Category: Statistics

Z Evid Fortbild Qual Gesundhwes. 2021 Aug 16:S1865-9217(21)00121-5. doi: 10.1016/j.zefq.2021.07.004. Online ahead of print.

ABSTRACT

INTRODUCTION: The growing number of people with multimorbidity and polypharmacy in Germany has led to increasing complexity in health care and risks to patient safety. A high priority should therefore be placed on identifying and preventing avoidable adverse events. The patient perspective plays an important role in improving patient safety. In this study, we conducted a representative, population-based survey of knowledge, perceptions and experiences of patient safety, especially of subjectively experienced errors in health care. Our aim was in particular to assess patient safety from the patients’ point of view, and to analyze differences in assessments of risk and preventability between persons that felt well or poorly informed about patient safety topics.

METHODS: In 2019, computer-assisted telephone interviews were conducted nationwide as part of the “TK-Monitor Patient Safety” project. Recruitment was carried out by using multistage selection and forming a stratified random sample. Adults (18 years and older) with sufficient knowledge of German were included. The survey was conducted using a structured guideline containing 21 questions concerning perceptions and experiences of patient safety, and 12 questions on sociodemographic factors. The results were analyzed both descriptively and using inferential statistical methods.

RESULTS: Of a total of 1,000 respondents (51% female), approx. half (52%) were gainfully employed, and 57% rated their state of health as “very good” or “good”. The patients regarded data protection, medication errors, hospital infections and diagnostic (un)certainty as of major relevance to patient safety. Overall, 55% of the respondents rated their knowledge of patient safety as “very good” or “good”. The results showed that subjective knowledge was negatively associated with important outcome parameters such as having experience of medication errors or suspecting errors had been made in a medical examination or treatment. Patients that considered themselves well-informed also reckoned they could contribute towards increasing safety in health care.

DISCUSSION: The respondents considered diagnostic uncertainty to be one of the greatest risks to their person. This shows that they recognized a need for further information and felt this need was inadequately satisfied in the German research landscape. With regard to the correlation between subjective knowledge and outcome parameters, it is also necessary to analyze whether the respondents’ subjective knowledge reflects their actual knowledge, as this would be necessary for preventive measures to be effective. This question will be the subject of further studies.

CONCLUSION: The patient perspective is an important addition to the study of the safety of medical care in Germany. Factors influencing subjective knowledge should be investigated. Furthermore, regular surveys would be desirable in order to gain greater insight into the topic.

PMID:34412979 | DOI:10.1016/j.zefq.2021.07.004

Arch Med Res. 2021 Aug 9:S0188-4409(21)00167-3. doi: 10.1016/j.arcmed.2021.08.002. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: During the current Coronavirus Disease 2019 (COVID-19) pandemic, patients with diabetes face disproportionately more. This study was performed to clarify anti-inflammatory effects of anti-diabetic agents on COVID-19 in patients with diabetes.

METHODS AND RESULTS: Relevant literature was searched on 15 databases up to November 14, 2020 and was updated on April 13, 2021. The pooled ORs along with 95% CIs were calculated to evaluate combined effects. 31 studies with 66,914 patients were included in qualitative and quantitative synthesis. Meta-analysis showed that metformin was associated with a statistically significant lower mortality (pooled OR = 0.62, 95% CI, 0.50-0.76, p = 0.000) and poor composite outcomes (pooled OR = 0.83, 95% CI, 0.71-0.97, p = 0.022) in diabetic patients with COVID-19. Significance of slight lower mortality remained in sulfonylurea/glinides (pooled OR = 0.93, 95% CI, 0.89-0.98, p = 0.004), but of poor composite outcomes was not (pooled OR = 1.48, 95% CI, 0.61-3.60, p = 0.384). Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were associated with statistically non-significant lower mortality (pooled OR = 0.95, 95% CI, 0.72-1.26, p = 0.739) or poor composite outcomes (pooled OR = 1.27, 95% CI, 0.91-1.77, p = 0.162) of COVID-19 in diabetic patients.

CONCLUSION: Metformin might be beneficial in decreasing mortality and poor composite outcomes in diabetic patients infected with SARS-CoV-2. DPP-4 inhibitors, sulfonylurea/glinides, SGLT-2 inhibitors, and GLP-1RA would not seem to be adverse. There was insufficient evidence to conclude effects of other anti-diabetic agents. Limited by retrospective characteristics, with relative weak capability to verify causality, more prospective studies, especially RCTs are needed. Registration number: PROSPERO-CRD42020221951.

PMID:34412904 | DOI:10.1016/j.arcmed.2021.08.002

Am J Geriatr Psychiatry. 2021 Jul 29:S1064-7481(21)00398-5. doi: 10.1016/j.jagp.2021.07.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the circulating cell-free mitochondrial DNA (ccf-mtDNA) levels, a marker of cellular stress and damage, in older adults with late-life depression (LLD) and frailty. We hypothesize that individuals with both frailty and LLD will have higher ccf-mtDNA levels than individuals with either condition in isolation.

METHODS: Fifty-three older adults (Never Depressed+Robust (reference group, n = 16), LLD+Robust (n = 9), Never Depressed+Prefrail/Frail (n = 5), and LLD+Prefrail/Frail (n = 23)) were included in the study. DNA was extracted from EDTA plasma samples, and ccf-mtDNA was quantified by RT-PCR.

RESULTS: We found a statistically significant difference in the levels of ccf-mtDNA across groups (F_(3,49) = 3.07, p = 0.036), with individuals in the LLD+Prefrail/Frail group showing the highest levels of ccf-mtDNA.

CONCLUSION: The coexistence of LLD and frailty is associated with increased markers of cellular damage and stress (i.e., ccf-mtDNA). Our results suggest that these conditions may share cellular stress and mitochondrial dysfunction phenomena as a common biological mechanism, offering potential future opportunities for geroscience-guided interventions for these conditions.

PMID:34412934 | DOI:10.1016/j.jagp.2021.07.012

Acta Otorrinolaringol Esp. 2021 Aug 16:S0001-6519(21)00093-5. doi: 10.1016/j.otorri.2021.05.006. Online ahead of print.

ABSTRACT

BACKGROUND: Myringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs.

METHODS: Two independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs.

RESULTS: Four randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. The decision to protect the ear when exposed to water should be individualized and protection should be recommended during the first month after surgery and in cases of recurrent otorrhoea.

CONCLUSION: Based on the literature available, allowing water surface activities with no ear protection seems to present a minimum risk, so it is not necessary to prohibit patients from swimming. However, some recommendations should be followed.

PMID:34412895 | DOI:10.1016/j.otorri.2021.05.006

Int Dent J. 2021 Aug 16:S0020-6539(21)00132-5. doi: 10.1016/j.identj.2021.06.006. Online ahead of print.

ABSTRACT

AIM: The objective of this study was to evaluate the effect of additional light curing on the colour stability of composite resins.

MATERIALS AND METHODS: Four different composite resins-a nanofill, a nanohybrid, a microhybrid, and a bulk-fill composite resin-were tested. Eighty disc-shaped specimens were prepared from each material using either a quartz tungsten halogen or a light-emitting diode light source and were randomly divided into 2 groups according to the surface treatment: no polishing (nonpolished) or polishing with aluminum oxide discs (polished). Then additional light curing was applied to half of the specimens in each group. All specimens were immersed in coffee solution for 1 week. Colour was measured with a spectrophotometer at baseline and after 1 week of storage in coffee solution.

RESULTS: Statistically significant differences in colour stability were observed in the restorative materials according to the composition of composite resin, the polishing protocol, and additional light curing, whilst there were no significant differences according to the light source. Additional light curing reduced discolouration in all groups tested.

CONCLUSIONS: Additional light curing may be beneficial after finishing and polishing in order to maintain aesthetics and increase the resistance of composite resins to discolouration.

PMID:34412897 | DOI:10.1016/j.identj.2021.06.006

Artif Intell Med. 2021 Aug;118:102120. doi: 10.1016/j.artmed.2021.102120. Epub 2021 May 28.

ABSTRACT

BACKGROUND AND AIM: Hypoglycaemia prediction play an important role in diabetes management being able to reduce the number of dangerous situations. Thus, it is relevant to present a systematic review on the currently available prediction algorithms and models for hypoglycaemia (or hypoglycemia in US English) prediction.

METHODS: This study aims to systematically review the literature on data-based algorithms and models using diabetics real data for hypoglycaemia prediction. Five electronic databases were screened for studies published from January 2014 to June 2020: ScienceDirect, IEEE Xplore, ACM Digital Library, SCOPUS, and PubMed.

RESULTS: Sixty-three eligible studies were retrieved that met the inclusion criteria. The review identifies the current trend in this topic: most of the studies perform short-term predictions (82.5%). Also, the review pinpoints the inputs and shows that information fusion is relevant for hypoglycaemia prediction. Regarding data-based models (80.9%) and hybrid models (19.1%) different predictive techniques are used: Artificial neural network (22.2%), ensemble learning (27.0%), supervised learning (20.6%), statistic/probabilistic (7.9%), autoregressive (7.9%), evolutionary (6.4%), deep learning (4.8%) and adaptative filter (3.2%). Artificial Neural networks and hybrid models show better results.

CONCLUSIONS: The data-based models for blood glucose and hypoglycaemia prediction should be able to provide a good balance between the applicability and performance, integrating complementary data from different sources or from different models. This review identifies trends and possible opportunities for research in this topic.

PMID:34412843 | DOI:10.1016/j.artmed.2021.102120

Artif Intell Med. 2021 Aug;118:102131. doi: 10.1016/j.artmed.2021.102131. Epub 2021 Jun 25.

ABSTRACT

Big data importance and potential are becoming more and more relevant nowadays, enhanced by the explosive growth of information volume that is being generated on the Internet in the last years. In this sense, many experts agree that social media networks are one of the internet areas with higher growth in recent years and one of the fields that are expected to have a more significant increment in the coming years. Similarly, social media sites are quickly becoming one of the most popular platforms to discuss health issues and exchange social support with others. In this context, this work presents a new methodology to process, classify, visualise and analyse the big data knowledge produced by the sociome on social media platforms. This work proposes a methodology that combines natural language processing techniques, ontology-based named entity recognition methods, machine learning algorithms and graph mining techniques to: (i) reduce the irrelevant messages by identifying and focusing the analysis only on individuals and patient experiences from the public discussion; (ii) reduce the lexical noise produced by the different ways in how users express themselves through the use of domain ontologies; (iii) infer the demographic data of the individuals through the combined analysis of textual, geographical and visual profile information; (iv) perform a community detection and evaluate the health topic study combining the semantic processing of the public discourse with knowledge graph representation techniques; and (v) gain information about the shared resources combining the social media statistics with the semantical analysis of the web contents. The practical relevance of the proposed methodology has been proven in the study of 1.1 million unique messages from >400,000 distinct users related to one of the most popular dietary fads that evolve into a multibillion-dollar industry, i.e., gluten-free food. Besides, this work analysed one of the least research fields studied on Twitter concerning public health (i.e., the allergies or immunology diseases as celiac disease), discovering a wide range of health-related conclusions.

PMID:34412847 | DOI:10.1016/j.artmed.2021.102131

Artif Intell Med. 2021 Aug;118:102118. doi: 10.1016/j.artmed.2021.102118. Epub 2021 May 29.

ABSTRACT

Critical care clinicians are trained to analyze simultaneously multiple physiological parameters to predict critical conditions such as hemodynamic instability. We developed the Multi-task Learning Physiological Deep Learner (MTL-PDL), a deep learning algorithm that predicts simultaneously the mean arterial pressure (MAP) and the heart rate (HR). In an external validation dataset, our model exhibited very good calibration: R² of 0.747 (95% confidence interval, 0.692 to 0.794) and 0.850 (0.815 to 0.879) for respectively, MAP and HR prediction 60-minutes ahead of time. For acute hypotensive episodes defined as a MAP below 65 mmHg for 5 min, our MTL-PDL reached a predictive value of 90% for patients at very high risk (predicted MAP ≤ 60 mmHg) and 2‰ for patients at low risk (predicted MAP >70 mmHg). Based on its excellent prediction performance, the Physiological Deep Learner has the potential to help the clinician proactively adjust the treatment in order to avoid hypotensive episodes and end-organ hypoperfusion.

PMID:34412841 | DOI:10.1016/j.artmed.2021.102118

Ecol Lett. 2021 Aug 19. doi: 10.1111/ele.13862. Online ahead of print.

ABSTRACT

Predicting complex species-environment interactions is crucial for guiding conservation and mitigation strategies in a dynamically changing world. Phenotypic plasticity is a mechanism of trait variation that determines how individuals and populations adapt to changing and novel environments. For individuals, the effects of phenotypic plasticity can be quantified by measuring environment-trait relationships, but it is often difficult to predict how phenotypic plasticity affects populations. The assumption that environment-trait relationships validated for individuals indicate how populations respond to environmental change is commonly made without sufficient justification. Here we derive a novel general mathematical framework linking trait variation due to phenotypic plasticity to population dynamics. Applying the framework to the classical example of Nicholson’s blowflies, we show how seemingly sensible predictions made from environment-trait relationships do not generalise to population responses. As a consequence, trait-based analyses that do not incorporate population feedbacks risk mischaracterising the effect of environmental change on populations.

PMID:34412157 | DOI:10.1111/ele.13862

J Obstet Gynaecol Res. 2021 Aug 19. doi: 10.1111/jog.14993. Online ahead of print.

ABSTRACT

AIM: To determine whether preoperative genital hiatus at rest is predictive of medium-term prolapse recurrence.

METHODS: We conducted a retrospective study of women who underwent native tissue prolapse surgery from 2002 to 2017 with pelvic organ prolapse quantification data including resting genital hiatus at one of three time points: preoperatively, 6 weeks, and ≥1 year postoperatively. Demographics and clinical data were abstracted from the chart. Prolapse recurrence was defined by anatomic outcomes (Ba > 0, Bp > 0, and/or C ≥ -4) or retreatment. Descriptive statistics, bivariate analyses, and logistic regression analyses were performed.

RESULTS: Of the 165 women included, 36 (21.8%) had prolapse recurrence at an average of 1.5 years after surgery. Preoperative resting genital hiatus did not differ between women with surgical success versus recurrence (3.5 cm [interquartile range, IQR 2.25, 4.0) vs 3.5 cm (IQR 3.0, 4.0), p = 0.71). Point Bp was greater in the recurrence group at every time point. Preoperative Bp (odds ratio [OR] 1.24, confidence interval [CI] [1.06-1.45], p = 0.01) and days from surgery (OR 1.001, CI [1.000-1.001], p < 0.01) were independently associated with recurrence. Preoperative genital hiatus at rest and strain were significantly larger among women who underwent a colpoperineorrhaphy (rest: 4.0 [3.0, 4.5] cm vs 3.5 [3.0, 4.0] cm, p < 0.01; strain: 6.0 [4.0, 6.5] cm vs 5.0 [4.0, 6.0] cm, p = 0.01).

CONCLUSIONS: Preoperative genital hiatus at rest was not associated with prolapse recurrence when the majority of women underwent colpoperineorrhaphy. Preoperative Bp was more predictive of short-term prolapse recurrence. For every 1 cm increase in point Bp, there is a 24% increased odds of recurrence.

PMID:34412156 | DOI:10.1111/jog.14993