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Nevin Manimala Statistics

Characterizing the real-world economic burden of metastatic castration-sensitive prostate cancer in the United States

J Med Econ. 2024 Feb 29:1-16. doi: 10.1080/13696998.2024.2323901. Online ahead of print.

ABSTRACT

Aims: To describe healthcare resource utilization (HRU) and costs of patients with metastatic castration-sensitive prostate cancer (mCSPC).Methods: Linked data from Flatiron Metastatic PC Core Registry and Komodo’s Healthcare Map were evaluated (01/2016-12/2021). Patients with chart-confirmed diagnoses for metastatic PC without confirmed castration resistance in Flatiron who initiated androgen deprivation therapy (ADT) monotherapy or advanced therapy for mCSPC in 2017 or later (index date) with a corresponding pharmacy or medical claim in Komodo Health were included. Advanced therapies considered were androgen-receptor signaling inhibitors, chemotherapies, estrogens, immunotherapies, poly ADP-ribose polymerase inhibitors, and radiopharmaceuticals. Patients with <12 months of continuous insurance eligibility before index were excluded. Per-patient-per-month (PPPM) all-cause and PC-related HRU and costs (medical and pharmacy; from a payer’s perspective in 2022 $USD) were described in the 12-month baseline period and follow-up period (from the index date to castration resistance, end of continuous insurance eligibility, end of data availability, or death).Results: Of 871 patients included (mean age: 70.6 years), 52% initiated ADT monotherapy as their index treatment without documented advanced therapy use. During baseline, 31% of patients had a PC-related inpatient admission and 94% had a PC-related outpatient visit; mean all-cause costs were $2,551 PPPM and PC-related costs were $839 PPPM with $787 PPPM attributable to medical costs. Patients had a mean follow-up of 15 months, during which 38% had a PC-related inpatient admission and 98% had a PC-related outpatient visit; mean all-cause costs were $5,950 PPPM with PC-related total costs of $4,363 PPPM, including medical costs of $2,012 PPPM.Limitations: All analyses were descriptive; statistical testing was not performed. Treatment effectiveness and clinical outcomes were not assessed.Conclusion: This real-world study demonstrated a significant economic burden in mCSPC patients, and a propensity to use ADT monotherapy in clinical practice despite the availability and guideline recommendations of advanced life-prolonging therapies.

PMID:38420699 | DOI:10.1080/13696998.2024.2323901

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Effect of topical application of autologous platelet gel on sternal wound infection after cardiac surgery: A meta-analysis

Int Wound J. 2024 Mar;21(3):e14761. doi: 10.1111/iwj.14761.

ABSTRACT

Following heart operation, a severe life-threatening complication has been identified by investigators who have recently discovered that local application of platelet-rich plasma (PRP) can lower the rate of wound infection in heart surgery. Nevertheless, due to the low quality of these trials, we have tried to perform high-quality meta-analyses to prove the efficacy of PRP in heart surgery for post-operative wound infections. In this study, five randomised controlled trials (RCTs) were chosen from three databases, and there were 1005 studies to analyse the data. Among 181 cases, PRP was applied to the surgical site, and 205 in the control group. Both the CI and the OR or the average difference (MD) were computed with either a fixed or random-effect model. A meta-analysis of the data was carried out with RevMan 5.3. The results showed that there were no statistically significant differences in the incidence of post-operative surgical site infection (SSI) in control group compared to those treated with PRP gel (OR, 0.97; 95% CI, 0.38, 2.47; p = 0.95); In the heart operation, the local application of PRP gel decreased the rate of drainage after operation (MD, -217.82; 95% CI, -335.38, -100.26; p = 0.0003); The operation time of the PRP gel was not significantly different from that of the control group (MD, 12.65; 95% CI, -2.95, 28.24; p = 0.11). Contrary to earlier research, the application of autoplatelet gel in heart surgery did not seem to decrease operative site infections after the operation, but it did decrease the amount of postoperative drainage. Nevertheless, because of the limited number of RCTs in this meta-analysis, caution should be exercised in their treatment. More high-quality randomised, large-sample trials are required to further confirm the findings.

PMID:38420690 | DOI:10.1111/iwj.14761

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Risk factors and clinical characteristics of surgical site infections in athletes undergoing Achilles tendon repair surgery

Int Wound J. 2024 Mar;21(3):e14666. doi: 10.1111/iwj.14666.

ABSTRACT

Achilles tendon ruptures are common in athletes, requiring surgical intervention. However, the risk of surgical site infections (SSIs) post-surgery poses significant challenges. This study aims to analyse the risk factors and microbial aetiology associated with SSIs in athletes undergoing Achilles tendon repair. A comprehensive retrospective analysis was conducted from May 2021 to July 2023. The study included 25 patients with SSIs (case group) and 50 patients without SSIs (control group) post Achilles tendon repair surgery. Inclusion criteria encompassed patients with medically confirmed Achilles tendon ruptures who underwent surgical repair. Exclusion criteria included prior tendon pathologies and significant chronic illnesses. Diagnostic criteria for SSIs involved symptoms like elevated body temperature and localized tenderness, along with laboratory confirmations such as positive microbiological cultures. The study utilized VITEK® 2 for bacterial identification and involved statistical analyses like univariate and multivariate logistic regression. The study identified Staphylococcus aureus as the primary pathogen in SSIs. Significant risk factors included lack of prophylactic antibiotic use, presence of diabetes, open wounds and prolonged surgery duration. Univariate analysis revealed stark contrasts in these factors between infected and non-infected groups, while multivariate analysis underscored their importance in SSI development. S. aureus emerged as the predominant pathogen in SSIs post Achilles tendon repair. Critical risk factors such as absence of prophylactic antibiotics, diabetes, open wounds and extended surgery duration play a vital role in SSIs. Addressing these factors is essential for better postoperative outcomes in Achilles tendon repair surgeries.

PMID:38420668 | DOI:10.1111/iwj.14666

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Graduate Prospects Explain Undergraduate Program Standing in University League Sports Science Tables

Adv Physiol Educ. 2024 Feb 29. doi: 10.1152/advan.00126.2023. Online ahead of print.

ABSTRACT

UK university undergraduate programs are compared by independent subject-specific rankings (Complete, Guardian, Times), based upon data from National Student Survey, Higher Education Statistics Agency, Universities and Colleges Admissions Service, Research Excellence Framework, and the universities. The sports and exercise science program at University of Glasgow, has steadily risen to currently rank as the top UK program. This investigation aimed to identify the underlying factors that explain this. Therefore, we obtained underlying scores for entry standard, student satisfaction, research foundation, graduate prospects, staff-student ratio, expenditure/student, continuation, program support to students, and teaching quality from the ranking providers for years 2010-2024, and statistically modelled which factors significantly affected the rankings. We found that entry standard and graduate prospects strongly correlated significantly with ranking results. Principal component analysis indicated that a model of graduate prospects and entry standard explained 66.2% of the variance in ranking results. Multiple linear regression with all underlying factors included in the model indicated they explained 78% (R2=0.78) of the total variance, while stepwise elimination of insignificant factors identified graduate prospects as the sole factor that significantly affected outcome by explaining 71% (R2=0.71) of the variance. Therefore, the primary predictor of ranking success in UK university league tables for sports science is graduates’ professional success (graduate prospects).

PMID:38420665 | DOI:10.1152/advan.00126.2023

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What importance do donors and recipients attribute to the nuclear DNA-related genetic heritage of oocyte donation?

Hum Reprod. 2024 Feb 28:deae030. doi: 10.1093/humrep/deae030. Online ahead of print.

ABSTRACT

STUDY QUESTION: How do oocyte donors and recipients perceive the genetic link related to the transfer of nuclear DNA between donors and offspring?

SUMMARY ANSWER: Whether they are donors or recipients, individuals attach great importance to the transmission of their genetic heritage, since 94.5% would opt for the pronuclear transfer method to preserve this genetic link in the context of oocyte donation.

WHAT IS KNOWN ALREADY: Since 1983, the use of oocyte donation has increased worldwide. Performed in France since the late 1980s and initially offered to women with premature ovarian insufficiency, its indications have progressively expanded and now it is proposed in many indications to prevent the transmission of genetically inherited diseases. This has resulted in an increase in the waiting time for access to oocyte donation due to the difficulty in recruiting oocyte donors in French ART centres. Several articles have discussed how to fairly distribute donor oocytes to couples, but few have interviewed women in the general population to record their feelings about oocyte donation, as either the donor or recipient and the importance given to the genetic link between the oocyte donors and the children born. Mitochondrial replacement therapy (MRT) is a technique originally developed for women at risk of transmitting a mitochondrial DNA mutation. Recently, MRT has been considered for embryo arrest and oocyte rejuvenation as it could help females to reproduce with their own genetic material through the transfer of their oocyte nucleus into a healthy donor oocyte cytoplasm.

STUDY DESIGN, SIZE, DURATION: We conducted an opinion survey from January 2021 to December 2021, during which 1956 women completed the questionnaire. Thirteen participants were excluded from the analysis due to incomplete responses to all the questions. Consequently, 1943 women were included in the study.

PARTICIPANTS/MATERIALS, SETTING, METHODS: We specifically developed a questionnaire for this study, which was created and distributed using the Drag’n Survey® software. The questionnaire consisted of 21 items presented alongside a video created with whiteboard animation software. The aim was to analyse whether certain factors, such as age, education level, marital status, number of children, use of ART for pregnancy, video viewing, and knowledge about oocyte donation, were associated with feelings towards oocyte donation, by using a univariate conditional logistic regression model. This statistical method was also used to assess whether women would be more inclined to consider oocyte donation with the pronuclear transfer technique rather than the whole oocyte donation. All parameters found to be statistically significant in the univariate analysis were subsequently tested in a multivariate model using logistic regression.

MAIN RESULTS AND THE ROLE OF CHANCE: Most women were concerned about the biological genetic contribution of the donated oocyte (94.8%). The most common reason for a women’s reluctance to donate their oocytes was their unwillingness to pass on their genetic material (33.3%). Nearly 70% of women who were initially hesitant to donate their oocytes indicated that they would reconsider their decision if the oocyte donation was conducted using donated cytoplasm and the pronuclear transfer technique. Concomitantly, >75% of the respondents mentioned that it would be easier to receive a cytoplasm donation. The largest proportion of the population surveyed (94.5%) expressed their support for its legalization.

LIMITATIONS, REASONS FOR CAUTION: In this study, a substantial portion of the responses came from individuals with medical or paramedical backgrounds, potentially introducing a recruitment bias among potential donors. The rate of missing responses to the question regarding the desire to become an oocyte donor was 13.6%, while the question about becoming an oocyte cytoplasm donor had a missing response rate of 23%. These missing responses may introduce a bias in the interpretation of the data.

WIDER IMPLICATIONS OF THE FINDINGS: This study was the first to demonstrate that, for the French population studied, the combination of oocyte cytoplasm donation with pronuclear transfer could offer a promising approach to enhance the acceptance of oocyte donation for both the donor and the recipient.

STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study. The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER: N/A.

PMID:38420661 | DOI:10.1093/humrep/deae030

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Urinary schistosomiasis and anemia among school-aged children from southwestern Nigeria

Pathog Glob Health. 2024 Feb 28:1-9. doi: 10.1080/20477724.2024.2322800. Online ahead of print.

ABSTRACT

Schistosomiasis and anemia, are one of the leading global public health problem among children between age 5 and 14 years in marginalized settings. In this study, we provide prevalence and intensity data for both conditions in three southwestern states of Nigeria, where such are lacking. Epidemiological assessment involving parasitological analysis of urine and blood samples was conducted among 1783 consenting school-aged children in Ondo, Osun, Ekiti States of Nigeria. Participants’ age and sex data were obtained using field forms, and statistical analysis was performed in R software with a significance level of 95%. An overall prevalence of 26.8% and 29.5% was recorded for urinary schistosomiasis and anemia, respectively. Prevalence varied by location with (40.3% and 29.8%) in Ondo (34.4% and 37.5%) in Osun and (13.4% and 20.9%) in Ekiti for urinary schistosomiasis and anemia, respectively (p=0.00). Schistosoma infections were found among males (28.7%, p=0.05) and children between the age 9-11 years (30.0%, p=0.01). About 36% of children with anemia was also infected with schistosomiasis. Children who were positive for schistosomiasis (OR:1.51; 95% CI: 1.19, 1.93; p=0.001) and between the age category 15-16 years, (OR:1.86; 95% CI: 1.12, 3.09; p<0.05) were twice likely to become anemic. Our findings have shown that children infected with schistosomiasis are twice likely to become anemic than those without infection. It is important to complement ongoing MDA programmes targeted at schistosomiasis with nutrition intervention programs for example micronutrient supplementation for better impact and cost-effectiveness.

PMID:38419138 | DOI:10.1080/20477724.2024.2322800

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Pragmatic Return to Effective Dental Infection Control through Triage and Testing (PREDICT): an observational, feasibility study to improve dental office safety

Pilot Feasibility Stud. 2024 Feb 28;10(1):44. doi: 10.1186/s40814-024-01471-x.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, there was a substantial interruption of care, with patients and workers fearful to return to the dental office. As dental practice creates a highly aerosolized environment, the potential for spread of airborne illness is magnified. As a means to increase safety and mitigate risk, pre-visit testing for SARS-CoV-2 has the potential to minimize disease transmission in dental offices. The Pragmatic Return to Effective Dental Infection Control through Testing (PREDICT) Feasibility Study examined the logistics and impact of two different testing mechanisms (laboratory-based PCR viral testing and point-of-care antigen testing) in dental offices.

METHODS: Dental healthcare workers (DHCWs) and patients in four dental offices within the National Dental Practice-based Research Network participated in this prospective study. In addition to electronic surveys, participants in two offices completed POC testing, while participants in two offices used lab-based PCR methods to detect SARS-CoV-2 infection. Analysis was limited to descriptive measures, with median and interquartile ranges reported for Likert scale responses and mean and standard deviation for continuous variables.

RESULTS: Of the total 72 enrolled, 28 DHCWs and 41 patients completed the protocol. Two patients (4.9%) tested positive prior to their visit, while 2 DHCWs (12.5%) tested positive for SARS-CoV-2 infection at the start of the study. DHCWs and patients shared similar degree of concern (69% and 63%, respectively) for contracting COVID-19 from patients, while patients feared contracting COVID-19 from DHCWs less (49%). Descriptive statistics calculations revealed that saliva, tongue epithelial cells, and nasal swabs were the most desirable specimen collection method; both testing (LAB and POC) protocols took similar amounts of total time to complete; and DHCWs and patients reported feeling more comfortable when both groups were tested.

CONCLUSIONS: While a larger-scale, network study is necessary for generalizability of results, this feasibility study suggests that SARS-CoV-2 testing can be effectively implemented into dental practice workflows and positively impact perception of safety for DHCWs and patients. As new virulent infectious diseases emerge, preparing dental personnel to employ an entire toolbox of risk mitigation strategies, including testing, may have the potential to decrease dental practice closure time, maintaining continuity of dental care services for patients.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT05123742.

PMID:38419131 | DOI:10.1186/s40814-024-01471-x

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Dietary assessment of type 2 diabetic patients using healthful plant-based diet score in the Eastern Province of Saudi Arabia

BMC Nutr. 2024 Feb 28;10(1):37. doi: 10.1186/s40795-024-00843-z.

ABSTRACT

BACKGROUND: Diabetes mellitus is a chronic disease characterized by a wide range of metabolic problems. The current study sought to assess nutritional habits of Saudi patients with type 2 diabetes (T2D) and to propose recommendations to improve these patients’ dietary habits and delay possible disease complications.

METHODS: Over a period of three years, (2017-2019) 577 patients with T2D attending the outpatient’s diabetic clinics at King Fahd Hospital of the University, Al Khobar, Saudi Arabia were invited to participate in this study. Data of dietary intake were collected by trained nurses using a pretested structured validated semi quantitative food frequency questionnaire. The dietary data were collected using 7-day dietary recall questionnaire. A modified score system that associates dietary habits with glycemic control and lipid profile was used.

RESULTS: Overall, a high healthful plant-based diet score was associated with a significant (P = 0.018) reduction in triglycerides (TG) level (mean difference – 3.78%; 95% CI, -0.65% to -6.81%) and a statistically non-significant (P = 0.06) increase in high density lipoprotein (HDL) levels (mean difference 1.87%; 95% CI -0.06-3.84%) in T2D patients from the Eastern Province of Saudi Arabia. Additionally, in our patient group, the prevalence of coronary artery disease, stroke, peripheral artery disease, and chronic kidney disease in T2D patients was 11.3%, 6.2%, 3.3%, and 8.4%, respectively and were higher when compared to the prevalence in the general population.

CONCLUSION: The present study showed that adherence to a healthful plant-based diet, when compared to high glycemic index diet, is associated with a favorable outcome in glycemic control and lipid profile in T2D patients. Prior assessment of total diet quality may be beneficial when giving nutritional advice to T2D patients with the possibility of improving glycemic control and lipid profile.

PMID:38419128 | DOI:10.1186/s40795-024-00843-z

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Influence of socio-demographic factors on medicinal plant knowledge among three selected ethnic groups in south-central Ethiopia

J Ethnobiol Ethnomed. 2024 Feb 28;20(1):29. doi: 10.1186/s13002-024-00672-1.

ABSTRACT

BACKGROUND: The influence of socio-demographic variables was widely explored to evaluate their impact on indigenous and local ethnobotanical knowledge. However, the studies conducted in Ethiopia mainly focused on rural areas. They were limited to exploring and documenting ethnobotanical knowledge and the associated impacts of socio-demographic variables in rural-urban interface areas among ethnic groups. Hence, this study aimed to document plant-based indigenous and local ethnomedicinal knowledge and the associated impacts of socio-demographic variables among selected three ethnic groups in south-central Ethiopia.

METHODS: Ethnobotanical data were collected using semi-structured interviews with 189 key informants, floristic species inventories, and field observations. Quantitative approaches were used to evaluate the use values (UV) of the most important medicinal plants, the informant consensus factor (ICF), fidelity level (FL), relative popularity level (RPL), and rank-order priority (ROP). Statistical tests were applied to evaluate the influences of socio-demographic factors and associations between variables on local ethnobotanical knowledge across ethnic groups in different informant categories.

RESULTS: Statistical analysis revealed significant differences (p < 0.05) in the mean number of medicinal plants reported among age categories. There was also a positive association between the respondent’s age and plant knowledge acquisition. Croton macrostachyus Hochst. ex Delile, Albizia gummifera C.A.Sm., Zingiber officinale Roscoe, Aloe macrocarpa Tod., Gymnanthemum amygdalinum (Delile) Sch.Bip., Calpurnia aurea (Aiton) Benth, and Allium sativum L. had the highest use values among ethnic groups. The highest informant consensus factor values were recorded for circulatory system disorders (0.68) followed by febrile illness and reproductive organ complications (0.66 each) across the three studied ethnic groups. The highest FL, RPL, and ROP values were noted for Lactuca inermis Forssk., Moringa stenopetala (Baker f.) Cufod., Withania somnifera (L.) Dunal, Allium sativum L., Citrus limon (L.) Osbeck, Ricinus communis L., Schinus molle L., Antiaris toxicaria (J.F.Gmel.) Lesch., Brucea antidysenterica J.F.Mill., Echinops kebericho Mesfin, Ocimum jamesii Sebald, Afrocarpus falcatus (Thunb.) C.N.Page, Searsia natalensis (Bernh. ex Krauss) F.A.Barkley, and Ricinus communis L. across ethnic groups in the study areas, which showed the conformity of knowledge on species curing potential and their prevalent uses.

CONCLUSION: The study revealed that the ethnic groups of Gedeo, Oromo, and Sidama have considerable indigenous and local ethnobotanical knowledge practices. Statistical analysis shown high variation in the acquisition of local ethnobotanical knowledge among age groups, which boosted our understanding of the effects of socio-demographic factors on the local ethnobotanical knowledge dynamics. Thus, this finding advocates for efforts to repair the observed generation gap via continued professional support and educating local communities to preserve traditional knowledge and practices through systematic documentation.

PMID:38419117 | DOI:10.1186/s13002-024-00672-1

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Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus

Addict Sci Clin Pract. 2024 Feb 28;19(1):14. doi: 10.1186/s13722-024-00446-w.

ABSTRACT

BACKGROUND: The prevalence and associated overdose death rates from opioid use disorder (OUD) have dramatically increased in the last decade. Despite more available treatments than 20 years ago, treatment access and high discontinuation rates are challenges, as are personalized medication dosing and making timely treatment changes when treatments fail. In other fields such as depression, brief measures to address these tasks combined with an action plan-so-called measurement-based care (MBC)-have been associated with better outcomes. This workgroup aimed to determine whether brief measures can be identified for using MBC for optimizing dosing or informing treatment decisions in OUD.

METHODS: The National Institute on Drug Abuse Center for the Clinical Trials Network (NIDA CCTN) in 2022 convened a small workgroup to develop consensus about clinically usable measures to improve the quality of treatment delivery with MBC methods for OUD. Two clinical tasks were addressed: (1) to identify the optimal dose of medications for OUD for each patient and (2) to estimate the effectiveness of a treatment for a particular patient once implemented, in a more granular fashion than the binary categories of early or sustained remission or no remission found in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

DISCUSSION: Five parameters were recommended to personalize medication dose adjustment: withdrawal symptoms, opioid use, magnitude (severity and duration) of the subjective effects when opioids are used, craving, and side effects. A brief rating of each OUD-specific parameter to adjust dosing and a global assessment or verbal question for side-effects was viewed as sufficient. Whether these ratings produce better outcomes (e.g., treatment engagement and retention) in practice deserves study. There was consensus that core signs and symptoms of OUD based on some of the 5 DSM-5 domains (e.g., craving, withdrawal) should be the basis for assessing treatment outcome. No existing brief measure was found to meet all the consensus recommendations. Next steps would be to select, adapt or develop de novo items/brief scales to inform clinical decision-making about dose and treatment effectiveness. Psychometric testing, assessment of acceptability and whether the use of such scales produces better symptom control, quality of life (QoL), daily function or better prognosis as compared to treatment as usual deserves investigation.

PMID:38419116 | DOI:10.1186/s13722-024-00446-w