Category: Statistics

Neurosurgery. 2021 Aug 19:nyab301. doi: 10.1093/neuros/nyab301. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative prophylactic antibiotics are commonly used in pituitary surgery, but evidence supporting their use is lacking, which has implications for antibiotic stewardship.

OBJECTIVE: To evaluate whether receipt of postoperative oral antibiotics results in superior sinonasal quality of life (QOL) compared with placebo among patients who undergo endoscopic endonasal transsphenoidal pituitary surgery.

METHODS: Patients were randomized to receive either oral placebo or cefdinir (trimethoprim-sulfamethoxazole in patients intolerant to cefdinir) for 7 d after surgery. They were monitored for 12 wk. The primary outcome measure was sinonasal QOL at 2 wk on the Anterior Skull Base Nasal Inventory-12. Supplementary end points included sinonasal QOL reported on the Sinonasal Outcome Test-22 and objective endoscopy scores to assess nasal healing according to the Lund-Kennedy method.

RESULTS: A total of 461 patients were screened, 131 were randomized, and 113 (placebo arm: 55; antibiotic arm: 58) were analyzed. There was no clinically meaningful or statistically significant difference in sinonasal QOL at any measured time point (P ≥ .24) using either instrument. Nasal cavity endoscopy scores were not significantly different at 1 to 2 wk after surgery (P = .25) or at 3 to 4 wk after surgery (P = .08).

CONCLUSION: Postoperative prophylactic oral antibiotics did not result in superior sinonasal QOL compared with placebo among patients who underwent standard endoscopic transsphenoidal surgery.

PMID:34411264 | DOI:10.1093/neuros/nyab301

Oper Dent. 2021 Aug 19. doi: 10.2341/20-062-C. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Repairing defective crown margins can extend the functional life of existing crowns.

SUMMARY: Objective: The objective of this study was to determine the survival time of crown margin repairs (CMRs) with glass ionomer and resin-modified glass ionomer cements on permanent teeth using electronic dental record (EDR) data.Methods: We queried a database of EDR (axiUm; Exan Group, Coquitlam, BC, Canada) in the Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA, for records of patients who underwent CMRs of permanent teeth at the Graduate Operative Dentistry Clinic. Two examiners developed guidelines for reviewing the records and manually reviewed the clinical notes of patient records to confirm for CMRs. Only records that were confirmed with the presence of CMRs were retained in the final dataset for survival analysis. Survival time was calculated by Kaplan-Meier statistics, and a Cox proportional hazards model was performed to assess the influence of age, gender, and tooth type on survival time (a<0.05).Results: A total of 214 teeth (115 patients) with CMR were evaluated. Patient average age was 69.4 ± 11.7 years old. Posterior teeth accounted for 78.5% (n=168) of teeth treated. CMRs using glass ionomer cements had a 5-year survival rate of 62.9% and an annual failure rate (AFR) of 8.9%. Cox proportional-hazards model revealed that none of the factors examined (age, gender, tooth type) affected time to failure.Conclusion: The results indicate the potential of CMRs for extending the functional life of crowns with defective margins, thus reducing provider and patient burden of replacing an indirect restoration. We recommend future studies with a larger population who received CMR to extend the generalizability of our findings and to determine the influence of factors such as caries risk and severity of defects on survival time.

PMID:34411254 | DOI:10.2341/20-062-C

Mil Med. 2021 Aug 19:usab322. doi: 10.1093/milmed/usab322. Online ahead of print.

ABSTRACT

INTRODUCTION: The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD’s largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic.

MATERIALS AND METHODS: We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020).

RESULTS: Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P < .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P < .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P < .001 for all).

CONCLUSIONS: The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.

PMID:34411255 | DOI:10.1093/milmed/usab322

Int J Oral Maxillofac Implants. 2021 Jul-Aug;36(4):755-761. doi: 10.11607/jomi.8722.

ABSTRACT

PURPOSE: The study aimed to evaluate the outcomes of flapless guided surgery related to surgery, patient, operator, assistant, and advisor, comparing it with conventional surgery performed by undergraduate students who had never placed implants in patients.

MATERIALS AND METHODS: A randomized controlled split-mouth clinical trial was carried out. Ten patients with bilateral mandibular posterior tooth loss received an implant on each side with conventional flap surgery or flapless guided surgery that was performed by undergraduate students. Surgery time, pain, patient satisfaction, quantity of consumed medications, time of procedure, ease of procedure, anxiety, and stress were assessed.

RESULTS: Conventional surgery showed statistically significantly inferior results compared with flapless guided surgery in terms of procedure time (56 minutes, 36 seconds ± 8 minutes, 38 seconds vs 30 minutes, 1 second ± 6 minutes, 2 seconds), consumption of analgesic medications (49 tablets vs 15 tablets), intraoperative (1.75 ± 1.56 vs 0.65 ± 0.64) and postoperative pain (4.62 ± 2.17 vs 1.17 ± 0.72), and operator anxiety (4.76 ± 1.66 vs 3.47 ± 1.50), respectively.

CONCLUSION: Flapless guided implant surgeries performed by individuals with no previous clinical experience showed reduced surgery time and delivered better patient-reported outcomes both in the intraoperative and postoperative periods; reduced medication consumption; and showed better results in the operator and assistant perspectives.

PMID:34411217 | DOI:10.11607/jomi.8722

Int J Oral Maxillofac Implants. 2021 Jul-Aug;36(4):762-770. doi: 10.11607/jomi.8682.

ABSTRACT

PURPOSE: The aim of this study was to investigate the influence of different clinical parameters on the primary stability of a variable thread tapered implant system with a focus on surgical undersizing protocols.

MATERIALS AND METHODS: This retrospective study evaluated patients who received NobelActive implants in a single institution. The relationship between the independent variables, bone quality, implant diameter, implant length, implantation time, region of the jaw, and surgical undersizing protocol, and the dependent variable, maximum insertion torque, was investigated. Statistical analysis was conducted using analysis of variance (ANOVA) and multiple linear regression.

RESULTS: A total of 1,292 implants placed in 574 fully or partially edentulous patients were evaluated. For the total sample size, without further differentiation between bone qualities, statistically significantly higher primary stability values were shown for an 8% to 9% undersized group (50.33 ± 17.16 Ncm), compared with a 16% undersized group (41.88 ± 17.63 Ncm), a 20% undersized group (33.65 ± 15.78 Ncm), a 26% to 28% undersized group (34.53 ± 15.49 Ncm), and a 35% to 44% undersized group (32.78 ± 18.80 Ncm). No statistical differences were found for undersizing protocols in bone quality 4. Bone quality had the highest influence on primary stability (Welch-Test F(3, 65.57) = 119.48, P < .001, η² = .20). Contrary to the other investigated independent variables, no statistically significant differences in primary stability were found for the different implantation times.

CONCLUSION: Undersizing protocols exceeding 8% to 9% do not seem to enhance primary stability values. Further studies are needed to investigate the biologic consequences of undersizing, including the impact of implant design characteristics.

PMID:34411218 | DOI:10.11607/jomi.8682

Int J Oral Maxillofac Implants. 2021 Jul-Aug;36(4):723-729. doi: 10.11607/jomi.8647.

ABSTRACT

PURPOSE: To assess the impact of abutment angulation on loosening torque, torque loss, and percentage of torque loss in the prosthesis and abutment screws after aging of the implant-supported prosthesis.

MATERIALS AND METHODS: Fifty epoxy maxillary casts with missing central, lateral, and canine teeth were used, and each cast received two implants. All casts were divided into five groups (n = 10): (1) both implants received straight abutments (0-0); (2) the central implant received a straight abutment and the canine implant received a 17.5-degree angled abutment (0-17.5); (3) the central implant received a straight abutment and the canine implant received a 35-degree angled abutment (0-35); (4) both implants received 17.5-degree angled abutments (17.5-17.5); and (5) both implants received 35-degree angled abutments (35-35). For each cast, a three-unit zirconia restoration was fabricated, and a torque meter was utilized to tighten the abutment screw (25 Ncm) and prosthesis screw (18 Ncm). The reverse torque value was recorded for each screw. All restorations were subjected to 3,500 thermal cycles between 5°C and 55°C and load cycled for 150,000 cycles with 50-N load. After the loosening torque was measured for each screw, the torque loss and percentage of torque loss were calculated.

RESULTS: There was a statistically significant difference in the torque loss of the central prosthesis screw (P < .001) and canine prosthesis screw (P < .001) between study groups. The 35-35 group showed the highest percentage of torque loss, while the 0-0 group showed the lowest value. A significant difference was found regarding the torque loss of the central abutment screw (P < .001) and canine abutment screw (P < .001). The abutment screws of the 35-35 group showed the highest percentage of torque loss, while the 0-0 groups showed the lowest percentage of torque loss.

CONCLUSION: Screw loosening of the prosthesis and abutment screws increases with increasing abutment angulation after aging. In the same fixed prosthesis, the torque loss in the prosthesis and abutment screws was higher in canine screws employing different angled abutments.

PMID:34411211 | DOI:10.11607/jomi.8647

Int J Oral Maxillofac Implants. 2021 Jul-Aug;36(4):703-714. doi: 10.11607/jomi.8695.

ABSTRACT

PURPOSE: To evaluate the impact on healing of bioactivation with argon plasma of a xenogeneic graft with adequate fixation but poor adaptation to the native host bone.

MATERIALS AND METHODS: Xenogeneic grafts were either treated with argon plasma or left untreated and randomly secured with a titanium screw to both lateral aspects of the mandible angle of rabbits. A discrepancy was obtained between the xenograft and the mandible due to the convexity of the recipient site. Collagen membranes were placed on the grafts. Thirty animals were included and euthanized in groups of 10 after 2, 6, and 10 weeks, respectively. Histomorphometric evaluations were performed on ground sections. Newly formed bone was the primary outcome, while the distance between the peak of new bone inside the graft and the upper surface of the graft, the xenograft percentages, and the area of the xenograft were considered as secondary variables. The Wilcoxon test was applied for statistical analyses.

RESULTS: After 2 weeks of healing, gaps of ~0.5 mm were observed at the interface between the graft and the recipient sites, and new bone was mainly located in the interface and within the inferior regions of the grafts. New bone increased over time in all regions, including those in the upper zones of the graft, reaching proportions of 20.3% ± 6.5% and 19.3% ± 7.4% (P = .484) after 10 weeks in the plasma and control groups, respectively. The mean distance between the peak of new bone inside the graft and the upper surface of the graft decreased between 2 and 10 weeks of healing from 1.4 mm to 0.4 mm and from 1.7 mm to 0.3 mm at the plasma and control sites, respectively.

CONCLUSION: The xenogeneic grafts of both groups were incorporated into the recipient sites by newly formed bone that presented a growth close to the upper surface of the graft. The bioactivation with argon plasma did not improve healing.

PMID:34411209 | DOI:10.11607/jomi.8695

Int Tinnitus J. 2021 Mar 1;25(1):94-99. doi: 10.5935/0946-5448.20210017.

ABSTRACT

PURPOSE: Music is an aesthetic whole consisting of sounds combined according to a certain purpose, method and understanding. Therefore, it also interacts with emotions in listeners. Music sounds are in the range of approximately 20-8000 Hz. This frequency range is within the frequency spectrum of the human cochlea. The aim of this research is to evaluate the hearing thresholds of music teachers and to determine whether they cause tinnitus.

MATERIAL AND METHODS: This research was conducted in Turgut Özal University Medical Faculty Hospital Audiology and Speech Disorders clinic. A total of 35 people (17 music teachers, 18 control groups) participated in the research. In this research, 17 music teachers (11 females, 6 males) aged 24-39, and 18 volunteers (12 females, 6 males) participated in the control group. After the otoscopic examination of all participants, pure tone audiometry (in the range of 125-16,000 Hz), immitansmetric examination and Distortion Product Otoacoustic Emission (DPOAE) tests were performed. Tinnitus Handicap Inventory (THI) was used in the evaluation of tinnitus.

RESULTS: There was no statistically significant difference between the music teachers and the control group in all pure tone hearing threshold averages of 125-16,000 Hz (p>0.05). The Uncomfortable Level (UCL) average of music teachers was 104.12 ± 3.83 dB for the right ear, 108.33 ± 3.83 dB for the control group, 107.78 ± 4.28 dB for the left ear, and 103.53 ± 4.28 for the control group. DPOAE results were found statistically significant at 3000 Hz only for the right and left ears (p=0.036; p=0.015, respectively). Also, for DPOAE test, the control group’s OAE values were higher than the music teachers. According to the Tinnitus Handicap Inventory in music teachers, 1st degree tinnitus has emerged.

CONCLUSION: According to the findings obtained, the low UCL value in music teachers compared to the control group suggests the tolerance problem. Continuous exposure to the sound was thought to create a noise effect on the cochlea, and as a result, tinnitus susceptibility appeared in music teaching.

PMID:34410086 | DOI:10.5935/0946-5448.20210017

Int Tinnitus J. 2021 Mar 1;25(1):118-123. doi: 10.5935/0946-5448.20210021.

ABSTRACT

PURPOSE: Auditory processing is the analysis of sounds’ attributions such as localization, lateralization, temporality, frequency, loudness, phase, auditory memory and auditory attention through primer and secondar central auditory paths. This study aims to show that music contributes on auditory processing by applying central auditory tests on two groups who are musicians and nonmusicians.

MATERIALS AND METHODS: The participants in this study are aged between 20 and 40. The mean age of the musician participants is 24.40±3.811, when the mean age of non-musician participants is 26.07±4.525. Each group has 30 participants. All participants got examined for otorhinolaryngology and they were tested for pure tone audiometry and immitansmetric measurement. For musician participants, this study included people who have professional music career for at least 5 years and for non-musician participants, it has been included those who are capable of normal hearing. All participants tested for Frequency Patterns Test (FPT), Duration Patterns Test (DPT), Random Gap Detection Test (RGDT) and Staggered Spondaic Word Test (SSWT).

RESULTS: The results of the FPT, DPT, RGDT and SSWT tests applied to musician and non-musician participants indicate that there is a statistical significance on auditory processing between these two groups (p<0.05). It is founded that there is a considerable difference as a result of statistical significance between the tests from right to left and from left to right (p<0.05). In addition, it is founded that musician participants have much more comprehension ability in the tests from left to right than the tests from right to lefts.

CONCLUSION: This study indicates that people who are interested in music professionally have developed auditory processing skills and senses than people who does not show any professional interest in music.

PMID:34410090 | DOI:10.5935/0946-5448.20210021

Int Tinnitus J. 2021 Mar 1;25(1):34-38. doi: 10.5935/0946-5448.2021008.

ABSTRACT

INTRODUCTION: Tinnitus- the perception of sound without external stimulation can also lead to disruption in the quality of life and has been over the years been benefitted by tinnitus masking. Hence this study to understand the effectiveness of tinnitus masking using the Auditory Brainstem Response (ABR) Test.

OBJECTIVES: The intention of this experimental research design is to determine whether tinnitus masking as treatment for tinnitus makes a significant difference in auditory evoked brainstem responses before and after masking for understanding the effectiveness of the treatment objectively and possible quantification of benefit measurement through ABR.

DESIGN: 30 subjects with normal hearing and unilateral tinnitus were assessed using ABR before and after tinnitus masking. Data was collected and compared to evaluate pre-masking and post-masking values of Latency-Intensity function and Interpeak Latency differences. Data was analyzed using descriptive statistics, test of homogeneity of variances and Two-way ANOVA.

RESULTS: Both latency-intensity functions and interpeak latency differences showed significant differences before and after tinnitus masking with significance values of Two-way ANOVA as .001, (Calculated at p < .05).

CONCLUSIONS: Despite the patient’s subjective feedback, objective proof of the patient’s benefit is a necessity. Therefore, this study shows that ABR shows significant differences in patients treated with tinnitus masking. Further suggesting benefit quantification of tinnitus masking as a treatment to tinnitus suffering individuals and for further understanding the intricacies of changes in the central auditory pathway due to masking.

PMID:34410077 | DOI:10.5935/0946-5448.2021008