Category: Statistics

Telemed J E Health. 2023 Feb 15. doi: 10.1089/tmj.2022.0382. Online ahead of print.

ABSTRACT

Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children’s Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.

PMID:36791325 | DOI:10.1089/tmj.2022.0382

Pain Physician. 2023 Jan;26(1):61-68.

ABSTRACT

BACKGROUND: Pain assessments are an important aspect of health care quality because the high prevalence of pain in inpatients may contribute to complications. Several studies revealed a gap in the pain intensity evaluated by nurses (PEN) and patients (PEP). The aim of the present study was to analyze the correlation and agreement between pain assessments conducted by nurses and patients, and to determine patients at high risk of misestimated pain.

OBJECTIVES: To compare the difference of pain intensity between the questionnaires conducted by additional assessors and electronic records by nursing staff.

STUDY DESIGN: A retrospective study.

SETTING: A medical center in Taichung, Taiwan.

METHODS: We approached 1,034 patients admitted from January 1, 2018 to December 31, 2018 in our hospital. We compared the assessments of pain intensity using questionnaires conducted by additional assessors with those entered into electronic records by nursing staff. Continuous data were reported as the mean (± standard deviation). The analysis of agreement and correlation were performed by kappa statistics or weighted kappa statistics, and correlation (Spearman rank correlation method).

RESULTS: Among the 1,034 patients, 307 patients were excluded. Thus, the final analysis included 686 patients. Patients’ median pain intensity was 5 in PEP and 1 in PEN. The patients’ pain intensity was underestimated (PEN < PEP) in 539 patients (78.6%), matched (PEN = PEP) in 126 patients (18.3%), and overestimated (PEN > PEP) in 21 patients (3.1%). The surgical interventions (chi squared = 7.996, and P = 0.018) and pain in the past 24 hours (chi squared = 17.776, and P < 0.001) led to a significant difference.

LIMITATIONS: The limitation of the study was the single-center and retrospective design.

CONCLUSIONS: The gap in pain assessments between inpatients and nurses is an important issue in daily practice. The underestimations of pain were more common than overestimations (78.6% vs 3.1%). Surgical interventions and persistent pain lasting over 24 hours were high risk factors for underestimation, but patients’ gender, receiving anesthesia, type of anesthesia, and patient-controlled analgesia did not contribute significantly to differences in pain estimation.

PMID:36791295

Pain Physician. 2023 Jan;26(1):29-37.

ABSTRACT

BACKGROUND: The controversy continues on how to best become proficient in contemporary minimally invasive spinal surgery techniques (MISST). Postgraduate training programs typically lag behind the innovation. Other subspecialty spine care providers often compete with spine surgeons particularly when they do not offer the treatments needed by their patients. The public debate centers around who should be taught and credentialed in providing surgical spine care.

OBJECTIVES: The purpose of this study was to conduct an opinion survey amongst spine care providers regarding the learning curve of MISST and which credentialing standards should be established.

SETTING: Surgeon online opinion survey sent by email, and chat groups in social media networks, including WeChat, WhatsApp, and LinkedIn.

METHODS: Surgeons were asked the following questions: 1) Do you think MISS is harder to learn compared to open surgery? 2) Do you perform MISS? 3) What type of MISS do you perform? 4) If you perform endoscopic surgery, which approach(es)/technique(s) do you employ? 5) In your opinion, where does the innovation take place? 6) Where should MISST be taught? 7) Do you think mastering the MISST learning curve and surgeon skill level affect patient outcomes? 8) Which credentialing criteria do you recommend? Demographic data of responding surgeons, including age, postgraduate training and years from graduation, and practice setting, were also obtained. Descriptive statistics were employed to count the responses and compared to the surgeon’s training using statistical package SPSS Version 27.0 (IBM Corporation, Armonk, NY).

RESULTS: The online survey was viewed by 806 surgeons, started by 487, and completed by 272, yielding a completion rate of 55.9%. Orthopedic surgeons comprised 52.6% (143/272) of respondents, followed by 46.7% (127/272) neurosurgeons, and 0.7% pain management physicians (2/272). On average, respondents had graduated from a postgraduate training program 15.43 ± 10.13 years. Nearly all respondents employed MISST (252/272; 92.8%) and thought that proficiency in MISST affects patients’ outcomes (270/272; 98.2%). Some 54.1% (146/270) opined that MISS is more challenging to learn than traditional open spine surgery. Preferred credentialing criteria were 1) number of MISST cases (87.5%; 238/272), b) skill level (69.9%; 190/272), and c) proficiency assessment (59.9%; 163/272). A case log review (42.3%; 116/272) or an oral examination (26.1%; 71/272) was not favored by surgeons. Surgeons reported academia (43.4%; 116/267) and private practice (41.2%; 110/267) as the centers of innovation. Only 15.4% (41/267) of respondents opined that industry was the main driver over innovation.

LIMITATIONS: Geographical and cultural biases may impact the opinions of responding surgeons.

CONCLUSIONS: Respondents preferred case volume, skill level, and proficiency assessment as credentialing criteria. Surgeons expect academic university programs and specialty societies to provide the necessary training in novel MISST while working with governing boards to update the certification programs.

PMID:36791291

Pain Physician. 2023 Jan;26(1):21-27.

ABSTRACT

BACKGROUND: The postsurgical management of patients with ankylosing spondylitis is often only focused on the incision pain, and the pain caused by abdominal skin traction is paid little attention.

OBJECTIVES: To explore the effectiveness of ultrasound-guided transversus abdominis plane block (TAPB) in treating abdominal skin tension pain after kyphosis surgery.

STUDY DESIGN: Randomized controlled trial.

SETTING: This prospective study consecutively enrolled patients scheduled to undergo kyphosis correction surgery at the Department of Orthopedics of Xijing Hospital from March 2021 to December 2021.

METHODS: The patients were randomized 1:1 to the TAPB and control groups. The Visual Analog Scale (VAS) for abdominal pain, Bruggrmann Comfort Scale (BCS), abdominal skin tension blisters, bed rest duration, length of hospitalization, and the use of patient-controlled analgesia pumps (PCAPs) were compared. The primary endpoint was pain alleviation at 24 hours after surgery.

RESULTS: Thirty-one patients were enrolled, without differences between the 2 groups regarding age, body mass index, preoperative kyphosis severity, operation duration, and blood loss. The TAPB group (n = 16) had lower abdominal VAS scores than the control group (n = 15) at 2, 4, 6, 8, and 12 hours after surgery (P < 0.05). The TAPB group had higher BCS scores than the control group at 4, 6, 8, and 12 hours after surgery (P < 0.05). The TAPB group used PCAPs less frequently than the control group after surgery (P < 0.001). The incidence of tension blisters in the TAPB group was numerically lower than that of the control group, but the difference was not statistically significant (18.8% vs 33.3%, P > 0.05).

LIMITATIONS: The sample size of this study is small and a single-center study, there might be data bias.

CONCLUSIONS: In the first 24 hours after severe kyphosis surgery, TAPB can reduce the pain from abdominal skin tension and increase the comfort scores, but its effects on tension blisters remain to be further studied.

PMID:36791290

Pain Physician. 2023 Jan;26(1):1-11.

ABSTRACT

BACKGROUND: Postoperative nausea and vomiting (PONV) are common unpleasant adverse effects after surgery. The incidence of PONV in pediatric patients is often twice as high as in adults.

OBJECTIVES: This study aimed to evaluate the effects of dexmedetomidine, dexamethasone, and ondansetron for preventing PONV in children undergoing dental rehabilitation surgery.

STUDY DESIGN: A prospective, randomized controlled clinical trial.

SETTING: Sharurah Armed Forces Hospital, Ministry of Defense Medical Services, Saudi Arabia.

METHODS: One hundred patients (6-12 years old) scheduled for dental rehabilitation were included. Patients were randomly allocated into 4 groups (25 each) to receive either 0.15 mg/kg dexamethasone (DEX), 0.05 mg/kg ondansetron (OND), 0.3 microgram/kg dexmedetomidine (DEXMED), or normal saline (control[CONT]) in DEX, OND, DEXMED or CONT groups, respectively, via infusion after induction of anesthesia. The primary outcome was a PONV incident in the first 24 hours. Secondary outcomes were: granisetron doses during 24 hours postoperative, Paediatric Anaesthesia Emergence Delirium (PAED) scale, Pediatric Objective Pain Scale (POPS) for 4 hours postoperatively, and complications in the first 24 hours.

RESULTS: The reduction of PONV and the overall number of patients who developed PONV was statistically significant in the DEXMED group compared to the CONT group (P = 0.041). However, the DEXMED group was higher compared to the DEX and OND groups but not statistically significant. Granisetron requirements and doses were statistically significantly lower in the DEXMED group than in the CONT group. PAED and POPS scores were much better in the DEXMED group than in the other groups with a statistically significant difference in most of the time measurements.

LIMITATION: Optimal dexmedetomidine dose for better effect on PONV without affecting hemodynamic stability requires more studies.

CONCLUSION: Dexmedetomidine is effective in reducing PONV in children undergoing dental rehabilitation with better sedative and analgesic scores as compared to the control group.

PMID:36791288

J Cataract Refract Surg. 2023 Feb 15. doi: 10.1097/j.jcrs.0000000000001169. Online ahead of print.

ABSTRACT

PURPOSE: To develop a novel virtual surgery simulation platform to predict postoperative corneal stiffness (Kcmean) after laser vision correction (LVC) surgery.

SETTING: Narayana Nethralaya eye hospital and Sankara Nethralaya, India; Humanitas Clinical and Research Center, Italy.

DESIGN: Retrospective, observational case series.

METHODS: 529 eyes from 529 patients from three eye centres and 10 post-SMILE ectasia eyes were included. The software (called AcuSimX™) derived the anisotropic, fibril and extra-cellular matrix biomechanical properties (using finite element calculation) of the cornea using the preoperative Corvis-ST, Pentacam (OCULUS Optikgerate Gmbh, Germany) measurement and inverse finite element method assuming published healthy collagen fibril orientations. Then, the software computed postoperative Kcmean was adjusted with an artificial intelligence (AI) model (Orange AI, Slovenia) for measurement uncertainties. A decision tree was developed to classify ectasia from normal eyes using the software computed and preoperative parameters.

RESULTS: In the training cohort (n = 371), the mean absolute error (MAE) and intraclass correlation coefficient (ICC) were 6.24 N/m and 0.84 [95% CI: 0.80-0.87], respectively. Similarly in the test cohort (n = 158), these were 6.47 N/m and 0.84 [0.78-0.89], respectively. In the 10 ectasia eyes, the measured in vivo (74.01 [70.01, 78.01]) and software computed (74.1 [69.03, 79.17]) Kcmean weren’t statistically different (p=0.96). While no statistically significant differences in these values were observed between the stable and ectasia groups (p≥0.14), the decision tree classification had an AUROC of 1.0.

CONCLUSION: The novel software provided an easy to use virtual surgery simulation platform for post-LVC corneal stiffness prediction by clinicians and was assessed in post-SMILE ectasia eyes. Further assessments with ectasia after surgeries are required.

PMID:36791274 | DOI:10.1097/j.jcrs.0000000000001169

Health Rep. 2023 Feb 15;34(2):29-39. doi: 10.25318/82-003-x202300200003-eng.

ABSTRACT

BACKGROUND: Utility scores are an important tool for evaluating health-related quality of life. Utility score norms have been published for Canadian adults, but no nationally representative utility score norms are available for children and youth.

DATA AND METHODS: Health Utilities Index Mark 3 (HUI3) data from two recent cycles of the Canadian Health Measures Survey (i.e., 2016 and 2017, and 2018 and 2019) were used to provide utility score norms for children aged 6 to 11 years and adolescents aged 12 to 17 years. Children younger than 14 years answered the HUI3 under the supervision of an adult, while older children answered without supervision. Utility scores were reported as a weighted average (95% confidence intervals [CIs]) and median values (interquartile range). Utility scores were stratified by sociodemographic and medical characteristics of the child or adolescent. Regression analyses were used to identify predictors of utility scores. All results were weighted using sampling weights provided by Statistics Canada.

RESULTS: Among the 2,297,136 children aged 6 to 11 years and the 2,329,185 adolescents aged 12 to 17 years in the weighted sample, the average utility scores were 0.95 (95% CI: 0.94 to 0.95) and 0.89 (95% CI: 0.87 to 0.90), respectively. Approximately 60% of the children and 34% of the adolescents had a utility score of 1.00. Analyses identified several factors associated with utility scores (e.g., age, chronic condition and income levels), although differences were observed between children and adolescents.

INTERPRETATION: This study provides utility score estimates based on a nationally representative sample of Canadian children and youth. Further research examining the determinants of utility scores of children and adolescents is warranted.

PMID:36791271 | DOI:10.25318/82-003-x202300200003-eng

Health Rep. 2023 Feb 15;34(2):17-28. doi: 10.25318/82-003-x202300200002-eng.

ABSTRACT

BACKGROUND: Online digital media are a central part of adolescents’ lives, providing opportunities for social connection. However, some research has suggested that online digital media use may be negatively associated with mental health. Little population-based research has examined associations between various types of online digital media use and adolescent mental health.

DATA AND METHODS: Data from 13,600 adolescents aged 12 to 17 were drawn from the 2019 Canadian Health Survey on Children and Youth. Adolescents reported on how frequently they used social media, video or instant messaging, and online gaming, as well as their general mental health, eating disorder symptoms and, for those aged 15 to 17, suicidal ideation and attempt. Logistic regression was used to estimate the odds of each outcome from the frequency of each type of digital media use, stratified by sex.

RESULTS: Associations were noted between the frequency of social media and video and instant messaging use, and general mental health, eating disorder symptoms, and suicidal ideation and attempt. After cybervictimization and sleep adequacy were accounted for, associations with eating disorder symptoms remained significant for girls and boys. Never participating in online gaming was associated with lower odds of lower general mental health and suicidal ideation among girls, but not boys.

INTERPRETATION: Different types of online digital media use are differentially associated with mental health outcomes, and associations differ between sexes. The associations between social media and video or instant messaging, and mental ill health may be partially explained by the experience of cybervictimization and sleep adequacy. More research on online gaming, particularly among girls, is needed to clarify associations with mental health.

PMID:36791270 | DOI:10.25318/82-003-x202300200002-eng

Health Rep. 2023 Feb 15;34(2):3-16. doi: 10.25318/82-003-x202300200001-eng.

ABSTRACT

BACKGROUND: Mortality rates in Canada have been shown to vary by population group (e.g., Indigenous peoples, immigrants) and social economic status (e.g., income levels). Mortality patterns for some groups, including Black individuals, are not as well known. The objective of this study was to assess cause-specific mortality for Black adults living in Canada.

METHODS: Mortality inequalities between Black and White cohort members were estimated by sex using Cox proportional hazard models, based on data from the 2001, 2006 and 2011 Canadian Census Health and Environment Cohorts (CanCHECs). The CanCHEC cycles were combined and followed for mortality between Census Day and December 31, 2016 or 2019, resulting in a follow-up period of 15.6, 13.6 or 8.6 years, depending on the CanCHEC cycle.

RESULTS: Ischemic heart disease mortality was the leading cause of death among adult Black males (12.9%) and females (9.8%), as it is for adult White males (16.4%) and females (12.4%). Despite reduced risk of all-cause mortality among Black males and females, compared with White cohort members, there was notable increased risk for some cause-specific mortality. For instance, in the age-adjusted model, among the 25 causes of death examined, Black males had an increased risk of dying from four causes (HIV/AIDS, prostate cancer, diabetes mellitus and cerebrovascular disease), compared with White males. Similarly, Black females were at an increased risk for 6 causes of death (HIV/AIDS, stomach cancer, corpus uteri cancer, lymphomas and multiple myeloma, diabetes mellitus, and endocrine disorders) out of the 27 causes of death examined. These relative increased risks persisted for most causes of death after adjustment for differences in important social determinants of health.

INTERPRETATION: Results showed substantial variability in the risk of dying by cause of death between Black and White cohort members. An important step in reducing health inequities is the routine identification and surveillance of different health outcomes by population groups. This study helps fill that information gap.

PMID:36791269 | DOI:10.25318/82-003-x202300200001-eng

Environ Sci Technol. 2023 Feb 15. doi: 10.1021/acs.est.2c06117. Online ahead of print.

ABSTRACT

In the marine environment, discarded cigarette filters (CFs) deteriorate and leach filter-associated chemicals. The study aim was to assess the effects of smoked CFs (SCFs) and non-smoked CFs (NCFs) particles on individual life-history traits in the deposit-feeding polychaete Capitella teleta and extrapolate these to possible population-level effects. C. teleta was exposed to sediment-spiked particles of NCFs and SCFs at an environmentally realistic concentration (0.1 mg particles g^-1 dw sed) and a 100-fold higher (10 mg particles g^-1 dw sed) concentration. Experimental setup incorporated 11 individual endpoints and lasted approximately 6 months. There were significant effects on all endpoints, except from adult body volume and egestion rate, in worms exposed to 10 mg SCF particles g^-1 dw sed. Although not statistically significant, there was ≥50% impact on time between reproductive events and number of eggs per female at 0.1 mg SCF particles g^-1 dw sed. None of the endpoints was significantly affected by NCFs. Results suggest that SCFs are likely to affect individual life-history traits of C. teleta, whereas the population model suggests that these effects might not transform into population-level effects. The results further indicate that chemicals associated with CFs are the main driver causing the effects rather than the CF particles.

PMID:36791268 | DOI:10.1021/acs.est.2c06117