Tag: pubmed

BMJ Evid Based Med. 2021 Oct 11:bmjebm-2020-111634. doi: 10.1136/bmjebm-2020-111634. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess cost-effectiveness of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF) by pooling incremental net benefits (INBs).

DESIGN: Systematic review and meta-analysis.

SETTING: We searched PubMed, Scopus and Centre for Evaluation of Value and Risks in Health Registry from inception to December 2019.

PARTICIPANTS: Patients with AF.

MAIN OUTCOME MEASURES: The INB was defined as a difference of incremental effectiveness multiplied by willing to pay threshold minus the incremental cost; a positive INB indicated favour treatment. These INBs were pooled (stratified by level of country income, perspective, time-horizon, model types) with a random-effects model if heterogeneity existed, otherwise a fixed effects model was applied. Heterogeneity was assessed using Q test and I² statistic. Risk of bias was assessed using the economic evaluations bias (ECOBIAS) checklist.

RESULTS: A total of 100 eligible economic evaluation studies (224 comparisons) were included. For high-income countries (HICs) from a third-party payer (TPP) perspective, the pooled INBs for DOAC versus VKA pairs were significantly cost-effective with INBs (95% CI) of $6632 ($2961.67 to $10 303.72; I²=59.9%), $6353.24 ($4076.03 to $8630.45; I²=0%), $7664.58 ($2979.79 to $12 349.37; I²=0%) and $8573.07 ($1877.05 to $15 269.09; I²=0%) for dabigatran, apixaban, rivaroxaban and edoxaban relative to VKA, respectively but only dabigatran was significantly cost-effective from societal perspective (SP) with an INB of $11 746.96 ($2429.34 to $21 064.59; I²=52.4%). The pooled INBs of all comparisons for upper-middle income countries (UMICs) were not significantly cost-effective. The ECOBIAS checklist indicated that risk of bias was mostly low for most items with the exception of five items which should be less influenced on pooling INBs.

CONCLUSIONS: Our meta-analysis provides comprehensive economic evidence that allows policy makers to generalise cost-effectiveness data to their local context. All DOACs may be cost-effective compared with VKA in HICs with TPP perspective. The pooling results produced moderate to high heterogeneity particularly in UMICs. Further studies are required to inform UMICs with SP.

PROSPERO REGISTERATION NUMBER: CRD 42019146610.

PMID:34635480 | DOI:10.1136/bmjebm-2020-111634

An Pediatr (Engl Ed). 2021 Oct 9:S2341-2879(21)00161-7. doi: 10.1016/j.anpede.2020.08.013. Online ahead of print.

ABSTRACT

INTRODUCTION: Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management.

OBJECTIVES: To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit.

METHODS: Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed.

RESULTS: 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)).

CONCLUSIONS: There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes.

PMID:34635463 | DOI:10.1016/j.anpede.2020.08.013

Stat Med. 2021 Oct 11. doi: 10.1002/sim.9218. Online ahead of print.

ABSTRACT

This article discusses regression analysis of clustered interval-censored failure time data in the presence of a cured fraction or subgroup. Such data often occur in many areas, including epidemiological studies, medical studies, and social sciences. For the problem, a class of semiparametric transformation nonmixture cure models is presented and for estimation, the maximum likelihood estimation procedure is derived. For the implementation of the proposed method, we develop a novel EM algorithm based on a Poisson variable-based augmentation. An extensive simulation study is conducted and suggests that the proposed approach works well in practical situations. Finally the method is applied to an example that motivated this study.

PMID:34634837 | DOI:10.1002/sim.9218

PLoS One. 2021 Oct 11;16(10):e0257682. doi: 10.1371/journal.pone.0257682. eCollection 2021.

ABSTRACT

In this paper, we present autopsych, a novel online tool that allows school assessment experts, test developers, and researchers to perform routine psychometric analyses and equating of student test data and to examine the effect of student demographic and group conditions on student test performance. The app extends current open-source software by providing (1) extensive embedded result narration and summaries for written reports, (2) improved handling of partial credit data via customizable item-person Wright maps, (3) customizable item- and person-flagging systems, (4) item-response theory model constraints and controls, (5) many-facets Rasch analysis to examine item bias, (6) Rasch fixed item equating for mapping student ability across test forms, (7) tabbed spreadsheet outputs and immediate options for secondary data analysis, (8) customizable graphical color schemes, (9) extended ANOVA analysis for examining group differences, and (10) inter-rater reliability analyses for the verifying the consistency of rater scoring systems. We present the app’s architecture and functionalities and test its performance with simulated and real-world small-, medium-, and large-scale assessment data. Implications and planned future developments are also discussed.

PMID:34634792 | DOI:10.1371/journal.pone.0257682

Neurosurgery. 2021 Oct 11:nyab360. doi: 10.1093/neuros/nyab360. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have assessed the impact of overlapping surgery during different timepoints of neurosurgical procedures.

OBJECTIVE: To evaluate the impact of overlap before the critical portion of surgery on short-term patient outcomes following lumbar fusion.

METHODS: In total, 3799 consecutive patients who underwent single-level, posterior-only lumbar fusion over 6 yr (2013-2019) at an academic hospital system were retrospectively studied. Outcomes included 30-d emergency department (ED) visit, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. Duration of overlap that occurred before the critical portion of surgery was calculated as a percentage of total beginning operative time. Univariate logistic regression was used to assess the impact of incremental 1% increases in the duration of overlap within the whole population and patients with beginning overlap. Subsequently, univariate analysis was used to compare exact matched patients with the least (bottom 40%) and most amounts of overlap (100% beginning overlap). Coarsened exact matching was used to match patients on key demographic factors, as well as attending surgeon. Significance was set at a P-value < .05.

RESULTS: Increased duration of beginning overlap was associated with a decrease in 30-d ED visit (P = .03) within all patients with beginning overlap, but not within the whole population undergoing lumbar fusion. Duration of beginning overlap was not associated with any other short-term morbidity or mortality outcome in either the whole population or patients with beginning overlap.

CONCLUSION: Increased duration of overlap before the critical step of surgery does not predict adverse short-term outcomes after single-level, posterior-only lumbar fusion.

PMID:34634816 | DOI:10.1093/neuros/nyab360

Ecotoxicol Environ Saf. 2021 Oct 8;226:112881. doi: 10.1016/j.ecoenv.2021.112881. Online ahead of print.

ABSTRACT

Geological disasters seriously threaten the safety of human life, property, ecological resources, and the environment. Effective control of geological disasters is the focus of achieving sustainable social development. The Helong City (Jilin Province, China) was selected as the case study. Combined with GIS technology, a new integrated prediction model of geological disaster susceptibility was developed to improve the accuracy of geological disaster assessment, reduce the cost of geological disaster treatment, and ensure the sustainable development of ecological environment. The research results showed that elevation and normalized difference vegetation index (NDVI) were the key factors affecting susceptibility. Compared with the conventional model, the accuracy of the developing integrated model FR-DT and FR-RF was improved by more than 6%, and the disaster points were more concentrated in the high susceptibility zone. Statistical results of disaster treatment cost estimation and gross domestic product (GDP) value showed that the integrated model can save about 10% of treatment cost, and the ratio of total GDP/disaster governance cost was higher. The performance of the integrated model FR-DT and FR-RF had obvious advantages over the conventional model in terms of prediction accuracy, prevention pertinence, and prevention cost. These research results promote the advancement of geological disaster prevention and control technology, ensure the safety of the geological environment, and are of great significance to the sustainable development of the regional economy.

PMID:34634737 | DOI:10.1016/j.ecoenv.2021.112881

Lung Cancer. 2021 Sep 30;162:1-8. doi: 10.1016/j.lungcan.2021.09.020. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients with lung cancer have high symptom burden and diminished quality of life. Electronic patient-reported outcome (PRO) platforms deliver repeated longitudinal surveys via web or telephone to patients and alert clinicians about concerning symptoms. This study aims to determine feasibility of electronic PRO monitoring in lung cancer patients receiving treatment in community settings.

METHODS: Adults receiving treatment for advanced or metastatic lung cancer at 26 community sites were invited to participate in a prospective trial of weekly electronic PRO symptom monitoring for 12 months (NCT03249090). Surveys assessing patients’ satisfaction with the electronic PRO system were administered at 3 months. Descriptive statistics were generated for demographics, survey completion rates, symptom occurrence, and provider PRO alert management approaches. Pairwise relationships between symptom items were evaluated using intra-individual repeated-measures correlation coefficients.

RESULTS: Lung cancer patients (n = 118) participating in electronic PROs were older (mean 64.4 vs 61.9 years, p = 0.03), had worse performance status (p = 0.002), more comorbidities (p = 0.02), and less technology experience than patients with other cancers. Of delivered weekly PRO surveys over 12 months, 91% were completed. Nearly all (97%) patients reported concerning (i.e., severe or worsening) symptoms during participation, with 33% of surveys including concerning symptoms. Pain was the most frequent and longest lasting symptom and was associated with reduced activity level. More than half of alerts to clinicians for concerning symptoms led to intervention. The majority (87%) would recommend using electronic PRO monitoring to other lung cancer patients.

CONCLUSIONS: Remote longitudinal weekly monitoring of patients with lung cancer using validated electronic PRO surveys was feasible in a multicenter, community-based pragmatic study. A high symptom burden specific to lung cancer was detected and clinician outreach in response to alerts was frequent, suggesting electronic PROs may be a beneficial strategy for identifying actionable symptoms and allow opportunities to optimize well-being in this population.

PMID:34634754 | DOI:10.1016/j.lungcan.2021.09.020

Diagn Microbiol Infect Dis. 2021 Sep 4;101(4):115535. doi: 10.1016/j.diagmicrobio.2021.115535. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate a pharmacist-facilitated evidence-based bundle (EBB) initiative with infectious disease consultation (IDC) for Staphylococcus aureus bacteremia (SAB).

METHODS: This was a before-and-after quasi-experimental study of adult patients with SAB before and after the pharmacist-facilitated EBB initiative, which included IDC, timely definitive antibiotics, source control, echocardiography, and repeat blood cultures.

RESULTS: Ninety and 111 patients were included in pre- and post-intervention cohorts, respectively. We observed significant increases in adherence to all 5 (4.4% vs 68.5%, P < 0.001) and 4 (10.0% vs 76.6%, P < 0.001) EBB elements. Time to definitive antibiotics (48 vs 16 hours, P < 0.001), time to IDC (43.5 vs 32 hours, P < 0.001), SAB duration (95 vs 66 hours, P = 0.009), persistent SAB (18.9% vs 9.0%, P = 0.041), and length of stay (14 vs 13 days, P = 0.027) also improved. No statistically significant differences for SAB-related readmission or all-cause mortality were observed.

CONCLUSIONS: Our pharmacist-facilitated SAB initiative was associated with improved EBB adherence and clinical outcomes.

PMID:34634714 | DOI:10.1016/j.diagmicrobio.2021.115535

J Environ Manage. 2021 Oct 8;301:113893. doi: 10.1016/j.jenvman.2021.113893. Online ahead of print.

ABSTRACT

Amongst different climatic and anthropogenic drivers, water resources management can cause massive changes to the natural regime of a lake after its regulation, thereby affecting the quantity and quality of water intended for satisfying the multiple basin water requirements. Here, we investigate the multi-decadal variation of the water levels and outflows of Lake Garda, the largest in Italy, where the dam operational rules and the related basin water needs heavily altered the annual and seasonal trend of the lake regime since its regulation in 1951. Daily lake levels and outflows were first collected and digitized for the period 1888-2020, thus providing a unique database of 133 years that allowed a consistent comparison between natural and regulated periods. Statistical analyses highlighted a significant change of the inter-annual trend of the lake outflows, which passed from upward to downward after regulation, against a constant increasing trend of the water levels. Conversely, water levels showed a more remarkable shifts on a seasonal scale if compared to the outflows, revealing the influence of summer and winter basin water needs. Additional analyses on the inter-annual variation of the main downstream water demands regulated by the dam, i.e. the irrigation, hydropower and fluvial ecosystem requirements, outlined their relevance in changing the lake regime, influencing dam operational policies, which progressively limited the share of water released for ecosystem integrity. A comparison between the lake levels and outflows recorded for the pre-regulation and post-regulation periods of some selected European perialpine lakes finally highlighted different effects on the lake regime, drawing attention to the importance of defining the role of the dam operational policies within the current scenario of climate change and changing water demands.

PMID:34634725 | DOI:10.1016/j.jenvman.2021.113893

Forensic Sci Int. 2021 Oct 5;328:111035. doi: 10.1016/j.forsciint.2021.111035. Online ahead of print.

ABSTRACT

Forensic soil examination has a well-established foundation in forensic science, this is in part due to the widely varied and complex nature of soil. Within this domain, mineral suite studies are a commonly utilized tool in soil examination. However, statistical or probabilistic approaches towards the interpretation of results from such analysis are lacking and this study aims to fill that gap. Soil samples from four different locations in the city of Lausanne, Switzerland were sampled and their mineral fractions, light and heavy of size between 90 and 180 µm, were studied utilizing microscopical methods. First, the light minerals were identified and counted by employing scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM-EDS). Second, the heavy minerals were identified and counted manually under a polarized light microscope (PLM). The resulting count data were subjected to various multivariate statistical treatments such as principal components analysis (PCA), hierarchical clustering analysis (HCA), and linear discriminant analysis (LDA). These methods assist in identifying pertinent variables and subsequently in building various classification models. The validities of these models were then tested and evaluated using blind tests. Finally, these methods demonstrate how a probabilistic approach can be taken in the interpretation of the results to answer source level questions.

PMID:34634691 | DOI:10.1016/j.forsciint.2021.111035