Category: Statistics

Eur J Haematol. 2021 Feb 23. doi: 10.1111/ejh.13606. Online ahead of print.

ABSTRACT

We conducted a retrospective study to analyze the prognostic factors impacting the overall survival (OS) and progression-free survival (PFS) of diffuse large B cell lymphoma (DLBCL) patients undergoing first-line therapy and admitted to intensive care unit (ICU) compared to a control cohort who did not required ICU admission. Between January 1, 2008, and December 31, 2018, 828 patients were diagnosed with DLBCL at our institution, including 72 patients who were required ICU admission during disease course. Among them, forty-five patients undergoing homogeneous first-line therapy with /R-CHOP-like regimen and ICU-admitted were selected for the present analysis. Control “non-ICU” DLBCL patients were matched by age, IPI score and treatment received. The median age at ICU admission was 65 years, 97.8% of patients displayed advanced-stage disease (III/IV), and 84.4% had a high IPI score (3 – 5). The main reasons for ICU admission were acute respiratory failure (40.0%) and septic shock (33.3%). The ICU mortality rate was 33.3%. The 2-year PFS was lower in ICU survivors patients than in non-ICU patients: 31.7% (95% CI 18.5 – 54.1) vs 60.8% (95% CI 51.2 – 72.1, p=0.00049). Admission to the ICU is an event that clearly impacts the outcomes of patients with DLBCL, until two years after the event. ICU prognosis seems mainly related to critical patient severity at admission rather than lymphoma-related prognostic factors (IPIs), suggesting that ICU admission criteria should not be based only on the lymphoma prognosis.

PMID:33624346 | DOI:10.1111/ejh.13606

Magn Reson Med. 2021 Feb 23. doi: 10.1002/mrm.28715. Online ahead of print.

ABSTRACT

PURPOSE: Spin-echo (SE) functional MRI (fMRI) can be highly advantageous compared to gradient-echo (GE) fMRI with respect to magnetic field-inhomogeneity artifacts. However, at 3T, the majority of blood oxygenation level-dependent (BOLD) fMRI experiments are performed using T2∗ -weighted GE sequences because of their superior sensitivity compared to SE-fMRI. The presented SE implementation of a highly accelerated GE pulse sequence therefore aims to improve the sensitivity of SE-fMRI while profiting from a reduction of susceptibility-induced signal dropout.

METHODS: Spin-echo MR encephalography (SE-MREG) is compared with the more conventionally used spin-echo echo-planar imaging (SE-EPI) and spin-echo simultaneous multislice (SE-SMS) at 3T in terms of capability to detect neuronal activations and resting-state functional connectivity. For activation analysis, healthy subjects underwent consecutive SE-MREG (pulse repetition time [TR] = 0.25 seconds), SE-SMS (TR = 1.3 seconds), and SE-EPI (TR = 4.4 seconds) scans in pseudorandomized order applied to a visual block design paradigm for generation of t-statistics maps. For the investigation of functional connectivity, additional resting-state data were acquired for 5 minutes and a seed-based correlation analysis using Stanford’s FIND (Functional Imaging in Neuropsychiatric Disorders) atlas was performed.

RESULTS: The increased sampling rate of SE-MREG relative to SE-SMS and SE-EPI improves the sensitivity to detect BOLD activation by 33% and 54%, respectively, and increases the capability to extract resting-state networks. Compared with a brain region that is not affected by magnetic field inhomogeneities, SE-MREG shows 2.5 times higher relative signal strength than GE-MREG in mesial temporal structures.

CONCLUSION: SE-MREG offers a viable possibility for whole-brain fMRI with consideration of brain regions that are affected by strong susceptibility-induced magnetic field gradients.

PMID:33624352 | DOI:10.1002/mrm.28715

Psychooncology. 2021 Feb 23. doi: 10.1002/pon.5665. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine if baseline stigma predicts psychological distress at 3 months and 6 months follow-up among patients newly diagnosed with lung cancer.

METHODS: This longitudinal study was nested within a larger randomised controlled trial. Eligible participants were recruited via respiratory and oncology out-patient clinics in Australia (n=194). Consenting participants were asked to complete surveys at baseline, 3 months and 6 months post-recruitment. Measures included lung cancer stigma (Cataldo Lung Cancer Stigma Scale) and psychological distress (General Health Questionnaire 12).

RESULTS: One-hundred and ninety-four participants were included for analysis. Most were male (57.7%) with a mean age of 68 years (SD=8.8). A significant relationship between baseline lung cancer stigma and psychological distress at six months was found, where a one unit increase in lung cancer stigma increases psychological distress by 0.044 when adjusting for age, gender, smoking status, baseline GHQ-12 scores and intervention allocation (as part of the larger trial; p=0.001; β=0.044, 95% CI=0.010, 0.079).

CONCLUSION: Temporal links between lung cancer stigma and psychological distress was found at 6 months, suggesting stigma-related experiences may have a delayed impact. Development of routine lung cancer stigma assessments is recommended to identify those at risk of psychological distress. This article is protected by copyright. All rights reserved.

PMID:33624377 | DOI:10.1002/pon.5665

Pain Ther. 2021 Feb 23. doi: 10.1007/s40122-021-00238-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Multidisciplinary patient-reported outcomes are a critical part of assessing patients to better understand their well-being during treatment. The use of multidisciplinary patient-reported outcomes is recommended in many areas of medicine. The Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) has been utilized as a common measurement language across universally relevant domains, including pain, mood, sleep, social participation, and function.

METHODS: Retrospective analysis of prospectively collected data was performed. Subjects were identified and consecutively enrolled upon entry into chronic pain centers across 24 sites in the United States. The PROMIS-29 v2.1 and the numerical rating scale (NRS) were recorded. The pain impact score and the Health Utilities Index Mark 3 (HUI-3) were calculated. Statistical differences were assessed between genders and among age groups comprising subjects less than 40, 41-60, 61-80, and over 80 years of age.

RESULTS: A total of 19,546 patients were assessed over the enrollment period from 2018 to 2020. The PROMIS-29 v2.1 was evaluated across the seven domains, along with the numerical rating sale (NRS). The mean scores of the population for PROMIS SF v1.0 Pain Interference 4a, PROMIS SF v1.0 Sleep Disturbance 4a, PROMIS SF v1.0 Fatigue 4a, PROMIS SF v1.0 Anxiety 4a, PROMIS SF V1.0 Depression 4a, PROMIS SF v2.0 Ability to Participate in Social Roles and Activities 4a, and PROMIS SF v1.0 Physical Function 4a, measuring pain interference, sleep disturbance, fatigue, anxiety, depression, social participation, and physical function, were 64.61, 57.19, 58.50, 53.94, 54.45, 40.06, and 36.23, respectively. Pain intensity was 6.38 on an 11-point NRS scale. The pain impact score (PIS) and health utilities index mark 3 (HUI-3) scores, calculated across the designated age groups, were 33.19 and 0.67, respectively. Statistical differences were observed for the domains of sleep disturbance and physical function for age groups less than 40 and greater than 80 years of age.

CONCLUSION: This data set is the first published normative data set describing the PROMIS-29 assessment in the chronic pain population. The patient population is more homogeneous than expected, and females were found to have higher levels of dysfunction.

PMID:33624253 | DOI:10.1007/s40122-021-00238-z

Turk Neurosurg. 2020 Jun 30. doi: 10.5137/1019-5149.JTN.30774-20.4. Online ahead of print.

ABSTRACT

AIM: One of the main complications caused by traumatic brain injury (TBI) is intracerebral hemorrhage, and if we can somehow prevent the expansion of intracerebral hemorrhage, it reduces mortality and also the need for surgical intervention. This study aimed to determine the effect of Intravenous Tranexamic Acid (TXA) on a traumatic intracerebral hemorrhage Material and Methods: 94 cases of TBI with intracerebral hemorrhage, admitted to the emergency department, who did not need surgical intervention, were randomly assigned into two groups of 47 patients. In the treatment group Intravenous TXA was administered every 6 hours for 48 hours, and in the control group, the placebo was administered in the same way. After 6, 24, and 48 hours all the cases underwent a brain CT scan. Scans were examined for the size and diameter of hematoma and the midline shift. The information regarding the level of consciousness, hematoma volume, and diameter on CT scan were recorded on arrival and 48h later Results: Statistical results depicts that while there was no considerable difference in the demographic aspect of the two groups, volume and diameter of hematoma and the midline shift in the first CT scans and also their level of consciousness, the diameter and volume of hematoma and also the amount of hematoma expansion in follow up have significant differences in the two groups.

CONCLUSION: This study showed that the prescription of TXA would reduce the amount of hematoma expansion in traumatic intracerebral hemorrhage, and the medicine can be introduced to reduce the morbidity and complications.

PMID:33624275 | DOI:10.5137/1019-5149.JTN.30774-20.4

Turk Neurosurg. 2020 Oct 16. doi: 10.5137/1019-5149.JTN.31668-20.1. Online ahead of print.

ABSTRACT

AIM: We sought to evaluate the usefulness of the rostral line (R-line) as a new index for determining the degree of C2 lamina decompression in the context of ossification of the posterior longitudinal ligament (OPLL) extending to the C2 level.

MATERIAL AND METHODS: The R-line was devised based on the mechanism by which the cord is shifted backward following cervical posterior decompression. According to their R-line status, 36 patients with cervical OPLL extending to the C2 level were divided into two groups of R-line (+)and R-line (-) cases, where the R-line touched the upper half of the posterior C2 lamina in the R-line (+) group and the inferior half of the posterior C2 lamina in the R-line (-) group, respectively.

RESULTS: Eighteen patients were classified as R-line (+) and 18 patients were classified as R-line (-). Total laminectomy of the C2 lamina was more common in the R-line (+) group, while dome-shape C2 laminectomy was more common in the R-line (-) group. All patients requiring reoperation were included in the R-line (+) group. Only the operation type showed a statistically significant difference according to the need for reoperation in the R-line (+) group; specifically, all patients who underwent reoperation in the R-line (+) group had dome-shape C2 laminectomy. It was determined that the risk factor for reoperation in the R-line (+) group was a history of dome-shape C2 laminectomy.

CONCLUSION: If the R-line touches the upper half of the posterior C2 lamina, total decompression of the C2 lamina should be performed.

PMID:33624283 | DOI:10.5137/1019-5149.JTN.31668-20.1

J Adv Nurs. 2021 Feb 23. doi: 10.1111/jan.14805. Online ahead of print.

ABSTRACT

AIM: To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes.

DESIGN: A cross-sectional and correlational study, using a structural equation model.

METHODS: One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R² ), the predictive validity coefficient (Q² ) and the effect size (f² ).

RESULTS: The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10).

CONCLUSION: The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations.

IMPACT: This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.

PMID:33624302 | DOI:10.1111/jan.14805

Environ Sci Pollut Res Int. 2021 Feb 23. doi: 10.1007/s11356-021-12942-6. Online ahead of print.

ABSTRACT

Most studies focused on the temporal trend of mortality risk associated with temperature exposure. The relative role of heat, cold, and temperature variation (TV) on morbidity and its temporal trends are explored insufficiently. This study aims to investigate the temporal trends of emergency ambulance dispatch (EAD) risk and the attributable burden of heat, cold, and hourly temperature variation (HTV). We collected time-series data of daily EAD and ambient temperature in Shenzhen from 2010 to 2017. HTV was calculated as the standard deviation of the hourly temperatures between 2 consecutive days. Quasi-Poisson generalized additive models (GAM) with a time-varying distributed lag nonlinear model (DLNM) were applied to examine temporal trends of the HTV-, heat-, and cold-EAD association. The temporal variation of the attributable fraction (AF%) and attributable number (AN) for different temperature exposures was also calculated. The largest RR was observed in extreme cold [1.30 (95% CI: 1.18, 1.43)] and moderate cold [1.25 (95% CI: 1.17, 1.34)]. Significant increasing trends in HTV-related effects and burden were observed, especially for the extreme HTV effects (P for interaction < 0.05). Decreasing trends were observed in the heat-related effect and burden, though it showed no significance (P for interaction = 0.46). There was no clear change pattern of cold-related effects and burdens. Overall, the three temperature exposure caused 13.7% of EAD, of which 4.1%, 4.3%, and 5.3% were attributed to HTV, heat, and cold, respectively. All the temperature indexes in this study, especially the cold effect, are responsible for the increased risk of EAD. People have become more susceptible to HTV over the recent decade. However, there is no clear evidence to support the temporal change of the population’s susceptibility to heat and cold. Thus, in addition to heat and cold, the emergency ambulance service department should pay more attention to HTV under climate change.

PMID:33624238 | DOI:10.1007/s11356-021-12942-6

Environ Sci Pollut Res Int. 2021 Feb 23. doi: 10.1007/s11356-021-12896-9. Online ahead of print.

ABSTRACT

The defensibility of field sampling data collected in support of natural resource damage assessments and other environmental investigations depends on rigorous quality assurance and control both in the field and laboratory. One important step in field procedures is the cleaning of sampling equipment between samples to minimize the carryover of contaminants. Large-scale sampling efforts during the Deepwater Horizon oil spill event have highlighted the importance of understanding how multiple equipment cleaning protocols affect interstation cross-contamination and the resulting chemical data quality. In this study, six field cleaning techniques were tested on metal sampling equipment using two different sediment types spiked with crude oil in order to understand their relative and absolute effectiveness in reducing chemical carryover. The complexity of the cleaning protocols ranged from a simple water and scrub brush application to protocols that included soap and/or solvent. In this study, percent residual hydrocarbon transfer, relative to total loading in sediments, never exceeded 0.032%. The least labor-intensive protocol, water and scrub brush application, had the highest potential for hydrocarbon transfer (0.011-0.032%). Statistical differences were observed among treatments, and it was found that protocols containing a solvent step were more effective than protocols without solvents. Depending on the data quality objectives, the differences may not be meaningful, and choosing a cleaning technique should be governed by health, safety, and environmental factors. The residual hydrocarbons measured after equipment cleanings for all techniques in this study were negligible when compared with other variables that occur during routine sampling and laboratory activities.

PMID:33624247 | DOI:10.1007/s11356-021-12896-9

J Sleep Res. 2021 Feb 23:e13278. doi: 10.1111/jsr.13278. Online ahead of print.

ABSTRACT

Primary insomnia is often considered a disorder of 24-hr hyperarousal. Numerous attempts have been made to investigate nocturnal heart rate (HR) and its variability (HRV) as potential pathophysiological hallmarks of altered arousal levels in insomnia, with mixed results. We have aimed to overcome some of the pitfalls of previous studies by using a young, medication-free, age- and gender-matched population consisting of 43 students aged 18-30 years half with a subthreshold insomnia complaint. We employed at-home ambulatory polysomnography and compared this attenuated insomnia group to a good sleeping group. The poor sleepers had significantly higher wake after sleep onset, arousal count, mean HR in all sleep stages (with the exception of Stage 1) and lower sleep efficiency. Consistent with previous research, we also found a significant group-by-sleep stage interaction in the prediction of nocturnal HR, highlighting the insomnia group to have a lower wake-sleep HR reduction compared to good sleepers. When restricting our analyses to insomnia with objectively determined short sleep duration, we found significantly lower standard deviation of RR intervals (SDNN; a measure of HRV) compared to good sleepers. Taken together, this lends credence to the hyperarousal model of insomnia and may at least partially explain the increased prevalence of cardiovascular morbidity and mortality observed in patients with insomnia.

PMID:33622029 | DOI:10.1111/jsr.13278