Tag: statistics

Cancer Med. 2023 Jun 14. doi: 10.1002/cam4.6231. Online ahead of print.

ABSTRACT

BACKGROUND: Choosing the optimal treatment approach for patients with painful bone metastases during the COVID-19 pandemic became challenging. A simple technique, single fraction radiotherapy was recommended for these patients usually referring to bone metastases as a single entity, although it is a very heterogeneous group of patients.

AIM: This study aimed to analyze the response to palliative single fraction radiotherapy in relation to age, performance status, primary tumor, histopathology, and bone localization in the group of patients with painful bone metastases.

METHODS: A clinical, prospective, non-randomized study was conducted at the Institute for Oncology and Radiology of Serbia, which included 64 patients with noncomplicated, painful bone metastases who underwent palliative, pain-relieving radiation therapy with a single tumor dose of 8Gy in a single hospital visit. Response to treatment was patient reported via telephone interview using visual analog scale. The response assessment was based on the international consensus panel of radiation oncologists.

RESULTS: In the entire group of patients, 83% responded to radiotherapy. No statistically significant difference was observed in response to therapy, time to reach the maximum response, degree of pain reduction, nor in response duration depending on the patient’s age, performance status, the primary origin of the tumor, histopathology, or location of the metastasis (bone) that was irradiated.

CONCLUSION: Regardless of clinical parameters, palliative radiotherapy with a single dose of 8Gy can be considered very effective in quick pain relief in patients with noncomplicated painful bone metastases. Single fraction radiotherapy in a single hospital visit, as well as patient-reported outcome for these patients may be considered favorable beyond Covid pandemics.

PMID:37317639 | DOI:10.1002/cam4.6231

Nurse Res. 2023 Jun 15. doi: 10.7748/nr.2023.e1885. Online ahead of print.

ABSTRACT

BACKGROUND: Quantitative methods and statistical analysis are essential tools in nursing research, as they support researchers testing phenomena, illustrate their findings clearly and accurately, and provide explanation or generalisation of the phenomenon being investigated. The most popular inferential statistics test is the one-way analysis of variance (ANOVA), as it is the test designated for comparing the means of a study’s target groups to identify if they are statistically different to the others. However, the nursing literature has identified that statistical tests are not being used correctly and findings are being reported incorrectly.

AIM: To present and explain the one-way ANOVA.

DISCUSSION: The article presents the purpose of inferential statistics and explains one-way ANOVA. It uses relevant examples to examine the steps needed to successfully apply the one-way ANOVA. The authors also provide recommendations for other statistical tests and measurements in parallel to one-way ANOVA.

CONCLUSION: Nurses need to develop their understanding and knowledge of statistical methods, to engage in research and evidence-based practice.

IMPLICATIONS FOR PRACTICE: This article enhances the understanding and application of one-way ANOVAs by nursing students, novice researchers, nurses and those engaged in academic studies. Nurses, nursing students and nurse researchers need to familiarise themselves with statistical terminology and develop their understanding of statistical concepts, to support evidence-based, quality, safe care.

PMID:37317616 | DOI:10.7748/nr.2023.e1885

Disaster Med Public Health Prep. 2023 Jun 15:1-39. doi: 10.1017/dmp.2023.101. Online ahead of print.

ABSTRACT

The rapid onset of COVID-19 created a complex virtual collective consciousness. Misinformation and polarization were hallmarks of the pandemic in the United States, highlighting the importance of studying public opinion online. Humans express their thoughts and feelings more openly than ever before on social media, co-occurrence of multiple data sources becomes valuable for monitoring and understanding public sentimental preparedness and response to an event within our society. In this study, Twitter and Google Trends data were used as the co-occurrence data for the understanding of the dynamics of sentiment and interest during the COVID-19 pandemic in the United States from January 2020 to September 2021. Developmental trajectory analysis of Twitter sentiment was conducted using corpus linguistic techniques and word cloud mapping to reveal eight positive and negative sentiments and emotions. Machine learning algorithms were employed to implement the opinion mining how Twitter sentiment was related to Google Trends interest with historical COVID-19 public health data. The sentiment analysis went beyond polarity to detect specific feelings and emotions during the pandemic. The discoveries on the behaviors of emotions at each stage of the pandemic were presented from the emotion detection when associated with the historical COVID-19 data and Google Trends data.

PMID:37317615 | DOI:10.1017/dmp.2023.101

J Clin Nurs. 2023 Jun 15. doi: 10.1111/jocn.16799. Online ahead of print.

ABSTRACT

AIMS: To explore the implementation of a dementia care pathway in an acute care setting.

BACKGROUND: Dementia care in acute settings is often constrained by contextual factors. We developed an evidence-based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care.

DESIGN: Process evaluation using quantitative and qualitative methods.

METHODS: Pre-implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence-based dementia care. Post-implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR).

REPORTING GUIDELINE: Standards for Reporting Qualitative Research Checklist.

RESULTS: Pre-implementation, staff’s perceived skills in family and dementia care were moderate overall, with high skills in ‘building relationships’ and ‘sustaining personhood’. Evidence-based interventions were delivered seldom to frequent, with ‘individualized care’ scoring lowest and ‘assessing cognition’ scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational- and process-related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines.

CONCLUSIONS: Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process.

RELEVANCE TO CLINICAL PRACTICE: Our study provides important learning around improving care for persons with dementia and their families in hospitals.

PATIENT OR PUBLIC CONTRIBUTION: A family caregiver was involved in the development of the education and training programme.

PMID:37317613 | DOI:10.1111/jocn.16799

Gan To Kagaku Ryoho. 2023 Jun;50(6):701-705.

ABSTRACT

To date, there are no reports that examine the relationship between geriatric nutritional risk index(GNRI)at the start of chemotherapy for malignant lymphoma and adverse effects. In this study, we investigated the relationship between GNRI at the start of chemotherapy and the incidence of side effects and time to treatment failure(TTF)in(R-)EPOCH-treated patients with relapsed or refractory malignant lymphoma. A significant difference in the incidence of Grade 3 or higher thrombocytopenia was observed between high and low GNRI groups(p=0.043). The GNRI may be an indicator of hematologic toxicity in malignant lymphoma patients treated with(R-)EPOCH. There was a statistically significant difference in TTF between the high and low GNRI groups(p=0.025), suggesting that nutritional status at the start of(R-)EPOCH may affect treatment continuation.

PMID:37317604

JMIR Res Protoc. 2023 Jun 14. doi: 10.2196/47025. Online ahead of print.

ABSTRACT

BACKGROUND: This non-randomized exploratory intervention and feasibility study examines how digital assistive technology (DAT), comprising a Dfree ultrasound sensor, affects nursing care for continence support and evaluates nurses’ willingness to incorporate DAT into the planning and practical implementation of care processes.

OBJECTIVE: The relief provided by DFree in the clinical care setting and the extent it supports nursing care for activities of daily living (ADL) pertaining to “micturition” are unclear. DAT DFree is expected to reduce nurses’ workload in clinical continence-care settings and was designed as a human-technology interaction that ensures a high level of usability for the subjects (i.e. the nurses) and increases user acceptance by at least one level (e.g., from average to slightly above average) during the study.

METHODS: Approximately 45 nurses from neurology, neurosurgery, and geriatric medicine clinics and polyclinics at the University Medicine Halle will be included in the 90-day (3-month) intervention onsite in the respective wards. After the wards are equipped with digital technologies, the participating nurses will be trained to use DFree and will be able to select DFree as a possible patient-care resource if the anamnesis includes bladder dysfunction among only patients who are willing to participate. The willingness of nurse participants to use DFree in planning their care process will be assessed using the Technology Usage Inventory (TUI) at three measurement points. The primary target values include the results of the multidimensional TUI assessment that will be processed using descriptive statistics. Ten participating nurses will be invited to conduct extensive guided interviews that are intended to provide information about the usefulness, feasibility in the specific field of continence care, and possible improvements of the device.

RESULTS: It is expected that the intention to use will be confirmed by nurses and the number of nursing problems, such as bladder dysfunction-induced bedwetting, will be reduced with a high rating of DAT usability.

CONCLUSIONS: First, this study aims to produce multilevel innovative impacts, including practical, scientific, and societal effects. The results will provide practical solutions for workload reduction in the field of nursing support for continence care, where digital assistive technologies are becoming increasingly important. The DFree ultrasonic sensor is a new technical tool for the treatment of bladder dysfunction. Generating feedback to improve technical application can increase the user-friendliness and usefulness of the device.

CLINICALTRIAL: This study was approved by the Ethics Committee of the Faculty of Medicine, Martin-Luther-University Halle-Wittenberg (approval no. 2023-031, dated May 9, 2023). The study was registered in the German Register of Clinical Studies (registration no. DRKS00031483), and the protocol has not been published previously.

PMID:37317590 | DOI:10.2196/47025

Int J Gynaecol Obstet. 2023 Jun 14. doi: 10.1002/ijgo.14921. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate fetomaternal outcomes in women who are normoglycemic by Diabetes in Pregnancy Study Group India (DIPSI) but have gestational diabetes mellitus (GDM) by WHO criteria versus those who are normoglycemic by both DIPSI and WHO criteria.

METHODS: This was a prospective, cohort study. A total of 635 women participated. They underwent a 2-h non-fasting oral glucose tolerance test (OGTT) and results were interpreted by DIPSI. Out of 635 women, 52 were lost to follow up and 33 were diagnosed as GDM by DIPSI and excluded from the study. The remaining 550 women, after 72 h from the first test, underwent a 75-g fasting-OGTT and results were interpreted using WHO 2013 criteria. Results of the second test were blinded till delivery. The 550 women were followed for fetomaternal outcomes. Participants with normal DIPSI and normal WHO 2013 OGTT were labeled group 1. Participants with normal DIPSI but abnormal WHO 2013 OGTT were labeled group 2. Fetomaternal outcomes were compared between these groups.

RESULTS: Occurrence of GDM by DIPSI was 5.1%, by WHO 2013 criteria it was 10.5%. Composite fetomaternal outcomes occurred more commonly in women with a normal DIPSI but an abnormal WHO 2013 test. Out of 550 women, 492 had normal DIPSI and normal WHO 2013 test. Out of this 492, 116 (23.6%) women had adverse fetomaternal outcomes. Fifty-eight women out of 550 had a normal DIPSI but an abnormal WHO 2013 test. Thirty-seven (63.8%) women out of 58 had adverse fetomaternal outcomes. We found statistically significant association between adverse fetomaternal outcome and GDM by WHO 2013 test (with normal DIPSI test).

CONCLUSION: WHO 2013 has superior diagnostic value compared with DIPSI criteria for diagnosis of GDM.

PMID:37317584 | DOI:10.1002/ijgo.14921

Br J Surg. 2023 Jun 15:znad157. doi: 10.1093/bjs/znad157. Online ahead of print.

ABSTRACT

BACKGROUND: Decision-making in the management of patients with retroperitoneal sarcoma is complex and requires input from a number of different specialists. The aim of this study was to evaluate the levels of agreement in terms of resectability, treatment allocation, and organs proposed to be resected across different retroperitoneal sarcoma multidisciplinary team meetings.

METHODS: The CT scans and clinical information of 21 anonymized retroperitoneal sarcoma patients were sent to all of the retroperitoneal sarcoma multidisciplinary team meetings in Great Britain, which were asked to give an opinion about resectability, treatment allocation, and organs proposed to be resected. The main outcome was inter-centre reliability, which was quantified using overall agreement, as well as the chance-corrected Krippendorff’s alpha statistic. Based on the latter, the level of agreement was classified as: ‘slight’ (0.00-0.20), ‘fair’ (0.21-0.40), ‘moderate’ (0.41-0.60), ‘substantial’ (0.61-0.80), or ‘near-perfect’ (>0.80).

RESULTS: Twenty-one patients were reviewed at 12 retroperitoneal sarcoma multidisciplinary team meetings, giving a total of 252 assessments for analysis. Consistency between centres was only ‘slight’ to ‘fair’, with rates of overall agreement and Krippendorff’s alpha statistics of 85.4 per cent (211 of 247) and 0.37 (95 per cent c.i. 0.11 to 0.57) for resectability; 80.4 per cent (201 of 250) and 0.39 (95 per cent c.i. 0.33 to 0.45) for treatment allocation; and 53.0 per cent (131 of 247) and 0.20 (95 per cent c.i. 0.17 to 0.23) for the organs proposed to be resected. Depending on the centre that they had attended, 12 of 21 patients could either have been deemed resectable or unresectable, and 10 of 21 could have received either potentially curative or palliative treatment.

CONCLUSIONS: Inter-centre agreement between retroperitoneal sarcoma multidisciplinary team meetings was low. Multidisciplinary team meetings may not provide the same standard of care for patients with retroperitoneal sarcoma across Great Britain.

PMID:37317571 | DOI:10.1093/bjs/znad157

Transfusion. 2023 Jun 15. doi: 10.1111/trf.17448. Online ahead of print.

ABSTRACT

BACKGROUND: Urgent red cell exchange (RBCx) is indicated for many complications of sickle cell disease (SCD), including acute chest syndrome, stroke, and hepatic/splenic sequestration. Many who receive RBCx remain hospitalized and develop further complications, including multiple organ dysfunction syndrome (MODS), a leading cause of death in intensive care units. Therapeutic plasma exchange (TPE) has been advocated as an effective treatment of MODS, but its role in SCD compared with RBCx alone is not well studied.

METHODS: We identified all ICU encounters from 2013 to 2019 involving RBCx procedures for MODS or SCD crisis that progressed to MODS, a total of 12 encounters. Data regarding hospital length of stay (LOS), survival, number of TPE procedures following RBCx, and procedure characteristics were collected. Surrogate laboratory markers of end-organ damage and disease severity scores were recorded at the time of admission, post-RBCx, post-TPE, and at discharge.

RESULTS: Eight encounters involved RBCx followed by TPE (TPE group) while four involved RBCx alone (RBCx group). The TPE group had a higher SOFA score at ICU admission (9.5 vs. 7.0), greater predicted mortality, and a statistical trend toward higher disease severity scores following RBCx relative to the RBCx group (p = 0.10). The TPE group showed a significantly greater decrease in SOFA score between RBCx and discharge (p = 0.04). No significant difference in mortality or hospital LOS was observed between the groups.

CONCLUSION: The findings suggest TPE may be considered as an adjunct treatment for patients with acute complications of SCD that progress to MODS, especially in cases where there is no significant improvement following RBCx.

PMID:37317564 | DOI:10.1111/trf.17448

Kurume Med J. 2023 Jun 14. doi: 10.2739/kurumemedj.MS6834004. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical site infection following spinal surgery causes prolonged delay in recovery after surgery, increases cost, and sometimes leads to additional surgical procedures. We investigated risk factors for the occurrence of surgical site infection events in terms of patient-related, surgery-related, and postoperative factors.

METHODS: This retrospective study included 1000 patients who underwent spinal surgery in our hospital between April 2016 and March 2019.

RESULTS: Patient-related factors were dementia, length of preoperative hospital stay (≥ 14 days), and diagnosis at the time of surgery (traumatic injury or deformity). The one surgery-related factor was multilevel surgery (≥ 9 intervertebral levels), and the one postoperative factor was time to ambulation (≥ 7 days) were statistically significant risk factors for spinal surgical site infection.

CONCLUSION: One risk factor identified in this study that is amenable to intervention is time to ambulation. As delayed ambulation is a risk factor for postoperative surgical site infection, how medical staff can intervene in postoperative ambulation to further reduce the incidence of surgical site infection is a topic for future research.

PMID:37316293 | DOI:10.2739/kurumemedj.MS6834004