Category: Statistics

Clin Ther. 2023 Dec 16:S0149-2918(23)00431-9. doi: 10.1016/j.clinthera.2023.11.001. Online ahead of print.

ABSTRACT

PURPOSE: Major adverse drug reactions (ADRs) are the leading causes of poor adherence, switching of drugs, morbidity, and mortality. A limited studies was conducted to investigate major ADR in developing countries including Ethiopia, and the purpose of this study was to assess the incidence and predictors of major ADRs among HIV-infected children receiving antiretroviral therapy (ART) in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia.

METHODS: An institutional-based retrospective follow-up study was conducted among 460 children receiving ART from January 1, 2014 to December 31, 2021. A simple random sampling technique was employed, and data were collected using Kobo Toolbox software and then deployed to STATA 14 for analysis. The Kaplan-Meier survival curve and the log-rank test were used to estimate and compare survival times. Both bivariable and multivariable Weibull regression models were fitted to identify predictors. Finally, an adjusted hazards ratio (AHR) with a 95% CI was computed, and variables with P < 0.05 were considered statistically significant predictors of major ADR.

FINDINGS: The overall incidence rate of major ADRs was 5.8 (95% CI, 4.6-7.3) per 1000 child months. Being female (AHR, 2.71; 95% CI, 1.52-4.84), tuberculosis (TB)-HIV co-infection (AHR, 2.49; 95% CI, 1.32-4.68), World Health Organization stage (III and IV) (AHR, 2.52; 95% CI, 1.39-4.56), zidovudine-based (AHR, 2.84; 95% CI, 1.11-7.31), and stavudine-based (AHR, 5.96; 95% CI, 1.63-21.84) regimens were found to be significant predictors of major ADRs.

IMPLICATIONS: The major ADR incidence rate was high. Health professionals should employ early screening and close follow-up for children with advanced World Health Organization clinical staging, females, those with TB-HIV co-infection, and those receiving stavudine- and zidovudine-based initial regimens to reduce the incidence of major ADRs.

PMID:38105175 | DOI:10.1016/j.clinthera.2023.11.001

Cont Lens Anterior Eye. 2023 Dec 16:102106. doi: 10.1016/j.clae.2023.102106. Online ahead of print.

ABSTRACT

PURPOSE: RigidCare is an electrolysis-based device that recently obtained approval from the US’s FDA to sterilise microorganisms and remove proteins for orthokeratology (O-K) lenses. The study was conducted to investigate the device’s performance in varied clinical circumstances.

METHODS: Trial lenses and private lenses were employed by O-K lens wearers from five hospitals for an evaluation of disinfection and sterilisation and an assessment of protein removal, respectively. Menicon multipurpose solution and protein remover were selected for use with the control group. Following the instructions, pre-cleaning lens samples, post-cleaning lens samples and residual solution samples of trial lenses of the experimental and control groups were collected for microorganism examinations by an experienced third-party testing organisation. The levels of protein deposition for these two approaches were rated by senior O-K experts. Categorical variables were analysed using statistical tests, such as the chi-squared test and Fisher’s exact test.

RESULTS: The microbial positive rate detected from the pre-cleaning and post-cleaning lens samples and the residual solution of the trial lenses for the experimental and control group was 4/76 vs 1/74 (P = 0.37), 1/76 vs 0/74 (P = 1.00) and 0/76 vs 8/74 (P = 0.006), respectively. Following protein removal, the experimental group exhibited a significantly higher overall proportion of lenses rated as ‘clean’ or with a ‘mild deposit’ (96.4 %, 79/82) compared to the control group (85.7 %, 66/77), with a significant difference (P < 0.05).

CONCLUSION: This multi-center study demonstrated that RigidCare exhibited superior efficacy in disinfection, sterilisation and protein removal as compared to Menicon multipurpose solution and protein remover.

PMID:38105172 | DOI:10.1016/j.clae.2023.102106

Surgeon. 2023 Dec 16:S1479-666X(23)00142-7. doi: 10.1016/j.surge.2023.11.008. Online ahead of print.

ABSTRACT

BACKGROUND: There is a trend for specialist care in breast surgery resulting in fewer primary operative cases for general surgery trainees; and subsequently that trainees performing advanced oncoplastic techniques in breast surgery may negatively impact patient morbidity. We have reviewed the complication rates between Australian general surgery trainees and Breast Consultants.

METHODS: A retrospective analysis was performed over a 5-year period (January 2016-December 2021). The key endpoints measured were relative complication rates for consultants compared to trainees, subdivided by surgery type. Surgeries were categorised as either benign, primary breast cancer surgery or re-excision.

RESULTS: A total of 2646 operative cases were performed with the primary operator rate for consultants 58.35 % (n = 1544) and for trainees 41.65 %% (n = 1102). The overall complication rate was 2.83 % (n = 75); the overall rate for the consultants was 2.65 % and 3.08 % for the trainees. The complication rates were not statistically significant (p = 0.59) between the two groups. The mastectomy only complication rate was higher in the consultant group with a result of 7.3 % compared to 2.8 % for the trainees however was not statistically significant (p = 0.18). The most common complication was haematoma formation for both groups.

CONCLUSIONS: This study has demonstrated that trainees can safely perform advanced oncoplastic techniques without statistically elevated morbidity. In an era where breast surgery caseloads are increasing, but the exposure to breast surgery during training are decreasing, it is necessary to implement a practice where trainees can perform breast operations under supervision at a specialized unit.

PMID:38105134 | DOI:10.1016/j.surge.2023.11.008

J Cardiothorac Vasc Anesth. 2023 Nov 19:S1053-0770(23)00931-X. doi: 10.1053/j.jvca.2023.11.024. Online ahead of print.

ABSTRACT

OBJECTIVES: It is unknown whether there is a difference in pulmonary outcome in different intraoperative ventilation modes for cardiac surgery with cardiopulmonary bypass (CPB). The aim of this trial was to determine whether patients undergoing cardiac surgery with CPB could benefit from intraoperative optimal ventilation mode.

DESIGN: This was a single-center, prospective, randomized controlled trial.

SETTING: The study was conducted at a single-center tertiary-care hospital.

PARTICIPANTS: A total of 1,364 adults undergoing cardiac surgery with CPB participated in this trial.

INTERVENTIONS: Patients were assigned randomly (1:1:1) to receive 1 of 3 ventilation modes: volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure-controlled ventilation-volume guaranteed (PCV-VG). All arms of the study received the lung-protective ventilation strategy.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite of postoperative pulmonary complications (PPCs) within the first 7 postoperative days. Pulmonary complications occurred in 168 of 455 patients (36.9%) in the PCV-VG group, 171 (37.6%) in the PCV group, and 182 (40.1%) in the VCV group, respectively. There was no statistical difference in the risk of overall pulmonary complications among groups (p = 0.585). There were no significant differences in the severity grade of PPCs within 7 days, postoperative ventilation duration, intensive care unit stay, postoperative hospital stay, or 30-day postoperative mortality.

CONCLUSIONS: Among patients scheduled for cardiac surgery with CPB, intraoperative ventilation mode type did not affect the risk of postoperative pulmonary complications.

PMID:38105126 | DOI:10.1053/j.jvca.2023.11.024

Int J Occup Saf Ergon. 2023 Dec 17:1-33. doi: 10.1080/10803548.2023.2294627. Online ahead of print.

ABSTRACT

ABSTRACTThis systematic review and meta-analysis study aimed to explore the global prevalence of MSDs among firefighters. A systematical search was performed in three international academic databases (Scopus, PubMed, and Web of Science). Overall, 31 articles were included in this review. The pooled prevalence of total MSDs in firefighters was identified as 41% (95% CI (33, 50)). The prevalence of MSDs in neck, shoulders, upper back, lower back, upper extremity, and lower extremity was 9% (95% CI (7, 10)), 11% (95% CI (8, 15)), 8% (95% CI (5, 12)), 31% (95% CI (27, 34)), 13% (95% CI (9, 17)), and 16% (95% CI (14, 18)), respectively. No statistically significant relationship was observed between prevalence of MSDs and year of study, mean of age, size of sample, duration of prevalence, region, or income level. The demographic, occupational, and medical condition factors were identified that can create these disorders among firefighters.

PMID:38105113 | DOI:10.1080/10803548.2023.2294627

Am J Emerg Med. 2023 Dec 10;77:72-76. doi: 10.1016/j.ajem.2023.12.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the rates of clinically significant tachyarrhythmias and mortality in the management of post-resuscitative shock after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) who receive a continuous epinephrine versus norepinephrine infusion.

DESIGN: Retrospective cohort study.

SETTING: A large multi-site health system with hospitals across the United States.

PATIENTS: Adult patients admitted for OHCA with post-resuscitative shock managed with either epinephrine or norepinephrine infusions within 6 h of ROSC.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Between May 5^th, 2018, to January 31^st, 2022, there were 221 patients admitted for OHCA who received post-resuscitative epinephrine or norepinephrine infusions. There was no difference in the rate of tachyarrhythmias between epinephrine and norepinephrine infusion in univariate (47.1% vs 41.7%, OR 1.24, 95% CI 0.71-2.20) or multivariable analysis (OR 1.34, 95% CI 0.68-2.62). Patients treated with epinephrine were more likely to die during hospitalization than those treated with norepinephrine (90.0% vs 54.3%, OR 6.21, 95% CI 2.37-16.25, p < 0.001). Epinephrine treated patients were more likely to have re-arrest during hospital admission (55.7% vs 14.6%, OR 5.77, 95% CI 2.74-12.18, p < 0.001).

CONCLUSION: There was no statistically significant difference in clinically significant cardiac tachyarrhythmias in post-OHCA patients treated with epinephrine versus norepinephrine infusions after ROSC. Re-arrest rates and in-hospital mortality were higher in patients who received epinephrine infusions in the first 6 h post-ROSC. Results of this study add to the literature suggesting norepinephrine may be the vasopressor of choice in post-OHCA patients with post-resuscitative shock after ROSC.

PMID:38104386 | DOI:10.1016/j.ajem.2023.12.003

Mar Pollut Bull. 2023 Dec 16;198:115743. doi: 10.1016/j.marpolbul.2023.115743. Online ahead of print.

ABSTRACT

This study aims at characterizing the hydrodynamic context and transport patterns that prevailed during the MERITE-HIPPOCAMPE cruise to assist in the interpretation of in-situ observations. The main physical attributes and structures (mesoscale eddies as well as fine-scale fronts and filaments) are analyzed based on various physical diagnostics. They were computed from satellite data and data-assimilative model outputs to describe ocean dynamics. The Northern and Algerian Currents were prominent features during the cruise while the western basin is divided by the vertically-tilted Balearic front. Temperature and salinity were used to distinguish different water masses at both surface and sub-surface. Sea-level anomalies, relative vorticity, and Okubo-Weiss parameter distributions have shown the presence of marked eddies around stations St10 and St11. Furthermore, Finite-Size Lyaponuv Exponents revealed that the former was rather located on a fine-scale filament near the edge of a cyclonic eddy while the latter was closer to the core of an anticyclone. Nearshore thermal fronts were detected with the Belkin and O’Reilly Algorithm (BOA), especially around stations St17 and St19. The potential coastal sources of contaminants were tested using Lagrangian Origin Maps (LOM), suggesting that stations St1, St2, St4, St11, and St15 were most likely influenced by coastal waters. Additionally, an atmospheric reanalysis combined with a Lagrangian dispersal model allowed for estimating wet deposition events of contaminants while tracking the fate of water masses where rainfall took place. Finally, we provide a set of explanatory quantitative and qualitative variables for future statistical analyses that aim at explaining the distribution of both chemical and biological samples collected during the cruise.

PMID:38104384 | DOI:10.1016/j.marpolbul.2023.115743

J Stroke Cerebrovasc Dis. 2023 Dec 16;33(1):107511. doi: 10.1016/j.jstrokecerebrovasdis.2023.107511. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the occurrence of post-stroke cognitive impairment (PSCI) and its influencing factors in convalescent young patients with first-ever stroke.

METHODS: A total of 300 first-ever young stroke patients (age ≤45 years) were collected. The Mini-Mental State Examination (MMSE) was used to assess the cognitive status. The sociodemographic data, clinical symptoms, social environment, and behavior-related information were collected and analyzed.

RESULTS: The incidence of PSCI in young stroke patients was 62.33 %. Through univariate analysis, there were statistical differences in different levels of education, smoking status and hypertension (P < 0.05). With subsequently multivariate logistic regression analysis, it was found that junior high school (OR=8.58,95 %CI:2.25∼32.70) and high school (OR=10.50,95 %CI:2.69∼41.00) education levels, lesion volume >3.00 cm³ (OR=8.03,95 %CI:2.28∼28.36), stroke in the frontal-parietal-temporal region (OR=7.26,95 %CI:1.58∼33.40) and the basal ganglia area (OR=6.13,95 %CI:1.24∼30.43), high NIHSS score (OR=1.17,95 %CI: 1.06∼1.29), and high diastolic blood pressure variability coefficient (OR=1.43,95 %CI: 1.02∼2.01) were risk factors for PSCI. Meanwhile, 24≤BMI<28 (OR=0.06,95 %CI:0.02∼0.23) and BMI<24 (OR=0.18,95 %CI:0.06∼0.53), hospitalization cost >20,000/month (OR=0.22,95 %CI:0.09∼0.56), and stroke onset in spring and summer (OR=0.37,95 %CI:0.14∼0.96) were protective factors.

CONCLUSION: The incidence of PSCI is relatively high in young stroke patients. Junior high and high school education, stroke lesions >3.00cm³, strokes in the frontal-parietal-temporal and basal ganglia regions, high NIHSS scores, and high DBPV are risk factors for PSCI in young stroke patients. Meanwhile, BMI<28, treatment cost >20,000/month, and stroke onset in spring and summer are protective factors for PSCI in young stroke patients.

PMID:38104360 | DOI:10.1016/j.jstrokecerebrovasdis.2023.107511

Econ Hum Biol. 2023 Dec 10;52:101337. doi: 10.1016/j.ehb.2023.101337. Online ahead of print.

ABSTRACT

Physical pain has trended upward globally over the last decade. Here, we explore whether the COVID-19 pandemic modified this alarming trend. We used data from 146 countries worldwide (510,247 respondents) to examine whether pain levels changed during the COVID-19 pandemic. Adjusted regressions across countries revealed that 33.3% of people were in pain in 2019, 32.8% in 2020, 32.5% in 2021, and 34.1% in 2022. The change in pain from 2019 to each of the pandemic years was not statistically significant. This suggests that, on average, there was no significant change in pain during the pandemic. However, from 2019 to 2020 there was a significant decline in pain among individuals over 55 years of age, those who were widowed, and those without children in the household. On a global scale, the COVID-19 pandemic was not associated with a significant change in pain levels. The concerning pre-pandemic elevation in global pain continued during this challenging period.

PMID:38104357 | DOI:10.1016/j.ehb.2023.101337

Med Pr. 2023 Dec 15;74(5):377-387. doi: 10.13075/mp.5893.01426. Epub 2023 Dec 7.

ABSTRACT

BACKGROUND: The lack of nursing staff is a current problem not only in Poland, but also in the world. The decision of nurses to leave the workplace, apart from the financial aspect, often results from unfavourable working conditions related to the work environment.

MATERIAL AND METHODS: The study was multicentre, cross-sectional. The study was conducted among a group of 1509 nurses employed in surgical and internal medicine wards in 21 hospitals in Poland. The key variables of the study were: the intention of the nurses to leave their jobs, the nurses’ working environment, the level of satisfaction, the level of occupational burnout and the number of patients cared for on the last shift, the number of nurses on the last shift. The Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI) questionnaire were used in the research.

RESULTS: Almost half of the surveyed nurses (48.84%) declared their willingness to leave their current workplace. The statistical analysis showed that nurses declaring their willingness to quit their job in the hospital where they were employed were significantly younger (42.88 vs. 45.04, p = 0.000), had shorter total length of service overall (19.96 vs. 23.20), and also in the hospital where they were employed (15.86 vs. 18.50, p = 0.000). The increase in the number of patients by one was significantly associated with a 1% increase in the risk of leaving work (OR = 1.01, 95% CI 1.00-1.02). An increase in emotional exhaustion significantly increased the risk of leaving work by 2% (OR = 1.02, 95% CI 0.99-1.03).

CONCLUSIONS: Younger age of nurses, greater workload resulting from more patients and occupational burnout – emotional exhaustion is correlated with the risk of leaving work in the hospital. A lower risk of leaving the job is associated with a higher level of job satisfaction in the hospital, salary and promotion opportunities. Med Pr Work Health Saf. 2023;74(5):377-87.

PMID:38104338 | DOI:10.13075/mp.5893.01426