Category: Statistics

Drugs Real World Outcomes. 2023 Oct 13. doi: 10.1007/s40801-023-00392-0. Online ahead of print.

ABSTRACT

PURPOSE: There are only limited data on drug utilization patterns in pediatric inpatients, especially on general wards. The aim of the study was to describe prescribing patterns and their associations with prescribing errors in a university children’s hospital in the German-speaking part of Switzerland.

METHOD: This was a subanalysis of a retrospective single-center observational study. Patient characteristics and drug use of 489 patients with 2693 drug prescriptions were associated with prescribing errors. Drugs were categorized by the Anatomic Therapeutic Chemical Classification System (ATC), patients were categorized by age group according to European Medicines Agency guidelines, and prescribing errors were analyzed by type [Pharmaceutical Care Network Europe (PCNE) classification] and severity of error [adapted National Coordinating Council for Medication Error Reporting (NCC MERP) index].

RESULTS: The most frequently prescribed ATC classes were nervous system (N) (42.6%), alimentary system (A) (15.6%), and anti-infective drugs (J) (10.7%). Eighty-two percent of patients were prescribed an analgesic. Most drugs were prescribed for oral (47%) or intravenous (32%) administration, but the rectal route was also frequent (10%). The most frequently prescribed drugs were paracetamol, metamizole, and ibuprofen. The high number of metamizole prescriptions (37% of patients were prescribed metamizole) is typical for German-speaking countries. Older pediatric patients were prescribed more drugs than younger patients. A statistically significant difference was found in the rate of potentially harmful errors across age groups and for gender; children between 2 and 11 years had a higher rate of potentially harmful errors than infants under 2 years (p = 0.029) and female patients had a higher rate of potentially harmful errors than male patients (p = 0.023). Recurring errors were encountered with certain drugs (nalbuphine, cefazolin).

CONCLUSIONS: Our study provides insight into prescribing patterns on pediatric general wards in a university children’s hospital in Switzerland and highlights some areas for future research. Especially, the higher risk for prescribing errors among female pediatric patients needs further investigation.

PMID:37831373 | DOI:10.1007/s40801-023-00392-0

Reprod Sci. 2023 Oct 13. doi: 10.1007/s43032-023-01376-9. Online ahead of print.

ABSTRACT

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Previous studies have suggested that metabolites may play a pivotal mediating role in the progression of phenotypic variations. Although several metabolites had been identified as potential markers for PCOS, the relationship between blood metabolites and PCOS was not comprehensively explored. Previously, Pickrell et al. designed a robust approach to infer evidence of a causal relationship between different phenotypes using independently putative causal SNPs. Our previous paper extended this approach to make it more suitable for cases where only a few independently putative causal SNPs were identified to be significantly associated with the phenotypes (i.e., metabolites). When the most significant SNPs in each independent locus (the independent lead SNPs) with p-values of < 1 × 10^-5 were used, 3 metabolites (2-tetradecenoyl carnitine, threitol, 1-docosahexaenoylglycerophosphocholine) causally influencing PCOS and 2 metabolites (asparagine and phenyllactate) influenced by PCOS were identified, (relative likelihood r < 0.01). Under a less stringent threshold of r < 0.05, 7 metabolites (trans-4-hydroxyproline, glutaroyl carnitine, stachydrine, undecanoate, 7-Hoca, N-acetylalanine and 2-hydroxyisobutyrate) were identified. Taken together, this study can provide novel insights into the pathophysiological mechanisms underlying PCOS; whether these metabolites can serve as biomarkers to predict PCOS in clinical practice warrants further investigations.

PMID:37831368 | DOI:10.1007/s43032-023-01376-9

Clin Rheumatol. 2023 Oct 13. doi: 10.1007/s10067-023-06787-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Comparisons of Janus kinase inhibitors (JAKi) for treatment of rheumatoid arthritis in patients with inadequate response to biologic disease-modifying anti-rheumatic drugs are lacking. We assessed the relative efficacy and safety of four JAKi (tofacitinib, baricitinib, upadacitinib, and filgotinib) in this context.

METHOD: We performed an adjusted indirect comparison (IC) of randomized clinical trials using Bucher’s method with an IC and mixed calculator. Endpoints were Disease Activity Score C-reactive protein (DAS28-CRP) and American College of Rheumatology-20 (ACR20). Equivalence was assessed using the equivalent therapeutic alternatives (ETA) guidelines.

RESULTS: We included four of 133 potentially relevant studies. IC showed no statistically significant differences between the four JAKi regarding DAS28-CRP < 3.2. Results were similar in terms of ACR20 except for tofacitinib showing lower efficacy than upadacitinib (RAR -18.4% [IC95% -33.4 to -3.5], p=0.0157). Statistically significant differences were related to the relevant difference for tofacitinib in both endpoints. Despite no statistical differences for baricitinib, we observed a probably clinically relevant difference regarding DAS28-CRP. Probably clinically relevant differences were found for tofacitinib vs. upadacitinib in both endpoints, and for baricitinib vs. upadacitinib in DAS28-CRP. Safety, drug-drug interactions, and convenience considerations did not modify the result of therapeutic equivalence assessment based on efficacy data.

CONCLUSIONS: In conclusion, our results show that filgotinib and upadacitinib are ETA. Baricitinib and upadacitinib are also ETA due to a lack of clear differences and for showing superiority over placebo. The results for tofacitinib and upadacitinib show some inconsistency and more data are needed. Key Points • To date, neither a head-to-head comparison nor an indirect comparison between the Janus kinase inhibitors has been performed in patients with rheumatoid arthritis and an inadequate response to biologic disease-modifying anti-rheumatic drugs. • We performed an adjusted indirect comparison that included randomized clinical trials of tofacitinib, baricitinib, upadacitinib, and filgotinib to assess their equivalence in this scenario. • Our results show that baricitinib and filgotinib are equivalent therapeutic alternatives compared to upadacitinib. However, there is some inconsistency in the results of tofacitinib in front of upadacitinib.

PMID:37831336 | DOI:10.1007/s10067-023-06787-2

Updates Surg. 2023 Oct 13. doi: 10.1007/s13304-023-01666-6. Online ahead of print.

ABSTRACT

Seroma formation is one of the important postoperative problems in inguinal hernia surgery, especially after scrotal hernia surgery. The present study aimed to present primarily the incidence of seroma after reduction and transection of the hernia sac in endo-laparoscopic scrotal hernia repair, and secondarily the results of early postoperative complications. Patients were divided into two groups TAPP and TEP. These groups were also divided into transection and reduction subgroups. In the reduction group, the hernia sac was completely dissected and pulled to the peritoneal area, while in the transection group, the neck of the hernia sac was cut by ligating, and its distal part was fixed to the posterior abdominal wall. The groups were compared, and data were analyzed. The reduction was performed in 13 (43.33%) of the 30 patients included in the study, and transection in 17 (56.67%). Seroma developed in 2 (15.38%) of the reduction group and 7 (41.18%) of the transection group. There was no statistical difference between the groups (p = 0.229). Cord and testicular complications were seen in 6 (20%) patients, 5 (38.46%) in the reduction group, and 1 (5.88%) in the transection group. No statistical difference was detected between the groups (p = 0.061). Although not statistically significant, seroma was more common in transection, while cord and testicular complications were more common in reduction. If dissection of the hernia sac is difficult, the complete reduction should not be insisted on, and the neck of the sac should be transection by ligating, and its distal part should be fixed to the posterior abdominal wall.

PMID:37831327 | DOI:10.1007/s13304-023-01666-6

Brain Topogr. 2023 Oct 13. doi: 10.1007/s10548-023-01013-3. Online ahead of print.

ABSTRACT

We applied diffusion-tensor imaging (DTI) including measurements of fractional anisotropy (FA), a parameter of neuronal fiber integrity, mean diffusivity (MD), a parameter of brain tissue integrity, as well as voxel-based morphometry (VBM), a measure of gray and white matter volume, to provide a basis to improve our understanding of the neurobiological basis of dependent personality disorder (DPD). DTI was performed on young girls with DPD (N = 17) and young female healthy controls (N = 17). Tract-based spatial statistics (TBSS) were used to examine microstructural characteristics. Gray matter volume differences between the two groups were investigated using voxel-based morphometry (VBM). The Pearson correlation analysis was utilized to examine the relationship between distinct brain areas of white matter and gray matter and the Dy score on the MMPI. The DPD had significantly higher fractional anisotropy (FA) values than the HC group in the right retrolenticular part of the internal capsule, right external capsule, the corpus callosum, right posterior thalamic radiation (include optic radiation), right cerebral peduncle (p < 0.05), which was strongly positively correlated with the Dy score of MMPI. The volume of gray matter in the right postcentral gyrus and left cuneus in DPD was significantly increased (p < 0.05), which was strongly positively correlated with the Dy score of MMPI (r_1,2= 0.467,0.353; p_1,2 = 0.005,0.04). Our results provide new insights into the changes in the brain structure in DPD, which suggests that alterations in the brain structure might implicate the pathophysiology of DPD. Possible visual and somatosensory association with motor nerve circuits in DPD.

PMID:37831323 | DOI:10.1007/s10548-023-01013-3

Eur J Health Econ. 2023 Oct 13. doi: 10.1007/s10198-023-01630-6. Online ahead of print.

ABSTRACT

BACKGROUND: A Pay-for-Performance (P4P) programme, known as Prescribed Specialised Services Commissioning for Quality and Innovation (PSS CQUIN), was introduced for specialised services in the English NHS in 2013/2014. These services treat patients with rare and complex conditions. We evaluate the implementation of PSS CQUIN contracts between 2016/2017 and 2018/2019.

METHODS: We used a mixed methods evaluative approach. In the quantitative analysis, we used a difference-in-differences design to evaluate the effectiveness of ten PSS CQUIN schemes across a range of targeted outcomes. Potential selection bias was addressed using propensity score matching. We also estimated impacts on costs by scheme and financial year. In the qualitative analysis, we conducted semi-structured interviews and focus group discussions to gain insights into the complexities of contract design and programme implementation. Qualitative data analysis was based on the constant comparative method, inductively generating themes.

RESULTS: The ten PSS CQUIN schemes had limited impact on the targeted outcomes. A statistically significant improvement was found for only one scheme: in the clinical area of trauma, the incentive scheme increased the probability of being discharged from Adult Critical Care within four hours of being clinically ready by 7%. The limited impact may be due to the size of the incentive payments, the complexity of the schemes’ design, and issues around ownership, contracting and flexibility.

CONCLUSION: The PSS CQUIN schemes had little or no impact on quality improvements in specialised services. Future P4P programmes in healthcare could benefit from lessons learnt from this study on incentive design and programme implementation.

PMID:37831298 | DOI:10.1007/s10198-023-01630-6

Neurosurg Rev. 2023 Oct 13;46(1):268. doi: 10.1007/s10143-023-02178-y.

ABSTRACT

Following meningioma removal, there are numerous methods available for reconstructing the orbital wall. This systematic review seeks to summarize the published data on the surgical treatment of cranioorbital meningiomas, and to analyze the effectiveness and safety of various techniques and materials used for the reconstruction of bony orbital walls. We conducted a search of the two databases and included original articles with a series of 10 or more cases. Descriptive statistics and meta-analysis of individual patient date were performed. The analysis included a total of 858 patients from 29 sources. No reconstruction of the orbital walls was performed in 525 patients (61.2%), while 333 observations (38.8%) involved resection followed by reconstruction. A relative improvement in eye position was achieved in 94.4% of cases with a 95% CI of (88.92%; 97.25%). However, normalization of eye position, regardless of reconstruction technique, was only present in 6.22% of cases with a 95% CI of (1.24%; 25.9%). The best results were observed with the use of autologous bone implants (64%, 95% CI [33.35%; 86.33%]) and titanium implants (55.78%, 95% CI [2.86%; 98.18%]). In cases of endoscopic resection and microsurgical resection without reconstruction, symmetrical eye position accounted for only 1.94% (95% CI [0%; 96.71%]) and 2.35% (95% CI [0.13%; 31.23%]), respectively. The frequency of normalization of eye position differed significantly (p < 0.01) among the subgroups. A total of 49 postoperative complications were registered, with wound infection (1.52%, 95% CI [0.86%; 2.65%]) and wound cerebrospinal fluid leak (1.32%, 95% CI [0.6%; 2.91%]) being the most frequent. No significant differences were found in the rates of complications among the different subgroups. One of the primary objectives of cranioorbital meningioma surgery is to correct the position of the eye. Simultaneous reconstruction of the bony orbital leads to better cosmetic outcomes. Postoperative complications did not depend on the reconstructive technique or the materials.

PMID:37831295 | DOI:10.1007/s10143-023-02178-y

Environ Monit Assess. 2023 Oct 13;195(11):1308. doi: 10.1007/s10661-023-11875-6.

ABSTRACT

The extent of aquatic pollution of Karachi Port Trust (KPT) coastal area located at the south of Pakistan coast has increased considerably in the last few decades due to unrestricted discharge of sanitary waste. The current study lays emphasis on the identification of vulnerable zones severely impacted by pollution in the KPT coastal area using laboratory monitoring, geospatial techniques, and statistical analysis. During 2019, sampling was conducted along the KPT coastal area, and 54 samples of seawater were collected during pre- and post-monsoon seasons. The outcomes of physical and chemical analysis revealed that the concentrations of BOD (biochemical oxygen demand), COD (chemical oxygen demand), nitrate, phosphate, phenol, cyanide, and oil and grease frequently exceeded the permitted limit of international norms and reached much greater levels. The levels of perilous metals in the seawater samples were in the order Ni>Cr>Cu>Pb>Cd>As in both phases and also reached to elevated levels as a consequence of the indiscriminate discharge of untreated industrial and domestic wastewater. Based on detailed examination during pre- and post-monsoon, six sites near KPT, Lyari River outfall, and Karachi Harbour were identified as highly polluted zones due to heavy discharge of sanitary effluents at these sites. In particular, the industrial zones present in the formal and informal sectors of Karachi are responsible for the deterioration of the KPT coastal area. Therefore, it is advised to design and build a submerged drainage system to transport and distribute massive amounts of treated municipal and industrial waste to the deep open sea in order to minimize the high pollutant levels in these locations.

PMID:37831294 | DOI:10.1007/s10661-023-11875-6

Environ Monit Assess. 2023 Oct 13;195(11):1314. doi: 10.1007/s10661-023-11912-4.

ABSTRACT

Underwater soundscape that spans a broad frequency band shows variability consistent with contributing noise sources and ocean environment. However, increased anthropogenic activities result in noise proliferation which can harm natural marine habitat. Continuous monitoring of background sound is useful to assess such spatio-temporal variability of soundscape. Standard noise level metrics, for instance, mean (μ), 90th percentiles (90P), standard deviation (σ), and kurtosis (β), are constructed from noise field measured from three coastal stations in Eastern Arabian Sea. These metrics are found to be suitable to describe the soundscape variability with respect to season, frequency, and depth. Mean and 90P are used to compare the seasonal variations while kurtosis metrics are exercised to check the impulsive nature of composite signal. Histogram representation and probability density function (PDF) were utilized to analyze the spectral variation in soundscape with respect to season. Analysis was carried out at 500-ms temporal window in two spectral bands corresponding to traffic and wind noise fields. Seasonal analysis shows that in summer, mean noise level decreases as hydrophone depth increases, while in winter, deeper depths have higher mean value with the presence of seasonal surface duct. This implication of sound speed profile on noise field has also been confirmed using appropriate noise model.

PMID:37831220 | DOI:10.1007/s10661-023-11912-4

Eur Phys J E Soft Matter. 2023 Oct 13;46(10):97. doi: 10.1140/epje/s10189-023-00355-x.

ABSTRACT

Strongly charged polyelectrolytes (PEs) demonstrate complex solution behavior as a function of chain length, concentrations, and ionic strength. The viscosity behavior is important to understand and is a core quantity for many applications, but aspects remain a challenge. Molecular dynamics simulations using implicit solvent coarse-grained (CG) models successfully reproduce structure, but are often inappropriate for calculating viscosities. To address the need for CG models which reproduce viscoelastic properties of one of the most studied PEs, sodium polystyrene sulfonate (NaPSS), we report our recent efforts in using Bayesian optimization to develop CG models of NaPSS which capture both polymer structure and dynamics in aqueous solutions with explicit solvent. We demonstrate that our explicit solvent CG NaPSS model with the ML-BOP water model [Chan et al. Nat Commun 10, 379 (2019)] quantitatively reproduces NaPSS chain statistics and solution structure. The new explicit solvent CG model is benchmarked against diffusivities from atomistic simulations and experimental specific viscosities for short chains. We also show that our Bayesian-optimized CG model is transferable to larger chain lengths across a range of concentrations. Overall, this work provides a machine-learned model to probe the structural, dynamic, and rheological properties of polyelectrolytes such as NaPSS and aids in the design of novel, strongly charged polymers with tunable structural and viscoelastic properties.

PMID:37831216 | DOI:10.1140/epje/s10189-023-00355-x