Category: Statistics

Spine (Phila Pa 1976). 2022 Sep 30. doi: 10.1097/BRS.0000000000004489. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort.

OBJECTIVE: To quantify any reduction in venous thromboembolic events (VTE) caused by chemoprophylaxis among lumbar surgery patients.

SUMMARY OF BACKGROUND DATA: Chemoprophylactic anticoagulation (chemoprophylaxis) is used to prevent VTE after lumbar surgery. However, the treatment effect of chemoprophylaxis has not been reported among spine surgery patients, as conventional statistical methods preclude such inferences.

METHODS: 1243 consecutive lumbar fusions and 1433 non-instrumented lumbar decompressions performed at our institution over a six-year period were identified, and clinical and demographic data were collected, including on VTE events within 30 days postoperatively. Instrumented lumbar fusions and non-instrumented lumbar surgeries were analyzed separately. Patients who were given chemoprophylaxis (treatment) and controls were matched according to known VTE risk factors, including age, body mass index, sex, diabetes, chronic kidney disease, history of VTE, estimated blood loss, length of surgery, transfusion, whether surgery was staged, and whether surgery used an anterior approach. K-nearest neighbor propensity score matching was performed, and the treatment effect of chemoprophylaxis was calculated.

RESULTS: Unadjusted, there was no difference in the rate of VTE between treatment and controls in either population. Baseline clinical and demographic characteristics differed significantly between treatment and control groups. 575 lumbar fusion patients and 435 non-instrumented lumbar decompression patients were successfully propensity score matched, yielding balanced models (Rubin’s B<25, 0.5<Rubin’s R<2.0) and >60% reduction in known bias for both populations. The treatment effect of chemoprophylaxis after lumbar fusion in our patient population was a reduction in VTE incidence from 9.4% to 4.2% (P<0.05), and propensity score adjusted regression confirmed a reduced odds of VTE with chemoprophylaxis (OR=0.37, P=0.035). The treatment effect was not significant for non-instrumented lumbar decompression patients.

CONCLUSION: Among patients undergoing instrumented lumbar fusions, chemoprophylactic anticoagulation causes a significant reduction in VTE, but causes no significant reduction among patients undergoing non-instrumented lumbar decompression.

PMID:36191060 | DOI:10.1097/BRS.0000000000004489

J Am Assoc Nurse Pract. 2022 Oct 1;34(10):1133-1138. doi: 10.1097/JXX.0000000000000775.

ABSTRACT

BACKGROUND: Anterior capsular contraction syndrome (ACCS) describes the progressive fibrotic phimosis of the anterior capsular bag that usually occurs a few months after cataract surgery. YAG laser anterior capsulotomy (YAGAC) is the most common treatment option due to the low-risk profile of this intervention.

PURPOSE: In this series, we evaluated the outcomes of an advanced nurse practitioner (ANP) in conducting this laser intervention, comparing the results with those of ophthalmologists.

METHODOLOGY: Our study represents a single-centre, retrospective, continuous case series of 108 eyes that underwent YAGAC due to ACCS between January 2017 and July 2020 at the Birmingham and Midland Eye Centre, the second largest tertiary referral centre in the United Kingdom.

RESULTS: The groups treated by ANPs and ophthalmologists were similar in respect to age, gender, and laterality of the laser procedure. Eyes treated by ophthalmologists had significantly more ocular comorbidities (p < .001), the most common of which was glaucoma. Although the complication rate was higher in the ophthalmologist group, it did not reach statistical significance. However, there was a trend toward significance in the retreatment rate, with 8.6% (7/81) of eyes lasered by ophthalmologists requiring further YAGAC, and no repeat procedure was needed in the ANP group.

CONCLUSIONS: YAGAC leads to good visual outcomes and a low complication rate in both ophthalmologist and ANP groups.

IMPLICATIONS: Advanced nurse practitioners can deliver results that are comparable with those of experienced ophthalmologists.

PMID:36191073 | DOI:10.1097/JXX.0000000000000775

Spine (Phila Pa 1976). 2022 Oct 3. doi: 10.1097/BRS.0000000000004499. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective study.

OBJECTIVE: The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center.

SUMMARY OF BACKGROUND DATA: Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well established.

METHODS: We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes and risk factors.

RESULTS: A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation (P<0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery (P=0.010), thoracic kyphosis ≥45° (P=0.039), and intraoperative dural injury (P=0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS.

CONCLUSION: The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine durgery, thoracic kyphosis≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS.

LEVEL OF EVIDENCE: 4.

PMID:36191058 | DOI:10.1097/BRS.0000000000004499

PLoS Comput Biol. 2022 Oct 3;18(10):e1010577. doi: 10.1371/journal.pcbi.1010577. Online ahead of print.

ABSTRACT

Consensus clustering has been widely used in bioinformatics and other applications to improve the accuracy, stability and reliability of clustering results. This approach ensembles cluster co-occurrences from multiple clustering runs on subsampled observations. For application to large-scale bioinformatics data, such as to discover cell types from single-cell sequencing data, for example, consensus clustering has two significant drawbacks: (i) computational inefficiency due to repeatedly applying clustering algorithms, and (ii) lack of interpretability into the important features for differentiating clusters. In this paper, we address these two challenges by developing IMPACC: Interpretable MiniPatch Adaptive Consensus Clustering. Our approach adopts three major innovations. We ensemble cluster co-occurrences from tiny subsets of both observations and features, termed minipatches, thus dramatically reducing computation time. Additionally, we develop adaptive sampling schemes for observations, which result in both improved reliability and computational savings, as well as adaptive sampling schemes of features, which lead to interpretable solutions by quickly learning the most relevant features that differentiate clusters. We study our approach on synthetic data and a variety of real large-scale bioinformatics data sets; results show that our approach not only yields more accurate and interpretable cluster solutions, but it also substantially improves computational efficiency compared to standard consensus clustering approaches.

PMID:36191044 | DOI:10.1371/journal.pcbi.1010577

J Correct Health Care. 2022 Sep 28. doi: 10.1089/jchc.21.02.0018. Online ahead of print.

ABSTRACT

Data from the Bureau of Justice Statistics occasional jail inmate and state prisoner surveys reveal that behavioral health issues-mental health and substance use disorders-are consistently the most prevalent health issues among criminal justice-involved (CJ-I) persons. Although these surveys provide a national-level perspective, they do not provide a true public health surveillance approach to determining the prevalence and types of behavioral health issues that burden the populations who pass through the criminal justice process. The fact that there are no “reportable” behavioral health conditions is cited as a factor in the lack of agreement on what constitutes the case definition of behavioral health disorders. This article takes an organizational systems perspective to provide a “flow” analysis of CJ-I individuals and the organizational entities involved at each step of the criminal justice system decision-making process. Issues associated with questions of “screening,” “assessment,” and “diagnosis” and how such information is potentially stored and reported to a centralized surveillance agency are explored. Informatics and standardization and the role of accrediting bodies in the development of behavioral health surveillance data are canvassed. A series of “first steps” in the development of a state- and national-level behavioral health surveillance system for CJ-I populations is provided.

PMID:36191038 | DOI:10.1089/jchc.21.02.0018

JMIR Diabetes. 2022 Oct 3;7(4):e40377. doi: 10.2196/40377.

ABSTRACT

BACKGROUND: Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A_1c (HbA_1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease.

OBJECTIVE: This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM.

METHODS: The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA_1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA_1c≤7.5% with a ≥0.5% reduction in HbA_1c at week 24.

RESULTS: Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA_1c≤7.5% (64% vs 24%; P=.02) or HbA_1c≤8% (85% vs 53%; P=.02). The mean HbA_1c was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed.

CONCLUSIONS: The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.

PMID:36190763 | DOI:10.2196/40377

Psychol Rev. 2022 Oct 3. doi: 10.1037/rev0000379. Online ahead of print.

ABSTRACT

In real-world scene perception, human observers generate sequences of fixations to move image patches into the high-acuity center of the visual field. Models of visual attention developed over the last 25 years aim to predict two-dimensional probabilities of gaze positions for a given image via saliency maps. Recently, progress has been made on models for the generation of scan paths under the constraints of saliency as well as attentional and oculomotor restrictions. Experimental research demonstrated that task constraints can have a strong impact on viewing behavior. Here, we propose a scan-path model for both fixation positions and fixation durations, which include influences of task instructions and interindividual differences. Based on an eye-movement experiment with four different task conditions, we estimated model parameters for each individual observer and task condition using a fully Bayesian dynamical modeling framework using a joint spatial-temporal likelihood approach with sequential estimation. Resulting parameter values demonstrate that model properties such as the attentional span are adjusted to task requirements. Posterior predictive checks indicate that our dynamical model can reproduce task differences in scan-path statistics across individual observers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36190753 | DOI:10.1037/rev0000379

JAMA Netw Open. 2022 Oct 3;5(10):e2234215. doi: 10.1001/jamanetworkopen.2022.34215.

ABSTRACT

IMPORTANCE: Patients with stroke due to nontraumatic (spontaneous) intracerebral hemorrhage (ICH) often harbor vascular risk factors and comorbidities, but it is unclear which major adverse cardiovascular events (MACEs) occur more frequently among patients with a prior ICH than the general population.

OBJECTIVE: To evaluate the risk of a MACE for patients with a prior ICH compared with the general population.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study identified 8991 patients with a first ICH in the Danish Stroke Registry from January 1, 2005, to June 30, 2018, who were aged 45 years or older and survived more than 30 days after an ICH. Patients in this ICH cohort were matched 1:40 on age, sex, and ICH-onset date with a comparison cohort of 359 185 individuals from the general population without a prior ICH. Both cohorts were followed up for 6 months or more until December 31, 2018, for outcomes using registry data. Data were analyzed from October 1, 2021, to July 19, 2022.

EXPOSURES: Intracerebral hemorrhage identified by a nationwide clinical database.

MAIN OUTCOMES AND MEASURES: The main outcomes were ICH, ischemic stroke, myocardial infarction, and a composite of MACEs. For each outcome, a case-control study nested within the cohorts was also performed, adjusting for time-varying exposures and potential confounders. Crude absolute event rates per 100 person-years, adjusted hazard ratios (aHRs) and 95% CIs and, in the nested case-control analyses, crude and adjusted odds ratios and 95% CIs were calculated.

RESULTS: The ICH cohort (n = 8991; 4814 men [53.5%]; mean [SD] age, 70.7 [11.5] years) had higher event rates than the comparison cohort (n = 359 185; 192 256 men [53.5%]; mean [SD] age, 70.7 [11.5] years) for MACEs (4.16 [95% CI, 3.96-4.37] per 100 person-years vs 1.35 [95% CI, 1.33-1.36] per 100 person-years; aHR, 3.13 [95% CI, 2.97-3.30]), ischemic stroke (1.52 [95% CI, 1.40-1.65] per 100 person-years vs 0.56 [95% CI, 0.55-0.57] per 100 person-years; aHR, 2.64 [95% CI, 2.43-2.88]), and ICH (1.44 [95% CI, 1.32-1.56] per 100 person-years vs 0.06 [95% CI, 0.06-0.07] per 100 person-years; aHR, 23.49 [95% CI, 21.12-26.13]) but not myocardial infarction (0.52 [95% CI, 0.45-0.60] per 100 person-years vs 0.48 [95% CI, 0.47-0.49] per 100 person-years; aHR, 1.12 [95% CI, 0.97-1.29]). Nested case-control analyses returned risk estimates of similar magnitude as the cohort analyses.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that Danish patients with a prior ICH had statistically significantly higher rates of MACEs than the general population, indicating a need for attention to optimal secondary prevention with blood pressure lowering and antithrombotic and statin therapies after an ICH in clinical research and practice.

PMID:36190733 | DOI:10.1001/jamanetworkopen.2022.34215

JAMA Netw Open. 2022 Oct 3;5(10):e2234269. doi: 10.1001/jamanetworkopen.2022.34269.

ABSTRACT

IMPORTANCE: Acute appendicitis is a common cause of abdominal pain and the most common reason for emergency surgery in several countries. Increased cases during summer months have been reported.

OBJECTIVE: To investigate the incidence of acute appendicitis by considering local temperature patterns in geographic regions with different climate over several years.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used insurance claims data from the MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database from January 1, 2001, to December 31, 2017. The cohort included individuals at risk for appendicitis who were enrolled in US insurance plans that contribute data to the MarketScan databases. Cases of appendicitis in the inpatient, outpatient, and emergency department settings were identified using International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. Local weather data were obtained for individuals living in a metropolitan statistical area (MSA) from the Integrated Surface Database. Associations were characterized using a fixed-effects generalized linear model based on a negative binomial distribution. The model was adjusted for age, sex, and day of week and included fixed effects for year and MSA. The generalized linear model was fit with a piecewise linear model by searching each 0.56 °C in temperature for change points. To further isolate the role of temperature, observed temperature was replaced with the expected temperature and the deviation of the observed temperature from the expected temperature for a given city on a given day of year. Data were analyzed from October 1, 2021, to July 31, 2022.

MAIN OUTCOMES AND MEASURES: The primary outcome was the daily number of appendicitis cases in a given city stratified by age and sex, with mean temperature in the MSA over the previous 7 days as the independent variable.

RESULTS: A total of 450 723 744 person-years at risk and 689 917 patients with appendicitis (mean [SD] age, 35 [18] years; 347 473 male [50.4%] individuals) were included. Every 5.56 °C increase in temperature was associated with a 1.3% increase in the incidence of appendicitis (incidence rate ratio [IRR], 1.01; 95% CI, 1.01-1.02) when temperatures were 10.56 °C or lower and a 2.9% increase in incidence (IRR, 1.03; 95% CI, 1.03-1.03) for temperatures higher than 10.56 °C. In terms of temperature deviations, a higher-than-expected temperature increase greater than 5.56 °C was associated with a 3.3% (95% CI, 1.0%-5.7%) increase in the incidence of appendicitis compared with days with near-0 deviations.

CONCLUSIONS AND RELEVANCE: Results of this cohort study observed seasonality in the incidence of appendicitis and found an association between increased incidence and warmer weather. These results could help elucidate the mechanism of appendicitis.

PMID:36190731 | DOI:10.1001/jamanetworkopen.2022.34269