Category: Statistics

Paediatr Anaesth. 2023 May 19. doi: 10.1111/pan.14695. Online ahead of print.

ABSTRACT

BACKGROUND: Inhalational anesthetic agents are potent greenhouse gases with global warming potential that far exceed that of carbon dioxide. Traditionally, pediatric inhalation inductions are achieved with a volatile anesthetic delivered to the patient in oxygen and nitrous oxide at high fresh gas flows. While contemporary volatile anesthetics and anesthesia machines allow for a more environmentally conscious induction, practice has not changed. We aimed to reduce the environmental impact of our inhalation inductions by decreasing the use of nitrous oxide and fresh gas flows.

METHODS: Through a series of four plan-do-study-act cycles, the improvement team used content experts to demonstrate the environmental impact of the current inductions and to provide practical ways to reduce this, by focusing on nitrous oxide use and fresh gas flows, with visual reminders introduced at point of delivery. The primary measures were the percentage of inhalation inductions that used nitrous oxide and the maximum fresh gas flows/kg during the induction period. Statistical process control charts were used to measure improvement over time.

RESULTS: 33 285 inhalation inductions were included over a 20-month period. nitrous oxide use decreased from 80% to <20% and maximum fresh gas flows/kg decreased from a rate of 0.53 L/min/kg to 0.38 L/min/kg, an overall reduction of 28%. Reduction in fresh gas flows was greatest in the lightest weight groups. Induction times and behaviors remained unchanged over the duration of this project.

CONCLUSIONS: Our quality improvement group decreased the environmental impact of inhalation inductions and created cultural change within our department to sustain change and foster the pursuit of future environmental efforts.

PMID:37203788 | DOI:10.1111/pan.14695

Stud Health Technol Inform. 2023 May 18;302:541-545. doi: 10.3233/SHTI230201.

ABSTRACT

The use and shareability of Clinical Quality Language (CQL) artefacts is an important aspect in enabling the exchange and interoperability of clinical data to support both clinical decisions and research in the medical informatics field. This paper, while basing on use cases and synthetic data, developed purposeful CQL reusable libraries to showcase the possibilities of multidisciplinary teams and how CQLs could be best used to support clinical decision making.

PMID:37203744 | DOI:10.3233/SHTI230201

Stud Health Technol Inform. 2023 May 18;302:490-491. doi: 10.3233/SHTI230185.

ABSTRACT

In 2013 using a Public Procurement of Innovation procedure the Region of Galicia developed a patient portal called “E-Saúde”, that went live in 2015. COVID situation in 2019 produced a high demand of e-health services, scaling by 10x the number of users in 2021.

OBJECTIVE: In this study a quantitative description of patient portal usage from 2018 to 2022 is made to show the behaviour of usage trends of a patient portal before, during and after COVID pandemic.

METHODS: Two main data sets were obtained from patient portal logs to obtain: 1) Enrolment of new users and number of sessions opened in the portal. 2) Detailed usage of relevant functionalities. Descriptive statistical methods were applied to show the usage of the portal in a biannual time series description.

RESULTS: Prior to the pandemic, the portal was gradually being introduced to citizens. During pandemics, more than 1 million users were registered and a peak of 15x usage could be observed. After COVID, the level of usage of portal services decreased, but kept a sustained trend five times higher than in Pre-COVID situation.

CONCLUSION: There is limited information available on metrics, functionalities and acceptability for general purpose patient portals, but the analysis performed on usage levels shows that after a high peak reached during COVID period, explained by the need of direct access to clinical information, the level of usage of the patient portal remains five times higher than in pre-pandemic situation for all functionalities of the patient portal.

PMID:37203729 | DOI:10.3233/SHTI230185

Stud Health Technol Inform. 2023 May 18;302:484-485. doi: 10.3233/SHTI230182.

ABSTRACT

The German Association for Medical Informatics, Biometry and Epidemiology (GMDS) aims to develop subject-specific methods, which are then to be applied in collaboration with various medical domains. Furthermore, the support of young scientists is an essential field of activity of the GMDS, since the need for junior staff has increased due to the acceleration in medical digitization. A specially established Presidential Commission strives to promote young talents and scientists in the above-mentioned disciplines. For this purpose, various strategies and concepts are elaborated in regular meetings and finally implemented. These include online formats such as a lecture series on research-related topics, as well as events such as summer schools and PhD symposia.

PMID:37203726 | DOI:10.3233/SHTI230182

Stud Health Technol Inform. 2023 May 18;302:458-462. doi: 10.3233/SHTI230172.

ABSTRACT

One of the major barriers to joining pulmonary rehabilitation (PR) programs is a lack of awareness about its benefits, combined with overall skepticism about regular exercise among COPD patients. Empowering COPD patients with foundational knowledge about PR may potentially facilitate their decision to join a PR program. A virtual reality (VR) app may serve as an engaging and interactive means to deliver PR education; however, the feasibility of this approach in COPD patients is unknown. The goal of this project was to assess the feasibility of VR-based PR education in COPD patients. Using mixed methods design, the feasibility of the VR app was assessed by evaluating its usability, patient acceptance, and its impact on patient knowledge about PR. The results of the usability assessment showed high user acceptance of the VR system and the ability to successfully operate the VR appliances. The use of the VR education app resulted in a statistically significant increase in patient understanding of the main concepts of pulmonary rehabilitation. Further development and evaluation of VR-based systems for patient engagement and empowerment are warranted.

PMID:37203716 | DOI:10.3233/SHTI230172

Stud Health Technol Inform. 2023 May 18;302:356-357. doi: 10.3233/SHTI230138.

ABSTRACT

Patient-Accessible Electronic Health Records (PAEHR) are particularly disputed in mental healthcare. We aim to explore if there is any association between patients having a mental health condition and someone unwanted seeing their PAEHR. A chi-square test showed a statistically significant association between group belonging and experiences of someone unwanted seeing their PAEHR.

PMID:37203682 | DOI:10.3233/SHTI230138

Stud Health Technol Inform. 2023 May 18;302:272-276. doi: 10.3233/SHTI230117.

ABSTRACT

The German Medical Informatics Initiative makes clinical routine data available for biomedical research. In total, 37 university hospitals have set up so-called data integration centers to facilitate this data reuse. A standardized set of HL7 FHIR profiles (“MII Core Data Set”) defines the common data model across all centers. Regular Projectathons ensure continuous evaluation of the implemented data sharing processes on artificial and real-world clinical use cases. In this context, FHIR continues to rise in popularity for exchanging patient care data. As reusing data from patient care in clinical research requires high trust in the data, data quality assessments are a key point of concern in the data sharing process. To support the setup of data quality assessments within data integration centers, we suggest a process for finding elements of interest from FHIR profiles. We focus on the specific data quality measures defined by Kahn et al.

PMID:37203661 | DOI:10.3233/SHTI230117

Stud Health Technol Inform. 2023 May 18;302:237-241. doi: 10.3233/SHTI230110.

ABSTRACT

Missing data is a common problem in the intensive care unit as a variety of factors contribute to incomplete data collection in this clinical setting. This missing data has a significant impact on the accuracy and validity of statistical analyses and prognostic models. Several imputation methods can be used to estimate the missing values based on the available data. Although simple imputations with mean or median generate reasonable results in terms of mean absolute error, they do not account for the currentness of the data. Furthermore, heterogeneous time span of data records adds to this complexity, especially in high-frequency intensive care unit datasets. Therefore, we present DeepTSE, a deep model that is able to cope with both, missing data and heterogeneous time spans. We achieved promising results on the MIMIC-IV dataset that can compete with and even outperform established imputation methods.

PMID:37203654 | DOI:10.3233/SHTI230110

Eur Respir J. 2023 May 18:2300291. doi: 10.1183/13993003.00291-2023. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to study whether statin use is associated with lowering the development of interstitial lung disease (ILD) or idiopathic pulmonary fibrosis (IPF).

METHODS: The study population was the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS). ILD and IPF cases were identified using the diagnosis codes (J84.1 for ILD and J84.1A for special code for IPF) based on the International Classification of Diseases, 10th revision codes. The study participants were followed up from January 1, 2004 to December 31, 2015. Statins use was defined by the cumulative defined daily dose per 2-year interval and categorized into never-use, less than 182.5, 182.5 to 365.0, 365.0 to 547.5, and 547.5 or more. A Cox model was used to fit a model with a time-dependent variable of statin use.

RESULTS: Incidence rates for ILD with and without statin use were 20.0 and 44.8/100 000 person-year, respectively and those for IPF were 15.6 and 19.3/100 000 person-year, respectively. The use of statins was independently associated with a lower incidence of ILD and IPF in a dose-response fashion (p’s for trend<0.001). ILD showed adjusted hazard ratios (aHRs) 1.02 (95% confidence interval (CI) 0.87-1.20), 0.60 (0.47-0.77), 0.27 (0.16-0.45) and 0.24 (0.13-0.42) according to the increasing category of statin use compared to the never-use. IPF showed aHRs 1.29 (1.07-1.57), 0.74 (0.57-0.96), 0.40 (0.25-0.64) and 0.21 (0.11-0.41), respectively.

INTERPRETATION: A population-based cohort analysis found that statin use is independently associated with a decreased risk of ILD and IPF in a dose-response manner.

PMID:37202155 | DOI:10.1183/13993003.00291-2023

Pediatr Obes. 2023 May 18:e13042. doi: 10.1111/ijpo.13042. Online ahead of print.

ABSTRACT

Obesity and components of the metabolic syndrome (MetS) are associated with differences in brain structure and function and in general and food-related cognition in adults. Here, we review evidence for similar phenomena in children and adolescents, with a focus on the implications of extant research for possible underlying mechanisms and potential interventions for obesity and MetS in youth. Current evidence is limited by a relative reliance on small cross-sectional studies. However, we find that youth with obesity and MetS or MetS components show differences in brain structure, including alterations in grey matter volume and cortical thickness across brain regions subserving reward, cognitive control and other functions, as well as in white matter integrity and volume. Children with obesity and MetS components also show some evidence for hyperresponsivity of food reward regions and hyporesponsivity of cognitive control circuits during food-related tasks, altered brain responses to food tastes, and altered resting-state connectivity including between cognitive control and reward processing networks. Potential mechanisms for these findings include neuroinflammation, impaired vascular reactivity, and effects of diet and obesity on myelination and dopamine function. Future observational research using longitudinal measures, improved sampling strategies and study designs, and rigorous statistical methods, promises to further illuminate dynamic relationships and causal mechanisms. Intervention studies targeted at modifiable biological and behavioural factors associated with paediatric obesity and MetS can further inform mechanisms, as well as test whether brain and behaviour can be altered for beneficial outcomes.

PMID:37202148 | DOI:10.1111/ijpo.13042