Tag: statistics

Pediatr Blood Cancer. 2021 May 22:e29127. doi: 10.1002/pbc.29127. Online ahead of print.

ABSTRACT

BACKGROUND: Modern therapeutic advances in high-risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high-risk neuroblastoma and whether SES-associated disparities have changed over time.

PROCEDURE: In this population-based cohort study, children <18 years diagnosed with high-risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Associations of county-level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual-level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near-significance (p ≤ .1) in univariate and bivariate modeling with treatment era.

RESULTS: Among 1217 children, 2-year OS improved from 53.0 ± 3.4% in 1991-1998 to 76.9 ± 2.9% in 2011-2015 (p < .001). In univariate analyses, children in high-poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17-2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05-1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time.

CONCLUSIONS: Survival disparities among children with high-risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.

PMID:34022098 | DOI:10.1002/pbc.29127

Drug Test Anal. 2021 May 22. doi: 10.1002/dta.3102. Online ahead of print.

ABSTRACT

The use of cannabidiol in electronic liquids (e-liquids) is becoming increasingly widespread and the current regulations enforced onto nicotine-containing e-liquids are not applicable to cannabidiol-based products. This has led to concerns about the quality of cannabidiol vapes. Articles investigating the reliability of product labelling were reviewed using systematic review criteria. Of 70 e-liquids, 77.1% of the e-liquids tested in the articles were found to have under- or over-estimated the cannabidiol quantities stated in the product labelling. Statistical analysis confirmed that there was a significant difference between the labelled and analysed cannabidiol concentrations (p < 0.05, Mann-Whitney U and Wilcoxon Signed Rank). Inaccuracies in received cannabidiol dosages could lead to an increased risk of adverse reactions or limit the therapeutic effect received, highlighting the benefit of enforcing specific regulations on cannabidiol-based e-liquids to protect consumer safety and guarantee product efficacy.

PMID:34022104 | DOI:10.1002/dta.3102

Pediatr Blood Cancer. 2021 May 22:e29121. doi: 10.1002/pbc.29121. Online ahead of print.

ABSTRACT

BACKGROUND: Naxitamab is a humanized anti-disialoganglioside (GD2) monoclonal antibody approved for treatment of bone/bone marrow refractory high-risk neuroblastoma (HR-NB). Compassionate use (CU) expanded access program at Hospital Sant Joan de Deu permitted treatment of patients in complete remission (CR). We here report the survival, toxicity, and relapse pattern of patients in first or second CR treated with naxitamab and sargramostim (GM-CSF).

PROCEDURE: Seventy-three consecutive patients with HR-NB (stage M at age >18 months or MYCN-amplified stages L1/L2 at any age) were treated in first or second CR. Treatment comprised five cycles of subcutaneous (SC) GM-CSF for 5 days at 250 μg/m² /day (days -4 to 0), followed by naxitamab + SC GM-CSF for 5 days at 500 μg/m² /day (days 1-5). Naxitamab was infused over 30 minutes at 3 mg/kg/day, days 1, 3, and 5, outpatient.

RESULTS: Fifty-five patients were in first CR and 18 in second CR. Seventeen patients had MYCN-amplified NB and 11 detectable minimal residual disease in the bone marrow. Fifty-eight (79.5%) patients completed therapy. Four (5%) experienced grade 4 toxicities and 10 (14%) early relapse. Three-year event-free survival (EFS) 58.4%, 95% CI = (43.5%, 78.4%) and overall survival (OS) 82.4%, 95% CI = (66.8%, 100%). First CR patients 3-year EFS 74.3%, 95% CI = (62.7%, 88.1%), and OS 91.6%, 95% CI = (82.4%, 100%). EFS is significantly different between first and second CR (p = .0029). The pattern of relapse is predominantly (75%) of an isolated organ, mainly bone (54%). Univariate Cox models show prior history of relapse as the only statistically significant predictor of EFS but not OS.

CONCLUSIONS: Consolidation with naxitamab and GM-CSF resulted in excellent survival rates for HR-NB patients in CR.

PMID:34022112 | DOI:10.1002/pbc.29121

J Nurs Manag. 2021 May 22. doi: 10.1111/jonm.13379. Online ahead of print.

ABSTRACT

AIM: To identify the factors affecting nurses’ turnover intention.

BACKGROUND: The shortage of nurses has been a great challenge worldwide and nurses’ turnover may exacerbate the situation.

METHODS: A cross-sectional study was conducted among nurses in six secondary hospitals in China. A model was constructed and structured questionnaires were adopted to measure model variables. Structural equation modeling was used to verify the model.

RESULTS: Totally, 594 valid questionnaires were collected. The final model showed an acceptable fit, 35.0% of the total variation was explained. Nine of the ten pathways were statistically significant. The model verified the contribution of professional value, nursing practice, job stress, and social support to turnover intention and their effects were mediated by job satisfaction and organizational commitment. As hypothesized, there existed a significant effect between job satisfaction and organizational commitment. Unexpectedly, job stress had a greater direct effect on turnover intention than job satisfaction and organizational commitment.

CONCLUSIONS: The structural model provided a feasible model that could explain nurses’ turnover intention in China.

IMPLICATIONS FOR NURSING MANAGEMENT: To prevent the turnover of nurses, administrators and managers should advisably prioritize the effect of job stress, especially in hospitals with similar medical context.

PMID:34022081 | DOI:10.1111/jonm.13379

Clin Exp Dermatol. 2021 May 22. doi: 10.1111/ced.14753. Online ahead of print.

ABSTRACT

BACKGROUND: Linear lesions are fairly common in our day to day practice. However, the appearances can be deceptive which puts dermatologists in a diagnostic dilemma.

AIMS: To study the various clinical presentations, demographic profile of patients and clinico-pathological correlations of dermatoses presenting with a linear distribution.

METHODS: We conducted an institution based cross-sectional, descriptive study on 281 consecutive patients with linear lesions, attending the Dermatology clinic. MedCalc version 11.6 software was used for statistical analysis.

RESULTS: Patients were divided into eight groups : lesions along Blaschko’s lines(n=136), along blood vessels(n=3), along lymphatics(n=3), koebner’s phenomenon(n=24), autoinoculation(n=24), external factors(n=45), infestations(n=2) and others(n=44). Mean age at presentation was 24.50±18.82 years. Male:female ratio was 1.32:1. Commonest complaints were itching/burning in 56.94% patients. Commonest site was upper limb (44.48%); followed by lower limb(30.60%), trunk and abdomen(22.42%), head and neck(19.20%) and genitalia(0.35%). Apart from the common cases, we came across a wide gamut of rare conditions (angiokeratoma circumscriptum neviforme, porokeratotic eccrine ostial and dermal duct nevus, blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral nevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus etc.) CONCLUSION: Linear lesions act as diagnostic clues in many dermatological conditions. Therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

PMID:34022084 | DOI:10.1111/ced.14753

Int J Paediatr Dent. 2021 May 22. doi: 10.1111/ipd.12800. Online ahead of print.

ABSTRACT

BACKGROUND: Although single-file rotary systems are accepted in the field of paediatric dentistry in terms of providing time advantage, research works continue due to the variable anatomical structure of the root canal.

AIM: This study aimed to evaluate rotary systems in different kinematics in terms of microcracks and the shaping of the danger zone in primary molars by micro-CT.

DESIGN: The mesial canals of primary molars (n = 30) were used. Root canals in each group (n = 10) were prepared with single-file rotary systems (One Shape®, OS; XP-endo® Shaper, XP-ES; WaveOne Gold, WOG). The images were evaluated for dentin thickness in the danger zone and microcrack formation.

RESULTS: WOG caused the highest dentin reduction in the danger zone area. OS led to significantly less dentin reduction than XP-ES and WOG (P < .05). The XP-ES showed the highest number of microcracks (P < .05). No statistically significant difference was found between WOG and OS (P > .05). In all systems, more microcracks were observed in the middle third than coronal and apical.

CONCLUSION: Within the limitations of this study, the rotary systems were superior to reciprocating in terms of shaping ability in the danger zone. It is thought that further studies with different systems should be designed considering the anatomical variations and chemical composition of primary teeth.

PMID:34022087 | DOI:10.1111/ipd.12800

Rheumatology (Oxford). 2021 May 22:keab456. doi: 10.1093/rheumatology/keab456. Online ahead of print.

ABSTRACT

OBJECTIVES: Knee joint distraction (KJD) has shown long-term clinical improvement and short-term cartilage restoration in young osteoarthritis (OA) patients. The current objective was to evaluate MRI cartilage thickness up to ten years after KJD treatment, using a three-dimensional surface-based approach.

METHODS: Twenty end-stage knee OA patients were treated with KJD. 1.5 T MRI scans were performed before and at one, two, five, seven, and ten years after treatment. Tibia and femur cartilage segmentation and registration to a canonical surface were performed semi-automatically. Statistical parametric mapping (SPM) with linear mixed models was used to analyse whole-joint changes. The influence of baseline patient characteristics was analysed with SPM using linear regression. Relevant weight-bearing parts of the femur were selected to obtain the average cartilage thickness in the femur and tibia of the most (MAC) and least affected compartment (LAC). These compartmental changes over time were analysed using repeated measures ANOVA; missing data was imputed. In all cases, p< 0.05 was considered statistically significant.

RESULTS: One- and two-years post-treatment, cartilage in the MAC weight-bearing region was significantly thicker than pre-treatment, gradually thinning after five years, but still increased at ten years post-treatment. Long-term results showed areas in the LAC were significantly thicker than pre-treatment. Male sex and more severe OA at baseline somewhat predicted short-term benefit (p> 0.05). Compartmental analyses showed significant short- and long-term thickness increase in the tibia and femur MAC (all p< 0.05).

CONCLUSIONS: KJD results in significant short- and long-term cartilage regeneration, up to ten years post-treatment.

PMID:34022055 | DOI:10.1093/rheumatology/keab456

Pain Med. 2021 May 22:pnab176. doi: 10.1093/pm/pnab176. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the effectiveness and safety of epidural analgesia in the presurgical period on hip fracture patients undergoing surgical repair.

DESIGN: Systematic review.

METHODS: The study protocol was registered with the PROSPERO systematic reviews register: CRD42019140396. Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia to other forms of pain management in hip fracture patients. The primary outcomes included perioperative cardiac events and mortality. Pain, non-cardiac complications, and adverse effects were also examined as secondary outcomes. Heterogeneity of the included studies was assessed using the I2 statistic and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated.

RESULTS: Four studies met the inclusion criteria, which included a total of 221 patients. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (RR 0.30; 95% CI 0.14-0.63; I2 = 0%). Preoperative epidural analgesia was also associated with decreased perioperative mortality in a meta-analysis of two studies (RR 0.13; 95% CI 0.02-0.98; I2 = 0%). Pain was not pooled due to variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies.

CONCLUSIONS: Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and mortality, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for hip fractured patients.

PMID:34022058 | DOI:10.1093/pm/pnab176

Child Care Health Dev. 2021 May 22. doi: 10.1111/cch.12886. Online ahead of print.

ABSTRACT

BACKGROUND: Advancing physical therapy interventions for children and young people is a high research priority. This includes research to describe and specify the control condition, typically “current care”, for effectiveness trials. This paper aims to identify physical therapy outcomes commonly targeted, and intervention techniques and approaches commonly used, by physiotherapists working with children (aged 2-19 years) with mobility limitations in the United Kingdom.

METHODS: A cross-sectional survey. Participants were recruited through the interactive Chartered Society of Physiotherapy members-only online discussion forum, the Association of Paediatric Chartered Physiotherapists, direct emails and snowball sampling within the authors’ professional networks, and Twitter. Data were collected using a structured online questionnaire and analysed using descriptive statistics.

RESULTS: We received 146 responses, 95/146 (65.1%) of which were fully complete. Therapists reported targeting 367 unique outcome constructs of which 193 (52.6%) mapped onto activities and participation (e.g. moving around using equipment, maintaining body position, walking), 158 (43.1%) on body functions (e.g. muscle strength, joint mobility, gait functions), 11 (3.0%) on body structure (e.g. muscle length), and 3 (0.8%) on environmental factors (e.g. access home environment, access school environment, family confidence). The most commonly used interventions related to postural management (115/133 of respondents, 86.4%) and exercise therapy (116/137, 84.67%), and included techniques such as ‘use equipment’ (118/137, 86.1%), ‘instruct how to do something’ (117/137, 85.4%), ‘practice’ (105/137, 76.6%), and ‘stretch’ (99/137, 72.3%).

CONCLUSIONS: In designing trials, current care can be described as a combination of biomechanical and physiological techniques and approaches targeted at body functions and through that to activity and participation. While some environmental behaviour change techniques and strategies were reported, the explicit use of these in current care appears limited.

PMID:34022063 | DOI:10.1111/cch.12886

J Cosmet Dermatol. 2021 May 22. doi: 10.1111/jocd.14247. Online ahead of print.

ABSTRACT

BACKGROUND: The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA) based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique.

OBJECTIVES: To identify the safety and aesthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, increase jawline contouring when included into a full-face injection algorithm.

METHODS: The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4) kg/m² were retrospectively analyzed after a full-face injection algorithm was performed using HA based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region and the pyriform fossa using both needles and cannula.

RESULTS: No adverse events were observed during the 6-months retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p < 0.001.

CONCLUSION: Despite each in dividual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and aesthetically effective. Future studies will need confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective aesthetic outcomes.

PMID:34021958 | DOI:10.1111/jocd.14247