Category: Statistics

Pediatr Blood Cancer. 2021 Nov 29:e29421. doi: 10.1002/pbc.29421. Online ahead of print.

ABSTRACT

BACKGROUND: Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10%-20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian-sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed.

DESIGN: This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. A national retrospective review of girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, second events and their management were retrieved.

RESULTS: Overall, 350 children were included. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases, respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: eight cases including one malignant tumor; contralateral: 18 cases; both ovaries: three cases). A large palpable mass, bilateral forms, at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas the type of surgery or approach did not.

CONCLUSION: This study is a plea in favor of OSS as the first-choice treatment of OMT when possible. Close follow-up during the first 5 years is mandatory considering the risk of 8.3% of second events, especially in cases with risk factors.

PMID:34842332 | DOI:10.1002/pbc.29421

J Magn Reson Imaging. 2021 Nov 29. doi: 10.1002/jmri.28007. Online ahead of print.

ABSTRACT

BACKGROUND: Medulloblastoma, ependymoma, and pilocytic astrocytoma are common pediatric posterior fossa tumors. These tumors show overlapping characteristics on conventional MRI scans, making diagnosis difficult.

PURPOSE: To investigate whether apparent diffusion coefficient (ADC) values differ between tumor types and to identify optimum cut-off values to accurately classify the tumors using different performance metrics.

STUDY TYPE: Systematic review and meta-analysis.

SUBJECTS: Seven studies reporting ADC in pediatric posterior fossa tumors (115 medulloblastoma, 68 ependymoma, and 86 pilocytic astrocytoma) were included following PubMed and ScienceDirect searches.

SEQUENCE AND FIELD STRENGTH: Diffusion weighted imaging (DWI) was performed on 1.5 and 3 T across multiple institution and vendors.

ASSESSMENT: The combined mean and standard deviation of ADC were calculated for each tumor type using a random-effects model, and the effect size was calculated using Hedge’s g.

STATISTICAL TESTS: Sensitivity/specificity, weighted classification accuracy, balanced classification accuracy. A P value < 0.05 was considered statistically significant, and a Hedge’s g value of >1.2 was considered to represent a large difference.

RESULTS: The mean (± standard deviation) ADCs of medulloblastoma, ependymoma, and pilocytic astrocytoma were 0.76 ± 0.16, 1.10 ± 0.10, and 1.49 ± 0.16 mm² /sec × 10^-3 . To maximize sensitivity and specificity using the mean ADC, the cut-off was found to be 0.96 mm² /sec × 10^-3 for medulloblastoma and ependymoma and 1.26 mm² /sec × 10^-3 for ependymoma and pilocytic astrocytoma. The meta-analysis showed significantly different ADC distributions for the three posterior fossa tumors. The cut-off values changed markedly (up to 7%) based on the performance metric used and the prevalence of the tumor types.

DATA CONCLUSION: There were significant differences in ADC between tumor types. However, it should be noted that only summary statistics from each study were analyzed and there were differences in how regions of interest were defined between studies.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 3.

PMID:34842328 | DOI:10.1002/jmri.28007

Pediatr Blood Cancer. 2021 Nov 29:e29473. doi: 10.1002/pbc.29473. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Despite the pervasiveness of late effects in childhood cancer survivors, many parents feel inadequately informed about their child’s risks. We assessed early parental knowledge of risks of late effects and predictors of increased knowledge.

DESIGN/METHODS: Parents of children receiving cancer treatment at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center were surveyed about their knowledge of their child’s likelihood of eight late effects. Individual risk for each late effect (yes/no) was assessed using the Children’s Oncology Group’s Long-Term Follow-Up Guidelines v5 as a reference. Descriptive statistics were used to summarize knowledge scores; ordinal logistic regression was used to identify predictors of higher knowledge.

RESULTS: Of 96 parent participants, 11 (11.46%) correctly identified all of their child’s risks for the eight late effects. Five of eight was the median number of correctly identified late effect risks. Among 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents of at-risk children were less knowledgeable about risks of secondary malignancy (63% correct identification, of N = 94 at risk), cardiac toxicity (61%; N = 71), neurocognitive impairment (56%; N = 63), and infertility (28%; N = 61). Ordinal logistic regression analysis identified no significant differences in parental knowledge of late effect risks by any factors evaluated.

CONCLUSIONS: Gaps in parental knowledge of potential late effects of childhood cancer treatment emerge early in a child’s care, and parents are more knowledgeable about some late effects, such as ototoxicity, than others, such as infertility. As no child- or parent-specific factors were associated with increased knowledge of late effect risks, interventions must be applied broadly.

PMID:34842331 | DOI:10.1002/pbc.29473

J Magn Reson Imaging. 2021 Nov 29. doi: 10.1002/jmri.28008. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative differentiation of borderline from malignant epithelial ovarian tumors (BEOT vs. MEOT) is challenging and can significantly impact surgical management.

PURPOSE: To develop a multiple instance convolutional neural network (MICNN) that can differentiate BEOT from MEOT, and to compare its diagnostic performance with that of radiologists.

STUDY TYPE: Retrospective study of eight clinical centers.

SUBJECTS: Between January 2010 and June 2018, a total of 501 women (mean age, 48.93 ± 14.05 years) with histopathologically confirmed BEOT (N = 165) or MEOT (N = 336) were divided into the training (N = 342) and validation cohorts (N = 159).

FIELD STRENGTH/SEQUENCE: Three axial sequences from 1.5 or 3 T scanner were used: fast spin echo T2-weighted imaging with fat saturation (T2WI FS), echo planar diffusion-weighted imaging, and 2D volumetric interpolated breath-hold examination of contrast-enhanced T1-weighted imaging (CE-T1WI) with FS.

ASSESSMENT: Three monoparametric MICNN models were built based on T2WI FS, apparent diffusion coefficient map, and CE-T1WI. Based on these monoparametric models, we constructed an early multiparametric (EMP) model and a late multiparametric (LMP) model using early and late information fusion methods, respectively. The diagnostic performance of the models was evaluated using the receiver operating characteristic (ROC) curve and compared to the performance of six radiologists with varying levels of experience.

STATISTICAL TESTS: We used DeLong test, chi-square test, Mann-Whitney U-test, and t-test, with significance level of 0.05.

RESULTS: Both EMP and LMP models differentiated BEOT from MEOT, with an area under the ROC curve (AUC) of 0.855 (95% CI, 0.795-0.915) and 0.884 (95% CI, 0.831-0.938), respectively. The AUC of the LMP model was significantly higher than the radiologists’ pooled AUC (0.884 vs. 0.797).

DATA CONCLUSION: The developed MICNN models can effectively differentiate BEOT from MEOT and the diagnostic performances (AUCs) were more superior than that of the radiologists’ assessments.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

PMID:34842320 | DOI:10.1002/jmri.28008

Work. 2021 Nov 26. doi: 10.3233/WOR-210510. Online ahead of print.

ABSTRACT

BACKGROUND: Mindfulness-based interventions (MBIs) are known for their beneficial effects on positive and negative psychological factors. When applied in an occupational context, MBIs might help workers to cope with stress, increase their professional outcomes and wellbeing.

OBJECTIVE: In this two-groups pre-post experimental design we tested the effect of our MBI, called Integral Meditation (IM), among the employers of an Italian service company by measuring positive and negative aspects of psychological wellbeing related to mindfulness and workplace functioning through eight self-report questionnaires (CORE-OM, FFMQ, WEMWBS, MAIA, PSS, PANAS, STAI-X1, SCS).

METHOD: Forty-two voluntary non-clinical employers of the company, randomly assigned to the experimental or the control group, were analyzed. The experimental group underwent our IM program, which consists of 12 weekly meditation classes given after the afternoon shift, while the control group did not receive any intervention. Data was analyzed via linear mixed models.

RESULTS: Statistically significant results were obtained for FFMQ observing subscale (β= 0.49, p = 0.014), WEMWBS (β= 5.31, p = 0.02), PSS (β= -3.31, p = 0.03), the whole scale of SCS (β= 0.47, p = 0.01) and self-judgment (β= 0.68, p = 0.003) and isolation (β= -0.66, p = 0.01) SCS subscales. Statistically significant results were also found in four out of eight subscales of MAIA: emotional awareness (β= 1.26, p < 0.001), self-regulation (β= 1.28, p < 0.001), body listening (β= 1.08, p < 0.001) and trusting (β= 1.1, p < 0.001).

CONCLUSION: Our intervention has demonstrated to bring beneficial effects in a mindfulness subdomain, in perceived stress, self-compassion, interoception and psychological wellbeing. Based on our results, we conclude that our intervention was effective in increasing the positive aspects of wellbeing and in reducing stress.

PMID:34842215 | DOI:10.3233/WOR-210510

Work. 2021 Nov 26. doi: 10.3233/WOR-210643. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the anxiety levels of employees by determining the working conditions and protective practices in the workplace of individuals who had to work during the COVID-19 pandemic.

METHODS: The cross-sectional study was carried out with 801 employees from different sectors who continued to work during the COVID-19 pandemic.

RESULTS: The mean age of the employees was 33.1±10.3 years, and 63.4%were male while 46.1%were workers. The GAD-7 anxiety level mean score of the participants was determined as 6.6±5.1. Per this, 25.2%of the participants showed a high tendency to anxiety and 38.5%showed a moderate tendency. A statistically significant difference was found between anxiety level and gender, sector and profession. Besides, there was a statistically significant difference between the perception of workplace risk, the way of transportation to the workplace, the social distance in the workplace, measures taken for COVID-19 in the workplace, and anxiety levels (p < 0.05). In the multiple regression analysis, age, gender, work sector, COVID-19 anxiety levels, infection status, knowledge level and life satisfaction levels were determined as effective predictors on common anxiety disorder and explained 23.2%of the developed model variance (R2 = 0.232, p≤0.001).

CONCLUSION: During the pandemic, it was determined that the anxiety susceptibility levels of the employees were very high and their protective practices against COVID-19 in the workplace were insufficient.

PMID:34842219 | DOI:10.3233/WOR-210643

Work. 2021 Nov 25. doi: 10.3233/WOR-205134. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the prevalence of metabolic syndrome (MS) among dentists in Riyadh, Saudi Arabia. The study also explored the causes of occupational stress among the participating dentists.

MATERIALS & METHODS: The participants included a conveniently selected sample of dentists (N = 126; Males = 65; Females = 61). The participants’ anthropometric measurements/blood sample analysis were carried out and they completed a self-administered questionnaire. Data analysis included demographics, gender/age wise comparison using SPSS (p < 0.05). For the diagnosis of MS, updated criteria of the National Cholesterol Education Program was applied.

RESULTS: Participants diagnosed with MS were 13 (10.3%), Males = 11(8.7%) and Females = 2(1.5%). Physical activity of 6 (15.8%) with MS was only 0-2 hours/week. 9 (14.5%) participants with MS declared positive family history for MS. The average systolic (117.55±11.33) and diastolic blood pressure (71.9±9.34) of the participants was found to be normal with no gender wise statistical difference. No gender wise statistical differences (p > 0.05) were observed for cholesterol, triglycerides and HDL. However, significant difference (p = 0.00) was found for the fasting glucose level (Males = 5.69±1.49; Females = 4.94±0.42). Overall mean scoring (3.00±1.11) for the stress showed that the participants fall into the average/moderate level of stress category (Males = 3.16±1.02; Females = 2.83±1.08). Almost two third (68.26%) of the participant’s responded that they were under some kind of stress.

CONCLUSIONS: MS was found to be less frequent among the dentists working in the city of Riyadh. Overall, the dentists were under moderate level of occupational stress, with male dentists being more prone to work related stress.

PMID:34842205 | DOI:10.3233/WOR-205134

Work. 2021 Nov 25. doi: 10.3233/WOR-210045. Online ahead of print.

ABSTRACT

BACKGROUND: The perceptions and trends of magnification use in dentistry need to be determined since magnification significantly enhances clinical practice.

OBJECTIVE: To assess perception and practices of Operative and Endodontic specialists currently working in Pakistan, regarding use of magnification.

METHODS: A structured questionnaire administered for this analytical cross-sectional study recorded demographics, trends of magnification devices used in practice and their perceived advantages and disadvantages by the specialists with close-ended questions and three-point Likert scale.

RESULTS: Out of 91 forms, 77 responses were received (response rate of 84%). Most participants had 1-4 years’ practical experience, were employed at both faculty and clinical positions, were more interested in operative/restorative procedures and used TLL (through the lens loupes) at low magnification. Use of magnification devices was learnt mostly during post-graduate training and was used daily or weekly for complicated cases. Noteworthy perceptions included improved treatment quality and standard of care. However, they were also perceived as irritating, increasing treatment time, with adverse effect on eyesight with prolonged use. No statistically significant correlation was found between the variables recorded (p > 0.05).

CONCLUSIONS: Most specialists used magnification devices in some form and were abreast with their advantages. Proper training and continued dental education courses can help dispel any observed misapprehensions.

PMID:34842213 | DOI:10.3233/WOR-210045

Work. 2021 Nov 25. doi: 10.3233/WOR-205029. Online ahead of print.

ABSTRACT

BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care.

OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention.

METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency.

RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant.

CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.

PMID:34842202 | DOI:10.3233/WOR-205029

J Surg Educ. 2021 Nov 25:S1931-7204(21)00318-4. doi: 10.1016/j.jsurg.2021.11.002. Online ahead of print.

ABSTRACT

OBJECTIVE: Integrated plastic surgery (PS) is one of the most competitive residency programs, but current literature lacks data specific to matched applicants from medical schools without home integrated PS residency programs (NHP). Therefore, there is a need to examine this specific demographic of applicants to identify key factors that led to a successful match.

DESIGN: An anonymous survey was sent to PS residents who graduated from US allopathic medical schools with NHP. Survey questions focused on applicants’ objective statistics (USMLE scores, research experiences, etc.), as well as various other factors, including access to resources and letters of recommendation.

SETTING: All US-based integrated plastic surgery residency programs.

PARTICIPANTS: PGY-1 through PGY-6 integrated PS residents who graduated from US allopathic medical schools with NHP.

RESULTS: The survey was distributed to 178 NHP residents from May to June of 2021, achieving a 55.1% response rate. Thirty-seven percent attended an institution with an independent, but not integrated, residency program. Average USMLE Step 1 and 2 scores were 248 ± 10.1 and 256 ± 9.7, respectively. Respondents reported having 9.8 ± 9.5 abstracts, presentations, and publications listed on their residency applications. NHP applicants had an average of 1.5 letters of recommendation written by away rotation faculty. Forty-five percent reported accessing resources at institutions with home integrated residency programs (HP), 55.6% of whom “strongly agreed” or “agreed” that this significantly helped in matching.

CONCLUSION: The USMLE Step scores and research experiences of NHP residents are similar to those which are reported among all matched applicants nationally. NHP respondents optimized their success by utilizing plastic surgery-related resources at their own institutions, while often seeking resources at other institutions.

PMID:34840121 | DOI:10.1016/j.jsurg.2021.11.002