Category: Statistics

J R Soc Med. 2021 Aug 4:1410768211032589. doi: 10.1177/01410768211032589. Online ahead of print.

ABSTRACT

OBJECTIVE: Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics.

DESIGN: Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports.

SETTING: Patient safety incident reports (10 years, 2005-2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales.

PARTICIPANTS: Reports describing severe harm/death in acute medical unit were identified.

MAIN OUTCOME MEASURES: Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement.

RESULTS: A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors (n = 79), medication-related errors (n = 61), and failures monitoring patients (n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination.

CONCLUSION: This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.

PMID:34348052 | DOI:10.1177/01410768211032589

J Long Term Eff Med Implants. 2021;31(2):71-79. doi: 10.1615/JLongTermEffMedImplants.2021035972.

ABSTRACT

Tooth loss has become one of the most raising issues to be brought up in dentistry, by both patients and dentists. Teeth are considered to be important in case of function and esthetics. Compromise to the dentition would raise social disturbances for the individual. Dental implants are surgical fixtures or artificial tooth roots that are placed into the jawbone. It is one of the best methods of tooth replacement. When considering implants, the dentist must approach it with a multidisciplinary treatment plan. They should consider factors such as age, gender, habit, systemic diseases, oral hygiene, placement site and technique, bone width and bone height, bone density, etc. complications for implant surgery would include bleeding, infections, pain, breakage, etc. A single center retrospective study was done in an institutional setting. The data for the study was retrieved from the college’s patient records management software. All patients undergoing implant surgery in the posterior mandibular region were considered. The patients age, gender, implant site, bone width, and bone height were taken into account as variables. The data received was analyzed using SPSS. A total of 737 patients were considered in the study, 383 being male patients and remaining 354 being female patients. the right and left molar teeth were more commonly replaced in comparison to premolars. The association between the primary stability and bone density was statistically significant (p < 0.05). Within the limitations of the study, males had better bone density than females and D2 bone density was predominantly seen in both males and females and between the age group between 26 to 40 years. D2 bone density is seen in both left and right molar regions. Primary stability was associated with the implant length, width and bone density.

PMID:34348015 | DOI:10.1615/JLongTermEffMedImplants.2021035972

Exp Physiol. 2021 Aug 4. doi: 10.1113/EP089348. Online ahead of print.

ABSTRACT

NEW FINDINGS: What is the central question of the study? Massive infusion can destroy the endothelial glycocalyx (EG). We compared the serum concentrations of EG components, atrial natriuretic peptide (ANP), and the outcomes of patients with different levels of stroke volume variation (SVV). What is the main finding and its importance? With a decrease in SVV, the serum concentrations of EG components and ANP increased, while the oxygenation index decreased. When the intraoperative SVV was maintained at 7-10%, the patients had better postoperative recovery and shorter postoperative hospital stays. Therefore, it is better to maintain the SVV value between 7% and 10%.

ABSTRACT: Dynamic hemodynamic parameters, such as stroke volume variation (SVV), can be used for volume monitoring. However, studies have only determined the SVV threshold but not the optimal level. The endothelial glycocalyx (EG) plays an important role in maintaining vascular permeability. Moreover, rapid and massive infusion can lead to the degradation, shedding, and destruction of the EG. We aimed to explore the effects of different SVV values (11-14%, 7-10%, or 3-6%) on the EG in 54 patients who were scheduled for elective colorectal tumour surgery and identify the optimal perioperative fluid therapy strategy. The concentrations of EG degradation products (heparin sulphate, hyaluronic acid, syndecan-1) and atrial natriuretic peptide (ANP) were higher when the SVV was maintained between 3% and 6% after fluid therapy compared to before infusion (p < 0.05). Comparison of postoperative complications and hospitalisation time among the three SVV levels was not statistically significant (p >0.05). The postoperative hospitalisation time in group M was shorter than that in group L. When the SVV was maintained between 7% and 10%, patients had shorter postoperative recovery time compared to patients whose SVV was maintained at other levels. High fluid volume with increasing EG degeneration and ANP levels may be related to postoperative outcomes. This article is protected by copyright. All rights reserved.

PMID:34347918 | DOI:10.1113/EP089348

J Clin Lab Anal. 2021 Aug 4:e23941. doi: 10.1002/jcla.23941. Online ahead of print.

ABSTRACT

Both celiac disease (CD) and type 1 diabetes (T1D) are autoimmune diseases resulting from a complex interplay between genetic susceptibility and environmental factors.

AIM: In this retrospective study, we determined the frequency of auto-antibodies of T1D in adult patients with active CD.

MATERIALS AND METHODS: Eighty adult patients with active CD were included in our study. Ninety healthy blood donors (HBD) served as control group. Anti-glutamic acid decarboxylase IgG antibodies (GAD-Ab), anti-tyrosine phosphatase IgG antibodies (IA2-Ab), and anti-zinc transporter IgG antibodies (Zn-T8-Ab) were determined by enzyme-linked immunosorbent assay (ELISA) for patients and control group. For statistical analysis, we used Chi-square or Fisher’s exact test.

RESULTS: Out of 80 patients, 10 (12.50%) had auto-antibodies of T1D vs. only one in control group (1.11%) (p = 0.003). Simultaneous presence of GAD-Ab, IA2-Ab, and Zn-T8-Ab was found in one patient (1.25%). Nine patients had only GAD-Ab. IA2-Ab and Zn-T8-Ab were absent in all HBD. The frequency of GAD-Ab was significantly higher in CD patients than in HBD (12.5% vs 1.11%, p = 0.003).

CONCLUSION: The present study has shown that CD is associated with a high frequency of auto-antibodies of T1D. Screening for T1D in this population, at risk for other autoimmune diseases, may be useful.

PMID:34347922 | DOI:10.1002/jcla.23941

J Long Term Eff Med Implants. 2021;31(2):39-44. doi: 10.1615/JLongTermEffMedImplants.2021037026.

ABSTRACT

Low back pain (LBP) is a common problem, affecting 11% of the population in Greece. Pain can last upwards of 6 wk and impact functional ability and quality of life. Treating LBP often includes the use of alternative methods, such as relaxation techniques. We tested whether relaxation techniques could reduce stress and pain and improve quality of life. Patients engaged in methods such as diaphragmatic breathing, progressive muscular relaxation, autogenic training, and guided imagery. The treatment group consisted of 31 randomized patients and the control group had 33. The treatment group followed an 8-wk relaxation program with weekly sessions and practiced techniques every day by listening to a compact disk at home (2×/d). The control group did not follow relaxation techniques. No statistically significant differences were present regarding the Perceived Stress Scale, body-mass index, and satisfaction with functional ability. However, statistically significant differences were found in the Brief Pain Inventory score and multidimensional locus of control. We also found decreases in all three cortisol measurements for the treatment group. Relaxation techniques provide positive results in pain reduction and cortisol decrease and must therefore be incorporated into rehabilitation protocols.

PMID:34348011 | DOI:10.1615/JLongTermEffMedImplants.2021037026

Hematol Oncol. 2021 Aug 4. doi: 10.1002/hon.2902. Online ahead of print.

ABSTRACT

Diffuse large B-cell lymphoma featuring overexpression of MYC and B-Cell Lymphoma 2 (double expressor lymphoma, DEL) is associated with poor outcomes. Existing evidence suggesting improved outcomes for DEL with the use of more intensive regimens than R-CHOP is restricted to younger patients and based on limited evidence from low patient numbers. We retrospectively evaluated the impact of intensive frontline regimens versus R-CHOP in a multicenter analysis across 7 academic medical centers in the United States. We collected 90 cases of DEL, 46 out of 90 patients (51%) received R-CHOP and 44/90 (49%) received an intensive regimen, which was predominantly DA-EPOCH-R. Treatment cohorts were evenly balanced for demographics and disease characteristics, though the intensive group had a higher lactate dehydrogenase (LDH, 326 vs. 230 U/L p = 0.06) and presence of B-symptoms (50% vs. 22%, p = 0.01) compared to the R-CHOP cohort. There was no difference in PFS (median 53 vs. 38 months, p = 0.49) or overall survival (67 vs. not reached months, p = 0.14) between the R-CHOP and intensive therapy cohorts, respectively. On multivariate analysis, intensive therapy was associated with a hazard ratio of 2.35 (95% CI 0.74-7.41), though this was not statistically significant. Additionally, a subgroup analysis of intermediate high-risk lymphoma defined by IPI ≥3 did not identify a difference in survival outcomes between regimens. We conclude that in our multi-center cohort there is no evidence supporting the use of intensive regimens over R-CHOP, suggesting that R-CHOP remains the standard of care for treating DEL.

PMID:34347909 | DOI:10.1002/hon.2902

Vet Surg. 2021 Aug 4. doi: 10.1111/vsu.13698. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary objective of this study was to describe the clinical management and surgical treatment of production size pigs (PrdP) with uterine neoplasia. A secondary objective was to compare tumor diagnoses as well as short- and long-term survival between PrdP and a published report of pot-bellied pigs (PBP) following surgical intervention.

STUDY DESIGN: Retrospective clinical study.

ANIMALS OR SAMPLE POPULATION: Client-owned PrdP (n = 13) treated with exploratory celiotomy ±ovariohysterectomy for uterine neoplasia.

METHODS: Medical records from a university hospital were reviewed for historical treatment, presenting complaint, clinical signs, diagnostics, surgical intervention, pathology, and outcome. An online owner survey was performed for follow-up. The novel PrdP cohort was compared to a previously published PBP cohort for differences in tumor diagnoses, surgical complications, and survival. Descriptive statistics, Fischer’s exact tests and odds ratios were reported.

RESULTS: PrdP were affected by uterine leiomyoma (4/11), leiomyosarcoma (2/11), adenoma (1/11), adenocarcinoma (3/11), and carcinosarcoma (1/11) with no difference in tumor types between PrdP and PBP. PrdP surviving to hospital discharge (6/13) survived at least 1 year postoperatively, with median follow-up of 16 months (14-60 months). PrdP were less likely than PBP to survive in the short-term despite similar frequencies of marked intraoperative hemorrhage. PrdP and PBP had comparable rates of long-term survival following hospital discharge.

CONCLUSION: PrdP are afflicted by similar uterine neoplasia diagnoses as PBP, but they have lower rates of short-term survival to hospital discharge with surgical treatment.

CLINICAL SIGNIFICANCE/IMPACT: PrdP have a guarded prognosis for survival to hospital discharge when operated for uterine neoplasia.

PMID:34347882 | DOI:10.1111/vsu.13698

PLoS One. 2021 Aug 4;16(8):e0255560. doi: 10.1371/journal.pone.0255560. eCollection 2021.

ABSTRACT

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa (HS) significantly affects the patient`s quality of life and leads to multiple medical consultations. Aim of this study was to assess the utilization of medical care of HS patients.

PATIENTS AND METHODS: All patients presenting in 2017 for an outpatient, day patient and / or inpatient treatment with leading claim type HS at the Department of Dermatology, University Hospital Würzburg, were included. Primary outcome was the economic burden of HS patients, measured by resource utilization in €.

RESULTS: The largest share of the direct medical costs for HS were the inpatient costs with a leading surgical diagnosis-related group (DRG). Antiseptics were the predominant topical prescription. While doxycycline was the most frequently prescribed systemic therapy, adalimumab was the main cost driver. The difference between in-patient (€ 110.25) and outpatient (€ 26.34) direct non-medical costs was statistically significant (p < 0.001). With regards to indirect medical costs, a statistically significantly higher loss of gross value added (inpatient mean € 1,827.00; outpatient mean € 203.00) and loss of production (inpatient mean € 1,026.00; outpatient mean € 228.00) could be noted (p < 0.001), respectively.

CONCLUSIONS: The present study on disease-specific costs of HS confirms that the hospital care of patients with this disease is cost-intensive. However, the primary goal of physicians is not and should not be to save costs regarding their patients`treatment, but rather the premise to utilize the existing resources as efficient as possible. Reducing the use of costly therapeutics and inpatient stays therefore requires more effective therapy options with an improved cost-benefit profile.

PMID:34347845 | DOI:10.1371/journal.pone.0255560

PLoS One. 2021 Aug 4;16(8):e0255465. doi: 10.1371/journal.pone.0255465. eCollection 2021.

ABSTRACT

BACKGROUND: Nutritional support is becoming more widely acknowledged as a crucial component of the key package of care for HIV/AIDS patients. This nutritional support is exceptionally important for patients in sub-Saharan Africa, including Ethiopia, where HIV/AIDS is very prevalent. However, there is a lack of evidence on the recovery rate and predictors at the study site and at large in Ethiopia. Therefore, this study will give some insight into the recovery rate and its predictors among under-nourished HIV-positive adults treated with Ready to Use Therapeutic Food (RUTF) attending at Debre Markos referral hospital. Moreover, the findings of this study will be used by both governmental and non-governmental organizations to allocate more resources to mitigate the nutritional problems for people living with HIV.

METHODS: An institution-based retrospective cohort study was conducted among 453 under-nourished HIV positive adults treated with RUTF at Debre Markos referral Hospital from the 1st of July, 2015 to the 31st of December, 2017. The study participants were selected using a simple random sampling technique. Data were extracted from patient charts using a standardized data extraction checklist. Data were entered into Epi-Data Version 4.2 and analyzed using Stata Version 14. The Kaplan-Meier survival curve was used to estimate the time to recovery. Log-rank test was used to compare the recovery time between different baseline categorical variables. The bivariable and multivariable Cox-proportional hazard regression models were fitted for potential predictors of recovery time. Adjusted hazard Ratios (AHRs) with 95% CIs were used to measure the strength of association and test statistical significance.

RESULTS: A total of 453 undernourished HIV-positive adults were included in the final analysis. About 201, 44.4% (95%CI: 38.9, 49.0%) patients participating in the RUTF program were recovered based on predetermined exit criteria with incidence of 10.65 (95% CI: 9.28, 12.23) per 100 person-month observations. Being moderately undernourished (AHR: 11.0, 95% CI: 5.3, 23.1), WHO clinical stage (I or II) (AHR:1.8, 95% CI: 1.2, 2.6), and working functional status at baseline (AHR = 2.34, 95%CI: 1.01,5.45) were predictors of recovery time.

CONCLUSION: This study concluded that the overall nutritional recovery rate was below the acceptable minimum requirement which at least 75% of patients should recovered. Mild to moderate undernutrition at baseline, WHO clinical stage I or II at enrolment, and working functional status were found to be predictors of recovery time in HIV/AIDS patients treated with the RUTF. As a result, special attention should be paid to severely malnourished patients, WHO clinical stages III or higher, and patients who are bedridden or ambulatory during treatment.

PMID:34347849 | DOI:10.1371/journal.pone.0255465

PLoS One. 2021 Aug 4;16(8):e0255589. doi: 10.1371/journal.pone.0255589. eCollection 2021.

ABSTRACT

Using productivity change as a measure of farm economic performance, we analyze the relationship between women’s empowerment in agriculture and farm productivity change and its components, which include efficiency change, technological change, and scale efficiency change. A non-parametric Malmquist approach is used to measure farm specific productivity change and its decomposition. We use a bootstrap regression to analyze factors that cause differences in productivity change and its components, testing, in particular, the role women’s empowerment plays. The empirical application focuses on a sample of Bangladesh rice farms over the crop cultivation period 2011 and 2014. Results suggest that improvements in women’s empowerment in agriculture were associated with higher levels of productivity change, efficiency change, and technical change, while they had no impact on scale efficiency change. We find that empowering women, specifically, improving their ability to make independent choices regarding agricultural production had a statistically significant positive association with productivity change, efficiency change, and technical change. We also find that lowering the gender parity gap is positively related with improving productivity of the sample farms.

PMID:34347833 | DOI:10.1371/journal.pone.0255589