Category: Statistics

Turk J Anaesthesiol Reanim. 2023 Dec 27;51(6):477-484. doi: 10.4274/TJAR.2023.231328.

ABSTRACT

OBJECTIVE: Numerous studies performed worldwide indicate that the public has limited knowledge of anaesthesia practices and anaesthetists’ duties and responsibilities. This study aimed to identify the level of knowledge about anaesthetists and anaesthesia practices, and to assess the reasons for anxiety about anaesthesia of the population admitted to our hospital, which is tertiary in Turkey. The secondary aim was to analyze their differences according to sex, education level, and acquired anaesthesia experience.

METHODS: A survey comprising 23 questions was administered to 400 patients and/or their relatives, aged 18-85 years, who presented to our clinic for preoperative anaesthesia evaluation and for whom elective surgery was planned from March through October 2017.

RESULTS: Of the 400 participants, 213 were women and 187 were men. Of all participants in the survey, 51.2% were patients and 48.8% were patient relatives; 64.2% had anaesthesia experience and 35.8% had never had anaesthesia before. The survey group’s level of knowledge about anaesthesia was generally low. According to education level, there was a statistically significant difference in the anaesthesia recognition level. However, the acquired anaesthesia experience did not affect the anaesthesia recognition level.

CONCLUSION: To raise the level of knowledge about this topic, anaesthetists must provide patients with more detailed information during preoperative and postoperative visits, which would significantly reduce their anxiety levels. Further, we determined that increasing the use of methods such as media-based brochures, booklets, and videos to inform patients may increase knowledge levels and reduce anxiety levels.

PMID:38149358 | DOI:10.4274/TJAR.2023.231328

Microsurgery. 2023 Dec 27. doi: 10.1002/micr.31139. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic osteomyelitis is an invalidating disease, and its severity grows according to the infection’s particular features. The Cierny-Maiden criteria classify it according to the anatomical aspects (I to IV) and also by physiological class (A host being in good immune condition and B hosts being locally (L) or systemically (S) compromised). The surgical approach to chronic osteomyelitis involves radical debridement and dead space reconstruction. Two-stage management with delayed reconstruction is the most common surgical management, while one-stage treatment with concomitant reconstruction is a more aggressive approach with less available literature. Which method gives the best results is unclear. The purpose of this study is to compare single and two-stage techniques.

METHODS: The authors carried out a retrospective multicentric cohort study to compare two primary outcomes (bone union and infection healing) in one versus two-stage reconstructions with vascularized bone flaps in 23 cases of limb osteomyelitis (22 patients, 23 extremities). Thirteen subjects (56.5%) sustained a single-stage treatment consisting of a single surgery of radical debridement, concomitant soft tissue coverage, and bone reconstruction. Ten cases (43.5%) sustained a two-stage approach: radical debridement, simultaneous primary soft tissue closure, and antibiotic PMMA spacers implanted in 7 patients.

RESULTS: No statistical differences were observed between one- and two-stage approaches in bone union rate and infection recurrence risk. Even though bone union seems to be higher and faster in the two-stage than in the one-stage group, and all infection relapses occurred in the one-stage group, data did not statistically confirm these differences. Two of the six cases (33.3%) of bone nonunion occurred in compromised hosts (representing only 17.4% of our sample). The B-hosts bone union rate was 50.0%, while it reached 78.9% in A-hosts, but the difference was not statistically significant (p = .5392). Infection recurrence was higher in B-hosts than in A-hosts (p = .0086) and in Pseudomonas aeruginosa sustained infections (p = .0208), but in the latter case, the treatment strategy did not influence the outcome (p = .4000).

CONCLUSIONS: Bone union and infection healing rates are comparable between one and two-stage approaches. Pseudomonas aeruginosa infections have a higher risk of infection relapse, with similar effectiveness of one- and two-stage strategies. B-hosts have a higher infection recurrence rate without comparable data between the two approaches. Further studies with a larger sample size are required to confirm our results and define B-hosts’ best strategy.

LEVEL OF EVIDENCE: Level III of evidence, retrospective cohort study investigating the results of treatments.

PMID:38149353 | DOI:10.1002/micr.31139

Stat Med. 2023 Dec 27. doi: 10.1002/sim.9982. Online ahead of print.

ABSTRACT

Nearly 300,000 older adults experience a hip fracture every year, the majority of which occur following a fall. Unfortunately, recovery after fall-related trauma such as hip fracture is poor, where older adults diagnosed with Alzheimer’s disease and related dementia (ADRD) spend a particularly long time in hospitals or rehabilitation facilities during the post-operative recuperation period. Because older adults value functional recovery and spending time at home versus facilities as key outcomes after hospitalization, identifying factors that influence days spent at home after hospitalization is imperative. While several individual-level factors have been identified, the characteristics of the treating hospital have recently been identified as contributors. However, few methodological rigorous approaches are available to help overcome potential sources of bias such as hospital-level unmeasured confounders, informative hospital size, and loss to follow-up due to death. This article develops a useful tool equipped with unsupervised learning to simultaneously handle statistical complexities that are often encountered in health services research, especially when using large administrative claims databases. The proposed estimator has a closed form, thus only requiring light computation load in a large-scale study. We further develop its asymptotic properties with stabilized inference assisted by unsupervised clustering. Extensive simulation studies demonstrate superiority of the proposed estimator compared to existing estimators.

PMID:38149345 | DOI:10.1002/sim.9982

Cardiol Young. 2023 Dec 27:1-7. doi: 10.1017/S1047951123004195. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aimed to investigate the relationship between unexplained chest pain in children with parents’ mental problems, parental attitudes, family functionality, and the child’s mental problems.

MATERIAL AND METHOD: A total of 433 children (between 11 and 18 years of age) applied to the Pediatric Cardiology Outpatient Clinic due to chest pain in the last year. A clinical interview was conducted by a child psychiatrist with 43 patients and 33 controls included in the study due to unexplained chest pain.

RESULTS: Family history of physical illness was significantly higher in the chest pain group. When evaluated in terms of psychosocial risk factors, life events causing difficulties, derangement in the family, loss of a close person, and exposure to violence were statistically significantly higher in the group with chest pain. Mental disorders were observed in 67.4% of the children in the chest pain group as a result of the clinical interview. The total score of the DSM-5 somatic symptoms scale, which evaluates other somatic complaints in the chest pain group, was also significantly higher. When the family functions of both groups were evaluated, communication, emotional response, behaviour control, and general functions sub-dimensions were statistically significantly higher in families in the chest pain group.

CONCLUSION: We recommend that psychiatric evaluation be included in diagnostic research to prevent unnecessary medical diagnostic procedures in children describing unexplained chest pain, as well as to prevent the potential for diagnosing mental disorders in both children and adults.

PMID:38149344 | DOI:10.1017/S1047951123004195

Health Econ. 2023 Dec 26. doi: 10.1002/hec.4791. Online ahead of print.

ABSTRACT

The cost effectiveness of medical treatments is not precisely known due to the compounding effect of multiple determining factors. Ambulance response time (RT) to emergency calls is exploited to learn more about the effect of the timing of treatment on health outcomes. This causal relation is identified by exploiting rainfall at the time of the ambulance run as a shock to RT. The analysis focuses on patients who have undergone a cardiac event and shows that a one-minute increase in average RT leads to 105 more deaths each year in one Italian region. Finally, the economic value of the lives that would be saved by reducing RT is quantified to facilitate policymaking.

PMID:38148482 | DOI:10.1002/hec.4791

Ther Innov Regul Sci. 2023 Dec 26. doi: 10.1007/s43441-023-00598-y. Online ahead of print.

ABSTRACT

BACKGROUND: In 2016, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use updated its efficacy guideline for good clinical practice and introduced predefined quality tolerance limits (QTLs) as a quality control in clinical trials. QTLs are complementary to Quality by Design (QbD) principles (ICH-E8) and are one of the components of the risk-based clinical trial quality management system.

METHODS: Currently the framework for QTLs process is well established, extensively describing the operational aspects of Defining, Monitoring and Reporting, but a single source of commonly used methods to establish QTLs and secondary limits is lacking. This paper will primarily focus on closing this gap and include applications of statistical process control and Bayesian methods on commonly used study level quality parameters such as premature treatment discontinuation, study discontinuation and significant protocol deviations as examples.

CONCLUSIONS: Application of quality tolerance limits to parameters that correspond to critical to quality factors help identify systematic errors. Some situations pose special challenges to implementing QTLs and not all methods are optimal in every scenario. Early warning signals, in addition to QTL, are necessary to trigger actions to further minimize the possibility of an end-of-study excursion.

PMID:38148473 | DOI:10.1007/s43441-023-00598-y

Odontology. 2023 Dec 26. doi: 10.1007/s10266-023-00875-0. Online ahead of print.

ABSTRACT

AIM: To evaluate the bleaching efficacy and effects on enamel properties of experimental gels with carbamide peroxide (CP; 10%) or hydrogen peroxide (HP; 6%) containing calcium polyphosphate sub-microparticles (CaPPs).

METHODS: A total of 216 bovine tooth specimens were divided for microhardness and color analyses (n = 108) and block randomized into nine groups (n = 12): (G1) commercial CP (Whiteness Perfect, FGM; Brazil); (G2) experimental CP; (G3) CP-0.5%CaPPs; (G4) CP-1.5%CaPPs; (G5) commercial HP (Potenza Bianco, PHS; Brazil); (G6) experimental HP; (G7) HP-0.5%CaPPs; (G8) HP-1.5%CaPPs; (G9) artificial saliva. The gels’ pH values were determined with a bench pH meter. Color (ΔE, ΔE₀₀, ΔWI_D) and microhardness variation were evaluated before and after the therapy. Part of the specimens used for microhardness was submitted to the scanning electron microscopy (SEM) (n = 3) and energy-dispersive X-ray spectroscopy EDX (n = 3) analyses. Statistical analyses were performed in the R statistical software (α = 0.05). Linear mixed models for repeated measures in time were used to analyze microhardness and L* values. Generalized linear models were used to analyze the a*, b*, ΔE, ΔE₀₀, and ΔWI_D, considering a group effect. The EDX data were analyzed using a one-way ANOVA with Tukey’s test.

RESULTS: The gels’ pH remained over 6,0. All gels effectively bleached the specimens and did not differ significantly. When compared to the control group, the hardness was significantly lower in the G1, G2, G6, and G7 groups. The G3, G4, G5, and G8 groups did not differ significantly (p > 0.05).

CONCLUSION: The incorporation of CaPPs in low-concentration whitening gels reduces its negative effects on microhardness without interfering with their bleaching efficacy.

PMID:38148447 | DOI:10.1007/s10266-023-00875-0

Behav Res Methods. 2023 Dec 26. doi: 10.3758/s13428-023-02242-x. Online ahead of print.

ABSTRACT

Semantic feature production norms have several desirable characteristics that have supported models of representation and processing in adults. However, several key challenges have limited the use of semantic feature norms in studies of early language acquisition. First, existing norms provide uneven and inconsistent coverage of early-acquired concepts that are typically produced and assessed in children under the age of three, which is a time of tremendous growth of early vocabulary skills. Second, it is difficult to assess the degree to which young children may be familiar with normed features derived from these adult-generated datasets. Third, it has been difficult to adopt standard methods to generate semantic network models of early noun learning. Here, we introduce Feats-a tool that was designed to make headway on these challenges by providing a database, the Language Learning and Meaning Acquisition (LLaMA) lab Noun Norms that extends a widely used set of feature norms McRae et al. Behavior Research Methods 37, 547-559, (2005) to include full coverage of noun concepts on a commonly used early vocabulary assessment. Feats includes several tools to facilitate exploration of features comprising early-acquired nouns, assess the developmental appropriateness of individual features using toddler-accessibility norms, and extract semantic network statistics for individual vocabulary profiles. We provide a tutorial overview of Feats. We additionally validate our approach by presenting an analysis of an overlapping set of concepts collected across prior and new data collection methods. Furthermore, using network graph analyses, we show that the extended set of norms provides novel, reliable results given their enhanced coverage.

PMID:38148439 | DOI:10.3758/s13428-023-02242-x

Hernia. 2023 Dec 26. doi: 10.1007/s10029-023-02925-6. Online ahead of print.

ABSTRACT

PURPOSE: As the global population continues to age, there is a noticeable yearly rise in the incidence of hernias. Simultaneously, smoking, a widespread addictive behavior and a significant contributor to mortality, has evolved into a pervasive public health concern. Existing literature has already established a connection between smoking and an increased risk of postoperative recurrence and postoperative infections following hernia surgery. However, there remains a dearth of research exploring the association between smoking and hernia morbidity. In this study, our objective is to systematically evaluate the causal relationship between cigarette smoking behaviors and hernia morbidity using a Mendelian randomization (MR) approach.

METHODS: Hernia-related data were sourced from the FinnGen Biobank database, while cigarette smoking behavior data were gathered from the GWAS and Sequencing Consortium of Alcohol and Nicotine Use. To assess the causal relationship, we employed five methods: the weighted median, the weighted mode the inverse variance weighted (IVW), MR-Egger, and the simple mode. Sensitivity analysis was conducted, incorporating Cochran’s Q test, the MR-Egger intercept test, leave-one-out analysis, and funnel plot. The presentation of the causal relationship is expressed as an odds ratio (OR) along with their corresponding 95% confidence intervals (CI).

RESULTS: Employing the IVW method as the reference standard, we found that smoking intensity is associated with an increased risk of diaphragmatic hernia (OR = 1.21, 95% CI 1.00-1.46, P = 0.047). These consistent findings were further corroborated by the weighted median and weighted mode methods (OR = 1.26, 95% CI 1.03-1.54, P = 0.026; OR = 1.25, 95% CI 1.02-1.52, P = 0.045). Conversely, when applying the IVW method, we identified no statistically significant causal relationship between smoking age, smoking initiation status, smoking cessation status, and the incidence of hernia.

CONCLUSIONS: Our MR study has uncovered genetic evidence linking smoking intensity and the occurrence of diaphragmatic hernia. The risk of developing diaphragmatic hernia rises in tandem with the intensity of smoking. This emphasizes the crucial role of regularly advising patients to cease smoking in clinical settings.

PMID:38148419 | DOI:10.1007/s10029-023-02925-6

Med Biol Eng Comput. 2023 Dec 27. doi: 10.1007/s11517-023-02989-7. Online ahead of print.

ABSTRACT

Thermography, as a harmless modality, thanks to its low equipment complexity in parallel with quick and cheap access, has been able to come up as a method with significant potential in the diagnosis of some cancers in recent years. However, the complexity of the images resulting from this method has caused the use of deep learning to interpret thermograms. A limiting factor in this process is the strong dependence of deep learning methods on the number of training data, which is a serious challenge in thermography due to the young age of this technology and the lack of available images. In this paper, an attempt is made to reduce the above challenge by utilizing the concept of statistical learning in such a way that the statistical distribution of the original data is estimated by using generative adversarial networks (i.e., GAN). Then, several fake images are reconstructed based on the estimated distribution in order to increase the training thermograms. Since the fake images are reconstructed based on similar statistics of real thermograms in each class, the effective features of each class are preserved to a significant extent in the reconstruction process. The use of this method indicates a significant improvement in the separation of healthy and cancerous thermograms compared to the benchmark method which does not use the concept of GAN in such a way that characteristics of sensitivity and accuracy are improved in ranges of 3-9% and 3-7%, respectively. In terms of specificity, although we have seen an improvement of up to 9%, in some cases, small drops of up to 2% have also been observed, which can still be justified due to the significant improvement in sensitivity and accuracy.

PMID:38148414 | DOI:10.1007/s11517-023-02989-7