Category: Statistics

J Nurs Manag. 2021 Aug 26. doi: 10.1111/jonm.13465. Online ahead of print.

ABSTRACT

AIM: The purpose was to evaluate an innovative Prospective Hiring Equation to determine registered nurse hiring needs.

BACKGROUND: The American Organization for Nursing Leadership identifies human resource management as a competency for nurse managers, yet calculations to determine when and how many registered nurses to hire are not readily available.

METHODS: We implemented an educational intervention to teach nurse mangers the Prospective Hiring Equation. We evaluated the processes (adoption, confidence) and outcomes (vacancy rates) using a pre/post evaluation design in a single cohort of nurse managers (n=9). We used a statistical process control chart to depict mean differences in vacancy rate at baseline and 6-months post-implementation.

RESULTS: Participants (n=9) were on average 43 years’ old, female, and had 2.94 (SD=2.66) years’ of nurse manager experience. Following implementation of the intervention, the combined vacancy rates of the intensive care units improved by 11.8% (SD=7), and use of agency nurses decreased by 42.5% (pre-median=7.2, interquartile ratio=3.6, 10.8; post-median=1.8, interquartile ratio 0.9, 8.55).

CONCLUSIONS: The Prospective Hiring Equation may be a useful tool to improve nurse managers human resource management competencies.

IMPLICATIONS FOR NURSING MANAGEMENT: The Prospective Hiring Equation may help nurse managers improve accuracy when evaluating hiring needs.

PMID:34437739 | DOI:10.1111/jonm.13465

Arthritis Care Res (Hoboken). 2021 Aug 26. doi: 10.1002/acr.24771. Online ahead of print.

ABSTRACT

We thank Li et al for their commentary on our recently published paper “Mortality in Ankylosing Spondylitis According to Treatment: A Nationwide Retrospective Cohort Study of 5900 Patients from Israel” (1). Their major concern was regarding the findings which demonstrated no excess mortality in ankylosing-spondylitis (AS) patients treated with TNF-inhibitors (TNFi).

PMID:34437772 | DOI:10.1002/acr.24771

S D Med. 2021 May;74(5):210-219.

ABSTRACT

INTRODUCTION: Ischemic preconditioning (IPC) has been shown to induce positive effects on skeletal muscle resulting in enhanced physical performance. Data display that IPC positively impacts both aerobic and anaerobic performance. However, there is inconclusive data exemplifying IPC’s effects on power and sprint performance. We hypothesized 15 minutes of bilateral lower limb IPC, applied 25-45 minutes prior to power and sprint activity, would enhance power and sprint performance.

METHODS: Using a randomized crossover design, 14 NCAA Division II athletes received IPC (100 percent occlusion) and sham (50 mmHg) treatments followed by either a 0 minute or a 20 minute rest. A Delfi Personalized Tourniquet System (PTS) for blood flow restriction with an internal doppler radar was used to occlude blood flow to the lower extremities. Followed by IPC treatment, power and sprint performance was assessed using a vertical jump, reactive strength index (RSI), broad jump, flying 10m dash, and pro-agility. Each of the fourteen subjects in the experimental group received all four protocols.

RESULTS: Using an ANOVA, no statistical significance was found between the type of treatment (i.e., sham 0 min, sham 20 min, IPC 0 min, IPC 20 min) and the performance tests: vertical jump (p=0.97), RSI (p=0.73), broad jump (p=0.98), flying 10m dash (p=0.99), and pro-agility (p=0.90). In addition, no statistical significance was found between the order of treatments and the performance tests (p=0.97).

CONCLUSION: Despite previous research suggesting IPC enhances anaerobic and anaerobic performance, the current results indicate IPC doesn’t significantly enhance power and sprint performance in highly trained athletes.

PMID:34437779

Biometrics. 2021 Aug 26. doi: 10.1111/biom.13553. Online ahead of print.

ABSTRACT

Biomedical research is increasingly data rich, with studies comprising ever growing numbers of features. The larger a study, the higher the likelihood that a substantial portion of the features may be redundant and/or contain contamination (outlying values). This poses serious challenges, which are exacerbated in cases where the sample sizes are relatively small. Effective and efficient approaches to perform sparse estimation in the presence of outliers are critical for these studies, and have received considerable attention in the last decade. We contribute to this area considering high-dimensional regressions contaminated by multiple mean-shift outliers affecting both the response and the design matrix. We develop a general framework and use mixed-integer programming to simultaneously perform feature selection and outlier detection with provably optimal guarantees. We prove theoretical properties for our approach, i.e., a necessary and sufficient condition for the robustly strong oracle property, where the number of features can increase exponentially with the sample size; the optimal estimation of parameters; and the breakdown point of the resulting estimates. Moreover, we provide computationally efficient procedures to tune integer constraints and warm-start the algorithm. We show the superior performance of our proposal compared to existing heuristic methods through simulations and use it to study the relationships between childhood obesity and the human microbiome. This article is protected by copyright. All rights reserved.

PMID:34437713 | DOI:10.1111/biom.13553

Cochrane Database Syst Rev. 2021 Aug 26;8:CD009380. doi: 10.1002/14651858.CD009380.pub3.

ABSTRACT

BACKGROUND: Glaucoma is one of the leading largely preventable causes of blindness in the world. It is usually addressed first medically with topical intraocular pressure-lowering drops or by laser trabeculoplasty. In cases where such treatment fails, glaucoma-filtering surgery such as trabeculectomy, is commonly considered. Surgeons can differ in their technique when performing trabeculectomy, for example, the choice of the type of the conjunctival flap (fornix- or limbal-based). In a fornix-based flap, the surgical wound is performed at the corneal limbus; while in a limbal-based flap, the incision is further away. Many studies in the literature compare fornix- and limbal-based trabeculectomy with respect to outcomes and complications.

OBJECTIVES: To assess the comparative effectiveness of fornix- versus limbal-based conjunctival flaps in trabeculectomy for adult glaucoma, with a specific focus on intraocular pressure (IOP) control and complication rates (adverse effects).

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 3); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 23 March 2021. There were no restrictions to language or year of publication.

SELECTION CRITERIA: We included RCTs comparing the benefits and complications of fornix- versus limbal-based trabeculectomy for glaucoma, irrespective of glaucoma type, publication status, and language. We excluded studies on children less than 18 years of age, since wound healing is different in this age group and the rate of bleb scarring postoperatively is high.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as per Cochrane criteria. MAIN RESULTS: We did not identify any new eligible studies for this review update. As presented in the original review, we included six trials with a total of 361 participants. Two studies were conducted in the USA and one each in Germany, Greece, India, and Saudi Arabia. The participants of four trials had open-angle glaucoma; one study included participants with primary open-angle or primary closed-angle glaucoma, and one study did not specify the type of glaucoma. Three studies used a combined procedure (phacotrabeculectomy). Trabeculectomy with mitomycin C (MMC) was performed in four studies, and trabeculectomy with 5-fluorouracil (5-FU) was performed in only one study. None of the included trials reported trabeculectomy failure at 24 months. Only one trial reported the failure rate of trabeculectomy as a late complication. Failure was higher among participants randomised to the limbal-based surgery: 1/50 eyes failed trabeculectomy in the fornix group compared with 3/50 in the limbal group (Peto odds ratio 0.36, 95% confidence interval (CI) 0.05 to 2.61)); therefore we are very uncertain as to the relative effect of the two procedures on failure rate. Four studies including 252 participants provided measures of mean IOP at 12 months. In the fornix-based surgeries, mean IOP ranged from 12.5 to 15.5 mmHg and similar results were noted in limbal-based surgeries with mean IOP ranging from 11.7 to 15.1 mmHg without significant difference. Mean difference was 0.44 mmHg (95% CI -0.45 to 1.33; 247 eyes) and 0.86 mmHg, (95% CI -0.52 to 2.24; 139 eyes) at 12 and 24 months of follow-up, respectively. Neither of these pooled analyses showed a statistically significant difference in IOP between groups (moderate certainty evidence). One trial reported number of anti-glaucoma medications at 24 months of follow-up with no difference noted between surgical groups. However, three trials reported the mean number of anti-glaucoma medications at 12 months of follow-up without significant difference in the mean number of postoperative IOP-lowering medications between the two surgical techniques. Mean difference was 0.02, (95% CI -0.15 to 0.19) at 12 months of follow-up (high certainty evidence). Because of the small numbers of events and total participants, the risk of many reported adverse events was uncertain and those that were found to be statistically significant may have been due to chance. For risk of bias assessment: although all six trials were randomised selection bias was mostly unclear, with unclear random sequence generation in four of the six studies and unclear allocation concealment in five of the six studies. Attrition bias was encountered in only one trial which also suffered from reporting bias. All other trials had an unclear risk of reporting bias as there was no access to study protocols. All included trials were judged to have high risk of detection bias due to lack of masking of the outcomes. Trabeculectomy is quite a standard procedure and unlikely to induce bias due to surgeon ‘performance’, hence performance bias was not evaluated.

AUTHORS’ CONCLUSIONS: The main result of this review was that there was uncertainty as to the difference between fornix- and limbal-based trabeculectomy surgeries due to the small number of events and confidence intervals that cross the null. This also applied to postoperative complications, but without any impact on long-term failure rate between the two surgical techniques.

PMID:34437715 | DOI:10.1002/14651858.CD009380.pub3

Res Nurs Health. 2021 Aug 26. doi: 10.1002/nur.22179. Online ahead of print.

ABSTRACT

Breastfeeding self-efficacy is a relevant predictor of exclusive breastfeeding during the first six months of life. The Prenatal Breastfeeding Self-Efficacy Scale (PBSES) is a 20-item tool developed to determine breastfeeding self-efficacy during pregnancy. Our study aimed to assess the structural validity and psychometric characteristics of the PBSES and to explore item reduction according to the statistical criteria for parsimony and incremental validity. In this study, conducted in six hospitals in eastern Spain, we recruited 1183 women with healthy, full-term, single-birth newborns. Data on sociodemographic, breastfeeding-related variables, and the PBSES, were obtained from self-administered questionnaires during the third trimester of pregnancy, at postpartum discharge, and 5 months postpartum, and from a phone survey 12 months postpartum. Item reduction was conducted after revising the PBSES item floor and ceiling effects, interitem correlations, and item-score relationships with breastfeeding-status variables during follow-up. The factorial structure of the short form of the PBSES (PBSES-SF) was tested using both exploratory and confirmatory approaches. After item reduction, the confirmatory factor analysis of the 12 remaining items of the PBSES-SF revealed adequate fit statistics for a three-factor structure and a second-order factor. Internal consistency was measured using the Cronbach’s α coefficient of the PBSES-SF (0.86). We provided evidence on the discriminant validity of the PBSES-SF by comparing its scores between known groups, convergent validity by examining its correlations with other variables, and predictive validity by assessing the association of PBSES-SF scores with breastfeeding behavior at critical points in time during the first postpartum year.

PMID:34437707 | DOI:10.1002/nur.22179

J Anim Ecol. 2021 Aug 26. doi: 10.1111/1365-2656.13578. Online ahead of print.

ABSTRACT

1. Body condition is an important concept in behaviour, evolution and conservation, commonly used as a proxy of an individual’s performance, for example in the assessment of environmental impacts. Although body condition potentially encompasses a wide range of health state dimensions (nutritional, immune or hormonal status), in practice most studies operationalize body condition using a single (univariate) measure, such as fat storage. One reason for excluding additional axes of variation may be that multivariate descriptors of body condition impose statistical and analytical challenges. 2. Structural equation modelling (SEM) is used in many fields to study questions relating multidimensional concepts, and we here explain how SEM is a useful analytical tool to describe the multivariate nature of body condition. In this “How To” paper, we show how SEM can be used to resolve different challenges in analysing the multivariate nature of body condition, such as (i) variable reduction and conceptualization, (ii) specifying the relationship of condition to performance metrics, (iii) comparing competing causal hypothesis, and (iv) including many pathways in a single model to avoid stepwise modelling approaches. We illustrated the use of SEM on a real-world case study, and provide R-code of worked examples as a learning tool. 3. We compared the predictive power of SEM with conventional statistical approaches that integrate multiple variables into one condition variable: multiple regression and principal component analysis. We show that model performance on our dataset is higher when using SEM, and led to more accurate and precise estimates compared to conventional approaches. 4. We encourage researchers to consider SEM as a flexible framework to describe the multivariate nature of body condition and thus understand how it affects biological processes, thereby improving the value of body condition proxies for predicting organismal performance. Finally, we highlight that it can be useful for other multidimensional ecological concepts as well, such as immunocompetence, oxidative stress and environmental conditions.

PMID:34437709 | DOI:10.1111/1365-2656.13578

R I Med J (2013). 2021 Sep 1;104(7):55-58.

ABSTRACT

PURPOSE: Concern about the decline in physician scientists has generated interest in promoting research participation among medical students. This study aimed to examine perceptions of research and research-oriented careers among college-level baccalaureate-MD (BA/MD) students at one institution in the United States.

METHODS: A cross-sectional survey was distributed to a sample of 241 BA/MD students. Descriptive statistics were used to examine research perceptions of participants.

RESULTS: The response rate was 52% (126/241). Most respondents conducted scientific research in high school and were interested in research-oriented careers. Most students participated in a research program (research course, faculty mentorship, or research grant), disseminated their research, and believed that research programs would be helpful for their research participation. The most common perceived barriers were a lack of time, interest, and prior research experience.

CONCLUSIONS: College-level BA/MD students had positive perception of research-oriented careers and found student research programs helpful. However, addressing key barriers such as lack of time, interest and experience will help expand BA/MD student engagement in research.

PMID:34437667

Arch Pathol Lab Med. 2021 Aug 26. doi: 10.5858/arpa.2020-0779-EP. Online ahead of print.

ABSTRACT

CONTEXT.—: Acquiring objective, timely, and comprehensive feedback on resident diagnostic performance is notoriously difficult.

OBJECTIVE.—: To implement a custom software application (Resident Case Tracker) to improve evaluative diagnostic analysis for residency programs.

DESIGN.—: Residents and faculty use a graphical user interface with restricted access to their own cases and evaluations. For each sign-out, residents enter their diagnoses and comments for each case. Faculty are provided a sign-out queue to review the resident diagnosis and select their level of agreement alongside optional comments. After sign-out, residents can review the agreement level and comments for each case, overall sign-out statistics, and organ-specific performance, and they have the option of opening and reviewing groups of cases by agreement status. A sign-out evaluation is automatically generated and stored alongside additional reports. Administrative access allows privileged users to readily review data analytics at both an individual and residency-wide global level.

RESULTS.—: A marked increase in completed evaluations and feedback was noted in the initial 36 months of implementation. During a 3-year academic period, faculty completed individual feedback on 33 685 cases and 1073 overall sign-out evaluations.

CONCLUSIONS.—: Resident Case Tracker is an invaluable tool for our residency program and has provided unparalleled feedback and data analytics. Throughout residency, trainees have access to each completed sign-out with the ability to learn from discrepant cases while also monitoring improvements in diagnostic acumen over time. Faculty are able to assess resident milestones much more effectively while more readily identifying residents who would benefit from targeted study.

PMID:34437701 | DOI:10.5858/arpa.2020-0779-EP

PLoS One. 2021 Aug 26;16(8):e0256801. doi: 10.1371/journal.pone.0256801. eCollection 2021.

ABSTRACT

Minimal residual disease (MRD) appeared to be a potent prognostic indicator in patients with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL), with potential value in informing individualized treatment decisions. Hence, we performed herein a systemic literature review and meta-analysis to comprehensively address the prognostic value of MRD in Ph+ ALL. Systematic literature review was conducted in PubMed, Embase, and Cochrane databases with the data access date up to September 23, 2020. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models. Furthermore, subgroup analyses were performed to assess the robustness of the associations. 27 studies with a total number of 3289 patients were eligible for this meta-analysis. Combined HRs suggested that MRD positivity was associated with inferior event-free survival (EFS) (HR = 2.00, 95% CI 1.77-2.26) and overall survival (OS) (HR = 2.34, 95% CI 1.86-2.95). The associations remained statistically significant in subgroup analyses including age group, MRD timing, disease status at MRD, MRD cutoff level, et al. Our findings suggested MRD as a potent clinical tool for assessing the prognosis of Ph+ ALL. Further studies using MRD-based risk stratification might help optimize individualized treatment strategies for Ph+ ALL patients.

PMID:34437635 | DOI:10.1371/journal.pone.0256801