Category: Statistics

Clin Breast Cancer. 2022 Jan 22:S1526-8209(22)00023-4. doi: 10.1016/j.clbc.2022.01.007. Online ahead of print.

ABSTRACT

INTRODUCTION: The rate of refusal of chemotherapy ranges from 3% to 19%, but varies widely by patient profile and treatment setting. Using a large national registry, we explore factors significantly associated with the decision to decline chemotherapy in patients with early-stage, HR+/HER2- breast cancer (BC) despite high risk scoring on multigene sequencing analysis for OncotypeDX (ODX) or MammaPrint (MP), in which the survival benefit of chemotherapy is clear.

PATIENTS AND METHODS: Patients with HR+/HER2- BC and high risk scoring on ODX (score >26) or MP were selected from the National Cancer Database (2004-2017). Only those who refused to get chemotherapy despite their physician’s recommendations were included. Univariate frequency and proportion statistics were used to describe the patient cohort. Bivariate Chi-square analysis evaluated the association between refusal of recommended chemotherapy and sociodemographic characteristics. Significant variables (P < .05) were included in a multivariable logistic regression model.

RESULTS: N = 43,533 patients were included (88.7% ODX, 11.3% MP). A total of n = 4415 (10.1%) patients declined chemotherapy despite recommendation by the patient’s primary oncologist. Age >70 (OR: 3.46, 95% CI: 2.96-4.04, P < .001), black race (OR: 1.20, 95% CI: 1.07-1.36, P = .01), non-private insurance, lobular carcinoma histology (OR: 1.21, 95% CI: 1.09-1.35, P < .001), and tumor grade of I significantly predicted chemotherapy decline.

CONCLUSION: Identifying and addressing many of the factors that contribute to under-treatment in minorities is to be key to reducing cancer disparity and improving equity in cancer care and outcome.

PMID:35190262 | DOI:10.1016/j.clbc.2022.01.007

J Sci Med Sport. 2021 Dec 29:S1440-2440(21)00560-0. doi: 10.1016/j.jsams.2021.12.009. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to document the technical and transferrable skills required for sport scientists, and perceived employment opportunities both currently and in the future with a particular emphasis on comparisons between academic and applied sport scientists.

DESIGN: Cross-sectional survey methodology.

METHODS: 117 Australian sport science employees completed an online survey capturing demographic information, perceptions about the importance of technical skills, transferable skills, future employment opportunities as well as free-text information on future careers, challenges, and opportunities for the profession. Descriptive statistics were used to summarise information and comparisons made between academic and applied sport science participants.

RESULTS: Participants were predominantly male and 35 years or younger, with half reporting they held only one position within the industry. Most technical and transferrable skills were rated as important (>4.0 out of 5.0), with practitioner-focused skills rated somewhat more important by applied sport scientists compared to scientific-focused skills rated somewhat more important by academics, and applied sport scientists generally rating transferable skills as more important compared to academics (d > 0.5). Value and supply/demand were identified as challenges to the industry with discipline-specific roles and non-elite populations considered areas for future jobs.

CONCLUSIONS: Participants felt there would be more jobs in the future and that these would be in discipline-specific roles and/or non-elite populations. Both technical and interpersonal skills were considered important for sport scientists. The greatest challenges are how sport science is valued and the potential oversupply of sport science graduates.

PMID:35190264 | DOI:10.1016/j.jsams.2021.12.009

Cancer Radiother. 2022 Jan 24:S1278-3218(22)00002-6. doi: 10.1016/j.canrad.2021.08.024. Online ahead of print.

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) epidemic continues to spread exponentially around the world. Cancer patients have a higher risk of commorbidity than the rest of the population. Radiotherapy departments are actively involved in the management of these patients, whether they have COVID or not, and it is recognized that the time taken to take charge and the continuity of treatment have a prognostic impact. The main objective was to assess the impact of the coronavirus on the treatment times of patients undergoing radiotherapy.

MATERIAL AND METHODS: This retrospective study was conducted in the radiotherapy department of Gustave-Roussy institute (France) during the period from March 3, 2020 to January 12, 2021. Organizational changes, patient care times between the day of the scan and the last radiotherapy session as well as the time taken to take charge of patients between the first session and the last radiotherapy session has been studied.

RESULTS: A total of 1183 patients were included, among which 60 had COVID-19. Patients were divided into four categories. Treatment times of patients who did not have COVID-19 and those of patients who did were not statistically significantly different.

CONCLUSION: The organization of the radiotherapy department at the Gustave-Roussy institute is based on several points: carrying out preventive screening tests, protecting staff and patients and reorganizing the patient circuit. Thanks to the performance of diagnostic tests and the implementation of a specific workflow for patients with COVID, we ensure the continuity of patient treatment in complete safety without impacting treatment times.

PMID:35190250 | DOI:10.1016/j.canrad.2021.08.024

J Pediatr Nurs. 2022 Feb 18:S0882-5963(22)00036-7. doi: 10.1016/j.pedn.2022.02.004. Online ahead of print.

ABSTRACT

BACKGROUND: Perceptions and practices of parties in pediatric pain are critical in children’s access to adequate acute pain management. The personal factors of the child and parents have been shown to be central to pediatric pain management by the Symptom Management Theory.

AIM: To describe children and parents/guardians’ perceptions (knowledge, attitudes and beliefs) and practices regarding pediatric acute pain management and explain the influence of socio-cultural and environmental factors on those perceptions and practices.

METHODS: Descriptive cross-sectional survey using modified versions of the American Pain Society Patient Outcome Questionnaire-Revised among parents/guardians and children.

RESULTS: A convenience sample of 275 parents/guardians and 42 children aged 8 to 13 years admitted between date November 2018 and February 2019 to two Botswana tertiary hospitals completed the surveys. Forty-seven percent (n = 129) of parents/guardians reported the child to be in moderate-severe pain, while 38% (n = 16) of children reported pain as moderate-severe at the time of the survey. The children mean scores for cm-APS-POQ-R were 113(33) while parents/guardian’s guardians for m-APS-POQ-R were 123(26). The subscales except for the parents/’guardians’ pain interference (p = .96) were statistically significant (p = .000), showing adequate knowledge, positive attitudes and high pain intensity for both parents/guardians and children.

CONCLUSION: Parent/guardians and children reported a high incidence of acute pain, were content with pain management services, and showed adequate knowledge of pediatric pain and its management. The incongruence between the intensity of pain, satisfaction on the adequacy of pain management and knowledge and attitudes demonstrated in this study need further inquiry.

PMID:35190237 | DOI:10.1016/j.pedn.2022.02.004

J Arthroplasty. 2022 Feb 18:S0883-5403(21)00898-6. doi: 10.1016/j.arth.2021.11.033. Online ahead of print.

ABSTRACT

BACKGROUND: The ultrasound-guided adductor canal block (High-ACB) is an effective option for pain control in total knee arthroplasty (TKA), but its use can add substantial cost and preparatory time to a TKA procedure. An intraoperative adductor canal block (Low-ACB) performed by the operative surgeon has been described as an alternative. The hypothesis of this study is that the Low-ACB would achieve noninferior pain control and opioid utilization postoperatively when compared to the High-ACB.

METHODS: This is a retrospective study of a prospectively maintained database comparing the High-ACB vs the Low-ACB. The primary outcome measure was morphine milligram equivalents consumed. Secondary outcome measures included Visual Analog Scale pain scores, postoperative outcomes (Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, knee range of motion), length of stay, postoperative speed of mobilization, and complications related to the type of block.

RESULTS: There were 139 patients in the study. There was lower opioid use in the first 24 hours in the Low-ACB compared to the High-ACB group respectively (26.3 vs 30, P = .29) but this did not reach statistical significance. There was a statistically significant difference in Visual Analog Scale score on postoperative day 1 in the Low-ACB vs High-ACB groups respectively (4.6 vs 3.7, P = .02) but this did not reach the level of clinical significance. There was no statistical difference in the Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, or postoperative range of motion. There were no block-related complications in either group.

CONCLUSION: The Low-ACB is a safe, effective, and cost-saving alternative to the traditional High-ACB for pain control in TKA.

PMID:35190244 | DOI:10.1016/j.arth.2021.11.033

Dent Mater. 2022 Feb 18:S0109-5641(22)00026-4. doi: 10.1016/j.dental.2022.02.003. Online ahead of print.

ABSTRACT

OBJECTIVES: The fracture resistance of ultrathin computer-aided design and computer-aided manufacturing (CAD/CAM) occlusal veneers with different preparation designs was investigated under cycling mechanical loading and via finite element analysis (FEA).

METHODS: Eighty molars were prepared with a circular enamel ring until complete exposure of the occlusal dentin occurred. Forty were prepared via additional circular chamfer preparation. The teeth were restored with 0.5 mm-thick occlusal veneers. Each group received a CAD/CAM fabricated occlusal veneer with a low modulus of elasticity (composite, CeraSmart) and a high modulus of elasticity material (ceramic, Celtra Duo). The restorations were adhesively luted and underwent 2000 thermocycling cycles. The samples were loaded at 50 N under 1,000,000 cycles in a chewing simulator and were checked for failure after various cycles. A visible crack was defined as failure, and the Kaplan-Meier survival rate was used for data analysis. One sample per group was digitized using microcomputed tomography, and FEA was performed using open-source software. The comparative stresses were analyzed for specimens with and without chamfer preparation.

RESULTS: The survival probabilities were 60% for occlusal ceramic veneers without preparation and 40% for veneers with chamfer preparation, with no statistically significant differences. Composite veneers achieved 95% survival probability regardless of the preparation method. The main principal stress in ceramic restoration was visualized via FEA. In composite veneers, stress was also visible in the luting composite and dentin.

SIGNIFICANCE: The preparation method had no influence on mechanical fatigue. Minimally invasive preparation can be recommended. The restoration material is crucial for survival.

PMID:35190213 | DOI:10.1016/j.dental.2022.02.003

J Prosthet Dent. 2022 Feb 18:S0022-3913(22)00066-X. doi: 10.1016/j.prosdent.2022.01.017. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The placement of narrow-diameter implants (NDIs) in the posterior region is still debated in view of the high biomechanical risks in these areas.

PURPOSE: The purpose of this retrospective observational study was to evaluate the success and survival rates of NDIs restored with fixed prostheses in the posterior region (primary outcome) and analyze whether splinting multiple units (prosthesis design) affects the biological and mechanical complications (secondary outcome).

MATERIAL AND METHODS: Dental records from 2 private clinics were reviewed for NDIs in the posterior region installed between 2009 and 2018. Ninety study participants (58 women and 32 men) aged between 21 and 84 years (mean age 49.9 years) were recalled for the assessment of implant survival and success of 160 NDIs previously provided for partial posterior edentulism associated with moderate horizontal bone loss or reduced interradicular space (105 premolars and 55 molars). The implants were restored with metal-ceramic single crowns or splinted multiple-unit prostheses, either screw-retained or cemented on customized (n=100) or stock titanium abutments (n=60). Peri-implant probing depth (PPD), bleeding on probing (BOP), bone quality, type of edentulism, and patient satisfaction were scored. The chi-square test for independence and 2-sample Welch t test were performed for statistical analysis (α=.05).

RESULTS: The overall success rate was 89.37%. One implant had been removed 4 years after loading, another after 9 years, yielding a cumulative survival rate of 98.75%. Fourteen implants exhibited PPD > 5 mm. One implant and 1 abutment screw fractured, and 16 restorations demonstrated porcelain chipping. The chi-square test showed no significant relationship between prosthetic design and complications whether biological (P=.087) or mechanical (P=.805). Eighty-two percent of patients were satisfied with esthetics, 76% with function, 85% with total duration of treatment, and 90% with overall treatment cost.

CONCLUSIONS: Within the limitations of this retrospective study, NDIs may be considered a reliable option to replace posterior teeth. The prosthetic design had no significant impact on biological or mechanical complications.

PMID:35190196 | DOI:10.1016/j.prosdent.2022.01.017

Vaccine. 2022 Feb 16:S0264-410X(22)00124-4. doi: 10.1016/j.vaccine.2022.02.002. Online ahead of print.

ABSTRACT

INTRODUCTION: A mass vaccination campaign against SARS-CoV-2 was initiated in European countries on December 27, 2020. This study compared the antibody response in a sample of healthcare workers (HCWs) who, after the first dose of the BNT162b2 mRNA vaccine, were infected with SARS-CoV-2 (infection group) with the response in a control group of HCWs immunized with two doses (vaccine group).

METHODS: This two-arm observational cohort study was carried out using routine health surveillance data obtained from HCWs at Bari Policlinico General Hospital (Italy). The antibody response was determined infection group and vaccine group.

RESULTS: Among the 100 HCWs, 25 (25.0%) were in the infection group and 75 (75.0%) in the full-vaccine group. At the serological evaluation, all of the HCWs tested positive, with a geometric mean titer (GMT) of 7106.8 (95 %CI = 5628.5-8973.4) and a statistically significant difference (p < 0.0001) between the infection group (GMT = 2139.7; 95 %CI = 1310.4-3493.6) and the vaccine group (GMT = 10603.6; 95 %CI = 8698.0-12926.8).

DISCUSSION: Our results shed light on the vaccine response of individuals in different risk categories. It also emphasizes the need for the continued use by HCWs of PPE and good practices during the window between the first and second anti-SARS-CoV-2 vaccinations.

PMID:35190212 | DOI:10.1016/j.vaccine.2022.02.002

Rev Esp Geriatr Gerontol. 2022 Feb 18:S0211-139X(22)00007-5. doi: 10.1016/j.regg.2022.01.002. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Hopelessness is characterized by a set of negative cognitive schemas about the future, conceptualized on the basis of three dimensions: affective, motivational and cognitive. This construct is linked to loneliness, the incidence of which in older adults is increasingly high. The aim of this research is to test whether hopelessness factors predict levels of loneliness in older adults.

MATERIAL AND METHODS: 138 non-institutionalized persons from Valencia city between 65-90 years old participated, with a mean age of 73.67 (SD=4.8), and 59.4% were women. The Beck Hopelessness Scale (BHS) and University of California Los Angeles Loneliness Scale (UCLA) were administered to assess participants.

RESULTS: The motivational and cognitive factors acted as statistically significant predictors of loneliness, while the affective factor was not presented as a significant factor. The final model obtained an R²adj=.442, F(3, 87)=23.97, p<.001.

CONCLUSIONS: Loneliness is a phenomenon of great concern in the field of gerontology due to its high incidence and impact. The results indicate that hopelessness, specifically loss of motivation and negative expectations about the future, are critical issues for the development of feelings of loneliness in older adults. Thus, it is relevant to pay attention to these variables in order to apply loneliness prevention programs.

PMID:35190191 | DOI:10.1016/j.regg.2022.01.002

Curr Pharm Teach Learn. 2022 Feb;14(2):215-221. doi: 10.1016/j.cptl.2021.11.020. Epub 2021 Dec 28.

ABSTRACT

BACKGROUND AND PURPOSE: The objectives of this study were to implement and assess a telepharmacy simulation for third-year students at two universities.

EDUCATIONAL ACTIVITY AND SETTING: Using telepharmacy, students completed a prescription verification activity and a patient counseling activity. Students completed surveys at baseline and after both activities. Focus groups were conducted after the second activity. Descriptive statistics, Cronbach’s alpha, paired t-tests, and qualitative analysis were used to evaluate data.

FINDINGS: There was a statistically significant increase in students’ perceptions using telepharmacy to deliver patient education before (mean (M) = 2.68, SD = 0.36) to after the experience (M = 2.97, SD = 0.52). A comparison of attitudes toward and intent to provide telepharmacy services found no differences before and after the experience. Following each activity, students felt somewhat to very confident in their abilities to verify a prescription medication and to counsel a patient using telepharmacy. Students demonstrated slight gains in knowledge pre-/post- regarding the use of telepharmacy. Focus group comments referred to the activities as realistic and of value.

SUMMARY: A purposeful telepharmacy simulation impacted students’ perceptions and knowledge on the use of telepharmacy. Students were confident in their abilities to verify and counsel on medications and felt the simulation helped them better understand the pharmacist’s role in telepharmacy. However, students indicated little intent to explore telepharmacy-based opportunities in the future. The results support the development of a more robust simulation and incorporation of didactic content into pharmacy curricula to train students in the use of telepharmacy.

PMID:35190164 | DOI:10.1016/j.cptl.2021.11.020