Category: Statistics

Huan Jing Ke Xue. 2022 Feb 8;43(2):675-685. doi: 10.13227/j.hjkx.202105103.

ABSTRACT

This study investigated temporal and spatial variations in O₃-8h (defined as the maximum 8 h average result) in Hainan Province from 2015 to 2020 and further analyzed its relationships with precursors and meteorological factors based on a dataset of observations from 32 environmental monitoring stations in Hainan. Basic statistical methods, including the empirical orthogonal function (EOF), climatic tendency rate, and climatic trend coefficient analysis, were used here. The results showed that ρ(O₃-8h) was higher in northern and western Hainan than that in other regions, with the maximum value occurring in Dongfang City (91.5 μg·m^-3). Twelve cities and counties experienced a downward trend from 2015 to 2020, and six cities and counties reached a 95% confidence level. The variation in ρ(O₃-8h) in Hainan Province demonstrated remarkable seasonal changes, which were the largest in the autumn, spring, and winter followed by the smallest in the summer, exhibiting a clear declining trend in all seasons except autumn. In addition, the cumulative variance of the first two eigenvector fields decomposed by EOF was 72.58%, which could well describe the distributed characteristics of ρ(O₃-8h) in Hainan Province. The first mode reflected the consistency of ρ(O₃-8h) variation, and the second mode reflected regional differences. Meanwhile, the change in ρ(O₃-8h) had a good correlation with the precursors and meteorological factors. Among them, the correlation coefficients between ρ(O₃-8h) and ρ(NO₂), precipitation, sunshine duration, average temperature, average wind speed, atmospheric pressure, and total radiation passed the 99% confidence test. The results of multiple linear regression showed that the variation in regressed ρ(O₃-8h) was consistent with the observed ρ(O₃-8h), and the correlation coefficient between them was 0.853, which passed the 99.9% confidence test. The regression value explained 0.72 variance of the observed value.

PMID:35075841 | DOI:10.13227/j.hjkx.202105103

J Korean Med Sci. 2022 Jan 24;37(4):e26. doi: 10.3346/jkms.2022.37.e26.

ABSTRACT

BACKGROUND: The Korean Academy of Medical Sciences (KAMS) has been utilizing AGREE II to audit the quality of clinical practice guidelines (CPGs) developed in Korea. Monitoring the RIGHT Checklist adherence could help monitor the quality status and discover areas for improvement of CPG development.

METHODS: We included 129 CPGs from the past 5 years and assessed each item of the RIGHT Checklist. STATA version 15.0 was used for statistical analysis.

RESULTS: Among the seven sections of the RIGHT checklist, sections with a full compliance rate over 60% were ‘basic information’ (65%) and ‘background’ (66%). The other sections’ mean full compliance rates were ‘Evidence’ 52%, ‘Recommendation’ 35%, ‘Review and quality assurance’ 25% and ‘Funding, declaration and management of interest’ 17%. Sections with a partial compliance rate over 60% were ‘Recommendation’ (60%) and ‘Funding, declaration and management of interest’ (70%). Non-compliance was highest in the ‘Review and quality assurance’ (17%) domain. In comparison between groups 1 (under median group) and 2 (over median group), group 2 showed a tendency to have multi-stakeholder involvement and present sufficient information on financial resources and conflict of interest declarations. For the CPGs developmental methodology aspect, group 2 provided more pertinent information than group 1 about supporting evidence-making and the process from evidence to recommendation.

CONCLUSION: This study evaluated adherence to the RIGHT Checklist of CPGs developed in Korea. It can provide helpful information to develop strategic plans for enhancing the capabilities of developing CPGs in Korea.

PMID:35075825 | DOI:10.3346/jkms.2022.37.e26

J Cachexia Sarcopenia Muscle. 2022 Jan 24. doi: 10.1002/jcsm.12920. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients is not well understood.

METHODS: This pooled analysis investigates the impact of different physiotherapeutic strategies on insulin sensitivity in critically ill patients. We pooled data from two previous trials in adult patients with sequential organ failure assessment score (SOFA)≥ 9 within 72 h of intensive care unit (ICU) admission, who received hyperinsulinaemic euglycaemic (HE) clamps. Patients were divided into three groups: standard physiotherapy (sPT, n = 22), protocol-based physiotherapy (pPT, n = 8), and pPT with added muscle activating measures (pPT+, n = 20). Insulin sensitivity index (ISI) was determined by HE clamp. Muscle metabolites lactate, pyruvate, and glycerol were measured in the M. vastus lateralis via microdialysis during the HE clamp. Histochemical visualization of glucose transporter-4 (GLUT4) translocation was performed in surgically extracted muscle biopsies. All data are reported as median (25th/75th percentile) (trial registry: ISRCTN77569430 and ISRCTN19392591/ethics approval: Charité-EA2/061/06 and Charité-EA2/041/10).

RESULTS: Fifty critically ill patients (admission SOFA 13) showed markedly decreased ISIs on Day 17 (interquartile range) 0.029 (0.022/0.048) (mg/min/kg)/(mU/L) compared with healthy controls 0.103 (0.087/0.111), P < 0.001. ISI correlated with muscle strength measured by medical research council (MRC) score at first awakening (r = 0.383, P = 0.026) and at ICU discharge (r = 0.503, P = 0.002). Different physiotherapeutic strategies showed no effect on the ISI [sPT 0.029 (0.019/0.053) (mg/min/kg)/(mU/L) vs. pPT 0.026 (0.023/0.041) (mg/min/kg)/(mU/L) vs. pPT+ 0.029 (0.023/0.042) (mg/min/kg)/(mU/L); P = 0.919]. Regardless of the physiotherapeutic strategy metabolic flexibility was reduced. Relative change of lactate/pyruvate ratio during HE clamp is as follows: sPT 0.09 (-0.13/0.27) vs. pPT 0.07 (-0.16/0.31) vs. pPT+ -0.06 (-0.19/0.16), P = 0.729, and relative change of glycerol concentration: sPT -0.39 (-0.8/-0.12) vs. pPT -0.21 (-0.33/0.07) vs. pPT+ -0.21 (-0.44/-0.03), P = 0.257. The majority of ICU patients showed abnormal localization of GLUT4 with membranous GLUT4 distribution in 37.5% (3 of 8) of ICU patients receiving sPT, in 42.9% (3 of 7) of ICU patients receiving pPT, and in 53.8% (7 of 13) of ICU patients receiving pPT+ (no statistical testing possible).

CONCLUSIONS: Our data suggest that a higher duration of muscle activating measures had no impact on insulin sensitivity or metabolic flexibility in critically ill patients with sepsis-related multiple organ failure.

PMID:35075782 | DOI:10.1002/jcsm.12920

J Cosmet Dermatol. 2022 Jan 25. doi: 10.1111/jocd.14791. Online ahead of print.

ABSTRACT

BACKGROUND: Striae gravidarum (SG) is a connective tissue disorder seen commonly in primigravidas. It is associated with impairment in the quality of life.

OBJECTIVE: To determine the efficacy of ablative fractional carbon dioxide (CO2) laser combined with autologous platelet-rich plasma (PRP) versus ablative fractional CO2 laser and placebo in the treatment of SG.

STUDY DESIGN: Randomized, double-blinded, placebo-controlled trial METHODOLOGY: The study was conducted in 16 patients with SG. The assigned treatment area (abdomen) was divided into two sides and was randomly assigned to the PRP side and the control side. All patients received ablative fractional CO2 laser. Immediately after each laser procedure, the PRP side received autologous PRP, while the control side received plain normal saline solution (pNSS) as a placebo. The study was done for three sessions, at intervals of 4 weeks. An independent assessor used the photographs taken at weeks 6, 10, 14 and 16 to assess the clinical improvement. The patient satisfaction was reported at the same intervals. A quartile grading scale was used to measure both the clinical improvement and patient satisfaction. Data were analyzed using the Jonckheere-Terpstra test. Histopathology was done before treatment, and at the end of the study period.

RESULTS: The combination of ablative fractional CO2 laser and autologous PRP had better clinical improvement and patients’ satisfaction compared to ablative fractional CO2 laser and placebo. However, both outcome measures were not statistically significant.

CONCLUSION: Ablative fractional CO2 laser combined with autologous PRP appears to be an effective treatment in SG.

PMID:35075752 | DOI:10.1111/jocd.14791

Int J Dent Hyg. 2022 Jan 24. doi: 10.1111/idh.12581. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the direct and indirect influence of fluoridated toothpastes and fluoride-free toothpaste with hydroxyapatite (HAP) as active ingredient on initial bacterial colonization on enamel in situ.

METHODS: For this clinical-experimental pilot-study, eight subjects were instructed to brush their teeth with three different toothpastes (Elmex®: 1400 ppm AmF, Meridol®: 1400ppm AmF + SnF2, Karex®: HAP), using each for two consecutive days. As a control, brushing without toothpaste was performed. To evaluate bacterial colonization, subject wore splints with buccally placed bovine enamel-platelets overnight. Two modes were tested. In a first pass (regimen A), the splints were inserted after toothbrushing to examine the indirect effects of the dentifrices. In order to investigate the direct effects, the specimens were brushed in situ in a second pass (regimen B). Biofilm formation was visualized and quantified using fluorescence microscopy (DAPI and BacLight) and transmission electron microscopy (TEM).

RESULTS: For brushing regimen A (indirect effect of dentifrices), no statistical differences were detected between any of the tested dentifrices or the control. Likewise, no statistically significant differences were recorded for brushing regimen B (direct effect of dentifrices). Furthermore, no differences between the different brushing techniques were determined with regard to the ultrastructure of the overnight biofilm.

CONCLUSION: Within the limitations of the present pilot study, it can be concluded that in patients with good oral hygiene, dentifrices and their chemical composition have no statistically significant effect on the initial bacterial colonization of enamel platelets in situ, irrespectively of the mode of application.

PMID:35075780 | DOI:10.1111/idh.12581

J Clin Nurs. 2022 Jan 24. doi: 10.1111/jocn.16227. Online ahead of print.

ABSTRACT

BACKGROUND: Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological.

AIMS: To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients.

METHODS: A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication.

RESULTS: 26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded.

CONCLUSIONS: Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients.

RELEVANCE TO CLINICAL PRACTICE: In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients’ emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.

PMID:35075716 | DOI:10.1111/jocn.16227

Eur J Neurol. 2022 Jan 24. doi: 10.1111/ene.15258. Online ahead of print.

ABSTRACT

BACKGROUND: There are no systematic reviews of cerebrospinal fluid and blood biomarkers for sporadic Creutzfeldt-Jakob disease (sCJD) in specialised care settings that compare diagnostic accuracies in a network meta-analysis (NMA).

METHODS: We searched Medline, Embase, and Cochrane Library for diagnostic studies of sCJD biomarkers. Studies had to use established diagnostic criteria for sCJD and for diseases in the non-CJD groups, which had to represent a consecutive population of patients suspected as a CJD case, as reference standard. Risk of bias was assessed with QUADAS-2. We conducted individual biomarker meta-analyses with generalised bivariate models. To investigate heterogeneity, we performed subgroup analyses based on QUADAS-2 quality and clinical criteria. For the NMA, we applied a Bayesian beta-binomial ANOVA model. The study protocol was registered at PROSPERO (CRD42019118830).

RESULTS: Out of 2,976 publications screened, we included 16 studies, which investigated 14-3-3β (n=13), 14-3-3γ (n=3), neurofilament light chain (NfL, n=1), neuron specific enolase (n=1), p-tau181/t-tau ratio (n=2), RT-QuIC (n=7), S100B (n=3), t-tau (n=12), and t-tau/Aβ42 ratio (n=1). Excluded diagnostic studies had strong limitations in study design. In the NMA, RT-QuIC (0.91; 95% CI [0.83, 0.95]) and NfL (0.93 [0.78, 0.99]) were the most sensitive biomarkers for the diagnosis of definite, probable and possible sCJD cases. RT-QuIC was the most specific biomarker (0.97 [0.89, 1.00]). Heterogeneity in accuracy estimates was high between studies.

CONCLUSIONS: We identified RT-QuIC as the most accurate biomarker, partially confirming currently applied diagnostic criteria. The shortcomings identified in many diagnostic studies for sCJD biomarkers need to be addressed in future studies.

PMID:35075751 | DOI:10.1111/ene.15258

J Magn Reson Imaging. 2022 Jan 24. doi: 10.1002/jmri.28076. Online ahead of print.

ABSTRACT

BACKGROUND: Time-resolved three-directional velocity-encoded (4D flow) magnetic resonance imaging (MRI) enables the quantification of left ventricular (LV) intracavitary fluid dynamics and energetics, providing mechanistic insight into LV dysfunctions. Before becoming a support to diagnosis and patient stratification, this analysis should prove capable of discriminating between clearly different LV derangements.

PURPOSE: To investigate the potential of 4D flow in identifying fluid dynamic and energetics derangements in ischemic and restrictive LV cardiomyopathies.

STUDY TYPE: Prospective observational study.

POPULATION: Ten patients with post-ischemic cardiomyopathy (ICM), 10 patients with cardiac light-chain cardiac amyloidosis (AL-CA), and 10 healthy controls were included.

FIELD STRENGTH/SEQUENCE: 1.5 T/balanced steady-state free precession cine and 4D flow sequences.

ASSESSMENT: Flow was divided into four components: direct flow (DF), retained inflow, delayed ejection flow, and residual volume (RV). Demographics, LV morphology, flow components, global and regional energetics (volume-normalized kinetic energy [KE_V ] and viscous energy loss [EL_V ]), and pressure-derived hemodynamic force (HDF) were compared between the three groups.

STATISTICAL TESTS: Intergroup differences in flow components were tested by one-way analysis of variance (ANOVA); differences in energetic variables and peak HDF were tested by two-way ANOVA. A P-value of <0.05 was considered significant.

RESULTS: ICM patients exhibited the following statistically significant alterations vs. controls: reduced KE_V , mostly in the basal region, in systole (-44%) and in diastole (-37%); altered flow components, with reduced DF (-33%) and increased RV (+26%); and reduced basal-apical HDF component on average by 63% at peak systole. AL-CA patients exhibited the following alterations vs. controls: significantly reduced KE_V at the E-wave peak in the basal segment (-34%); albeit nonstatistically significant, increased peaks and altered time-course of the HDF basal-apical component in diastole and slightly reduced HDF components in systole.

DATA CONCLUSION: The analysis of multiple 4D flow-derived parameters highlighted fluid dynamic alterations associated with systolic and diastolic dysfunctions in ICM and AL-CA patients, respectively.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 3.

PMID:35075711 | DOI:10.1002/jmri.28076

Stat Med. 2022 Jan 25. doi: 10.1002/sim.9308. Online ahead of print.

ABSTRACT

Major advances have been made regarding the utilization of machine learning techniques for disease diagnosis and prognosis based on complex and high-dimensional data. Despite all justified enthusiasm, overoptimistic assessments of predictive performance are still common in this area. However, predictive models and medical devices based on such models should undergo a throughout evaluation before being implemented into clinical practice. In this work, we propose a multiple testing framework for (comparative) phase III diagnostic accuracy studies with sensitivity and specificity as co-primary endpoints. Our approach challenges the frequent recommendation to strictly separate model selection and evaluation, that is, to only assess a single diagnostic model in the evaluation study. We show that our parametric simultaneous test procedure asymptotically allows strong control of the family-wise error rate. A multiplicity correction is also available for point and interval estimates. Moreover, we demonstrate in an extensive simulation study that our multiple testing strategy on average leads to a better final diagnostic model and increased statistical power. To plan such studies, we propose a Bayesian approach to determine the optimal number of models to evaluate simultaneously. For this purpose, our algorithm optimizes the expected final model performance given previous (hold-out) data from the model development phase. We conclude that an assessment of multiple promising diagnostic models in the same evaluation study has several advantages when suitable adjustments for multiple comparisons are employed.

PMID:35075684 | DOI:10.1002/sim.9308

Mov Disord. 2022 Jan 24. doi: 10.1002/mds.28935. Online ahead of print.

NO ABSTRACT

PMID:35075696 | DOI:10.1002/mds.28935