Category: Statistics

Aust Dent J. 2023 Oct 24. doi: 10.1111/adj.12991. Online ahead of print.

ABSTRACT

BACKGROUND: The use of systemic azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ) as adjuncts provided additional clinical and microbiological benefits over subgingival instrumentation alone. However, the superiority of one antibiotic regimen over another has not been proven. Therefore, the aim of this systematic review and meta-analyses was to evaluate the clinical efficacy and safety of subgingival instrumentation (SI) in conjunction with the systemic use of AZT or AMX/MTZ for the treatment of periodontitis from current published literature.

METHODS: Electronic databases were searched to identify randomized controlled trials (RCTs), controlled clinical trials, prospective and retrospective human studies that compared the adjunctive use of systemic AZT to AMX/MTZ with SI in the treatment of periodontitis. The eligibility criteria were defined based on the participant (who had periodontitis), intervention (SI with adjunctive use of systemic AZT), comparison (SI with adjunctive use of systemic AMX/MTZ), outcomes (primary outcome: changes in probing pocket). The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Data were analysed using a statistical software program.

RESULTS: Five studies with 151 participants with periodontitis were included in the present review. Of these, 74 participants received adjunctive AZT, while the remaining participants received AMX/MTZ as an adjunct to SI. The adjunctive use of AZT and AMX/MTZ had comparable changes in probing pocket depths at 1-3 months with no statistically significant difference (mean difference (MD) 0.01; 95% CI -0.20 to 0.22; P = 0.94). The adjunctive use of AZT had significantly fewer number of residual sites with probing pocket depths of ≥5 mm at 1-3 months compared to the adjunctive use of AMX/MTZ (MD -3.41; 95% CI -4.73 to -2.10; P < 0.0001). The prevalence rates of adverse events among participants who received AZT and AMX/MTZ were 9.80% and 14.8%, respectively. The meta-analysis showed that the difference between the two groups was not statistically significant (risk ratio 0.69; 95% CI 0.28 to 1.72; P = 0.43).

CONCLUSIONS: Within the limitation of this review, there was no superiority between AZT and AMX/MTZ in terms of mean changes in probing pocket depths, clinical attachment level, bleeding on probing at 1-3 months. AZT seem to be associated with less sites with residual probing pocket depths of ≥5 mm at 1-3 months and fewer adverse events compared with AMX/MTZ. © 2023 Australian Dental Association.

PMID:37875345 | DOI:10.1111/adj.12991

J Neurol Neurosurg Psychiatry. 2023 Oct 24:jnnp-2022-330967. doi: 10.1136/jnnp-2022-330967. Online ahead of print.

ABSTRACT

BACKGROUND: Tai Chi has shown beneficial effects on the motor and non-motor symptoms of Parkinson’s disease (PD), but no study has reported the effect of long-term Tai Chi training.

OBJECTIVE: To examine whether long-term Tai Chi training can maintain improvement in patients with PD.

METHODS: Cohorts of patients with PD with Tai Chi training (n=143) and patients with PD without exercise as a control group (n=187) were built from January 2016. All subjects were assessed at baseline and in November 2019, October 2020 and June 2021. A logarithmic linear model was used to analyse rating scales for motor and non-motor symptoms. The need to increase antiparkinsonian therapies was presented as a Kaplan-Meier plot and as a box plot. The bootstrap method was used to resample for statistical estimation.

RESULTS: Tai Chi training reduced the annual changes in the deterioration of the Unified Parkinson’s Disease Rating Scale and delayed the need for increasing antiparkinsonian therapies. The annual increase in the levodopa equivalent daily dosage was significantly lower in the Tai Chi group. Moreover, patients benefited from Tai Chi training in motor symptoms, non-motor symptoms and complications.

CONCLUSION: Tai Chi training has a long-term beneficial effect on PD, with an improvement in motor and non-motor symptoms and reduced complications.

TRIAL REGISTRATION NUMBER: NCT05447975.

PMID:37875337 | DOI:10.1136/jnnp-2022-330967

Inj Prev. 2023 Oct 24:ip-2023-044919. doi: 10.1136/ip-2023-044919. Online ahead of print.

ABSTRACT

OBJECTIVE: This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and current firearm storage practices.

METHODS: The present study used data from a large online study (n=6410) and included data from individuals who were currently or previously being employed as an LEO (n=369; M (SD) age=39.2 y (15.8 y), 75.2% male, 66.7% white). Self-report measures were used to assess for firearm ownership, storage habits and suicidal ideation. Descriptive statistics were used to describe the frequency of firearm ownership and logistic regressions were used to examine the extent to which demographic characteristics and suicidal ideation were associated with firearm ownership.

RESULTS: Overall, 70.5% (n=261) of the sample reported firearm ownership. LEO who were older had significantly lower odds of reporting firearm ownership. Those who were married and those who reported lifetime suicidal ideation had significantly greater odds of reporting firearm ownership. Whereas firearm-owning LEO who reporting storing a firearm locked had significantly lower odds of reporting lifetime suicidal ideation, those who reported storing a firearm unloaded had significantly greater odds of reporting lifetime suicidal ideation.

CONCLUSION: Findings have important public health implications and can be used to increase adherence with secure storage recommendations. Increasing secure storage may help reduce suicide risk among LEO, a sample at heightened risk for suicide.

PMID:37875335 | DOI:10.1136/ip-2023-044919

CMAJ Open. 2023 Oct 24;11(5):E982-E987. doi: 10.9778/cmajo.20230033. Print 2023 Sep-Oct.

ABSTRACT

BACKGROUND: In 2020, International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes were created for laboratory-confirmed SARS-CoV-2 infections. We assessed the operating characteristics of ICD-10 discharge diagnostic code U07.1 within the General Medicine Inpatient Initiative (GEMINI).

METHODS: GEMINI assembles hospitalization data (including administrative ICD-10 discharge diagnostic codes, laboratory results and demographic data) from hospitals in Ontario, Canada. We studied adults (age ≥ 18 yr) admitted during 2020 and tested at least once for SARS-CoV-2 via polymerase chain reaction (PCR) during (or within 48 h before) hospitalization. With PCR results as the reference standard, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for ICD-10 code U07.1 hospital discharge diagnostic codes. Analyses were stratified by demographic data, calendar period and timing of the first test (within or after 48 h of hospital admission).

RESULTS: In 11 852 hospitalizations with at least 1 SARS-CoV-2 PCR test, 444 (3.7%) were positive. The sensitivity of code U07.1 to identify SARS-CoV-2 infection was 97.8%, specificity was 99.5%, PPV was 88.2% and NPV was 99.9%. Operating characteristics were similar in most stratified analyses, but the specificity and PPV were lower if the first SARS-CoV-2 test was done more than 48 hours after admission.

INTERPRETATION: The sensitivity, specificity, PPV and NPV of code U07.1 were high. This supports using code U07.1 to identify SARS-CoV-2 infection in hospitalization data.

PMID:37875313 | DOI:10.9778/cmajo.20230033

BMJ Open Qual. 2023 Oct;12(4):e002311. doi: 10.1136/bmjoq-2023-002311.

ABSTRACT

BACKGROUND: The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.

METHODS: We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction).

INFORMATION SOURCES: Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023.

RISK OF BIAS: Cochrane Risk of Bias instrument.

DATA SYNTHESIS: Narrative synthesis.

RESULTS: 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK’s general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice.

CONCLUSION: Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed.

TRIAL REGISTRATION NUMBER: OSF Registration DOI:10.17605/OSF.IO/EUDK8.

PMID:37875307 | DOI:10.1136/bmjoq-2023-002311

Med J Aust. 2023 Oct 24. doi: 10.5694/mja2.52132. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine the relationship between vitamin C status and demographic factors in New South Wales on the basis of serum vitamin C test results undertaken at the central pathology laboratory in Sydney, and to assess associations with age, gender, social disadvantage, and geographic remoteness.

DESIGN, SETTING: Retrospective observational study; analysis of vitamin C test results undertaken at the Royal Prince Alfred Hospital, 1 January 2017 – 31 December 2021.

MAIN OUTCOME MEASURES: Vitamin C status (normal, serum concentration ≥ 40 μmol/L; hypovitaminosis C, 12-39 μmol/L; significant deficiency, < 12 μmol/L); associations of vitamin C status with year of testing, age, gender, socio-economic status (Index of Relative Socio-Economic Advantage and Disadvantage quintile), and geographic remoteness (Australian Statistical Geography Standard); rate of hypovitaminosis C or significant deficiency test results (relative to findings of normal levels; per 100 000 estimated resident population) by Statistical Area 3.

RESULTS: Of 17 507 vitamin C tests undertaken during 2017-2021, 4573 were excluded (multiple tests for individuals); of 12 934 included results, 6654 were for women (51.5%), 9402 for people living in major cities (73.5%), and 81 for people in remote or very remote areas (0.6%). In multivariable multinomial regression analyses, significant deficiency (relative to normal test results) was more likely for men than women (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.27-1.52); the likelihood of hypovitaminosis C (IRSAD quintile 1 v 5, aOR, 1.35; 95% CI, 1.19-1.53) or significant deficiency (aOR, 2.07; 95% CI, 1.79-2.40) generally increased with postcode-level socio-economic disadvantage. Several of the population areas with the highest low vitamin C rates were areas of greatest disadvantage in NSW.

CONCLUSIONS: The prevalence of vitamin C deficiency among older people and people living in areas of socio-economic disadvantage indicates that population assessment of vitamin C levels would be appropriate.

PMID:37875282 | DOI:10.5694/mja2.52132

J Sport Rehabil. 2023 Oct 24:1-7. doi: 10.1123/jsr.2023-0139. Online ahead of print.

ABSTRACT

CONTEXT: The aim of this prospective cohort study was to identify whether Y-Balance Test (YBT) performance and asymmetry are associated with lower limb injury in elite adult football athletes.

DESIGN: A prospective cohort study.

METHODS: Preseason YBT measures were obtained from 121 male footballers participating in National League One across the 2021-2022 season. Lower limb injuries were tracked across the season to determine the relationship between YBT variables and injury incidence using logistic regression analysis. The statistical significance level was .05.

RESULTS: The average YBT score was 111.0 (5.8) cm on the left limb and 112.0 (5.5) cm on the right limb, with an average asymmetry of 2.3 (1.4) cm. Athletes with lower YBT scores on both the left (odds ratio = 2.9; 95% confidence interval, 1.7 to 4.8: P ≤ .001) and right (odds ratio = 2.3; 95% confidence interval, 1.6 to 3.2: P ≤ .001) limbs were at a greater risk of injury. Similarly, athletes with greater amounts of asymmetry were also more likely to get injured (odds ratio = 2.1; 95% confidence interval, 1.3 to 3.3: P = .002).

CONCLUSIONS: Results indicate that lower and asymmetrical YBT scores have a significant relationship with future lower limb injuries in professional male footballers. The YBT offers a simple, reliable, and effective screening tool that can be used by practitioners in football to help identify players at a greater risk of injury before the season commences.

PMID:37875255 | DOI:10.1123/jsr.2023-0139

Am J Cardiol. 2023 Oct 21:S0002-9149(23)01118-9. doi: 10.1016/j.amjcard.2023.09.108. Online ahead of print.

ABSTRACT

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) in patients with failed bioprostheses arose as an alternative to redo surgical aortic valve replacement. There is an increasing interest in exploring the differences between self-expanding valves (SEVs) and balloon-expandable valves (BEVs). Our study aimed to evaluate the all-cause mortality in ViV-TAVI with SEV versus BEV in patients with failed bioprostheses. We performed a study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by March 30, 2023. A total of 5 studies met our eligibility criteria and included 1,454 patients who underwent ViV-TAVI (862 with SEV and 592 with BEV). Almost all BEVs were iterations of the Edwards BEVs (SAPIEN, SAPIEN XT, and SAPIEN 3) and almost all SEVs were iterations of the Medtronic SEVs (CoreValve/Evolut). During the first year after ViV-TAVI, 67 deaths (11.8%) occurred in patients treated with BEV compared with 92 deaths (11.1%) in patients treated with SEV (hazard ratio 0.92, 95% confidence interval 0.66 to 1.27, p = 0.632). At 8 years of follow-up, the all-cause death was not statistically significantly different between the groups, with mortality rates of 65.4% in the group treated BEV and 58.8% in the group treated with SEV (hazard ratio 0.91, 95% confidence interval 0.75 to 1.09, p = 0.302). The restricted mean survival time was overall 0.25 years greater with SEV than BEV, but this difference was not statistically significant (p = 0.278), which indicates no lifetime gain or loss with SEV in comparison with BEV. There seems to be no difference in terms of all-cause death in ViV-TAVI with SEV versus BEV. Randomized controlled trials are warranted to validate our results.

PMID:37875248 | DOI:10.1016/j.amjcard.2023.09.108

Int J Radiat Oncol Biol Phys. 2023 Oct 22:S0360-3016(23)08008-2. doi: 10.1016/j.ijrobp.2023.10.004. Online ahead of print.

ABSTRACT

PURPOSE: To compare anatomical and functional dose-volume parameters as predictors of acute radiation-induced lung toxicity (RILT) in patients with lung tumors treated with stereotactic body radiation therapy (SBRT).

MATERIALS AND METHODS: 59 patients treated with SBRT were prospectively included. All patients underwent Gallium-68 lung perfusion PET/CT imaging before treatment. Mean lung dose (MLD) and volumes receiving xGy (VxGy, 5 to 30 Gy) were calculated in five lung volumes: the conventional anatomical volume (AV) delineated on CT images, three lung functional volumes defined on lung perfusion PET imaging (FV50%, FV70%, FV90%, i.e. the minimal volume containing 50%, 70% and 90% of the total activity within the AV), and a low functional volume (LFV = AV-FV90%). The primary endpoint of this analysis was grade ≥2 acute RILT at 3 months as assessed with NCI CTCAE v.5. Dose volume parameters in patients with and without acute RILT were compared. ROC curves assessing the ability of dose-volume parameters to discriminate between patients with and without acute RILT were generated and area under the curves (AUC) were calculated.

RESULTS: Out of the 59 patients, 10 (17%) had grade ≥2 acute RILT. The MLD and the VxGy in the AV and LFV were not statistically different in patients with and without acute RILT (p>0.05). All functional parameters were significantly higher in acute RILT patients (p<0.05). AUCs (CI 95%) for MLD AV, LFV, FV50%, FV70% and FV90% were 0.66 (0.46-0.85), 0.60 (0.39-0.80), 0.77 (0.63-0.91), 0.77 (0.64-0.91), 0.75 (0.58-0.91), respectively. AUCs for V20Gy AV, LFV, FV50%, FV70% and FV90% were 0.65 (0.44-0.87), 0.64 (0.46-0.83), 0.82 (0.69-0.95), 0.81 (0.67-0.96), 0.75 (0.57-0.94), respectively.

CONCLUSION: The predictive value of PET perfusion-based functional parameters outperforms the standard CT-based dose-volume parameters for the risk of grade ≥2 acute RILT. Functional parameters could be useful to guide radiotherapy planning to reduce the risk of acute RILT.

PMID:37875246 | DOI:10.1016/j.ijrobp.2023.10.004

Spine J. 2023 Oct 22:S1529-9430(23)03460-5. doi: 10.1016/j.spinee.2023.10.003. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Lumbar interbody instrumentation techniques are common and effective surgical options for a variety of lumbar degenerative pathologies. Anterior lumbar interbody fusion (ALIF) has become a versatile and powerful means of decompression, stabilization, and reconstruction. As an anterior only technique, the integrity of the posterior muscle and ligaments remain intact. Adding posterior instrumentation to ALIF is common and may confer benefits in terms of higher fusion rate but could contribute to adjacent segment degeneration due to additional rigidity. Large clinical studies comparing stand-alone ALIF with and without posterior supplementary fixation (ALIF+PSF) are lacking.

PURPOSE: To compare rates of operative nonunion and adjacent segment disease (ASD) in ALIF with or without posterior instrumentation.

STUDY DESIGN: Retrospective cohort study.

PATIENT SAMPLE: Adult patients (≥ 18 years old) who underwent primary ALIF for lumbar degenerative pathology between levels L4 to S1 over a 12-year period. Exclusion criteria included trauma, cancer, infection, supplemental decompression, noncontiguous fusions, prior lumbar fusions, and other interbody devices.

OUTCOME MEASURES: Reoperation for nonunion and ASD compared between ALIF only and ALIF+PSF.

METHODS: Reoperations were modeled as time-to-events where the follow-up time was defined as the difference between the primary ALIF procedure and the date of the outcome of interest. Crude cumulative reoperation probabilities were reported at five-years follow-up. Multivariable Cox proportional hazard regression was used to evaluate risk of operative nonunion and for ASD adjusting for patient characteristics.

RESULTS: The study consisted of 1377 cases; 307 ALIF only and 1070 ALIF+PSF. Mean follow up time was 5.6 years. The 5-year crude nonunion incidence was 2.4% for ALIF only and 0.5% for ALIF+PSF; after adjustment for covariates, a lower operative nonunion risk was observed for ALIF+PSF (HR=0.22, 95% CI=0.06-0.76). Of the patients who are deemed potentially suitable for ALIF alone, one would need to add posterior instrumentation in 53 patients to prevent one case of operative nonunion at a 5-year follow-up (number needed to treat). Five-year operative ASD incidence was 4.3% for ALIF only and 6.2% for ALIF+PSF; with adjustments, no difference was observed between the cohorts (HR=0.96, 95% CI=0.54-1.71).

CONCLUSIONS: While the addition of posterior instrumentation in ALIFs is associated with lower risk of operative nonunion compared to ALIF alone, operative nonunion is rare in both techniques (<5%). Accordingly, surgeons should evaluate the added risks associated with the addition of posterior instrumentation and reserve the supplemental posterior fixation for patients that might be at higher risk for operative nonunion. Rates of operative ASD were not statistically higher with the addition of posterior instrumentation suggesting concern regarding future risk of ASD perhaps should not play a role in considering supplemental posterior instrumentation in ALIF.

PMID:37875244 | DOI:10.1016/j.spinee.2023.10.003