Nevin Manimala Statistics

Elevated Blood Pressure in Women of Childbearing Age in the United States

MCN Am J Matern Child Nurs. 2022 Jan-Feb 01;47(1):47-51. doi: 10.1097/NMC.0000000000000775.


PURPOSE: Elevated blood pressure is frequently associated with adverse health issues among women during and after childbirth in the United States. The purpose of this study was to describe incidence of and determine predictors of prehypertension and hypertension among women of childbearing age in the United States.

STUDY DESIGN AND METHODS: Using secondary data analysis, existing data from the National Health and Nutrition Examination Survey (NHANES; 2013-2018) were used to address study aims. Inclusion criteria were women in the age range commonly considered to be of childbearing age, 15 to 44 years of age. Simple random sampling was to select subjects from the 2,932 women in the NHANES dataset who met inclusion criteria. We calculated a sample size as adequate for the statistical group comparison to be significant with a power of 95% to detect a difference among groups. An ordinal logistic regression model was created to discriminate predictors of normotensive blood pressure, prehypertension, and hypertension.

RESULTS: The sample (n = 393) included 300 women with normal blood pressure, 46 women with prehypertension, and 47 with hypertension. Older women (within childbearing age range), women with high body mass index, and African American women are highly likely to have prehypertension and hypertension.

CLINICAL IMPLICATIONS: Contrary to previous research, poverty income ratio was not associated with prehypertension and hypertension. Future research should test interventions that include promoting heathy lifestyles and address elevated body mass index. Interventions should be tailored to be culturally appropriate for African American women and older women within this age range.

PMID:34860787 | DOI:10.1097/NMC.0000000000000775

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The redesign of an advanced practice registered nurse professional evaluation process and tool at a midwest academic medical center: A pilot project

J Am Assoc Nurse Pract. 2021 Feb 3;33(12):1300-1306. doi: 10.1097/JXX.0000000000000554.


BACKGROUND: Inconsistency and a lack of clarity exist regarding the advanced practice registered nurse peer review process in hospitals throughout the country.

LOCAL PROBLEM: The current APRN peer review process in place for over a decade at an academic medical center has never been evaluated, and neither fulfills ongoing professional practice evaluation requirements nor meets the expectations of peer review.

METHODS: Pre-post intervention quality improvement project (Standards for Quality Improvement Reporting Excellence checklist).

INTERVENTIONS: Using current professional standards and guidelines that meet the requirements for ongoing professional practice evaluation and nursing peer review, a redesigned process and tool was created and piloted in three specialty groups of nurse practitioners (NPs) at the medical center. Satisfaction before and after the pilot survey was measured using a Likert-type scale, and results were compared and analyzed following the completion of the pilot survey.

RESULTS: The posttest measure revealed a statistically significant improvement in satisfaction with the redesigned professional evaluation tool compared with the prepilot peer review tool.

CONCLUSIONS: The redesign project demonstrated that using current professional standards and guidelines, a comprehensive process and tool for professional evaluation and peer review is achievable across NP specialties.

PMID:34860753 | DOI:10.1097/JXX.0000000000000554

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Impact of a nutrition education program on health behaviors in a university workplace wellness program

J Am Assoc Nurse Pract. 2021 Feb 3;33(12):1198-1206. doi: 10.1097/JXX.0000000000000553.


BACKGROUND: Obesity is a complex health issue associated with the leading causes of preventable chronic diseases, such as heart disease and type 2 diabetes. As part of an interprofessional team, nurse practitioners can play an integral role in leading worksite interventions to enhance health behavior change. Although worksite nutrition interventions have existed for many years, effective weight management programs are needed in the workplace.

PURPOSE: The purpose of this study was to determine the effect of a novel nutrition education program implemented in the workplace on health behaviors (dietary habits and physical activity), motivators and barriers, emotional eating, confidence, and biometrics (body mass index and lipid levels).

METHODS: A total of 96 university employees participated in a one-group pre- and postintervention from 2017 to 2019. The intervention included eight weekly face-face education sessions. We assessed dietary habits, physical activity, motivators and barriers of a healthy lifestyle, emotional eating, confidence levels, body mass index, and lipid levels. Descriptive statistics, chi-square test, one-way analysis of variance, and Wilcoxon rank test were performed.

RESULTS: The consumption of fruits, vegetables, beans, grains, and physical activity increased significantly. Barriers, body mass index, and triglycerides significantly decreased. There was no significant difference in emotional eating and motivators after the intervention.

IMPLICATIONS FOR PRACTICE: Nurse practitioners are positioned to lead an interprofessional team to provide nutrition education to help mitigate risk factors for obesity in various settings, including the workplace.

PMID:34860752 | DOI:10.1097/JXX.0000000000000553

Nevin Manimala Statistics

Interobserver and Intra-Observer Reliability of Eyelid Tests for Ocular Myasthenia Gravis

J Neuroophthalmol. 2021 Oct 22. doi: 10.1097/WNO.0000000000001425. Online ahead of print.


BACKGROUND: Lid fatigability test (LFT), Cogan lid twitch (CLT), and forced eyelids closure test (FECT) are simple clinical screening tests for ocular myasthenia gravis (OMG). However, these tests are subjectively interpreted. We thus evaluated the interobserver and intra-observer reliability of each test.

METHODS: The 3 eyelid tests were performed in ptotic patients associated with various conditions, including OMG and others. Video clips of all tests were recorded using smartphone with built-in camera in the following order; LFT, CLT, and FECT. All video clips were distributed to 3 neuro-ophthalmologists and 3 general ophthalmologists, who were trained to evaluate the tests using a single standard instruction. After 3 months, all video clips were re-organized for the second evaluation. Interobserver and intra-observer reliability were calculated using Cohens’ Kappa coefficient and Fleiss Kappa statistic.

RESULTS: The 3 eyelid tests were performed and recorded in 35 patients, which included the diagnosis of OMG, levator muscle dehiscence, partial oculomotor nerve palsy, and Horner syndrome. CLT received moderate-to-substantial interobserver reliability in neuro-ophthalmologist group (Fleiss Kappa 0.77 [95% CI 0.60-0.94] and 0.66 [95% CI 0.46-0.85] in first and second evaluation respectively), but the results varied in general ophthalmologist group (Fleiss Kappa 0.58 [95% CI 0.37-0.79] and 0.54 [95% CI 0.33-0.76] in first and second evaluation respectively). FECT and LFT received lower interobserver reliability in both groups. CLT also received moderate-to-almost perfect intra-observer reliability in neuro-ophthalmologist group (Cohen Kappa 0.55, 0.58, and 0.92), whereas FECT and LFT received lower intra-observer reliability. The intra-observer reliability varied among general ophthalmologists for all 3 eyelid tests.

CONCLUSIONS: CLT is the most reliable test among the 3 eyelid tests. However, all tests should be interpreted with caution by general ophthalmologists.

PMID:34860746 | DOI:10.1097/WNO.0000000000001425

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The Use of the Saccadometer to Identify Saccadic Characteristics in Myasthenia Gravis: A Pilot Study

J Neuroophthalmol. 2021 Oct 22. doi: 10.1097/WNO.0000000000001438. Online ahead of print.


BACKGROUND: Myasthenia gravis (MG) often presents with ocular signs that mimic other forms of ocular defects, such as isolated cranial nerve palsy. Normal velocity or even hyperfast saccadic eye movements in the presence of deficits of smooth pursuit have been well described in the literature in myasthenic patients. The reason for these paradoxical clinical findings has been reported to be due to increased postsynaptic folding of the fast-twitch fibers responsible for the execution of a saccade which is absent in those fibers responsible for slower, smooth eye movement. Saccadic characteristics therefore offer a point of differential diagnosis between patients suspected of having ocular motility deficits as a result of MG and those caused by other neuropathies. The advent of portable quantitative saccadic assessment means that previously laboratory-based assessments that require specialist equipment and training may now be undertaken clinically, providing a noninvasive test that can aid the differential diagnosis of the condition. The aim of this pilot study was to investigate the feasibility of the saccadometer (Ober Consulting, Poznan, Poland) in detecting the saccadic characteristics associated with myasthenia, specifically normal peak velocity (PV) in a group of patients confirmed with myasthenia.

METHODS: A group of 5 patients with a confirmed diagnosis of MG were recruited from a single site into the study along with 5 age-matched healthy volunteers. All myasthenic patients had ocular signs such as underaction or limitations of motility confirmed through ocular clinical examination. Healthy volunteers were screened for any underlying ocular motility or neurological defects before inclusion within the study. All participants undertook 100 trials of both 10 and 20° amplitude saccades, and mean PV, amplitude, and latency were recorded using the saccadometer for each individual. Overall, mean PV, amplitude, and latency were collated for both myasthenic and healthy control groups for each saccade size and compared.

RESULTS: The mean PV was significantly greater (481 ± 103.5 deg/seconds) for myasthenic patients compared with healthy controls (384 ± 42.8 deg/seconds) (P < 0.05) in 10° saccades. PV was also greater in myasthenics for 20° saccades; however, this difference did not reach statistical significance for patients with MG (547 ± 89.8 deg/seconds vs 477 ± 104.5 deg/seconds) (P = 0.14). The latency of participants with MG was not significantly different from those of age-matched healthy participants in 10° saccades but was significantly different for 20° saccades. There was no difference in amplitude measured between the groups.

CONCLUSIONS: PV for both 10 and 20° saccades was greater in myasthenic patients compared with healthy controls. All myasthenic patients produced normal velocity saccades in the presence of deficits of smooth ocular motility. The results from this small pilot study demonstrate the potential use of the saccadometer in a clinical setting to provide a noninvasive aid in the diagnosis of patients suspected with myasthenia.

PMID:34860741 | DOI:10.1097/WNO.0000000000001438

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Risk of Hypersensitivity Reactions to Iopromide in Children and Elderly: An Analysis of 132,850 Patients From 4 Observational Studies and Pharmacovigilance Covering >288 Million Administrations

Invest Radiol. 2021 Dec 1. doi: 10.1097/RLI.0000000000000840. Online ahead of print.


PURPOSE: The aim of this study was to analyze the risk of hypersensitivity reactions (HSRs) to iopromide in children and elderly patients in comparison to adults.

MATERIALS AND METHODS: Four observational studies were pooled and analyzed (analysis I). In addition, spontaneous reports from 1985 to 2020 from the pharmacovigilance database were evaluated (analysis II). All patients received iopromide for angiographic procedures or contrast-enhanced computed tomography in various indications. In analysis I, a nested case-control analysis, including a multivariable logistic regression model, based on pooled observational study data, was performed. Cases were defined as patients with a typical and unequivocal HSR; controls were patients without any recorded reaction. In analysis II, all spontaneous reports on HSRs after iopromide administration recorded in the pharmacovigilance database were descriptively analyzed. Exposure estimates on the size of the exposed age groups were derived from sales data and data from market research. The primary target variable was the risk of HSR to iopromide in children (<18 years) and elderly patients (≥65 years) compared with adults (≥18 to <65 years).

RESULTS: In analysis I, a total of 132,850 patients were included (2978 children, 43,209 elderly, and 86,663 adults). Hypersensitivity reactions were significantly less frequent in children (0.47%) and elderly (0.38%) compared with adults (0.74%). The adjusted odds ratio (vs adults) for children was 0.58 (95% confidence interval, 0.34-0.98; P < 0.043), and that for the elderly was 0.51 (95% confidence interval, 0.43-0.61; P < 0.001), indicating a lower risk for both subpopulations as compared with adults. In analysis II, of the overall >288 million iopromide administrations, 5.87, 114.18, and 167.97 million administrations were administered to children, elderly, and adults, respectively. The reporting rate for HSRs in children (0.0114%) and elderly (0.0071%) was significantly lower as compared with adults (0.0143%) (P < 0.0001).

CONCLUSIONS: Hypersensitivity reactions to iopromide were significantly less frequent in children and elderly compared with adults.

PMID:34860739 | DOI:10.1097/RLI.0000000000000840

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Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis

J Am Acad Orthop Surg Glob Res Rev. 2021 Dec 2;5(12). doi: 10.5435/JAAOSGlobal-D-21-00181.


INTRODUCTION: To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction.

METHODS: A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs.

RESULTS: The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08).

CONCLUSIONS: This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.

PMID:34860735 | DOI:10.5435/JAAOSGlobal-D-21-00181

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Intermittent pain in patients with chronic low back pain is associated with abnormalities in muscles and fascia

Int J Rehabil Res. 2021 Dec 2. doi: 10.1097/MRR.0000000000000507. Online ahead of print.


We investigated the relationship between paravertebral muscles and perimuscular connective tissues of the thoracolumbar fascia region and the four types of pain in patients suffering from chronic low back pain. A total of 17 patients with chronic low back pain participated in this study. Ultrasound imaging method was used to measure the thickness and echogenicity of the paravertebral muscles and perimuscular connective tissues. The measurement site considered in this study was located lateral to the midpoint between L2-3 and L4-5 spines. In addition, age, gender, BMI, numerical rating scale and the short-form McGill pain questionnaire 2 (includes questions with respect to continuous pain, intermittent pain, neuropathic pain and affective descriptors) were used for assessment. Statistical analysis was performed using correlation analysis and multiple regression analysis. A significant association was observed between paravertebral muscle echogenicity at L2-3 and the numerical rating scale (r = 0.499), between paravertebral muscle echogenicity at L4-5 with numerical rating scale (r = 0.538) and intermittent pain (r = 0.594), and between perimuscular connective tissue thickness at L2-3 and numerical rating scale (r = 0.762). We observed that the factor influencing perimuscular connective tissue thickness at L2-3 and L4-5 was intermittent pain (β = 0.513, β = 0.597, respectively). It was also observed that some of the imaging findings were associated with age and BMI. In conclusion, we observed that paravertebral muscle echogenicity and perimuscular connective tissue thickness in patients with chronic low back pain were associated with pain, especially intermittent pain.

PMID:34860730 | DOI:10.1097/MRR.0000000000000507

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Cholesteatoma Is Associated With Pediatric Progressive Sensorineural Hearing Loss

Ear Hear. 2021 Nov 30. doi: 10.1097/AUD.0000000000001176. Online ahead of print.


OBJECTIVES: This study identified an association between cholesteatoma and progressive sensorineural hearing loss using a large pediatric longitudinal audiologic dataset. Cholesteatoma is a potential sequela of chronic otitis media with effusion, a commonly observed auditory pathology that can contribute to hearing loss in children. The purpose of this report is to (i) describe the process of identifying the association between cholesteatoma and progressive sensorineural hearing loss in a large pediatric dataset and (ii) describe the audiologic data acquired over time in patients identified with cholesteatoma-associated progressive sensorineural hearing loss.

DESIGN: Records of patients included in the Audiologic and Genetics Database (n = 175,215 patients) were examined using specified criteria defining progressive hearing loss. A linear regression model examined the log frequency of all diagnostic codes in the electronic health record assigned to patients for a progressive hearing loss cohort compared with a stable hearing loss group. Based on findings from the linear regression analysis, longitudinal audiometric air (AC) and bone conduction (BC) thresholds were extracted for groups of subjects with cholesteatoma-associated progressive (n = 58 subjects) and stable (n = 55 subjects) hearing loss to further analyze changes in hearing over time.

RESULTS: The linear regression analyses identified that diagnostic codes for cholesteatoma were associated with progressive sensorineural hearing loss in children. The longitudinal audiometric data demonstrated within-subject changes in masked BC sensitivity consistent with progressive sensorineural hearing loss in children diagnosed with cholesteatoma. Additional analyses showed that mastoidectomy surgeries did not appear to contribute to the observed progressive hearing loss and that a high number of cholesteatoma patients with progressive hearing loss had normal-hearing thresholds at their first test.

CONCLUSIONS: The statistical analyses demonstrated an association between cholesteatoma and pediatric progressive sensorineural hearing loss. These findings inform clinical management by suggesting that children with cholesteatoma diagnoses may be at increased risk for progressive sensorineural hearing loss and should receive continued monitoring even after a normal masked BC baseline has been established.

PMID:34860720 | DOI:10.1097/AUD.0000000000001176

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AudioChip: A Deep Phenotyping Approach for Deconstructing and Quantifying Audiological Phenotypes of Self-Reported Speech Perception Difficulties

Ear Hear. 2021 Nov 23. doi: 10.1097/AUD.0000000000001158. Online ahead of print.


OBJECTIVES: About 15% of U.S. adults report speech perception difficulties despite showing normal audiograms. Recent research suggests that genetic factors might influence the phenotypic spectrum of speech perception difficulties. The primary objective of the present study was to describe a conceptual framework of a deep phenotyping method, referred to as AudioChipping, for deconstructing and quantifying complex audiometric phenotypes.

DESIGN: In a sample of 70 females 18 to 35 years of age with normal audiograms (from 250 to 8000 Hz), the study measured behavioral hearing thresholds (250 to 16,000 Hz), distortion product otoacoustic emissions (1000 to 16,000 Hz), click-evoked auditory brainstem responses (ABR), complex ABR (cABR), QuickSIN, dichotic digit test score, loudness discomfort level, and noise exposure background. The speech perception difficulties were evaluated using the Speech, Spatial, and Quality of Hearing Scale-12-item version (SSQ). A multiple linear regression model was used to determine the relationship between SSQ scores and audiometric measures. Participants were categorized into three groups (i.e., high, mid, and low) using the SSQ scores before performing the clustering analysis. Audiometric measures were normalized and standardized before performing unsupervised k-means clustering to generate AudioChip.

RESULTS: The results showed that SSQ and noise exposure background exhibited a significant negative correlation. ABR wave I amplitude, cABR offset latency, cABR response morphology, and loudness discomfort level were significant predictors for SSQ scores. These predictors explained about 18% of the variance in the SSQ score. The k-means clustering was used to split the participants into three major groups; one of these clusters revealed 53% of participants with low SSQ.

CONCLUSIONS: Our study highlighted the relationship between SSQ and auditory coding precision in the auditory brainstem in normal-hearing young females. AudioChip was useful in delineating and quantifying internal homogeneity and heterogeneity in audiometric measures among individuals with a range of SSQ scores. AudioChip could help identify the genotype-phenotype relationship, document longitudinal changes in auditory phenotypes, and pair individuals in case-control groups for the genetic association analysis.

PMID:34860719 | DOI:10.1097/AUD.0000000000001158