Category: Statistics

Scand J Surg. 2023 Dec 25:14574969231220179. doi: 10.1177/14574969231220179. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Numerous studies have reported superior outcome for patients with hepatocellular carcinoma (HCC) in non-cirrhotic compared to cirrhotic livers. This cohort study aims to describe the clinical presentation, disease course, treatment approaches, and survival differences in a population-based setting.

METHODS: Data on patients diagnosed with HCC in Sweden between 2008 and 2018 were identified and extracted from the Swedish Liver registry (SweLiv). Descriptive and survival statistics were applied.

RESULTS: Among the 4259 identified patients, 34% had HCC in a non-cirrhotic liver. Cirrhotic patients presented at a younger age (median = 64 vs 74 years, p < 0.001) and with a poorer performance status (Eastern Cooperative Oncology Group (ECOG) = 0-1: 64% vs 69%, p = 0.024). Underlying liver disease was more prevalent among cirrhotic patients (81% vs 19%, p < 0.001). Tumors in non-cirrhotic livers were diagnosed at a more advanced stage (T3-T4: 46% vs 31%) and more frequently with metastatic disease at diagnosis (22% vs 10%, p < 0.001). Tumors were significantly larger in non-cirrhotic livers (median size of largest tumor 7.5 cm) compared to cirrhotic livers (3.5 cm) (p < 0.001). Curative interventions were more commonly intended (45% vs 37%, p < 0.001) and performed (40% vs 31%, p < 0.001) in the cirrhotic vs non-cirrhotic patients. Median survival was 19 months (95% confidence interval (CI) = 18-21 months), in patients with cirrhosis as compared to 13 months in non-cirrhotic patients (95% CI = 11-15) (p < 0.001). In the multivariable Cox regression model, cirrhosis was not an independent predictor of survival, neither among curatively nor palliatively treated patients.

CONCLUSION: These population-based data show that patients with HCC in a cirrhotic liver receive curative treatment to a greater extent and benefit from superior survival compared to those with HCC in a non-cirrhotic liver. The differences in survival are more attributable to patient and tumor characteristics rather than the cirrhotic status itself.

CLINICAL TRIAL REGISTRATION: not applicable. Patient confidentially: not applicable.

PMID:38145321 | DOI:10.1177/14574969231220179

PM R. 2023 Dec 25. doi: 10.1002/pmrj.13122. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantify the benefits versus harms of amantadine in the treatment of irritability and aggression following traumatic brain injury.

METHODS: Secondary outcome data from a randomized controlled multi-site trial of amantadine 100 mg twice daily were used to calculate Number-Needed-To-Treat (NNT). Given prior findings of positive clinician-perceived effects and low incidence of adverse events, we hypothesized low Number-Needed-To-Treat for Benefit (NNTB; high benefit) and high Number-Needed-To-Treat for Harm (NNTH; low risk) based on the clinician ratings, supporting the use of amantadine in clinical practice. Specifically, NNTB values were calculated using number of individuals with improvement on the Clinician Global Impressions-Global Improvement scale (GI). NNTB values were computed using number of individuals with worsening on the GI and experiencing serious and any adverse events.

RESULTS: Based on clinician ratings, on average for every 6 patients treated with amantadine rather than placebo, 1 extra patient would be expected to improve (NNTB=6.4; 95% CI: [3.3, 76.8]). More participants in the placebo group worsened than in the amantadine group, but the result was not statistically significant (NNTH=-92.4; 95% CI: [NNTB -32.9 to -infinity to NNTH -19.2]). The amantadine and placebo groups did not differ on the numbers of adverse events experienced during the trial.

CONCLUSION: Clinician ratings suggest modest benefit of amantadine 100mg twice daily with low risk to appropriately selected patients with adequate renal clearance. Thus, amantadine should be considered a treatment option for the experienced brain injury clinician. These data may support treatment decisions when a pharmaceutical agent is being considered to control irritability/aggression. This article is protected by copyright. All rights reserved.

PMID:38145314 | DOI:10.1002/pmrj.13122

Int J Psychiatry Clin Pract. 2023 Dec 25:1-8. doi: 10.1080/13651501.2023.2296889. Online ahead of print.

ABSTRACT

OBJECTIVES: To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data.

METHODS: The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model.

RESULTS: Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly.

CONCLUSIONS: Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.Key pointsDepressive symptoms are present in approximately 20% of older adults.More than 10% of older individuals with dementia or mild cognitive impairment report moderate-to-severe depressive symptoms.Female sex, lower education, lower cognitive performance, living in urban areas and treatment with psychotropic medication pertain to more severe depressive symptoms in ageing.Timely detection and effective treatment of depressive symptoms are crucial in the clinical practice of the care of older adults.Further research is needed in order to elucidate the complex relationship between depressive symptoms and cognitive impairment in ageing.

PMID:38145312 | DOI:10.1080/13651501.2023.2296889

Autism. 2023 Dec 25:13623613231216155. doi: 10.1177/13623613231216155. Online ahead of print.

ABSTRACT

Under the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), language impairment can co-occur with autism. It is not yet clear how research defines, reports, and characterizes structural language abilities of autistic individuals eligible for school-based special education services (aged 3-21 years) in the United States. In the United States, students typically must be formally diagnosed to be eligible for services and supports. However, the quality of diagnosis is only as good as the research evidence on which diagnosis depends. To evaluate evidence quality, we examined how studies of school-aged autistic individuals report assessments of language ability. This systematic review included 57 studies using English language age-referenced assessments used to measure structural language. Findings showed many differences across studies in how language abilities were measured and reported. Also, none of the studies fully reported the variables relevant to characterizing language impairment. Outcomes were similar across versions of the Diagnostic and Statistical Manual of Mental Disorders. Findings indicate that researchers and clinicians should pay attention to reporting diagnostic and grouping criteria. Carefully interpreting research evidence is critical for ensuring that diagnostic criteria and supports are representative of and accessible to autistic individuals and relevant parties.

PMID:38145307 | DOI:10.1177/13623613231216155

Vasc Health Risk Manag. 2023 Dec 19;19:837-853. doi: 10.2147/VHRM.S447936. eCollection 2023.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is the leading cause of a surge in hospital expenses for the treatment of strokes. However, evidence regarding clinical features and survival of patients admitted with acute ischemic stroke (AIS) plus AF in Ethiopia is lacking.

OBJECTIVE: We assess clinical characteristics, survival, and predictors of mortality of patients with acute ischemic stroke and atrial fibrillation among patients admitted to Tertiary Care Hospitals in Amhara regional state.

METHODS: A retrospective cohort study was done on patients diagnosed with AIS who received care at Tibebe Ghion and Felege Hiwot hospitals from November 2018 to November 2021. Data were analyzed using SPSS version 25. Cox regression analysis was used to identify predictors of in-hospital mortality. Kaplan-Meier analysis was used to identify survival rates and mean survival time. The hazard ratio was used as a measure of the strength of the association and statistical significance was declared at p-value <0.05.

RESULTS: Of 378 patients with AIS, 58.7% were male. AF was diagnosed in 102 (26.9%) patients. Compared with patients without AF, patients with AF were more likely to have Glasgow Coma Scale <8 (83.3 vs 4%), valvular heart disease (56.9 vs 4.7%), and coronary heart disease (11.8 vs 4%). Patients with AF had a significant incidence of in-hospital mortality (38 per 1000 vs 17 per 1000) person-days. Glasgow Coma Scale <8: (AHR=12.69, 95% CI: [2.603-61.873]), aspirational pneumonia (AHR=2.602, 95% CI: 1.085-6.242), acute renal failure (AHR=6.114, 95% CI: [1.817-20.576]), hypokalemia (AHR=1.179, 95% CI: [1.112,-3.373]), atrial fibrillation (AHR=1.104, 95% CI: [1.015-5.404]), HIV/AIDS (AHR=8.302, 95% CI: [1.585-43.502]) and chronic liver disease (AHR=4.969, 95% CI: [1.192-20.704]) were indicators of in-hospital mortality.

CONCLUSION: In the current study, hospital mortality was greater in AIS associated with atrial fibrillation. Stroke-related complications were significant predictors of mortality. Hence, effective strategies should be in place to curb the impacts of these factors.

PMID:38145253 | PMC:PMC10748565 | DOI:10.2147/VHRM.S447936

Front Glob Womens Health. 2023 Dec 7;4:1270261. doi: 10.3389/fgwh.2023.1270261. eCollection 2023.

ABSTRACT

BACKGROUND: The Maternal Mortality Rate (MMR) in Tanzania is 78 times higher than that of the UK. Obstetric haemorrhage accounts for two-thirds of these deaths in Mbeya, Tanzania. A lack of healthcare providers’ (HCPs’) competencies has been the key attribute. This study measured the impact on HCP’s competencies from a blended training programme on obstetric haemorrhage.

METHODS: A “before and after” cohort study was undertaken with HCPs in 4 hospitals in the Mbeya region of Tanzania between August 2021 and April 2022. A multidisciplinary cohort of 34 HCPs (doctors, nurses, midwives, anaesthetists and radiologists) were enrolled on a blended face-to-face and virtual training course. The training was delivered by a multidisciplinary team (MDT) from London, UK, assisted by local multidisciplinary trainers from Mbeya, Tanzania and covered anaesthetic, obstetrics, haematology and sonographic use.

RESULTS: There were 33 HCP in the cohort of trainees where 30/33 (90.9%) of HCPs improved their Anaesthesia skills with a mean score improvement of 26% i.e., 0.26 (-0.009 -0.50), 23 HCPs (69.7%) improved obstetric skills 18% i.e., 0.18 (-0.16 to 0.50), 19 (57.6%), (57.6%) improved competences in Haematology 15%.i.e., 0.15 (-0.33 to 0.87), 20 out of 29 HCPs with ultrasound access (68.8%) improved Sonographic skills 13%.i.e., 0.13 (-0.31 to 0.54). All 33 HCPs (100%) presented a combined change with the mean score improvement of difference of 25% i.e., 0.25 (0.05-0.66). The deaths attributed to obstetric haemorrhage, the mortality rate declined from 76/100,000 to 21/100,000 live births. Actual number of deaths due to obstetric haemorrhage declined from 8 before training to 3 after the completion of the training.

CONCLUSION: This comprehensive blended training on anaesthetic surgical, haematological, and sonographic management of obstetric haemorrhage delivers a significant positive impact on the detection, management and outcomes of obstetric haemorrhage.

PMID:38145250 | PMC:PMC10748492 | DOI:10.3389/fgwh.2023.1270261

J R Stat Soc Ser A Stat Soc. 2023 Mar 22;186(4):682-706. doi: 10.1093/jrsssa/qnad031. eCollection 2023 Oct.

ABSTRACT

Many demographic problems require models for partnership formation. We consider a model for matchings within a bipartite population where individuals have utility for people based on observed and unobserved characteristics. It represents both the availability of potential partners of different types and the preferences of individuals for such people. We develop an estimator for the preference parameters based on sample survey data on partnerships and population composition. We conduct simulation studies based on the Survey of Income and Program Participation showing that the estimator recovers preference parameters that are invariant under different population availabilities and has the correct confidence coverage.

PMID:38145242 | PMC:PMC10746550 | DOI:10.1093/jrsssa/qnad031

Explor Res Clin Soc Pharm. 2023 Nov 28;12:100381. doi: 10.1016/j.rcsop.2023.100381. eCollection 2023 Dec.

ABSTRACT

BACKGROUND: Deaths due to cardiovascular diseases is on the rise, with hypertension as its most important risk factor. Effective management of hypertension, however, remains a challenge. Globally, only one in five adults with hypertension have it under control. The situation is worse in sub-Saharan Africa where hypertension prevalence is highest. Telepharmacy presents a great opportunity to enhance the way we address hypertension management.

OBJECTIVES: This study sought to determine the effectiveness of pharmaceutical care interventions implemented through telepharmacy on medication adherence, practice of therapeutic lifestyles and overall blood pressure control among patients with hypertension.

METHODS: This was a randomized control trial conducted among individuals with hypertension recruited from two Ghanaian hospitals from May 2022 to December 2022. Patients with confirmed diagnosis of hypertension were recruited and assigned into a control or intervention group. Both groups were followed for six months with the intervention group receiving telepharmacy services in addition to standard clinical care. Outcome measures included changes in blood pressure, medication adherence, lifestyle modifications, identification and resolution of pharmaceutical care issues.

RESULTS: One hundred and eighteen (118) patients with hypertension were involved in the study. There was a statistically significant reduction in mean blood pressures for the intervention group after six months (Systolic-148.1 + 23.6, to 134.8 + 13.7, Diastolic- 85.8 + 9.8, to 79.5 + 8.7) (p < 0.05). The proportion of patients with adequately controlled blood pressure increased from 39.0% to 66.1%. There was also an increase in the mean adherence score (p < 0.05). The number of participants who adopted lifestyle modifications such as reducing salt consumption (89.5%) and exercising (77.2%) increased. The majority (87%) of all pharmaceutical care issues were identified and resolved over the six-month period.

CONCLUSION: Telepharmacy service provided via phone calls was effective in improving the control of blood pressure. It also promoted the practice of therapeutic lifestyle modifications, medication adherence and identification of pharmaceutical care issues among patients with hypertension.

PMID:38145235 | PMC:PMC10746503 | DOI:10.1016/j.rcsop.2023.100381

Front Artif Intell. 2023 Dec 5;6:1278593. doi: 10.3389/frai.2023.1278593. eCollection 2023.

ABSTRACT

Manual sleep staging (MSS) using polysomnography is a time-consuming task, requires significant training, and can lead to significant variability among scorers. STAGER is a software program based on machine learning algorithms that has been developed by Medibio Limited (Savage, MN, USA) to perform automatic sleep staging using only EEG signals from polysomnography. This study aimed to extensively investigate its agreement with MSS performed during clinical practice and by three additional expert sleep technicians. Forty consecutive polysomnographic recordings of patients referred to three US sleep clinics for sleep evaluation were retrospectively collected and analyzed. Three experienced technicians independently staged the recording using the electroencephalography, electromyography, and electrooculography signals according to the American Academy of Sleep Medicine guidelines. The staging initially performed during clinical practice was also considered. Several agreement statistics between the automatic sleep staging (ASS) and MSS, among the different MSSs, and their differences were calculated. Bootstrap resampling was used to calculate 95% confidence intervals and the statistical significance of the differences. STAGER’s ASS was most comparable with, or statistically significantly better than the MSS, except for a partial reduction in the positive percent agreement in the wake stage. These promising results indicate that STAGER software can perform ASS of inpatient polysomnographic recordings accurately in comparison with MSS.

PMID:38145233 | PMC:PMC10739507 | DOI:10.3389/frai.2023.1278593

Open Access Emerg Med. 2023 Dec 18;15:465-471. doi: 10.2147/OAEM.S439423. eCollection 2023.

ABSTRACT

PURPOSE: To examine the validity and predictability of thrombolysis in myocardial infarction (TIMI) risk and HEART scores in patients presenting to the emergency department (ED) with chest pain in Jordan (representative of the Middle East and North Africa Region, MENA).

PATIENTS AND METHODS: Risk scores were calculated for 237 patients presenting to the ED with chest pain. Patients were followed-up prospectively for the need for percutaneous coronary intervention, major adverse cardiovascular events, and all-cause mortality, looking for correlation and accuracy between the predicted cardiovascular risk from TIMI risk score and HEART score and the clinical outcome.

RESULTS: Of the 237 patients, approximately 77% were diagnosed with unstable angina and 23% diagnosed with non-ST elevation myocardial infarction (NSTEMI). about two thirds of the study population were smokers and known to have hypertension and dyslipidaemia. In 50 patients, the primary outcome (need for percutaneous coronary intervention (PCI) and/or major adverse cardiovascular events (MACE) at days 14 and 40, all-cause mortality) was observed. Regarding the predictability of the TIMI score, a larger number of events were observed in the study population than predicted. Patients with TIMI scores of 3 to 5 have about a 5-8% higher event rate than predicted.

CONCLUSION: Both TIMI and HEART risk scores were able to predict an elevated risk of major cardiovascular adverse events (MACE). The overall impression was that the TIMI risk score tended to underestimate risk in the study population.

PMID:38145228 | PMC:PMC10743701 | DOI:10.2147/OAEM.S439423