Tag: statistics

J Appl Clin Med Phys. 2024 Jul 20:e14479. doi: 10.1002/acm2.14479. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to introduce modified fixed field volumetric modulated arc therapy (MF-VMAT) which manually opened the field size by fixing the jaws and comparing it to the typical planning technique, auto field volumetric modulated arc therapy (AF-VMAT) in cervical cancer treatment planning.

METHODS AND MATERIALS: Previously treated twenty-eight cervical cancer plans were retrospectively randomly selected and replanned in this study using two different planning techniques: AF-VMAT and MF-VMAT, resulting in a total of fifty-six treatment plans. In this study, we compared both planning techniques in three parts: (1) Organ at Risk (OARs) and whole-body dose, (2) Treatment plan efficiency, and (3) Treatment plan accuracy.

RESULTS: For OARs dose, bowel bag (p-value = 0.001), rectum (p-value = 0.002), and left femoral head (p-value = 0.001) and whole-body (p-value = 0.000) received a statistically significant dose reduction when using the MF-VMAT plan. Regarding plan efficiency, MF-VMAT exhibited a statistically significant increase in both number of monitor units (MUs) and control points (p-values = 0.000), while beam-on time, maximum leaf travel, average maximum leaf travel, and maximum leaf travel per gantry rotation were statistically significant decreased (p-values = 0.000). In terms of plan accuracy, the average gamma passing rate was higher in the MF-VMAT plan for both absolute dose (AD) (p-value = 0.001, 0.004) and relative dose (RD) (p-value = 0.000, 0.000) for 3%/3 and 3%/2 mm gamma criteria, respectively.

CONCLUSION: The MF-VMAT planning technique significantly reduces OAR doses and decreases the spread of low doses to normal tissues in cervical cancer patients. Additionally, this planning approach demonstrates efficient plans with lower beam-on time and reduced maximum leaf travel. Furthermore, it indicates higher plan accuracy through an increase in the average gamma passing rate compared to the AF-VMAT plan. Consequently, MF-VMAT offers an effective treatment planning technique for cervical cancer patients.

PMID:39032169 | DOI:10.1002/acm2.14479

Am J Biol Anthropol. 2024 Jul 20:e24998. doi: 10.1002/ajpa.24998. Online ahead of print.

ABSTRACT

OBJECTIVES: Grotta-Riparo di Uluzzo C (Apulia, southern Italy) is a pivotal site for investigating the evolution of the Middle Paleolithic and the earliest phases of the Upper Paleolithic in southern Italy, as the extensive stratigraphic record of this site includes a thick Mousterian sequence followed by the Uluzzian. Here, we investigate the taxonomic affinity of seven unpublished deciduous human teeth retrieved from the site of Uluzzo C in 1960.

MATERIALS AND METHODS: The teeth are represented by seven plaster dental casts, which are housed at the Museo Civico di Paleontologia e Paletnologia in Maglie (Lecce, Apulia). The location of the original specimens remains unknown, rendering these casts the only human remains evidence yielded by Uluzzo C to date. Based on occlusal-view photographs and digital models of the casts, we examined the external morphology and morphometry of the teeth, comparing them to Homo sapiens and H. neanderthalensis samples. Through geometric morphometric methods and statistical analyses, we analyzed the crown outline of the deciduous molars.

RESULTS: The teeth show morphological and morphometric features that are variably found in H. neanderthalensis, H. sapiens, or both. Specifically, crown outline analysis shows that all molars fall within H. neanderthalensis variability, except for Uluzzo 853 (lower right deciduous first molar), which falls within H. sapiens variability.

DISCUSSION: This study provides the first taxonomic assessment of the hominin teeth from Uluzzo C. The results contribute additional insights into the Paleolithic peopling of southern Italy during a crucial period marked by the persistence of post-Tyrrhenian Neanderthal techno-complexes and the arrival of H. sapiens.

PMID:39032165 | DOI:10.1002/ajpa.24998

J Spec Pediatr Nurs. 2024 Jul;29(3):e12435. doi: 10.1111/jspn.12435.

ABSTRACT

PURPOSE: This study aimed to examine determinants of undernutrition among children under 2 years of age.

DESIGN AND METHODS: A matched case-control study design was conducted to recruit 300 mothers comprising 100 mothers with an undernourished child (case group) and 200 mothers with a healthy child (control group). Measurements consisted of demographic characteristics of children data, mother’s data, household data, mother’s knowledge of child undernutrition, mother’s knowledge of nutrition, complementary feeding practices, and undernutrition parameters of the children. A conditional logistic regression was used to identify determinants of undernutrition. The risk of undernutrition was estimated by odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was defined as any p value of <.05.

RESULTS: Findings showed that mother’s knowledge of undernutrition (AOR: 0.95; 95% CI: 0.91-0.98), mother’s knowledge of nutrition (AOR: 0.90; 95% CI: 0.85-0.96), and mother’s knowledge (AOR: 0.78; 95% CI: 0.67-0.91) and behavior of complementary feeding practices (AOR: 0.97; 95% CI: 0.94-0.99) were significant determinants of undernutrition (p < .05).

PRACTICE IMPLICATIONS: Mothers with high scores on knowledge of undernutrition, knowledge of nutrition, and knowledge and behaviors of complementary feeding practices would benefit the children under 2 years to reduce the risk of undernutrition. Healthcare professionals (i.e., pediatric nurses and community health nurses) should provide early assessment of knowledge related to undernutrition, nutrition, and complementary feeding practices for mothers with children under 2 years.

PMID:39032153 | DOI:10.1111/jspn.12435

Nurs Open. 2024 Jul;11(7):e2241. doi: 10.1002/nop2.2241.

ABSTRACT

AIMS: To explore Registered Nurses’ motives to undergo specialist training and to choose a particular speciality.

DESIGN: A descriptive qualitative interview study.

METHODS: Semi-structured interviews were conducted during 2021 with 20 Swedish specialist nurse students from different specialisation areas. Qualitative content analysis was used. The COREQ checklist was used to report the study.

RESULTS: Specialist nurse students’ motivations for further training were divided into three main categories with two sub-categories each. The main categories were ‘toward new challenges and conditions in work life’, ‘contributions to the development and higher competencies in health care’ and ‘personal work and life experiences as ground for choice’.

CONCLUSION: Our study demonstrates the importance of motivating factors in the career choices of Specialist nurse students, such as personal challenges, desirable working conditions, career growth opportunities and personal experiences in the career choices. Creating a supportive work environment that helps to prioritise work-life balance and offers the development of new skills might help retain nurses.

NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was used. However, if more nurses would choose to undergo specialist training, especially in areas facing significant shortages, it would most likely lead to improved health-related outcomes for patients or populations.

PMID:39032132 | DOI:10.1002/nop2.2241

Nurs Crit Care. 2024 Jul 20. doi: 10.1111/nicc.13131. Online ahead of print.

ABSTRACT

BACKGROUND: With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing-related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs).

AIM: To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs.

STUDY DESIGN: The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an “ST chart” to record patient demographic characteristics, clinical variables and skin assessment.

RESULTS: STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals’ average body mass index (BMI) (p = .043), age (p = .014), length of stay in the ICU (p = .004) and having ST. There was also a statistically significant relationship between skin temperature (p = .002), skin turgor (p = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness (p = .014), incontinence (p = .006), the Braden score (p = .004), the Itaki fall risk score (p = .006) and ST.

CONCLUSIONS: In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified.

RELEVANCE TO CLINICAL PRACTICE: Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.

PMID:39032130 | DOI:10.1111/nicc.13131

Transfus Med. 2024 Jul 20. doi: 10.1111/tme.13070. Online ahead of print.

ABSTRACT

BACKGROUND: Bleeding is a primary outcome for many transfusion-related trials in acute leukaemia (AL) patients, typically graded using the World Health Organisation (WHO) bleeding scale (clinically significant bleed (CSB) is ≥grade 2). This composite outcome fails to differentiate minor bleeds that may not be significant, poorly represents the total burden of bleeding and lacks input from healthcare providers (HCPs) and patients. As part of a multi-step project to create a better bleeding tool for trials, our objective was to identify HCPs’ perspectives on the components of CSB in AL patients.

STUDY DESIGN AND METHODS: Using qualitative description, we interviewed 19 physicians and nurses who care for AL patients undergoing induction chemotherapy. Participants were recruited from professional organisations, networks and social media. An inductive approach to conventional content analysis was used.

RESULTS: HCPs identified features of CSB as the anatomical site of bleeding, amount of bleeding, need for intervention and changes in vital signs. Using these characteristics, bleeding events were categorised into three groups: clinically significant, could evolve into a CSB and not clinically significant. HCPs considered the patient’s condition, bleeding history and clinical intuitions when deciding whether a bleed could escalate into serious bleeding.

DISCUSSION: Using data from HCPs, we categorised bleeds as clinically significant, could evolve into a CSB, and not significant. A study of patients’ perspectives on the importance of different kinds of bleeding is the next step to creating a bleeding definition that is informed by evidence, clinicians and patients.

PMID:39032121 | DOI:10.1111/tme.13070

Head Neck. 2024 Jul 20. doi: 10.1002/hed.27884. Online ahead of print.

ABSTRACT

PURPOSE: To determine whether objective measures of oral health and salivary gland irradiation correlates with subjective measures of eating, drinking, and salivation in patients following head and neck radiation therapy (HNRT).

METHODS: This cross-sectional study included 112 patients following HNRT with a completed patient-reported outcome (PRO) scale. Objective measures at post-HNRT visit included decayed-missing-filled teeth (DMFT) scores, periodontal disease condition, oral hygiene status, dental prosthesis use, and prescribed radiation dose to salivary glands. Data were collected and statistical analysis was performed.

RESULTS: There was no significant association between PRO scales and dental prosthesis use, periodontal disease, and oral hygiene. Although some significant findings were seen with DMFT and prescribed radiation dose to salivary glands, this explained only very small amounts of the variation in eating, drinking, and salivation measures in these patients.

CONCLUSION: PRO measures should be integrated in the routine care of patients with head and neck cancer.

PMID:39032116 | DOI:10.1002/hed.27884

Am J Hum Biol. 2024 Jul 20:e24136. doi: 10.1002/ajhb.24136. Online ahead of print.

ABSTRACT

Changes in the immune status and the content of blood transport components reflect adaptations in the human body in response to adverse factors, showcasing the organism’s adaptive capabilities and functional state. In this study, we aimed to determine the features of the immune system and levels of transport components of the blood system in residents of the Arctic of the Russian Federation.

METHODS: The peripheral venous blood of 191 residents of the Arctic of the Russian Federation (Murmansk Oblast) aged 21-55 analyzed comprehensively. Blood was sampled from the ulnar vein on an empty stomach in the morning. The hemogram, phagocytic activity of neutrophils, lymphocyte content with CD3, CD4, CD8, CD10, CD19, CD16, CD71, CD25, HLA-DR and CD95 phenotypes, concentrations of cytokines: TNF-α, IFN-γ, IL-6, IL-10, extracellular receptor pool: sCD71, sCD62L, sApo-1/Fas, sFasL, circulating immune complexes (CIC) and blood transport components: haptoglobin (Hp), transferrin, IgM, IgG, IgA, IgE (immunoglobulins M, G, A and E) low-density lipoproteins (LDL), and high density lipoprotein (HDL) were evaluated. The results were analyzed using descriptive statistics and comparative, factorial, and regression analyses.

RESULTS: Residents of the Murmansk Oblast exhibit a high prevalence of erythrocytosis (62.3%), thrombocytosis (25.0%), leukocytosis (20.1%), and increased hemoglobin (Hb) concentrations (42.5%), coupled with a significantly decreased level of active phagocytes (47.6%). A significantly decreased level of lymphocytes with phenotypes CD3 (92.4%), CD4 (40.4%), CD71 (62.3%) was revealed, coupled with the activation of lymphocytes with phenotypes CD16 (50.1%), CD8 (37.5%), CD19 (15.9%) and increased concentrations of pro-inflammatory IFN-γ (47.9%), IL-6 (33.3%), and TNF-α (20.1%). Elevated levels of sCD71 (56.6%), sCD62L (32.1%), sApo-1/Fas (22.1%), sFasL (10.2%), and autoantibodies to double-stranded DNA (57.1%), RNA (10.4%), and oLDL (oxidized-modified LDL) (16.3%) were recorded in residents of the Murmansk Oblast. Arctic residents showed elevated concentrations of Hp (63.3%), IgM (63.9%), IgA (42.4%), IgE (18.8%), LDL (24.9%), and a decreased level of HDL (21.1%) owing to an ApoA-I ligand deficiency (58.1%). Elevated levels of Hp in the blood are associated with increased erythrocyte aggregation frequency, T-lymphocyte activation, and increased concentration of free receptors of the extracellular pool. Increased IgM and IgA levels in the blood are attributed to the need to bind components of the extracellular receptor pool sCD71, sCD62L, sApo-1/Fas, sFasL and are associated with decreased levels lymphocyte with CD8 and CD16 phenotypes. The humoral immune response in Arctic residents is triggered when the cellular component of immunity is under strain which compounded by ineffective clearance of metabolic byproducts owing to imbalanced LDL and HDL lipid transport complexes.

CONCLUSIONS: The immune system of Arctic residents is characterized by excessive cytotoxic activity of lymphocytes and increased concentrations of pro-inflammatory cytokines, free forms of receptors of the extracellular pool, and autoantibodies. The change in the content of transport components of the blood system is directed at maintaining homeostasis by exhibiting antioxidant, anti-inflammatory, and immunoregulatory properties.

PMID:39032081 | DOI:10.1002/ajhb.24136

Clin Oral Implants Res. 2024 Jul 20. doi: 10.1111/clr.14318. Online ahead of print.

ABSTRACT

PURPOSE: To histometrically compare the osseointegration and crestal bone healing of a novel tapered, self-cutting tissue-level test implant with a standard tissue-level control implant in a submerged healing regimen.

MATERIALS AND METHODS: In a mandibular minipig model, implants were inserted and evaluated histometrically after a healing period of 3, 6, and 12 weeks. The primary outcome was the evaluation of bone-to-implant contact (BIC) and secondary outcomes were primary stability as per insertion torque and first BIC (fBIC). Outcomes for the test and control implants were compared using Wilcoxon signed-rank tests and mixed linear regression models.

RESULTS: Insertion torque values were significantly higher for the test (50.0 ± 26.4 Ncm) compared to the control implants (35.2 ± 19.7 Ncm, p = .0071). BIC values of test implants were non-inferior to those of control implants over the investigated study period. After 12 weeks, the corresponding values measured were 81.62 ± 11.12% and 90.41 ± 4.81% (p = .1763) for test and control implants, respectively. Similarly, no statistical difference was found for fBIC values, except for the 12 weeks outcome that showed statistically lower values for the test (-675.58 ± 590.88 μm) compared to control implants (-182.75 ± 197.40 μm, p = .0068).

CONCLUSIONS: Novel self-cutting tissue-level implants demonstrated noninferior osseointegration and crestal bone height maintenance to the tissue-level implants. Histometric outcomes between both implants demonstrated test implants were statistically noninferior to control implants, despite substantial differences in the bone engagement mechanism and resulting differences in insertion torque and qualitative bone healing patterns.

PMID:39032079 | DOI:10.1111/clr.14318

Cancer. 2024 Aug 1;130(15):2568. doi: 10.1002/cncr.35444.

NO ABSTRACT

PMID:39032060 | DOI:10.1002/cncr.35444