Category: Statistics

J Couns Psychol. 2023 Jul;70(4):340. doi: 10.1037/cou0000666.

ABSTRACT

Reports an error in “Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting” by Simon B. Goldberg, Tony Rousmaniere, Scott D. Miller, Jason Whipple, Stevan Lars Nielsen, William T. Hoyt and Bruce E. Wampold (Journal of Counseling Psychology, 2016[Jan], Vol 63[1], 1-11). The article (https://doi.org/10.1037/cou0000131), had an error in the Method section in the Early termination section under the Variables heading. The coding was reversed in the sentence “Patients received a code of 0 (early termination) or 1 (nonearly termination) on this dichotomous variable” and should have read “Patients received a code of 1 (early termination) or 0 (nonearly termination) on this dichotomous variable.” The online version of this article has been corrected. (The following abstract of the original article appeared in record 2015-58774-001.) Objective: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time.

METHOD: The present study examined changes in psychotherapists’ outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen.

RESULTS: Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists’ patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased.

CONCLUSIONS: Implications of these findings for the development of expertise in psychotherapy are explored. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37428762 | DOI:10.1037/cou0000666

PLoS One. 2023 Jul 10;18(7):e0274439. doi: 10.1371/journal.pone.0274439. eCollection 2023.

ABSTRACT

The relationship of food comminution and individual age in Tupaia belangeri is investigated. It is hypothesized that with increasing age the performance of the molar dentition decreases due to progressive tooth wear. While this relationship is well-documented for herbivores, age-related test series are largely lacking for insectivorous mammals. 15 individuals of Tupaia belangeri were fed exclusively with mealworms, and their faeces were analyzed for the number and size of chitin particles. The exoskeleton of a mealworm is resistant to digestive fluids in the gastrointestinal tract, and the size of individual chitin particles indicates the effectiveness of mechanical comminution that occurs in the oral cavity during mastication. It is hypothesized that a more precise occlusion of the dentition results in smaller particle size. Although individuals of all ages (juvenile, adult, and senile) were able to effectively process mealworms with their dentition prior to digestion, a larger area of very large chitin particles (98% quantile of all particles in senile animals as compared to in the same quantile in adults) in the feces of senile animals was detected. Even though the particle size of indigestible material is irrelevant for the digestive process, these findings either document somatic senescence in the functionality of the teeth, or alternatively a change in chewing behaviour with age.

PMID:37428732 | DOI:10.1371/journal.pone.0274439

PLoS One. 2023 Jul 10;18(7):e0283412. doi: 10.1371/journal.pone.0283412. eCollection 2023.

ABSTRACT

This study investigates the association between individuals’ concern about contracting COVID-19 and their compliance with recommended preventive and mitigation measures, namely wearing face masks, maintaining social distancing and handwashing, in the context of the Middle East and North Africa (MENA) region. The empirical analysis is based on a panel dataset from the Combined COVID-19 MENA Monitor Household Survey, which was carried out in Jordan, Morocco, Sudan, Tunisia and Egypt. Applying a probit estimation technique, a positive and statistically significant association was found between the level of COVID-19 worries and individuals’ compliance with the mitigation measures. Notably, the results revealed that this association followed a “first-up-then-down” trend, showing that compliance with the three mitigation measures rose as individuals’ worries about contracting the virus increased, and then markedly decreased after they had been infected. Socio-demographic characteristics contributing to lower levels of compliance included being male, being over 60, having lower levels of education and having a lower household income. A cross-country analysis revealed remarkable differences between the five countries, with the strongest association between COVID-19 concerns and adherence to mitigation measures observed in Tunisia and Sudan, and the weakest association seen in Jordan and Morocco. Policy implications are outlined for effective risk communication and management during disease outbreaks and public health emergencies to encourage appropriate public health behaviours.

PMID:37428731 | DOI:10.1371/journal.pone.0283412

BJS Open. 2023 Jul 10;7(4):zrad051. doi: 10.1093/bjsopen/zrad051.

ABSTRACT

BACKGROUND: Intraoperative neuromonitoring is widely used in thyroid and parathyroid surgery to prevent unilateral and especially bilateral recurrent nerve paresis. Reference values for amplitude and latency for the recurrent laryngeal nerve and vagus nerve have been published. However, data quality measures that exclude errors of the underlying intraoperative neuromonitoring (IONM) data (immanent software errors, false data labelling) before statistical analysis have not yet been implemented.

METHODS: The authors developed an easy-to-use application (the Mainz IONM Quality Assurance and Analysis tool) using the programming language R. This tool allows visualization, automated and manual correction, and statistical analysis of complete raw data sets (electromyogram signals of all stimulations) from intermittent and continuous neuromonitoring in thyroid and parathyroid surgery. The Mainz IONM Quality Assurance and Analysis tool was used to evaluate IONM data generated and exported from ‘C2’ and ‘C2 Xplore’ neuromonitoring devices (inomed Medizintechnik GmbH) after surgery. For the first time, reference values for latency and amplitude were calculated based on ‘cleaned’ IONM data.

RESULTS: Intraoperative neuromonitoring data files of 1935 patients consecutively operated on from June 2014 to May 2020 were included. Of 1921 readable files, 34 were excluded for missing data labelling. Automated plausibility checks revealed: less than 3 per cent device errors for electromyogram signal detection; 1138 files (approximately 60 per cent) contained potential labelling errors or inconsistencies necessitating manual review; and 915 files (48.5 per cent) were indeed erroneous. Mean(s.d.) reference onset latencies for the left vagus nerve, right vagus nerve, recurrent laryngeal nerve, and external branch of the superior laryngeal nerve were 6.8(1.1), 4.2(0.8), 2.5(1.1), and 2.1(0.5) ms, respectively.

CONCLUSION: Due to high error frequencies, IONM data should undergo in-depth review and multi-step cleaning processes before analysis to standardize scientific reporting. Device software calculates latencies differently; therefore reference values are device-specific (latency) and/or set-up-specific (amplitude). Novel C2-specific reference values for latency and amplitude deviate considerably from published values.

PMID:37428557 | DOI:10.1093/bjsopen/zrad051

Games Health J. 2023 Jul 10. doi: 10.1089/g4h.2023.0004. Online ahead of print.

ABSTRACT

Introduction: Early mobilization after surgery is crucial for reducing postoperative complications and restoring patients’ fitness and ability to care for themselves. Immersive, activity-promoting fitness games in virtual reality (VR) can be used as a low-cost motivational adjunct to standard physiotherapy to promote recovery after surgery. In addition, they have potentially positive effects on mood and well-being, which are often compromised after colorectal surgery. The purpose of this pilot study was to evaluate the feasibility and clinical outcomes of a VR-based intervention that provides additional mobilization. Methods: Patients undergoing curative surgery for colorectal cancer were randomly assigned to an intervention group or a control group. Participants in the intervention group (VR group) received daily bedside fitness exercises using immersive, activity-promoting, virtual reality fitness games in addition to standard care during their postoperative hospital stay. Results: A total of 62 patients were randomized. The feasibility outcomes were in line with the predefined goals. In the VR group, an improvement in overall mood (+0.76 points; 95% confidence interval [CI] 0.39 to 1.12; P < 0.001) and a shift toward positive feelings were observed. The median length of hospital stay was 7.0 days in the VR group compared with 9.0 days in the control group, but the difference (2.0 days) did not reach statistical significance (95% CI -0.0001 to 3.00; P = 0.076). Surgical outcomes, health status, and measures of distress did not differ between groups. Conclusions: The study demonstrated the feasibility of a VR intervention that improved overall mood and showed a desirable effect on feelings and length of hospital stay after colorectal surgery. The results should stimulate further research investigating the potential of VR as an adjunct to physiotherapy to enhance mobilization after surgery.

PMID:37428543 | DOI:10.1089/g4h.2023.0004

JMIR Res Protoc. 2023 Jul 10;12:e46649. doi: 10.2196/46649.

ABSTRACT

BACKGROUND: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted.

OBJECTIVE: This article aims to describe the “digital outpatient service” intervention and present the protocol for an ongoing multicenter, nonrandomized trial evaluating this intervention.

METHODS: Based on previous experiences and evidence-based knowledge, we developed this intervention through patient-journey maps in collaboration with each clinical specialty. The patients gain access to a mobile app for self-monitoring and patient-reported outcomes and a chat for contact between the patients and health care workers. The health care workers’ dashboard includes a traffic light system to draw attention to the most urgent patient reports. In this multicenter, non-randomized controlled trial, patients are allocated to the control group receiving standard care or the 6-month intervention. Eligible patients are aged 18 years or older who receive outpatient care at the neurology, lung, pain, or cancer departments at 2 university hospitals in Norway. Our evaluation will include patient-reported outcomes, qualitative interviews, and clinical measures. The primary outcome will be health literacy using the Health Literacy Questionnaire. A sample size of 165 participants is split into a 1:2 ratio in favor of the intervention. We will analyze quantitative data in SPSS (IBM Corp) using descriptive statistics and logistic regression, and qualitative data using thematic analysis.

RESULTS: This trial started in September 2021, and the intervention started in January 2022. Recruitment has ended, with 55 patients in the control group and 107 patients in the intervention group. Follow-up is expected to end in July 2023, with results expected to be obtained in December 2023.

CONCLUSIONS: This study will evaluate an intervention facilitated by an already certified digital multicomponent solution, with intervention content based on patient-reported outcomes, health literacy, and self-monitoring. The intervention is specifically tailored to each participating center and the needs of their patients using patient journey maps. The comprehensive and generic evaluation of this digital outpatient service intervention is a strength as it targets a heterogeneous sample of patients. Thus, this study will provide important knowledge about the applicability and effects of digital health care services. As a result, patients and health care workers will gain a new, evidence-based understanding of whether and how digital tools may be used in clinical care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46649.

PMID:37428533 | DOI:10.2196/46649

J Med Internet Res. 2023 Jul 10;25:e45922. doi: 10.2196/45922.

ABSTRACT

BACKGROUND: Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it.

OBJECTIVE: The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events.

METHODS: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models.

RESULTS: In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I²=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I²=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I²=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I²=90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48).

CONCLUSIONS: Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life.

TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208.

PMID:37428532 | DOI:10.2196/45922

Breastfeed Med. 2023 Jul 10. doi: 10.1089/bfm.2022.0239. Online ahead of print.

ABSTRACT

Objective: To determine the prevalence of ankyloglossia in diamniotic monochorionic and diamniotic dichorionic twins, as well as to verify the relationship between gender and type of pregnancy. Study Design: A cross-sectional observational study, carried out with 52 pairs of dichorionic/diamniotic twins and 49 monochorionic/diamniotic pairs. The data collection was carried out through the analysis of medical records and the results of the Neonatal Screening of the Tongue Frenulum Assessment Protocol in Babies, and corresponded to the period of 2 years (2020-2022). Statistical analysis of data was performed, considering the significance value of 5%. The study was approved by the Human Research Ethics Committee of the institution. Results: The statistical analysis of multiple logistic regression between the two groups of twins (Mono/Di and Di/Di) according to the socioeconomic, demographic, and clinical-epidemiological profile was statistically significant for some variables. The prevalence of ankyloglossia, according to the type of twin pregnancy, showed a statistically significant difference. There was no statistical difference in relation to sex and ankyloglossia, or between couples diagnosed with ankyloglossia according to the type of pregnancy. Conclusion: Monochorionic/diamniotic twins had a higher prevalence of ankyloglossia, regardless of gender.

PMID:37428528 | DOI:10.1089/bfm.2022.0239

J Med Internet Res. 2023 Jul 10;25:e37140. doi: 10.2196/37140.

ABSTRACT

BACKGROUND: Latinx populations are severely underrepresented among organ donors compared with the non-Hispanic White population. The Promotoras de Donación e-learning module was developed to train Latinx lay health educators (ie, promotoras) to discuss deceased organ donation and promote donor designation within their communities.

OBJECTIVE: This paper described the results of 2 studies designed to assess the direct and indirect effects of the module on promotoras’ and mature Latinas’ organ donation and donor designation knowledge, attitudes, and behaviors.

METHODS: In partnership with 4 community-based promotoras organizations, we designed 2 nonrandomized, quasiexperimental pragmatic studies to evaluate the Promotoras de Donación e-learning module, with participating promotoras and mature Latinas serving as their own controls. Brief surveys were administered to participating promotoras before and after module completion to assess changes in organ donation knowledge and support and communication confidence (study 1). Promotoras participating in the first study were asked to hold at least 2 group conversations about organ donation and donor designation with mature Latinas (study 2); paper-pencil surveys were completed by all participants before and after the group conversations. Descriptive statistics, means and SDs, and counts and percentages were used as appropriate to categorize the samples. Paired sample 2-tailed t test was used to assess changes in knowledge of and support for organ donation and confidence in discussing donation and promoting donor designation from pre- to posttest.

RESULTS: Overall, 40 promotoras completed this module (study 1). Increases in organ donation knowledge (mean 6.0, SD 1.9 to mean 6.2, SD 2.9) and support (mean 3.4, SD 0.9 to mean 3.6, SD 0.9) were observed from pre- to posttest; however, these changes did not reach statistical significance. A statistically significant increase in communication confidence was found (mean 692.1, SD 232.4 to mean 852.3, SD 139.7; P=.01). The module was well received, with most participants deeming it well organized, presenting new information, and providing realistic and helpful portrayals of donation conversations. A total of 52 group discussions with 375 attendees were led by 25 promotoras (study 2). The trained promotora-led group discussions about organ donation resulted in increased support for organ donation in promotoras and mature Latinas from pre- to posttest. Knowledge of the steps to become an organ donor and belief that the process is easy to perform increased in mature Latinas from pre- to posttest by 30.7% and 15.2%, respectively. In total, 5.6% (21/375) of attendees submitted completed organ donation registration forms.

CONCLUSIONS: This evaluation provides preliminary support for the module’s direct and indirect effects on organ donation knowledge, attitudes, and behaviors. The need for additional modifications to and future evaluations of the module are discussed.

PMID:37428526 | DOI:10.2196/37140

J Spinal Cord Med. 2023 Jul 10:1-9. doi: 10.1080/10790268.2023.2231674. Online ahead of print.

ABSTRACT

PURPOSE: To examine the interrelationship of pulse duration and pulse frequency on torque production and muscle fatigue in both impaired and non-impaired skeletal muscle of men and women.

METHODS: Individuals with [n = 14 (6 females), 38 ± 13 yr; 175 ± 11 cm; 76 ± 20 kg] and without [n = 14 (6 females), 29 ± 8 yr; 175 ± 9 cm; 74 ± 14 kg] spinal cord injury (SCI) participated. Muscle torque was recorded during a series of NMES-induced isometric muscle contractions using different combinations of pulse durations and frequencies. Additionally, two different muscle fatigue protocols (20 and 50 Hz/200µs) were utilized to elicit repeat isometric muscle contractions (1s on and 1s off × 3 min).

RESULTS: There was a statistically significant linear trend for pulse charge (the product of pulse frequency and pulse duration) on isometric torque production in participants without (p < 0.001, η² = 0.79), and in participants with SCI (p < 0.001, η² = 0.66), with higher total pulse charge generating higher torque values. Participants with SCI had significantly greater muscle fatigue for both muscle fatigue protocols (p < 0.05).

CONCLUSIONS: NMES protocols should consider using longer pulse durations with lower frequencies to maximize force production for individuals with SCI. However, because mechanisms of muscle fatigue may be different for impaired muscle when compared to non-impaired muscle, further studies on protocols to offset fatigue are warranted.

PMID:37428446 | DOI:10.1080/10790268.2023.2231674