Category: Statistics

CJEM. 2023 Jun 23. doi: 10.1007/s43678-023-00530-1. Online ahead of print.

ABSTRACT

OBJECTIVES: To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.

METHODS: Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care.

RESULTS: A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change – 23.76 min, 95% CI – 37.99, – 9.52). Total physician claims increased significantly at only 1 of 5 sites.

CONCLUSIONS: Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05095012.

PMID:37351798 | DOI:10.1007/s43678-023-00530-1

J Epidemiol Glob Health. 2023 Jun 23. doi: 10.1007/s44197-023-00131-2. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the medium-term impacts of the COVID-19 pandemic on violence-related offences in Australia, and whether there was evidence of a ‘dual pandemic’ of family violence in addition to COVID-19.

METHODS: Autoregressive Integrated Moving Average time series were conducted to analyse publicly available violent crime statistics data from January 2017 to November 2021. Population rates of homicide, sexual, domestic and non-domestic assault were assessed across each Australian state and territory, with the effects of COVID-19 being modelled using the average monthly World Health Organization COVID-19 stringency rating for each jurisdiction.

FINDINGS: All jurisdictions in Australia showed increasing or stable domestic assault trends over the past decade, which were not significantly impacted by COVID-19, nor by the subsequent lockdowns. Non-domestic assaults demonstrated a significant, negative relationship with the stringency index for each jurisdiction, except Western Australia. There was no significant change in the rates of homicide or sexual assault across Australia in relation to COVID-19.

CONCLUSION: Overall, there was no evidence of a ‘dual pandemic’ in Australia, and whilst domestic assaults continue to increase across the country, non-domestic assaults showed a notable but brief decline. However, these have returned to levels at least as high as pre-COVID-19 and some states show a continuing upward trend. The findings also suggest that alcohol availability may have played a role in continuing high violence numbers. Given the ongoing increasing and high levels of family violence in Australia, revised conceptual frameworks and interventions are indicated.

PMID:37351780 | DOI:10.1007/s44197-023-00131-2

J Ultrasound. 2023 Jun 23. doi: 10.1007/s40477-023-00797-1. Online ahead of print.

ABSTRACT

BACKGROUND: Traditionally, for the assessment of follicle growth during IVF, two-dimensional (2D) transvaginal ultrasound (US) is used. In the past few years three-dimensional (3D) US has also been introduced.

OBJECTIVES: To compare follicular sizes between 2 and 3D ultrasound imaging on the final day of controlled ovarian stimulation.

METHODS: A prospective observational cohort study including 121 women undergoing controlled ovarian stimulation (COS) between January 2017 and July 2018. All women were assessed by transvaginal 2D and 3D ultrasonography to measure ovarian follicle dimensions on the final day of COS.

RESULTS: The mean difference in paired comparisons between the 3D and 2D US measurements in 25 women with monofollicular development was + 1.6 ± 2.5 mm for the x-dimension and + 1.7 ± 2.4 mm for the y-dimension; and in the total number of 1197 paired measurements of follicles the mean difference + 2.1 ± 3.3 mm and + 1.8 ± 3.9 mm for the x- and y-dimension respectively. In all cases the paired t-test showed that differences were statistically significant (p < 0.01). Further it was conjectured that the 2D underestimation results from the inherent difficulty to precisely place the US probe simultaneously on the perpendicular maximal of the x and y follicle diameters, leading to measurement errors that, by theory, are normally distributed. Running Monte-Carlo simulations based on these measurement errors it was found that both the mean difference and standard deviation are of the same magnitude as the ones found in real measurements, thus proving the conjecture.

CONCLUSIONS: The utilisation of 3D US results in different measurements of the follicular dimensions, and volumes, when compared to conventional 2D US. The differences in the x- and y-dimensions may affect the outcome of an IVF cycle as they are used to define the day of triggering final oocyte maturation, which is associated with the yield of mature oocytes and the probability of live birth.

PMID:37351770 | DOI:10.1007/s40477-023-00797-1

Obes Surg. 2023 Jun 23. doi: 10.1007/s11695-023-06681-5. Online ahead of print.

ABSTRACT

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most popular primary bariatric metabolic procedure worldwide but severe complications are still reported, and there is no ideal technique to avoid them. This study analyses the impact of oversewing (OS) and gastropexy (GP) on complication rate, early dyspeptic and late de novo GERD symptoms after LSG.

MATERIAL AND METHOD: A case-control study was conducted on patients with obesity who underwent LSG. The total cohort was divided in group A (control group) – patients with no oversewing (OS) or gastropexy (GP), group B – patients with OS but no gastropexy and group C – patients with both OS and GP performed during LSG.

RESULTS: We included 272 patients with obesity with a mean BMI 42.9±6.94 kg/m², 96 patients in group A, 90 patients in group B and 86 in group C with no statistical differences between them. We had 5 cases of postoperative hemorrhage (4 in group A) and three patients who developed leaks (2 in group A and one in group B). Prolonged and severe early dyspeptic episodes and after 6 months reflux symptoms were significantly more in groups A and B (p<0.05). The operative time was longer in group B and C (p<0.05) but with no difference in procedure -related morbidity and in hospital length of stay.

CONCLUSION: Adding both OS and GP to LSG reduce complications rate with no influence on procedure-related postoperative morbidity and in-hospital length of stay. GP reduces early postoperative dyspeptic and de novo GERD symptoms after LSG.

PMID:37351763 | DOI:10.1007/s11695-023-06681-5

Obes Surg. 2023 Jun 23. doi: 10.1007/s11695-023-06668-2. Online ahead of print.

ABSTRACT

PURPOSE: Weight regain after Roux-en-Y gastric bypass (RYGB) is associated with worsening of liver outcomes. However, the effect of transoral outlet reduction (TORe) on liver fibrosis in RYGB patients with weight regain and possible advanced fibrosis remains unknown.

MATERIALS AND METHODS: This was a retrospective analysis of prospectively collected data of RYGB patients who underwent TORe for weight regain. Only patients with possible advanced fibrosis were included. TORe was performed using either an endoscopic suturing device (S-TORe) or plication device (P-TORe) to reduce the gastrojejunal anastomosis (GJA) and pouch sizes. Primary outcomes included changes in non-invasive tests (NITs) for fibrosis at 6-12 months. Secondary outcomes included weight loss and changes in insulin resistance and lipid profile at 6-12 months.

RESULTS: Fifty RYGB patients were included. Baseline age and BMI were 55 ± 11 years and 40.1 ± 7.3 kg/m². Baseline GJA and pouch sizes were 20 ± 7 mm and 5 ± 2 cm, respectively. Thirty patients (60%) underwent S-TORe and 20 patients (40%) underwent P-TORe. At 12 months following TORe, there were statistically significant improvements in NITs for fibrosis, including ALT, AST and FIB-4. There was a trend towards significant improvement in liver stiffness measurement on transient elastography. Patients experienced 8.8 ± 11.2% total weight loss (TWL) (p < 0.0001), with 60% experiencing at least 10% TWL. Additionally, there was a significant improvement in HbA1c and a trend toward significant improvement in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), suggestive of improved insulin sensitivity.

CONCLUSION: TORe is associated with an improvement in hepatic fibrosis in patients with NAFLD and possible advanced fibrosis.

PMID:37351762 | DOI:10.1007/s11695-023-06668-2

J Bioinform Comput Biol. 2023 Jun 22:2350013. doi: 10.1142/S0219720023500130. Online ahead of print.

ABSTRACT

Precision medicine has been a global trend of medical development, wherein cancer diagnosis plays an important role. With accurate diagnosis of cancer, we can provide patients with appropriate medical treatments for improving patients’ survival. Since disease developments involve complex interplay among multiple factors such as gene-gene interactions, cancer classifications based on microarray gene expression profiling data are expected to be effective, and hence, have attracted extensive attention in computational biology and medicine. However, when using genomic data to build a diagnostic model, there exist several problems to be overcome, including the high-dimensional feature space and feature contamination. In this paper, we propose using the overlapping group screening (OGS) approach to build an accurate cancer diagnosis model and predict the probability of a patient falling into some disease classification category in the logistic regression framework. This new proposal integrates gene pathway information into the procedure for identifying genes and gene-gene interactions associated with the classification of cancer outcome groups. We conduct a series of simulation studies to compare the predictive accuracy of our proposed method for cancer diagnosis with some existing machine learning methods, and find the better performances of the former method. We apply the proposed method to the genomic data of The Cancer Genome Atlas related to lung adenocarcinoma (LUAD), liver hepatocellular carcinoma (LHC), and thyroid carcinoma (THCA), to establish accurate cancer diagnosis models.

PMID:37350314 | DOI:10.1142/S0219720023500130

Otolaryngol Head Neck Surg. 2023 Jun 23. doi: 10.1002/ohn.382. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic cauterization is an effective method for treating pyriform sinus fistula (PSF). However, these approaches sometimes result in a higher failure rate. We present an effective technique utilizing suture combined with chemocauterization as first-line treatment in patients with PSF and evaluate the safety and efficacy of its use in 126 patients.

STUDY DESIGN: Retrospective study.

SETTING: Tertiary referral center.

METHODS: Retrospective case review of patients treated between March 2012 and June 2021 at our institution with descriptive statistical analysis.

RESULTS: A total of 126 patients with PSF were included in this study with a mean age of 14.7 years. There was no sex predilection. The majority of patients presented with a left-sided neck lesion (89.7%). Ten patients presented following prior attempts at the surgery of the PSF at another institution; 8 via open surgery and 2 following endoscopic CO₂ laser cauterization; other patients only had a history of repeat incision and drainage or antibiotic treatment. The success rate of obliteration of the internal opening was 96.83% after a single treatment without complications. Following reoperation, a successful outcome was achieved in the remaining 4 patients. Length of stay ranged from 10 to 14 days. No recurrences occurred within 12 to 120 months followed-up.

CONCLUSION: Endoscopic suture combined with chemocauterization is a safe and effective treatment of PSF. Surgery can be performed during the acute cervical inflammatory period without increased risk of complication or recurrence, however, patients found to have acute changes affecting the pyriform sinus should be treated with a staged surgery strategy.

PMID:37350304 | DOI:10.1002/ohn.382

Alzheimers Dement. 2023 Jun 23. doi: 10.1002/alz.13060. Online ahead of print.

ABSTRACT

INTRODUCTION: It is unclear if sex differences exist in cognitive disease progression in mild cognitive impairment (MCI) and dementia associated with atrial fibrillation (AF).

METHODS: Using a variety of statistical methods, we examined sex differences between AF and neuropsychological tests and cognitive disease progression, using the National Alzheimer’s Coordinating Center data (N = 43,630).

RESULTS: AF is associated with higher odds of dementia (odds ratio [OR] 3.00, 95% confidence interval [CI] [1.22, 7.37] in women and MCI in women (OR 3.43, 95% CI [1.55, 7.55]) versus men. Women with AF and normal baseline cognition had a higher risk of disease progression (hazard ratio [HR] 1.26, 95% CI [1.06, 1.50]) from normal to MCI and from MCI to vascular dementia (HR3.27, 95% CI [1.89, 5.65]) than men with AF or men and women without AF.

DISCUSSION: AF was associated with more rapid progression to MCI and dementia in women, but more research is needed to confirm these findings.

PMID:37350284 | DOI:10.1002/alz.13060

Stroke. 2023 Jun 23. doi: 10.1161/STROKEAHA.123.042708. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the longitudinal associations between serum uric acid (SUA) and stroke was limited and yielded inconsistent conclusions. We aimed to investigate the associations of cumulative SUA (cumSUA), incorporating the time course of cumSUA accumulation, with the risk of stroke.

METHODS: The prospective cohort study enrolled 50 871 participants from Kailuan, China. CumSUA from 2006 to 2010 was derived by calculating the means of SUA values between consecutive examinations and multiplying by time intervals between visits. Time course of cumSUA accumulation was categorized as the slope of SUA versus time or by splitting the overall accumulation into an early (cumSUA_06-08) and late accumulation (cumSUA_08-10). Participants were classified by cumSUA quartiles, SUA slope (negative versus positive), and the combined median cumSUA (1105.21 μmol/L×year) with SUA slope, respectively. The associations with incident stroke between 2010 and 2019 were evaluated with competing risk model.

RESULTS: During a median follow-up of 9.02 years, 2217 cases of incident stroke were identified. In the multivariable-adjusted model, a higher risk of stroke was observed in participants with the highest quartile versus the lowest quartile of cumSUA (subdistribution hazard ratio, 1.15 [95% CI, 1.01-1.31]), and those with a negative versus positive SUA slope (subdistribution hazard ratio, 1.09 [95% CI, 1.01-1.19]). Consistently, a later accumulation of SUA was not associated with the risk of stroke after adjustment for an early accumulation, indicating early accumulation may contribute more to the risk of stroke than later accumulation. When cumSUA was incorporated with its time course, those with changes in cumSUA suggesting early accumulation had elevated risk of stroke (subdistribution hazard ratio, 1.17 [95% CI, 1.03-1.33]). Similar results were observed for ischemic stroke.

CONCLUSIONS: Incident stroke risk was associated with cumulative exposure to SUA and its accumulation time course. Early SUA accumulation resulted in a greater risk compared with later accumulation, underscoring the importance of early control of SUA to an optimal level.

PMID:37350271 | DOI:10.1161/STROKEAHA.123.042708

Urologia. 2023 Jun 23:3915603231183754. doi: 10.1177/03915603231183754. Online ahead of print.

ABSTRACT

Transplantation is the most effective treatment for end-stage chronic kidney disease, as this procedure prolongs and improves the patient’s quality of life. One of the key problems is the risk of graft rejection. The purpose of this research was to identify and analyse prognostic factors that will prevent rejection. In particular, the prognostic factors grouped by methods of synthesis, generalisation and statistical processing with calculation and graphical representation of hazard ratio and correlation coefficient were grouped, namely: age of donor and recipient, time of cold kidney ischaemia, duration of preoperative dialysis, body mass index, presence of concomitant diseases (diabetes mellitus, hypertension), primary causes causing transplantation. Several molecular genetic and biochemical prognostic markers (transcription factors, immunocompetent cell signalling and receptors, cytostatin C, creatinine, citrate, lactate, etc.) are annotated. It has been demonstrated that creatinine reduction rate determines the risk of rejection, displaying the dynamics of cystatin C and creatinine changes in the postoperative period. Young recipients who underwent prolonged preoperative dialysis were identified as having the highest risk of rejection. Diabetes and hypertension bear a non-critical but commensurately equal risk of rejection. The survival rate of the graft is better when transplanted from a living donor than from a deceased donor. A correlation between cold ischaemia time, body mass index and the probability of graft failure has been proven, namely, the greater the donor and recipient body mass index and the longer the cold ischaemia time, the lower the chance of successful long-term organ acclimation. The data obtained can be used as prognostic factors for graft accommodation at different intervals after surgery.

PMID:37350238 | DOI:10.1177/03915603231183754