relative survival differed substantially more between TNM stages than between countries emphasizing that TNM stage is an important predictor for survival and that stage recording is performed similarly in the Nordic countries.

INTERPRETATION: Assessment and registration of TNM stage is an imperative tool in evaluations of trends in cancer survival between the Nordic countries.

PMID:38716485 | DOI:10.2340/1651-226X.2024.35232

Acta Oncol. 2024 May 7;63:294-302. doi: 10.2340/1651-226X.2024.27731.

ABSTRACT

BACKGROUND: Survival of children with cancer has markedly improved over recent decades, largely due to intensified treatment regimes. The intensive treatment may, however, result in fatal complications. In this retrospective cohort study, we assessed temporal variation in the incidence of treatment-related death and associated risk factors among children diagnosed with cancer in Denmark during 2001-2021.

METHOD: Among all children diagnosed with first incident cancer before age 15 years recorded in the Danish Childhood Cancer Register (n = 3,255), we estimated cumulative incidence of treatment-related death (death in the absence of progressive cancer) within 5 years from diagnosis using Aalen-Johansen estimators and assessed associated risk factors using Cox regression.

RESULTS: Among all 3,255 children with cancer, 93 (20% of all 459 deaths) died from treatment. Of these treatment-related deaths, 39 (42%) occurred within 3 months of diagnosis. The 5-year cumulative incidences of treatment-related death were 3.3% during 2001-2010 and 2.5% during 2011-2021 (p = 0.20). During 2011-2021, treatment-related deaths accounted for more than half of all deaths among children with haematological cancers. Risk factors varied according to cancer group and included female sex, age below 1 year at diagnosis, disease relapse, stem cell transplantation, central nervous system involvement, and metastasis at diagnosis.

INTERPRETATION: Despite increasing treatment intensities, the incidence of treatment-related death has remained stable during the past 20 years in Denmark. Still, clinical attention is warranted to prevent treatment-related deaths, particularly among children with haematological cancers. Patient characteristics associated with increased treatment-related death risk support patient-specific treatment approaches to avoid these fatalities.

PMID:38716484 | DOI:10.2340/1651-226X.2024.27731

Research (Wash D C). 2024 Apr 29;7:0368. doi: 10.34133/research.0368. eCollection 2024.

ABSTRACT

Complex diseases do not always follow gradual progressions. Instead, they may experience sudden shifts known as critical states or tipping points, where a marked qualitative change occurs. Detecting such a pivotal transition or pre-deterioration state holds paramount importance due to its association with severe disease deterioration. Nevertheless, the task of pinpointing the pre-deterioration state for complex diseases remains an obstacle, especially in scenarios involving high-dimensional data with limited samples, where conventional statistical methods frequently prove inadequate. In this study, we introduce an innovative quantitative approach termed sample-specific causality network entropy (SCNE), which infers a sample-specific causality network for each individual and effectively quantifies the dynamic alterations in causal relations among molecules, thereby capturing critical points or pre-deterioration states of complex diseases. We substantiated the accuracy and efficacy of our approach via numerical simulations and by examining various real-world datasets, including single-cell data of epithelial cell deterioration (EPCD) in colorectal cancer, influenza infection data, and three different tumor cases from The Cancer Genome Atlas (TCGA) repositories. Compared to other existing six single-sample methods, our proposed approach exhibits superior performance in identifying critical signals or pre-deterioration states. Additionally, the efficacy of computational findings is underscored by analyzing the functionality of signaling biomarkers.

PMID:38716473 | PMC:PMC11075703 | DOI:10.34133/research.0368

Acta Ortop Bras. 2024 May 6;32(spe1):e273366. doi: 10.1590/1413-785220243201e273366. eCollection 2024.

ABSTRACT

OBJECTIVE: to determine the surgical indications for glenoid bone grafting associated with better postoperative ranges of motion.

METHODS: This systematic review was conducted according to PRISMA. The included studies were subdivided according to the criteria used to indicate glenoid bone graft surgery: group for radiological indications only (Group R), group for radiological indications associated with clinical indications (Group R + C), and group for arthroscopic indications (Group A). The extracted and evaluated data were the range of motion of the shoulder.

RESULTS: in the electronic search conducted in October 2022, 1567 articles were selected. After applying the inclusion criteria, 14 articles were selected for the systematic review. Regarding the ranges of motion, group A had the highest number of statistically positive results together with group R. Group A showed positive results in elevation parameters, loss of lateral rotation in adduction, and medial rotation in abduction. Group R showed positive results in lateral rotation in adduction and loss of lateral rotation in adduction. On the other hand, Group R + C was the one that presented the highest number of statistically negative results, in the following parameters: elevation, lateral rotation in abduction, loss of lateral rotation in adduction, and medial rotation in abduction.

CONCLUSION: the subgroups presented variable results in the evaluated parameters; however, the groups with arthroscopic and radiological indications showed the highest number of positive results, with the latter group showing the best results regarding lateral rotation. Level of Evidence II, Systematic Reviews.

PMID:38716462 | PMC:PMC11073535 | DOI:10.1590/1413-785220243201e273366

Niger Med J. 2022 May 13;62(5):267-272. doi: 10.60787/NMJ-62-5-53. eCollection 2021 Sep-Oct.

ABSTRACT

BACKGROUND: Massive obstetric haemorrhage is still a prime cause of maternal mortality and morbidity. Remarkable efficacy of off-label use of Recombinant Activated Factor VII (rFVIIa) has been reported in cases of postpartum haemorrhage (PPH) refractory to conventional measures. This study aims to determine the clinical efficacy of rFVIIa for patients with massive obstetric haemorrhage.

METHODOLOGY: This was a retrospective cross-sectional comparative study of patients with PPH who received rFVIIa during their treatment at the Department of Obstetrics and Gynaecology from November 2009 to April 2018. The data was collected by chart review on a specified form. The age, parity, cause of bleeding, primary treatment measures followed by rFVIIa treatment were recorded. Time since bleeding to administration of rFVIIa was also recorded. The response of rFVIIa in terms of required transfusion volume, need for ICU/ventilator support, fertility preservation and maternal outcome were also compared and analyzed.

RESULTS: In this study, mean age of patients was 33 ±4 years and uterine atony was the most frequent (>50%) cause of Post-partum Haemorrhage (PPH). Out of 12 patients, 50% received injection rFVIIa who within 6 hours were labelled as early group while 50% received it after 6 hours were labelled as late group. Statistically significant difference was observed in terms of fertility preservation, transfusion requirement and duration of ICU/ hospital stay in early and late groups. Although improved maternal outcome was noted following early rFVIIa administration, but it was not found statistically significant between the two groups.

CONCLUSION: Massive PPH not responding to conventional measures can be managed with early administration of rFVIIa which is an effective haemostatic agent.

KEY MESSAGE: Massive PPH not responding to conventional measures can be managed with rFVIIa which also has a significant role in preserving fertility if used before hysterectomy.

PMID:38716439 | PMC:PMC11073838 | DOI:10.60787/NMJ-62-5-53

Diabetes Obes Metab. 2024 May 7. doi: 10.1111/dom.15644. Online ahead of print.

ABSTRACT

AIM: To assess the efficacy and safety of dulaglutide 1.5 mg versus dulaglutide 0.75 mg in Japanese participants with type 2 diabetes (T2D).

MATERIALS AND METHODS: A Phase 3, multicentre, randomized, double-blind, parallel-group study was conducted in Japanese participants aged ≥20 years, with T2D for ≥6 months and inadequate glycaemic control, while on a single oral antihyperglycaemic medication (NCT04809220). The primary objective was to evaluate superiority of dulaglutide 1.5 mg versus dulaglutide 0.75 mg measured by mean change in glycated haemoglobin (HbA1c) from baseline to 26 weeks. Other efficacy and safety endpoints were evaluated at 26 and 52 weeks. All statistical analyses were conducted using the intention-to-treat population.

RESULTS: Overall, 591 participants were randomized to once-weekly dulaglutide 1.5 mg or 0.75 mg. At Week 26, dulaglutide 1.5 mg was superior to dulaglutide 0.75 mg in HbA1c reduction from baseline (least squares mean [LSM] difference -0.29% [95% confidence interval {CI} -0.43, -0.14]). At Week 52, the dulaglutide 1.5-mg arm had a significantly greater proportion of participants who achieved HbA1c <7.0% (46.3% vs. 38.5%; p = 0.03) and showed significantly greater reduction in fasting serum glucose (LSM difference -9.4 mg/dL [95% CI -14.4, -4.3]; p < 0.001) versus the dulaglutide 0.75-mg arm. No statistically significant change in body weight was observed in either treatment arm. Overall, 442 participants (75.4%) experienced treatment emergent adverse events (TEAEs). Constipation (11.3%), diarrhoea (9.6%) and pyrexia (9.0%) were the most commonly reported TEAEs.

CONCLUSIONS: Dulaglutide 1.5 mg once weekly demonstrated superior glycaemic control versus dulaglutide 0.75 mg once weekly, with comparable safety and tolerability, in Japanese people with T2D.

PMID:38715179 | DOI:10.1111/dom.15644

Fam Pract. 2024 May 8:cmae027. doi: 10.1093/fampra/cmae027. Online ahead of print.

ABSTRACT

BACKGROUND: The number of patients under home mechanical ventilation is increasing worldwide. The unique nature of these patients and their complex health needs exposes home caregivers to various needs and challenges regarding different dimensions of care.

OBJECTIVE: The present study was conducted to investigate the effect of the universal model of family-centered care on the clinical outcomes of the patient and the family.

METHODS: This clinical trial was conducted between 2020 and 2021. A total of 60 patients under invasive mechanical ventilation was selected and divided into control (routine training that is usually given by hospital staff to families to care for patients) and intervention (comprehensive pre-discharge training program to post-discharge follow-up using the universal model of family-centered care) groups using random block design and universal model of family-centered care. Home caregivers’ functional skills and burden, as well as patients’ readmission and mortality rates, were compared in the two groups.

RESULTS: Implementing the intervention 1 and 3 months later effectively increased home caregivers’ functional skills. Moreover, a statistically significant difference was observed between the two groups in terms of the psychological burden of caregiving (P < .001); the implementation of the intervention could highly reduce the psychological burden of caregiving in the intervention group (EF = 0.94). The hospital readmission and mortality rate in the intervention group was significantly lower than in the control group (P = .02 and P = .03, respectively).

CONCLUSIONS: Given the significant impact of the universal model of family-centered care on the clinical outcomes of the patient and the family, pre-discharge training and its post-discharge follow-up and continuity of education with an active presence of nurses, as one of the main pillars of the treatment, seems essential.

PMID:38715176 | DOI:10.1093/fampra/cmae027

Arch Esp Urol. 2024 Apr;77(3):303-314. doi: 10.56434/j.arch.esp.urol.20247703.40.

ABSTRACT

OBJECTIVE: Bladder cancer (BC) is the most common malignant tumour of the urinary system, and radical cystectomy combined with pelvic lymph node dissection (LND) is the standard treatment for BC. We conducted this meta-analysis to explore the efficacy and safety of extended lymph node dissection in radical cystectomy for BC.

METHODS: PubMed, Embase, ProQuest PsycINFO, CINAHL, Web of Science and The Cochrane Library databases were searched for studies on extended lymph node dissection during radical BC surgery. The search time limit was from the establishment of the database to December 2023. Screening and quality assessment of literature were conducted. This meta-analysis was conducted to evaluate the influence of different lymph node dissection methods on recurrence-free survival (RFS), overall survival (OS), operation time, 90-day readmission rate and postoperative complication rate.

RESULTS: A total of 15 studies were included, including 4854 patients. All studies were of high quality. This meta-analysis showed no statistically significant difference in the operation time, postoperative complications and 90-day hospitalisation rate between the two groups of patients. The harvested volume of lymph nodes, RFS and OS rate were not statistically different.

CONCLUSIONS: Among patients with BC undergoing radical cystectomy, extended lymph node dissection did not have a significant effect on operative time, 90-day readmission rates or postoperative complication rates. Thus, extended lymph node dissection is a safe treatment that does not increase the patient’s surgical risk.

PMID:38715172 | DOI:10.56434/j.arch.esp.urol.20247703.40

Arch Esp Urol. 2024 Apr;77(3):256-262. doi: 10.56434/j.arch.esp.urol.20247703.34.

ABSTRACT

OBJECTIVE: This study aimed to investigate the effect of electroacupuncture combined with pelvic floor muscle exercise in the treatment of female overactive bladder (OAB).

METHODS: The clinical data of 134 female patients with OAB admitted to our hospital from April 2022 to June 2023 were retrospectively analysed. The patients were divided into the combination group (n = 74) and the single group (n = 60). The general demographic data, total effective rate, pad weight, female sexual function index (FSFI) score, oxford muscle grading scale and incontinence impact questionnaire short form (IIQ-7) were collected. Propensity score matching (PSM) was used to match the baseline data of the two groups at 1:1 ratio, and t test, chi-square test and analysis of variance were used for calculation.

RESULTS: A total of 90 patients were selected after PSM. No significant difference in baseline data was found between the two groups (p > 0.05). Before treatment, no significant difference in FSFI score, oxford muscle grading scale and IIQ-7 score was found between the two groups (p > 0.05). The total effective rate of the combination group was higher than that of the single group (p < 0.05). After 3 weeks and 1 month of treatment, in addition to orgasm and sexual desire, the scores of sexual excitement and sexual satisfaction in the combination group were higher than those in the single group (p < 0.05). The combination group displayed higher oxford muscle grading scale and lower IIQ-7 and pad weight than the single group, and the differences were statistically significant (p < 0.05).

CONCLUSIONS: The effect of electroacupuncture stimulation combined with pelvic floor muscle exercise is more significant, which can alleviate urinary symptoms, reduce urine leakage, enhance pelvic floor muscle strength and alleviate sexual dysfunction.

PMID:38715166 | DOI:10.56434/j.arch.esp.urol.20247703.34

Arch Esp Urol. 2024 Apr;77(3):249-255. doi: 10.56434/j.arch.esp.urol.20247703.33.

ABSTRACT

OBJECTIVE: To study the effect of high-simulation teaching on nursing students’ learning knowledge related to stoma tube care after ureteral flexible mirror lithotripsy.

METHODS: A total of 80 nursing students who were admitted to our hospital from January 2020 to December 2022 were selected as the study objects. They were divided into the control group (traditional teaching) and observation group (high-simulation teaching based on traditional teaching) in accordance with teaching method. General demographic information and specialty theory, Objective Structured Clinical Examination, Chinese Critical Thinking Disposition Inventory, Teaching Quality Evaluation Scale and System for Evaluation of Teaching Qualities scores were collected from both groups of nursing students. Data were analysed with t– and chi-square tests.

RESULTS: The general demographics of the two groups were not statistically significantly different (p > 0.05). No significant differences in examination scores, clinical skills, thinking skills, teaching quality and nursing students’ satisfaction were found between the two groups before teaching (p > 0.05). Examination scores, clinical skills, thinking skills, teaching quality and nursing students’ satisfaction were higher in the observation group than in the control group after teaching (p < 0.05).

CONCLUSIONS: High-simulation teaching can effectively improve theoretical and clinical skill examination results, strengthen critical thinking, and improve teaching quality and nursing students’ overall satisfaction with teaching. Therefore, it has application value.

PMID:38715165 | DOI:10.56434/j.arch.esp.urol.20247703.33