Category: Statistics

J Am Acad Orthop Surg Glob Res Rev. 2021 Nov 19;5(11). doi: 10.5435/JAAOSGlobal-D-20-00197.

ABSTRACT

INTRODUCTION: The Fragility Index (FI) and the Fragility Quotient (FQ) are powerful statistical tools that can aid clinicians in assessing clinical trial results. The purpose of this study was to use the FI and FQ to evaluate the statistical robustness of widely cited surgical clinical trials in orthopaedic trauma.

METHODS: We performed a PubMed search for orthopaedic trauma clinical trials in high-impact orthopaedics-focused journals and calculated the FI and FQ for all identified dichotomous, categorical outcomes.

RESULTS: We identified 128 studies with 545 outcomes. The median FI was 5, and the median FQ was 0.0482. For statistically significant and not statistically significant outcomes, the median FIs were 3 and 5, and the mean FQs were 0.0323 and 0.0526, respectively. The FI was greater than the number of patients lost to follow-up in most outcomes.

CONCLUSIONS: The orthopaedic trauma literature is of equal or higher quality than research in other orthopaedic subspecialties, suggesting that other orthopaedic subspecialties may benefit from modeling their clinical trials after those in orthopaedic trauma.

PMID:34807889 | DOI:10.5435/JAAOSGlobal-D-20-00197

Adv Skin Wound Care. 2021 Dec 1;34(12):645-650. doi: 10.1097/01.ASW.0000797956.61055.87.

ABSTRACT

OBJECTIVE: To determine the factors affecting the quality of life of patients with chronic wounds.

METHODS: This descriptive cross-sectional study was conducted in a university hospital wound care unit in western Turkey with 134 patients. The data were collected via personal information form, Barthel Index for activities of daily living, visual analog scale, and Short Form-12 questionnaire. Descriptive statistics and Spearman correlation were used for data analysis.

RESULTS: The mean age of the participants was 60.4 ± 10.7 years; 79.9% of the research group had diabetic foot wounds, and 56.7% had wounds on their right/left big toe. The mean duration of wounds was 9.4 ± 11.4 months, and 68.7% had previously been hospitalized because of wounds. The average visual analog scale pain level was 3.5 ± 2.5, and 45.5% of the patients were PEDIS (perfusion, extent, depth, infection, and sensation) classification grade II. A positive correlation was detected between Short Form-12 physical summary score and activities of daily living score.

CONCLUSIONS: Patients with chronic wounds have a poor quality of life. Patient quality of life decreases as pain and PEDIS score increase and increases with their level of independence.

PMID:34807896 | DOI:10.1097/01.ASW.0000797956.61055.87

Female Pelvic Med Reconstr Surg. 2021 Dec 1;27(12):e705-e709. doi: 10.1097/SPV.0000000000001114.

ABSTRACT

OBJECTIVES: Our primary objective was to compare the total opioid use by patients undergoing apical pelvic organ prolapse surgery before and after implementation of an enhanced recovery protocol (ERP).

METHODS: Participants of this ambispective cohort study included a “pre-ERP” retrospective cohort and an “ERP” cohort of patients prospectively enrolled after the full implementation of the ERP in January 2019. Demographic and clinical data were collected from the electronic record. Descriptive statistics were used for demographic variables. Total opioid use was calculated for each participant using morphine milligram equivalents (MMEs) and compared between cohorts using the Student t test.

RESULTS: Study participants (n = 65) were similar between cohorts and had a mean (SD) age of 62.4 (9.7) years and body mass index of 28.9 (4.8), and had a median parity of 3 (interquartile range, 2-4). Comorbid conditions, assessed with the Charlson Comorbidity Index, were also similar, with a mean (SD) of 2 (2.9). Hysterectomy approach and apical procedures did not differ between groups. After ERP implementation, mean (SD) intraoperative and postoperative MMEs decreased significantly (59.4 [31.6] vs 36.9 [20.5], P < 0.01). Total MMEs prescribed at discharge also decreased (392.3 [88.4] vs 94.6 [61.3], P < 0.01). Total anesthesia time and surgical time were similar, whereas mean total admission time decreased (27.3 [10.8] vs 18 [8.6] hours, P < 0.01). Telephone calls within 30 days increased from mean 1 (1.0) to 2.2 (1.9) (P < 0.01), whereas clinic visits and 30-day readmissions did not differ.

CONCLUSIONS: Women undergoing apical pelvic organ prolapse surgery at an academic medical center received significantly fewer opioids after implementation of an ERP without a change in postoperative pain scores.

PMID:34807884 | DOI:10.1097/SPV.0000000000001114

IEEE Trans Med Imaging. 2021 Nov 22;PP. doi: 10.1109/TMI.2021.3129700. Online ahead of print.

ABSTRACT

The minimum histological criterion for the diagnostics of Alzheimer’s disease (AD) in tissue is the presence of senile plaques and neurofibrillary tangles in specific brain locations. The routine procedure of morphological analysis implies time-consuming and laborious steps including sectioning and staining of formalin-fixed paraffin-embedded (FFPE) tissue. We developed a multispectral Stokes polarimetric imaging approach that allows characterization of FFPE brain tissue samples to discern the stages of AD progression without sectioning and staining the tissue. The Stokes polarimetry approach is highly sensitive to structural alterations of brain tissue, particularly to the changes in light scattering and birefringence. We present the results of the label-free non-destructive screening of FFPE mouse brain tissue and show several polarization metrics that demonstrate statistically significant differences for tissues at different stages of AD.

PMID:34807820 | DOI:10.1109/TMI.2021.3129700

JMIR Aging. 2021 Nov 19;4(4):e30420. doi: 10.2196/30420.

ABSTRACT

BACKGROUND: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them.

OBJECTIVE: The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps.

METHODS: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis.

RESULTS: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services.

CONCLUSIONS: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults.

PMID:34807836 | DOI:10.2196/30420

Hosp Top. 2021 Nov 22:1-7. doi: 10.1080/00185868.2021.2005500. Online ahead of print.

ABSTRACT

INTRODUCTION: One of the most essential steps in improving the quality of service delivery in the health service is the improvement of patients’ medical record completeness. The aim of this study is to assess patient medical record completeness in the Saint Paul hospital department of surgery and assess the pattern of improvement in record completeness after intervention.

METHODS: surgical Patient charts were randomly reviewed with a standard patient chart completeness evaluation checklist prepared by the Federal Ministry of Health. Baseline data was collected in June 2019 and post intervention data was collected in November 2019. The schedule for intervention was carried out between July and October 2019. Interventions include modification of formats, continuous monitoring, and inclusion of chart completeness in the monthly morbidity and mortality conference, and establishment of a recognition system for best performing wards.

RESULT: A total of 253 and 273 medical charts were evaluated during baseline and post intervention. The Post intervention assessment showed 206 (75.5%) of records had admission notes completed, 205 (75%), the order sheet was completed in 218 (79.7%) and the discharge summary was completed in 217 (79.5%) of medical records. From nursing parameters, the medication sheet was completed in 177 (64.8%) and the nursing care plan was completed in 155 (56.8%) of medical records. When all six indicators were seen in aggregate, total medical record completeness showed a statistically significant improvement from 41% during base line to 72% post intervention (p < 0.05).

CONCLUSION AND RECOMMENDATION: Study has shown that small and persistent quality improvement interventions that focus on continuous evaluation, leadership engagement, and innovative strategies bring significant improvement in record completeness.

PMID:34807810 | DOI:10.1080/00185868.2021.2005500

Inquiry. 2021 Jan-Dec;58:469580211060295. doi: 10.1177/00469580211060295.

ABSTRACT

The aim of the study was to analyse the temporal and geographic distribution of radiologists, computed tomography and magnetic resonance scanners in Croatia. In this observational study we estimated radiologists’ number per 100,000 population for 1997, 2006, and 2017 and compared private and public CT and MR scanners between 2011 and 2018. We analyzed the availability of radiologists and scanners, and the relationship between the radiological workforce and economic strength among counties. The workforce increased significantly from 1997 to 2017 and was associated with economic strength categories in 2017. In 2018, there were more CT scanners in the public sector, while MR scanners were distributed evenly. In 2011, there was similar distribution of CT and MR between sectors, while in 2018 there were significantly more public CT scanners. Counties with a medical school had significantly more radiologists and MR scanners. The high-to-low ratios per CT and MR were 11 and 8.2, suggesting inequality of health care. Croatia significantly increased its radiological workforce; however, cross-county inequality remained. Counties with higher economic strength and medical schools have better availability of radiologists and equipment. To ensure the sustainable activity of the health care system, a precise estimate of supply and demand of radiology services is needed.

PMID:34807799 | DOI:10.1177/00469580211060295

Acta Oncol. 2021 Nov 22:1-6. doi: 10.1080/0284186X.2021.2005255. Online ahead of print.

ABSTRACT

BACKGROUND: Presence of comorbid diseases at time of cancer diagnosis may affect prognosis. We evaluated the impact of comorbidity on survival of patients diagnosed with renal cell carcinoma (RCC), overall and among younger (<70 years) and older (≥70 years) patients.

METHODS: We established a nationwide register-based cohort of 7894 patients aged ≥18 years diagnosed with RCC in Denmark between 2006 and 2017. We computed 1- and 5-year overall survival and hazard ratios (HRs) for death according to the Charlson Comorbidity Index (CCI) score.

RESULTS: Survival decreased with increasing CCI score despite an overall increase in survival over time. The 5-year survival rate of patients with no comorbidity increased from 57% among those diagnosed in 2006-2008 to 69% among those diagnosed in 2012-2014. During the same periods, the survival rate increased from 46% to 62% among patients with a CCI score of 1-2 and from 39% to 44% for those with a CCI score of ≥3. Patients with CCI scores of 1-2 and ≥3 had higher mortality rates than patients with no registered comorbidity (HR 1.15, 95% CI 1.06-1.24 and HR 1.56, 95% CI 1.40-1.73). Patterns were similar for older and younger patients. Particularly, diagnoses of liver disease (HR 2.09, 95% CI 1.53-2.84 and HR 4.01, 95% CI 2.44-6.56) and dementia (HR 2.16, 95% CI 1.34-3.48) increased mortality.

CONCLUSION: Comorbidity decreased the survival of patients with RCC, irrespective of age, despite an overall increasing survival over time. These results highlight the importance of focusing on comorbidity in this group of patients.

PMID:34807805 | DOI:10.1080/0284186X.2021.2005255

Community Dent Oral Epidemiol. 2021 Nov 22. doi: 10.1111/cdoe.12709. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time.

METHODS: Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income.

RESULTS: The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income.

CONCLUSION: People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

PMID:34806803 | DOI:10.1111/cdoe.12709

MSMR. 2021 Sep 1;28(9):8-12.

ABSTRACT

This study explored rates of death by suicide by birth cohort including Baby Boomers (1946-1964), Generation X (1965-1980), Millennials (1981-1996), and Generation Z (1997-2012), among active component U.S. Army soldiers during 1 January 2000-4 June 2021. From 1 January 2008 through 4 June 2021, the most likely cluster of suicides, although not statistically significant, was identified between March 2020 and June 2021, which coincided with the coronavirus disease 2019 (COVID-19) pandemic. Since the onset of the COVID-19 pandemic, the Army has observed 55%-82% increases in suicide rates among Millennials, Generation Z, and Generation X compared to 1 year before the pandemic. The largest proportional increase in rates affected the members of Generation X, but the highest rates both before and after the onset of the pandemic affected those in Generation Z. Discussion of the findings introduces theories that have been used to explain psychological states that may predispose to suicidal behavior and posits ways in which Army leaders and organizations may be able to reduce suicide risk among soldiers. The limitations of the study and possible additional inquiries are described.

PMID:34806854