Category: Statistics

Orthop Surg. 2023 Feb 16. doi: 10.1111/os.13684. Online ahead of print.

ABSTRACT

OBJECTIVE: The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol.

METHODS: This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2- to 6-month, group 2: 6- to 12-month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease.

RESULTS: We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups (P = 0.21). For the mean LOS, the 6- to 12-month group had a significantly shorter LOS compared with the 2- to 6-month group (P < 0.01). There was also a significant decrease in Hct of the 2- to 6-month group compared with the 6- to 12-month group and the >12 months group (P = 0.02; P < 0.05, respectively).

CONCLUSION: Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period.

PMID:36794464 | DOI:10.1111/os.13684

J Appl Clin Med Phys. 2023 Feb 16:e13932. doi: 10.1002/acm2.13932. Online ahead of print.

ABSTRACT

ICRU 91, published in 2017, is an international standard for prescribing, recording, and reporting stereotactic treatments. Since its release, there has been limited research published on the implementation and impact of ICRU 91 on clinical practice. This work provides an assessment of the recommended ICRU 91 dose reporting metrics for their use in clinical treatment planning. A set of 180 intracranial stereotactic treatment plans for patients treated by the CyberKnife (CK) system were analyzed retrospectively using the ICRU 91 reporting metrics. The 180 plans comprised 60 trigeminal neuralgia (TGN), 60 meningioma (MEN), and 60 acoustic neuroma (AN) cases. The reporting metrics included the planning target volume (PTV) near-minimum dose ( Dnear–min${D}_{{rm{near}} – {rm{min}}}$ ), near-maximum dose ( Dnear–max${D}_{{rm{near}} – {rm{max}}}$ ), and median dose ( D50%${D}_{50{rm{% }}}$ ), as well as the gradient index (GI) and conformity index (CI). The metrics were assessed for statistical correlation with several treatment plan parameters. In the TGN plan group, owing to the small targets, Dnear–min${D}_{{rm{near}} – {rm{min}}}$ was greater than Dnear–max${D}_{{rm{near}} – {rm{max}}}$ in 42 plans, whereas both metrics were not applicable in 17 plans. The D50%${D}_{50{rm{% }}}$ metric was predominantly influenced by the prescription isodose line (PIDL). The GI was significantly dependent on target volume in all analyses performed, where the variables were inversely related. The CI was only dependent on target volume in treatment plans for small targets. The ICRU 91 Dnear–min${D}_{{rm{near}} – {rm{min}}}$ and Dnear–max${D}_{{rm{near}} – {rm{max}}}$ metrics breakdown in plans for small target volumes below 1 cm³ ; the Min and Max pixel should be reported in such cases. The D50%${D}_{50{rm{% }}}$ metric is of limited use for treatment planning. Given their volume dependence, the GI and CI metrics could potentially serve as plan evaluation tools in the planning of the sites analyzed in this study, which would ultimately improve treatment plan quality.

PMID:36794436 | DOI:10.1002/acm2.13932

Pediatrics. 2023 Feb 16:e2022057330. doi: 10.1542/peds.2022-057330. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with limited English proficiency (LEP) benefit from the appropriate use of medical interpreters. A multidisciplinary quality improvement team sought to improve communication with patients with LEP within a pediatric emergency department (ED). Specifically, the team aimed to improve the early identification of patients and caregivers with LEP, the utilization of interpreter services for those identified, and documentation of interpreter use in the patient chart.

METHODS: Using clinical observations and data review, the project team identified key processes for improvement in the ED workflow and introduced interventions to increase identification of language needs and offer interpreter services. These include a new triage screening question, an icon on the ED track board that communicates language needs to staff, an electronic health record (EHR) alert with information on how to obtain interpreter services, and a new template to prompt correct documentation in the ED provider’s note. Outcomes were tracked using statistical process control charts.

RESULTS: All study measures met special cause for improvement during the 6-month study period and have been sustained during surveillance data collection. Identification rates for patients with LEP during triage increased from 60% to 77%. Interpreter utilization increased from 77% to 86%. The documentation of interpreter use increased from 38% to 73%.

CONCLUSION: Using improvement methods, a multidisciplinary team increased the identification of patients and caregivers with LEP in an ED. Integration of this information into the EHR allowed for the targeted prompting of providers to use interpreter services and to correctly document their use.

PMID:36794433 | DOI:10.1542/peds.2022-057330

J Clin Endocrinol Metab. 2023 Feb 16:dgad079. doi: 10.1210/clinem/dgad079. Online ahead of print.

ABSTRACT

CONTEXT: Craniopharyngioma is a benign brain tumour with frequent local recurrence or progression after treatment. Growth hormone replacement therapy (GHRT) is prescribed in children with growth hormone deficiency due to childhood-onset craniopharyngioma.

OBJECTIVE: To evaluate whether shorter time delay of GHRT initiation after childhood-onset craniopharyngioma completion therapy increased the risk of new event (progression or recurrence).

METHODS: Retrospective, observational, monocenter study. We compared a cohort of 71 childhood-onset craniopharyngiomas all treated with recombinant human growth hormone (rhGH). Twenty-seven patients were treated with rhGH at least 12 months after craniopharyngioma treatment (“>12 months group”) and forty-four patients before 12 months (“<12 months group”) among which twenty-nine patients were treated between 6 and 12 months (“6-12 months group”). The main outcome was the risk of tumour new event (progression of residual tumour or tumour recurrence after complete resection) after primary treatment in the “>12 months” group and in the “<12 months” or in the “6-12 months” group patients.

RESULTS: In the “>12 months group”, the 2- and 5- years event-free survivals were respectively 81.5% (95% CI 61.1-91.9) and 69.4% (95% CI 47.9-83.4), as compared with 72.2% (95% CI 56.3-83.1) and 69.8% (95% CI 53.8-81.2) in the “<12 months” group. The 2- and 5- years event-free survivals were the same in the “6-12 months group” (72.4%, 95% CI 52.4-85.1). By Log-rank test, the event-free survival was not different between groups (p = 0,98 and p = 0,91).The median time for event was not statistically different.In univariate and multivariate analysis, the risk of craniopharyngioma new event was not associated with the GHRT time delay after craniopharyngioma treatment.

CONCLUSIONS: No association was found between GHRT time delay after childhood-onset craniopharyngioma treatment and an increased risk of recurrence or tumour progression, suggesting GH replacement therapy can be initiated 6 months after last treatment for craniopharyngiomas.

PMID:36794424 | DOI:10.1210/clinem/dgad079

Hum Vaccin Immunother. 2023 Feb 15:2179222. doi: 10.1080/21645515.2023.2179222. Online ahead of print.

ABSTRACT

Rotavirus vaccination is the most effective means to prevent rotavirus gastroenteritis, but its coverage in China is not ideal. We aimed to explore parental preferences for rotavirus vaccination for their children under 5years old to improve vaccination coverage. A Discrete Choice Experiment was conducted online on 415 parents with at least one child under 5years old in 3 cities. Five attributes including vaccine effectiveness, protection duration, risk of mild side-effects, out-of-pocket costs, and time required for vaccination were identified. Each attribute was set at three levels. Mixed-logit models were used to measure parental preferences and the relative importance of vaccine attributes. The optimal vaccination strategy was also explored. 359 samples were included in the analysis. The impacts of the vaccine attribute levels on vaccine choice were all statistically significant (p < .01), except for 1-hour vaccination time. The risk of mild side-effects was the most important factor influencing vaccination. The time required for vaccination was the least important attribute. The largest increase in vaccination uptake (74.45%) occurred with decreased the vaccine risk of mild side-effects from 1/10 to 1/50. The predicted vaccination uptake of the optimal vaccination scenario was 91.79%. When deciding about vaccination, parents preferred the rotavirus vaccination with lower risk of mild side-effects, higher effectiveness, longer protection duration, 2-hour vaccination time and lower cost. The authorities should support enterprises to develop vaccines with lower side-effects, higher effectiveness and longer protection duration in the future. We call for appropriate government subsidies for the rotavirus vaccine.

PMID:36794417 | DOI:10.1080/21645515.2023.2179222

Cancer Cytopathol. 2023 Feb 15. doi: 10.1002/cncy.22684. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence guiding the management of cytologically indeterminate thyroid nodules with nondiagnostic (ND) or benign cytology on repeat fine-needle aspiration (FNA) is limited. This study evaluates the utility of molecular testing and estimates the risk of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and cancer among such nodules.

METHODS: This was a retrospective single-institution review of thyroid nodules from adults that were classified as atypia of undetermined significance (AUS) or follicular neoplasm (FN) on initial FNA and underwent repeat FNA for cytology and Afirma testing (June 2013-July 2021). The association between repeat FNA cytology and RNA yield for Afirma was determined. Histologic outcomes were integrated with Afirma results to define end points for each nodule.

RESULTS: A total of 691 AUS and FN nodules underwent repeat FNA and Afirma testing. Diagnostic Afirma results were obtained in 98% of cases overall and in 91% of nodules with ND cytology on repeat FNA. Using combined molecular and histologic end points, the NIFTP and/or cancer prevalence for nodules with ND cytology on repeat FNA was 9% (95% confidence interval [CI], 0.042-0.182), falling between those nodules classified as benign (5%; 95% CI, 0.029-0.094) and those classified as AUS or FN (18%; 95% CI, 0.140-0.218) on repeat FNA, although not reaching statistical significance from either subgroup (p = .38 and .10, respectively).

CONCLUSIONS: AUS and FN nodules that are ND on repeat FNA have low but nonnegligible risk of NIFTP and/or cancer and may benefit from molecular testing, given the low test failure rate in this subgroup. Conversely, AUS and FN nodules reclassified as benign on repeat FNA have a very low risk of NIFTP and/or cancer and are unlikely to benefit from molecular testing.

PMID:36792948 | DOI:10.1002/cncy.22684

J Chest Surg. 2023 Feb 16. doi: 10.5090/jcs.22.117. Online ahead of print.

ABSTRACT

BACKGROUND: Pneumonia caused by severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, often requiring prolonged mechanical ventilation and eventually tracheostomy. Both procedures occur in isolation units where personal protective equipment is needed. Additionally, the high bleeding risk in patients with extracorporeal membrane oxygenation (ECMO) places a great strain on surgeons. We investigated the clinical characteristics and outcomes of percutaneous dilatational tracheostomy (PDT) in patients with coronavirus disease 2019 (COVID-19) supported by ECMO, and compared the outcomes of patients with and without ECMO.

METHODS: This retrospective, single-center, observational study included patients with severe COVID-19 who underwent elective PDT (n=29) from April 1, 2020, to October 31, 2021. The patients were divided into ECMO and non-ECMO groups. Data were collected from electronic medical records at Ajou University Hospital in Suwon, Korea.

RESULTS: Twenty-nine COVID-19 patients underwent PDT (24 men [82.8%] and 5 women [17.2%]; median age, 61 years; range, 26-87 years; interquartile range, 54-71 years). The mean procedure time was 17±10.07 minutes. No clinically or statistically significant difference in procedure time was noted between the ECMO and non-ECMO groups (16.35±7.34 vs. 18.25±13.32, p=0.661). Overall, 12 patients (41.4%) had minor complications; 10 had mild subdermal bleeding from the skin incision, which was resolved with local gauze packing, and 2 (6.9%) had dislodgement. No healthcare provider infection was reported.

CONCLUSION: Our PDT approach is safe for patients and healthcare providers. With bronchoscopy assistance, PDT can be performed quickly and easily even in isolation units and with acceptable risk, regardless of the hypo-coagulable condition of patients on ECMO.

PMID:36792944 | DOI:10.5090/jcs.22.117

Global Spine J. 2023 Feb 15:21925682231157373. doi: 10.1177/21925682231157373. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVES: To describe the common types of complications and their risk factors during spine surgery in patients with achondroplasia.

METHODS: A retrospective review was performed of medical records of adult achondroplasia patients who underwent spine surgery at our institution between 2007 and 2021. Inclusion criteria were achondroplasia and age >16 years. Surgical encounters were evaluated for durotomy, postoperative neurologic deficit, wound compromise, medical complications, and return to the operating room. Statistical analysis included evaluation of relationships across complications and fisher exact test applied to bivariate/categorical variables and t-test/ANOVA for continuous variables. Multivariable analysis using logistic regression was performed to account for patient characteristics.

RESULTS: Fifty-five patients with achondroplasia underwent 95 surgeries. Forty-nine percent of the surgeries involved a complication. These included durotomy (33.7%), neurologic deficit (11.6%), wound compromise (6.3%), and other medical complications (6.3%). Thirteen percent of surgeries required return to the operating room. The greatest number of complications occurred in thoracolumbar region (60.0%) compared to cervicothoracic (18.2%) and craniocervical junction (33.3%). Chronologically later surgical encounters had decreased complications and durotomies only occurred in thoracolumbar surgeries (45.7%).

CONCLUSIONS: Adult patients with achondroplasia undergoing surgery chronologically later in this set of consecutive patients were at a decreased risk for complications. Thoracolumbar surgeries were at the greatest risk for durotomies. Male sex was a risk factor for durotomy, while age was a risk factor for neurologic deficit. The potential for adverse surgical events should be considered when evaluating patients with achondroplasia for spine surgery. .

PMID:36792924 | DOI:10.1177/21925682231157373

Tissue Eng Part B Rev. 2023 Feb 15. doi: 10.1089/ten.TEB.2022.0178. Online ahead of print.

ABSTRACT

OBJECTIVE: To conduct a systematic review of studies reporting the treatment of tendon injury using biomaterials in animal models.

METHODS: A systematic search was conducted to retrieve studies involving animal models of tendon repair using biomaterials, in PubMed (database construction to August 2022) and Ovid-Embase (1946 to August 2022). Data related to tendon repair with biomaterials were extracted by two researchers respectively. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was performed based on the classification of tendon repair biomaterials included in our study.

RESULTS: A total of 8413 articles were retrieved, with 78 studies included in our analysis. For tendon repair in animal models using biomaterials, the most commonly seen characteristics were: naturally derived biomaterials, rabbits and rats as animal models, surgery as the injury model, and the Achilles tendon as the injury site. The histology and biomechanical recovery of tendon injury following repair is affected by different biomaterials.

CONCLUSION: Studies of tendon repair in animal models indicate that biomaterials can significantly improve repair outcomes, including tendon structure and biomechanics. Among effective biomaterial strategies are the use of new composites and incorporation of cells or growth factors into the material, both of which provide obvious benefits for tendon healing. More high quality preclinical studies are required to encourage the translation of biomaterials into clinical practice for tendon repair.

PMID:36792921 | DOI:10.1089/ten.TEB.2022.0178

Environ Sci Pollut Res Int. 2023 Feb 15. doi: 10.1007/s11356-023-25650-0. Online ahead of print.

ABSTRACT

Differences in model application effectiveness, insufficient numbers of disaster samples, and unreasonable selection of non-hazard samples are common problems in landslide susceptibility studies. Therefore, in this paper, we propose a semi-integrated supervised approach to improve the prediction performance of machine learning (ML) models in landslide susceptibility studies. First, taking the lower reaches of the Jinsha River as the study area, a geospatial dataset consisting of 349 landslides, an equal number of randomly selected non-landslide points, and 12 environmental factors were randomly divided into training (70%) and testing (30%) datasets. Then, K-nearest neighbors (KNN), random forest (RF), and Bayesian-regularized neural network (BRNN) models were built. Second, the three models were combined to form an integrated weighted model. Very high- and low-prone areas were selected and, combined with the prediction results and remote sensing images, landslide and non-landslide samples were identified. The identified samples were then combined with the original samples to form new samples, which were used to sequentially construct the ensemble-supervised K-nearest neighbors (ESKNN), ensemble-supervised random forest (ESRF), and ensemble-supervised Bayesian-regularized neural network (ESBRNN) models. Finally, the area under the curve (AUC), true skill statistic (TSS), and frequency ratio (FR) values were used to test the accuracy of each model. The traditional ML model results and accuracy were improved by the semi-integrated supervised method. The ESRF model had the best prediction effect (AUC = 0.939, TSS = 0.440, and FR = 95.8%). The proposed semi-integrated supervised ML model solved the problems observed in traditional landslide susceptibility studies and provided insights for reducing variations in model applications, expanding landslide data sources, and improving non-landslide sample selection.

PMID:36792857 | DOI:10.1007/s11356-023-25650-0