Category: Statistics

Zhonghua Yi Xue Za Zhi. 2023 Jun 6;103(21):1596-1602. doi: 10.3760/cma.j.cn112137-20221212-02635.

ABSTRACT

Objective: To evaluate the value of ultrasound-guided intra-articular anesthetic injection in predicting postoperative outcomes for borderline developmental hip dysplasia (BDDH). Methods: A follow-up study. The clinical data of 37 BDDH patients who received ultrasound-guided intra-articular anesthetic injection and arthroscopic examination in the Department of Sports Medicine, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital from May 2018 to February 2021 were retrospectively analyzed. Among them, there were 17 males and 20 females with a mean age of (37.9±12.8) years. All patients underwent ultrasound-guided intra-articular anesthetic injection prior to arthroscopy, and were evaluated with hip physical examination before and after injection, as well as before and after arthroscopy, in order to obtain the visual analog score (VAS) of pain for seven assessments. The total VAS score was calculated based on these evaluations. Follow-up was conducted for at least 12 months. The effective rate of injection referred to the ratio of the improvement of VAS score after anesthetic injection to the total VAS score before injection. Pearson correlation analysis and Bland-Altman analysis were used to test the correlation between modified Harris hip score (mHHS) after ultrasound-guided intra-articular anesthetic injection and mHHS score after arthroscopic surgery. A binary logistic regression model was established to analyze the substantial clinical benefit (SCB) for patients. Following the logistic regression analysis, a receiver operating characteristic (ROC) curve was constructed to evaluate the predictive power of ultrasound-guided intra-articular anesthetic injection in achieving SCB in those patients. The optimal cut-off value for injection efficacy was determined based on the ROC curve when SCB was achieved. Results: The follow-up time for all patients was (26.3±7.6) months. After anesthetic injection for 20 minutes, the total VAS score of pain [M(Q₁,Q₃)] decreased from 13(8,23) points before injection to 1(0,4) points; and the mHHS score [M(Q₁,Q₃)] increased from 60(46,70) points before arthroscopy to 90(84,96) points after, with statistically significant differences before and after injection and before and after arthroscopy (both P<0.001). Pearson correlation analysis showed that the mHHS score after intra-articular anesthetic injection was positively correlated with the mHHS score after surgery (r=0.961, P<0.001). The area under the ROC curve for predicting SCB after arthroscopy with ultrasound-guided intra-articular anesthetic injection was 0.769 (95%CI: 0.561-0.976), the Youden index was 0.663, the cut-off value was 0.569 2, the sensitivity was 96.3%, and the specificity was 70.0%. Conclusions: The results of ultrasound-guided intra-articular anesthetic injection before arthroscopy can indicate the presence of intra-articular lesions, and the degree of pain relief after injection is proportional to the functional recovery after arthroscopy. Patients with intra-articular anesthetic injection efficacy>56.92% have better results in hip arthroscopy.

PMID:37248058 | DOI:10.3760/cma.j.cn112137-20221212-02635

Aust Health Rev. 2023 May 30. doi: 10.1071/AH22266. Online ahead of print.

ABSTRACT

ObjectivesThis study aimed to conduct a learning and development needs analysis of quality improvement partnership capabilities of staff and consumers on partnership committees at an Australian metropolitan hospital and health service. Objectives were to compare consumer and staff self-rated capability importance, performance, and learning needs; to investigate if years of partnership experience influenced ratings; and to ascertain staff and consumer preferred learning strategies.MethodsAn online cross-sectional survey was adapted from the Hennessy-Hicks Training Needs Analysis questionnaire. Participants self-rated the importance of, and their performance on, 10 capabilities, across four domains, of an internationally validated co-produced capability development framework. They also rated preferences regarding learning approaches and media.ResultsA total of 199 members from 41 committees (174 staff; 25 consumers; response rate 35.38%) participated. There was a statistically significant learning and development need across all capabilities (P < 0.01). The highest learning need was for influencing organisational systems and policy (mean = -0.96; s.d. = 1.23), followed by equalising power and leadership (mean = -0.91; s.d. = 1.22), and then implementing partnership best practices (mean = -0.89; s.d. = 1.22). There were no statistically significant differences between consumers and staff on ratings, or correlations between years of partnership experience and ratings (P < 0.01). A combination of learning approaches was preferred, followed by learning through experience. Self-reflection was least preferred, which is concerning given it may promote equalising power and leadership. Face-to-face then videoconferencing were the preferred learning media.ConclusionsContinuous co-learning for staff and consumers about QI partnerships is essential. Committee members needed more feedback regarding their influence and to be engaged in innovative co-design practices.

PMID:37248052 | DOI:10.1071/AH22266

Psychogeriatrics. 2023 May 29. doi: 10.1111/psyg.12976. Online ahead of print.

ABSTRACT

BACKGROUND: The noradrenergic systems in the brain maintain cognitive functions including attention/concentration and establishment of long-term memory. In addition, hypofunction of noradrenergic systems is supposed to be involved in the pathophysiology of Alzheimer’s disease. In this study, we tried to examine the possible associations of concentrations of basal salivary 3-methoxy-4-hydroxyphenylglycol (sMHPG), a major metabolite of noradrenaline, and brain volume changes during 4 years in elderly people living in a rural community.

METHODS: The survey was conducted twice in Kurokawa-cho, Imari, Saga Prefecture, Japan, among people aged 65 years and older. We collected data from 226 residents. Measurements of sMHPG and brain MRIs were collected at Time 1 (2005-2007). Follow-up brain MRIs were taken at Time 2 (2009-2011). A total of 70 participants (18 men, mean age 71.9 ± 4.8 years; 52 women, mean age 72.0 ± 4.3 years) completed this survey. Concentrations of sMHPG at baseline were divided into two groups using the mean value (12.83 ng/ml). We compared the brain volumes between groups with higher and lower sMHPG concentrations over time using voxel-based morphometry implemented with statistical parametric mapping.

RESULTS: In participants with higher sMHPG concentrations at baseline, brain volumes including right precuneus were significantly larger 4 years after baseline than those with lower sMHPG concentrations at baseline. No interaction between sMHPG concentration and MRI acquisition interval was found.

CONCLUSION: Our results suggest that higher sMHPG concentrations in elderly people might be associated with maintenance of brain volume, especially in brain regions closely related to cognitive function.

PMID:37248036 | DOI:10.1111/psyg.12976

Rev Infirm. 2023 May;72(291):39-41. doi: 10.1016/j.revinf.2023.04.011. Epub 2023 May 10.

ABSTRACT

Adapted physical activities (APA) in the workplace improve workers’ health. Paradoxically, APA remains marginal in the very places where improving health is the central objective of health care workers, namely clinics and hospitals. Promoting physical activity in the workplace is a twofold challenge. Not only does PA improve the health and well-being of caregivers, but it also allows them to be more effective in their daily work with patients.

PMID:37247988 | DOI:10.1016/j.revinf.2023.04.011

BMJ Open. 2023 May 29;13(5):e068130. doi: 10.1136/bmjopen-2022-068130.

ABSTRACT

OBJECTIVE: The aim is to integrate quantitative and qualitative evidence to understand the effectiveness and experience of advance care planning (ACP) for frail elderly.

DESIGN: A mixed-methods systematic review and meta-analysis was conducted. Quality evaluation was conducted using critical appraisal tools from the Joanna Briggs Institute. Data were synthesised and pooled for meta-analysis or meta-aggregation as needed.

DATA SOURCES: An electronic search of MEDLINE, CINAHL, Embase, PubMed, PsycINFO, and Cochrane Library databases from January 2003 to April 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included experimental and mixed-methods studies. The quantitative component attempts to incorporate a broader study design. The qualitative component aids in comprehending the participant’s experience with ACP and its efficacy.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers undertook screening, data extraction and quality assessment. The quantitative and qualitative data were synthesised and integrated using a convergent segregated approach.

RESULTS: There were 12 158 articles found, and 17 matched the inclusion criteria. The quality of the quantitative component of most included studies (6/10) was rated as low, and the qualitative component of half included studies (4/8) was rated as moderate. The meta-analysis showed that the intervention of ACP for frail elderly effectively increases readiness, knowledge and process of ACP behaviours. The meta-aggregation showed that the participants hold a positive attitude towards ACP and think it facilitates expressing their preferences for the medical decision.

CONCLUSION: ACP is an effective and feasible strategy to facilitate frail elderly to express their healthcare wishes timely and improve their outcomes. This study could provide proof for a better understanding of the subject and help direct future clinical practice. More well-designed randomised controlled trials evaluating the most effective ACP interventions and tools are needed for the frail elderly population.

PROSPERO REGISTRATION NUMBER: CRD42022329615.

PMID:37247960 | DOI:10.1136/bmjopen-2022-068130

Anticancer Res. 2023 Jun;43(6):2593-2599. doi: 10.21873/anticanres.16426.

ABSTRACT

BACKGROUND/AIM: Cancer cachexia describes a multifactorial wasting syndrome marked by a metabolic imbalance leading to the loss of muscle and fat tissue. Extracellular vesicles (EV) provide unique insights into their parental cells’ metabolism. The value of these vesicles as diagnostic tools in cancer cachexia has not been investigated so far.

PATIENTS AND METHODS: A previously analyzed metabolomics dataset on large EV from breast cancer patients was used for analyzing the metabolomic changes in patients with malnutrition. Follow-up time was 6 months. The data were analyzed using fold change analysis, volcano plotting, receiver operator characteristic (ROC) analysis, pathway analysis, and survival analysis.

RESULTS: In patients with weight loss, statistical analysis revealed an increase in lysophosphatidylcholines (lysoPC a C16:0, lysoPC a C18:0, lysoPC a C18:1, lysoPC a C18:2, lysoPC a C20:4), sphingomyelins (SM (OH) C22:2 and SM C18:1), and phosphatidylcholines (PC aa C24:0, PC ae C34:3). When combined, these metabolites are a good predictor for cachexia in ROC curve analysis (AUC of 0.970; 95%CI=0.920-1.000; p<0.0001). Pathway analysis revealed an involvement of metabolites in “choline metabolism in cancer” and “glycerophospholipid metabolism”.

CONCLUSION: Large EV reflect metabolic changes in cancer patients suffering from cancer cachexia. Metabolic changes at the time of drawing blood were associated with the weight status (stable vs. weight loss) six months later and thereby could have a predictive impact.

PMID:37247938 | DOI:10.21873/anticanres.16426

Anticancer Res. 2023 Jun;43(6):2733-2739. doi: 10.21873/anticanres.16440.

ABSTRACT

BACKGROUND/AIM: The aim of this study was to investigate the relationship between radiation exposure to the spleen, dose-dependent organ changes, and their possible influence on clinical and oncological outcome. Furthermore, to provide evidence and sensitivity for considering the spleen as an relevant organ at risk.

PATIENTS AND METHODS: A total of 93 patients with carcinoma of the distal esophagus or gastroesophageal junction were selected for this retrospective study. Changes in spleen volume, infections, and oncological outcome were assessed during follow-up using linear and logistic regression models.

RESULTS: Spleen volume decreased significantly by a median of 27.5 ml to an absolute value of 178.1 ml (p<0.001) within twelve months. Statistical analyses revealed a significant association of infectious events with worse progression-free survival (PFS) (p=0.002) and overall survival (OS) (p=0.001). With a mean spleen dose <4 Gray, both OS and PFS were also significantly prolonged.

CONCLUSION: A decrease in spleen organ volume after neoadjuvant radiochemotherapy was demonstrated with a consecutive increased incidence of infectious events, significantly correlating with worse PFS and OS.

PMID:37247933 | DOI:10.21873/anticanres.16440

Anticancer Res. 2023 Jun;43(6):2645-2657. doi: 10.21873/anticanres.16431.

ABSTRACT

BACKGROUND/AIM: Interferon-alpha (IFN-alpha) has shown survival benefits in metastatic renal cell carcinoma (mRCC), but the knowledge about long-term outcome is sparse. Additional knowledge is beneficial because IFN-alpha usage in combination therapy such as immune checkpoint inhibitor for mRCC is an area of interest. This is the longest follow-up concerning IFN-alpha treatment.

PATIENTS AND METHODS: A total of 117 metastatic renal cell cancer (mRCC) patients without prior chemotherapy were enrolled between 1994-2002 and followed-up until January 2022. The median follow-up was 18 months. After progression to IFN-alpha, the patients were not treated with tyrosine kinase, mTOR inhibitors or bevacizumab as these were not standard therapies at that time or the patients’ performance status was too poor. Mean treatment duration was 11 months.

RESULTS: Median overall survival was 19.0 months, 5-year survival rate 16.2%, and 10-year survival rate 9.0%. There were statistically significant differences in survival in response to treatment (log-rank test, p<0.001): median overall survival was 52.0 months for objective responses, 25.0 months for stable disease and 5.0 months for progressive disease. Proportion of 5-year survivors was 29% in low, 20% in intermediate, and 7% in high-risk groups, respectively (p=0.001).

CONCLUSION: With prolonged INF-alpha treatment stable and responding patients can obtain late objective responses, long-lasting complete responses, and long-term outcome with acceptable toxicity. IFN-alpha is an alternative therapy when multiple treatment lines are used for mRCC and an interesting option to study for combined therapies such as immune checkpoint inhibitor-based therapies.

PMID:37247917 | DOI:10.21873/anticanres.16431

Anticancer Res. 2023 Jun;43(6):2821-2829. doi: 10.21873/anticanres.16451.

ABSTRACT

BACKGROUND/AIM: Chronic inflammation and cytokine storm can cause uncontrolled events in cancer. Pro-inflammatory molecules released by malignant cells send signals to the brain, liver, and neuroendocrine cells, interfering with appetite and promoting anorexia. Malnutrition in cancer patients is associated with increased treatment toxicity, reduced physical efficiency, and decreased survival. Therefore, early recognition of malnutrition could improve quality of life, treatment compliance, and survival. The aim of the study was to explore the relationship between inflammatory parameters with disease stage and nutritional status in patients with solid cancers.

PATIENTS AND METHODS: We screened 77 consecutive patients from 3 clinical Institutions in Sicily, Italy, with solid tumors who were either in follow-up after curative treatment or being treated for metastatic disease using the Mini Nutritional Assessment (MNA) questionnaire. Inflammatory parameters, including interleukin 6 (IL6), C-reactive protein (CRP), β2-microglobulin, ferritin, and transferrin were evaluated.

RESULTS: A statistically significant difference was found in mean values of IL6, CRP, β2-microglobulin, ferritin, and transferrin between patients without evidence of disease and metastatic patients. Among the metastatic group, there was a significant difference in mean values of these inflammatory parameters between patients with malnutrition and those with normal nutritional status. The difference in average IL6, CRP, β2-microglobulin, and ferritin between patients at risk of malnutrition and those with normal nutritional status was also significant. However, the difference between patients at risk of malnutrition and those with malnutrition was not significant.

CONCLUSION: IL6, CRP, transferrin, ferritin, and β2-microglobulin are functional inflammatory parameters that indicate risk of malnutrition and support the MNA screening test to identify patients with solid tumors who require nutritional support.

PMID:37247899 | DOI:10.21873/anticanres.16451

Anticancer Res. 2023 Jun;43(6):2671-2681. doi: 10.21873/anticanres.16433.

ABSTRACT

BACKGROUND/AIM: The role of single nucleotide polymorphisms (SNPs) in the frequency and intensity of chemotherapy-induced nausea and vomiting (CINV) in women with breast cancer (BC) is unclear. The primary purpose of this study was to compare/evaluate the effect of SNP-guided antiemetic treatment versus standard CINV treatment.

PATIENTS AND METHODS: A randomised, factorial, phase II multicentre study design was used. Women planned for neoadjuvant or adjuvant chemotherapy with epirubicin, cyclophosphamide and fluorouracil (FEC /EC, with or without fluorouracil) for BC were randomised to SNP-guided antiemetic treatment (based on the results of SNP analyses) versus standard CINV treatment. Blood samples were taken before the treatment was initiated. Patient-reported data on CINV (during 10 days from onset of cancer treatment) and health-related quality of life (HRQoL), were collected before and after the first cancer treatment.

RESULTS: A total of 188 women were included. Overall, nausea was reported by 86% (n=129) of the patients during the ten-day period from the start of cancer treatment. The SNP genotype studied varied. In FAS-CD95, the genotypes AG and GG were overrepresented; in RB1-LPAR6, GG was overrepresented, and in CCL2, both AA and GG were overrepresented. We found no statistically significant difference in CINV between SNP-guided antiemetic treatment versus standard CINV treatment.

CONCLUSION: SNP-guided antiemetic treatment could be as effective as standard treatment. SNP-guided antiemetic treatment of CINV is possibly useful in detecting patients with a higher or lower risk for CINV and thus may help in avoiding over-treatment with toxic components. CINV negatively affects the HRQL.

PMID:37247895 | DOI:10.21873/anticanres.16433