Category: Statistics

J Glaucoma. 2021 Aug 12. doi: 10.1097/IJG.0000000000001922. Online ahead of print.

ABSTRACT

PRCIS: Tape sealing of the face mask can prevent fogging artifacts of visual field testing. Here we demonstrate that tape sealing can improve visual field scores even when fogging artifacts are not obvious.

PURPOSE: To demonstrate that visual field scores improve when the face masks are taped in order to prevent fogging artifacts.

METHODS: Single-center, randomized 2×2 cross-over study. Twenty-six visual fields of 13 patients of the glaucoma outpatient clinic were included. Patients were randomized in either sequence 1 (Octopus visual field examination without tape sealing, followed by examination with tape sealing) or sequence 2 (examination with, followed by without tape sealing).

RESULTS: The results for mean defect and square root of Loss Variance (sLV) differ significantly in the examination with and without tape sealing (mean difference (without-with) 0.39▒dB; 95% CI: 0.07 to 0.70▒dB; P=0.018 and 0.49▒dB; 95% CI: 0.19 to 0.79▒dB; P=0.003, respectively). There was no sequence effect (P=0.967) for mean defect nor sLV (P=0.779). A significant effect for period (P=0.023) for mean defect was yielded.

CONCLUSION: Tape sealing of face masks during visual field testing prevented fogging artifacts and improved visual field scores even when fogging artifacts were not obvious, and should be considered in clinical practice.

PMID:34387258 | DOI:10.1097/IJG.0000000000001922

Cancer Nurs. 2021 Aug 11. doi: 10.1097/NCC.0000000000000970. Online ahead of print.

ABSTRACT

BACKGROUND: The quality of life of patients receiving chemotherapy decreases, and fatigue is one of the most common symptoms. Reiki is used for cancer patients as an energy-based complementary and alternative method.

OBJECTIVE: The aim of this study was to determine the effect of Reiki therapy on the quality of life and fatigue levels in breast cancer patients receiving chemotherapy.

METHODS: This was a pretest-posttest, quasi-experimental study with a control group: 70 patients enrolled with 35 participants in the experimental group and 35 in the control group. The experimental group received 6 sessions of Reiki therapy. The data were collected using a Patient Information Form, the Piper Fatigue Scale, and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire.

RESULTS: The mean scores on the general well-being subscale in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire increased in the experimental group and decreased in the control group, whereas the mean scores on the general function and general symptom subscales decreased in the experimental group and increased in the control group. The differences between the groups were statistically significant (P < .001). The mean Piper Fatigue Scale scores of the experimental group decreased, whereas that of the control group increased; the group differences were statistically significant (P < .001).

CONCLUSION: Reiki can reduce fatigue and increase the quality of life of breast cancer patients receiving chemotherapy.

IMPLICATIONS FOR PRACTICE: Reiki therapy can be used as a nursing intervention to increase the quality of life and reduce fatigue in breast cancer patients receiving chemotherapy.

PMID:34387236 | DOI:10.1097/NCC.0000000000000970

J Dev Behav Pediatr. 2021 Aug 11. doi: 10.1097/DBP.0000000000000986. Online ahead of print.

ABSTRACT

OBJECTIVE: School readiness is strongly associated with a child’s future school success and well-being. The primary objective of this study was to determine whether meeting 24-hour movement guidelines (national physical activity, sedentary behaviors, and sleep recommendations) was associated with school readiness measured with mean scores in each of the 5 developmental domains of the Early Development Instrument (EDI) in Canadian children aged 4 to 6 years. Secondary objectives include examining the following: (1) the association between meeting 24-hour movement guidelines and overall vulnerability in school readiness and (2) the association between meeting individual physical activity, screen use and sleep recommendations, and overall school readiness.

METHODS: A prospective cohort study was performed using data from children (aged 4-6 years) who participated in a large-scale primary care practice-based research network.

RESULTS: Of the 739 participants (aged 5.9 + 0.12 years) in this prospective cohort study, 18.2% met the 24-Hour Movement Guidelines. Linear regression models (adjusted for child/family demographic characteristics, number of siblings, immigration status, and annual household income) revealed no evidence of an association between meeting all 24-hour movement guidelines and any of the 5 domains of the EDI (p > 0.05). Adjusted linear regression models revealed evidence of an association between meeting screen use guidelines and the “language and cognitive development” (β = 0.16, p = 0.004) domain, and for the sleep guideline, there was a statistically significant association with the “physical health and well-being” (β = 0.23, p = 0.001), the “language and cognitive development” (β = 0.10, p = 0.003), and the “communication skills and general knowledge” (β = 0.18, p < 0.001) domain.

CONCLUSION: Early lifestyle interventions targeting screen use and sleep may be beneficial for improving a child’s readiness for school.

PMID:34387247 | DOI:10.1097/DBP.0000000000000986

Retina. 2021 Aug 6. doi: 10.1097/IAE.0000000000003284. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the screening potential of a deep learning algorithm derived severity score by determining its ability to detect clinically significant severe retinopathy of prematurity (ROP).

METHODS: Fundus photographs were collected, and standard panel diagnosis was generated for each examination by combining 3 independent image-based gradings. All images were analyzed using a deep learning algorithm and a quantitative assessment of retinal vascular abnormality (DeepROP score) were assigned on a 1-100 scale. The area under the receiver operating curve (AUROC) and distribution pattern of all diagnostic parameters and categories of ROP were analyzed. The correlation between the DeepROP score and expert rank ordering according to overall ROP severity of 50 examinations was calculated.

RESULTS: A total of 9882 individual examinations with 54626 images from 2801 infants were analyzed. 56 (0.6%) examinations demonstrated type 1 ROP, 54 (0.5%) examinations demonstrated type 2 ROP. The DeepROP score had an AUROC of 0.981 for detecting type 1 ROP and 0.986 for type 2 ROP. There was a statistically significant correlation between the expert rank ordering of overall disease severity and the DeepROP score (correlation coefficient 0.758, p<0.001). When hypothetical referral cut-off score of 35 was selected, all cases of severe ROP (type 1 and type 2 ROP) was captured, 8562 (87.6%) eyes with no or mild ROP were excluded.

CONCLUSION: The DeepROP score determined by deep learning algorithm was an objective and quantitative indicator for the severity of ROP, and it had potential in automated detecting clinically significant severe ROP.

PMID:34387234 | DOI:10.1097/IAE.0000000000003284

J Thorac Imaging. 2021 Aug 12. doi: 10.1097/RTI.0000000000000613. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study is to investigate the performance of artificial intelligence (AI) convolutional neural networks (CNN) in detecting lung nodules on chest computed tomography of patients with complex lung disease, and demonstrate its noninferiority when compared against an experienced radiologist through clinically relevant assessments.

METHODS: A CNN prototype was used to retrospectively evaluate 103 complex lung disease cases and 40 control cases without reported nodules. Computed tomography scans were blindly evaluated by an expert thoracic radiologist; a month after initial analyses, 20 positive cases were re-evaluated with the assistance of AI. For clinically relevant applications: (1) AI was asked to classify each patient into nodules present or absent and (2) AI results were compared against standard radiology reports. Standard statistics were performed to determine detection performance.

RESULTS: AI was, on average, 27 seconds faster than the expert and detected 8.4% of nodules that would have been missed. AI had a sensitivity of 67.7%, similar to an accuracy reported for experienced radiologists. AI correctly classified each patient (nodules present/absent) with a sensitivity of 96.1%. When matched against radiology reports, AI performed with a sensitivity of 89.4%. Control group assessment demonstrated an overall specificity of 82.5%. When aided by AI, the expert decreased the average assessment time per case from 2:44 minutes to 35.7 seconds, while reporting an overall increase in confidence.

CONCLUSION: In a group of patients with complex lung disease, the sensitivity of AI is similar to an experienced radiologist and the tool helps detect previously missed nodules. AI also helps experts analyze for lung nodules faster and more confidently, a feature that is beneficial to patients and favorable to hospitals due to increased patient load and need for shorter turnaround times.

PMID:34387227 | DOI:10.1097/RTI.0000000000000613

J Pediatr Orthop. 2021 Aug 12. doi: 10.1097/BPO.0000000000001932. Online ahead of print.

ABSTRACT

BACKGROUND: Patients continue to utilize physician review websites (PRWs) to assist in their selection of a health care provider. Studies on PRWs and how they affect patient care have recently become popular in the literature. This study analyzes PRW ratings of a previously unexamined subspecialty, pediatric orthopaedic surgeons.

METHODS: Three hundred ninety-nine randomly selected Pediatric Orthopaedic Society of North America member’s PRW ratings were examined from May 4, 2020 to July 18, 2020. Healthgrades.com, Vitals.com, RateMDs.com, and Google.com were reviewed. Number of ratings and average ratings (0 to 5.0) were recorded. Provider sex, years in practice (0 to 10, 11 to 20, and 21+), practice type (academic, private), geographic location (Northeast, Southeast, Midwest, Southwest, West), degree (Medical Doctor, Doctor of Osteopathic Medicine), and fellowship training (yes, no) were recorded. Kruskal-Wallis testing was performed to determine factors affecting positive surgeon ratings.

RESULTS: 98.5% (393) of Pediatric Orthopaedic Society of North America surgeons were rated on a PRW at least once and were highly rated with an average rating of 4.14 of 5.0. Surgeons in practice 1 to 10 years had higher ratings than those in practice 11 to 20 and 21+ years, on Healthgrades.com (P=0.049) and RateMDs.com (P=0.011). Academic surgeons were found to have higher ratings than those in private practice on Google.com (P=0.007). Sex, region of practice, degree type, and fellowship training status did not have an effect on online ratings across all PRWs.

CONCLUSIONS: Pediatric orthopaedic surgeons are frequently and highly rated, similar to other orthopaedic subspecialties. Surgeons in practice 1 to 10 years were found to have statistically higher ratings on some websites. Academic surgeons were found to have statistically higher ratings on some websites.

PMID:34387231 | DOI:10.1097/BPO.0000000000001932

J Strength Cond Res. 2021 Aug 11. doi: 10.1519/JSC.0000000000004103. Online ahead of print.

ABSTRACT

Collison, J, Debenedictis, T, Fuller, JT, Gerschwitz, R, Ling, T, Gotch, L, Bishop, B, Sibley, L, Russell, J, Hobbs, A, and Bellenger, CR. Supramaximal interval running prescription in Australian Rules Football players: A comparison between maximal aerobic speed, anaerobic speed reserve and the 30-15 intermittent fitness test. J Strength Cond Res XX(X): 000-000, 2021-Accurate prescription of supramaximal interval running during Australian Rules Football (AF) preparatory periods is important to facilitate the specific targeting of physiological and neuromuscular adaptation. This study compared the variability in supramaximal interval running performance prescribed by proportion of maximal aerobic speed (MAS), anaerobic speed reserve (ASR), and 30-15 intermittent fitness test (30-15IFT) terminal speed. Seventeen male junior AF players first completed assessments of MAS, ASR, and 30-15IFT in a randomized order. They subsequently performed supramaximal interval running trials (15 seconds on: 15 seconds off until volitional exhaustion) at 120% MAS, 20% ASR, and 95% 30-15IFT in a randomized order. Variability in time to exhaustion (TTE) for each prescription method was calculated as the mean of the square root of the squared difference between the individual value and the mean value, and it was compared via repeated-measures analysis of variance with statistical significance set at p ≤ 0.05. Time to exhaustion during supramaximal interval running was not different between the prescription methods (p = 0.58). Time to exhaustion residuals were reduced when prescribed by ASR compared with MAS (standardized mean difference [SMD] = -0.47; 29%); however, confidence intervals about this reduction indicated that there was some uncertainty in this finding (SMD = -1.03 to 0.09; p = 0.09). Trivial differences in TTE residuals were present when prescribed by 30-15IFT compared with MAS (SMD = -0.05 ± 0.59; p = 0.86). Although there was some uncertainty about the reduction in supramaximal interval running performance variability when prescribed by ASR compared with MAS, the 29% reduction exceeds the inherent error in TTE efforts (i.e., ∼9-15%) and may thus be considered practically meaningful. Reducing supramaximal interval running performance variability ensures similar physiological demand across individuals, potentially facilitating similar degrees of physiological adaptation.

PMID:34387223 | DOI:10.1519/JSC.0000000000004103

BDJ Open. 2021 Aug 12;7(1):30. doi: 10.1038/s41405-021-00083-4.

ABSTRACT

BACKGROUND: Immediate loading is an attractive option for avoiding secondary surgery. However, it is unclear whether it provides a better aesthetic outcome compared to conventional loading with implants placed in healed ridges.

AIMS: To compare the aesthetic outcomes of immediately and conventionally loaded single implants in healed anterior maxillary ridges.

METHODOLOGY: A systematic review using PICO was conducted. EMBASE, MEDLINE and DoSS databases were searched. The Cochrane Risk of Bias tool for Randomised Controlled Trials and the Effective Public Health Practice Project tool for other study designs were used for quality appraisal. A narrative synthesis was undertaken.

RESULTS: A total of 622 articles were identified. After screening, a total of five papers were included. Results indicated no statistically significant difference in pink or white aesthetic scores between the immediate and conventional loading groups at 1- and 5-year review and the Papilla Index at the 1-year review.

CONCLUSION: Within the limitations of this review, immediate loading of single implants provides a comparable aesthetic outcome to conventional loading in healed ridges of the anterior maxillary.

PMID:34385413 | DOI:10.1038/s41405-021-00083-4

J Am Soc Nephrol. 2021 Aug 12:ASN.2020121694. doi: 10.1681/ASN.2020121694. Online ahead of print.

ABSTRACT

BACKGROUND: The association between variabilities in body mass index (BMI) or metabolic parameters and prognosis of patients with CKD has rarely been studied.

METHODS: In this retrospective observational study on the basis of South Korea’s national health screening database, we identified individuals who received ≥3 health screenings, including those with persistent predialysis CKD (eGFR <60 ml/min per 1.73 m² or dipstick albuminuria ≥1). The study exposure was variability in BMI or metabolic parameters until baseline assessment, calculated as the variation independent of the mean and stratified into quartiles (with Q4 the highest quartile and Q1 the lowest). We used Cox regression adjusted for various clinical characteristics to analyze risks of all-cause mortality and incident myocardial infarction, stroke, and KRT.

RESULTS: The study included 84,636 patients with predialysis CKD. Comparing Q4 versus Q1, higher BMI variability was significantly associated with higher risks of all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [95% CI], 1.53 to 1.81), P [for trend] <0.001), KRT (HR, 1.20; 95% CI, 1.09 to 1.33; P<0.001), myocardial infarction (HR, 1.19; 95% CI, 1.05 to 1.36, P=0.003), and stroke (HR, 1.19; 95% CI, 1.07 to 1.33, P=0.01). The results were similar in the subgroups divided according to positive or negative trends in BMI during the exposure assessment period. Variabilities in certain metabolic syndrome components (e.g., fasting blood glucose) also were significantly associated with prognosis of patients with predialysis CKD. Those with a higher number of metabolic syndrome components with high variability had a worse prognosis.

CONCLUSIONS: Higher variabilities in BMI and certain metabolic syndrome components are significantly associated with a worse prognosis in patients with predialysis CKD.

PMID:34385363 | DOI:10.1681/ASN.2020121694

J Nucl Med. 2021 Aug 12:jnumed.121.262473. doi: 10.2967/jnumed.121.262473. Online ahead of print.

ABSTRACT

Background: Better biomarkers are needed to predict treatment outcome in NSCLC patients treated with anti PD-(L)1 checkpoint inhibitors. PD-L1 immunohistochemistry has limited predictive value, possibly due to tumor heterogeneity of PD-L1 expression. Noninvasive PD-L1 imaging using ⁸⁹Zr-durvalumab might provide a better reflection of tumor PD-L1 expression and can therefore support treatment decision making. Patients and Methods: NSCLC patients eligible for second line immunotherapy treatment were enrolled. Patients received two injections of ⁸⁹Zr-durvalumab; one without a preceding dose of unlabeled durvalumab (‘tracer dose only’) and one with a preceding dose of 750 mg durvalumab, directly prior to tracer injection. Up to four PET/CT scans were obtained after tracer injection. Post-imaging acquisition, patients were treated with 750mg durvalumab every two weeks. Tracer biodistribution and tumor uptake were visually assessed and quantified as standardized uptake value (SUV) and both imaging acquisitions were compared. Tumor tracer uptake was correlated with PD-L1 expression and clinical outcome, defined as treatment response to durvalumab treatment. Results: Thirteen patients were included and ten completed all scheduled PET scans. No tracer related adverse events were observed and all patients started durvalumab treatment. Biodistribution analysis showed ⁸⁹Zr-durvalumab accumulation in the blood pool, liver and spleen. Serial imaging showed that image acquisition 120 hours post injection delivered the best tumor to blood pool ratio. Most tumor lesions were visualized with the tracer-dose only versus the co-injection imaging acquisition (25% vs 13.5% of all lesions). Uptake heterogeneity was observed within (range SUVpeak 0.2 to 15.1) and between patients. Tumor uptake was higher in patients with treatment response or stable disease, compared to patients with disease progression according to RECIST 1.1. However, this difference was not statistically significant (median SUVpeak 4.9 vs 2.4, P = 0.06). SUVpeak correlated better with the combined tumor and immune cell PD-L1 score than with PD-L1 expression on tumor cells, although both were not statistically significant (P = 0.06 and P = 0.93, respectively). Conclusion: ⁸⁹Zr-durvalumab was safe without any tracer related adverse events and more tumor lesions were visualized using the tracer dose only imaging acquisition. ⁸⁹Zr-durvalumab tumor uptake was higher in patients with response to durvalumab treatment, but did not correlate with tumor PD-L1 IHC.

PMID:34385342 | DOI:10.2967/jnumed.121.262473