Category: Statistics

J Am Acad Orthop Surg. 2021 Oct 19. doi: 10.5435/JAAOS-D-21-00240. Online ahead of print.

ABSTRACT

INTRODUCTION: Surgical navigation technology has recently become more prevalent for total knee arthroplasty. Surgical navigation typically requires pin placement in the proximal tibia diaphysis to stabilize the bone-tracking hardware, and there have been several recent reports of fractures through these residual navigation pin holes. The objective of this biomechanical study was to determine whether a difference exists in the torsional bone strength of a 5-mm navigation pin hole drilled at a single location in three different orientations: unicortical, bicortical, and transcortical.

METHODS: Biomechanical composite sawbone tibias were used to test four conditions: the intact condition with no holes, a unicortical hole, a bicortical hole, and a transcortical hole through the proximal diaphysis. Seven specimens from each group were tested in external rotation to failure at 1 deg/sec. Torque-to-failure, absorbed energy-to-failure, and rotational angle-to-failure were statistically compared across the four groups.

RESULTS: All specimens failed proximally by spiral oblique fractures. No statistical differences were found between unicortical and bicortical groups in torque-to-failure, energy-to-failure, and angle-to-failure. However, both unicortical and bicortical groups were markedly lower in all measures than the intact group. The transcortical group was markedly lower in all measures than the intact group and both unicortical and bicortical groups.

DISCUSSION: An appropriately placed navigation residual pin hole, either unicortical or bicortical, markedly decreases the torque-to-failure, energy-to-failure, and angle-to-failure of the tibia compared with the intact condition in a synthetic sawbones model. No notable difference was detected between the unicortical and bicortical holes; however, an errant transcortical residual navigation pin hole markedly decreases all measures compared with an appropriately placed unicortical or bicortical hole.

PMID:34695042 | DOI:10.5435/JAAOS-D-21-00240

J Trauma Acute Care Surg. 2021 Nov 1;91(5):781-789. doi: 10.1097/TA.0000000000003201.

ABSTRACT

BACKGROUND: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) is controversial. We hypothesize that REBOA outcomes are improved in centers with high REBOA utilization.

METHODS: We examined the Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry over a 5-year period (2014-2018). Resuscitative endovascular balloon occlusion of the aorta outcomes were analyzed by stratifying institutions into low-volume (<10), average-volume (11-30), and high-volume (>30) deployment centers. A multivariable model adjusting for volume group, mechanism of injury, signs of life, systolic blood pressure at initiation, operator level, device type, zone of placement, and hemodynamic response to aortic occlusion was created to analyze REBOA mortality and REBOA-related complications.

RESULTS: Four hundred ninety-five REBOA placements were included. High-volume centers accounted for 63%, while low accounted for 13%. High-volume institutions were more likely to place a REBOA in the emergency department (81% vs. 63% low volume, p = 0.003), had a lower mean systolic blood pressure at insertion (53 ± 38 vs. 64 ± 40, p = 0.001), and more Zone I deployments (64% vs. 55%, p = 0.002). Median time from admission to REBOA placement was significantly less in patients treated at high-volume centers (15 [7-30] minutes vs. 35 [20-65] minutes, p = 0.001). Resuscitative endovascular balloon occlusion of the aorta mortality was significantly higher at low-volume centers (67% vs. 57%; adjusted odds ratio, 1.29; adj p = 0.040), while average- and high-volume centers were similar. Resuscitative endovascular balloon occlusion of the aorta complications were less frequent at high-/average-volume centers, but did not reach statistical significance (adj p = 0.784).

CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta survival is increased at high versus low utilization centers. Increased experience with REBOA may be associated with earlier deployment and subsequently improved patient outcomes.

LEVEL OF EVIDENCE: Therapeutic/Care Management, level IV.

PMID:34695057 | DOI:10.1097/TA.0000000000003201

Phys Med. 2021 Oct 20;91:18-27. doi: 10.1016/j.ejmp.2021.10.011. Online ahead of print.

ABSTRACT

INTRODUCTION: Gamma pass percentage (GPP) is the predominant metric used for Patient Specific Quality Assurance (PSQA) in radiation therapy. The dimensionality of the measurement geometry in PSQA has evolved from 2D planar to 3D planar, and presently to state-of-the-art 3D volumetric geometry. We aim to critically examine the performance of the three-dimensional gammas vis-à-vis the older gamma metrics of lower dimensionality to determine their mutual fungibility in PSQA, using clinically approved Volumetric Arc Therapy (VMAT) plans.

METHODS AND MATERIALS: Gamma pass percentages derived from PSQA for VMAT plans using Octavius 4D phantom with 2D-Array 1500 and its proprietary software were recorded. 2D planar, 3D planar, and 3D volumetric gamma pass percentages were retrospectively extracted for multiple treatment plans at three sites, using three acceptance limits, and for two modes of normalization. The differences in mean pass percentages, and the pairwise correlation between geometries were calculated within limits of statistical significance.

RESULTS: A significant increase in mean pass rates was observed from 2D planar to 3D planar geometries. The difference was less pronounced from 3D planar to 3D volumetric. 2D planar v/s 3D planar showed a significant degree of correlation among themselves, which was not seen against most of the 3D volumetric pass rates.

CONCLUSION: The mean gamma pass rates show conclusive evidence of the benefits of shifting from 2D planar to higher dimensions measurement geometries, but the benefits of using 3D volumetric compared to 3D planar is not always unequivocal. The correlations show mixed results regarding the interdependence of pass percentages at different geometries.

PMID:34688208 | DOI:10.1016/j.ejmp.2021.10.011

Singapore Med J. 2021 Oct 24. doi: 10.11622/smedj.2021142. Online ahead of print.

ABSTRACT

INTRODUCTION: To collect and analyse clinical and functional variables of patients undergoing rehabilitation after total knee arthroplasty (TKA), in order to identify which amongst them could influence the post-operative length of hospital stay (LOS).

METHODS: We conducted a retrospective analysis of prospectively collected data of 1,082 consecutive patients (746 females and 336 males) who underwent primary TKA and rehabilitation in our Orthopedic Institute between January 2013 and July 2017. Clinical and anthropometric data were analysed using a multivariate linear regression model.

RESULTS: The average LOS was 5.08 ± 2.52 days in the Department of Orthopedic Surgery, and 12.67 ± 5.54 days in the Rehabilitation Unit. Age, female sex and the presence of comorbidities were predictive of a longer stay. The presence of caregiver assistance at home was associated with shorter LOS. There was no evidence of a statistically significant positive association between BMI and LOS.

CONCLUSION: An in-depth and early knowledge of these factors may enable the whole multidisciplinary team to plan a patient-tailored rehabilitation path and a better allocation of resources to maximize patients’ functional recovery, while reducing LOS and the overall cost of the procedure.

PMID:34688227 | DOI:10.11622/smedj.2021142

Eur J Obstet Gynecol Reprod Biol. 2021 Oct 6;267:1-5. doi: 10.1016/j.ejogrb.2021.10.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the long-term outcomes of single-incision midurethral slings (SIMS) in real-life practice.

STUDY DESIGN: This retrospective, single-arm, patient cohort study was performed in a large Dutch teaching hospital, including 397 consecutive women who underwent a SIMS-procedure between 2009 and 2018. Data were obtained through questionnaires and patient record study. Subjective improvement was the primary outcome, defined as a Patient Global Impression of Improvement (PGI-I) of ‘(very) much better’. Secondary outcomes were subjective cure rate (defined as a negative Urogenital Distress Inventory – item 4 ‘Do you experience involuntary urine leakage related to physical activity, coughing or sneezing?’), complication rate and sling failure (defined as the need for additional research or treatment for persisting stress urinary incontinence (SUI)). All data was analysed with a statistical significance level of 5%.

RESULTS: The mean follow-up time was 54 months. All patients received SIMS (Ajust® or Altis®). Of all respondents, 75% reported a (very) much improved burden of disease. The subjective cure rate was 61%. In 93 patients a total of 120 complications were registered. In 10% of patients a sling failure was observed, 76% of these failures appeared in the first two years post-surgery.

CONCLUSION: This study showed that, in real life practice, SIMS are both effective and safe over a long period of time.

PMID:34688183 | DOI:10.1016/j.ejogrb.2021.10.003

Pediatr Neurol. 2021 Sep 30;126:3-8. doi: 10.1016/j.pediatrneurol.2021.09.016. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic presented many challenges for graduate medical education, including the need to quickly implement virtual residency interviews. We investigated how different programs approached these challenges to determine best practices.

METHODS: Surveys to solicit perspectives of program directors, program coordinators, and chief residents regarding virtual interviews were designed through an iterative process by two child neurology residency program directors. Surveys were distributed by email in May 2021. Results were summarized using descriptive statistics.

RESULTS: Responses were received from 35 program directors and 34 program coordinators from 76 programs contacted. Compared with the 2019-2020 recruitment season, in 2020-2021, 14 of 35 programs received >10% more applications and most programs interviewed ≥12 applicants per position. Interview days were typically five to six hours long and were often coordinated with pediatrics interviews. Most programs (13/15) utilized virtual social events with residents, but these often did not allow residents to provide quality feedback about applicants. Program directors could adequately assess most applicant qualities but felt that virtual interviews limited their ability to assess applicants’ interpersonal communication skills and to showcase special features of their programs. Most respondents felt that a combination of virtual and in-person interviewing should be utilized in the future.

CONCLUSIONS: Residency program directors perceived some negative impacts of virtual interviewing on their recruitment efforts but in general felt that virtual interviews adequately replaced in-person interviews for assessing applicants. Most programs felt that virtual interviewing should be utilized in the future.

PMID:34688202 | PMC:PMC8482581 | DOI:10.1016/j.pediatrneurol.2021.09.016

Comput Biol Med. 2021 Oct 13;139:104934. doi: 10.1016/j.compbiomed.2021.104934. Online ahead of print.

ABSTRACT

BACKGROUND: Electrocardiographic imaging (ECGI) allows evaluating the complexity of the reentrant activity of atrial fibrillation (AF) patients. In this study, we evaluated the ability of ECGI metrics to predict the success of pulmonary vein isolation (PVI) to treat AF.

METHODS: ECGI of 24 AF patients (6 males, 13 paroxysmal, 61.8 ± 14 years) was recorded prior to PVI. Patients were distributed into two groups based on their PVI outcome 6 months after ablation (sinus vs. arrhythmia recurrence). Metrics derived from phase analysis of ECGI signals were computed for two different temporal segments before ablation. Correlation analysis and variability over time were studied between the two recorded segments and were compared between patient groups.

RESULTS: Temporal variability of both rotor duration and spatial entropy of the rotor histogram presented statistical differences between groups with different PVI outcome (p < 0.05). The reproducibility of reentrant metrics was higher (R² > 0.8) in patients with good outcome rather than arrhythmia recurrence patients (R² < 0.62). Prediction of PVI success based on ECGI temporal variability metrics allows for an increased specificity over the classification into paroxysmal or persistent (0.85 vs. 0.64).

CONCLUSIONS: Patients with favorable PVI outcome present ECGI metrics more reproducible over time than patients with AF recurrence. These results suggest that ECGI derived metrics may allow selecting which patients would benefit from ablation therapies.

PMID:34688171 | DOI:10.1016/j.compbiomed.2021.104934

Epilepsy Res. 2021 Oct 7;177:106784. doi: 10.1016/j.eplepsyres.2021.106784. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine changes in dimensions of personality in a sample of patients suffering from drug-resistant epilepsy at the 1-year follow-up following surgery, compared to non-surgically treated controls.

METHODS: We conducted a prospective comparative controlled study, including drug-resistant epilepsy surgery candidates. Demographic, psychiatric, neurological, and psychological data were recorded. Presurgical and 12-months follow-up evaluations were performed. Personality dimensions were measured by the NEO Five-Factor Inventory, Revised version (NEO-FFI-R), anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS: HADA-Anxiety and HADD-Depression), psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis-I disorders classification. Statistical analysis consisted of comparative tests, correlation analysis, and the stepwise multiple regression test (ANOVA).

RESULTS: A 1-year follow-up was completed by 70 out of 80 patients. Through the study, the surgical group decreased in neuroticism and increased in agreeableness. The controls increased in consciousness, and these changes were predicted by the earlier age of epilepsy onset and lesser score in HADD at the baseline. No personality changes were associated with seizure frequency. The presurgical evaluation concluded that both groups had no differences in demographic, psychiatric, or neurological variables with the only exception being for the number of seizures per month, which was higher in the surgical group. Psychiatric comorbidity in patients was associated with their higher degree of neuroticism and agreeableness at the baseline. Comparing control and surgical groups at the one-year follow-up, the agreeableness personality variable was higher in the surgical group, and as expected, HADS scores were higher in the control group, and seizure frequency was also higher in the control group.

SIGNIFICANCE: Higher agreeableness was the most relevant difference in personality dimensions in patients who underwent surgical treatment compared with the non-surgical treatment group. After surgery patients decreased in neuroticism and increased in agreeableness scores.

PMID:34688182 | DOI:10.1016/j.eplepsyres.2021.106784

Int Immunopharmacol. 2021 Oct 15;101(Pt B):108241. doi: 10.1016/j.intimp.2021.108241. Online ahead of print.

ABSTRACT

BACKGROUND: IFNβs are known as one of the most promising drugs used for COVID-19 treatment. This study aimed to investigate the effects of treatment with INF-β 1-a (interferon beta-1a) and IFN-β 1-b (interferon beta-1b) on COVID-19 inpatients.

METHODS: In this study, we retrospectively evaluated the clinical treatment outcomes of 100 patients with COVID-19 who received IFN-β 1-a and IFN-β 1-b during their hospitalization period. The rate of discharge from the hospital was considered equal to the clinical improvement and then evaluated as a primary outcome. Moreover, mortality, ICU admission and length of ICU stay, frequency of intubation and use of mechanical ventilation, duration of hospitalization, laboratory factors, and medications were assessed as secondary outcomes.

RESULTS: The median discharge time of IFN-β 1a recipients was approximately equal to that of IFN-β 1-b recipients as 9 (5-10) days and 7 (5-11) days, respectively (HR = 2.43, P = 0.75). Mortality rate was also estimated as 10% among IFN-β 1-a recipients and 14% among IFN-β 1-b recipients, which was not statistically significant (p = 0.190). ICU hospitalization rate for the IFN-β 1-a recipients and IFN-β 1-b recipients was 26% and 36%, respectively. In addition, no significant difference was found between these two intervention groups in terms of ICU length of stay (1 (0-2) vs. 1 (0-4.25(, respectively,) P = 0.357). There was no significant difference between the two study groups in terms of frequency of mechanical ventilation and length of hospital stay.

CONCLUSION: There was no significant difference between the two groups in terms of shortening the disease time, clinical improvements and other outcomes.

PMID:34688151 | PMC:PMC8516800 | DOI:10.1016/j.intimp.2021.108241

J Forensic Leg Med. 2021 Oct 4;84:102257. doi: 10.1016/j.jflm.2021.102257. Online ahead of print.

ABSTRACT

AIM: The Council of Forensic Medicine is an institution affiliated with the Ministry of Justice in the Republic of Turkey which acts in an official oversight capacity in cases of alleged medical malpractice in forensic medical science. Sonographers may face judicial sanctions as a result of ultrasonography examinations that they do not perform according to current guidelines. In this study we focused our attention to claims of medical malpractice related to obstetric ultrasonography that had been referred to the Council of Forensic Medicine. Our aim was to investigate the causes of malpractice claims related to obstetric ultrasonography and to present the expert opinions of our council about these claims in the light of literature. We have also planned to discuss what can be done with current guideline information to prevent situations that cause malpractice claims.

MATERIALS AND METHODS: The study herein was performed on 73 claims of medical malpractice in obstetric ultrasonography findings, all of which were referred by forensic authorities to the Second Specialization Board of Council Forensic Medicine from 2014 to 2018. A retrospective review of the reports generated from information contained within case files illuminates the reasoning behind medical error claims. Among the reasons examined are features of the ultrasonographic evaluation (number, week of examination, health institution), the traits of the evaluating physicians (institutions, branches, academic titles), congenital anomalies detected after birth, and maternal age.

RESULTS: Analysis of the data shows that 79.5% of ultrasonographic examinations leading to claims of medical malpractice were performed in private health institutions. All cases of medical malpractice claims were associated with undiagnosed congenital anomalies, and that the form for informed consent was obtained for only 19.1% of cases that underwent second level ultrasonographic examination. Further, 53.3% of cases with congenital anomalies subject to litigation were anomalies of the extremities, and all four cases of alleged malpractice within obstetric ultrasonography were associated with extremity anomalies. The variety of academic titles of physicians performing the ultrasonographic examinations was not statistically significant. It was concluded that two ultrasonography examinations performed by two nuclear medicine specialists were not in accordance with medical norms.

CONCLUSION: Although organizations such as AIUM, ACR, and ACOG try to set standards for ultrasound examination through practice guidelines, it is difficult to establish optimal standards for ultrasonographic examination. In light of the guidelines created by the above organizations, each country should set its own standard based on their own socioeconomic and health data. We conclude that it is not appropriate for obstetric ultrasonographic examinations to be performed by specialists in fields such as nuclear medicine, where ultrasonographic examinations are not a part of the core training curriculum. Obtaining a signed informed consent form from the patient prior to the second level ultrasonography examination will be useful for medicolegal defense purposes should a subsequent claim of malpractice be filed.

PMID:34688159 | DOI:10.1016/j.jflm.2021.102257