Category: Statistics

World J Surg. 2021 Apr 17. doi: 10.1007/s00268-021-06126-z. Online ahead of print.

ABSTRACT

BACKGROUND: There are controversies about the ability of neutrophil to lymphocyte ratio to predict the recurrence and survival in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation. The objective of this study is to investigate the prognostic potential of combined lymphocyte count (LC) and neutrophil count (NC) in LARC patients treated with chemoradiotherapy (CRT) followed by curative surgery.

METHODS: Patients with LARC who underwent surgical resection between January 2010 and December 2017 were reviewed retrospectively. We divided the patients into three groups: high LC and low NC, low LC and high NC, and the remaining patients. The cut-off values of LC and NC were determined by receiver operating characteristic curve analysis and log-rank test statistics. We compared the disease-free survival (DFS) rate between the groups.

RESULTS: A total of 176 consecutive patients were included in this study. The 5 year DFS rate was significantly different among the three groups in pathologic node (pN)+ patients (73.2% vs. 61.9% vs. 14.2%; P = 0.025). Cox multivariate analysis for pN+ patients demonstrated that combination of low LC and high NC (hazard ratio, 3.630; 95% confidence interval [CI], 1.306-10.093; P = 0.013) was significantly correlated with decreased DFS.

CONCLUSIONS: This study showed that the combination of LC and NC is a powerful predictive factor for disease recurrence in pN+ LARC patients who underwent CRT.

PMID:33866423 | DOI:10.1007/s00268-021-06126-z

J Radiat Res. 2021 Apr 19:rrab021. doi: 10.1093/jrr/rrab021. Online ahead of print.

ABSTRACT

We aimed to assess the predictive value of the modified Glasgow prognostic score (mGPS) in patients with non-small cell lung cancer (NSCLC) who underwent stereotactic body radiation therapy (SBRT). We retrospectively reviewed the records of 207 patients, with a median age of 79 years. The pretreatment mGPS was calculated and categorized as high (mGPS = 1-2) or low (mGPS = 0). The median follow-up duration was 40.7 months. The five-year overall survival (OS), progression-free survival (PFS) and time to progression (TTP) rates were 44.3%, 36% and 54.4%, respectively. Multivariate analysis revealed that mGPS was independently predictive of OS (hazard ratio [HR] 1.67; 95% confidence interval 1.14-2.44: P = 0.009), PFS (HR 1.58; 1.10-2.28: P = 0.014) and TTP (HR 1.66; 1.03-2.68: P = 0.039). Patients who had high mGPS showed significantly worse OS (33.3 vs 64.5 months, P = 0.003) and worse PFS (23.8 vs 39 months, P = 0.008) than those who had low mGPS. The data showed a trend that patients with high mGPS suffered earlier progression compared to those with low mGPS (54.3 vs 88.1 months, P = 0.149). We confirmed that mGPS is independently predictive of prognosis in NSCLC patients treated with SBRT.

PMID:33866376 | DOI:10.1093/jrr/rrab021

Value Health Reg Issues. 2021 Apr 14;25:104-107. doi: 10.1016/j.vhri.2020.10.008. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide real-world data on the impact of autologous hematopoietic stem cell transplantation (AHSCT) on treatment costs of patients with multiple sclerosis (MS) in Poland.

METHODS: Medical data of 105 patients who underwent AHSCT in the years 2011 to 2016 were obtained from the National Health Fund (NHF) database. Treatment costs were calculated from the public payer’s perspective per patient-year for the total available period as well as 12 months before and after AHSCT. The statistical analysis was performed using MATLAB 2016b.

RESULTS: Mean treatment-related costs covered by the NHF per patient-year before and after the transplantation were €4314.9 and €1188.8 , respectively. The average cost of disease-modifying drugs per patient was reduced from €2497.9/year before to €65.3/year after AHSCT.

CONCLUSIONS: Although the initial cost of AHSCT is high, the costs involving AHSCT and post-AHSCT treatment could, according to our analysis, pay off in 3.9 years, when compared to the costs of disease-modifying drug therapy in aggressive MS. The study provides evidence that the AHSCT can lead to significant savings in treatment costs of aggressive MS from the public payer’s perspective.

PMID:33865219 | DOI:10.1016/j.vhri.2020.10.008

JMIR Form Res. 2021 Apr 17. doi: 10.2196/25503. Online ahead of print.

ABSTRACT

BACKGROUND: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCP). Health information and communication technologies can potentially facilitate these efforts in order to increase the quality of care received by CSHCN.

OBJECTIVE: In this study, we assessed the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs.

METHODS: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary like the SpeakHealth app. Quantitative data was analyzed through descriptive statistics and correlational analysis. Theoretical thematic analysis was used for analyzing qualitative data.

RESULTS: Survey results reported a positive attitude towards voice enabled technology and features, however there was no strong correlation among measured items. Caregivers identified communication, information sharing, tracking medication and appointments as fairly and highly important features in the app. Qualitative analysis revealed 2 overarching themes: “Enablers and barriers in care communication” and “Enablers and barriers in communication technologies”. Subthemes included parent roles, care communication technologies and challenges. HCPs found the SpeakHealth app promising for timely information collection that could be available for sharing with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN as well as opportunities for voice interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCP. Healthcare and communication technologies can potentially improve care communications and coordination addressing the needs.

CONCLUSIONS: We believe the perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and health events tracking at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app.

PMID:33865233 | DOI:10.2196/25503

Ann Diagn Pathol. 2021 Mar 31;52:151738. doi: 10.1016/j.anndiagpath.2021.151738. Online ahead of print.

ABSTRACT

INTRODUCTION: The TNM staging system is the main prognostic tool for GC, but the number of metastatic lymph nodes (LN) can be affected by surgical, pathological, tumor or host factors. Several authors have shown that lymph node ratio (LNR) may be superior to TNM staging in GC. However, cut-off values vary between studies and LNR assessment is not standardized.

MATERIAL AND METHODS: Retrospective study of all GC resected in a western tertiary center (N = 377). Clinical features were collected and pathological features were assessed by two independent pathologists. Eight LNR classifications were selected and applied to our patients. Statistical analyses were performed.

RESULTS: 315 patients were included. Most tumors were T3 (49.2%) N+ (59.3%). During follow-up, 36.7% of patients progressed and 27.4% died due to tumor. All LNR classifications were significantly associated with clinicopathological features such as Laurén subtype, lymphovascular invasion, perineural infiltration, T stage, tumor progression or death. All LNR classifications were independent prognostic factors for OS and DFS, and ROC analyses calculated similar AUC values for all staging systems. Kaplan-Meier curves showed that Pedrazzani, Wang, Liu and Huang classifications stratified patients better into three (Pedrazzani) or four categories. These classifications tended to downstage TNM N2 and N3 tumors. In cases with less than 16 LNs resected, Pedrazzani and Wang classifications showed the best prognostic performance.

CONCLUSIONS: Pedrazzani, Wang, Liu and Huang classifications showed good prognostic performance in western GC patients. Larger studies in other cohorts are needed to identify the most consistent LNR classification for GC.

PMID:33865185 | DOI:10.1016/j.anndiagpath.2021.151738

Nurse Educ Today. 2021 Apr 9;101:104890. doi: 10.1016/j.nedt.2021.104890. Online ahead of print.

ABSTRACT

BACKGROUND: The assessment of reasoning skills is recommended in undergraduate nursing student selection. Reasoning skills are crucial for sound decision-making, improving patient safety and are necessary from the very beginning of studies. Nursing applicants’ reasoning skills based on the reasoning process have not been previously measured.

OBJECTIVES: To assess undergraduate nursing applicants’ reasoning skills and factors related to them.

DESIGN: A cross-sectional study.

SETTING AND PARTICIPANTS: Undergraduate nursing applicants (n = 1056, response rate 55.4%), who consented to the study and performed a joint electronic entrance examination to six Finnish Universities of Applied Sciences in spring 2019, participated in the study.

METHODS: The Reasoning Skills (ReSki) test, based on the steps of the reasoning process, was used, comprising three question sections (collecting information, processing information, and identifying the problem and establishing goals). Background variables were collected through a questionnaire and the Positive System Usability Scale (P-SUS). The data were analysed with descriptive statistics, Pearson correlation coefficients and analysis of covariance with Tukey’s test in post-hoc multiple group comparisons.

RESULTS: Applicants’ total reasoning skills mean scores were above the centre of the range of possible scores (2.72/4.5, SD = 0.80). The applicants scored higher in collecting and processing information than in identifying the problem and establishing goals. Standard deviations demonstrated variance between the applicants’ ability. Age, gender, and previous education were statistically significantly related to applicants’ reasoning skills. Previous work experience was statistically significantly related to success only in the step of identifying the problem and establishing goals.

CONCLUSIONS: Nursing applicants’ reasoning skills vary in the student selection phase. Applicants are less able to identify the problem and establish goals than to collect and process information. Vocational education does not necessarily develop adequate reasoning skills and thus prepare students for higher education studies. The results have implications for educational institutions and further research.

PMID:33865188 | DOI:10.1016/j.nedt.2021.104890

Eur J Cancer. 2021 Apr 14;149:184-192. doi: 10.1016/j.ejca.2021.01.055. Online ahead of print.

ABSTRACT

BACKGROUND: RAS variant-related functional impact on the mitogen-activated protein kinase (MAPK) pathway, and correlation between MAPK activation and MAPK/ERK kinase (MEK) inhibitor responsiveness, is not established.

PATIENTS AND METHODS: Of 1,693 tumours sequenced, 576 harboured a RAS alteration; 62 patients received an MEK inhibitor (MEKi) and had RAS mutations that were functionally characterised. We report that RAS mutants have variable levels of MAPK activity, as measured by a functional cell-based assay that quantified MAPK pathway activation after transfection with a variety of RAS mutations.

RESULTS: Patients with tumours harbouring RAS alterations with high versus low MAPK activity who were treated with an MEKi showed significantly longer median progression-free survival (PFS) (5.0 vs. 2.3 months; p = 0.0034) and overall survival (20.0 vs. 5.0 months; p = 0.0146) and a trend towards higher rates of clinical benefit (stable disease ≥6 months or partial/complete remission) (38% versus 15%; p = 0.095) (p-values as per univariate analysis). PFS remained statistically significant after the multivariate analysis (p = 0.003).

CONCLUSIONS: These results support a correlation between RAS-mutant cancers with greater MAPK signalling and PFS after MEKi treatment.

PMID:33865203 | DOI:10.1016/j.ejca.2021.01.055

Asian J Psychiatr. 2021 Apr 6;60:102651. doi: 10.1016/j.ajp.2021.102651. Online ahead of print.

ABSTRACT

Neuropsychological impairments represent a central feature of psychosis-spectrum disorders. It is characterized by a great both within- and between-subjects variability (i.e. cognitive heterogeneity), which needs to be better disentangled. The present study aimed to describe the distribution of performance on the Brief Assessment of Cognition in Schizophrenia (BACS) by using the Equivalent Scores, in order to balance statistical methodological problems. To do so, cognitive performance groups were branded, identifying the main factors contributing to cognitive heterogeneity. A sample of 583 patients with a diagnosis of Schizophrenia or Psychotic Disorder Not Otherwise Specified was enrolled and assessed for neurocognition and intellectual level. K-means cluster analysis was performed based on BACS Equivalent Scores. Differences among clusters were analyzed throughout Analysis of Variance and Discriminant Function Analysis in order to identify the most significant predictors of cluster membership. For each cognitive task, roughly 40% of patients displayed poor performance, while up to 63% displayed a symbol-coding deficit. K-means cluster analysis depicted three profiles characterized by “near-normal” cognition, widespread impairment, and “borderline” profile. Discriminant analysis selected Verbal IQ and diagnosis as predictors of cluster membership. Our findings support the usefulness of Equivalent Scores and cluster analysis to explain cognitive heterogeneity, and tailor better interventions.

PMID:33865160 | DOI:10.1016/j.ajp.2021.102651

Tuberculosis (Edinb). 2021 Apr 10;128:102082. doi: 10.1016/j.tube.2021.102082. Online ahead of print.

ABSTRACT

Host markers to monitor the response to tuberculosis (TB) therapy hold some promise. We evaluated the changes in concentration of Mycobacterium tuberculosis (M.tb)-induced soluble biomarkers during early treatment for predicting short- and long-term treatment outcomes. Whole blood samples from 30 cured and 12 relapsed TB patients from diagnosis, week 1, 2, and 4 of treatment were cultured in the presence of live M.tb for seven days and patients followed up for 24 weeks after the end of treatment. 57 markers were measured in unstimulated and antigen-stimulated culture supernatants using Luminex assays. Top performing multi-variable models at diagnosis using unstimulated values predicted outcome at 24 months after treatment completion with a sensitivity of 75.0% (95% CI, 42.8-94.5%) and specificity of 72.4% (95% CI, 52.8-87.3%) in leave-one-out cross validation. Month two treatment responder classification was correctly predicted with a sensitivity of 79.2% (95% CI, 57.8-92.9%) and specificity of 92.3% (95% CI, 64.0-99.8%). This study provides evidence of the early M.tb-specific treatment response in TB patients but shows that the observed unstimulated marker models are not outperformed by stimulated marker models. Performance of unstimulated predictive host marker signatures is promising and requires validation in larger studies.

PMID:33865162 | DOI:10.1016/j.tube.2021.102082

Surg Oncol. 2021 Apr 7;38:101564. doi: 10.1016/j.suronc.2021.101564. Online ahead of print.

ABSTRACT

BACKGROUND & OBJECTIVE: Thermal ablation is the predominant methodology to treat liver tumors for segregating patients who are not permitted to have surgical intervention. However, noticing or predicting the size of the thermal strategies is a challenging endeavor. We aim to analyze the effects of ablation district volume following radiofrequency ablation (RFA) of ex-vivo liver exploiting a custom Hyperspectral Imaging (HSI) system.

MATERIALS AND METHODS: RFA was conducted on the ex-vivo bovine liver at focal and peripheral blood vessel sites and observed by Custom HSI system, which has been designed to assess the exactness and proficiency using visible and near-infrared wavelengths region for tissue thermal effect. The experiment comprised up to ten trials with RFA. The experiment was carried out in two stages to assess the percentage of the thermal effect on the investigated sample superficially and for the side penetration effect. Measuring the diffuse reflectance (Ŗ_d) of the sample to identify the spectral reflectance shift which could differentiate between normal and ablated tissue exploiting the designed cross-correlation algorithm for monitoring of thermal ablation.

RESULTS: Determination of the diffuse reflection (Ŗ_d) spectral signature responses from normal, thermal effected, and thermal ablation regions of the investigated liver sample. Where the ideal wavelength range at (600-640 nm) could discriminate between these different regions. Then, exploited the converted RGB image of the HS liver tissue after RFA for more validations which shows that the optimum wavelength for differentiation at (530-560 nm and 600-640 nm). Finally, applying statistical analysis to validate our results presenting that wavelength 600 nm had the highest standard deviation (δ) to differentiate between various thermally affected regions regarding the normal tissue and wavelength 640 nm shows the highest (δ) to differentiate between the ablated and normal regions.

CONCLUSION: The designed and implemented medical imaging system incorporated the hyperspectral camera capabilities with the associate cross-correlation algorithm that could successfully distinguish between the ablated and thermally affected regions to assist the surgery during the tumor therapy.

PMID:33865183 | DOI:10.1016/j.suronc.2021.101564