Category: Statistics

Pediatr Blood Cancer. 2021 Apr 24:e29080. doi: 10.1002/pbc.29080. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents’ perceptions about whether their child sensed that pediatric cancer created financial problems for their family.

PROCEDURE: Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents’ (n = 417) responses to questions about the child’s sense of pediatric cancer-related financial problems from a larger survey study.

RESULTS: Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children’s sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden.

CONCLUSION: Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children’s awareness of those effects.

PMID:33894050 | DOI:10.1002/pbc.29080

Int Nurs Rev. 2021 Apr 24. doi: 10.1111/inr.12679. Online ahead of print.

ABSTRACT

AIM: To identify the factors affecting fear, anxiety and depressive symptoms among frontline nurses working with COVID-19 patients or are in charge of COVID-19 screening in Korea.

BACKGROUND: Nurses are at a higher risk of COVID-19 infection because they are in closer, longer-duration contact with patients. These situations can negatively affect the mental health of nurses.

METHODS: This study analysed data from COVID-19 module in the Korean Nurses’ Health Study. Data from 906 participants were analysed. To identify the factors influencing mental health, descriptive statistics, Pearson’s correlation and hierarchical multiple regression analyses were performed.

RESULTS: Caring for patients who are COVID-19-positive increased levels of fear, anxiety and depressive symptoms of nurses. The hospital safety climate influenced mental well-being among nurses.

CONCLUSION: Caring for patients with COVID-19 had a negative impact on fear, anxiety and depressive symptoms. However, the higher was the perceived hospital safety climate, the lower were the nurses’ psychological symptoms. Further research on the mental health of nurses is warranted.

IMPLICATIONS FOR NURSING AND HEALTH POLICY: Institutions should manage human resources to enable periodic rotation of nurses’ work and working periods related to COVID-19. In addition, hospital managers should provide sufficient personal protective equipment, related education, and safety climate.

PMID:33894067 | DOI:10.1111/inr.12679

Laryngoscope. 2021 Apr 24. doi: 10.1002/lary.29585. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to add to the body of evidence for efficacy of Superior Laryngeal Nerve (SLN) blocks for treatment of neurogenic cough. Efficacy at short- and long-term intervals are presented as well as relationships with laryngoscopic findings.

METHODS: A retrospective chart review of patients treated with SLN block between 2018 and 2020 was conducted. Patient demographics, videostroboscopic findings, and patient-subjective perception of outcomes were recorded and analyzed. Cough Severity Index (CSI) scores from pre-injection, short-term follow-up, and long-term follow-up were compared.

RESULTS: Twenty patients underwent SLN block in the clinic setting. Four patients were excluded for incomplete records. The indication was neurogenic cough refractory to medical management and/or cough suppression therapy. Patients with short-term follow-up (n = 13) had statistically significant decrease in CSI scores, with a mean baseline CSI of 24.3 decreasing to 16.15 (P = .006). Patients with evidence of Vocal Fold Motion/Vibratory Abnormalities (VFA) (n = 8) showed improvement in short-term CSI scores, with a mean baseline CSI of 24.13 decreasing to 14.5 (P = .004). Those without evidence of VFA did not have statistically significant improvement in short-term CSI scores. At long-term follow-up, patients with VFA had improvements that approached statistical significance with a mean baseline CSI of 22.56 decreasing to 14.56 (P = .057), while patients without VFA showed no improvement.

CONCLUSIONS: Our results are consistent with previous literature indicating efficacy of SLN block. The presence of VFA may be an indicator of patients who experience increased therapeutic effect.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2021.

PMID:33894012 | DOI:10.1002/lary.29585

Biochem Mol Biol Educ. 2021 Apr 24. doi: 10.1002/bmb.21523. Online ahead of print.

ABSTRACT

In the past 5 years, the MOOC-based teaching method has been extensively applied as an experimental educational method in medical education in China. However, the effects of this teaching method on medical education are still controversial and ambiguous. To assess the effectiveness of the MOOC-based teaching method in medical education in China, we conducted the meta-analysis. Literature search was performed through the PubMed, Embase, Web of Knowledge and CNKI databases through March 3, 2020. Studies evaluating the effectiveness of the MOOC-based teaching method in medical education in China were included in our meta-analysis. All data were pooled using a fixed- or random-effect model based on a heterogeneity test. Hedges’ g was calculated to evaluate the effectiveness of the MOOC-based teaching method on the final exam knowledge scores of participants. Subgroup analyses were also carried out. There were 27 studies (25 records) identified in our meta-analysis. The final exam knowledge scores of participants were statistically higher in the MOOC group compared with the controls in medical courses in China (Hedges’ g = 1.080, 95%CI 0.592-1.567, p < 0.001). Obvious heterogeneity across studies was found in the study. Further analysis demonstrated that a significant difference in favor of the MOOC-based teaching method compared with the traditional teaching method in medical students and doctors. The MOOC-based teaching method may be applicable to medical education in China, strengthening the roles of MOOCs in medical education.

PMID:33894023 | DOI:10.1002/bmb.21523

Int J Clin Pract. 2021 Apr 24:e14269. doi: 10.1111/ijcp.14269. Online ahead of print.

ABSTRACT

AIMS: To assess the effect of oral anticoagulant (OAC) administration on incidence of dementia in patients with atrial fibrillation (AF) with Systematic review and meta-analysis.

METHODS: We systematically searched the electronic databases including Pubmed, Embase, Cochrane library, and ClinicalTrails.gov for relevant articles. The primary outcome was the incidence of dementia. The adjusted risk ratio (RR), odds ratio, or hazard ratio were extracted and pooled by the random-effects models. Subgroup analysis was performed according to the setting observational window. Risk of bias was assessed using the Newcastle-Ottawa Scale, while publication bias was assessed by the Begg’s and Egger’s tests.

RESULTS: Nine studies were included in this review (2 prospective and 7 retrospective observational studies, including 613,920 patients). The results presented the significant association between OAC therapy and the reduced risk of dementia compared with no treatment (RR [95%CI] =0.72 [0.60, 0.86], I² =97.2%; P =0.000). In the subgroup analysis with an observational window, the pooled RR became statistically non-significant (including four studies, RR [95%CI] =0.75 [0.51, 1.10], I² =98.8%; P =0.000). There is no significant risk of bias and publication bias.

CONCLUSIONS: This study indicated the protective effect of OAC therapy for dementia in patients with AF. However, the results are limited because of high heterogeneity, inconsistent direction of effect in subgroup analysis with an observational window. Further prospective well-designed study is needed with longer follow-up duration in younger patients.

PMID:33894031 | DOI:10.1111/ijcp.14269

Sci China Life Sci. 2021 Apr 20. doi: 10.1007/s11427-020-1896-x. Online ahead of print.

ABSTRACT

Evidence about the response patterns of fruit and vegetable consumption with the risk of cardiovascular disease (CVD) and all-cause mortality was inconsistent. These associations were examined using a large-scale, population-based Chinese cohort comprising 100,728 participants. A food-frequency questionnaire was used to assess fruit and vegetable consumption. Outcomes were ascertained by interviewing individuals or their proxies and checking hospital records or death certificates. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). At the 736,668 person-years of follow-up, 3,677 CVD cases and 5,466 deaths were identified. The multivariable-adjusted HRs for CVD across increasing quartiles of total fruit and vegetable consumption were 1 (reference), 0.94 (95%CI=0.85-1.04), 0.89 (95%CI=0.80-0.98), and 0.85 (95% CI=0.11-0.95). Moreover, participants in the highest quartile displayed a 13% lower risk of all-cause mortality (HR=0.81; 95% CI=0.80-0.95). A nonlinear dose-response relation was found for CVD, without additional benefits beyond a consumption of 600 g d^-1, whereas the all-cause mortality risk decreased along with higher consumption, with a linear trend. These associations remained significant for fruit consumption but not for vegetable consumption. Our findings indicated that greater fruit and vegetable consumption was significantly associated with a lower risk of CVD and all cause mortality. Increasing fruit and vegetable consumption, especially fruit, in the general population would prevent CVD and premature mortality.

PMID:33893978 | DOI:10.1007/s11427-020-1896-x

Scand J Caring Sci. 2021 Apr 24. doi: 10.1111/scs.12987. Online ahead of print.

ABSTRACT

BACKGROUND: Care left undone is a worldwide problem for both the quality of health care and the safety of patients. In surgical nursing, care left undone is a critical issue arising from the intensive pace of work, invasive procedures and the pressure for efficiency. Previous knowledge about care left undone in surgical contexts is missing.

OBJECTIVE: To describe care left undone and its relationship to nursing and organisational characteristics in the surgical wards of regional and central hospitals in Estonia.

METHODS: A cross-sectional study with an online questionnaire took place from June to October of 2018. The target population (N = 570) consisted of nurses working in the surgical wards of two regional and three central hospitals at the time of the study. The data were analysed using descriptive statistics and Fisher’s exact test. The open-ended questions were analysed with deductive content analysis.

RESULTS: Nursing care in the surgical wards was reported as having been left undone sometimes or often by 88% of the nurses. Most often, the documentation and evaluation of care plans (33%) were reported as undone and most rarely, disinfection measures were left undone (5%). Nurses with a shorter employment history left care undone more frequently, and when the number of patients per nurse increased, the amount of care left undone increased as well. More than half of the participants (59%) considered work organisation to be the cause of care left undone.

CONCLUSIONS: Work organisation and staffing in surgical wards require more attention at the management level, as nursing care left undone occurred to a significant degree in the investigated wards, and more than half of the nurses considered work organisation to be the reason for care left undone.

PMID:33894008 | DOI:10.1111/scs.12987

Scand J Caring Sci. 2021 Apr 24. doi: 10.1111/scs.12991. Online ahead of print.

ABSTRACT

AIM: To investigate if acupuncture reduces nausea and vomiting in terminally ill patients.

DESIGN: A comparative effectiveness research design was used to generate evidence-based knowledge close to practice for the use of clinicians. The sample size was calculated to 136 patients randomised into an intervention and a control group, respectively. Nausea and vomiting were measured using the EORTC QLQ-c15-PAL (European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire, core 15, Palliation).

LOCATION: The trial was conducted among terminally ill patients admitted to three in-bed hospices in Demark.

PARTICIPANTS: Terminally ill patients suffering from nausea and/or vomiting; 95% of patients had cancer.

INTERVENTION: The intervention group received acupuncture in addition to usual care for three days. We used the acupuncture spots: Pericardium-6, Stomach-36, Liver-3 and Yin Tang. The control group received usual care only.

RESULTS: In total, 136 patients were randomised, 24 patients withdrew resulting in a total sample of 112 patients: 52 patients in the intervention group and 60 patients in the control group. In the intervention group, 75% of the patients experienced a reduction of their nausea score after the intervention compared to 55% in the control group. The statistical difference was p = 0.028. In the intervention group, 52% of the patients did not experience nausea at all after the intervention compared to 30% in the control group. In the intervention group, 31% of the patients were still vomiting after the intervention compared to 34% in the control group; no statistically significant difference was found.

CONCLUSION: Acupuncture reduced the experience of nausea among terminally ill patients but did not reduce vomiting. Thus, acupuncture is recommended to reduce nausea among terminally ill patients.

PMID:33894009 | DOI:10.1111/scs.12991

Pharmacoecon Open. 2021 Apr 24. doi: 10.1007/s41669-021-00263-w. Online ahead of print.

ABSTRACT

INTRODUCTION: The type of methods used in economic evaluations of health technology can lead to results that may influence decisions. Despite the potential impact on decision making, there is very little documentation of methods used in economic evaluation in oncology pertaining to key assumptions and extrapolation methods of survival benefits, especially in terms of survival analysis techniques and methods for extrapolation.

OBJECTIVES: The primary objectives of this study were to identify, examine, and describe the methods used in economic evaluations in oncology over a 10-year period, while secondary objectives included examining the use of identified methods across different geographic regions.

METHODS: A systematic search of the published oncology literature was conducted to identify economic evaluations of advanced or metastatic cancers published between 2010 and 2019 using the PUBMED, Ovid MEDLINE, and EMBASE databases. A random sample was taken, and information on type of study, data source, modeling techniques, and survival analysis methods were abstracted and descriptively summarized.

RESULTS: A total of 8481 abstracts were identified and 76 economic evaluations were abstracted and assessed. Most identified studies were from North America (38%), East Asia (21%), continental Europe (18%), or the UK (16%), and most commonly focused on lung cancer (18%), colorectal cancer (16%), or breast cancer (13%). A large majority of studies were based on data from randomized controlled trials (82%), utilized a cost-utility approach (82%), and took a public healthcare system perspective (83%). Common model structures included Markov (49%) and partitioned survival (17%). Fitted parametric curves were the most commonly used extrapolation method (89%) for overall survival and most often utilized the Weibull distribution (64%). Secondary assessments showed modest regional variation in the use of identified methods, including the use of fitted parametric curves, testing of the proportional hazards assumption, and validation of results.

CONCLUSION: A majority of papers in the study sample reported basic characteristics of study type, data source used, modeling techniques, and utilization of survival analysis methods. However, greater detail in reporting extrapolation methods, statistical analyses, and validation of results could be potential improvements, especially across regions, in order to support greater consistency in decision making. Future research could document the diffusion of novel modeling techniques into economic evaluation.

PMID:33893974 | DOI:10.1007/s41669-021-00263-w

J Autism Dev Disord. 2021 Apr 23. doi: 10.1007/s10803-021-04988-9. Online ahead of print.

ABSTRACT

The addition of ‘clinically significant impairment’ (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, Author, 2013) to the diagnostic criteria for autism in DSM-5 attempts to establish a threshold for the condition. However, the increased prominence of the neurodiversity paradigm and social model of disability runs counter to the idea that characteristics of autism are fundamentally impairing. Consequently, diagnostic criteria for autism are becoming misaligned with the contemporary views of ‘disorder’ and ‘disability’. In this commentary, we outline six clinical issues that arise from this misalignment during diagnostic assessment for autism, and the tension this creates in making diagnostic decisions. We conclude by considering ways the ‘clinically significant impairment’ criterion could be changed, and the implications this would have on clinical practice, and the concept of autism.

PMID:33893595 | DOI:10.1007/s10803-021-04988-9