Category: Statistics

Pol Merkur Lekarski. 2023;51(3):201-206. doi: 10.36740/Merkur202303103.

ABSTRACT

OBJECTIVE: Aim: To evaluate primary health physicians’ clinical and behavioral practices towards antibiotics administration in a specific region in Greece.

PATIENTS AND METHODS: Materials and methods: A cross sectional study was conducted using a questionnaire in all structures of primary health care (PHC) of the Peloponnese Region. The study was conducted in May-October 2020.

RESULTS: Results: In total, 306 out of 404 primary healthcare physicians completed the questionnaire (response rate of 75.8%). Our results showed that most of physicians used to prescribing antibiotics empirically in common diseases, except for the prevention of secondary respiratory tract infection. Overall, 66.3% answered that they do not feel diagnostic uncertainty that would lead them to prescribe antibiotics. Approximately 40% of the physicians stated an increase on antibiotics use and patients demand for antibiotic prescribing, however 71.4% “rarely/never” affected by this requirement. 51.9% of the sample used to prescribed brand name antibiotics. Statistically significant differences were found between demographic and professional characteristics, and physicians’ clinical and behavioral practices (p≤ 0.05).

CONCLUSION: Conclusions: Our findings could provide decision makers with information on how to manage antibiotic prescribing in primary health care in the country, focusing mainly on the use of specific diagnostic tests as well as relevant guidelines and protocols for changing prescription behavior.

PMID:37589103 | DOI:10.36740/Merkur202303103

Pediatrics. 2023 Aug 17:e2023061607. doi: 10.1542/peds.2023-061607. Online ahead of print.

ABSTRACT

BACKGROUNDAND OBJECTIVES: Despite being preventable, neonatal hypothermia remains common. We hypothesized that the proportion of newborns with hypothermia on admission would be high in all settings, higher in hospitals in middle-income countries (MIC) compared with high-income countries (HIC), and associated with morbidity and mortality.

METHODS: Using the Vermont Oxford Network database of newborns with birth weights 401 to 1500 g or 22 to 29 weeks’ gestational age from 2018 to 2021, we analyzed maternal and infant characteristics, delivery room management, and outcomes by temperature within 1 hour of admission to the NICU in 12 MICs and 22 HICs.

RESULTS: Among 201 046 newborns, hypothermia was more common in MIC hospitals (64.0%) compared with HIC hospitals (28.6%). Lower birth weight, small for gestational age status, and prolonged resuscitation were perinatal risk factors for hypothermia. The mortality was doubled for hypothermic compared with euthermic newborns in MICs (24.7% and 15.4%) and HICs (12.7% and 7.6%) hospitals. After adjusting for confounders, the relative risk of death among hypothermic newborns compared with euthermic newborns was 1.21 (95% confidence interval 1.09-1.33) in MICs and 1.26 (95% confidence interval 1.21-1.31) in HICs. Every 1°C increase in admission temperature was associated with a 9% and 10% decrease in mortality risk in MICs and HICs, respectively.

CONCLUSIONS: In this large sample of newborns across MICs and HICs, hypothermia remains common and is strongly associated with mortality. The profound burden of hypothermia presents an opportunity for strategies to improve outcomes and achieve the neonatal 2030 Sustainable Development Goal.

PMID:37589082 | DOI:10.1542/peds.2023-061607

Front Endocrinol (Lausanne). 2023 Jul 31;14:1231784. doi: 10.3389/fendo.2023.1231784. eCollection 2023.

ABSTRACT

Differentiating between thyroid and parathyroid lesions by means of ultrasound can be a challenge in some cases. This study explores the diagnostic efficacy of bidimensional shear wave elastography planewave ultrasound (2D SWE PLUS) as an auxiliary technique in distinguishing these superficial structures. We evaluated 86 cases, presenting with concurrent thyroid nodules and hyperparathyroidism, through conventional ultrasound and 2D SWE PLUS, employing an Aixplorer Supersonic Mach30 with a 5-18 MHz linear probe. Statistically significant differences were observed for the elasticity index (EI) between parathyroid and normal thyroid tissue (p<0.0001, U=291), and between parathyroid lesions and thyroid nodules (p<0.0001, U=248.5). An area under the curve (AUC) of 0.961, with an optimal cut-off value of ≤8.9 kPa, was established to effectively distinguish parathyroid tissue from normal thyroid tissue (sensitivity of 91.9%; specificity of 97.5%). Furthermore, an AUC of 0.963 and an optimal cut-off of 9.24 kPa (sensitivity of 94.2%, specificity of 91.1%) were determined for parathyroid vs thyroid lesions. Elasticity values were significantly elevated in the cancer group compared to benign thyroid nodules (p<0.0001). Our findings suggest that 2D SWE PLUS is an effective tool in differentiating between thyroid nodules and parathyroid lesions, enhancing diagnostic performance in neck ultrasonography.

PMID:37588988 | PMC:PMC10425532 | DOI:10.3389/fendo.2023.1231784

Korean J Intern Med. 2023 Aug 17. doi: 10.3904/kjim.2023.115. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Antimicrobial de-escalation (ADE) remains a challenging strategy in the treatment of pneumonia. We investigated the outcomes of ADE as measured by mortality and duration of the use of antibiotics in patients with culture- negative pneumonia.

METHODS: We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. The primary outcome was inpatient mortality.

RESULTS: We examined six studies comprising 11,933 subjects, of whom 1,152 received ADE. Overall, the ADE strategy was associated with a statistically lower risk of in-hospital mortality compared with non-ADE (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.93). Although substantial heterogeneity was found among the included studies (I2 = 66%), a meta-regression analysis could not reveal plausible sources of heterogeneity. And ADE was associated with a shorter duration of total and initial antibiotic therapies and total length of hospital stay compared with non-ADE.

CONCLUSIONS: Our findings suggest that ADE seems to be significantly associated with better clinical outcomes compared with non-ADE. Caution is demanded when interpreting data of this study because of substantial between-study heterogeneity.

PMID:37586813 | DOI:10.3904/kjim.2023.115

BMJ Open Diabetes Res Care. 2023 Aug;11(4):e003278. doi: 10.1136/bmjdrc-2022-003278.

ABSTRACT

INTRODUCTION: To evaluate the degree to which socioeconomic differences in gestational diabetes mellitus (GDM) are accounted for by differences in maternal risk factors, to assess whether age-related risks of GDM differ across socioeconomic groups, and to identify priority populations for future interventions.

RESEARCH DESIGN AND METHODS: We performed a register-based study using data from the Finnish Medical Birth Register and Statistics Finland on the 474 166 women who gave birth in Finland from 2008 to 2015. We collected information on GDM based on the International Classification of Diseases 10th Revision codes O24.4 and O24.9. We used multivariable models to examine the association between socioeconomic status, maternal risk factors, and GDM. We further tested interaction on multiplicative and additive scales.

RESULTS: The incidence of GDM was 8.7% in 2008-2011 and 12.5% in 2012-2015. Lower socioeconomic levels than upper level employees were associated with an increased risk of GDM. Up to 64.0% of socioeconomic differences in GDM were attributed to body mass index and 5.5% to smoking. There was evidence for effect modification. Relative to women in the upper level category who were aged less than 19 years, GDM adjusted ORs (95% CIs) for women 35 years or older in upper level versus long-term unemployed groups were 3.28 (2.08-5.18) and 5.29 (3.35-8.35), respectively.

CONCLUSIONS: There is a paradox that socioeconomic advantage increases the incidence of GDM at the population level while reducing the incidence of GDM within the population. Nevertheless, socioeconomic differences in GDM persist and widen with increasing maternal age, even after accounting for maternal risk factors.

PMID:37586779 | DOI:10.1136/bmjdrc-2022-003278

BMJ Health Care Inform. 2023 Aug;30(1):e100769. doi: 10.1136/bmjhci-2023-100769.

ABSTRACT

BACKGROUND: In achieving the WHO’s Universal Health Coverage and the Global Developmental Agenda: Sustainable Development Goal 3 and 9, the Ministry of Health launched a nationwide deployment of the lightwave health information management system (LHIMS) in the Central Region to facilitate health service delivery. This paper assessed the efficient use of the LHIMS among health professionals in the Central Region.

METHODS: A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified and simple random sampling for selecting 1126 study respondents from 10 health facilities that use the LHIMS. The respondents included prescribers, nurses, midwives and auxiliary staff. Descriptive statistics (weighted mean) was computed to determine the average weighted score for all the indicators under efficiency. Also, bivariate (χ²) and multivariate (ordinal logistic regression) analyses were conducted to test the study’s hypotheses.

RESULTS: Findings revealed that the LHIMS enhanced efficient health service delivery. From the bivariate analysis, external factors; sex, educational qualification, work experience, profession type and computer literacy were associated with the efficient use of the LHIMS. However, training offered prior to the use of the LHIMS, and the duration of training had no association. At the multivariate level, only work experience and computer literacy significantly influenced the efficient use of the LHIMS.

CONCLUSION: The implementation of LHIMS has the potential to significantly improve health service delivery. General computing skills should be offered to system users by the Ministry of Health to improve literacy in the use of computers. Active participation in the use of LHIMS by all relevant healthcare professionals should be encouraged.

PMID:37586751 | DOI:10.1136/bmjhci-2023-100769

BMJ. 2023 Aug 16;382:e073713. doi: 10.1136/bmj-2022-073713.

ABSTRACT

OBJECTIVE: To estimate the effects of providing access to an alcohol intervention based on a smartphone.

DESIGN: Randomised controlled trial..

SETTING: Four higher education institutions in Switzerland.

PARTICIPANTS: 1770 students (≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption (AUDIT-C) of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10.

INTERVENTION: Providing access to a brief, smartphone based alcohol intervention.

OUTCOME MEASURES: The primary outcome studied was number of standard drinks per week at six months and the secondary outcome was number of heavy drinking days (past 30 days). Additional outcomes were maximum number of drinks consumed on one occasion, alcohol related consequences, and academic performance. Follow-up assessments occurred at months three, six, and 12. Data were analysed by intention to treat and by using generalised linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention (v control), time (three months v six months; 12 months v six months), and baseline outcome values as fixed effects.

RESULTS: Between 26 April 26 2021 and 30 May 2022, 1770 participants (intervention group (n=884); control group (n=886)) were included. Mean age was 22.4 years (standard deviation 3.07); 958 (54.1%) were women; and 1169 (66.0%) were undergraduate students, 533 (30.1%) were studying for a master’s degree, 43 (2.4%) were studying for a doctorate, and 25 (1.4%) were students of other higher education programme. The baseline mean number of standard drinks per week was 8.59 (standard deviation 8.18); the baseline number of heavy drinking days was 3.53 (4.02). Of 1770 participants, follow-up rates were 1706 (96.4%) at three months, 1697 (95.9%) at six months, and 1660 (93.8%) at 12 months. Of 884 students randomly assigned to the intervention group, 738 (83.5%) downloaded the smartphone application. The intervention had a significant overall effect on the number of standard drinks per week (incidence rate ratio 0.90 (95% confidence interval 0.85 to 0.96)), heavy drinking days (0.89 (0.83 to 0.96)), and the maximum number of drinks consumed on one occasion (0.96 (0.93 to 1.00), P=0.029), indicating significantly lower drinking outcomes in the intervention group than in the control group during the follow-up period. The intervention did not affect alcohol related consequences or academic performance.

CONCLUSIONS: Providing access to the smartphone application throughout the 12 month follow-up was effective at limiting the average drinking volume of university students who had self-reported unhealthy alcohol use at baseline.

TRIAL REGISTRATION: ISRCTN 10007691.

PMID:37586742 | DOI:10.1136/bmj-2022-073713

BMJ. 2023 Aug 16;382:p1893. doi: 10.1136/bmj.p1893.

NO ABSTRACT

PMID:37586728 | DOI:10.1136/bmj.p1893

Ultrasonography. 2023 Jun 30. doi: 10.14366/usg.23084. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study was to evaluate pain and image quality associated with the use of two different ultrasound transducers.

METHODS: Fifty healthy male participants aged 30 years or older were prospectively enrolled. All ultrasound procedures were performed using a V8 machine (Samsung Medison, Seoul, Korea) equipped with EA2-11 (conventional) and miniER7 (small-caliber) transrectal transducers, operated by a single genitourinary radiologist. To minimize bias, one group of volunteers underwent ultrasonography with the conventional transducer first, followed by the small transducer. For the remaining participants, the examinations were performed in the opposite order. Ultrasonography, including the measurement of total prostate and transitional zone volumes, was conducted in accordance with standard practice. After testing with both probes, participants were asked to rate their pain on a 10-point numerical rating scale (NRS). A radiologist then evaluated the quality of the images acquired with each probe using a 5-point numeric scale and compared the prostate volume measurements obtained by each method.

RESULTS: The mean NRS scores associated with the conventional and small transducers were 4.7±1.8 and 2.7±1.2, respectively (P<0.05). The mean ultrasound image qualities from the two transducers were statistically similar (4.78 and 4.74, P>0.05). The whole prostate gland volume as measured with the conventional transducer (mean±standard deviation, 24.2±9.1 mL) was greater than the measurement (22.1±8.7 mL) obtained with the small-caliber transducer (P<0.05). However, only two of the 50 whole gland volume measurements differed by more than two standard deviations.

CONCLUSION: The use of a small transrectal probe significantly reduced pain without compromising image quality.

PMID:37586719 | DOI:10.14366/usg.23084

Clin Respir J. 2023 Aug 16. doi: 10.1111/crj.13687. Online ahead of print.

ABSTRACT

BACKGROUND: To help elderly patients with severe or very severe chronic obstructive pulmonary disease (COPD) with pulmonary rehabilitation, we have developed Zheng’s supine rehabilitation exercise (ZSRE). Currently, none of the terminal or critically ill patients with severe exercise limitation can complete the 6-min walking distance (6MWD) and cardiopulmonary exercise testing (CPET).

METHODS: In this study, we discuss the definition of the standardized 3-min simulated pedal motion (3MSPM) test and its operational specifications. Also, we evaluate the minimal clinically important difference (MCID) value of the 3MSPM.

RESULTS: The results showed that the mMRC score of COPD patients with acute exacerbation of dyspnea was progressively reduced from the second day of respiratory rehabilitation, and the difference between the first and seventh days was statistically significant (p < 0.000, χ² = 176.664). 6MWD increased progressively, and the difference between 6MWD on day 1-7 was statistically significant (p = 0.024, F = 2.443). The difference between 3MSPM on day 1-7 was also statistically significant (p < 0.000, F = 4.481). Further analysis showed that 6MWD was negatively correlated with mMRC (p < 0.000, OR = -0.524). 3MSPM was positively correlated with 6MWD (p < 0.000, OR = 0.640) but negatively correlated with mMRC (p < 0.000, OR = -0.413). There is a linear regression relationship between 6MWD and 3MSPM, that is, 6MWD = 14.151 + 0.301 * 3MSPM, adjusted R² = 0.401.

CONCLUSION: Based on the regression equation, 3MSPM can predict 6MWD, and it can be used as a simple exercise endurance method to evaluate patients with safety hazards in underground activities or who cannot complete the 6MWD test. The minimum clinically important difference value is increased by 23.

PMID:37586707 | DOI:10.1111/crj.13687