Category: Statistics

Health Care Manag Sci. 2022 Jul 8. doi: 10.1007/s10729-022-09599-z. Online ahead of print.

ABSTRACT

Clinical pathways are standardized processes that outline the steps required for managing a specific disease. However, patient pathways often deviate from clinical pathways. Measuring the concordance of patient pathways to clinical pathways is important for health system monitoring and informing quality improvement initiatives. In this paper, we develop an inverse optimization-based approach to measuring pathway concordance in breast cancer, a complex disease. We capture this complexity in a hierarchical network that models the patient’s journey through the health system. A novel inverse shortest path model is formulated and solved on this hierarchical network to estimate arc costs, which are used to form a concordance metric to measure the distance between patient pathways and shortest paths (i.e., clinical pathways). Using real breast cancer patient data from Ontario, Canada, we demonstrate that our concordance metric has a statistically significant association with survival for all breast cancer patient subgroups. We also use it to quantify the extent of patient pathway discordances across all subgroups, finding that patients undertaking additional clinical activities constitute the primary driver of discordance in the population.

PMID:35802305 | DOI:10.1007/s10729-022-09599-z

Environ Sci Pollut Res Int. 2022 Jul 8. doi: 10.1007/s11356-022-21903-6. Online ahead of print.

ABSTRACT

In this research, diatoms as the first step and fishes as the last step of the food chain were compared as toxic metal accumulation bioindicator in an A-class wetland in Turkey. Bioaccumulations of potentially toxic elements (PTEs) were determined in liver, gill and muscle tissues of two commercially consumed fish species Carassius gibelio and Cyprinus carpio and in frustules of epiphytic diatom communities living on submerged macrophytes. Samples were collected seasonally from the Gala Lake, which is among the best stopover habitats of birds migrating between Europe and Africa, considering the paddy harvest period that is a major stress factor for the ecosystem. Also, potential human health risks associated with the consumption of fishes and consumption – dermal contact of diatoms were evaluated both for summer – before paddy harvest (BPH) and autumn – after paddy harvest (APH) periods. As a result of this research, the investigated toxic metal concentrations were increased significantly in diatoms in the APH period, while less significant exchanges were recorded in fishes. The bioaccumulations of PTEs were ranked as follows: Zn > Mn > Se > Cu > B > Cr > Ni > As > Pb > Cd for C. gibelio; Zn > Mn > Se > Cu > B > Cr > As > Ni > Pb > Cd for C. carpio; and Mn > Zn > Se > Pb > B > Ni > Cr > Cu > As > Cd for diatom frustules. Although the HI values in diatoms detected in the APH period were statistically significantly higher (about 1000 times; p < 0.05) than detected in the BPH period, they were less than the limit of 1 in both seasons. However, the HI coefficients of fishes were quite higher than the limit (an average of 23.59 for C. gibelio and 19.18 for C. carpio), which means quite high probable non-carcinogenic health risks for humans. Furthermore, the CR coefficients of Cr, Ni and As in muscle tissues of fishes were considerably higher than the limit of 10^-4, which reflects a significant carcinogenic health risk for consumers. The data showed that although the fishes at the top of the food chain bioaccumulate the PTEs in their tissues much higher than the diatoms at the bottom of the food chain, the diatoms are much more sensitive to changes in the environmental conditions than the fishes and they are more effective biological tools as toxic metal accumulation bioindicators.

PMID:35802324 | DOI:10.1007/s11356-022-21903-6

Inflammopharmacology. 2022 Jul 8. doi: 10.1007/s10787-022-01019-6. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor necrosis factor inhibitor (TNFi) is recently reported to treat noninfectious uveitis (NIU) effectively. However, as a new kind of TNFi, golimumab is just on the market in China for several years, and its administration for NIU treatment lacks sufficient evidence. Therefore, the current study aimed to investigate the efficacy and safety of golimumab in refractory NIU patients.

METHODS: Thirty NIU patients with 49 affected eyes refractory to conventional treatments (corticosteroids and immunosuppressive agents) were consecutively enrolled. They received treatment of TNFi (50 mg golimumab every 4 weeks) for at least 6 months. The anterior chamber cell grade, vitreous haziness grade, central macular thickness, and visual acuity were evaluated at baseline, month (M) 1, M3, and M6.

RESULTS: After treatment, the anterior chamber cell grade declined from baseline (0.6 ± 0.7) to M6 (0.3 ± 0.5) (P < 0.001); the vitreous haziness grade decreased from baseline (1.2 ± 1.2) to M6 (0.4 ± 0.5) (P < 0.001); meanwhile, the central macular thickness also reduced from baseline (351.4 ± 90.8 μm) to M6 (271.8 ± 54.4 μm) (P < 0.001). In terms of visual acuity (LogMAR), it showed a declined trend from baseline (0.5 ± 0.3) to M6 (0.4 ± 0.2), but without statistical significance (P = 0.096). Subgroup analyses revealed that TNFi history related to decreased golimumab efficacy. In addition, 13.3% of patients had adverse events, including elevated liver enzymes (6.7%), fatigue (3.3%), and rash (3.3%).

CONCLUSION: Golimumab is effective and safe for refractory NIU treatment, while a large-scale trial is still needed for verification.

PMID:35802282 | DOI:10.1007/s10787-022-01019-6

J Clin Immunol. 2022 Jul 8. doi: 10.1007/s10875-022-01322-5. Online ahead of print.

NO ABSTRACT

PMID:35802274 | DOI:10.1007/s10875-022-01322-5

Pediatr Nephrol. 2022 Jul 8. doi: 10.1007/s00467-022-05674-3. Online ahead of print.

ABSTRACT

BACKGROUND: For the purpose of a better understanding of enteric hyperoxaluria in Crohn’s disease (CD) in children and adolescents, we investigated the occurrence and risk factors for development of hyperoxaluria in those patients.

METHODS: Forty-five children with CD and another 45 controls were involved in this cross-sectional study. Urine samples were collected for measurement of spot urine calcium/creatinine (Ur Ca/Cr), oxalate/creatinine (Ur Ox/Cr), and citrate/creatinine (Ur Citr/Cr) ratios. Fecal samples were also collected to detect the oxalyl-CoA decarboxylase of Oxalobacter formigenes by PCR. Patients were classified into 2 groups: group A (with hyperoxaluria) and group B (with normal urine oxalate excretion). The disease extent was assessed, and the activity index was calculated.

RESULTS: According to the activity index, 30 patients (66.7%) had mild disease and 13 patients (28.9%) had moderate disease. There was no significant difference in Ur Ox/Cr ratio regarding the disease activity index. O. formigenes was not detected in 91% of patients in group A while it was detected in all patients in group B (p < 0.001). By using logistic regression analysis, the overall model was statistically significant when compared to the null model, (χ² (7) = 52.19, p < 0.001), steatorrhea (p = 0.004), frequent stools (p = 0.009), and O. formigenes (p < 0.001).

CONCLUSION: Lack of intestinal colonization with O. formigenes, steatorrhea, and frequent stools are the main risk factors for development of enteric hyperoxaluria in CD patients. Identifying risk factors facilitates proper disease management in future studies. A higher resolution version of the Graphical abstract is available as Supplementary information.

PMID:35802269 | DOI:10.1007/s00467-022-05674-3

Eur J Orthop Surg Traumatol. 2022 Jul 8. doi: 10.1007/s00590-022-03326-8. Online ahead of print.

ABSTRACT

BACKGROUND: Outcomes data of intramedullary nail fixation (IMN) constructs for complex Schatzker VI tibial plateau fractures are scant in the literature. This study compares the clinical and radiographic outcomes of IMN, dual plate, and single plate constructs for Schatzker IV tibial plateau fractures.

METHODS: Retrospective cohort study of sixty-two patients at a University-based Level 1 trauma center who underwent open reduction internal fixation for Schatzker VI tibial plateau fracture. Constructs evaluated were IMN (with or without raft screws), dual plating, and single plating. Demographic, clinical, and radiographic outcomes were recorded. All fractures were additionally classified based on the OTA classification for sub analyses. Mean follow-up was 13.2 (SD 13.3) months. Predictors of construct selection and outcomes were evaluated with bivariate logistic regression. Outcomes were compared between groups with independent samples t-tests and Chi Square tests.

RESULTS: No significant demographic differences were found between IMN, dual plate or single plate construct cohorts. There was a higher proportion of open fractures within the IMN construct group versus the dual plate cohort (21.1% vs 3.6%). No statistically significant differences in radiographic outcomes were observed between cohort groups except for small but statistically significant differences in condylar width (CW) ratio change and tibial slope; when fracture cohorts were sub analyzed by specific OTA classification, there were no significant differences in any radiographic outcomes. There was a significant difference between the ratio of OTA 41C1, C2 and C3 fractures regarding treatment allocation (p = 0.004), favoring dual plate fixation for OTA 41C3 fractures. There were no significant differences found between treatment cohorts in terms of all cause complications (p > 0.05). IMN and single plate constructs were utilized when posteromedial condyle fractures were nondisplaced or minimally displaced.

CONCLUSION: Intramedullary nail fixation with or without supplemental raft screws produced similar short-term clinical and radiographic results compared to dual and single plate constructs among patients with Schatzker VI fracture types, regardless of OTA classification. Level of Evidence Level III retrospective cohort.

PMID:35802263 | DOI:10.1007/s00590-022-03326-8

J Pept Sci. 2022 Jul 8:e3443. doi: 10.1002/psc.3443. Online ahead of print.

ABSTRACT

Peptides have gained popularity in the global market during recent years and have been placed between small molecule drugs and biologics. However, little is known about the comprehensive landscape of peptide drugs in obstetrics and gynaecology. Herein, we analysed new peptide drug-related clinical trials in obstetrics and gynaecology registered on ClinicalTrials.gov. The number and percentage were used for statistical analysis, and a time trend analysis was conducted by calculating the annual growth rate. We aimed to provide the first overview of the changing landscape and status of global peptide drugs in this prospective field, including exploring drug targets, the cutting-edge oncotherapy of peptide vaccines and peptide-drug conjugates, and unsolved challenges with oral administration.

PMID:35802249 | DOI:10.1002/psc.3443

Stem Cell Rev Rep. 2022 Jul 8. doi: 10.1007/s12015-022-10404-1. Online ahead of print.

ABSTRACT

BACKGROUND: Hair follicle stem cells (HFSCs) are derived from the bulge region and are important autologous stem cell sources. Bibliometric is a statistical method that quantitatively analyses the research papers concerned about one special topic. This study aims to estimate the research status and trends of HFSCs worldwide by bibliometric analyses.

METHODS: Data were obtained from the Web of Science by searching keywords related to HFSCs. Publication distributions stratified by countries/regions, institutions, journals, and authors were systematically assessed. The frequency of keywords was assessed, and bibliometric mapping was employed to describe the development of HFSC research.

RESULTS: A total of 458 publications that met our screening criteria were included in this study, consisting of 423 (92.4%) articles and 35 (7.6%) reviews. The United States of America (USA) ranked first in the number of publications at 146 (31.9%), followed by China at 130 (28.4%), which is consistent with the rank of the H-index. Author keywords were classified into three clusters, namely, basic study, applied study, and biomarker; average publication time of keywords in applied study cluster is later than basic study cluster. The keywords “bulge”, “nestin”, and “skin” are the top three most frequent keywords in basic studies; “differentiation”, “proliferation”, and “alopecia” are the top three most frequent keywords in applied studies. With respect to the latest research hotspots, “apoptosis” and “tissue engineering” are relatively new keywords.

CONCLUSIONS: The USA and China were the most productive countries for research on HFSCs. The focus of keywords gradually shifted from basic study to applied study. Research on the differentiation/proliferation of HFSCs and the role of HFSCs in alopecia have been recent research focuses. Apoptosis and tissue engineering are recommended as promising research hotspots. Our study provides profound insights into the research history, current status, and future trend of HFSCs.

PMID:35802225 | DOI:10.1007/s12015-022-10404-1

Int J Comput Assist Radiol Surg. 2022 Jul 8. doi: 10.1007/s11548-022-02712-1. Online ahead of print.

ABSTRACT

PURPOSE: Advanced developments in the medical field have gradually increased the public demand for surgical skill evaluation. However, this assessment always depends on the direct observation of experienced surgeons, which is time-consuming and variable. The introduction of robot-assisted surgery provides a new possibility for this evaluation paradigm. This paper aims at evaluating surgeon performance automatically with novel evaluation metrics based on different surgical data.

METHODS: Urologists ([Formula: see text]) from a hospital were requested to perform a simplified neobladder reconstruction on an ex vivo setup twice with different camera modalities ([Formula: see text]) randomly. They were divided into novices and experts ([Formula: see text], respectively) according to their experience in robot-assisted surgeries. Different performance metrics ([Formula: see text]) are proposed to achieve the surgical skill evaluation, considering both instruments and endoscope. Also, nonparametric tests are adopted to check if there are significant differences when evaluating surgeons performance.

RESULTS: When grouping according to four stages of neobladder reconstruction, statistically significant differences can be appreciated in phase 1 ([Formula: see text]) and phase 2 ([Formula: see text]) with normalized time-related metrics and camera movement-related metrics, respectively. On the other hand, considering experience grouping shows that both metrics are able to highlight statistically significant differences between novice and expert performances in the control protocol. It also shows that the camera-related performance of experts is significantly different ([Formula: see text]) when handling the endoscope manually and when it is automatic.

CONCLUSION: Surgical skill evaluation, using the approach in this paper, can effectively measure surgical procedures of surgeons with different experience. Preliminary results demonstrate that different surgical data can be fully utilized to improve the reliability of surgical evaluation. It also demonstrates its versatility and potential in the quantitative assessment of various surgical operations.

PMID:35802223 | DOI:10.1007/s11548-022-02712-1

Bone Jt Open. 2022 Jul;3(7):543-548. doi: 10.1302/2633-1462.37.BJO-2022-0026.R1.

ABSTRACT

AIMS: Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits.

METHODS: We retrospectively reviewed all patients who underwent TJA from 2011 to 2021 at a single, large, tertiary urban institution. Patients were separated into two cohorts based on whether they underwent primary or revision TJA (rTJA). Outcomes of interest included ED visit within 90-days of surgery, as well as reasons for ED visit and readmission rate. Multivariable logistic regressions were performed to compare the two groups while accounting for all statistically significant demographic variables.

RESULTS: Overall, 28,033 patients were included, of whom 24,930 (89%) underwent primary and 3,103 (11%) underwent rTJA. The overall rate of 90-day ED visits was significantly lower for patients who underwent primary TJA in comparison to those who underwent rTJA (3.9% vs 7.0%; p < 0.001). Among those who presented to the ED, the readmission rate was statistically lower for patients who underwent primary TJA compared to rTJA (23.5% vs 32.1%; p < 0.001).

CONCLUSION: ED visits present a significant burden to the healthcare system. Patients who undergo rTJA are more likely to present to the ED within 90 days following surgery compared to primary TJA patients. However, among patients in both cohorts who visited the ED, three-quarters did not require readmission. Future efforts should aim to develop cost-effective and patient-centred interventions that can aid in reducing preventable ED visits following TJA. Cite this article: Bone Jt Open 2022;3(7):543-548.

PMID:35801582 | DOI:10.1302/2633-1462.37.BJO-2022-0026.R1