Category: Statistics

Hosp Pediatr. 2023 Sep 6:e2022007045. doi: 10.1542/hpeds.2022-007045. Online ahead of print.

ABSTRACT

OBJECTIVES: The American Academy of Pediatrics published a guideline in 2011 recommending against the routine use of voiding cystourethrogram (VCUG) in infants aged 2 to 24 months with first febrile urinary tract infection (UTI); however, the rates of VCUG for infants aged <2 months are unknown. The objective of this study was to determine the trend in VCUG performance during index hospitalization among infants aged 0 to 2 months with UTI.

METHODS: This retrospective cohort study included infants aged birth to 2 months hospitalized with a UTI from 2008 to 2019 across 38 institutions in the Pediatric Health Information System. Outcome measures included recurrent UTI within 1 year, vesicoureteral reflux diagnosis within 1 year and antiurinary reflux procedure performed within 2 years. Trends over time were compared between preguideline (2008-2011) and postguideline periods (2012-2019) using piecewise mixed-effects logistic regression.

RESULTS: The odds of VCUG decreased by 21% per year in the preguideline period (adjusted odds ratio, 0.79; 95% confidence interval, 0.77-0.81; P < .001) versus 20% (adjusted odds ratio, 0.80; 95% confidence interval, 0.77-0.83; P < .001) in the postguideline period. The preguideline and postguideline difference was not statistically significant (P = .60). There was no difference in the postguideline odds of UTI within 1 year (P = .07), whereas the odds of vesicoureteral reflux diagnosis (P < .001) and antiurinary reflux procedure performance (P < .001) decreased.

CONCLUSIONS: VCUG performance during hospitalization has declined over the past decade among young infants hospitalized with UTI. Further work is needed to determine the optimal approach to imaging in these young infants.

PMID:37671444 | DOI:10.1542/hpeds.2022-007045

Eur J Ophthalmol. 2023 Sep 6:11206721231199774. doi: 10.1177/11206721231199774. Online ahead of print.

ABSTRACT

PURPOSE: To determine if glaucoma medications are associated with pregnancy and/or postnatal complications.

METHODS: Multicenter descriptive survey. Subjects were female patients 18-45 years who were previously pregnant with a diagnosis of glaucoma or ocular hypertension prior to pregnancy. Chart review queried diagnosis, glaucoma severity, and race. Survey questions were asked for each pregnancy and queried pregnancy age, medications used, and pregnancy outcomes/complications.

RESULTS: 114 pregnancies of 56 patients (mean 2.0 pregnancies per patient) were included. Three pregnancies with therapeutic abortion were excluded from further analysis. Mean age during pregnancy was 29.1 ± 5.7 years. Of the 111 pregnancies, 20 (18.0%) used no medications and 91 (82.0%) used at least one medication. Medications were topical carbonic anhydrase inhibitors (n = 45), beta-blockers (n = 55), alpha-agonists (n = 56), and prostaglandin analogues (n = 28). Outcomes were: preterm contractions/labour (6.3%), miscarriage (4.5%), stillbirth (4.5%), induction of labour (11.9%), emergency/unplanned caesarean delivery (13.9%), neonatal intensive care unit (NICU) stay (15.8%), congenital anomalies (8.1%), and low birth weight (10.9%). Fisher exact test assessed outcome associations with individual agents, use of any agent, and different number of agents. Alpha-agonist use was associated with NICU stay: 25.5% rate (p = 0.012) in alpha-agonist use. Most of the alpha-agonist use NICU stays occurred in pregnancies with third trimester use. All other associations were not statistically significant.

CONCLUSIONS: The data from this survey suggest an overall favourable safety profile for topical glaucoma medications in pregnancy, but further investigation is needed. Caution should be employed regarding third trimester alpha-agonist use owing to association with NICU stay.

PMID:37671417 | DOI:10.1177/11206721231199774

Asian Cardiovasc Thorac Ann. 2023 Sep 6:2184923231197872. doi: 10.1177/02184923231197872. Online ahead of print.

ABSTRACT

INTRODUCTION: The feasibility and standardization of coronary artery bypass grafting (CABG) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and unstable angina (UA) remain topics of ongoing debate. In this study, feasibility and early-term outcomes of CABG in patients with NSTE-ACS and UA were discussed.

METHODS: This study enrolled 79 patients who underwent on-pump CABG with complete revascularization between January 2020 and May 2022. the survival rates analyzed using Kaplan Meier test with log rank test. The p value of statistical significance was taken as below 0.05.

RESULTS: Preoperatively, the patients had a mean age of 60.9 years and a BMI of 28.0. The medical history included hypertension (50.6%), peripheral arterial disease and atrial fibrillation (12.7%), and other comorbidities such as COPD (22.8%) and type 2 diabetes mellitus (44.3%). Intraoperatively, the mean distal anastomosis count was 3.4, with average cardiopulmonary bypass and aortic cross-clamp times of 84.0 and 49.0 min, respectively. Early-term outcomes revealed low rates of mortality (2.5%) and complications such as myocardial infarction (1.3%), acute kidney injury (5.1%) and transient ischemic attack (5.1%). Post-discharge outcomes demonstrated low cardiac and all-cause mortality rates (2.5% and 3.8%, respectively) and a high overall survival rate (93.7%) at 12-month follow-up.

CONCLUSION: This study demonstrated the feasibility and positive outcomes of complete surgical revascularization in patients with UA and NSTE-ACS. It showed no graft occlusion or stroke, low complication rates and promising survival outcomes. Further research is needed for confirmation and to establish the procedure’s efficacy and safety in this patient population.

PMID:37671414 | DOI:10.1177/02184923231197872

Cleft Palate Craniofac J. 2023 Sep 6:10556656231198945. doi: 10.1177/10556656231198945. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop risk prediction models for preterm birth among infants with orofacial clefts.

DESIGN: Data from the Texas Birth Defects Registry for infants with orofacial clefts born between 1999-2014 were used to develop preterm birth predictive models. Logistic regression was used to consider maternal and infant characteristics, and internal validation of the final model was performed using bootstrapping methods. The area under the curve (AUC) statistic was generated to assess model performance, and separate predictive models were built and validated for infants with cleft lip and cleft palate alone. Several secondary analyses were conducted among subgroups of interest.

SETTING: State-wide, population-based Registry data.

PATIENTS/PARTICIPANTS: 6774 infants with orofacial clefts born in Texas between 1999-2014.

MAIN OUTCOME MEASURE(S): Preterm birth among infants with orofacial clefts.

RESULTS: The final predictive model performed modestly, with an optimism-corrected AUC of 0.67 among all infants with orofacial clefts. The optimism-corrected models for cleft lip (with or without cleft palate) and cleft palate alone had similar predictive capability, with AUCs of 0.66 and 0.67, respectively. Secondary analyses had similar results, but the model among infants with delivery prior to 32 weeks demonstrated higher optimism-corrected predictive capability (AUC = 0.74).

CONCLUSIONS: This study provides a first step towards predicting preterm birth risk among infants with orofacial clefts. Identifying pregnancies affected by orofacial clefts at the highest risk for preterm birth may lead to new avenues for improving outcomes among these infants.

PMID:37671412 | DOI:10.1177/10556656231198945

Front Med (Lausanne). 2023 Aug 21;10:1228833. doi: 10.3389/fmed.2023.1228833. eCollection 2023.

ABSTRACT

BACKGROUND AND OBJECTIVE: Accurate and fast diagnosis of rheumatic diseases affecting the hands is essential for further treatment decisions. Fluorescence optical imaging (FOI) visualizes inflammation-induced impaired microcirculation by increasing signal intensity, resulting in different image features. This analysis aimed to find specific image features in FOI that might be important for accurately diagnosing different rheumatic diseases.

PATIENTS AND METHODS: FOI images of the hands of patients with different types of rheumatic diseases, such as rheumatoid arthritis (RA), osteoarthritis (OA), and connective tissue diseases (CTD), were assessed in a reading of 20 different image features in three phases of the contrast agent dynamics, yielding 60 different features for each patient. The readings were analyzed for mutual differential diagnosis of the three diseases (One-vs-One) and each disease in all data (One-vs-Rest). In the first step, statistical tools and machine-learning-based methods were applied to reveal the importance rankings of the features, that is, to find features that contribute most to the model-based classification. In the second step machine learning with a stepwise increasing number of features was applied, sequentially adding at each step the most crucial remaining feature to extract a minimized subset that yields the highest diagnostic accuracy.

RESULTS: In total, n = 605 FOI of both hands were analyzed (n = 235 with RA, n = 229 with OA, and n = 141 with CTD). All classification problems showed maximum accuracy with a reduced set of image features. For RA-vs.-OA, five features were needed for high accuracy. For RA-vs.-CTD ten, OA-vs.-CTD sixteen, RA-vs.-Rest five, OA-vs.-Rest eleven, and CTD-vs-Rest fifteen, features were needed, respectively. For all problems, the final importance ranking of the features with respect to the contrast agent dynamics was determined.

CONCLUSIONS: With the presented investigations, the set of features in FOI examinations relevant to the differential diagnosis of the selected rheumatic diseases could be remarkably reduced, providing helpful information for the physician.

PMID:37671403 | PMC:PMC10475553 | DOI:10.3389/fmed.2023.1228833

Front Med (Lausanne). 2023 Aug 21;10:1237601. doi: 10.3389/fmed.2023.1237601. eCollection 2023.

ABSTRACT

For decades, unfractionated heparin (hereafter, heparin) has been the primary anticoagulant used for extracorporeal membrane oxygenation (ECMO) support. More recently, however, bivalirudin, a direct thrombin inhibitor, has emerged as an alternative. This systematic review based on PRISMA guidelines, aims to summarize 16 comparative studies and 8 meta-analysis and review articles published from January, 2011 till May, 2023 which directly compares ECMO courses using heparin versus bivalirudin as the anticoagulant. While this comparison is complicated by the lack of a standardized definition of major bleeding or thrombosis, our overall findings suggest there is no statistical difference between heparin and bivalirudin in incidence of bleeding and thrombosis. That said, some studies found a statistical significance favoring bivalirudin in reducing major bleeding, thrombosis, and the need for transfusions. We also offer essential guidance for appropriately selecting an anticoagulant and monitoring its effect in ECMO settings.

PMID:37671395 | PMC:PMC10476497 | DOI:10.3389/fmed.2023.1237601

Int J Popul Data Sci. 2023 Mar 16;4(2):1817. doi: 10.23889/ijpds.v4i2.1817. eCollection 2019.

ABSTRACT

There has been a recent emphasis to establish and codify large-scale or national Trusted Research Environments (TREs) in the United Kingdom, with a view to limit smaller, local TREs. The basis for this argument is that it avoids duplication of infrastructure, information governance, privacy risks, monopolies and will promote innovation, particularly with commercial partners. However, the work around establishing TREs in the UK largely ignores the long-established local TRE landscape in Scotland, and the way in which local TREs can actually improve data quality, solve technical architecture challenges, promote information governance and risk minimisation, and encourage innovation and collaboration (both academic and commercial). This data centre profile focuses on the Grampian Data Safe Haven (DaSH), a secure, virtual healthcare data analysis and storage centre located in Aberdeen, Scotland. DaSH was co-established by the NHS Grampian Health Board and University of Aberdeen to allow for the secure processing and linking of health data for the Grampian and Scottish population when it is not practicable to obtain consent from individual patients. As an established trusted research environment now in its 10^th operating year, DaSH technology ensures healthcare, social care data and other types of sensitive data, routinely collected and used without individual patient consent, are made accessible for both academic research and clinical service evaluation and improvements whilst protecting individuals’ privacy at the local, national and international levels. DaSH has registered almost 600 projects and facilitated over 200 distinct research projects with data hosting, extraction, and novel linkages to completion. Ongoing innovation and collaboration between DaSH and the NHS Grampian Health Board continues to expand researcher access to new types of data and data linkages, introduce new technologies for advanced statistical research methods, and supports interdisciplinary research using population health and social care data for research, clinical and commercial advancements, and real-world practitioner applications. The purpose of this paper is to present DaSH’s data population, operating model, architecture and information technology, governance, legislation and management, privacy-by-design principles and data access, data linkage methods, data sources, noteworthy research outputs, and further developments in order to demonstrate the value of local TREs within the data management and access debate.

PMID:37671386 | PMC:PMC10476148 | DOI:10.23889/ijpds.v4i2.1817

Turk J Phys Med Rehabil. 2022 Aug 12;69(2):216-221. doi: 10.5606/tftrd.2023.10857. eCollection 2023 Jun.

ABSTRACT

OBJECTIVES: The aim of this study was to test the validity of the Turkish version of the Chronic Pain Acceptance Questionnaire (CPAQ)-8.

PATIENTS AND METHODS: This methodological and cross-sectional study was conducted with 80 female patients (mean age: 49.5±10 years; range, 28 to 75 years) diagnosed with fibromyalgia syndrome between January 2020 and December 2021. Participants completed the Turkish version of the CPAQ-8, as well as the Fibromyalgia Impact Questionnaire, Brief Pain Inventory, Hospital Anxiety and Depression Scale, and Tampa Kinesiophobia Scale. Internal consistency, confirmatory factor analysis, and construct validity were examined in the statistical analysis of the data obtained.

RESULTS: The two-factor model created by exploratory factor analysis provided a better fit than the global factor model. Cronbach’s alphas of both subscales of the CPAQ-8 were found to be 0.76 and 0.80; therefore, they provided internal consistency. The CPAQ-8 was found to be significantly correlated with all other scales compared.

CONCLUSION: The Turkish version of the CPAQ-8 is an assessment tool with sufficient validity in assessing pain acceptance levels in fibromyalgia patients experiencing chronic pain. Future studies are needed to evaluate the validity and reliability of the questionnaire in different chronic pain models.

PMID:37671382 | PMC:PMC10475906 | DOI:10.5606/tftrd.2023.10857

Turk J Phys Med Rehabil. 2022 Nov 24;69(2):207-215. doi: 10.5606/tftrd.2023.11054. eCollection 2023 Jun.

ABSTRACT

OBJECTIVES: In this study, we aimed to clarify the impact of a Pilates-based therapeutic exercise on disability, pain, mood, and sleep quality in patients with pregnancy-related lumbopelvic pain (LPP).

PATIENTS AND METHODS: In the single-blinded randomized controlled study conducted between January 2018 and June 2018, 34 pregnant women (mean age: 29.7±6.2 years; range, 18 to 40 years) in the second trimester (week 14-24) with LPP were randomly assigned to a control group and a Pilates group. All patients underwent usual prenatal care. In addition, the selected Pilates exercise was carried out twice a week for 60-min per session for 12 weeks in the Pilates group. The control group was not prescribed an exercise regimen; however, they were not discouraged from exercising. The primary outcome was disability; secondary outcomes were LPP, mood, and sleep quality. Disability [Roland-Morris Disability Questionnaire (RMDQ)], LPP [Visual Analog Scale (VAS)], mood [Hospital Anxiety and Depression Scale, Anxiety (HADS-A) and Depression (HADS-D) subscales], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were measured before and after 12 weeks. Adverse effects and adherence were recorded to determine exercise safety and compliance. The intention-to-treat analysis was applied.

RESULTS: The between-group effect sizes were moderate for the RMDQ and VAS scales (d=0.4 and d=0.7, respectively) and small for the HADS-A and HADS-D scales (both d=0.2). The intention-to-treat analysis demonstrated that there was a statistically significant difference in disability, pain, and mood in favor of the Pilates group (p0.05).

CONCLUSION: Adding Pilates to usual prenatal care should be considered a promising treatment option for pregnancy-related LPP.

PMID:37671372 | PMC:PMC10475913 | DOI:10.5606/tftrd.2023.11054

RSC Adv. 2023 Sep 4;13(38):26357-26365. doi: 10.1039/d3ra03200k. eCollection 2023 Sep 4.

ABSTRACT

The solid-state reaction method was utilised to create a down-conversion phosphor in an air environment in CaY₂O₄:Eu³⁺ nanocrystalline material. The calcination temperature was set at 1000 °C, and the sintering temperature was set at 1300 °C. Following annealing, confirmation of the crystallinity quality of the phosphor was accomplished by the use of X-ray diffraction analysis. The particle size was predicted to be 43.113 nm using Scherrer’s formula. To produce down-conversion luminescence spectra, an excitation wavelength of 247 nm was applied with a fluorescence spectrophotometer. The PL got increasingly intense as the concentration of the dopant increased. The maximum intensity was measured at 2.0 mol% of Eu³⁺ ion, which gradually decreased as the concentration increased because of concentration quenching. To analyse spectrophotometric peak determinations, the approach developed by the Commission Internationale de l’Éclairage (CIE) was used. Thermoluminescence (TL) glow curve analysis of the CaY₂O₄:Eu³⁺-doped phosphor manufactured here revealed a wide TL centred at 225 °C, which comprised of so many peaks that may be extracted by the computerised glow curve deconvolution (CGCD) approach using glow-fit software. The associated kinetic parameters were then determined. The prepared phosphor may be useful for application in various display devices upon excitation by 247 nm; the prominent 613 nm peak of the Eu³⁺ ion (⁵D₀ → ⁷F₂) electric dipole transition features a red component. CaY₂O₄:Eu³⁺ phosphors show promise as materials for potential use in phosphor-converted white LEDs in the field of solid-state lighting technology. The linear connection that the TL glow curve has with UV dose provides evidence for its possible use in dosimetry.

PMID:37671341 | PMC:PMC10476512 | DOI:10.1039/d3ra03200k