Category: Statistics

J Hand Surg Asian Pac Vol. 2023 Feb 13. doi: 10.1142/S2424835523500029. Online ahead of print.

ABSTRACT

Background: The coexistence of carpal tunnel syndrome (CTS) and trapeziometacarpal (TMC) osteoarthritis have been previously described. The influence of TMC osteoarthritis in the outcomes of CTS surgery is yet to be elucidated. The purpose of this study is to examine the prevalence of TMC osteoarthritis in patients who underwent open carpal tunnel release (OCTR) and to analyse the influence of osteoarthritis on the postoperative outcomes of CTS. Methods: We retrospectively reviewed 134 procedures on 113 patients who underwent OCTR between 2002 and 2017. The presence of TMC osteoarthritis was based upon preoperative plain radiograph. For the evaluation of CTS, pre- and postoperative muscle power of abductor pollicis brevis (APB) muscle by manual muscle testing (MMT) and distal motor latency (DML) detected on the APB muscle was examined. Results: The mean follow-up period was 11.4 months. The prevalence of radiographic TMC osteoarthritis was 40% in patients who underwent OCTR. In electrophysiological study, the mean pre- and postoperative DML showed no statistical difference regardless of the coexistence of TMC osteoarthritis. However, there was a significantly higher incidence of poorer muscle strength of the APB in patients with TMC osteoarthritis. No patients complained of TMC joint pain prior to OCTR, but four cases developed TMC joint pain during the postoperative follow-up period, all of whom had full recovery of APB muscle strength. Conclusions: The presence of asymptomatic TMC osteoarthritis may affect the postoperative outcomes of OCTR, so preoperative evaluation of TMC osteoarthritis should be considered in patients undergoing OCTR. In addition, the symptoms of TMC osteoarthritis may worsen in some patients after CTS surgery and should be taken into consideration during the postoperative follow-up. Level of Evidence: Level IV (Therapeutic).

PMID:36803330 | DOI:10.1142/S2424835523500029

BMC Public Health. 2023 Feb 17;23(1):359. doi: 10.1186/s12889-023-15160-6.

ABSTRACT

BACKGROUND: The spread of the COVID-19 (SARS-CoV-2) and the surging number of cases across the United States have resulted in full hospitals and exhausted health care workers. Limited availability and questionable reliability of the data make outbreak prediction and resource planning difficult. Any estimates or forecasts are subject to high uncertainty and low accuracy to measure such components. The aim of this study is to apply, automate, and assess a Bayesian time series model for the real-time estimation and forecasting of COVID-19 cases and number of hospitalizations in Wisconsin healthcare emergency readiness coalition (HERC) regions.

METHODS: This study makes use of the publicly available Wisconsin COVID-19 historical data by county. Cases and effective time-varying reproduction number [Formula: see text] by the HERC region over time are estimated using Bayesian latent variable models. Hospitalizations are estimated by the HERC region over time using a Bayesian regression model. Cases, effective Rt, and hospitalizations are forecasted over a 1-day, 3-day, and 7-day time horizon using the last 28 days of data, and the 20%, 50%, and 90% Bayesian credible intervals of the forecasts are calculated. The frequentist coverage probability is compared to the Bayesian credible level to evaluate performance.

RESULTS: For cases and effective [Formula: see text], all three time horizons outperform the three credible levels of the forecast. For hospitalizations, all three time horizons outperform the 20% and 50% credible intervals of the forecast. On the contrary, the 1-day and 3-day periods underperform the 90% credible intervals. Questions about uncertainty quantification should be re-calculated using the frequentist coverage probability of the Bayesian credible interval based on observed data for all three metrics.

CONCLUSIONS: We present an approach to automate the real-time estimation and forecasting of cases and hospitalizations and corresponding uncertainty using publicly available data. The models were able to infer short-term trends consistent with reported values at the HERC region level. Additionally, the models were able to accurately forecast and estimate the uncertainty of the measurements. This study can help identify the most affected regions and major outbreaks in the near future. The workflow can be adapted to other geographic regions, states, and even countries where decision-making processes are supported in real-time by the proposed modeling system.

PMID:36803324 | DOI:10.1186/s12889-023-15160-6

Phlebology. 2023 Feb 21:2683555231157566. doi: 10.1177/02683555231157566. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis (CDT) in acute lower extremity deep venous thrombosis (DVT) patients with severe iliac vein stenosis.

METHODS: The clinical data of 66 patients with acute lower extremity DVT complicated with severe iliac vein stenosis from May 2017 to May 2020 were retrospectively analyzed. Patients were divided into two groups by timing of iliac vein stent implantation: group A (iliac vein stent implantation before CDT treatment) for 34 and group B (iliac vein stent implantation after CDT treatment) for 32. The detumescence rate of affected limb, the thrombus clearance rate, the thrombolytic efficiency, the complication rate, the hospitalization cost, the stent patency rate within 1 year, and the scores (venous clinical severity score, Villalta, and chronic venous insufficiency questionnaire (CIVIQ) score) at 1 year postoperatively were compared between the two groups.

RESULTS: The thrombolytic efficiency of group A was higher than that of group B, while the incidence of complications and hospitalization expenses in group A were lower than those in group B. There was no statistical significance in the detumescence rate of affected limb, the thrombus clearance rate, the stent patency rate within 1 year, and the scores (VCSS, Villalta, and CIVIQ score) at 1 year postoperatively between the two groups.

CONCLUSIONS: For acute lower extremity DVT patients with severe iliac vein stenosis, iliac vein stent implantation before CDT treatment can improve the thrombolytic efficiency, and reduce the incidence of complications and hospitalization costs.

PMID:36803312 | DOI:10.1177/02683555231157566

BMC Cardiovasc Disord. 2023 Feb 20;23(1):94. doi: 10.1186/s12872-023-03113-1.

ABSTRACT

BACKGROUND: The Post Discharge Management of patients with heart failure impact significantly their incomes. This study aims to analyze the clinical findings and management at the first medical visit of these patients in our context.

MATERIAL AND METHODS: This is a retrospective cross-sectional descriptive study on consecutive files of patients hospitalized for heart failure from January to December 2018 in our Department. We analyse data from the first post discharge medical visit including medical visit time, clinical conditions and management.

RESULTS: Three hundred and eight patients (mean age: 53.4 ± 17.0 years, 60% males) were hospitalized on median duration of 4 days [1-22 days]. One hundred and fifty-three patients (49,67%) were presented at the first medical visit after 66.53 days[0.06-369] on average, 10 (3.24%) patients died before this first medical visit and 145 (47.07%) had been lost to follow-up. The re-hospitalization and treatment non-compliance rates were 9.4% and 3.6%, respectively. Male gender (p = 0.048), renal failure (p = 0.010), and Vitamin K antagonist (VKA) /direct oral anticoagulant (DOAC) (p = 0.049) were the main lost to follow-up factors in univariate analysis without statistic signification in multivariate analysis. Hyponatremia (OR = 2.339; CI 95% = 0.908-6.027; p = 0.020) and atrial fibrillation (OR = 2.673; CI 95% = 1.321-5.408; p = 0.012) were the major mortality factors.

CONCLUSION: The management of patients with heart failure after discharge from hospital seems to be insufficient and inadequate. A specialized unit is required to optimize this management.

PMID:36803293 | DOI:10.1186/s12872-023-03113-1

Lupus. 2023 Feb 20:9612033231157073. doi: 10.1177/09612033231157073. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore the feasibility and effectiveness of telehealth-supervised exercise for adults with Systemic lupus erythematosus (SLE).

METHODS: This was a non-randomised controlled pilot trial comparing telehealth-supervised exercise (8 weeks, 2 days/week, 45 min, moderate intensity) plus usual care with usual care alone. Mixed methods were used to assess change in fatigue (FACIT-fatigue), quality of life (SF36), resting fatigue and pain (11-point scale), lower body strength (five-time sit-to-stand) and endurance (30 s sit-to-stand), upper body endurance (30 s arm curl), aerobic capacity (2 min step test), and experience (survey and interviews). Group comparison was performed statistically using a two-sample T-test or Mann-Whitney U-test. Where known, we used MCID or MCII, or assumed a change of 10%, to determine clinically meaningful change within groups over time. Interviews were analysed using reflexive thematic analysis.

RESULTS: Fifteen female adults with SLE were included (control group n = 7, exercise group n = 8). Statistically significant differences between groups, in favour of the exercise intervention, were noted for SF36 domain emotional well-being (p = 0.048) and resting fatigue (p = 0.012). There were clinically meaningful improvements over time for FACIT-fatigue (+6.3 ± 8.3, MCID >5.9), SF36 domains physical role functioning (+30%), emotional role functioning (+55%), energy/fatigue (+26%), emotional well-being (+19%), social functioning (+30%), resting pain (-32%), and upper body endurance (+23%) within the exercise group. Exercise attendance was high (98%, 110/112 sessions); participants strongly agreed (n = 5/7, 71%) or agreed (n = 2/7, 29%) they would do telehealth-supervised exercise again and were satisfied with the experience. Four themes emerged: (1) ease and efficiency of exercising from home, (2) value of live exercise instruction, (3) challenges of exercising at home, and (4) continuation of telehealth-supervised exercise sessions.

CONCLUSION: Key findings from this mixed-method investigation suggest that telehealth-supervised exercise was feasible for, and well-accepted by, adults with SLE and resulted in some modest health improvements. We recommend a follow-up RCT with more SLE participants.

PMID:36803286 | DOI:10.1177/09612033231157073

Appl Neuropsychol Adult. 2023 Feb 20:1-12. doi: 10.1080/23279095.2023.2175321. Online ahead of print.

ABSTRACT

Homelessness is a multifactorial issue, influenced by structural and individual factors. These factors include health status, which has been reported to be poorer among people experiencing homelessness. Although the somatic and mental health of homeless individuals has already been studied in France, to our knowledge, no research has been conducted on neuropsychological functioning in this country. Studies out with France have identified cognitive impairments as highly prevalent among homeless people, and these impairments are likely affected by local structural factors, such as healthcare access. Therefore, we conducted an exploratory study in Paris to evaluate cognition and associated factors in homeless adults. The second objective was to identify methodological specificities to consider in a future larger-scale study and for the application of the outcomes. For this exploratory phase, 14 individuals were recruited from specific services and were interviewed regarding their social, neurological, and psychiatric history, before completing a set of cognitive tests. The results showed a high diversity of profiles in terms of demographic characteristics, including being a migrant and/or illiterate. A high proportion of participants had signs of traumatic brain injury, anxiety, depressive disorders, and post-traumatic stress disorders. Most cognitive scores were in the low average of normative data. No statistical association was found between identified risk factors and cognitive performance. Future studies should consider the sociodemographic specificities of the homeless population and design appropriate measurement tools to improve the understanding of neuropsychological profiles.

PMID:36803262 | DOI:10.1080/23279095.2023.2175321

Disabil Rehabil. 2023 Feb 20:1-7. doi: 10.1080/09638288.2023.2180545. Online ahead of print.

ABSTRACT

PURPOSE: To investigate if the responses to the Neck Disability Index (NDI) may produce some differential item functioning (DIF) comparing men and women.

MATERIALS AND METHODS: Register-based study among patients undergoing cervical surgery. Item response theory (IRT) analysis including a model for detecting a DIF.

RESULTS: Of 338 patients, 171 (51%) were women and 167 (49%) were men. The mean age was 54.0 years. For most of the items, the average level of disability in a studied sample was associated with the middle point of the scale. The ability to distinguish people with different levels of disability was high or perfect for seven out of 10 items. While the DIF could be seen for all 10 items, only three items demonstrated statistically significant DIF – “pain intensity”, “headaches” and “recreation”. While the other seven items did not show statistically significant DIFs, better discrimination (steeper curves) for women could be graphically observed for “personal care”, “lifting”, “work”, “driving” and “sleeping”.

CONCLUSIONS: It seemed that the NDI may behave differently depending on the sex of respondents. Several items of the NDI may be more precise and more sensitive when detecting restrictions in functioning among women compared to men. This finding should be taken into account when using the NDI in research and clinical practice.Implications for RehabilitationWhile the Neck Disability Index have been found to be a reliable and valid scale, potential differences in its properties across different sexes have mostly remained uninvestigated.This study showed that the Neck Disability Index may behave differently depending on the sex of respondents.Several items of the Neck Disability Index were more precise and sensitive when detecting restrictions in functioning among women compared to men.This difference should be taken into account when using the NDI in research and clinical practice.

PMID:36803260 | DOI:10.1080/09638288.2023.2180545

Drug Deliv. 2023 Dec;30(1):2181747. doi: 10.1080/10717544.2023.2181747.

ABSTRACT

Repaglinide (RPG), a monotherapy insulin secretagogue used to treat diabetes mellitus-type II yet, it suffers from poor water solubility and variable bioavailability (∼ 50%) due to hepatic first pass metabolism. In this study, 2FI I-Optimal statistical design was employed to encapsulate RPG into niosomal formulations using cholesterol,span 60 and peceol^TM. The optimized niosomal formulation (ONF) showed particle size 306.60 ± 84.00 nm, zeta potential -38.60 ± 1.20 mV, polydispersity index 0.48 ± 0.05 and entrapment efficiency 92.00 ± 2.60%. ONF showed > 65% RPG release that lasted for 3.5 h, and significantly higher sustained release compared to Novonorm® tablets after 6 h (p < 0.0001). TEM for ONF showed spherical vesicles with dark core and light-colored lipid bilayer membrane. RPG peaks disappeared in FTIR confirming successful RPG entrapment. To eliminate dysphagia associating conventional oral tablets, chewable tablets loaded with ONF were prepared using coprocessed excipients; Pharmaburst^® 500, F-melt^® and Prosolv^® ODT. Tablets showed friability <1%, hardness 3.9 ± 0.423-4.7 ± 0.410 Kg, thickness 4.1 ± 0.045-4.4 ± 0.017 mm and acceptable weight.All tablets showed robust RPG release at 30 min compared to Novonorm^® tablets. At 6h, chewable tablets containing only Pharmaburst^® 500 and F-melt^® showed sustained and significantly increased RPG release compared to Novonorm^® tablets (p < 0.05). Pharmaburst^® 500 and F-melt^® tablets showed rapid in vivo hypoglycemic effect with 5 and 3.5 fold significant reduction in blood glucose compared to Novonorm^® tablets (p < 0.05) at 30 min. Also, at 6h the same tablets showed 1.5 and 1.3 fold significant extended reduction in blood glucose compared to the same market product (p < 0.05). It could be concluded that chewable tablets loaded with RPG ONF represent promising novel oral drug delivery systems for diabetic patients suffering from dysphagia.

PMID:36803255 | DOI:10.1080/10717544.2023.2181747

J Pediatr Ophthalmol Strabismus. 2023 Feb 21:1-7. doi: 10.3928/01913913-20230119-01. Online ahead of print.

ABSTRACT

PURPOSE: To assess the relationship between posterior capsulotomy size and significant visual axis opacification (VAO) in congenital and developmental cataract.

METHODS: The charts of children aged 7 years and younger who underwent cataract surgery including primary posterior capsulotomy (PPC) and limited anterior vitrectomy between 2012 and 2022 were retrospectively reviewed. Eyes with PPC size smaller than the anterior capsulotomy size were considered as group 1. Eyes with PPC size larger than the anterior capsulotomy size were considered as group 2. Clinical characteristics, the need for Nd:YAG laser treatment or further surgery for significant VAO, and other postoperative complications were compared between the groups.

RESULTS: Sixty eyes of 41 children were included in the study. The median age at the time of surgery was 5.5 and 3 years in groups 1 and 2, respectively (P = .076). Primary intraocular lens implantation was performed in 23 (85.2%) eyes in group 1 and 25 (75.8%) eyes in group 2 (P = .364). There was no difference between the groups in terms of postoperative visual acuity (P = .983) and refractive errors (P = .154). Eight (29.6%) pseudophakic eyes received Nd:YAG laser treatment in group 1, but none of the eyes in group 2 (P = .001). Four (14.8%) eyes in group 1 and 1 (3%) eye in group 2 underwent further surgery for VAO (P = .100). The need for further intervention for significant VAO was statistically higher in group 1 (44.4% vs 3%, P < .001).

CONCLUSIONS: Larger PPC size in pediatric cataract may reduce the need for further intervention for significant VAO. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

PMID:36803243 | DOI:10.3928/01913913-20230119-01

Blood Press. 2023 Dec;32(1):2179337. doi: 10.1080/08037051.2023.2179337.

ABSTRACT

PURPOSE: To identify modifiable risk factors in early midlife associated with incident hypertension 26 years later in women and men.

MATERIALS AND METHODS: We used data from 1025 women and 703 men in the community-based Hordaland Health Study examined at the mean age of 42 years (baseline) and after a 26-year follow-up. Patients with hypertension at baseline were excluded. Blood pressure (BP) was classified according to European guidelines. Factors associated with incident hypertension were identified in logistic regression analyses.

RESULTS: At baseline, women had a lower average BP and a lower prevalence of high-normal BP (19% vs 37%, p < .05). Overall, 39% of women and 45% of men developed hypertension during follow-up (p < .05). Among those with high-normal BP at baseline, 72% of women and 58% of men developed hypertension (p < .01). In multivariable logistic regression analyses, high-normal BP at baseline was a stronger predictor of incident hypertension in women (odds ratio, OR 4.8, [95% confidence interval, CI 3.4-6.9]) than in men (OR 2.1, [95% CI 1.5-2.8]), p < .01 for sex interaction. A higher baseline body mass index (BMI) was associated with incident hypertension in both sexes.

CONCLUSIONS: High-normal BP in midlife is a stronger risk factor for developing hypertension 26 years later in women than in men, independent of BMI.

PMID:36803236 | DOI:10.1080/08037051.2023.2179337