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Nevin Manimala Statistics

To curb research misreporting, replace significance and confidence by compatibility: A Preventive Medicine golden jubilee article

Prev Med. 2022 Jul 1:107127. doi: 10.1016/j.ypmed.2022.107127. Online ahead of print.

ABSTRACT

It is well known that the statistical analyses in health-science and medical journals are frequently misleading or even wrong. Despite many decades of reform efforts by hundreds of scientists and statisticians, attempts to fix the problem by avoiding obvious error and encouraging good practice have not altered this basic situation. Statistical teaching and reporting remain mired in damaging yet editorially enforced jargon of “significance”, “confidence”, and imbalanced focus on null (no-effect or “nil”) hypotheses, leading to flawed attempts to simplify descriptions of results in ordinary terms. A positive development amidst all this has been the introduction of interval estimates alongside or in place of significance tests and P-values, but intervals have been beset by similar misinterpretations. Attempts to remedy this situation by calling for replacement of traditional statistics with competitors (such as pure-likelihood or Bayesian methods) have had little impact. Thus, rather than ban or replace P-values or confidence intervals, we propose to replace traditional jargon with more accurate and modest ordinary-language labels that describe these statistics as measures of compatibility between data and hypotheses or models, which have long been in use in the statistical modeling literature. Such descriptions emphasize the full range of possibilities compatible with observations. Additionally, a simple transform of the P-value called the surprisal or S-value provides a sense of how much or how little information the data supply against those possibilities. We illustrate these reforms using some examples from a highly charged topic: trials of ivermectin treatment for Covid-19.

PMID:35787846 | DOI:10.1016/j.ypmed.2022.107127

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Effects of therapeutic intervention on spatiotemporal gait parameters in adults with neurological disorder: systematic review and meta-analysis

Arch Phys Med Rehabil. 2022 Jul 1:S0003-9993(22)00485-3. doi: 10.1016/j.apmr.2022.06.003. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aimed to review and quantify the changes in gait parameters after therapeutic intervention in adults with neurological disorders.

DATA SOURCES: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (01/2000-12/2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods.

STUDY SELECTION: Studies were thoroughly screened using the following inclusion criteria: Study design: Randomized Controlled Trial (RCT); adults ≥ 55 years old with a neurological disorder; therapeutic intervention; spatiotemporal gait characteristics; and Language: English.

DATA EXTRACTION: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters such as cadence, step length, step width, or double limb support. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was > 50%, a random plot analysis was used, otherwise, a fixed plot analysis was done.

DATA SYNTHESIS: We included 25 out of 34 studies in our meta-analysis that examined gait in adults with neurological disorders. All analyses used effect sizes and standard error and a p < 0.05 threshold was considered statistically significant. Overall, we found that sensory (SS) and electrical stimulation (ES) had the most significant effect on step length (SS: z=5.44*, ES: z=2.42*) and gait speed (SS: z=6.19*, ES: z=7.38*) in adults with Parkinson’s disease (PD). Although balance or physical activity interventions were not found to be effective in modifying step length in adults with PD, they showed a significant effect on gait speed. Further, physical activity had the most significant effect on cadence in adults with PD (z=2.84*) relative to sensory stimulation effect on cadence (z=2.59*). For stroke, conventional physical therapy had the most significant effect on step length (z=3.12*) and cadence (z=3.57*).

CONCLUSION: Sensory stimulation such as auditory and somatosensory stimulation while walking had the most significant effect on step length in adults with PD. We also found that conventional PT did improve spatial gait parameters relative to other physical activity interventions in adults with PD and stroke.

PMID:35787837 | DOI:10.1016/j.apmr.2022.06.003

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Nevin Manimala Statistics

Remimazolam versus traditional sedatives for procedural sedation: a systematic review and meta-analysis of efficacy and safety outcomes

Minerva Anestesiol. 2022 Jul 5. doi: 10.23736/S0375-9393.22.16631-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Remimazolam is a novel and ultra-short-acting benzodiazepine currently approved for procedural sedation and induction of general anaesthesia, with a possible indication for ICU sedation. This study aimed to evaluate the efficacy and safety of remimazolam and traditional sedatives for patients undergoing procedural sedation.

EVIDENCE ACQUISITION: We systematically searched Cochrane Library, Embase, PubMed, Web of Science and ClinicalTrials.gov for randomized controlled trials of procedural sedation performed with remimazolam versus traditional sedatives. Data from the eligible studies were combined to calculate pooled risk ratio or standardized mean difference.

EVIDENCE SYNTHESIS: Eleven studies of 2356 patients met the inclusion criteria. The results showed that remimazolam was associated with a higher procedure success rate (RR: 1.28, 95% CI: 1.07 to 1.52, P = 0.006; I2 = 99%), a shorter duration of recovery after procedure (SMD: -0.56, 95% CI: -0.98, -0.14, P = 0.009; I2 = 89%), and an earlier patient discharge after procedure (SMD: -0.37, 95% CI: -0.49, -0.25, P 0.00001; I2 = 0%) in comparison with traditional sedatives. There were no statistically significant differences in onset time, procedure time, and cognitive recovery between remimazolam and traditional sedatives groups. Remimazolam significantly decreased the rate of bradycardia (RR: 0.65, 95% CI: 0.43, 0.97, P = 0.04; I2 = 0%), hypotension (RR: 0.57, 95% CI: 0.40, 0.80, P = 0.001; I2 = 80%), and respiratory depression/hypoxia (RR: 0.46, 95% CI: 0.25, 0.83, P = 0.01; I2 = 61%) compared to traditional sedatives.

CONCLUSIONS: Remimazolam is a safe and effective sedative for procedural sedation on account of a higher success procedure rate, a faster recovery, a shorter discharge time, and a superior safety profile in comparison with traditional sedatives. Larger sample-sized and well-designed clinical trials are needed to verify our finding.

PMID:35785930 | DOI:10.23736/S0375-9393.22.16631-9

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Nevin Manimala Statistics

Dynamic assessment of Surge Capacity in a large hospital network during Covid-19 pandemic

Minerva Anestesiol. 2022 Jul 5. doi: 10.23736/S0375-9393.22.16460-6. Online ahead of print.

ABSTRACT

BACKGROUND: The Covid-19 pandemic has provided an unprecedented scenario to deepen knowledge of surge capacity (SC), assessment of which remains a challenge. This study reports a large-scale experience of a multi-hospital network, with the aim of evaluating the characteristics of different hospitals involved in the response and of measuring a real-time SC based on two complementary modalities (actual, base) referring to the intensive care units (ICU).

METHODS: Data analysis referred to two consecutive pandemic waves (March-December 2020). Regarding SC, two different levels of analysis are considered: single hospital category (referring to a six-level categorization based on the number of hospital beds) and multi-hospital wide (referring to the response of the entire hospital network).

RESULTS: During the period of 114 days, the analysis revealed a key role of the biggest hospitals (>Category-4) in terms of involvement in the pandemic response. In terms of SC, Category-4 hospitals showed the highest mean surge capacity values, irrespective of the calculation method and level of analysis. At the multi-hospital level, the analysis revealed an overall ICU-SC (base) of 84.4% and an ICU-SC (actual) of 106.5%.

CONCLUSIONS: The results provide benchmarks to better understand ICU hospital response capacity, highlighting the need for a more flexible approach to surge capacity definition.

PMID:35785929 | DOI:10.23736/S0375-9393.22.16460-6

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Sequential combined approach in patients with mixed urinary incontinence: surgery followed by posterior tibial nerve stimulation

Minerva Obstet Gynecol. 2022 Jul 4. doi: 10.23736/S2724-606X.22.05106-5. Online ahead of print.

ABSTRACT

AIM: The aim of the study is to demonstrate the efficacy of sequential combined treatment with Transobturator Tape (TOT) followed by Posterior Tibial Nerve Stimulation (PTNS) in patients with Mixed Urinary Incontinence (MUI); quality of life and patients’ satisfaction was also assessed.

METHODS: Retrospective analysis on women affected by MUI with prevalent Stress Urinary Incontinence (SUI) component. Women, divided in 2 groups, underwent different treatments, TOT vs TOT+PTNS. Population was assessed by medical history, previous pelvic surgery, clinical exam, urodynamic exams, pelvic ultrasound examination, and questionnaires (The International Consultation on Incontinence Questionnaire Short Form, Overactive Bladder Questionnaire, Health Related Quality of Life) comparing them before and after 12 weeks after treatment.

RESULTS: 112 women were enrolled in the study. The mean age was 57.96±7.34 in the first group(N=60) and 58.29±6.14 in the second group(N=52). Peak flow (ml/s) statistically improved after treatment, 22.23±4.29 (TOT) vs 24.81±5.8 (TOT+PTNS). First voiding desire(ml) improved significantly between the two groups 108.72±19.24 vs 142.43±19.98. Maximum cystometric capacity (ml) in the TOT group at 12-weeks was 328.76±82.44 vs TOT+PTNS group of 396.26±91.21. Detrusor pressure at peak flow(cmH2O) showed a greater improvement in TOT+PTNS than TOT alone 14.45±6.10 vs 11.89±54.49. At 12-week, urinary diary and quality of life improved in terms of urgent urination events, mean number of voids, urge symptoms and nocturia events. The Patient Impression of Global Improvement (PGI-I) after 3 months was better in combined group.

CONCLUSIONS: Combined and sequential TOT+PTNS is more effective compared to TOT alone in MUI patients with prevalent SUI component.

PMID:35785925 | DOI:10.23736/S2724-606X.22.05106-5

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Nevin Manimala Statistics

The effect of statin administration on IL-6 and IL-1b expression in peripheral blood mononuclear cells of a hypertensive patient with SARS-CoV-2 spike protein stimulation

Med Glas (Zenica). 2022 Aug 1;19(2). doi: 10.17392/1481-22. Online ahead of print.

ABSTRACT

Aim The infection of the SARS-CoV-2 virus potentially causes a cytokine storm with elevated IL-6 and IL-1β levels. Statin therapy was common among COVID-19 patients due to their cardiovascular comorbidities. However, the effect of statins on COVID-19 infection is unclear. The aim of this study was to evaluate the impact of statin administration on IL-6 and IL-1β level in peripheral blood mononuclear cells (PBMCs) after SARS-CoV-2 spike protein stimulation. Methods The PBMCs were isolated from a hypertensive patient and stimulated by the SARS-CoV-2 subunit S1 spike protein. The PBMCs were then divided into four treatment groups and treated with simvastatin at various doses (10 µM, 25 µM, 50 µM, and control). IL-6 and IL-1β were measured from the supernatant using the ELISA method. Results The stimulation of SARS-CoV-2 spike protein in PBMC cell culture statistically increased IL-6 and IL1β expression of 5.2 and 35.07 fold, respectively (p<0.05). The expressions of IL-6 and IL-1β were not statistically significant among three simvastatin doses and control. Conclusion Statin administration did not have significant effect on IL-6 and IL-1β levels in PBMCs after SARS-CoV-2 spike protein stimulation in this study, a further study is needed.

PMID:35785915 | DOI:10.17392/1481-22

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Nevin Manimala Statistics

Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years

Asian Spine J. 2022 Jul 4. doi: 10.31616/asj.2021.0366. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

PURPOSE: To evaluate the clinical and radiological effects of epidural fluid hematoma in the medium term after lumbar endoscopic decompression.

OVERVIEW OF LITERATURE: There is limited literature comparing the effect of postoperative epidural fluid hematoma after uniportal endoscopic decompression.

METHODS: Magnetic resonance imaging (MRI) and clinical evaluation were performed for patients with single-level uniportal endoscopic lumbar decompression with a minimum follow-up of 2 years.

RESULTS: A total of 126 patients were recruited with a minimum follow-up of 26 months. The incidence of epidural fluid hematoma was 27%. Postoperative MRI revealed a significant improvement in the postoperative dura sac area at postoperative day 1 and at the upper endplate at 6 months in the hematoma cohort (39.69±15.72 and 26.89±16.58 mm2) as compared with the nonhematoma cohort (48.92±21.36 and 35.1±20.44 mm2), respectively (p <0.05); and at the lower endplate on postoperative 1 day in the hematoma cohort (51.18±24.69 mm2) compared to the nonhematoma cohort (63.91±27.92 mm2) (p <0.05). No significant difference was observed in the dura sac area at postoperative 1 year in both cohorts. The hematoma cohort had statistically significant higher postoperative 1-week Visual Analog Scale (VAS; 3.32±0.68) pain and Oswestry Disability Index (ODI; 32.65±5.56) scores than the nonhematoma cohort (2.99±0.50 and 30.02±4.84, respectively; p <0.05). No significant difference was found at the final follow-up VAS, ODI, and MRI dura sac area.

CONCLUSIONS: Epidural fluid hematoma is a common early postoperative MRI finding in lumbar endoscopic unilateral laminotomy with bilateral decompression. Conservative management is the preferred treatment option for patients who do not have a neurological deficit. Symptoms last only a few days and are self-limiting. A common endpoint is a remodeled fluid hematoma and the subsequent expansion of the dura sac area.

PMID:35785910 | DOI:10.31616/asj.2021.0366

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Nevin Manimala Statistics

Occupational hazard analysis of workers exposed to chromate in a steel plant

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022 Jun 20;40(6):450-453. doi: 10.3760/cma.j.cn121094-20210224-00104.

ABSTRACT

Objective: To investigate the occupational damage to workers exposed to chromate in a steel plant. Methods: In January 2021, a retrospective analysis was used to select 850 workers exposed to chromate (observation group) and 598 workers not exposed to chromate (control group) in a steel plant in Shandong Province from 2016 to 2017 as the investigation. We collected their occupational-related information, blood routine, fasting blood sugar, nasal lesions, skin lesions, chest X-rays and other inspection results, compared the differences in the abnormal detection rate of the two groups of respondents, and analyzed the occupational hazards of chromium workers. Results: Incidence of nasal damage, skin lesion, up-regulation of ALT (Alanine aminotransferase), abnormal chest radiograph, abnormal serum biochemical index, and abnormal serum glucose level were observed higher in the exposed group than those in the control group (χ(2)=125.69, 12.25, 5.82, 10.37, 10.46, 20.66, P=0.000, 0.000, 0.016, 0.001, 0.001, 0.000). Among the symptoms, the incidence of erythra, nasal septum deviation, nasal mucosal congestion, nasal mucosal erosion and rhinitis were more frequent than those in the control group (χ(2)=101.54, 4.07, 13.20, 32.05, P=0.000, 0.044, 0.000, 0.000). There was no significant increase in the incidence of work type, age, length of work and the area of nasal mucosa erosion in the observation group compared with the control table, and the difference was not statistically significant (χ(2)=5.31、0.42、0.28, P=0.505, 0.662, 0.871) . Conclusion: Occupational hazards of long-term exposure to chromate cannot be ignored. Attention should be paid to strengthening occupational protection and health education of workers exposed to chromium, and increasing their attention.

PMID:35785902 | DOI:10.3760/cma.j.cn121094-20210224-00104

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Nevin Manimala Statistics

Investigation of the occurrence of musculoskeletal disorders at shoulder, neck and elbow of digestive endoscopy operators

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022 Jun 20;40(6):430-434. doi: 10.3760/cma.j.cn121094-20210119-00037.

ABSTRACT

Objective: To investigate the effect of endoscopic operation volume on musculoskeletal disorders (MSDs) of shoulder, neck and elbow. Methods: From December 2019 to March 2020, random sampling was used to select 200 gastroenterologists from hospitals at or above the municipal level in Sichuan Province as the research object. Gastroenterologists were divided into 108 eadoscop in the low operation group (The operation volume is less than 5 000 cases) and 92 eadoscop in the high operation group (The operation volume is more than 5 000 cases) according to the operation volume. MSDS was investigated by UCLA shoulder scoring system, Tanaka Jingjiu cervical spondylosis scale and improved An and Morrey elbow scoring system, and the chi-square test was used to compare the basic conditions of different body parts in the two groups. The basic condition of each part of the two groups was tested and compared. Results: Compared with the low operation group, the age and working years of the high operation group were longer, and the difference was statistically significant (P<0.001). The most painful part between the two groups was the shoulder, accounting for 25.9% (28/108) and 37.0% (34/92), respectively. Occasional shoulder pain was the most (41.9%, 26/62) and normal function was the most (32.3%, 20/62) ; The forward flexion angle exceeds 150° at most (40.3%, 25/62). Slight pain often occurred in the neck, accounting for 57.7% (15/26), the occasional impact of pain on the upper limbs accounted for 61.5% (16/26), and the impact on the fingers accounted for 53.8% (14/26) ; 65.0% (15/26) had mild disturbance to the sense of signs; Normal tendon reflex accounted for 88.5% (23/26) ; The influence of opponents was weakness, discomfort and no dysfunction, accounting for 53.8% (14/26) ; Endoscopists with normal muscle strength (2 points) and mild decline accounted for 50.0% (13/26) respectively, and there was no significant difference among the groups (P=0.234、1.000、1.000、0.050、0.680、0.539、0.431、0.239). The elbow score scale showed that mild loss accounted for 55.0% (11/20), mild instability accounted for 65% (13/20), and mild pain accounted for 55.0% (11/20) . Conclusion: MSDs is a health problem faced by endoscopists, and targeted preventive measures should be taken for its possible causes.

PMID:35785896 | DOI:10.3760/cma.j.cn121094-20210119-00037

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Health hazards and hearing loss risk assessment of workers exposed to noise in an automobile manufacturing enterprise

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022 Jun 20;40(6):434-438. doi: 10.3760/cma.j.cn121094-20210615-00286.

ABSTRACT

Objective: To investigate the current situation of occupational exposure to noise among noise workers in an automobile manufacturing enterprise in Tianjin, understand the impact of noise on workers' nervous system and hearing, and assess the risk of hearing loss among noise workers. Methods: In May 2021, 3516 workers in an automobile manufacturing enterprise were investigated by using a self-made questionnaire"Noise Workers Questionnaire" and cluster sampling method. The occupational noise hygiene survey and occupational hazards detection were carried out in their workplaces. They were divided into noise exposure group and non-noise exposure group according to whether they were exposed to noise or not. The general characteristics, hearing and nervous system symptoms of the two groups of workers were compared, and the risk of hearing loss was assessed. Results: There were 758 workers in the noise exposure group, aged (26±5) years old, with a working age of 3.0 (2.0, 6.0) years exposed to noise. 2758 workers in the non-noise exposure group, aged (25±6) years old, with a working age of 2.0 (1.0, 4.0) years. There were statistically significant differences in the distribution of workers'education level, working age and memory loss between the two groups (χ(2)=37.98, 38.70, 5.20, P<0.05). The workers in the noise exposure group showed a decreasing trend of insomnia, dreaminess, sweating and fatigue with the increase of working age (χ(2trend)=6.16, 7.99, P<0.05). The risk classification of binaural high-frequency hearing loss for workers in all noise positions until the age of 50 and 60 was negligible, the risk of occupational noise deafness was low for workers in stamping and welding noise positions until the age of 60. Conclusion: The occupational noise exposed to automobile manufacturing workers may cause certain harm to their nervous and auditory systems. Noise protection measures should be taken to reduce the risk of hearing loss and occupational noise deafness.

PMID:35785897 | DOI:10.3760/cma.j.cn121094-20210615-00286