Category: Statistics

JAMA Netw Open. 2022 Jul 1;5(7):e2223099. doi: 10.1001/jamanetworkopen.2022.23099.

ABSTRACT

IMPORTANCE: Effective methods for engaging clinicians in continuing education for learning-based practice improvement remain unknown.

OBJECTIVE: To determine whether a smartphone-based app using spaced education with retrieval practice is an effective method to increase evidence-based practice.

DESIGN, SETTING, AND PARTICIPANTS: A prospective, unblinded, single-center, crossover randomized clinical trial was conducted at a single academic medical center from January 6 to April 24, 2020. Vanderbilt University Medical Center clinicians prescribing intravenous fluids were invited to participate in this study.

INTERVENTIONS: All clinicians received two 4-week education modules: 1 on prescribing intravenous fluids and 1 on prescribing opioid and nonopioid medications (counterbalancing measure), over a 12-week period. The order of delivery was randomized 1:1 such that 1 group received the fluid management module first, followed by the pain management module after a 4-week break, and the other group received the pain management module first, followed by the fluid management module after a 4-week break.

MAIN OUTCOMES AND MEASURES: The primary outcome was evidence-based clinician prescribing behavior concerning intravenous fluids in the inpatient setting and pain medication prescribing on discharge from the hospital.

RESULTS: A total of 354 participants were enrolled and randomized, with 177 in group 1 (fluid then pain management education) and 177 in group 2 (pain management then fluid education). During the overall study period, 16 868 questions were sent to 349 learners, with 11 783 (70.0%) being opened: 10 885 (92.4%) of those opened were answered and 7175 (65.9%) of those answered were answered correctly. The differences between groups changed significantly over time, indicated by the significant interaction between educational intervention and time (P = .002). Briefly, at baseline evidence-concordant IV fluid ordered 7.2% less frequently in group 1 than group 2 (95% CI, -19.2% to 4.9%). This was reversed after training at 4% higher (95% CI, -8.2% to 16.0%) in group 1 than group 2, a more than doubling in the odds of evidence-concordant ordering (OR, 2.56, 95% CI, 0.80-8.21). Postintervention, all gains had been reversed with less frequent ordering in group 1 than group 2 (-9.5%, 95% CI, -21.6% to 2.7%). There was no measurable change in opioid prescribing behaviors at any time point.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, use of smartphone app learning modules resulted in statistically significant short-term improvement in some prescribing behaviors. However, this effect was not sustained over the long-term. Additional research is needed to understand how to sustain improvements in care delivery as a result of continuous professional development at the institutional level.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03771482.

PMID:35881398 | DOI:10.1001/jamanetworkopen.2022.23099

Spine Deform. 2022 Jul 26. doi: 10.1007/s43390-022-00554-0. Online ahead of print.

ABSTRACT

PURPOSE: Early-onset scoliosis (EOS) is one of the most challenging areas of orthopedic management. Previous studies have reported that EOS patients were associated with high risk of complications following growth-friendly surgery. This study was performed to evaluate the complications of single traditional growing rods (TGRs) in the treatment of EOS.

METHODS: In a retrospective chart review study, medical records of all EOS patients treated with single TGRs between 2006 and 2018 were analyzed. Patients under the age of 10 at the time of surgery who had at least 24 months of follow-up were included. Intra- and post-operative complications included both device-related and disease-related complications. Statistical analysis was performed with SPSS.

RESULTS: A total of 35 patients with a mean age of 5.7 ± 2.1 years with the mean follow-up duration of 33.3 ± 9.1 months were included in the final analysis. Of the 35 participants, 27 children (77.1%) experienced at least one complication. A total of 61 complications were observed, giving rise to 1.7 complications per patient. An unplanned surgical procedure was needed to manage 42 of the 61 complications (68.8%). Thirty-five cases of implant failure, 11 cases of deep infection, and 2 cases of junctional kyphosis were identified.

CONCLUSION: It seems that even in the setting that the use of dual TGRs is not possible, the use of single TGRs as the only therapeutic modality should be minimized due to high rate of complications even as a bridge treatment.

LEVEL OF EVIDENCE: Therapeutic level III.

PMID:35881332 | DOI:10.1007/s43390-022-00554-0

Curr Microbiol. 2022 Jul 26;79(9):272. doi: 10.1007/s00284-022-02973-8.

ABSTRACT

From the very beginning of the SARS-CoV-2 pandemic, one of the very few common opinions was that to control the expansion of the virus as many as the possible test had to be done. Antigen tests, being affordable and easy and fast to use, represented a great opportunity to expand the testing capacities of many healthcare systems. However, in 2021 with the appearance of the new SARS-CoV-2 variants, variant tracking strategies had to be implemented, which often included needing a second test to determine the variant of the patients diagnosed with antigen tests or not taking these samples into consideration at all. Therefore, we proposed recovering the positive antigen test devices to include them in our routine variant tracking strategy. The recovered positive antigen test devices obtained from 1st April 2021 to 15the January 2022 were analysed following the variant tracking protocol in force. The results obtained were compared to the positive samples detected by RT-PCR which were processed for variant tracking during the same period. 21,304 samples were processed, 6297 from the recovered positive antigen devices and 15,007 from the standard nasopharyngeal swabs. Only 773 (3.63%) samples were no conclusive, 104 (1.65%) from the recovered antigen devices and 669 (4.46%) from the RT-PCR positive group. This difference was statistically significant (p < 0.01). Taking this into account the proposed method is suitable and very recommendable, as it is an important measure to have a better and immediate picture of the circulating variants in every community.

PMID:35881313 | DOI:10.1007/s00284-022-02973-8

J Relig Health. 2022 Jul 26. doi: 10.1007/s10943-022-01614-5. Online ahead of print.

ABSTRACT

By reference to a sample of 173 emerging adult seminarians in South Italy, this study evaluates the influence of attachment to one’s parents and peers on identity development and well-being in seminarians. The statistical analysis (PLS-PM) reports that secure attachment to one’s mother and secure attachment to a peer are positively associated with identity and well-being. No such association is found with attachment to one’s father. Attachment to one’s mother loses its association with identity during the shift from the freshmen to the senior group and is replaced by attachment with one’s peers. Both attachment relationships lose their associations with well-being between these groups. Our results demonstrate that attachment to one’s peers becomes the most relevant relationship, thus supporting this specific form of relationship among seminarians.

PMID:35881264 | DOI:10.1007/s10943-022-01614-5

Clin Exp Med. 2022 Jul 26. doi: 10.1007/s10238-022-00865-6. Online ahead of print.

ABSTRACT

Chronic nasal carriage of Staphylococcus aureus (S. aureus) is a risk factor for relapse of granulomatosis with polyangiitis (GPA), and genetic susceptibility to infections and autoimmune diseases is majorly affected by HLA genes. Previous studies have shown the association of HLA Class-II genes with GPA susceptibility. Here, we aim to assess immune responses of GPA patients against S. aureus antigens in relation to the HLA-DR-DQ genes polymorphism to determine the disease outcome. A total of 45 GPA patients and 128 healthy controls during 2010-2012 were included in this case-control study. HLA-DRB1/DQB1 allele typing was performed by polymerase chain reaction-sequence-specific primer (PCR-SSP) method. Immune responses against S. aureus antigens were investigated in 20 active vs. remitting GPA (after 6 months of cyclophosphamide and glucocorticoids) patients by Western blot. Statistical analysis was performed using χ² test and Fisher’s exact test. We observed a significant association of DRB1*08, DRB1*16 and DQB1*04 alleles with GPA susceptibility, whereas DRB1*15, DRB1*10 and DQB1*05 alleles were suggested as protective alleles. Among S. aureus antigens, active GPA patients’ sera reacted more strongly with 34 and 24 kDa antigens of S. aureus than remitting and healthy control sera. Furthermore, we observed that the lack of DQB1*06 allele confers complete remission even in the presence of anti-S. aureus antibodies against 24 kDa protein. Our findings suggest that the presence of DQB1*06 allele and S. aureus infection may prolong active disease. Further, our study indicates the potential of using anti-staphylococcal medications for achieving remission in patients having HLA-DQB1*06 allele.

PMID:35881260 | DOI:10.1007/s10238-022-00865-6

Arch Sex Behav. 2022 Jul 26. doi: 10.1007/s10508-022-02361-0. Online ahead of print.

ABSTRACT

Although many studies have examined reasons for sexting among young people, few have taken into account the underlying motivations associated with different reasons and how that may be associated with divergent positive or negative outcomes. This study addressed this gap by employing Self-determination Theory to assess how autonomous and controlled motivations for sexting were related to subjective well-being and relationship quality among emerging adults. Online survey data from 267 emerging adults (72 men, 195 women) ages 18-25 who had sent sexually explicit images or videos of themselves through electronic means to a committed partner were analyzed using Structural Equation Modeling. Autonomous and controlled motivations for sexting were significantly related to pleasant affect, with autonomous motivation predicting more pleasant affect and controlled motivation predicting less pleasant affect. Autonomous motivations for sexting were related to enhanced relationship quality, whereas controlled motivations for sexting were related to decreased relationship quality. Neither form of motivation had a statistically significant relationship with unpleasant affect or life satisfaction. These results demonstrate that the quality of motivations for sexting among emerging adults in committed relationships may contribute to different outcomes, particularly in terms of relationship quality. Implications for counselors, educators, and practitioners working with emerging adults who sext are discussed.

PMID:35881253 | DOI:10.1007/s10508-022-02361-0

Arch Microbiol. 2022 Jul 26;204(8):523. doi: 10.1007/s00203-022-03104-4.

ABSTRACT

The present meta-analysis provides literature data on the effect of lichen extracts and single secondary metabolites used against Fusarium spp. moulds. Lichen extracts were obtained from 51 corticolous, 17 terricolous and 18 saxicolous lichen species and 37 secondary compounds were tested against eight fungal species, i.e., Fusarium acuminatum, F. avenaceum, F. culmorum, F. fujikuroi, F. oxysporum, F. roseum, F. solani and F. udum. The researchers used several test methods, mostly to determine MIC and IZ. Extracts were obtained using several solvents, mainly organic ones with use of the Soxhlet apparatus. The most frequently tested species was F. oxysporum, against which lichen substances from Alectoria sarmentosa, Cladonia mitis, C. rangiferina, Flavoparmelia caperata, Hypotrachyna cirrhata, Leucodermia leucomelos, Parmotrema austrosinense, P. reticulatum, Physcia aipolia, Pseudevernia furfuracea, Roccella montagnei and Umbilicaria nylanderiana and secondary metabolites such as 2-hydroxy-4-methoxy-3,6-dimethylbenzoic acid, atranorin, lecanoric and (+)-usnic acids showed the highest antifungal potential. These agencies could compete with the potential of fungicides, such as flucytosine and fluconazole. Other species have been poorly investigated. Statistical analysis of literature data showed that the fungistatic potential of lichen extracts is significantly different from individual secondary metabolites. Similarly, the potential of secondary metabolites often differs significantly from that of non-lichen substances. This meta-analysis indicates the potential of lichen substances as future anti-fusarial agents.

PMID:35881248 | DOI:10.1007/s00203-022-03104-4

Pediatr Surg Int. 2022 Jul 26. doi: 10.1007/s00383-022-05180-5. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the study was to compare and evaluate the utility of three different risk stratification scores for gastroschisis neonates; simple/complex gastroschisis, gastroschisis prognostic score and risk stratification index.

METHODS: Data of neonates born with gastroschisis between the years 1993 and 2015 were collected. The national registers and patient records of four Finnish University Hospitals were retrospectively reviewed. Logistic and linear regression analysis were performed to identify independent predictors for adverse outcomes. The efficacy of these prognostic methods was further assessed using ROC-curves and DeLong (1988) test.

RESULTS: Gastroschisis risk stratification index was an acceptable predictor of in-hospital mortality, AUC 0.70, 95% CI 0.48-0.91, p = 0.049. Complex gastroschisis and gastroschisis prognostic score were able to predict short bowel syndrome, AUC 0.80, 95% CI 0.58-1.00, p = 0.012 and AUC 0.80, 95% CI 0.59-1.00, p = 0.012, respectively.

CONCLUSION: There are three easily obtainable risk stratification scores for outcome prediction in gastroschisis patients, however, their predictive ability did not have a statistical difference in the present study. The Gastroschisis risk stratification index seemed to perform moderately well in mortality prediction.

PMID:35881242 | DOI:10.1007/s00383-022-05180-5

Clin Oral Investig. 2022 Jul 26. doi: 10.1007/s00784-022-04648-x. Online ahead of print.

ABSTRACT

OBJECTIVES: As prevalence of molar-incisor hypomineralisation varies considerably in different countries and regions, the aim of this study was to obtain representative epidemiological data for schoolchildren living in the canton of Basel-Landschaft, Switzerland.

MATERIAL AND METHODS: A representative population of schoolchildren of three different age groups, i.e. 1st grade (mean age: 7.4 years), 6th grade (mean age: 12.6 years), and 9th grade (mean age: 15.7 years) visiting compulsory schools in the canton of Basel-Landschaft, Switzerland, was examined. The presence or absence of molar-incisor hypomineralisation at time of examination was recorded as well as potential influencing factors such as age group, gender, nationality, or the children’s place of residence.

RESULTS: A total of 1252 schoolchildren could be included. On average, the prevalence of MIH in the study population was 14.8%. No statistically significant differences were found for nationality, gender, or place of residence. Although not statistically significant, children from the youngest age group had the highest while children from the oldest age group had the lowest MIH prevalence.

CONCLUSION: With a mean value of 14.8%, MIH prevalence among schoolchildren living in the canton of Basel-Landschaft, Switzerland, is comparable to mean values recorded globally.

CLINICAL RELEVANCE: This study represents the first study on MIH prevalence in Switzerland and also provides further evidence on potential influencing factors.

PMID:35881241 | DOI:10.1007/s00784-022-04648-x

Clin Oral Investig. 2022 Jul 26. doi: 10.1007/s00784-022-04645-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the bond strength of four types of posts (pre-fabricated fiberglass post, fiberglass post anatomized with composite resin, milled fiberglass post, and milled polyetheretherketone (PEEK) post), and two types of resin cements (conventional and self-adhesive) by assessing immediate bond strength and post-mechanical aging at each root third.

MATERIALS AND METHODS: Bovine endodontically treated roots (16 groups, n = 8) were prepared and the posts were produced and luted; the specimens of aging groups were cycled (300,000 cycles under 50 N load at 1.2 Hz frequency); six slices of each root were obtained; push-out test was performed by using a universal testing machine (500 N load at 1 mm/min cross speed); fracture pattern was classified into five levels. The statistical analyses used were three-way ANOVA, Tukey’s test (for bond strength), and Fisher’s test (for fracture pattern) (α < 0.05).

RESULTS: Differences were found between the cements for posts (conventional: p < 0.001; self-adhesive: p = 0.002), whereas no difference was found for root region (p = 0.941; p = 0.056, respectively); analysis of each root showed significant differences for cements (p < 0.001), posts (p < 0.001), and mechanical cycling (p = 0.001); in terms of double interaction, differences were found for posts and mechanical cycling (p = 0.005); no other interactions were observed (double or triple); the fracture pattern showed difference between the groups for both cements.

CONCLUSIONS: Milled PEEK posts seem to be a good clinical option, but they require improvement of CAD-CAM technology and advances towards their adhesion.

CLINICAL RELEVANCE: Milled posts are promising and can reduce clinical time for rehabilitation of extensively destroyed teeth.

PMID:35881239 | DOI:10.1007/s00784-022-04645-0