Category: Statistics

PLoS One. 2022 Jan 10;17(1):e0262414. doi: 10.1371/journal.pone.0262414. eCollection 2022.

ABSTRACT

BACKGROUND: Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal sepsis. Several studies done have reported the presence of mixed populations of bacteria with a significant increase in Extended-Spectrum Beta-Lactamase (ESBL) Enterobacteriaceae spps, Methicillin-Resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant (MDR) bacteria in urine and blood cultures of catheterized patients despite the use of prophylactic antibiotics. This study aimed at determining the bacterial species diversity and susceptibility patterns of indwelling urinary catheters from postpartum mothers attending Mbale Regional Referral Hospital (MRRH).

METHODS: A cross-sectional study employing quantitative and qualitative was carried out in MRRH among postpartum mothers with urinary catheters and their care-takers. The purposive non-random sampling strategy was used to collect data using an interviewer-administered questionnaire for the quantitative data collection and in-depth interviews for qualitative data collection. All the data collection tools used were developed, pretested and validated. At the point of de-catheterization, Catheter tips from enrolled participants were cut about 2-3cm below the balloon aseptically into test-tube containing peptone water, sonication technique employed, and incubation done 24hours then cultured to ensure phenotypic identification. An antibiotic sensitivity test was performed using the disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Quantitative data collected was entered in Microsoft Excel and then exported to STATA14 for statistical analysis. Thematic analysis was used to analyse and organise qualitative data by an inductive coding method using Nvivo 12 software.

RESULTS: In this study, 208 postpartum mothers participated, the majority of whom were caesarean section mothers of age range 20-24 years and 17 care-takers with a median age of 32 years. The prevalence of catheter tips bacterial colonisation was 98% despite 88.5% of the participants being on broad-spectrum antibiotics. The average duration of catheterisation was 2 days. All bacteria isolates were potential uro-pathogens with a mean occurrence of 2 bacteria species in each urinary catheter tip. The rates of MDR to commonly used antibiotics were high. The urinary catheter size of greater than F14 and duration of catheterization greater than 2 days were significantly associated with the number of bacterial species isolated from each sample. The maintenance care and knowledge of care-urinary catheter care among the care-takers was found sub-optimal.

CONCLUSION: There was a high prevalence of catheter colonisation with bacterial spps diversity averaging 2 spps per sample despite use of broad spectrum antibiotics. The MDR rates were high, which calls for routine culture and sensitivity. Health workers practicing obstetric medicine need to pay attention to catheter sizes during catheterisation and its duration. Health education should be part of antenatal and postnatal care education.

PMID:35007300 | DOI:10.1371/journal.pone.0262414

PLoS Med. 2022 Jan 10;19(1):e1003884. doi: 10.1371/journal.pmed.1003884. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied according to ethnic and socioeconomic background.

METHODS AND FINDINGS: We conducted a national study of singleton births in English National Health Service hospitals. We compared births during the COVID-19 pandemic period (23 March 2020 to 22 February 2021) with births during the corresponding calendar period 1 year earlier. The Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, obstetric inventions (induction of labour, elective or emergency cesarean section, and instrumental birth), and outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged maternal length of stay (≥3 days), and maternal 42-day readmission). Multi-level logistic regression models were used to compare intervention and outcome rates between the corresponding pre-pandemic and pandemic calendar periods and to test for interactions between pandemic period and ethnic and socioeconomic background. All models were adjusted for maternal characteristics including age, obstetric history, comorbidities, and COVID-19 status at birth. The study included 948,020 singleton births (maternal characteristics: median age 30 years, 41.6% primiparous, 8.3% with gestational diabetes, 2.4% with preeclampsia, and 1.6% with pre-existing diabetes or hypertension); 451,727 births occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% pandemic versus 0.37% pre-pandemic, p = 0.16). Preterm birth and SGA birth rates were slightly lower during the pandemic (6.0% versus 6.1% for preterm births, adjusted odds ratio [aOR] 0.96, 95% CI 0.94-0.97; 5.6% versus 5.8% for SGA births, aOR 0.95, 95% CI 0.93-0.96; both p < 0.001). Slightly higher rates of obstetric intervention were observed during the pandemic (40.4% versus 39.1% for induction of labour, aOR 1.04, 95% CI 1.03-1.05; 13.9% versus 12.9% for elective cesarean section, aOR 1.13, 95% CI 1.11-1.14; 18.4% versus 17.0% for emergency cesarean section, aOR 1.07, 95% CI 1.06-1.08; all p < 0.001). Lower rates of prolonged maternal length of stay (16.7% versus 20.2%, aOR 0.77, 95% CI 0.76-0.78, p < 0.001) and maternal readmission (3.0% versus 3.3%, aOR 0.88, 95% CI 0.86-0.90, p < 0.001) were observed during the pandemic period. There was some evidence that differences in the rates of preterm birth, emergency cesarean section, and unassisted vaginal birth varied according to the mother’s ethnic background but not according to her socioeconomic background. A key limitation is that multiple comparisons were made, increasing the chance of false-positive results.

CONCLUSIONS: In this study, we found very small decreases in preterm birth and SGA birth rates and very small increases in induction of labour and elective and emergency cesarean section during the COVID-19 pandemic, with some evidence of a slightly different pattern of results in women from ethnic minority backgrounds. These changes in obstetric intervention rates and pregnancy outcomes may be linked to women’s behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.

PMID:35007282 | DOI:10.1371/journal.pmed.1003884

PLoS Genet. 2022 Jan 10;18(1):e1009604. doi: 10.1371/journal.pgen.1009604. Online ahead of print.

ABSTRACT

Short tandem repeats (STRs) are highly informative genetic markers that have been used extensively in population genetics analysis. They are an important source of genetic diversity and can also have functional impact. Despite the availability of bioinformatic methods that permit large-scale genome-wide genotyping of STRs from whole genome sequencing data, they have not previously been applied to sequencing data from large collections of malaria parasite field samples. Here, we have genotyped STRs using HipSTR in more than 3,000 Plasmodium falciparum and 174 Plasmodium vivax published whole-genome sequence data from samples collected across the globe. High levels of noise and variability in the resultant callset necessitated the development of a novel method for quality control of STR genotype calls. A set of high-quality STR loci (6,768 from P. falciparum and 3,496 from P. vivax) were used to study Plasmodium genetic diversity, population structures and genomic signatures of selection and these were compared to genome-wide single nucleotide polymorphism (SNP) genotyping data. In addition, the genome-wide information about genetic variation and other characteristics of STRs in P. falciparum and P. vivax have been available in an interactive web-based R Shiny application PlasmoSTR (https://github.com/bahlolab/PlasmoSTR).

PMID:35007277 | DOI:10.1371/journal.pgen.1009604

Oper Neurosurg (Hagerstown). 2021 Dec 22. doi: 10.1227/ONS.0000000000000044. Online ahead of print.

ABSTRACT

BACKGROUND: Both the pterional and supraorbital approaches have been proposed as optimal access corridors to deep and paramedian anatomy.

OBJECTIVE: To assess key intracranial structures accessed through the surgical approaches using the angle of attack (AOA) and the volume of surgical freedom (VSF) methodologies.

METHODS: Ten pterional and 10 supraorbital craniotomies were completed. Data points were measured using a neuronavigation system. A comparative analysis of the craniocaudal AOA, mediolateral AOA, and VSF of the ipsilateral paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA) complex was completed.

RESULTS: For the paraclinoid ICA, the pterional approach produced larger craniocaudal AOA, mediolateral AOA, and VSF than the supraorbital approach (28.06° vs 10.52°, 33.76° vs 23.95°, and 68.73 vs 22.59 mm3 normalized unit [NU], respectively; P < .001). The terminal ICA showed similar superiority of the pterional approach in all quantitative parameters (27.43° vs 11.65°, 30.62° vs 25.31°, and 57.41 vs 17.36 mm3 NU; P < .05). For the ACoA, there were statistically significant differences between the results obtained using the pterional and supraorbital approaches (18.45° vs 10.11°, 29.68° vs 21.01°, and 26.81 vs 16.53 mm3 NU; P < .005).

CONCLUSION: The pterional craniotomy was significantly superior in all instrument maneuverability parameters for approaching the ipsilateral paraclinoid ICA, terminal ICA, and ACoA. This global evaluation of 2-dimensional and 3-dimensional surgical freedom and instrument maneuverability by amalgamating the craniocaudal AOA, mediolateral AOA, and VSF produces a comprehensive assessment while generating spatially and anatomically accurate corridor models that provide improved visual depiction for preoperative planning and surgical decision-making.

PMID:35007268 | DOI:10.1227/ONS.0000000000000044

PLoS Comput Biol. 2022 Jan 10;18(1):e1009672. doi: 10.1371/journal.pcbi.1009672. Online ahead of print.

ABSTRACT

Animals display characteristic behavioural patterns when performing a task, such as the spiraling of a soaring bird or the surge-and-cast of a male moth searching for a female. Identifying such recurring sequences occurring rarely in noisy behavioural data is key to understanding the behavioural response to a distributed stimulus in unrestrained animals. Existing models seek to describe the dynamics of behaviour or segment individual locomotor episodes rather than to identify the rare and transient sequences of locomotor episodes that make up the behavioural response. To fill this gap, we develop a lexical, hierarchical model of behaviour. We designed an unsupervised algorithm called “BASS” to efficiently identify and segment recurring behavioural action sequences transiently occurring in long behavioural recordings. When applied to navigating larval zebrafish, BASS extracts a dictionary of remarkably long, non-Markovian sequences consisting of repeats and mixtures of slow forward and turn bouts. Applied to a novel chemotaxis assay, BASS uncovers chemotactic strategies deployed by zebrafish to avoid aversive cues consisting of sequences of fast large-angle turns and burst swims. In a simulated dataset of soaring gliders climbing thermals, BASS finds the spiraling patterns characteristic of soaring behaviour. In both cases, BASS succeeds in identifying rare action sequences in the behaviour deployed by freely moving animals. BASS can be easily incorporated into the pipelines of existing behavioural analyses across diverse species, and even more broadly used as a generic algorithm for pattern recognition in low-dimensional sequential data.

PMID:35007275 | DOI:10.1371/journal.pcbi.1009672

J Trauma Nurs. 2022 Jan-Feb 01;29(1):41-46. doi: 10.1097/JTN.0000000000000630.

ABSTRACT

BACKGROUND: Child maltreatment is widespread, and its victims are frequently treated by trauma providers. However, providers across disciplines report feeling ill-equipped to identify and treat victims of child maltreatment and also report high levels of burnout and secondary traumatic stress.

OBJECTIVE: This study aims to evaluate an intervention to improve health care provider knowledge, recognition, and reporting of child maltreatment and promote provider resilience as they care for victims of child maltreatment.

METHODS: This is a single-group pre/posttest study design conducted from April to October 2019 of an educational intervention addressing child maltreatment knowledge, recognition, and self-care strategies for providers. Baseline and 6-month post-event questionnaires evaluated child maltreatment recognition and reporting, and the Professional Quality of Life instrument was used to measure compassion satisfaction, burnout, and secondary traumatic stress. Statistical analyses were conducted to evaluate the impact of the intervention on participants’ self-reported knowledge, compassion, burnout, and secondary traumatic stress.

RESULTS: A total of 164 health care providers participated in the study; the majority were nurses (69.5%). There was a 51.2% response rate for the 6-month post-event questionnaire (n = 84). Health care providers’ knowledge of child maltreatment recognition and reporting significantly improved from pre-event (Mdn = 24.0) to post-event (Mdn = 27.0), z =-6.4, p < .001, and significantly decreased in secondary traumatic stress pre-event (Mdn = 20.0) to post-event (Mdn = 17.5), z =-2.11, p = .035. No changes were noted in compassion satisfaction or burnout.

CONCLUSIONS: Educational activities can improve provider knowledge and recognition of child maltreatment and facilitate secondary traumatic stress reduction.

PMID:35007250 | DOI:10.1097/JTN.0000000000000630

Ann Surg. 2022 Feb 1;275(2):406-413. doi: 10.1097/SLA.0000000000005258.

ABSTRACT

OBJECTIVE: The American College of Surgeons (ACS) conducts a robust quality improvement program for ACS-verified trauma centers, yet many injured patients receive care at non-accredited facilities. This study tested for variation in outcomes across non-trauma hospitals and characterized hospitals associated with increased mortality.

SUMMARY BACKGROUND DATA: The study included state trauma registry data of 37,670 patients treated between January 1, 2013, and December 31, 2015. Clinical data were supplemented with data from the American Hospital Association and US Department of Agriculture, allowing comparisons among 100 nontrauma hospitals.

METHODS: Using Bayesian techniques, risk-adjusted and reliability-adjusted rates of mortality and interfacility transfer, as well as Emergency Departments length-of-stay (ED-LOS) among patients transferred from EDs were calculated for each hospital. Subgroup analyses were performed for patients ages >55 years and those with decreased Glasgow coma scores (GCS). Multiple imputation was used to address missing data.

RESULTS: Mortality varied 3-fold (0.9%-3.1%); interfacility transfer rates varied 46-fold (2.1%-95.6%); and mean ED-LOS varied 3-fold (81-231 minutes). Hospitals that were high and low statistical outliers were identified for each outcome, and subgroup analyses demonstrated comparable hospital variation. Metropolitan hospitals were associated increased mortality [odds ratio (OR) 1.7, P = 0.004], decreased likelihood of interfacility transfer (OR 0.7, P ≤ 0.001), and increased ED-LOS (coef. 0.1, P ≤ 0.001) when compared with nonmetropolitan hospitals and risk-adjusted.

CONCLUSIONS: Wide variation in trauma outcomes exists across nontrauma hospitals. Efforts to improve trauma quality should include engagement of nontrauma hospitals to reduce variation in outcomes of injured patients treated at those facilities.

PMID:35007228 | DOI:10.1097/SLA.0000000000005258

J Trauma Nurs. 2022 Jan-Feb 01;29(1):34-40. doi: 10.1097/JTN.0000000000000629.

ABSTRACT

BACKGROUND: Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned.

OBJECTIVE: The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population.

METHODS: This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models’ prediction was performed using discrimination and calibration statistics.

RESULTS: A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113).

CONCLUSION: In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.

PMID:35007249 | DOI:10.1097/JTN.0000000000000629

J Bone Joint Surg Am. 2021 Nov 1. doi: 10.2106/JBJS.21.00287. Online ahead of print.

ABSTRACT

BACKGROUND: We investigated the influence of sex on patient-reported outcomes preoperatively and following total ankle replacement and ankle arthrodesis.

METHODS: Patients who had undergone total ankle replacement or ankle arthrodesis for the treatment of end-stage ankle arthritis and who had ≥2 years of follow-up were identified from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database. Standard surgical techniques and implantation methods were followed, and STAR, Hintegra, Mobility, and Agility prostheses were used. Data were collected on patient demographics, revisions, secondary procedures, complications, Ankle Osteoarthritis Scale (AOS) scores, Short Form-36 (SF-36) scores, and expectations and satisfaction. Statistical analyses included 3-way repeated-measures analysis of variance (ANOVA) and multiple linear regression models controlling for inflammatory arthritis, age, preoperative scores, and surgery type.

RESULTS: The study included 872 patients: 629 who had undergone total ankle replacement (316 men, 313 women) and 243 who had undergone ankle arthrodesis (154 men, 89 women). The mean duration of follow-up (and standard deviation) was 4.9 ± 2.4 and 4.0 ± 1.9 years for the total ankle replacement and ankle arthrodesis groups, respectively. Men were older than women (p ≤ 0.001). In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS pain scores (i.e., more pain) than men preoperatively (p < 0.05). Pain was reduced significantly in both sexes postoperatively (p < 0.05), with no significant difference between sexes. In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS disability scores (i.e., more disability) and lower SF-36 Physical Component Summary (PCS) scores (i.e., worse function) than men both preoperatively and postoperatively (p < 0.001). Postoperatively, AOS disability and SF-36 PCS scores improved significantly from baseline in both sexes (p < 0.001). After controlling for covariates, sex was not a significant predictor of postoperative SF-36 MCS (Mental Component Summary), AOS pain, or AOS disability scores (p > 0.05) but explained 0.5% of variance in SF-36 PCS scores (p = 0.03). Sex did not significantly influence preoperative expectations or postoperative satisfaction. When patients with inflammatory arthritis were excluded, preoperative and postoperative outcome measures, expectations, and satisfaction were similar.

CONCLUSIONS: Men and women with end-stage ankle arthritis benefited from total ankle replacement and ankle arthrodesis with similar magnitudes of improvement. Small differences in pain and function between men and women undergoing total ankle replacement and ankle arthrodesis mostly disappeared when controlling for potential confounding variables. Both total ankle replacement and ankle arthrodesis remain good options for men and women with end-stage ankle arthritis.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:35007215 | DOI:10.2106/JBJS.21.00287

J Drugs Dermatol. 2022 Jan 1;21(1):43-48. doi: 10.36849/JDD.2022.6492.

ABSTRACT

BACKGROUND: Fractional radiofrequency (FRF) technology has been shown in clinical studies to improve skin laxity, and to treat various skin conditions related to aging and alternate collagen structures such as rhytids. The objective of this clinical study was to evaluate the safety and performance of FRF (up to 124 mJ per pin) for the treatment of facial rhytids, emphasizing the upper lip and perioral areas.

METHODS: Enrolled subjects received a series of 3 FRF treatments to the full face, 3 to 5 weeks apart. Immediately after treatment, the subjects were given a scale to assess pain and tolerability of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Before and after photographs were graded for change by three blinded evaluators using the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and the Global Aesthetic Improvement Scale (GAIS).

RESULTS: Image sets of 10 enrolled subjects (average age 62.7 years) were assessed by blinded evaluators. The overall face FWES score improved from 5.97 (SE 0.20) at baseline to 5.78 (SE 0.22) at 12-week follow-up. The GAIS improved by 0.4 points and was significant compared to baseline (P = 0.0004). Subject satisfaction was high with subjects giving an average satisfaction score of 3.2 (&ldquo;satisfied&rdquo;) out of 4. Pain was rated &ldquo;mild to moderate&rdquo; with an average of 3.9 on a 11-point Wong Baker FACES Scale. Ninety percent (90%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Eighty percent (80%) of subjects reported that they would recommend the treatment to a friend. There were no reports of adverse events or unanticipated side effects during the duration of the study.

CONCLUSION: A statistically significant reduction in rhytids of the upper lip and the perioral area, was found, as evaluated by independent blinded evaluators. There were no adverse events. Treatment pain was low and tolerable, and subjects had high levels of satisfaction with the results at last follow-up. J Drugs Dermatol. 2022;21(1):43-48. doi:10.36849/JDD.6492.

PMID:35005858 | DOI:10.36849/JDD.2022.6492