Category: Statistics

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):426-431. doi: 10.13201/j.issn.2096-7993.2024.05.015.

ABSTRACT

Objective:To analyze the characteristics of vocal fold movement and glottic closure in patients with laryngeal neurogenic injury. Methods:A total of 185 patients with vocal fold paralysis diagnosed by laryngeal electromyography as neurogenic damage to cricothyroid muscle, thyreoarytenoid muscle and posterior cricoarytenoid muscle were enrolled, they were divided into unilateral vocal fold paralysis group and bilateral vocal fold paralysis group, respectively, and superior laryngeal paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group according to nerve injury. The characteristics of vocal fold movement and glottic closure were analyzed under strobe laryngoscope. The qualitative evaluation of vocal fold movement was fixed vocal fold, reduced vocal fold movement and normal vocal fold movement, and the qualitative evaluation of glottic closure was glottic closure and glottic imperfection. The results were analyzed statistically. Results:The proportion of normal, reduced and fixed vocal fold motion in bilateral vocal fold paralysis group was significantly different from that in unilateral vocal fold paralysis group（P<0.05）, the composition of normal and reduced vocal fold motion in bilateral vocal fold paralysis group（47.70%） was significantly greater than that in unilateral vocal fold paralysis group（12.27%）. There was no significant difference between the proportion of glottic closure and glottic imperfecta in bilateral vocal fold paralysis group and unilateral vocal fold paralysis group（P<0.05）. The proportion of decreased vocal fold motion in superior laryngeal nerve paralysis group（50.00%） was higher than that in recurrent laryngeal nerve paralysis group（9.32%） and vagal nerve paralysis group（9.00%）. The proportion of decreased and fixed vocal fold motion in superior laryngeal nerve paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group was statistically significant（P<0.05）.There was no significant difference in glottic closure among the three groups（P<0.05）. Conclusion:Vocal fold movement characteristics of patients with laryngeal neurogenic injury were mainly vocal fold fixation, or normal or weakened vocal fold movement. There may be missed diagnosis of unilateral vocal fold paralysis in clinical practice. In half of the patients with superior laryngeal nerve palsy, vocal fold movement is characterized by vocal fold fixation.

PMID:38686482 | DOI:10.13201/j.issn.2096-7993.2024.05.015

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):391-394. doi: 10.13201/j.issn.2096-7993.2024.05.008.

ABSTRACT

Objective:To summarize and analyze the effect of facial nerve decompression surgery for the treatment of Bell’s palsy and Hunt syndrome. Methods:The clinical data of 65 patients with facial nerve palsy who underwent facial nerve decompression in our center from October 2015 to October 2022 were retrospectively analyzed, including 54 patients with Bell’s palsy and 11 patients with Hunter syndrome. The degree of facial paralysis（HB grade） was evaluated before surgery, and ENoG, pure tone audiometry, temporal bone CT and other examinations were completed. All patients had facial palsy with HB grade V or above after conservative treatment for at least 1 month, and ENoG decreased by more than 90%. All patients underwent facial nerve decompression surgery through the transmastoid approach within 3 months after onset of symptoms. The recovery effect of facial nerve function after surgery in patients with Bell’s palsy and Hunter syndrome was summarized and analyzed. In addition, 15 cases in group A（operated within 30-60 days after onset） and 50 cases in group B（operated within 61-90 days after onset） were grouped according to the course of the disease（the interval between onset of symptoms and surgery） to explore the effect of surgical timing on postoperative effect. Results:There was no significant difference between the two groups of patients with Chi-square test（P=0.54） in 42 patients（77.8%, 42/54） with Bell’s palsy and 7 patients（63.6%, 7/11） in patients with Hunter syndrome who recovered to grade Ⅰ-Ⅱ. According to the course of the disease, 10 cases（66.7%, 10/15） in group A recovered to grade Ⅰ-Ⅱ after surgery. In group B, 39 patients（78.0%, 39/50） recovered to grade Ⅰ-Ⅱ after surgery, and there was no statistically significant difference between the two groups by Chi-square test（P=0.58）. Conclusion:Patients with Bell’s palsy and Hunter syndrome can achieve good results after facial nerve decompression within 3 months of onset, and there is no significant difference in the surgical effect between the two types of patients.

PMID:38686475 | DOI:10.13201/j.issn.2096-7993.2024.05.008

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):376-379. doi: 10.13201/j.issn.2096-7993.2024.05.005.

ABSTRACT

Objective:To retrospectively analyze the effectiveness of transcranial facial nerve bridging in the treatment of facial nerve dysfunction. Methods:A retrospective analysis was conducted on 27 patients with facial nerve dysfunction who underwent transcranial facial nerve bridging at the Eye, Ear, Nose, and Throat Hospital affiliated with Fudan University from 2017 to 2022. The main collected data includes the patient’s age, gender, primary lesion, damaged location, interval from facial paralysis to surgery, and preoperative and postoperative House-Brackmann（HB） scale for facial nerve function. Statistical comparisons were made between the average HB level of patients before and after surgery. Results:A total of 27 patients included 17 males and 10 females. The average age of patients during surgery is（42.50±3.38） years old. Primary lateral skull base diseases include trauma（n=3）, tumors（n=22）, and infections（n=2）. The duration of facial paralysis varies from 6 months to 5 years. Statistics analysis has found that the average postoperative HB score of patients who underwent transcranial facial nerve bridging was significantly lower at（3.750 ± 0.183） compared to preoperative（4.875±0.168）. The proportion of patients with good facial nerve function increased significantly from 7.4% before surgery to 42.9% after surgery. Conclusion:Transcranial facial nerve bridging surgery with interpositional graft has a significant effect on improving facial nerve function in patients with facial nerve injury. Further research is still needed to evaluate the long-term effectiveness of this surgery, to determine the optimal patient selection criteria and postoperative rehabilitation strategies.

PMID:38686472 | DOI:10.13201/j.issn.2096-7993.2024.05.005

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):368-371;375. doi: 10.13201/j.issn.2096-7993.2024.05.003.

ABSTRACT

Objective:To summarize the results of different facial nerve management modalities applied to tumor resection in the jugular foramen region. Methods:The clinical data of 54 patients with tumors in the jugular foramen region who underwent surgery from January 2015 to March 2023 were retrospectively analyzed: 18 males and 36 females; Age ranges from 21 to 67 years, with an average age of 44.4 years; and median follow-up time: 12 months. The House-Brackmann（HB） grading system was applied to assess the patients’ facial nerve function before surgery, 1-2 weeks after surgery and at the final follow-up （HBⅠ-Ⅱ grade for good function）: 42 cases with preoperative HB grades Ⅰ-Ⅱ; partial facial nerve transposition（9 cases）, complete facial nerve transposition（28 cases）, and facial nerve excision and re-construction（17 cases） were used, respectively（stage Ⅰor Ⅱ）. Relevant factors affecting postoperative facial nerve function were analyzed. Results:Postoperative pathology confirmed 39 cases of paraganglioma, 9 cases of nerve sheath tumor, 3 cases of meningioma, and 1 case each of fibromucinous sarcoma, chondrosarcoma, and intravascular myofibroma. Facial nerve function after partial facial nerve transposition was HB grade Ⅰ-Ⅱ in 89%（8/9）; after complete facial nerve transposition was HB grade Ⅰ-Ⅱ in 86%（24/28） in 28 cases; after facial nerve severance and reconstruction was HB grade Ⅰ-Ⅱ in 2/7（Stage Ⅰ） and 0/3（Stage Ⅱ）, respectively. Tumor size and surgical approach were correlated with postoperative facial nerve function in patients with facial nerve transposition（P<0.05）. There was no statistically significant difference in facial nerve function after complete and partial facial nerve transposition（P>0.05）. Conclusion:Intraoperative stretching of the facial nerve may be an important factor affecting facial nerve function during surgical treatment of tumors in the jugular venous foramen region; for patients with facial nerve dissection, facial nerve reconstruction should be adopted according to the situation, aiming at the recovery of facial nerve function.

PMID:38686470 | DOI:10.13201/j.issn.2096-7993.2024.05.003

Vet Med Sci. 2024 May;10(3):e1457. doi: 10.1002/vms3.1457.

ABSTRACT

BACKGROUND: The aim of this study was to examine variations in stress, metabolic, and physiological parameters of horses used in the traditional equestrian team sport of Kök-Börü in relation to winning and losing outcomes.

MATERIAL AND METHODS: To accomplish this, blood samples were taken from horses on four different teams who participated in two separate games, both before and after game. These samples were used to measure levels of cortisol, ACTH, beta-endorphin, adrenaline, noradrenaline, triiodothyronine (T3), and thyroxine (T4) via species-specific commercial ELISA kits. The autoanalyzer tested biochemical and hematological parameters. The gathered data were then analyzed statistically based on the teams’ winning or losing status.

RESULTS: The results suggested that winning teams had lower MID, red blood cell, HGB, RDW-SD, HCT, platelet distribution width, and creatine kinase values post-game in comparison to their pre-game state. Conversely, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH), and CREA values increased in the winning teams’ post-game. Additionally, horses in the winning teams showed a decrease in cortisol, beta-endorphin, and ACTH levels post-game but increased levels of adrenaline and T3. Considering the pre-game values, it was found that GRA and Cl levels were lower in the winning teams. Before the game, adrenaline and T3 levels were higher in the winning teams. No significant difference was observed in post-game hematological parameters between the teams. However, post-game K, adrenaline, and noradrenaline levels were higher among the winning teams’ horses, while cortisol and beta-endorphin levels were heightened in horses from the losing side.

CONCLUSION: In conclusion, significant differences were not observed in the distribution of hematological and biochemical parameters of horses following the Kök-Börü games, regardless of the outcome. However, decreased post-game cortisol, ACTH, and beta-endorphin levels in winning teams may suggest better stress management abilities among these horses.

PMID:38686465 | DOI:10.1002/vms3.1457

BMJ Open Qual. 2024 Apr 29;13(2):e002649. doi: 10.1136/bmjoq-2023-002649.

ABSTRACT

Utilisation rates for healthcare services vary widely both within and between nations. Moreover, healthcare providers with insurance-based reimbursement systems observe an effect of social determinants of health on healthcare utilisation rates and outcomes. Even in countries with publicly funded universal healthcare such as Norway, utilisation rates for medical and surgical interventions vary between and within health regions and hospitals.Most interventions targeting overuse and high utilisation rates are based on the assumption that knowledge of areas of unwarranted variation in healthcare automatically will lead to a reduction in unwarranted variation. Recommendations regarding how to reduce this variation are often not very detailed or prominent.This paper describes a protocol for reducing the overuse of upper endoscopy in a Norwegian health region. The protocol uses a combination of digital tools and psychological methods targeting behavioural change in order to alter healthcare workers’ approach to patient care.The aim of the planned intervention is to evaluate the effectiveness of a multifaceted set of interventions to reduce the overuse of upper endoscopy in patients under 45 years. A secondary aim is to evaluate the specific effect of the various parts of the intervention.

PMID:38684346 | DOI:10.1136/bmjoq-2023-002649

BMJ Open Qual. 2024 Apr 29;13(2):e002265. doi: 10.1136/bmjoq-2023-002265.

ABSTRACT

Caesarean section is the most common inpatient surgery in the USA, with more than 1.1 million procedures in 2020. Similar to other surgical procedures, healthcare providers rely on opioids for postoperative pain management. However, current evidence shows that postpartum patients usually experience less pain due to pregnancy-related physiological changes. Owing to the current opioid crisis, public health agencies urge providers to provide rational opioid prescriptions. In addition, a personalised postoperative opioid prescription may benefit racial minorities since research shows that this population receives fewer opioids despite greater pain levels. Our project aimed to reduce inpatient opioid consumption after caesarean delivery within 6 months of the implementation of an opioid stewardship programme.A retrospective analysis of inpatient opioid consumption after caesarean delivery was conducted to determine the baseline, design the opioid stewardship programme and set goals. The plan-do-study-act method was used to implement the programme, and the results were analysed using a controlled interrupted time-series method.After implementing the opioid stewardship programme, we observed an average of 80% reduction (ratio of geometric means 0.2; 95% CI 0.2 to 0.3; p<0.001) in inpatient opioid consumption. The institution designated as control did not experience relevant changes in inpatient opioid prescriptions during the study period. In addition, the hospital where the programme was implemented was unable to reduce the difference in inpatient opioid demand between African Americans and Caucasians.Our project showed that an opioid stewardship programme for patients undergoing caesarean delivery can effectively reduce inpatient opioid use. PDSA, as a quality improvement method, is essential to address the problem, measure the results and adjust the programme to achieve goals.

PMID:38684344 | DOI:10.1136/bmjoq-2023-002265

Int J Epidemiol. 2024 Apr 11;53(3):dyae049. doi: 10.1093/ije/dyae049.

NO ABSTRACT

PMID:38684341 | DOI:10.1093/ije/dyae049

Inj Prev. 2024 Apr 29:ip-2023-045206. doi: 10.1136/ip-2023-045206. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine trends in hospitalisation following drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic.

DESIGN: Retrospective analysis of administrative hospital admission records.

SETTING: Hospital admissions recorded in the Victorian Admitted Episodes Dataset.

PARTICIPANTS: Hospital-admitted patients with ≥1 drowning-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis code.

MAIN OUTCOME MEASURES: Incidence and incidence rate ratios (IRR; 95% CIs) of hospital-admitted drowning that occurred before (July 2017 to June 2019), during (July 2019 to June 2021) and after (July 2021 to June 2022) the onset of the COVID-19 pandemic.

RESULTS: There were 736 hospital admissions related to drowning in the study period; the incidence was 2.6 per 100 000 population pre-COVID-19 and dropped to 2.0 per 100 000 during (2019/2020-2020/2021) and after (2021/2022) the onset of the pandemic. Among Victorian residents, drowning was positively associated with younger age, male sex and regional/remote residence. Drowning was negatively associated with the onset of COVID-19 (IRR 0.76 (0.64, 0.90)) as well as the post-COVID-19 period (0.78 (0.64, 0.97)), compared with pre-COVID-19. Natural water drowning rates were consistently higher than pool or bathtub drowning rates. Pool or bathtub drowning rates decreased with the onset of COVID-19; no significant change was observed in the natural water drowning rate.

CONCLUSIONS: Pool and bathtub drowning rates declined since the onset of the COVID-19 pandemic, despite more time spent at home, while natural water drowning rates remained consistently high. Hospital admissions provide a valuable data source for monitoring of drowning, which is crucial to ensure a targeted, evidence-based approach to mitigate drowning risk.

PMID:38684336 | DOI:10.1136/ip-2023-045206

BMJ Paediatr Open. 2024 Apr 29;8(Suppl 2):e002573. doi: 10.1136/bmjpo-2024-002573.

ABSTRACT

BACKGROUND: Exclusive breastfeeding (EBF) is a major public health problem in Ethiopia. However, the spatial variation of EBF and the associated factors have not been studied as much as we have searched. This study aimed at assessing geospatial variation and the predictors of EBF using geographically weighted regression.

METHODS: A cross-sectional study was conducted using the 2019 Mini-Ethiopian Demographic and Health Survey data set. The study used a total weighted sample of 548 infants. Hotspot spatial analysis showed the hotspot and cold spot areas of EBF. The spatial distribution of EBF was interpolated for the target population using spatial interpolation analysis. SaTScan V.9.6 software was used to detect significant clusters. Ordinary least squares regression analysis identified significant spatial predictors. In geographically weighted regression analysis, the effect of predictor variables on the spatial variation of EBF was detected using local coefficients.

RESULTS: The weighted prevalence of EBF in Ethiopia was 58.97% (95% CI 52.67% to 64.99%), and its spatial distribution was found to be clustered (global Moran’s I=0.56, p<0.001). Significant hotspot areas were located in Amhara, Tigray, Southern Nations, Nationalities, and Peoples’ Region, and Somali regions, while significant cold spots were located in Dire Dawa, Addis Ababa and Oromia regions. Kulldorff’s SaTScan V.9.6 was used to detect significant clusters of EBF using a 50% maximum cluster size per population. The geographically weighted regression model explained 35.75% of the spatial variation in EBF. The proportions of households with middle wealth index and married women were significant spatial predictors of EBF.

CONCLUSION: Middle wealth index and married women were significant spatial predictors of EBF. Our detailed map of EBF hotspot areas will help policymakers and health programmers encourage the practice of EBF in hotspot areas and set national and regional programmes focused on improving EBF in cold spots by considering significant predictor variables.

PMID:38684333 | DOI:10.1136/bmjpo-2024-002573