Category: Statistics

Jpn J Clin Oncol. 2021 Aug 27:hyab137. doi: 10.1093/jjco/hyab137. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigated whether the Dementia Assessment Sheet for the Community-based Integrated Care System is useful for decision-making or problem detection in the treatment and care of older patients with inoperable advanced non-small cell lung cancer compared with the current standard model using performance status.

METHODS: This study retrospectively examined 1595 cases admitted to the Department of Respiratory Medicine at the Tokyo Metropolitan Geriatric Hospital between 26 July 2016 and 28 January 2020. Among these, 29 and 31 patients who received pharmacotherapies and best supportive care were extracted, respectively. The performance in identifying best supportive care using the Dementia Assessment Sheet for the Community-based Integrated Care System was evaluated in comparison with performance status. The ability to detect impairments in each Dementia Assessment Sheet for the Community-based Integrated Care System domain was also assessed.

RESULTS: The Dementia Assessment Sheet for the Community-based Integrated Care System total score had an area under the curve of 0.831 (95% confidence interval, 0.694-0.914), which was statistically equivalent to performance status. The discriminatory cut-off value for identification of best supportive care was set at 29 with a sensitivity and specificity of 0.742 and 0.897, respectively. Dementia Assessment Sheet for the Community-based Integrated Care System total score showed good concordance with performance status especially when reported by family members or caregivers. Deficits other than activities of daily living were recognized (2.8-19.4%) in patients with good performance status. Impairments were more frequently detected when reported by family members or caregivers.

CONCLUSIONS: The Dementia Assessment Sheet for the Community-based Integrated Care System discriminates the best supportive care for older patients with inoperable advanced non-small cell lung cancer. Moreover, it can identify vulnerabilities especially when reported by family members or caregivers that cannot be detected by performance status.

PMID:34453179 | DOI:10.1093/jjco/hyab137

HNO. 2021 Aug 27. doi: 10.1007/s00106-021-01103-3. Online ahead of print.

ABSTRACT

BACKGROUND: Patients suffering from tinnitus require individualized clarification (counseling), sometimes going beyond the scope of the field of ENT and the initiation of specific interventions.

AIM: To investigate if patients who had a specific neurotological assessment including a psychosomatic medical history follow the recommendations provided to them. In addition, it should be examined whether compliance with the treatment suggestions has led to any psychological improvement in the suffering from tinnitus, evaluated by psychological tests.

MATERIAL AND METHOD: In295 out of 699 patients audiological tests were evaluated using the mini-questionnaire (TF 12) according to Hiller and Goebel and the German language version of the Hospitality Anxiety and Depression Scale (HADS) at 2 points in time with an interval of a least 6 months. The group of those who followed the recommendations were compared to the group of those who did not follow the recommendations.

RESULTS: A total of 180 patients (64.5%) followed at least 1 of the recommendations made to them. Patients who followed at least one recommendation benefited significantly more than the whole group in the TF 12 and in both HADS categories compared to the group that did not follow the recommendations.

CONCLUSION: In addition to counseling it was shown that the implementation of a specific measure has a positive effect, detectable for the Progressive Muscle Relaxation (PMR). Specific for ENT, a hearing aid can initiate an improvement even if no statistically significant difference to the comparison group was found.

PMID:34453187 | DOI:10.1007/s00106-021-01103-3

J Anim Sci. 2021 Aug 28:skab232. doi: 10.1093/jas/skab232. Online ahead of print.

ABSTRACT

The objective of this experiment was to determine if statistical process control (SPC) procedures coupled with remote continuous data collection could accurately differentiate between animals experimentally inoculated with a viral-bacterial (VB) challenge or phosphate buffer solution (PBS). Crossbred heifers (N = 38; BW = 230 ± 16.4 kg) were randomly assigned to treatments by initial weight, ADG, BHV-1 and MH serum titers. Feeding behavior, DMI, animal activity and rumen temperature were continuously monitored remotely prior to and following VB challenge. VB-challenged heifers exhibited decreased (P < 0.01) ADG and DMI, as well as increased (P < 0.01) neutrophils and rumen temperature consistent with a bovine respiratory disease (BRD) infection. However, none of the heifers displayed overt clinical signs of disease. Shewhart and cumulative summation (CUSUM) charts were evaluated, with sensitivity and specificity computed on the VB-challenged heifers (n = 19), and PBS-challenged heifers (n = 19) respectively, accuracy was determined as the average of sensitivity and specificity. To address the diurnal nature of rumen temperature responses, summary statistics (Mean, minimum, maximum) were computed for daily quartiles (6-h intervals), and these quartile temperature models were evaluated separately. In the Shewhart analysis, DMI was the most accurate (95%) at deciphering between PBS- or VB-challenged heifers, followed by rumen temperature (94%) collected in the 2 nd and 3 rd quartiles. Rest was most the accurate accelerometer-based traits (89%), and meal duration (87%) and bunk visit (BV) frequency (82%) were the most accurate feeding behavior traits. Rumen temperature collected in the 3 rd quartile signaled the earliest (2.5 d) of all the variables monitored with the Shewhart, followed by BV frequency (2.8 d), meal duration (2.8 d), DMI (3.0 d) and rest (4.0 d). Rumen temperature and DMI and remained the most accurate variables in the CUSUM at 80 and 79%, respectively. Meal duration (58%), BV frequency (71%) and rest (74%) were less accurate when monitored with the CUSUM analysis. Furthermore, signal day was greater for DMI, rumen temperature and meal duration (4.4, 5.0 and 3.7 d, respectively) in the CUSUM compared to Shewhart analysis. These results indicate that Shewhart and CUSUM charts can effectively identify deviations in feeding behavior, activity and rumen temperature patterns for the purpose of detecting sub-clinical BRD in beef cattle.

PMID:34453166 | DOI:10.1093/jas/skab232

Mil Med. 2021 Aug 28:usab353. doi: 10.1093/milmed/usab353. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to evaluate the effect of the SARS-COV2 pandemic on chaplain utilization at Brooke Army Medical Center. Our hypothesis was that multiple pandemic-related factors led to a care environment with increased mental and spiritual stress for patients and their families, leading to an increased need for adjunct services such as chaplaincy.

MATERIALS AND METHODS: This was a single-institution retrospective chart review study that evaluated the records of 10,698 patients admitted between July 1, 2019, and January 31, 2020, or between July 1, 2020, and January 31, 2021. Our primary study outcomes included the number of chaplain consultations, the number of visits per consultation, and the time of visits between the two study cohorts. Secondary outcomes included inpatient mortality and the number of end-of-life visits. We also isolated a subgroup of patients admitted with COVID-19 and compared their outcomes with the two larger cohorts. Statistical analysis included t-test or chi-squared test, based on the variable. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board (IRB ID C.2021.010e).

RESULTS: Fewer consults were performed during the study period affected by the SARS-COV2 pandemic (4814 vs. 5884, P-value <.01). There were fewer individual visits per consult during the study period affected by the SARS-COV2 pandemic (1.44 vs. 1.64, P-value <.01), which led to fewer overall time spent per consult (37.41 vs. 41.19 minutes, P-value <.01). The 2020 cohort (without COVID-19 cases) demonstrated a higher mortality rate than the 2019 cohort (2.8% vs. 1.9%, P-value <.01). The COVID-19 diagnosis cohort demonstrated a much higher mortality rate compared to other patients in the 2020 cohort (19.3% vs. 2.8%, P-value <.01). We demonstrated the relative need for EOL consults by presenting the ratio of EOL consults to inpatient deaths. This ratio was highest for the COVID-19 diagnosis cohort (0.76) compared to the 2020 cohort (0.50) and the 2019 cohort (0.60).

CONCLUSIONS: This study demonstrates that factors related to the SARS-COV2 pandemic resulted in fewer chaplaincy consults in our inpatient setting. We did not find other reports of a change in the rate of chaplaincy consultation, but available reports suggest that many centers have had difficulty balancing the spiritual needs of patients with local exposure guidelines. Although fewer individual chaplain consults occurred during the SARS-COV2 pandemic, our chaplain service innovated by utilizing various phone, video, and web-based platforms to deliver spiritual support to our community. Our study also suggests that the patients most greatly affected by the pandemic have an increased need for spiritual support, especially at the end of life. Future studies in this subject should examine the effect of various types of chaplain services as they relate to the health and well-being of hospitalized patients.

PMID:34453171 | DOI:10.1093/milmed/usab353

Mil Med. 2021 Aug 28:usab325. doi: 10.1093/milmed/usab325. Online ahead of print.

ABSTRACT

INTRODUCTION: Brachytherapy, with external beam radiation, increases survival in the treatment of locally advanced cervical cancer (LACC). In 2016, Robin et al. reported only 44% of patients received standard-of-care (SOC) brachytherapy in the USA. The Pacific Island Health Care Project has provided humanitarian medical care to women from the U.S. Associated Pacific Islands (USAPI) for three decades at Tripler Army Medical Center (TAMC), a military health care system (MHS) facility. We evaluated whether this underserved and understudied patient population received SOC treatment for LACC at TAMC.

MATERIALS AND METHODS: The TAMC tumor registry was searched for all cervical cancer cases from 1997 to 2019. Subjects were excluded if they did not have stage IB2-IVA disease and were not from USAPI. The primary outcome was the overall utilization of brachytherapy, and statistical analysis was performed using the chi-square test.

RESULTS: We identified 214 women with cervical cancer treated at TAMC, of which 67 met the study criteria. Ninety-two percent had squamous cell carcinoma on histology. Of the patients identified, 48 (71.6%, P < .001) were treated with brachytherapy. Fifteen (22.4%) patients received external radiation alone, and four (6.0%) received chemoradiation without brachytherapy. A post-hoc power analysis was conducted with a power of 91.3%.

CONCLUSIONS: Women with cervical cancer from USAPI in the PIHCP program treated at TAMC received significantly higher rates of SOC radiation treatment than the U.S. population on average. This highlights the ability of PIHCP, through the MHS, to deliver SOC treatment for cervical cancer to an otherwise underserved patient population.

PMID:34453178 | DOI:10.1093/milmed/usab325

Ann Work Expo Health. 2021 Aug 28:wxab071. doi: 10.1093/annweh/wxab071. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to construct, validate, and calibrate an exposure matrix that would be used to estimate personal airborne exposures to total dust, manganese, nickel, chromium, and aluminum for welders in the WHAT-ME cohort. The Workers’ Health in Apprenticeship Trades: metal and electrical (WHAT-ME) study established a cohort of women and men welders to investigate pregnancy and other birth outcomes along with health issues related to welding. To construct the matrix, data were extracted and assembled from the literature and analyzed to produce exposure models. Final models derived in this first step were then compared with external data gathered under controlled conditions and later combined to form calibrated models.

METHODS: A systematic literature search was conducted to identify and extract all relevant data from published journal articles appearing in selected databases. Summary data were extracted that represented airborne personal exposures to total, inhalable and respirable dusts along with metal concentrations for manganese, nickel, chromium, and aluminum. Mathematical exposure models were derived and a validation of the models undertaken in the second part of this study. The most common welding combinations of welding process, base metal, and consumable (welding scenarios) for welders taking part in the WHAT-ME study were identified through detailed welding questionnaires completed by WHAT-ME participants. These were replicated under controlled conditions with a welder equipped with a personal air sampling pump to gather samples. A gravimetric analysis was performed to determine total dust exposures followed by a metals analysis using ICP-MS. Predictions were made for these welding scenarios replicated in the laboratory, using the exposure models derived in the literature and the predictions correlated against the results from the welding laboratory replications.

RESULTS: The systematic review yielded 92 published articles from which 737 summary statistics were extracted representing 4620 personal samples of total dust, 4762 of manganese, 4679 of nickel, 3972 of chromium, and 676 of aluminum. The highest total dust exposures were for flux-core arc welding (FCAW) while the highest manganese producing base metal was mild steel. For nickel, the highest emissions were from high alloyed steel using gas metal arc welding while chromium emissions were most abundant in manual metal arc welding on stainless steel. Aluminum exposures were highest in FCAW welding and on aluminum as a base metal. The replication of 21 scenarios covered more than 90% of the scenarios in the WHAT-ME study. Sixty-one laboratory welding sessions took place with a minimum of two replications per scenario. Spearman rank correlations between predicted exposures and mean measured exposures yielded a rho of 0.93 (P < 0.001) for total dust, 0.87 (P < 0.001) for manganese, 0.54 (P < 0.024) for nickel, 0.43 (P = 0.055) for chromium, and 0.29 (P = 0.210) for aluminum.

CONCLUSIONS: This study produced the first welding exposure matrix composed of process, base metal, and consumable. This model was able to predict exposures observed under controlled conditions and could be used by any researcher to estimate welding exposures in a wide range of occupational contexts.

PMID:34453157 | DOI:10.1093/annweh/wxab071

Brief Bioinform. 2021 Aug 27:bbab347. doi: 10.1093/bib/bbab347. Online ahead of print.

ABSTRACT

Continuous evaluation of drug safety is needed following approval to determine adverse events (AEs) in patient populations with diverse backgrounds. Spontaneous reporting systems are an important source of information for the detection of AEs not identified in clinical trials and for safety assessments that reflect the real-world use of drugs in specific populations and clinical settings. The use of spontaneous reporting systems is expected to detect drug-related AEs early after the launch of a new drug. Spontaneous reporting systems do not contain data on the total number of patients that use a drug; therefore, signal detection by disproportionality analysis, focusing on differences in the ratio of AE reports, is frequently used. In recent years, new analyses have been devised, including signal detection methods focused on the difference in the time to onset of an AE, methods that consider the patient background and those that identify drug-drug interactions. However, unlike commonly used statistics, the results of these analyses are open to misinterpretation if the method and the characteristics of the spontaneous reporting system cannot be evaluated properly. Therefore, this review describes signal detection using data mining, considering traditional methods and the latest knowledge, and their limitations.

PMID:34453158 | DOI:10.1093/bib/bbab347

Spinal Cord. 2021 Aug 27. doi: 10.1038/s41393-021-00695-5. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective descriptive study.

OBJECTIVES: To summarize epidemiologic data on nontraumatic spinal cord injury (NTSCI) for the last 30 years and compare these findings to data from individuals with traumatic spinal cord injury (TSCI).

SETTING: National Rehabilitation Center affiliated with the Ministry of Health and Welfare in Korea.

METHODS: The medical records of 948 individuals with NTSCIs were retrospectively reviewed. Three groups were created based on onset period (1990-1999, 2000-2009, 2010-2019) and six groups based on age (≤15, 16-30, 31-45, 46-60, 61-75, and ≥76 years). Pearson’s chi-square and analysis of variance tests were used for statistical analysis.

RESULTS: The male-to-female ratio was 1.30:1 for NTSCI individuals and 3.47:1 for TSCI individuals. The mean age (standard deviation [SD]) at the time of injury increased from 38.7 (SD = 18.1) years in the 1990s to 55.5 (SD = 16.6) years in the 2010s (F = 44.597, p ≤ 0.001). Vertebral column degenerative disorder was the primary cause of injury in 28.9% of the cases, and the most common neurologic level was T12-L2. Paraplegia occurred in 74.6% of cases, and tetraplegia in 25.4% of cases. The proportion of NTSCI individuals increased from 11.2% to 29.3% during the observation period.

CONCLUSIONS: The proportion of NTSCI among total spinal cord injuries has increased in Korea over the last 30 years (1990-2019). Compared to individuals with TSCI, those with NTSCI had a higher age at onset, with different male-to-female ratios. Our study is the most comprehensive investigation of NTSCI in Korea, and our findings can inform research directions and medical guidelines.

PMID:34453110 | DOI:10.1038/s41393-021-00695-5

Br J Cancer. 2021 Aug 27. doi: 10.1038/s41416-021-01524-5. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer outcomes are poor in socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced disease. Targeted cancer awareness interventions require evaluation.

METHODS: This is a randomised controlled trial involving adults aged 40+ years recruited in community and healthcare settings in deprived areas of South Yorkshire and South-East Wales.

INTERVENTION: personalised behavioural advice facilitated by a trained lay advisor.

CONTROL: usual care. Follow-up at two weeks and six months post-randomisation.

PRIMARY OUTCOME: total cancer symptom recognition score two weeks post-randomisation.

RESULTS: Two hundred and thirty-four participants were randomised. The difference in total symptom recognition at two weeks [adjusted mean difference (AMD) 0.6, 95% CI: -0.03, 1.17, p = 0.06] was not statistically significant. Intervention participants reported increased symptom recognition (AMD 0.8, 95% CI: 0.18, 1.37, p = 0.01) and earlier intended presentation (AMD -2.0, 95% CI: -3.02, -0.91, p < 0.001) at six months. “Lesser known” symptom recognition was higher in the intervention arm (2 weeks AMD 0.5, 95% CI: 0.03, 0.97 and six months AMD 0.7, 95% CI: 0.16, 1.17). Implementation cost per participant was £91.34, with no significant between-group differences in healthcare resource use post-intervention.

CONCLUSIONS: Improved symptom recognition and earlier anticipated presentation occurred at longer-term follow-up. The ABACus Health Check is a viable low-cost intervention to increase cancer awareness in socioeconomically deprived communities.

CLINICAL TRIAL REGISTRATION: ISRCTN16872545.

PMID:34453114 | DOI:10.1038/s41416-021-01524-5

Sci Rep. 2021 Aug 27;11(1):17554. doi: 10.1038/s41598-021-96120-1.

NO ABSTRACT

PMID:34453078 | DOI:10.1038/s41598-021-96120-1