Category: Statistics

J Cardiovasc Nurs. 2021 Jul 23. doi: 10.1097/JCN.0000000000000839. Online ahead of print.

ABSTRACT

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) requires prompt therapy. It is recommended for door-to-balloon (DTB) times to be less than 90 minutes. In the United States, some locations have difficulty meeting this goal.

OBJECTIVE: The objective of this study was to determine whether implementation of a STEMI network decreased DTB times at a large, STEMI-receiving, metropolitan academic hospital in the southeastern United States. Furthermore, differences among presentation types, including walk-in, emergency medical services, and transfers, were explored.

METHODS: A pre-post time series study of electronic medical record data was conducted to evaluate the efficacy of a STEMI network.

RESULTS: The sample included 127 patients with a diagnosis of STEMI, collected during 3 periods (T1, T2, and T3). Patients were primarily White (78.0%) and male (67.7%), with a mean (SD) age of 58.9 (13.9) years. The 1-way analysis of variance revealed a significant difference in overall DTB times, F2 = 11.66, P < .001. Post hoc comparisons indicated longer mean DTB times for T1 compared with T3 (P < .001) and T2 (P < .001). When exploring presentation type, 1-way analysis of variance revealed a significant difference in mean DTB times in transfer patients between T1 and T2 (P < .001) and T1 to T3 (P < .001). No other statistical differences were noted; however, all DTB times with the exception of T2 for emergency medical services presentation decreased.

CONCLUSIONS: Implementation of a STEMI network was effective at decreasing overall DTB times with patients who presented to the hospital with a diagnosis of STEMI.

PMID:34321434 | DOI:10.1097/JCN.0000000000000839

Circ J. 2021 Jul 28. doi: 10.1253/circj.CJ-21-0325. Online ahead of print.

ABSTRACT

BACKGROUND: Using a population-based stroke registry system, we evaluated the relationship between ambient temperature parameters and stroke incidence in a Japanese population.Methods and Results:We analyzed data from the Takashima Stroke Registry, which records all stroke occurrences in Takashima City, Japan. The study period of 8,401 days was divided into quintiles of daily weather parameters, and the middle quintile was used as the reference category. Incidence rates (IR per 100,000 person-years) were calculated across the quintiles. Poisson regression analysis was used to calculate the effect of temperature parameters on stroke incidence. There were 2,405 first-ever strokes (1,294 men), including 1,625 ischemic, 545 cerebral hemorrhages, 213 subarachnoid hemorrhages, and 22 unclassified strokes. The stroke IR was higher in the middle quintile of average temperature, 357.3 (328.4-388.8), and for other parameters. After adjustment for age and sex, for all stroke, the incidence rate ratio (IRR) in the highest (Q5: IRR 0.81, 95% confidence interval (CI) 0.71-0.92) and the second-highest (Q4: IRR 0.80, 95% CI 0.71-0.91) quintile was lower than that in the middle quintile (Q3: Reference). Analogous results were observed for the minimum, maximum, and lag-days temperatures, also in the subtypes and across ≥65 years of age, also in females.

CONCLUSIONS: Higher temperatures, irrespective of the parameter (average, minimum, or maximum), had a protective effect against stroke occurrence in Japan.

PMID:34321376 | DOI:10.1253/circj.CJ-21-0325

Clin Spine Surg. 2021 Jul 28. doi: 10.1097/BSD.0000000000001244. Online ahead of print.

ABSTRACT

STUDY DESIGN: This was a retrospective cohort study.

OBJECTIVE: The aim of this study was to compare the hospital charges and postoperative complications of minimally invasive surgery (MIS) and open approaches to sacroiliac joint (SIJ) fusion.

SUMMARY OF BACKGROUND DATA: The data source utilized in this study is the Healthcare Cost and Utilization Project National Readmission Database (NRD) from 2016 and 2017. The NRD is a yearly nationally representative inpatient database from the Agency for Healthcare Research and Quality with information regarding patient demographics, diagnoses, procedures, and readmissions.

MATERIALS AND METHODS: The 2016-2017 NRD was used to identify 2521 patients receiving SIJ fusion with open (n=1990) or MIS approaches (n=531) for diagnosed sacrum pain, sacroiliitis, sacral instability, or spondylosis after excluding for those who received prior SIJ fusion, those diagnosed with neoplasms or trauma of the pelvis or sacrum, and nonelective procedures. We then one-to-one propensity-matched the open (n=531) to the MIS approach (n=531) for age, sex, and Charlson Comorbidity Index. Statistical analysis was performed to compare total hospital charges, immediate surgical complications, nonelective readmission rate, and 30-, 90-, and 180-day postoperative complications between the 2 approaches.

RESULTS: The mean total hospital charge was the only significant difference between 2 group. Open SIJ fusion had significantly higher charge compared with the MIS approach (open $101,061.90±$81,136.67; MIS $83,594.78±$49,086.00, P<0.0001). The open approach was associated with nonsignificant higher rates of novel lumbar pathology at 30-, 90-, and 180-day readmissions and revision surgeries at 30 and 180 days. MIS approach had higher rates nervous system complications at 30-, 90-, and 180-day readmission, as well as infection and urinary tract infection within 30 days, none being significant. Novel postprocedural pain was similar between the 2 groups at 90 and 180 days.

CONCLUSIONS: The current study found that open SIJ fusion was associated with significantly higher hospital charges. Although no significant differences in postoperative complications were found, there were several notable trends specific to each surgical approach.

PMID:34321394 | DOI:10.1097/BSD.0000000000001244

Dent Mater J. 2021 Jul 27. doi: 10.4012/dmj.2021-074. Online ahead of print.

ABSTRACT

Adhesive strategies were evaluated on the bond strength of bi-functional monomers bonded to endodontically-treated-dentin (ETD). Superficial dentin was removed on human molars. Teeth were immersed in 5 mL 2.5% NaOCl, followed by immersion in 5 mL 17% EDTA. Dentin surface impregnated with epoxy resin-based sealer was then divided four groups (n=10): Scotchbond Multi-Purpose (SBMP); Single Bond Universal (SBU); Optibond All-in-One (OPB); and Tetric-N-Bond Universal (TBU). After 24-h or 1-year-of-storage specimens were submitted to microtensile bond strength (µTBS) and failure classification. A confocal laser scanning microscope (CLSM) evaluated the hybrid layer formation. Two-way ANOVA and Tukey-HSD test were performed (α=5%). The µTBS did not present statistical differences among adhesive strategies after 24-h. Significant differences were found after 1-year-of-storage. CLSM analysis showed water infiltration and consequently degradation of the hybrid layer after 1-year-of-storage. The use of SBU universal adhesive on the self-etching mode on ETD produced more stable bond over the 1-year-of-storage.

PMID:34321370 | DOI:10.4012/dmj.2021-074

J Prosthodont Res. 2021 Jul 29. doi: 10.2186/jpr.JPR_D_20_00197. Online ahead of print.

ABSTRACT

PURPOSE: Zirconia cores and frameworks are widely used in restorative dentistry. Although these structures are veneered with porcelain for esthetic reasons, the use of indirect composite resins (ICRs) is expected to increase in the future. The purpose of this study was to investigate the effects of microslits of different dimensions formed by Nd:YVO 4 laser machining on the bond strength between two types of zirconia (3 mol% yttria-partially stabilized zirconia (Y-TZP) and ceria-partially stabilized zirconia/alumina nanocomposite (Ce-TZP/A)) and porcelain or an ICR.

METHODS: The zirconia disks were assigned as follows: 1) blasted with alumina particles (AB) and 2-4) surface machined with gridded microslits with a width, pitch, and depth of 50, 75, or 100 µm (MS50, MS75, and MS100, respectively). After the bonding of the veneering materials to the disks, half of the specimens veneered with the ICR were subjected to thermocycling (4-60°C, 20000 cycles). All the specimens were subsequently shear tested (n = 10/group).

RESULTS: There was no significant difference between the groups of the disks bonded to porcelain. On the other hand, for the disks bonded to the ICR, the bond strengths of the MS groups after thermocycling were statistically higher than that of the AB group. However, there was no significant difference in the bond strengths of the disks with different microslits.

CONCLUSIONS: Within the study limitations, it can be concluded that, for porcelain, the design of the mechanical retentive structure must be modified. However, for the investigated ICR, a simple gridded pattern can improve the bond strength with zirconia.

PMID:34321372 | DOI:10.2186/jpr.JPR_D_20_00197

BMJ Open. 2021 Jul 28;11(7):e050947. doi: 10.1136/bmjopen-2021-050947.

ABSTRACT

OBJECTIVES: The aims were to study the risk of all-cause mortality associated with chronic obstructive pulmonary disease (COPD) and healthy ageing trajectories (HAT) in three birth cohorts and to determine the moderating role of HAT in the association between COPD and all-cause mortality.

DESIGN: Prospective cohort study.

SETTING: Data from waves 1 to 5 of The Survey of Health, Ageing and Retirement in Europe.

PARTICIPANTS: The total sample was 28 857 community-dwelling individuals aged 50+ years.

MAIN OUTCOME: All-cause mortality associated with COPD and HAT adjusting for covariates. We performed Aalen additive hazards models to explore these associations. Interactions between COPD and HAT were also explored. Analyses were conducted separately in three birth cohorts (>1945, 1936-1945 and ≤1935). Latent class growth analysis was used to classify participants into HAT.

RESULTS: Three parallel HAT were found in the three birth cohorts (‘low’, ‘medium’ and ‘high’ healthy ageing). Participants with COPD had an increased mortality risk, but this effect was no longer significant after adjusting for covariates. The ‘low’ HAT was associated with increased mortality risk in the three subsamples, although this effect was lower after adjustment. The interaction between COPD and HAT was significant only in the ≤1935 birth cohort, indicating that those with COPD and a ‘low’ trajectory had a greater risk of mortality.

CONCLUSIONS: The healthy ageing scale may be a suitable tool to identify patients at higher risk to mitigate disease burden and improve patients’ quality of life.

PMID:34321308 | DOI:10.1136/bmjopen-2021-050947

J Med Genet. 2021 Jul 28:jmedgenet-2021-107871. doi: 10.1136/jmedgenet-2021-107871. Online ahead of print.

ABSTRACT

BACKGROUND: Variants in HECW2 have recently been reported to cause a neurodevelopmental disorder with hypotonia, seizures and impaired language; however, only six variants have been reported and the clinical characteristics have only broadly been defined.

METHODS: Molecular and clinical data were collected from clinical and research cohorts. Massive parallel sequencing was performed and identified individuals with a HECW2-related neurodevelopmental disorder.

RESULTS: We identified 13 novel missense variants in HECW2 in 22 unpublished cases, of which 18 were confirmed to have a de novo variant. In addition, we reviewed the genotypes and phenotypes of previously reported and new cases with HECW2 variants (n=35 cases). All variants identified are missense, and the majority of likely pathogenic and pathogenic variants are located in or near the C-terminal HECT domain (88.2%). We identified several clustered variants and four recurrent variants (p.(Arg1191Gln);p.(Asn1199Lys);p.(Phe1327Ser);p.(Arg1330Trp)). Two variants, (p.(Arg1191Gln);p.(Arg1330Trp)), accounted for 22.9% and 20% of cases, respectively. Clinical characterisation suggests complete penetrance for hypotonia with or without spasticity (100%), developmental delay/intellectual disability (100%) and developmental language disorder (100%). Other common features are behavioural problems (88.9%), vision problems (83.9%), motor coordination/movement (75%) and gastrointestinal issues (70%). Seizures were present in 61.3% of individuals. Genotype-phenotype analysis shows that HECT domain variants are more frequently associated with cortical visual impairment and gastrointestinal issues. Seizures were only observed in individuals with variants in or near the HECT domain.

CONCLUSION: We provide a comprehensive review and expansion of the genotypic and phenotypic spectrum of HECW2 disorders, aiding future molecular and clinical diagnosis and management.

PMID:34321324 | DOI:10.1136/jmedgenet-2021-107871

BMJ Open. 2021 Jul 28;11(7):e047494. doi: 10.1136/bmjopen-2020-047494.

ABSTRACT

OBJECTIVES: The study aimed to assess the knowledge, attitude and practices (KAP) of HCPs regarding the use of probiotics in different health conditions and to identify various barriers that are associated with their use.

METHODS: A cross-sectional study was conducted on 405 HCPs by using a validated self- administered questionnaire for assessing their KAP towards probiotic use. The study data were analysed using descriptive statistics, χ² test and binary logistic regression (BLR).

RESULTS: Among the 405 participants, only 15.1 % of HCPs had good knowledge, while 15.6% had acceptable practices and 89.1% had a positive attitude towards probiotics. The professional position of HCPs was significantly associated with knowledge (p=0.001) and practice (p=0.001). Among all the HCPs, the pharmacists showed a significant association with good knowledge (p=0.016) and good practices (p=0.024) by using BLR. The lack of knowledge about probiotics was a major barrier to the utilisation of probiotics.

CONCLUSIONS: The poor knowledge and practices regarding the use of probiotics have been seen in the current study. While the participants showed a positive attitude towards the utilisation of probiotics. To transform HCPs’ positive attitude to their practices and to create awareness regarding probiotic use focused training programmes should be initiated by professional health organisations.

PMID:34321300 | DOI:10.1136/bmjopen-2020-047494

BMJ Open. 2021 Jul 28;11(7):e048126. doi: 10.1136/bmjopen-2020-048126.

ABSTRACT

INTRODUCTION: At least 68% of persons with aphasia (PWA) experience reading difficulties. Even though strategy-based interventions are a promising treatment approach for text level reading comprehension deficits in PWA, empirical evidence for their efficacy remains rare. The primary objective of this study is the analysis of the efficacy of a strategy-based intervention on text-level reading comprehension and on reading activities in PWA.

METHODS AND ANALYSIS: In a repeated measures trial, 24 PWA will first participate in a waiting period and then in a strategy-based intervention (14 face-to-face-sessions, 60 min each). We will apply two combinations of strategies to treat either the microstructure or the macrostructure, respectively. Participants will be randomly allocated to two parallel groups that will receive these combinations in interchanged sequences. Assessments will be implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure is text-level reading comprehension measured with a German version of the Test de Compréhension de Textes (TCT-D) and represented by the score TCT-D Total . A non-blinded and a blinded rater will evaluate the primary outcome measure. Secondary outcome measures will address specific reading functions, reading activities and cognitive functions. The sample size was determined with an a priori power analysis. For statistical analysis, we will use contrast analyses within repeated measures analysis of variance models. We expect significant improvements in primary and secondary outcome measures during the intervention as compared with changes during the waiting period.

ETHICS AND DISSEMINATION: This study was approved by the ethics committee of Deutscher Bundesverband für akademische Sprachtherapie und Logopädie (20-10074-KA-MunmErw+Ko). Results and relevant data will be disseminated in peer-reviewed journals, at conferences and on the Open Science Framework.

TRIAL REGISTRATION NUMBER: DRKS00021411 (see Supplementary Table 1).

PMID:34321303 | DOI:10.1136/bmjopen-2020-048126

BMJ Open. 2021 Jul 28;11(7):e050231. doi: 10.1136/bmjopen-2021-050231.

ABSTRACT

INTRODUCTION: Thyroid dysfunctions (TD) are common medical conditions affecting all global populations. Improved healthcare leading to increasing survival rates and delayed diagnosis rendered significant burden of the disease in the increasing number of patients with TD with comorbid illnesses. Therefore, reducing the burden of TD and improving the quality of care are crucial. Existing poor-quality data that guide evidence-based decisions only provide a fragmented picture of clinical care. The different outcomes across studies assessing the effectiveness of treatments impede our ability to synthesise results for determining the most efficient treatments. This project aims to produce a core outcome set (COS), which embeds the multiple complex dimensions of routine clinical care for the effectiveness studies and clinical care of adult patients with TD.

METHODS AND ANALYSIS: This mixed-method project has two phases. In phase 1, we will identify a list of patient-reported and clinical outcomes through qualitative research and systematic reviews. In phase 2, we will categorise the identified outcomes using the Core Outcome Measures in Effectiveness Trials taxonomy of core domains and the International Classification of Functioning, Disability and Health. We will develop questionnaires from the list of outcomes identified from each domain for the two-round online Delphi exercise, aiming to reach a consensus on the COS. The Delphi process will include patients, carers, researchers and healthcare participants. We will hold an online consensus meeting involving representatives of all key stakeholders to establish the final COS.

ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia and the Research Ethics Committee, National University of Malaysia. This proposed COS in TD will improve the value of data, facilitate high-quality evidence synthesis and evidence-based decision-making. Furthermore, we will present the results to participants, in peer-reviewed academic journals and conferences.

REGISTRATION DETAILS: Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: http://www.comet-initiative.org/studies/details/1371.

PMID:34321306 | DOI:10.1136/bmjopen-2021-050231