Category: Statistics

J Am Acad Orthop Surg. 2021 Nov 18. doi: 10.5435/JAAOS-D-21-00638. Online ahead of print.

ABSTRACT

INTRODUCTION: This study compared costs, length of visit, and utilization trends for patients with fractures seen in an immediate care orthopaedic center (I-Care) versus the emergency department (ED) in a major metropolitan area.

METHODS: A retrospective chart review of consecutive patients seen on an outpatient basis in the ED and I-Care over a 6-month period was conducted. Patient demographics, procedures done, care category, estimated costs, and disposition information were included for statistical analysis. Within the low-acuity fracture care group, a cost-comparison analysis was conducted.

RESULTS: A total of 610 patients met inclusion criteria with 311 seen in I-Care and 299 in the ER. I-Care patients were more likely to have low-acuity injuries compared with ED patients (60.1% versus 18.1%, P < 0.001). The length of visit was longer for patients seen in the ED compared with I-Care (6.1 versus 1.43 hours, P value < 0.001). A cost analysis of low-acuity patients revealed that an estimated $62,150 USD could have been saved in healthcare costs by the initial diversion of low-acuity patients seen in the ER to I-Care during the study period.

DISCUSSION: These results suggest that the I-Care orthopaedic urgent care model is a more cost-effective and more efficient alternative to the ED for patients with fractures requiring procedural treatment and low-acuity patients managed on an outpatient basis.

PMID:34844258 | DOI:10.5435/JAAOS-D-21-00638

Exp Clin Endocrinol Diabetes. 2021 Nov 29. doi: 10.1055/a-1686-8738. Online ahead of print.

NO ABSTRACT

PMID:34844280 | DOI:10.1055/a-1686-8738

Ophthalmologica. 2021 Nov 29. doi: 10.1159/000521071. Online ahead of print.

ABSTRACT

INTRODUCTION: To identify the changes in vessel density (VD) of choriocapillaris (CC) and in subfoveal choroidal thickness (SFCT) and to evaluate their correlation with functional response after three monthly intravitreal injections of Ranibizumab (loading phase) in patients affected by Polypoidal Choroidal Vasculopathy (PCV).

METHODS: A total of 30 eyes of 30 PCV patients and 30 eyes of 30 healthy subjects as control group were enrolled in this prospective study. The best corrected visual acuity (BCVA) was measured at baseline and after one month from third intravitreal injections in each patient. The VD of CC was evaluated in macular area by means of Optical Coherence Tomography Angiography (OCTA). Central macular thickness (CMT) and SFCT were analyzed by Enhanced Depth Imaging (EDI)-OCT.

RESULTS: The VD of CC showed statistically lower values in PCV patients at baseline respect to after loading phase (LP) and normal eyes (p<0.001). CMT and SFCT revealed a statistically significant reduction after LP (p<0.001). Multiple regression analysis revealed a significant negative correlation between the reduced SFCT, CMT at baseline and the improvement of BCVA after LP (p<0.05).

CONCLUSION: The close relationship between the thinner SFCT and better visual outcome after LP reveals the role of the EDI-OCT assessment of choroid as predictive biomarker of functional response to anti-VEGF therapy. This tool could provide a quantitative evaluation of structural features of choroid avoiding mistakes of evaluation at OCTA.

PMID:34844252 | DOI:10.1159/000521071

Cerebrovasc Dis. 2021 Nov 29:1-8. doi: 10.1159/000520100. Online ahead of print.

ABSTRACT

INTRODUCTION: Stroke remains a major cause of death and disability in Japan and worldwide. Detecting individuals at high risk for stroke to apply preventive approaches is recommended. This study aimed to develop a stroke risk prediction model among urban Japanese using cardiovascular risk factors.

METHODS: We followed 6,641 participants aged 30-79 years with neither a history of stroke nor coronary heart disease. The Cox proportional hazard model estimated the risk of stroke incidence adjusted for potential confounders at the baseline survey. The model’s performance was assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow statistics. The internal validity of the risk model was tested using derivation and validation samples. Regression coefficients were used for score calculation.

RESULTS: During a median follow-up duration of 17.1 years, 372 participants developed stroke. A risk model including older age, current smoking, increased blood pressure, impaired fasting blood glucose and diabetes, chronic kidney disease, and atrial fibrillation predicted stroke incidence with an area under the curve = 0.76 and p value of the goodness of fit = 0.21. This risk model was shown to be internally valid (p value of the goodness of fit in the validation sample = 0.64). On a risk score from 0 to 26, the incidence of stroke for the categories 0-5, 6-7, 8-9, 10-11, 12-13, 14-15, and 16-26 was 1.1%, 2.1%, 5.4%, 8.2%, 9.0%, 13.5%, and 18.6%, respectively.

CONCLUSION: We developed a new stroke risk model for the urban general population in Japan. Further research to determine the clinical practicality of this model is required.

PMID:34844243 | DOI:10.1159/000520100

Neonatology. 2021 Nov 29:1-2. doi: 10.1159/000520243. Online ahead of print.

NO ABSTRACT

PMID:34844246 | DOI:10.1159/000520243

Animal. 2021 Nov 26;15(12):100413. doi: 10.1016/j.animal.2021.100413. Online ahead of print.

ABSTRACT

This study evaluates if biomarkers of porcine health status in saliva samples is a mere reflection of serum to detect disease in pigs under field conditions. Four farms from the same commercial company were included to obtain samples from animals with different pathological conditions. A total of 10 healthy animals and 10-15 animals from each farm with clinical symptoms of the disease were sampled for paired saliva and blood during a veterinary clinical visit. The biomarker panel included acute-phase proteins (APPs), C-reactive protein (CRP), haptoglobin (Hp), an inflammatory marker, adenosine deaminase (ADA), the total antioxidant capacity (TAC), the levels of essential trace elements, copper (Cu) and zinc (Zn), and the measurement of the total protein content (TP). After detailed statistical analysis, the results showed that saliva could replace serum for APP measurements since a good agreement has been observed between the concentrations of APPs in both body fluids. For any other biomarker, no agreement between the concentrations quantified in serum and saliva samples was observed visually. However, salivary ADA and TP concentrations were statistically significantly higher in the diseased, whereas the statistical tests with serum concentrations were inconclusive. Furthermore, greater differentiation between healthy and diseased animals could be observed when the distribution of biomarkers was analysed in saliva than in other serum samples. The diagnostic power to discriminate between healthy and diseased pigs is similar in saliva and in serum samples. Preliminary regression models may offer an optimal combination of biomarkers for disease detection in saliva (Hp, CRP, and TAC) and serum (Hp, CRP, and Cu), which demands less labour, sample, and financial cost for saliva determinations. The contradictory results observed for TAC, Cu, and Zn levels between body fluids indicate a need for further studies. To sum up, saliva-based biomarkers instead of serum-based biomarkers could contribute to more efficient detection of diseased animals.

PMID:34844190 | DOI:10.1016/j.animal.2021.100413

Gerontology. 2021 Nov 29:1-9. doi: 10.1159/000520081. Online ahead of print.

ABSTRACT

BACKGROUND: Early identification of risk factors for cognition decline may contribute to the interventions for Alzheimer’s disease. Obesity is a common modifiable risk factor for chronic diseases. The association between obesity and cognition in older adults is limited, and sex differences in this area have not been well recognized.

OBJECTIVE: The aim of the study was to observe the sex differences in the relationship between obesity and cognition in a rural community-dwelling older population of Guizhou, China.

METHODS: Data were gathered from the baseline survey of a cohort study of older people in rural areas of Guizhou, China. Demographic and behavioral data (sex, age, education, household income, smoking history, drinking history, history of head injury, diet, and level of physical exercise time) were collected. The Mini-Mental State Examination (MMSE) was used to assess cognitive function. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) were used as different measures of obesity. Comparisons between the groups were made by the Wilcoxon rank-sum test or Kruskal-Wallis H test. Restricted cubic spline regression was used to examine a dose-response relationship between obesity indicators and cognitive function. Linear relationships were performed by the multivariable linear regression model.

RESULTS: A total of 1,654 participants including 964 women and 690 men were enrolled in this study. After adjustment, BMI showed a nonlinear relationship with MMSE scores in women. There was a significant trend toward increasing MMSE scores at the low end of BMI (13.52-20.10 kg/m2, p = 0.014). The multivariable linear regression model showed that MMSE increased by 0.631 (p < 0.001) for every one standard deviation increase in HC in women. No association was found between obesity parameters and cognitive function in men.

CONCLUSION: Our results suggest that there are significant sex differences in some obesity parameters and cognition in an older Chinese population. BMI and HC are positively associated with cognitive function in women. No association was found between obesity measures and cognitive function in men.

PMID:34844240 | DOI:10.1159/000520081

Asian J Psychiatr. 2021 Nov 24;67:102939. doi: 10.1016/j.ajp.2021.102939. Online ahead of print.

ABSTRACT

AIM: To study the association of clozapine pharmacometabolomics and clozapine response in Asian patients with treatment-resistant schizophrenia (TRS).

METHOD: A cross-sectional study was performed on 50 consecutive TRS patients following up in psychiatry department of the tertiary care hospital. Demographic details, response assessment, were collected on the case record form. A blood sample was also collected for trough concentration assessment of drug and its metabolites. Clozapine (CLZ) the parent drug and its two major metabolites – Clozapine N oxide (CNO) and N-Desmethyl clozapine (N-DSMC) levels were assessed using a high-performance liquid chromatography method. Clozapine responders and nonresponders patients were classified based upon Andreasen criteria.

RESULTS: The average trough concentration of CNO, N-DSMC, and CLZ were 123 ± 76.04, 171.93 ± 93.24, 229.27 ± 124.25 ng/ml, respectively. The two patient subgroups did not differ for CLZ, CNO, and N-DSMC concentrations statistically. However, clozapine nonresponse was associated with a higher CLZ/N-DSMC ratio (p = 0.03) and clozapine dose (p = 0.01). The receiver operator characteristic curve showed that the cut-off CLZ/N-DSMC ratio of 1.54 with a sensitivity of 85% and a positive predictive value of 84% for identifying nonresponders.

CONCLUSION: CLZ/N-DSMC ratio and clozapine dose were identified as significant variables for future dose optimization algorithms. Pharmacometabolomics-guided clozapine therapy has the potential to revolutionize TRS management.

PMID:34844176 | DOI:10.1016/j.ajp.2021.102939

Animal. 2021 Nov 26;15(12):100397. doi: 10.1016/j.animal.2021.100397. Online ahead of print.

ABSTRACT

Bovine respiratory disease is the leading user of antibiotics (AB) in calf production. Mycoplasma (M.) bovis could lead to greater use of AB as it is a persistent and AB resistant causative agent for respiratory diseases. Two cross-sectional studies were set up to assess the effects of lot size and feeding system on M. bovis infection and the effects of M. bovis seroconversion, lot size and feeding system on AB use in calves’ feedlots. Twenty-six lots in 22 fattening farms were monitored for 41-81 days, from all-in entry of calves until three consecutive weeks without using any collective antibiotics. M. bovis spread was estimated by measuring seroconversion at entry and at the end of study period in 10-15 calves randomly sampled in each lot. All AB treatments used in the meanwhile were recorded. The lots were selected according to feeding system, i.e. individual bucket (n = 7) vs. automated milk feeder (AMF, n = 19), and lot size (30-519 calves), less than 50 calves (n = 9) vs. more than 50 calves (n = 17). Statistical analysis was performed using multivariable generalised linear models with fattening farms as random effect. M. bovis spread increased with lot size (odds ratio (OR) 2.9[1.4; 5.8] per two-fold increase in lot size). This proportion of seroconverted calves was lower in bucket-fed lots compared to lots fed with the AMF using a shared nipple (OR = 0.03[0.003; 0.41]). The main risk factor for AB use was the lot size, with an increase of 1.5[0.94; 1.98] treatments per two-fold increase in lot size. For same size lots, the use of bucket can decrease AB consumption by up to 1.03[-2.18; 0.14] treatments per calf compared to AMF. Analysis of the association between seroconversion to M. bovis and AB use was inconclusive. We found that bucket feeding in small-size lots, i.e. up to a maximum of 50 calves in the same space, limits seroconversion to M. bovis and enables lower use of AB in veal calf production.

PMID:34844188 | DOI:10.1016/j.animal.2021.100397

Eur Neuropsychopharmacol. 2021 Nov 26;55:86-95. doi: 10.1016/j.euroneuro.2021.11.005. Online ahead of print.

ABSTRACT

About two-thirds of patients with major depressive disorder (MDD) fail to achieve symptom remission after the initial antidepressant treatment. Despite a role of genetic factors was proven, the specific underpinnings are not fully understood yet. Polygenic risk scores (PRSs), which summarise the additive effect of multiple risk variants across the genome, might provide insights into the underlying genetics. This study aims to investigate the possible association of PRSs for bipolar disorder, MDD, neuroticism, and schizophrenia (SCZ) with antidepressant non-response or non-remission in patients with MDD. PRSs were calculated at eight genome-wide P-thresholds based on publicly available summary statistics of the largest genome-wide association studies. Logistic regressions were performed between PRSs and non-response or non-remission in six European clinical samples, adjusting for age, sex, baseline symptom severity, recruitment sites, and population stratification. Results were meta-analysed across samples, including up to 3,637 individuals. Bonferroni correction was applied. In the meta-analysis, no result was significant after Bonferroni correction. The top result was found for MDD-PRS and non-remission (p = 0.004), with patients in the highest vs. lowest PRS quintile being more likely not to achieve remission (OR=1.5, 95% CI=1.11-1.98, p = 0.007). Nominal associations were also found between MDD-PRS and non-response (p = 0.013), as well as between SCZ-PRS and non-remission (p = 0.035). Although PRSs are still not able to predict non-response or non-remission, our results are in line with previous works; methodological improvements in PRSs calculation may improve their predictive performance and have a meaningful role in precision psychiatry.

PMID:34844152 | DOI:10.1016/j.euroneuro.2021.11.005