Category: Statistics

J Geriatr Oncol. 2021 Nov 11:S1879-4068(21)00247-2. doi: 10.1016/j.jgo.2021.11.001. Online ahead of print.

ABSTRACT

About 50% of patients with cancer are expected to need radiotherapy (RT), and the majority of these are older. To improve outcomes for older patients with cancer, geriatric assessment (GA) with management (GAM) is highly recommended. Evidence for its benefits is still scarce, in particular for patients receiving RT. We report the protocol of a cluster-randomised pilot study designed to test the effect, feasibility and health economic impact of a GAM intervention for patients ≥65 years, referred for palliative or curative RT. The randomising units are municipalities and city districts. The intervention is municipality-based and carried out in collaboration between hospital and municipal health services from the start of RT to eight weeks after the end of RT. Its main constituents are an initial GA followed by measures adapted to individual patients’ impairments and needs, systematic symptom assessments and regular follow-up by municipal cancer nurses, appointed to coordinate the patient’s care. Follow-up includes at least one weekly phone call, and a house call four weeks after the end of RT. All patients receive an individually adapted physical exercise program and nutritional counselling. Detailed guidelines for management of patients’ impairments are provided. Patients allocated to the intervention group will be compared to controls receiving standard care. The primary outcome is physical function assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire C-30. Secondary outcomes are global quality of life, objectively tested physical performance and use of health care services. Economic evaluation will be based on a comparison of costs and effects (measured by the main outcome measures). Feasibility will be assessed with mixed methodology, based on log notes and questionnaires filled in by the municipal nurses and interviews with patients and nurses. The study is carried out at two Norwegian RT centres. It was opened in May 2019. Follow-up will proceed until June 2022. Statistical analyses will start by the end of 2021. We expect the trial to provide important new knowledge about the effect, feasibility and costs of a GAM intervention for older patients receiving RT. Trial registration: ClinTrials.gov, ID NCT03881137, initial release 13th of March 2019.

PMID:34776384 | DOI:10.1016/j.jgo.2021.11.001

J Geriatr Oncol. 2021 Nov 11:S1879-4068(21)00250-2. doi: 10.1016/j.jgo.2021.11.004. Online ahead of print.

ABSTRACT

Older patients with cancer often have lower surgery rates and survival than younger patients, but this may reflect surgical contraindications of advanced disease, comorbidities, and frailty – and not necessarily under-treatment. This review describes variations in surgery rates and observed or net survival among younger (<75) and older (≥75) patients with lung, breast, and colorectal cancer, while taking account of pre-existing health factors, in order to understand how under-treatment is defined and estimated in the literature. MEDLINE, Embase, Web of Science and PubMed databases were searched. Thirty relatively high-quality studies of patients with breast (230,200; 71.9%), lung (77,573; 24.2%), and colorectal (12,407; 3.9%) cancers were identified. Compared to younger patients, older patients were less likely to receive surgical treatment for 1) breast cancer after adjusting for comorbidity, performance status (PS), functional status and patient choice, 2) lung cancer after accounting for stage, comorbidity, PS, and 3) colorectal cancer after adjusting for stage, comorbidity, and gender. The pooled unadjusted analyses showed lower surgery receipt in older patients in breast (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.78), lung (OR 0.54, 95% CI 0.39-0.75), and colorectal (OR 0.59, 95% CI 0.51-0.68) cancers. Lower surgery rates in older patients may contribute to their poorer survival compared to younger patients. Future research quantifying under-treatment should include necessary clinical factors, patient choice, patient’s quality of life and a statistically-robust approach, which will demonstrate how much of the survival deficit in older patients is due to their receiving lower surgery rates.

PMID:34776385 | DOI:10.1016/j.jgo.2021.11.004

J Ren Nutr. 2021 Nov 11:S1051-2276(21)00235-1. doi: 10.1053/j.jrn.2021.09.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Plant-based diets can delay the progression of chronic kidney disease (CKD) and help manage complications and co-morbid conditions such as hypertension, acidosis, diabetes, and cardiovascular disease. However, it is unclear how often plant-based diets are recommended to patients with kidney disease. The objective of this study was to understand nephrology professionals’ familiarity, perception, and recommendation of plant-based diets to people with kidney disease.

DESIGN AND METHODS: A survey to understand perception of recommendation of plant-based diets for patients with CKD was developed. Nephrology professionals from the National Kidney Foundation’s member directory were e-mailed a link to complete the survey online. This directory includes professionals who work in a variety of nephrology settings, including both CKD and end-stage renal disease care. Survey items were evaluated with descriptive statistics. Differences across items were determined using chi-square tests and t-tests.

RESULTS: A total of 3,901 professionals were sent the survey, and 644 completed the survey. A majority were dietitians (58%) and worked in dialysis clinics (54%). Most (88%) had heard of using plant-based diets for kidney disease treatment, and a majority (88%) believed it could improve CKD management, cardiovascular disease (90%), hypertension (90%), diabetes (84%), high cholesterol (90%), and obesity (84%). Dietitians were more likely to report plant-based diets as beneficial for each health condition (P < .05). Professionals were most confident that a plant-based diet could help control hypertension (3.75 ± 0.99 on a scale of 1-5), compared with delaying progression of CKD (3.68 ± 1.15) or treating acidosis (3.68 ± 1.13). Dietitians felt more confident in their ability to plan a balanced plant-based diet compared with other specialties (3.49 vs. 2.74, P < .001).

CONCLUSION: Nephrology professionals who work in nondialysis-dependent CKD settings, and those who work with patients on dialysis, are aware of the benefits of plant-based diets in kidney disease. However, plant-based diets are not routinely being offered as a treatment option. Nephrology practices should work to increase dietitian referrals to offer patients support in transitioning to a plant-based diet.

PMID:34776341 | DOI:10.1053/j.jrn.2021.09.008

J Cardiothorac Vasc Anesth. 2021 Oct 12:S1053-0770(21)00890-9. doi: 10.1053/j.jvca.2021.10.007. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the incidence and severity of acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass and the administration of exogenous nitric oxide in children.

DESIGN: A retrospective cohort study.

SETTING: A single institution, university hospital.

PARTICIPANTS: All children younger than 18 years of age who underwent surgery with cardiopulmonary bypass.

INTERVENTIONS: Medical records of all eligible patients between January 4, 2017, and June 28, 2019, were reviewed. Patients were divided into two groups based on whether they received exogenous nitric oxide.

MEASUREMENTS AND MAIN RESULTS: The primary endpoint was a change in serum creatinine level, defined as the difference between the preoperative creatinine and peak postoperative creatinine. The secondary endpoint was the incidence and severity of postoperative AKI. A difference-in-difference method using fixed-effect multiple linear regression was carried out to compare the difference in maximum serum creatinine changes between the control and intervention groups. Five hundred ninety-one patients were included in the analysis: 298 (50.5%) in the control group and 293 (49.5%) in the intervention group. Control and intervention groups did not vary significantly in terms of baseline characteristics except for bypass time. After adjusting for all baseline variables, there was no statistically significant difference in the increase in serum creatinine between the control and the intervention groups (0.01 [95% CI: -0.03, 0.05], p = 0.545).

CONCLUSIONS: This single-center, retrospective, cohort study found no change in the incidence and severity of postoperative AKI after the administration of nitric oxide into the cardiopulmonary bypass circuit in children.

PMID:34776350 | DOI:10.1053/j.jvca.2021.10.007

J Am Pharm Assoc (2003). 2021 Oct 26:S1544-3191(21)00442-8. doi: 10.1016/j.japh.2021.10.023. Online ahead of print.

ABSTRACT

BACKGROUND: There is a lack of research on the nature of drug-related problems (DRPs) in older adult communities in China and the impact of home medication review on DRP reduction and health-related quality-of-life (HRQoL) improvement.

OBJECTIVES: To identify and categorize DRPs in older adults in China and to assess the impact of home medication review.

METHODS: The prospective study was conducted in 2 community health service centers in Shanghai, China from December 2018 to December 2019. Eligible patients received a home medication review by a clinical pharmacist to assess for DRPs and adherence, propose pharmaceutical interventions, and measure outcomes of HRQoL. All enrolled patients were followed up for 3 months.

RESULTS: Medication use in 412 patients was analyzed. A total of 362 DRPs were identified, an average of 0.88 per patient. Treatment effectiveness was the primary DRP type (249; 68.8%). The most common causes of DRPs were patient-related (35.1%) and drug selection (31.0%). Pharmacists made 733 interventions, an average of 2 per DRP. A total of 82.1% of these interventions were accepted. At a 3-month follow-up, home medication review led to a statistically significant reduction in the mean number of DRPs (0.4 vs. 0.88, P < 0.001) and an increase in medication adherence (1.42 vs. 0.85, P < 0.001). Both HRQoL indicators also improved, EuroQol 5 Dimension scale (0.75 vs. 0.78, P < 0.001) and EuroQol-visual analog scale (70 vs. 77.65, P < 0.001).

CONCLUSION: Home medication review is a practical means to optimize drug therapy and improve patients’ HRQoL in community settings.

PMID:34776338 | DOI:10.1016/j.japh.2021.10.023

J Tissue Viability. 2021 Oct 30:S0965-206X(21)00116-9. doi: 10.1016/j.jtv.2021.10.008. Online ahead of print.

ABSTRACT

BACKGROUND: Consumer engagement is a requirement of high quality clinical guidelines. Developing strategies to engage consumers and incorporate the perspectives of individuals with or at risk of pressure ulcers/injuries and their informal caregivers was one priority in the recent update of the EPUAP/NPIAP/PPPIA’s Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline.

AIMS: The aims were to determine the goals of individuals and caregivers for pressure ulcer/injury care, priorities for pressure ulcer/injury education and biggest problems related to pressure ulcers/injuries.

METHODS: An online, anonymous, international 10-item survey, accessible in nine languages was provided to individuals and their caregivers from April to October 2018. Descriptive statistics were used for quantitative data and a thematic analysis approach was used to analyse qualitative data.

RESULTS: There were 1233 individuals from 27 countries who completed the survey. Overall, individuals and caregivers had similar goals of care. Reducing the size of pressure ulcer/injury was selected more often as a care goal than complete healing. Individuals, compared to caregivers, considered managing pain more important. Qualitative data analysis identified five themes including knowledge, attitudes, and skills; risk factors for pressure ulcer/injury; accessing pressure ulcer/injury care; quality of life for patients and caregivers; and the pressure ulcer/injury.

CONCLUSIONS: The consumer survey provided consumer engagement and perspective that was incorporated into guideline development, including consideration during evaluation of the relevance and acceptability of recommendations, and assignment of recommendation strength ratings.

PMID:34776327 | DOI:10.1016/j.jtv.2021.10.008

Foot Ankle Surg. 2021 Nov 7:S1268-7731(21)00215-0. doi: 10.1016/j.fas.2021.11.002. Online ahead of print.

ABSTRACT

BACKGROUND: Winograd procedures performed under a partial digital block with a single needle to the surgical side instead of the entire toe were not evaluated. This study aimed to examine the clinical results of classic ring block and partial digital block performed during Winograd procedures in cases of ingrown toenails.

METHODS: A total of 210 patients underwent Winograd surgery were divided into two groups according to the type of anesthesia used as follows: traditional ring block (TRB) and partial digital block (PDB). Visual analog scale (VAS) scores, Heifetz stage patient satisfaction levels, recurrence rates, and need for reoperation were recorded.

RESULTS: Compared with the PDB group, the during operation VAS score was statistically significantly higher in the TRB group (p = 0001). There was no statistically significant difference between the groups in terms of postoperative satisfaction, recurrence (p = 0294), and reoperation rates (p = 0651).

CONCLUSIONS: This study is the first to show that adequate anesthetic efficacy can be achieved with a less invasive intervention for Winograd procedures.

PMID:34776335 | DOI:10.1016/j.fas.2021.11.002

J Voice. 2021 Oct 13:S0892-1997(21)00334-9. doi: 10.1016/j.jvoice.2021.09.039. Online ahead of print.

ABSTRACT

INTRODUCTION: Dysphonia and laryngeal problems are some of the manifestations of the COVID-19 pandemic due to respiratory disease as a primary effect of COVID-19. The aim of the present study was to investigate voice quality and vocal tract discomfort symptoms in patients with COVID-19.

MATERIALS AND METHODS: Forty-four COVID-19 patients with a mean age of 49.61 ± 16.48 years and 44 healthy subjects with a mean age of 48.52 ± 13.8 years participated in the study. The voice quality of the participants was evaluated using auditory-perceptual evaluation with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale. The vocal tract discomfort symptoms of the participants were assessed using the Persian version of the VTD scale.

RESULTS: Patients with COVID-19 had higher scores in all items of the GRBAS, including grade, roughness, breathiness, asthenia, and strain, than healthy subjects, and these differences were statistically significant (P < 0.05). Among the GRBAS parameters, grade had the highest effect size and asthenia had the lowest effect size in both speech tasks. The COVID-19 patients had a greater frequency of vocal tract discomfort symptoms than healthy subjects in all items of the VTDp scale and these differences were statistically significant (P < 0.05) in the following items: burning, tight, dry, pain, sore, irritable, and lump in the throat. The most and the least effect size in frequency of the vocal tract discomfort symptoms were related to dry (d = 1.502) and tickling (d = 0.157), respectively. Also, COVID-19 patients had more significant severity in all items of the VTDp scale except tight and tickling. The most and the least effect size in severity of the vocal tract discomfort symptoms was related to dry (d = 1.416) and tickling (d = 0.152), respectively.

CONCLUSION: The present study suggests that COVID-19 patients have more deviations in voice quality than healthy subjects. Moreover, mild vocal tract discomfort is prevalent in patients with COVID-19, and patients have more frequent and severe physical discomforts of the vocal tract than healthy subjects.

PMID:34776316 | DOI:10.1016/j.jvoice.2021.09.039

Am J Orthod Dentofacial Orthop. 2021 Nov 11:S0889-5406(21)00694-6. doi: 10.1016/j.ajodo.2021.08.016. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to identify and analyze the 100 most-cited articles published in orthodontic scientific journals in the past 21 years.

METHODS: The research was conducted in the Thomson Reuters Web of Science data citation index, considering articles from 2000 to 2020 and the category of dentistry, oral surgery, and medicine. Information about the number of citations, citations per year, title, authors, year of publication, the title of scientific journals, type of study, keywords, and thematic field were extracted for each article. Descriptive statistical analyses were performed to evaluate the collected data. The Pearson correlation analysis was used to explore the relationship between publication and the number of citations received. The VOSviewer software (Leiden University Center for Science and Technology Studies, Leiden, the Netherlands) was used to generate the keyword cooccurrence network.

RESULTS: The number of citations of the 100 selected articles ranged from 122 to 547. The journal with the largest number of cited articles was the American Journal of Orthodontics and Dentofacial Orthopedics. Most of the papers were cross-sectional and longitudinal studies, and the most frequent thematic fields among the selected articles were anchorage, root resorption, and rapid maxillary expansion. Orthodontic treatment, anchorage, and root resorption were the most frequent keywords.

CONCLUSIONS: Bibliometric analysis of citations revealed a greater centralization of orthodontic studies. Most of the articles were published in a single journal and by one country. Anchorage is a trending topic in orthodontics, and cross-sectional and longitudinal studies are the most-cited types of papers.

PMID:34776322 | DOI:10.1016/j.ajodo.2021.08.016

Surgery. 2021 Nov 11:S0039-6060(21)00959-4. doi: 10.1016/j.surg.2021.10.001. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy operative difficulty is highly variable and influences outcomes. This systematic review analyzes the performance and clinical value of statistical models to preoperatively predict laparoscopic cholecystectomy operative difficulty.

METHODS: PRISMA guidelines were followed. PubMed, Embase, and the Cochrane Library were searched until June 2020. Primary studies developing or validating preoperative models predicting laparoscopic cholecystectomy operative difficulty in cohorts of >100 patients were included. Studies not reporting performance metrics or enough information for clinical implementation were excluded. Data were extracted according to CHARMS, and study quality was assessed using the PROBAST tool.

RESULTS: In total, 2,654 articles were identified, and 22 met eligibility criteria. Eighteen were model development, whereas 4 were validation studies. Eighteen studies were at high risk of bias. However, 11 studies showed low concern for applicability. Identified models predict 9 definitions of laparoscopic cholecystectomy operative difficulty, the most common being conversion to open surgery and operating time. The most validated models predict an intraoperative difficulty scale and procedures >90 minutes with an area under the curve of >0.70 and >0.76, respectively. Commonly used predictors include demographic variables such as age and gender (9/18 models) and ultrasound findings such as gallbladder wall thickness (11/18). Clinical implementation was never studied.

CONCLUSION: There is a longstanding interest in estimating laparoscopic cholecystectomy operative difficulty. Models to preoperatively predict laparoscopic cholecystectomy operative difficulty have generally good performance and seem applicable. However, an unambiguous definition of operative difficulty, validations, and clinical studies are needed to implement patients’ stratification in laparoscopic cholecystectomy.

PMID:34776259 | DOI:10.1016/j.surg.2021.10.001