Category: Statistics

Patient. 2023 Oct 24. doi: 10.1007/s40271-023-00649-4. Online ahead of print.

ABSTRACT

Health preference research (HPR) is being increasingly conducted to better understand patient preferences for medical decisions. However, patients vary in their desire to play an active role in medical decisions. Until now, few studies have considered patients’ preferred roles in decision making. In this opinion paper, we advocate for HPR researchers to assess and account for role preferences in their studies, to increase the relevance of their work for medical and shared decision making. We provide recommendations on how role preferences can be elicited and integrated with health preferences: (1) in formative research prior to a health preference study that aims to inform medical decisions or decision makers, (2a) in the development of health preference instruments, for instance by incorporating a role preference instrument and (2b) by clarifying the respondent’s role in the decision prior to the preference elicitation task or by including role preferences as an attribute in the task itself, and (3) in statistical analysis by including random parameters or latent classes to raise awareness of heterogeneity in role preferences and how it relates to health preferences. Finally, we suggest redefining the decision process as a model that integrates the role and health preferences of the different parties that are involved. We believe that the field of HPR would benefit from learning more about the extent to which role preferences relate to health preferences, within the context of medical and shared decision making.

PMID:37874464 | DOI:10.1007/s40271-023-00649-4

Int Ophthalmol. 2023 Oct 24. doi: 10.1007/s10792-023-02892-y. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure.

METHODS: One hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation.

RESULTS: Of the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax.

CONCLUSIONS: Our model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulation’s utility, by screening the video for subjects before operations.

PMID:37874440 | DOI:10.1007/s10792-023-02892-y

Clin Auton Res. 2023 Oct 24. doi: 10.1007/s10286-023-00991-5. Online ahead of print.

ABSTRACT

PURPOSE: We compared hemodynamic parameters between subjects with marked, intermediate and minimal cardioinhibition during vasovagal syncope.

METHODS: The study included subjects with a decrease in heart rate while experiencing a complete vasovagal syncope during tilt-table testing. The subjects were classified as having marked, intermediate or minimal cardioinhibition, based on tertile values of the decrease in heart rate. Hemodynamic parameters between these groups were compared before tilt in the supine position, shortly after tilt and during cardioinhibition.

RESULTS: A total of 149 subjects with a median age of 43 (interquartile range 24-60) years were included in the study. Among the three groups with different levels of cardioinhibition, the highest heart rate was observed in subjects with marked cardioinhibition both before and shortly after tilt and at the start of cardioinhibition. The heart rate decrease in these subjects was both larger and faster compared to subjects with minimal and intermediate cardioinhibition.

CONCLUSION: Subjects with marked cardioinhibition have both a larger and faster decrease in heart rate compared to subjects with intermediate and minimal cardioinhibition, as early as from the start of cardioinhibition. Marked cardioinhibition is related to differences in hemodynamic profiles already present well before the start of cardioinhibition.

PMID:37874434 | DOI:10.1007/s10286-023-00991-5

Langenbecks Arch Surg. 2023 Oct 24;408(1):416. doi: 10.1007/s00423-023-03152-4.

ABSTRACT

INTRODUCTION: Robotic-assisted surgery (RAS) offers potential advantages over traditional surgical approaches. This study aimed to assess outcomes from a district general hospital (DGH) robotic colorectal programme against published data.

MATERIALS AND METHODS: The robotic programme was established following simulator, dry/wet lab training, and proctoring. We performed a case series analysing technical, patient, and oncological outcomes extracted from a prospective database of colorectal RAS cases (2015-2022). A registered systematic review (PROSPERO CRD42022300773; PubMed, Web of Science, EMBASE) of single-centre colorectal series from established robotic centres (n>200 cases) was completed and compared to local data using descriptive summary statistics. Risk of bias assessment was performed using an adapted version of the Cochrane ROBINS-I tool.

RESULTS: Two hundred thirty-two RAS cases were performed including 122 anterior resections, 56 APERs, 19 rectopexies, and 15 Hartmann’s procedures. The median duration was 325 (IQR 265-400) min. Blood loss was < 100 ml in 97% of cases with 2 (0.9%) cases converted to open. Complications (Clavien-Dindo 3-5) occurred in 19 (8%) patients, with 3 (1.3%) deaths in < 30 days. Length of stay was 7 (IQR 5-11) days. In 169 rectal cancer cases, there were 9 (5.3%) cases with a positive circumferential or distal margin and lymph node yield of 17 (IQR 13-24). A systematic review of 1648 abstracts identified 13 studies from established robotic centres, totaling 4930 cases, with technical, patient, and oncological outcomes comparable to our own case series.

CONCLUSIONS: Outcomes from our robotic colorectal programme at a UK DGH are comparable with the largest published case series from world-renowned centres. Training and proctoring together with rolling audit must accompany the expansion of robotic surgery to safeguard outcomes.

PMID:37874420 | DOI:10.1007/s00423-023-03152-4

Sports Med Open. 2023 Oct 24;9(1):97. doi: 10.1186/s40798-023-00639-8.

ABSTRACT

BACKGROUND: Estrogen and progesterone are the primary female sex hormones and have net excitatory and inhibitory effects, respectively, on neuronal function. Fluctuating concentrations across the menstrual cycle has led to several lines of research in relation to neuromuscular function and performance; however evidence from animal and cell culture models has yet to be demonstrated in human motor units coupled with quantification of circulating hormones. Intramuscular electromyography was used to record motor unit potentials and corresponding motor unit potential trains from the vastus lateralis of nine eumenorrheic females during the early follicular, ovulation and mid luteal phases of the menstrual cycle, alongside assessments of neuromuscular performance. Multi-level regression models were applied to explore effects of time and of contraction level. Statistical significance was accepted as p < 0.05.

RESULTS: Knee extensor maximum voluntary contraction, jump power, force steadiness, and balance did not differ across the menstrual phases (all p > 0.4). Firing rate of low threshold motor units (10% maximum voluntary contraction) was lower during the ovulation and mid luteal phases (β = – 0.82 Hz, p < 0.001), with no difference in motor unit potentials analysed from 25% maximum voluntary contraction contractions. Motor unit potentials were more complex during ovulation and mid luteal phase (p < 0.03), with no change in neuromuscular junction transmission instability (p > 0.3).

CONCLUSIONS: Assessments of neuromuscular performance did not differ across the menstrual cycle. The suppression of low threshold motor unit firing rate during periods of increased progesterone may suggest a potential inhibitory effect and an alteration of recruitment strategy; however this had no discernible effect on performance. These findings highlight contraction level-dependent modulation of vastus lateralis motor unit function over the eumenorrheic cycle, occurring independently of measures of performance.

PMID:37874413 | DOI:10.1186/s40798-023-00639-8

Environ Monit Assess. 2023 Oct 24;195(11):1366. doi: 10.1007/s10661-023-11916-0.

ABSTRACT

The Soil and Water Assessment Tool (SWAT) is a computational hydrological model extensively utilised for developing sustainable strategies and viable approaches for prudent management of water resources. The central emphasis of this study is on the utilisation of SWAT model along with SWAT-CUP (SWAT calibration toolbox) to simulate streamflow in the upper Jhelum basin, the North West Himalayas, for a period of 20 years from 2000 to 2019. The global sensitivity analysis algorithm, Sequential Uncertainty Fitting 2 (SUFI-2) of SWAT-CUP, is used for sensitivity and uncertainty analysis. The optimised parameter set estimated by SUFI-2 constitutes 11 parameters that are found to be sensitive with soil conservation service (SCS) curve number (CN) being the most influential parameter followed by snowmelt base temperature. Autocorrelation analysis using the autocorrelation function was conducted on the temperature and precipitation time series data, followed by a pre-whitening procedure to remove any autocorrelation effects. Subsequently, the modified Mann-Kendall (MMK) test was applied to examine trends in the annual temperature and precipitation data. The results indicated statistically significant positive trends in both datasets on an annual scale. The results for the calibration period (2003-2014) for monthly simulation displayed good model performance at three gauging stations, Rambiara, Sangam and Ram Munshi Bagh with R² values of 0.83, 0.847, 0.829, P factor values of 0.73, 0.76, 0.75 and R factor values of 0.61, 0.58, 0.63, respectively. The validation results for monthly simulation for the 2015-2019 period showed good model agreement with R² values of 0.817, 0.853, and 0.836, P factor values of 0.76, 0.8, and 0.75 and R factor values of 0.62, 0.53, and 0.65, respectively. The study concludes that the SWAT hydrological model can perform satisfactorily in high mountainous catchments and can be employed to analyse the impact of land use-land cover changes and the effect of climate variation on streamflow dynamics.

PMID:37874405 | DOI:10.1007/s10661-023-11916-0

Graefes Arch Clin Exp Ophthalmol. 2023 Oct 24. doi: 10.1007/s00417-023-06220-z. Online ahead of print.

ABSTRACT

PURPOSE: To determine whether non-invasive measurements of the nailfold capillaries (NCs) are associated with the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes.

METHODS: Eighty-three eyes of 83 patients with type 2 diabetes were enrolled. Sixty-three age-matched non-diabetic subjects served as controls. Diabetic patients were classified by the severity of their DR: non-DR (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). We used nailfold capillaroscopy to measure NC parameters, including number, length, width, and turbidity.

RESULTS: Four NC parameters in the diabetic patients were significantly lower than in the controls (all P < 0.001). There was a statistically significant decrease in the NC parameters along with the increasing severity of DR (number: P = 0.02; all others: P < 0.001). Logistic regression analysis revealed that combining the systemic characteristics of age, sex, systolic blood pressure, estimated glomerular filtration rate, hemoglobin A1c level, and history of hypertension and dyslipidemia could indicate the presence of DR and PDR (the area under the receiver operating characteristic curve [AUC] = 0.81, P = 0.006; AUC = 0.87, P = 0.001, respectively). Furthermore, the discriminative power of DR was significantly improved (P = 0.03) by adding NC length to the systemic findings (AUC = 0.89, P < 0.001).

CONCLUSION: NC measurement is a simple and non-invasive way to assess the risk of DR and its severity.

PMID:37874367 | DOI:10.1007/s00417-023-06220-z

Ophthalmologie. 2023 Oct 24. doi: 10.1007/s00347-023-01942-1. Online ahead of print.

ABSTRACT

BACKGROUND: Glaucoma is a widespread ophthalmological disease. Knowledge about the spread of the disease in the population is necessary with respect to further questions on comorbidities, risk factors and the provision of care.

OBJECTIVE: An analysis of the use of glaucoma medications and the prevalence of glaucoma in an urban adult population was carried out.

MATERIAL AND METHODS: The Hamburg City Health Study (HCHS) is a prospective, long-term, population-based cohort study that includes a random sample of 45,000 participants aged between 45 and 79 years from the general population of Hamburg, Germany. Apart from various medical parameters, data include premedication and the medical history of the participants. The use of antiglaucomatous medication among the first 10,000 study participants was analyzed and the prevalence of glaucoma was estimated according to the use of medications as well as by the self-reported history of glaucoma. Descriptive analysis and logistic regression analysis were performed to analyze the data and to calculate correlations by age and gender.

RESULTS: In the study population 319 persons were on medication to lower the intraocular pressure (IOP, mean age 67.1 years, SD = 7.57 years), which is equivalent to an estimated prevalence of 3.35% (95% confidence interval, CI 3.00-3.70%). A positive correlation was observed between age and the use of IOP-lowering medication, which is statistically highly significant (p = < 0.001). The analysis by gender showed a slightly higher prevalence among women, which was not statistically significant. The estimated prevalence according to glaucoma medication and history were only partly congruent.

DISCUSSION: This estimated prevalence of glaucoma is comparable to other epidemiological studies. The study results cover not only patients with manifest glaucoma but also persons who were treated for ocular hypertension. The inconsistency between the prevalence of glaucoma medication and the diagnosis of glaucoma can be explained by different treatment strategies and also by information deficits.

PMID:37874364 | DOI:10.1007/s00347-023-01942-1

Clin Cancer Res. 2023 Oct 24. doi: 10.1158/1078-0432.CCR-23-0445. Online ahead of print.

ABSTRACT

PURPOSE: High numbers of tumor infiltrating lymphocytes (TIL) are linked to better survival in cancer patients. TRM(CD8+CD103+) are recognized as a key player of anti-cancer immune response. To assess TRM in primary, metastatic and recurrent HNSCC we developed a tissue microarray (TMA) and used multiplex immunohistochemistry (MxIHC).

EXPERIMENTAL DESIGN: 379 HNSCC cases from Southampton Hospitals (2000-2016) with material of primary tumors were retrieved. Of these, 105 cases had lymph node metastases and 82 recurrences. A TMA was generated with triplicate cores for each sample. MxIHC with a stain and strip approach was performed using CD8, CD103, TIM3. Scanned slides were analyzed (digital image analysis) and quality checked (QC).

RESULTS: After QC, 194 primary tumors, 76 lymph node metastases and 65 recurrences were evaluable. Alcohol drinking was statistically significantly correlated with a reduction of TRM cells in primary tumors (no drinker vs. heavy drinker: p = 0.0036). The known survival benefit of TRM infiltration in primary tumors was not found for lymph node metastasis. In recurrences a high TRM number led to a favorable outcome after 12 months. The checkpoint molecule TIM3, was expressed significantly higher on TRM and non-TRM cells in the lymph node compared to primary tumors (p < 0.0001), which was also seen in recurrences (p 0.0134, p=0.0007, respectively).

CONCLUSIONS: We confirm the prognostic impact of TIL in primary tumors and in recurrences. TRM cell density in lymph node metastases was not linked to outcome. The role of TIM3, as a therapeutic target remains to be defined.

PMID:37874322 | DOI:10.1158/1078-0432.CCR-23-0445

Cutan Ocul Toxicol. 2023 Oct 24:1-5. doi: 10.1080/15569527.2023.2268162. Online ahead of print.

ABSTRACT

PURPOSE: To compare the thickness of the retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL) in smoker and nonsmoker diabetics without diabetic retinopathy.

MATERIALS AND METHODS: Patients with diabetes were divided into two groups according to their smoking status: Group 1 consisted of 38 smoker diabetics who had chronically smoked more than 20 cigarettes per day for more than five years; Group 2 consisted of 38 nonsmoker diabetics. After a detailed ophthalmologic examination, the mean and regional (superior, supratemporal, inferior, inferotemporal, temporal, nasal, superonasal, and inferonasal) RNFL and GC-IPL thicknesses were measured with spectral-domain optic coherence tomography (SD-OCT) and compared between groups.

RESULTS: The mean age was 54.7 ± 10.5 and 51.2 ± 9.7 years in the smoker and nonsmoker groups, respectively (p = 0.14). Gender, duration of diabetes, and the mean axial length were similar between groups (p:0.43, p:0.54, p: 0.52, respectively). Mean RNFL thickness was 89.1 ± 8.0 µm in the smoker group and 93.4 ± 7.0 µm in the nonsmoker group, and it was significantly thinner in the smoker group (p = 0.01). The temporal RNFL thickness in the smoker group was thinner than in the nonsmoker group (p = 0.02). There was no difference in superior, inferior, and nasal RNFL thicknesses between the groups (p = 0.31, p = 0.12, p = 0.39, respectively). The mean macular GC-IPL thickness of the smoker and nonsmoker groups was 78.53 ± 15.74 µm and 83.08 ± 5.85 µm, respectively (p = 0.09). Superior, superonasal, inferonasal, inferior, inferotemporal, and superotemporal quadrant GC-IPL thicknesses were similar between the groups (p = 0.07, p = 0.60, p = 0.55, p = 0.77, p = 0.71, p = 0.08, respectively). The groups showed no difference in minimum GC-IPL thickness (p = 0.43). There was a significant negative correlation between smoking exposure and mean, inferior quadrant RNFL thicknesses in the smoker group (p = 0.04, r= -0.32, and p = 0.01, r= -0.39, respectively).

CONCLUSION: Mean RNFL thickness was significantly thinner in smoker diabetics. Although not statistically significant, especially mean, superior, and superotemporal GC-IPL was thinner in smoker diabetics. The results suggest a potential association between the coexistence of diabetes and smoking with alterations in RNFL and GC-IPL thickness.

PMID:37874321 | DOI:10.1080/15569527.2023.2268162