Category: Statistics

J Coll Physicians Surg Pak. 2022 Aug;32(8):996-1003. doi: 10.29271/jcpsp.2022.08.996.

ABSTRACT

OBJECTIVE: To evaluate the prognostic significance of the new index designed by formulating neutrophil, lymphocyte, and platelet counts in patients with metastatic disease receiving immune checkpoint inhibitors (ICI) and its effect on the immune-related adverse events (irAEs).

STUDY DESIGN: Cohort study.

PLACE AND DURATION OF STUDY: Department of Medical Oncology, University of Manisa Celal Bayar, University of Aydin Adnan Menderes, and University of Ege, and Izmir Kent Hospital, Turkey, from January 2016 to April 2020.

METHODOLOGY: Patients with metastatic disease receiving ICI sufficient follow-up data were included. Patients, who had received treatment for a minimum of 3 months, were evaluated for the response. Systemic immune-inflammation index (SII) was calculated as neutrophil (/L) × (lymphocyte (/L) / platelet (/L). The cut-off value was determined by examining the area under the receiver operating characteristic (ROC) curve for the SII value. The endpoints of this study included overall survival (OS) and progression-free survival (PFS).

RESULTS: A total of 168, patients who received ICI in the metastatic stage, were evaluated. The OS of the patients with low SII scores was 110.8 months (95% CI, 88.2-133.5), while patients with high SII scores were 36.0 months (95% CI, 28.4-43.6) and reached statistical significance (p <0.001). The results of univariate (HR=3.376, 95% CI, 1.986-5.739, p<0.001 and multivariate (HR=2.792, 95% CI, 1.495-5.215, p=0.011) analyses were statistically significant as well.

CONCLUSION: The SII score in patients with metastatic disease receiving ICI was closely related to the prognosis. Patients with a high SII score are associated with a worse prognosis, these patients develop fewer irAEs.

KEY WORDS: Systemic immune inflammation index, Overall survival, Progression-free survival, İmmune checkpoint inhibitor, Pembrolizumab, Nivolumab.

PMID:35932122 | DOI:10.29271/jcpsp.2022.08.996

J Coll Physicians Surg Pak. 2022 Aug;32(8):1004-1008. doi: 10.29271/jcpsp.2022.08.1004.

ABSTRACT

OBJECTIVE: To evaluate several lymphocyte subtypes with various parameters that can be applied easily and give fast results for their roles in evaluating the stage and prognosis of acute biliary pancreatitis.

STUDY DESIGN: Case-control study.

PLACE AND DURATION OF STUDY: The Emergency Department of Istanbul Training and Research Hospital, and Gaziosmanpasa Research and Training Hospital, Turkey, between June 2020 and April 2021.

METHODOLOGY: Patients, who admitted to the Emergency Department with acute pancreatitis and treated after hospitalisation, were included in the study. The patients were divided into three groups; mild, moderately severe and severe, according to the 2012 revised Atlanta classification. Hematocrit, creatinine, potassium, sodium values, and flow cytometry ratios of lymphocyte, monocyte, CD4+, CD8+, and regulatory T cells were measured and the difference between the groups were evaluated. Their results were compared with healthy volunteers.

RESULTS: A total of 53 persons including 40 with acute pancreatitis (14 mild, 14 moderately severe, and 12 in the severe pancreatitis groups) and 13 healthy volunteers, were included in the study. The average age of the studied participants was 50.9 ±13.42 years, 43.3% males and 56.7% females. Leukocyte values, lymphocyte rates, hematocrit rates, age, hospital staying duration, creatinine, potassium values, CD4+, and CD3+ lymphocyte rates were found to be different at a statistically significant level between the groups.

CONCLUSION: High leukocyte, low lymphocyte, high hematocrit, advanced age, elevated creatinine, elevated potassium, low CD4+ T lymphocyte, low CD3+ T lymphocyte, and low lymphocyte/monocyte ratio were identified as poor prognostic indicators.

KEY WORDS: Acute pancreatitis, Flow cytometry, Regulatory T cell, Atlanta.

PMID:35932123 | DOI:10.29271/jcpsp.2022.08.1004

J Coll Physicians Surg Pak. 2022 Aug;32(8):991-995. doi: 10.29271/jcpsp.2022.08.991.

ABSTRACT

OBJECTIVE: To evaluate the anatomy of the extrahepatic bile duct and to reveal its importance in the formation of acute calculous cholecystitis (ACC).

STUDY DESIGN: Case-control study.

PLACE AND DURATION OF STUDY: Department of General Surgery and Radiology, Kanuni Sultan Suleyman Training and Research Hospital of the University of Health Sciences, Turkey, between January 2016 and December 2021.

METHODOLOGY: The data of the patients treated with ACC were analysed on MRCP by an experienced radiologist. The patients were divided into two groups; asymptomatic gallstones (AsGS, control group) and ACC. The cystic duct, common hepatic duct, and common bile duct lengths and variations in cystic duct opening were measured. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value and compared categorical results of the two groups by Mann-Whitney U test.

RESULTS: One-hundred and seventy-three patients were analysed, one-hundred and seven were females, and 66 were males. The median age was 46 years in the AsGS group and 53 years in the ACC group. It was statistically significant that ACC had a higher median age value than AsGS (p=0.014). In the analysis of extrahepatic variations, cystic duct, common hepatic duct, and common bile duct length, were statistically longer in the calculous cholecystitis group (p<0.001, p=0.022, and p=0.019 respectively). ROC analysis was performed for cystic, common hepatic, and common bile duct length, respectively. Cut-off values ​​were 30.5 mm, 36.5 mm, and 42.5 mm.

CONCLUSION: Extrahepatic bile duct variations are of critical importance in ACC surgery. In the data, as the cystic duct and common bile duct lengthens, the possibility of ACC increases. There is need for studies with larger samples.

KEY WORDS: Acute calculous cholecystitis, Extrahepatic biliary tract, Anatomical variations, Cholelithiasis.

PMID:35932121 | DOI:10.29271/jcpsp.2022.08.991

J Coll Physicians Surg Pak. 2022 Aug;32(8):980-986. doi: 10.29271/jcpsp.2022.08.980.

ABSTRACT

OBJECTIVE: To compare conventional fluid management (CFM) with pleth variability index (PVI) guided goal-directed fluid management (GDFM) during elective total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO) operations.

STUDY DESIGN: Randomised controlled trial.

PLACE AND DURATION OF STUDY: Department of Anaesthesiology and Reanimation, Faculty of Medicine, Health Sciences University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey, from February to July 2021.

METHODOLOGY: This trial included 78 patients aged 18-65 years with ASA I-III who would undergo elective TAH-BSO under general anaesthesia. Following randomisation with the closed envelope method, standard monitoring, and 250 ml crystalloid infusion during anaesthesia induction, maintenance fluid therapy was administered at 8-10 ml/Kg/hour to the control group and 2-3 ml/Kg/hour to the PVI group. If the mean arterial pressure (MAP) was ≤65 mmHg and/or the MAP was decreased by more than 20%, and the PVI was >13%, a 250 ml colloid bolus was given. When there was no response, a vasoactive agent was administered. Vital signs, laboratory findings, and postoperative complications were evaluated.

RESULTS: Age, weight, BMI, urine output, bleeding, hospital stay, comorbidities, intraoperative use of blood products, and complication rates were not significantly different between the PVI and CFM groups (p>0.05). The PVI group had shorter operational times and used less crystalloid than the control group (p=0.033 and p<0.001, respectively). The PVI group’s postoperative base excess (BE) levels changed significantly less than the control group’s (p<0.001). In both pre- and postoperative haemoglobin, haematocrit, urea, creatinine, electrolytes, and lactate measurements, there were no statistically significant differences between the groups (p>0.05).

CONCLUSION: PVI-GDFM is equally safe as CFM for intraoperative fluid management during elective complete abdominal hysterectomy and bilateral salpingo-oophorectomy procedures.

KEY WORDS: Pleth variability index, Fluid management, Base excess.

PMID:35932119 | DOI:10.29271/jcpsp.2022.08.980

J Coll Physicians Surg Pak. 2022 Aug;32(8):969-974. doi: 10.29271/jcpsp.2022.08.969.

ABSTRACT

OBJECTIVE: To compare the postoperative graft patency rates of patients who had undergone coronary endarterectomies (CE) during coronary bypass surgery to those of patients who had not had CE, based on postoperative coronary angiography.

STUDY DESIGN: Comparative descriptive study.

PLACE AND DURATION OF STUDY: Coronary Angiography Unit, Tınaztepe University Faculty of Medicine, Turkey, from November 2010 through June 2021.

METHODOLOGY: Patients who had undergone CE during coronary bypass surgery were included. Postoperative morbidity results and the patency rates of the vessels with and without endarterectomy were evaluated via coronary angiographies that had been performed.

RESULTS: The patency rate in vessels that underwent coronary endarterectomy was determined to be 73.4% according to coronary angiographies performed after an average of 47.7 months. The patency rate in vessels without endarterectomy was 63.7%. The highest patency rate was found in the left anterior descending artery (LAD) in both CE and conventional bypass coronary arteries and the lowest patency rate was found in the diagonal artery (D) in both CE and conventional bypass coronary arteries. In the comparison of vessels with and without CE, the patency rate was found to be 66.6% in patients with CE on the right coronary artery (RCA) and 45.7% in patients without CE on the right coronary artery and the difference was statistically significant (p<0.037).

CONCLUSION: Coronary endarterectomy should be used when it is believed that a simple anastomosis would not provide adequate patency during coronary bypass surgery because the primary goal should be to achieve full revascularization and a long-term patency rate.

KEY WORDS: Coronary angiography, Coronary bypass grafting, Endarterectomy, Patency rate.

PMID:35932117 | DOI:10.29271/jcpsp.2022.08.969

Neurorehabil Neural Repair. 2022 Aug 5:15459683221115413. doi: 10.1177/15459683221115413. Online ahead of print.

ABSTRACT

While many areas of medicine have benefited from the development of objective assessment tools and biomarkers, there have been comparatively few improvements in techniques used to assess brain function and dysfunction. Brain functions such as perception, cognition, and motor control are commonly measured using criteria-based, ordinal scales which can be coarse, have floor/ceiling effects, and often lack the precision to detect change. There is growing recognition that kinematic and kinetic-based measures are needed to quantify impairments following neurological injury such as stroke, in particular for clinical research and clinical trials. This paper will first consider the challenges with using criteria-based ordinal scales to quantify impairment and recovery. We then describe how kinematic-based measures can overcome many of these challenges and highlight a statistical approach to quantify kinematic measures of behavior based on performance of neurologically healthy individuals. We illustrate this approach with a visually-guided reaching task to highlight measures of impairment for individuals following stroke. Finally, there has been considerable controversy about the calculation of motor recovery following stroke. Here, we highlight how our statistical-based approach can provide an effective estimate of impairment and recovery.

PMID:35932111 | DOI:10.1177/15459683221115413

J Am Psychiatr Nurses Assoc. 2022 Aug 5:10783903221115741. doi: 10.1177/10783903221115741. Online ahead of print.

ABSTRACT

INTRODUCTION: Affecting more than 3.9 million Americans, the hepatitis C virus (HCV) attacks the liver by causing inflammation. Left untreated, HCV can lead to serious consequences. Targeting high-risk individuals in the inpatient psychiatric setting can lead to increased testing and referral.

AIMS: This quality improvement project determined whether an intervention-consisting of a pretest, educational session, posttest, and screening implementation-increased staff knowledge about HCV screening recommendations, identified at-risk individuals, and increased the number of patients screened and referred for treatment.

METHOD: An online HCV educational session was provided to 30 staff at a Midwest regional psychiatric unit. An online pre/posttest was conducted to determine staff knowledge and understanding prior to and after the educational session. An HCV screening tool checklist was incorporated into the electronic health record (EHR) system. A 3-month pre/post-intervention chart review was completed to determine the number of patients identified and screened for HCV.

RESULTS: A comparison of the 30 staff members’ mean pre/posttest scores were calculated using an unpaired t test, showing a prescore mean of 55.15 ± 19.09 and a postscore mean of 85.75 ± 13.44, p < .001. A chi-square analysis indicated that there was a statistically significant post-intervention increase in the percentage of high-risk patients identified (5.6%-36.4%, p < .001) and screened (5.6%-31.4%, p < .001) for HCV compared with pre-intervention.

CONCLUSION: The study intervention increased staff knowledge of HCV guidelines and the number of at-risk patients identified and screened for the disease.

PMID:35932102 | DOI:10.1177/10783903221115741

BMC Health Serv Res. 2022 Aug 5;22(1):1000. doi: 10.1186/s12913-022-08313-7.

ABSTRACT

BACKGROUND: In hospitals, catheter acquired urinary tract infection causes significant resource waste and discomfort among admitted patients. An intervention for reducing indwelling catheterisations – No-CAUTI – was trialled across four hospitals in New South Wales, Australia. No-CAUTI includes: train-the-trainer workshops, site champions, compliance audits, and point prevalence surveys. The trial showed reductions on usual care catheterisation rates at 4- and 9-month post-intervention. This result was statistically non-significant; and post-intervention catheterisation rates rebounded between 4 and 9 months. However, No-CAUTI showed statistically significant catheterisation decreases for medical wards, female patients and for short-term catheterisations. This study presents a budget impact analysis of a projected five year No-CAUTI roll out across New South Wales public hospitals, from the cost perspective of the New South Wales Ministry of Health.

METHODS: Budget forecasts were made for five year roll outs of: i) No-CAUTI; and ii) usual care, among all public hospitals in New South Wales hosting overnight stays (n=180). The roll out design maintains intervention effectiveness with ongoing workshops, quality audits, and hospital surveys. Forecasts of catheterisations, procedures and treatments were modelled on No-CAUTI trial observations. Costs were sourced from trial records, the Medical Benefits Scheme, the Pharmaceutical Benefits Scheme and public wage awards. Cost and parameter uncertainties were considered with sensitivity scenarios.

RESULTS: The estimated five-year No-CAUTI roll-out cost was $1.5 million. It had an overall budget saving of $640,000 due to reductions of 100,100 catheterisations, 33,300 urine tests and 6,700 antibiotics administrations. Non-Metropolitan hospitals had a net saving of $1.2 million, while Metropolitan hospitals had a net cost of $0.54 million.

CONCLUSIONS: Compared to usual care, NO-CAUTI is expected to realise overall budget savings and decreases in catheterisations over five years. These findings allow a consideration of the affordability of a wide implementation.

TRIAL REGISTRATION: Registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12617000090314 ). First registered 17 January 2017, retrospectively. First enrolment, 15/11/2016.

PMID:35932078 | DOI:10.1186/s12913-022-08313-7

BMC Musculoskelet Disord. 2022 Aug 5;23(1):754. doi: 10.1186/s12891-022-05664-4.

ABSTRACT

BACKGROUND: Post-injection paralysis (PIP) of the sciatic nerve is an iatrogenic paralysis that occurs after an intramuscular injection, with resultant foot deformity and disability. This study investigates the epidemiology and treatment of PIP in Uganda.

METHODS: Health records of pediatric patients surgically treated for PIP at the CoRSU Rehabilitation Hospital from 2013 to 2018 were retrospectively reviewed. Pre-operative demographics, perioperative management, and outcomes were coded and analyzed with descriptive statistics, chi-square for categorical variables, and linear models for continuous variables.

RESULTS: Four-hundred and two pediatric patients underwent 491 total procedures. Eighty-three percent of reported injection indications were for febrile illness. Twenty-five percent of reported injections explicitly identified quinine as the agent. Although ten different procedures were performed, achilles tendon lengthening, triple arthrodesis, tibialis posterior and anterior tendon transfers composed 83% of all conducted surgeries. Amongst five different foot deformities, equinus and varus were most likely to undergo soft tissue and bony procedures, respectively (p=0.0223). Ninteen percent of patients received two or more surgeries. Sixty-seven percent of patients achieved a plantigrade outcome; 13.61% had not by the end of the study period; 19.3% had unreported outcomes. Those who lived further from the facility had longer times between the inciting injection and initial hospital presentation (p=0.0216) and were more likely to be lost to follow-up (p=0.0042).

CONCLUSION: PIP is a serious iatrogenic disability. Prevention strategies are imperative, as over 400 children required 491 total surgical procedures within just six years at one hospital in Uganda.

PMID:35932071 | DOI:10.1186/s12891-022-05664-4

J Cannabis Res. 2022 Aug 5;4(1):46. doi: 10.1186/s42238-022-00152-x.

ABSTRACT

BACKGROUND: While cannabis is known to have immunomodulatory properties, the clinical consequences of its use on outcomes in COVID-19 have not been extensively evaluated. We aimed to assess whether cannabis users hospitalized for COVID-19 had improved outcomes compared to non-users.

METHODS: We conducted a retrospective analysis of 1831 patients admitted to two medical centers in Southern California with a diagnosis of COVID-19. We evaluated outcomes including NIH COVID-19 Severity Score, need for supplemental oxygen, ICU (intensive care unit) admission, mechanical ventilation, length of hospitalization, and in-hospital death for cannabis users and non-users. Cannabis use was reported in the patient’s social history. Propensity matching was used to account for differences in age, body-mass index, sex, race, tobacco smoking history, and comorbidities known to be risk factors for COVID-19 mortality between cannabis users and non-users.

RESULTS: Of 1831 patients admitted with COVID-19, 69 patients reported active cannabis use (4% of the cohort). Active users were younger (44 years vs. 62 years, p < 0.001), less often diabetic (23.2% vs 37.2%, p < 0.021), and more frequently active tobacco smokers (20.3% vs. 4.1%, p < 0.001) compared to non-users. Notably, active users had lower levels of inflammatory markers upon admission than non-users-CRP (C-reactive protein) (3.7 mg/L vs 7.6 mg/L, p < 0.001), ferritin (282 μg/L vs 622 μg/L, p < 0.001), D-dimer (468 ng/mL vs 1140 ng/mL, p = 0.017), and procalcitonin (0.10 ng/mL vs 0.15 ng/mL, p = 0.001). Based on univariate analysis, cannabis users had significantly better outcomes compared to non-users as reflected in lower NIH scores (5.1 vs 6.0, p < 0.001), shorter hospitalization (4 days vs 6 days, p < 0.001), lower ICU admission rates (12% vs 31%, p < 0.001), and less need for mechanical ventilation (6% vs 17%, p = 0.027). Using propensity matching, differences in overall survival were not statistically significant between cannabis users and non-users, nevertheless ICU admission was 12 percentage points lower (p = 0.018) and intubation rates were 6 percentage points lower (p = 0.017) in cannabis users.

CONCLUSIONS: This retrospective cohort study suggests that active cannabis users hospitalized with COVID-19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation. However, our results need to be interpreted with caution given the limitations of a retrospective analysis. Prospective and observational studies will better elucidate the effects cannabis use in COVID-19 patients.

PMID:35932069 | DOI:10.1186/s42238-022-00152-x