Category: Statistics

J Magn Reson Imaging. 2023 Mar 6. doi: 10.1002/jmri.28670. Online ahead of print.

ABSTRACT

BACKGROUND: The volume doubling time (VDT) of breast cancer was most frequently calculated using the two-dimensional (2D) diameter, which is not reliable for irregular tumors. It was rarely investigated using three-dimensional (3D) imaging with tumor volume on serial magnetic resonance imaging (MRI).

PURPOSE: To investigate the VDT of breast cancer using 3D tumor volume assessment on serial breast MRIs.

STUDY TYPE: Retrospective.

SUBJECTS: Sixty women (age at diagnosis: 57 ± 10 years) with breast cancer, assessed by two or more breast MRI examinations. The median interval time was 791 days (range: 70-3654 days).

FIELD STRENGTH/SEQUENCE: 3-T, fast spin-echo T2-weighted imaging (T2WI), single-shot echo-planar diffusion-weighted imaging (DWI), and gradient echo dynamic contrast-enhanced imaging.

ASSESSMENT: Three radiologists independently reviewed the morphological, DWI, and T2WI features of lesions. The whole tumor was segmented to measure the volume on contrast-enhanced images. The exponential growth model was fitted in the 11 patients with at least three MRI examinations. The VDT of breast cancer was calculated using the modified Schwartz equation.

STATISTICAL TESTS: Mann-Whitney U test, Kruskal-Wallis test, Chi-squared test, intraclass correlation coefficients, and Fleiss kappa coefficients. A P-value <0.05 was considered statistically significant. The exponential growth model was evaluated using the adjusted R² and root mean square error (RMSE).

RESULTS: The median tumor diameter was 9.7 mm and 15.2 mm on the initial and final MRI, respectively. The median adjusted R² and RMSE of the 11 exponential models were 0.97 and 15.8, respectively. The median VDT was 540 days (range: 68-2424 days). For invasive ductal carcinoma (N = 33), the median VDT of the non-luminal type was shorter than that of the luminal type (178 days vs. 478 days). On initial MRI, breast cancer manifesting as a focus or mass lesion showed a shorter VDT than that of a non-mass enhancement (NME) lesion (median VDT: 426 days vs. 665 days).

DATA CONCLUSION: A shorter VDT was observed in breast cancer manifesting as focus or mass as compared to an NME lesion.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

PMID:36876593 | DOI:10.1002/jmri.28670

Paediatr Anaesth. 2023 Mar 6. doi: 10.1111/pan.14658. Online ahead of print.

ABSTRACT

BACKGROUND: Liberal fasting regimens, which support clear fluid intake up to 1 hour before surgery in children scheduled for elective surgery, are taking their place in guidelines. However, because of the lack of publications that investigate the gastric emptying time in preoperative obese children, the practice of 1-hour clear fluid fasting in obese children remained at the level of recommendation with weak evidence.

AIMS: The primary aim was to investigate whether there is a difference in gastric emptying times between obese and non- obese children after preoperative intake of 3 ml/kg clear liquid containing 5% dextrose by using ultrasound.

METHODS: A total of 70 children were included in the study in two groups, 35 obese and 35 non-obese, aged 6-14 years, who were scheduled for elective surgery. The baseline antral cross-sectional area measurements of the children in the groups were made using ultrasound. 3 ml/kg 5% dextrose was consumed. Ultrasound was repeated immediately after fluid intake and every 5 minutes until the antral cross-sectional area was at the baseline level.

RESULTS: The difference in median (IQR [range]) gastric emptying times (minutes) of non-obese [(35 (30.0-45.0 [20-60])] and obese children [(35 (30.0-40.0 [25-60])] were not statistically significant (median of differences 0.0, 95% CI 0.0 to 0.0; P=0,563). The antral cross-sectional area and weight- adjusted gastric volumes returned to the baseline level within 60 minutes after the intake of clear liquid with 3 ml/kg 5% dextrose in all children in both groups.

CONCLUSIONS: Obese and non-obese children have similar gastric emptying times, and these groups can be offered clear fluids containing 3 ml/kg 5% dextrose 1 hour before the surgery.

PMID:36876549 | DOI:10.1111/pan.14658

Folia Med (Plovdiv). 2022 Oct 31;64(5):782-786. doi: 10.3897/folmed.64.e67757.

ABSTRACT

The share of unwanted pregnancies and voluntary abortions among women from Central and Eastern Europe is still quite high, and Bulgaria is no exception to this statistic. This might be accounted for by the low frequency of use of contraceptives or their improper use. Our country is home to a variety of ethnic groups, with Roma being one of the most numerous, ranking third in population behind Bulgarians and Turks. This determines the influence of this ethnic group on the demographic indicators of the country.

PMID:36876529 | DOI:10.3897/folmed.64.e67757

Public Health Nutr. 2023 Mar 6:1-26. doi: 10.1017/S1368980023000411. Online ahead of print.

ABSTRACT

OBJECTIVE: Explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition, and describe associations with survival and non-communicable disease (NCD) risk seven years post-treatment.

DESIGN: Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score (WAZ) and height-for-age z-score (HAZ). Three categorisation methods included: no categorisation, quintiles, and latent class analysis (LCA). Associations with mortality risk, and seven NCD indicators were analysed.

SETTING: Secondary data from Blantyre, Malawi between 2006 and 2014.

PARTICIPANTS: A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score <70% median and/or MUAC<110 mm and/or bilateral oedema) at aged 5 to 168 months.

RESULTS: Faster weight gain during treatment (g/day) and after treatment (g/kg/day) were associated with lower risk of death (aOR 0.99, 95%CI 0.99 to 1.00; and aOR 0.91, 95% CI 0.87 to 0.94 respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0.02, 95%CI 0.00 to 0.03) and larger HAZ (6.62, 95%CI 1.31 to 11.9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0.02, 95%CI 0.01 to 0.03), an indicator of later life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/day during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder.

CONCLUSIONS: A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.

PMID:36876519 | DOI:10.1017/S1368980023000411

United European Gastroenterol J. 2023 Mar 6. doi: 10.1002/ueg2.12366. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The availability of biological agents for inflammatory bowel disease has increased over the past years. In this systematic review and meta-analysis, we aimed to explore time trends in clinical response and clinical remission rates in Crohn’s disease (CD) patients treated with biologics while discussing the need for new strategies.

METHODS: MEDLINE, Cochrane, and ISI Web of Science databases were searched for randomized placebo-controlled trials with biological agents in moderate-to-severe CD patients. Sub-group and meta-regression analyses compared treatment and placebo by calculating the pooled odds ratios of clinical remission and clinical response, across time categories and publication year. We also estimated the proportion of patients achieving clinical remission and clinical response by comparing both groups according to the publication year.

RESULTS: Twenty-five trials were included in the systematic review, which enrolled 8879 patients between 1997 and 2022. The clinical remission and clinical response odds, in induction and maintenance, have been constant over time, as no statistically significant differences were found between time categories (interaction p-values: clinical remission [induction, p = 0.19; maintenance, p = 0.24]; clinical response [induction, p = 0.43; maintenance, p = 0.59]). In meta-regression analyses, publication year did not influence these outcomes (clinical remission [induction, OR 1.01{95% CI 0.97-1.05}, p = 0.72; clinical response [induction, OR 1.01{95% CI 0.97-1.04]; p = 0.63; maintenance, OR 1.03{95% CI 0.98-1.07}; p = 0.21]), with the exception of clinical remission in maintenance studies, which presented a decreased effect (odds ratio 0.97{95% CI 0.94-1.00}, p = 0.03]).

CONCLUSIONS: Our review highlights that the odds of clinical outcomes in CD patients receiving biological treatment relative to placebo have been stable in the last decades.

PMID:36876515 | DOI:10.1002/ueg2.12366

Am Surg. 2023 Mar 6:31348231161082. doi: 10.1177/00031348231161082. Online ahead of print.

ABSTRACT

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) in acute trauma patients is a poorly characterized event. While ECMO most commonly has been deployed for advanced cardiopulmonary or respiratory failure following initial resuscitation, growing levels of evidence for out of hospital cardiac arrest support early ECMO cannulation as part of resuscitative efforts. We sought to perform a descriptive analysis evaluating traumatically injured patients, who were placed on ECMO, during their initial resuscitation period.

METHODS: We performed a retrospective analysis of the Trauma Quality Improvement Program Database from 2017 to 2019. All traumatically injured patients who received ECMO within the first 24 hours of their hospitalization were assessed. Descriptive statistics were used to define patient characteristics and injury patterns associated with the need for ECMO, while mortality represented the primary outcome evaluated.

RESULTS: A total of 696 trauma patients received ECMO during their hospitalization, of which 221 were placed on ECMO within the first 24 hours. Early ECMO patients were on average 32.5 years old, 86% male, and sustained a penetrating injury 9% of the time. The average ISS was 30.7, and the overall mortality rate was 41.2%. Prehospital cardiac arrest was noted in 18.2% of the patient population resulting in a 46.8% mortality. Of those who underwent resuscitative thoracotomy, a 53.3% mortality rate was present.

CONCLUSION: Early cannulation for ECMO in severely injured patients may provide an opportunity for rescue therapy following severe injury patterns. Further evaluation regarding the safety profile, cannulation strategies, and optimal injury patterns for these techniques should be evaluated.

PMID:36876475 | DOI:10.1177/00031348231161082

J Man Manip Ther. 2023 Mar 6:1-9. doi: 10.1080/10669817.2023.2179285. Online ahead of print.

ABSTRACT

OBJECTIVES: This study includes two separate parts: the objective for part A was to evaluate the practical manual therapy skills of undergraduate physiotherapy students who had learned manual therapy techniques either online or in classroom depending on the phases of the pandemic. The objective for part B was to evaluate in a randomized prospective design the effectiveness of video-based versus traditional teaching of a manual therapy technique.

DESIGN: Cross-sectional cohort study (part A) and randomized controlled trial (part B).

SETTING: University of Luebeck, undergraduate physiotherapy students in years 1-3.

METHOD: In part A, physiotherapy students who had learned manual therapy either online (during the pandemic) or in classroom (prior to and after the lock down periods of the pandemic) were videotaped while performing two manual techniques on the knee joint and on the lumbar spine. Recordings were analyzed independently by two blinded raters according to a 10-item list of criteria. Inter-rater reliability was assessed using Cohen’s kappa for each item. Performance across cohorts was analyzed using analysis of variance. In part B, students were randomized to learn a new technique on the cervical spine either from a lecturer or from the same lecturer on a video recording (independent variable). Practical performance of the technique was analyzed by two raters blinded to group allocation according to a 10-item list of criteria (dependent variable). Results were analyzed statistically by using ANCOVA with year of study as a covariate.

RESULTS: Sixty-three and 56 students participated in part A and part B of the study, respectively. The inter-rater reliability for video analyses for both parts of the study was moderate (k = 0.402 to 0.441). In part A, there was no statistically significant difference across years of study for the practical performance of the technique on the back F(2,59) = 2.271; p = 0.112 or the knee joint F(2,59) = 3.028; p = 0.056. In part B, performance was significantly better when learned from a lecturer and practiced on a peer than when learned from a video and practiced on a rescue dummy (p < 0.001).

CONCLUSION: Practical skill performance can be acquired from videos but immediate skill reproduction is significantly better when the technique is presented by a lecturer in classroom and practiced on peer students.

PMID:36876463 | DOI:10.1080/10669817.2023.2179285

Anat Sci Educ. 2023 Mar 6. doi: 10.1002/ase.2268. Online ahead of print.

ABSTRACT

An understanding of forearm and wrist anatomy is necessary for the diagnosis and treatment of various injuries. Evidence supports the use of peer-assisted learning (PAL) as an effective resource for teaching basic science courses. First-year medical students across three class years participated in an optional PAL kinesthetic workshop wherein participants created anatomically accurate paper models of forearm and wrist muscles. Participants completed pre- and post-workshop surveys. Participant and non-participant exam performances were compared. Participation ranged from 17.3-33.2% of each class; participants were more likely to identify as women than men (p<0.001). Participants in cohorts 2 and 3 reported increased comfort with relevant content after the workshop (p<0.001). Survey responses for cohort 1 were omitted due to low response rates; however, exam performances were assessed for all three cohorts. Cohort 2 participants scored higher than non-participants on forearm and wrist questions on the cumulative course exam (p=0.010), while the opposite was found for cohort 3 (p=0.051). No other statistically significant differences were observed. This is the first study to examine quantitative and qualitative results for a PAL intervention repeated for three separate cohorts. Although academic performance varied, two cohorts reported increased comfort with relevant course material after the workshop. Results of this study support the need for further exploration of PAL workshops as an instructional method in teaching anatomy, and highlight the challenges associated with repeating interventions over multiple years. As more studies attempt replication across multiple years, these challenges may be addressed, thereby informing PAL best practices.

PMID:36876457 | DOI:10.1002/ase.2268

JBI Evid Synth. 2023 Mar 7. doi: 10.11124/JBIES-22-00248. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this review is to describe the nature and extent of the literature regarding unlicensed assistive personnel’s involvement in delivering care to persons with or at risk of delirium.

INTRODUCTION: Initiatives that promote the involvement of unlicensed assistive personnel in providing additional supervision and care to persons with or at risk of delirium have been developed. Since no standardized approach guides unlicensed assistive personnel’s involvement with persons with or at risk of delirium, and since inconsistent training and expectations may pose a threat to the safety and quality of care, it is essential to clarify their role with persons with or at risk of delirium.

INCLUSION CRITERIA: This review will consider articles published in peer-reviewed journals, dissertations, theses, book chapters, and conference papers in French or English. Quantitative, qualitative, or mixed method studies that report on the development, implementation, or evaluation of the role of unlicensed assistive personnel in contexts of delirium will be included. We will consider editorials and opinion papers only if they report on the development, implementation, or evaluation of the role of unlicensed assistive personnel.

METHODS: Records will be identified via CINAHL, ProQuest Dissertations & Theses Global, Embase, MEDLINE, APA PsycINFO, and Web of Science. Two independent reviewers will select studies and extract data using a piloted form. Data will be synthesized narratively, using descriptive statistics and a tabular format. A consultation phase will include approximately 24 unlicensed assistive personnel and registered nurses who will be invited to comment on the review findings.

PMID:36876454 | DOI:10.11124/JBIES-22-00248

J Addict Dis. 2023 Mar 6:1-5. doi: 10.1080/10550887.2023.2173929. Online ahead of print.

ABSTRACT

The present study aims to compare Years of Life Lost for unintentional drug overdose and the leading underlying causes of death in the United States annually from 2017 to 2019. Years of Life Lost provide valuable context to incident deaths when comparing the relative mortality burden of underlying causes of death. Prior research has shown unintentional drug overdose was the third leading cause of Years of Life Lost in the state of Ohio in 2017. However, this finding has yet to be replicated at the national level in the US. Death statistics for 2017-2019 were accessed via CDC WONDER. Years of Life Lost were calculated for unintentional drug overdose and each of the top five causes of incident deaths in the US during the study period. Unintentional drug overdose caused nearly seven million Years of Life Lost in the US during the three-year period of study and was the fourth leading cause of Years of Life Lost after cancer, heart disease and other accidents. Incidence alone provides an incomplete picture of the effect of unintentional drug overdose on overall mortality burden in the US. Years of Life Lost give critical context to the overdose crisis, underscoring unintentional drug overdose as a leading cause of premature mortality.

PMID:36876385 | DOI:10.1080/10550887.2023.2173929