Category: Statistics

Am J Ind Med. 2021 Oct 1. doi: 10.1002/ajim.23291. Online ahead of print.

ABSTRACT

BACKGROUND: This study estimated the prevalence of hearing protection device (HPD) non-use among US workers exposed to hazardous workplace noise and provided risk estimates.

METHODS: Self-reported data from the National Health Interview Survey in 2007 (15,852 workers) and 2014 (23,656 workers) were examined. Weighted prevalence and adjusted prevalence ratios of HPD non-use (using HPDs half the time or less when exposed to hazardous noise) were estimated by demographic, industry, and occupation. Differences in the prevalences of non-use were estimated and compared.

RESULTS: The prevalence of HPD non-use was 53% among all noise-exposed workers in 2014. Workers in the Accommodation and Food Services industry had the highest prevalence (90%) and risk (PR: 2.47, 95% confidence interval: 1.54-3.96) of HPD non-use. The industries with the lowest prevalences of noise exposure, including Finance and Insurance (2%) and Health Care and Social Assistance (4%), had some of the highest prevalences of HPD non-use (80% and 83%, respectively). There were no statistically significant changes in HPD non-use among industries between 2007 and 2014. Among occupations, HPD non-use increased 37% in Arts, Design, Entertainment, Sports and Media, and decreased 39% in Architecture and Engineering.

CONCLUSION: The prevalence of HPD non-use remains high; especially within industries and occupations with fewer noise-exposed workers. These groups need targeted attention to increase awareness and compliance. Employers should require HPD use and trainings among noise-exposed workers and provide an assortment of HPDs tailored to noise level and type, workplace environment, communication and audibility needs, and individual comfort and convenience.

PMID:34597431 | DOI:10.1002/ajim.23291

Environ Toxicol Chem. 2021 Oct 1. doi: 10.1002/etc.5227. Online ahead of print.

NO ABSTRACT

PMID:34597437 | DOI:10.1002/etc.5227

Mol Biol Evol. 2021 Oct 1:msab291. doi: 10.1093/molbev/msab291. Online ahead of print.

ABSTRACT

In evolutionary genomics, it is fundamentally important to understand how characteristics of genomic sequences, such as gene expression level, determine the rate of adaptive evolution. While numerous statistical methods, such as the McDonald-Kreitman test, are available to examine the association between genomic features and the rate of adaptation, we currently lack a statistical approach to disentangle the independent effect of a genomic feature from the effects of other correlated genomic features. To address this problem, I present a novel statistical model, the MK regression, which augments the McDonald-Kreitman test with a generalized linear model. Analogous to the classical multiple regression model, the MK regression can analyze multiple genomic features simultaneously to infer the independent effect of a genomic feature, holding constant all other genomic features. Using the MK regression, I identify numerous genomic features driving positive selection in chimpanzees. These features include well-known ones, such as local mutation rate, residue exposure level, tissue specificity, and immune genes, as well as new features not previously reported, such as gene expression level and metabolic genes. In particular, I show that highly expressed genes may have a higher adaptation rate than their weakly expressed counterparts, even though a higher expression level may impose stronger negative selection. Also, I show that metabolic genes may have a higher adaptation rate than their non-metabolic counterparts, possibly due to recent changes in diet in primate evolution. Overall, the MK regression is a powerful approach to elucidate the genomic basis of adaptation.

PMID:34597406 | DOI:10.1093/molbev/msab291

Nurs Forum. 2021 Oct 1. doi: 10.1111/nuf.12655. Online ahead of print.

ABSTRACT

BACKGROUND: Interprofessional collaboration and teamwork have been identified as priorities for delivering quality client care. Improved teamwork, communication, and collaboration among healthcare professionals improve client outcomes. Nurse professionals are challenged to be equally engaged with other healthcare professionals to develop a culturally competent client-centered plan of care.

PURPOSE: The purpose of the current project was to examine the effectiveness of a multifaceted educational intervention on prelicensure nursing students’ development of interprofessional competencies with teams and teamwork, communication, roles and responsibility, values, and ethics.

METHODS: Metrics used included the Interprofessional Collaboration Competency Attainment (ICCAS) and the Assessment of Collaborative Environments (ACE-15) surveys.

RESULTS: The results support practical and statistical significance in the students’ self-reported collaborative competence across all items of the ICCAS at p < 0.000 level, and across each individual item.

CONCLUSIONS: The multifaceted educational strategy effectively engaged prelicensure nursing students with other healthcare disciplines to develop a client-centered plan of care and achieve interprofessional competencies.

PMID:34597424 | DOI:10.1111/nuf.12655

J Natl Cancer Inst. 2021 Oct 1:djab195. doi: 10.1093/jnci/djab195. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor-based classification of human glioma portends patient prognosis; however, considerable unexplained survival variability remains. Host factors (eg, age) also strongly influence survival times, partly reflecting a compromised immune system. How blood epigenetic measures of immune characteristics and age augment molecular classifications in glioma survival has not been investigated. We assess the prognostic impact of immune-cell fractions and epigenetic age in archived blood across glioma molecular subtypes for the first time.

METHODS: We evaluated immune-cell fractions and epigenetic age in archived blood from the University of California San Francisco Adult Glioma Study, including a training set of 197 IDH-wildtype, 1p19q intact, TERT wildtype (IDH/1p19q/TERT-WT) glioma patients, an evaluation set of 350 patients with other subtypes of glioma, and 454 subjects without glioma.

RESULTS: IDH/1p19q/TERT-WT patients had lower lymphocyte fractions (CD4+T, CD8+T, natural killer, and B cells) and higher neutrophil fractions than subjects without glioma. Recursive partitioning analysis delineated four statistically significantly different survival groups for IDH/1p19q/TERT-WT patients based on an interaction between chronological age and two blood immune factors, CD4+T cells, and neutrophils with median overall survival ranging from 0.76 years [95% confidence intervaI = 0.55 to 0.99] for the worst survival group (n = 28) to 9.72 years [95% confidence intervaI = 6.18 to NA] for the best (n = 33). The Recursive partitioning analysis also statistically significantly delineated four risk groups in patients with other glioma subtypes.

CONCLUSION: The delineation of different survival groups in the training and evaluation sets based on an interaction between chronological age and blood immune characteristics suggests that common host immune factors among different glioma types may impact survival. The ability of DNA methylation-based markers of immune status to capture diverse, clinically relevant information may facilitate non-invasive personalized patient evaluation in the neuro-oncology clinic.

PMID:34597382 | DOI:10.1093/jnci/djab195

J Natl Cancer Inst. 2021 Oct 1:djab197. doi: 10.1093/jnci/djab197. Online ahead of print.

ABSTRACT

BACKGROUND: Disease-free and overall survival associations with anthropometric measures of obesity and changes in these exposures remain unknown among endometrial cancer survivors.

METHODS: Endometrial cancer survivors diagnosed between 2002-2006 completed direct anthropometric measurements and self-reported lifetime weight history during in-person interviews approximately 4 months after diagnosis (peri-diagnosis) and approximately 3 years after diagnosis (follow-up). Participants were followed until death or March 20, 2019. Cox proportional regression estimated multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for body mass index (BMI), weight, waist circumference, and waist-hip ratio with disease-free survival (DFS) and overall survival (OS). Statistical tests were two-sided.

RESULTS: 540 and 425 cancer survivors were assessed peri-diagnosis and follow-up, respectively. During the median 14.2 years of follow-up (range = 0.3-16.5 years), 132 participants had a recurrence and/or died (DFS) with 111 deaths overall (OS). Reduced DFS was noted with greater recalled weight one-year before-diagnosis (HR = 1.88, 95% CI = 1.15 to 3.07), BMI one-year before-diagnosis (HR = 1.88, 95% CI = 1.09 to 3.22), and measured peri-diagnosis BMI (HR = 2.04, 95% CI = 1.18 to 3.53). Measured peri-diagnosis waist circumference ≥88 cm was associated with decreased DFS (HR = 1.94, 95% CI = 1.24 to 3.03) and OS (HR = 1.90, 95% CI = 1.16 to 3.13). A two-fold decrease in DFS and OS was associated with ≥5% BMI or weight change from one-year before diagnosis to peri-diagnosis. No associations were observed for the assessment during follow-up.

CONCLUSION: One-year before- and peri-diagnosis anthropometric measures of obesity were associated with reduced survival among endometrial cancer survivors. Anthropometric changes from one-year before- to peri-diagnosis may provide an important indication of future survival in this population.

PMID:34597394 | DOI:10.1093/jnci/djab197

J Clin Endocrinol Metab. 2021 Oct 1:dgab714. doi: 10.1210/clinem/dgab714. Online ahead of print.

ABSTRACT

CONTEXT: Some studies have suggested that patients with type 2 diabetes mellitus (T2DM) concomitant with obesity have better clinical outcomes than normal-weight patients with T2DM.

OBJECTIVE: We evaluated associations among obesity, cardiovascular disease (CVD) events, and mortality in elderly patients with T2DM without CVD.

DESIGN: Retrospective observational study between 2009 and 2017, with a mean follow-up of 7.26 years.

SETTING: Nationwide (Korea).

PARTICIPANTS: This study included 249,903 elderly (≥65 years) patients with T2DM and no pre-existing CVD using the Korean National Health Information Database.

MAIN OUTCOME MEASURES: We categorized subjects according to body mass index (BMI) and waist circumference (WC) and analyzed a composite of stroke, myocardial infarction, and all-cause death using Cox proportional hazards regression analysis, adjusting for baseline covariates.

RESULTS: The incidence rate of composite primary outcomes was 30.95/1,000 person-years. The primary outcome risk had an L-shaped and a U-shaped association with BMI and WC, respectively. In the multivariable Cox proportional hazard models, the risk of primary composite outcomes in the highest BMI group (≥30 kg/m 2; hazards ratio [HR]=0.824, 95% confidence interval [CI]: 0.794-0.855) was lower than in the normal BMI group (≥18.5 and <23 kg/m 2). Conversely, that in the highest WC group (≥100 cm/≥95 cm; men/women; HR=1.434, 95% CI: 1.384‒1.486) was higher than in the normal WC group (<90 cm/<85 cm; men/women).

CONCLUSION: Our study with elderly patients with diabetes results suggest that while BMI is an inadequate risk indicator for outcomes related to obesity, WC is a suitable alternative.

PMID:34597374 | DOI:10.1210/clinem/dgab714

Blood Adv. 2021 Oct 1:bloodadvances.2020004045. doi: 10.1182/bloodadvances.2020004045. Online ahead of print.

ABSTRACT

In the absence of head-to-head trials, an indirect-treatment comparison can estimate the treatment effect of tisagenlecleucel in comparison with blinatumomab on rates of complete remission (CR) and overall survival (OS) in patients with relapsed or primary refractory (R/R) acute lymphoblastic leukemia (ALL). Patient-level data from two pivotal trials, ELIANA (tisagenlecleucel; n = 79) and MT103-205 (blinatumomab; n = 70), were used in comparisons of CR and OS, controlling for cross-trial difference in available patient characteristics. Five different adjustment approaches were implemented: stabilized inverse probability of treatment weight (sIPTW); trimmed sIPTW; stratification by propensity score quintiles; adjustment for prognostic factors; and adjustment for both prognostic factors and propensity score. Comparative analyses indicate that treatment with tisagenlecleucel was associated with a statistically significant higher likelihood of achieving CR and lower hazard of death than treatment with blinatumomab. The tisagenlecleucel group exhibited a higher likelihood of CR than the blinatumomab group in every analysis regardless of adjustment approach (odds ratios: 6.71-9.76). Tisagenlecleucel was also associated with a lower hazard of death than blinatumomab in every analysis, ranging from 68% to 74% lower hazard of death than with blinatumomab, determined using multiple adjustment approaches (hazard ratios: 0.26-0.32). These findings support the growing body of clinical trial and real-world evidence demonstrating that tisagenlecleucel is an important treatment option for children and young adults with R/R ALL.

PMID:34597381 | DOI:10.1182/bloodadvances.2020004045

Am J Health Syst Pharm. 2021 Oct 1:zxab383. doi: 10.1093/ajhp/zxab383. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: The American Society of Health-System Pharmacists (ASHP) and Pediatric Pharmacy Advocacy Group (PPAG) guidelines for providing pediatric pharmacy services in hospitals and health systems can be used to improve medication safety wherever pediatric patients receive care, including in the emergency department (ED). The purpose of this initiative was to improve compliance with these guidelines in a primarily adult ED.

METHODS: This quality improvement initiative was conducted in a level 1 trauma center ED between October 2019 and March 2020. The ASHP-PPAG guidelines were used to create practice elements applicable to the ED. An initial compliance assessment defined elements as noncompliant, partially compliant, fully compliant, or not applicable. Investigators identified interventions to improve compliance for noncompliant or partially compliant elements and then reassessed compliance following implementation. Data were expressed using descriptive statistics. This initiative was exempt from institutional review board approval.

RESULTS: Ninety-three ED practice elements were identified within the 9 standards of the ASHP-PPAG guidelines. At the initial compliance assessment, the majority (59.8%) of practice elements were fully compliant; however, various service gaps were identified in 8 of the standards, and 16 interventions were implemented to improve compliance. At the final compliance assessment, there was a 19.5% increase in full compliance. Barriers to achieving full compliance included technology restrictions, time constraints, financial limitations, and influences external to pharmacy.

CONCLUSION: This quality improvement initiative demonstrated that the ASHP-PPAG guidelines can be used to improve ED pediatric pharmacy services in a primarily adult institution. The initiative may serve as an example for other hospitals to improve compliance with the guidelines.

PMID:34597368 | DOI:10.1093/ajhp/zxab383

Am J Health Syst Pharm. 2021 Oct 1:zxab381. doi: 10.1093/ajhp/zxab381. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: The purpose of this study was to evaluate the current state of problem list maintenance at an academic medical center.

SUMMARY: We included problem list data for patients who had at least 2 face-to-face encounters at Vanderbilt University Medical Center or its clinics between January 1, 2018, and December 31, 2019. We used the frequency of problem list additions, resolutions, deletions, duplicate problems (exact and SNOMED CT duplicates), inconsistencies (contradicting stages of disease state), and items that could be documented elsewhere in the electronic health record as surrogate markers of problem list maintenance. Descriptive statistics were used to summarize the results. A total of 546,510 patients met inclusion criteria. There were 3,762 (0.7%) patients who had the exact same active problem listed more than once. SNOMED CT code duplications occurred in the records for 56,399 (10.5%) patients. Of the patients with asthma, 2.5% (223/8,779) had contradicting asthma stages active on their problem list, and 6.4% (950/14,950) of patients with chronic kidney disease (CKD) had contradicting CKD stages. In addition, 17,205 (3.1%) patients had 20,365 active family history problems and 39,464 (7.2%) patients had an allergy documented on their problem list. On average, there were 43.7 (95% confidence interval [CI], 14-73.4) additions, 8.7 (95% CI, 0.1-17.4) resolutions, and 2.1 (95% CI, 0-4.6) deletions of problems per 100 face-to-face encounters, inpatient or outpatient.

CONCLUSION: Our study suggests areas for improvement for problem list maintenance. Further studies into semantic duplication and clinical decision support tools to encourage problem list maintenance and deduplication are needed.

PMID:34597358 | DOI:10.1093/ajhp/zxab381