Tag: statistics

Neurosurg Focus. 2023 Nov;55(5):E10. doi: 10.3171/2023.8.FOCUS23285.

ABSTRACT

OBJECTIVE: The aim of this study was to assess the diversity of neurosurgeons in terms of lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) gender and sexual minority status using the Graduation Questionnaire (GQ) as the single nationalized source of LGBTQ+ identification. Additionally, inclusivity was assessed through interviews by residents and attendings in the field.

METHODS: First, a PRISMA literature review was conducted and independently reviewed by two authors on studies involving LGBTQ+ representation in neurosurgery from PubMed, Web of Science, and Google Scholar. Then, aggregate responses of 16,901 participants’ sexual and gender identities from the GQ administered between 2016 and 2022 were compiled. To statistically analyze the response frequencies, the authors performed a chi-square analysis. Finally, interviews were conducted with individuals who identify as LGBTQ+ and are currently neurosurgical residents or attendings. Direct invitations were extended to participate in interviews, and all participants gave informed consent prior to the interview. Interviews were conducted using standardized questions and were video recorded.

RESULTS: Two studies were identified by literature review that referenced the LGBTQ+ community in neurosurgery. A GQ chi-square analysis comparing neurosurgical with nonneurosurgical LGBTQ+ identification proved statistically insignificant (p = 0.65). More broad analysis of majority sexual and gender identification (heterosexual and cisgendered) compared with the total gender and sexual minority group also proved statistically insignificant (p = 0.32) in response frequency. Five interviews, including 4 residents and 1 attending, provided several overarching themes including self-identification as an invisible minority, self-limiting behavior to ensure inclusion, and LGBTQ+ status as a direct departure from the stereotypical neurosurgeon.

CONCLUSIONS: Results from the GQ analysis indicate that neurosurgery is achieving LGBTQ+ diversity of its incoming members comparable to that of other fields in medicine. However, qualitative data from the interviews and a lack of specific literature indicate that despite obtaining diversity, inclusion of LGBTQ+ neurosurgeons and trainees is lacking.

PMID:37913532 | DOI:10.3171/2023.8.FOCUS23285

ASAIO J. 2023 Nov 2. doi: 10.1097/MAT.0000000000002050. Online ahead of print.

ABSTRACT

HeartMate 3 is the only durable left ventricular assist devices (LVAD) currently implanted in the United States. The purpose of this study was to develop a predictive model for 1 year mortality of HeartMate 3 implanted patients, comparing standard statistical techniques and machine learning algorithms. Adult patients registered in the Society of Thoracic Surgeons, Interagency Registry for Mechanically Assisted Circulatory Support (STS-INTERMACS) database, who received primary implant with a HeartMate 3 between January 1, 2017, and December 31, 2019, were included. Epidemiological, clinical, hemodynamic, and echocardiographic characteristics were analyzed. Standard logistic regression and machine learning (elastic net and neural network) were used to predict 1 year survival. A total of 3,853 patients were included. Of these, 493 (12.8%) died within 1 year after implantation. Standard logistic regression identified age, Model End Stage Liver Disease (MELD)-XI score, right arterial (RA) pressure, INTERMACS profile, heart rate, and etiology of heart failure (HF), as important predictor factors for 1 year mortality with an area under the curve (AUC): 0.72 (0.66-0.77). This predictive model was noninferior to the ones developed using the elastic net or neural network. Standard statistical techniques were noninferior to neural networks and elastic net in predicting 1 year survival after HeartMate 3 implantation. The benefit of using machine-learning algorithms in the prediction of outcomes may depend on the type of dataset used for analysis.

PMID:37913499 | DOI:10.1097/MAT.0000000000002050

Int Dent J (Phila). 1897 Jan;18(1):11-14.

NO ABSTRACT

PMID:37912237 | PMC:PMC10128772

Anesthesiology. 2023 Nov 1. doi: 10.1097/ALN.0000000000004827. Online ahead of print.

ABSTRACT

BACKGROUND: Regional anesthesia for total knee arthroplasty has been deemed high priority by national and international societies and its use can serve as a measure of healthcare equity. We estimated the association between utilization of regional anesthesia for postoperative pain and 1) race and 2) hospital in patients undergoing total knee arthroplasty. We hypothesized that Black patients would be less likely than White patients to receive regional anesthesia, and that variability in regional anesthesia would more likely be attributable to the hospital where surgery occurred than race.

METHODS: We used Medicare fee-for-service claims for patients aged 65 or older who underwent primary total knee arthroplasty between 1/1/2011 and 12/31/2016. Our primary outcome was administration of regional anesthesia for postoperative pain, defined as any peripheral (femoral, lumbar plexus, or other) or neuraxial (spinal or epidural) block. Our primary exposure was self-reported race (Black, White, or Other). We defined clinical significance as a relative difference of 10% in regional anesthesia administration.

RESULTS: Data from 733,406 cases across 2,507 hospitals were analyzed: 90.7% of patients were identified as White, 4.7% as Black, and 4.6% as Other. Median hospital-level prevalence of use of regional anesthesia was 51% (interquartile range 18-79%). Black patients did not have a statistically different probability of receiving a regional anesthetic compared to White patients (adjusted estimates: Black 53.3%, 95% CI 52.5-54.1%; White 52.7%, 95% CI 52.4-54.1%, p=0.132). Findings were robust to alternate specifications of the exposure and outcome. Analysis-of-variance revealed that 42.0% of the variation in block administration was attributable to hospital, compared to less than 0.01% to race, after adjusting for other patient-level confounders.

CONCLUSIONS: Race was not associated with administration of regional anesthesia in Medicare patients undergoing primary total knee arthroplasty. Variation in the use of regional anesthesia was primarily associated with the hospital where surgery occurred.

PMID:37910860 | DOI:10.1097/ALN.0000000000004827

Int J Oral Maxillofac Implants. 2023 Nov 1;0(0):1-24. doi: 10.11607/jomi.10467. Online ahead of print.

ABSTRACT

PURPOSE: In the clinical setting, assessing bone quality and quantity at the implant site is the basis to select implant characteristics and the insertion protocol to be applied. However, a quantitative method to classify bone quality and quantity is still lacking. A recently introduced implant placement micromotor that provides site-specific, operator-independent cancellous bone density measurements may be useful for this purpose, but it remains unknown whether this device can detect the presence of a cortical bone layer and measure its thickness and density.

MATERIALS AND METHODS: Thus, an in vitro experiment was performed on six double-layer polyurethane foam blocks mimicking the jaw bone with different cortical thickness/cancellous density combinations. The densities were measured using the micromotor, either removing the cortical layer or leaving it intact, with and without irrigation.

RESULTS: The results collected in each condition were compared by means of non-parametric statistical tests. Independent of irrigation, the micromotor detected the cortical layer when it was left intact and accurately estimated its thickness. The micromotor did not discriminate each block from the other ones when they were considered separately, but it did when they were grouped into four or three classes.

CONCLUSION: The present study suggested that the micromotor may represent a valid device to quantitatively assess bone quality and density. If the micromotor can quantitatively distinguish different cortical/cancellous bone combinations in humans, it may be a helpful tool to define finely-tuned, patient-tailored preparations of the implant seat, making teeth rehabilitation in challenging clinical conditions more predictable.

PMID:37910838 | DOI:10.11607/jomi.10467

Int J Oral Maxillofac Implants. 2023 Nov 1;0(0):1-17. doi: 10.11607/jomi.10597. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim of this study is to evaluate the correspondence between an Artificial Intelligence driven new tool prediction and the clinician’s evaluation in the immediate loading suitability of curves recorded during implant insertion in an in vitro test. The secondary aim is to analyse peak insertion torque (pIT) and variable torque work (VTW) values of the implants used for the in vitro study.

MATERIAL AND METHODS: The study was performed on artificial bone blocks of solid rigid polyurethane without cortical layer with four different densities. Five types of implants with different macrogeometries were used. A total of 140 implants (7 implants of each type in the four polyurethane blocks) were inserted. Immediately after implant placement the insertion curves were classified by the operator as suitable or non-suitable for immediate loading. In a second moment the same curves were analyzed by the new AIT that classified them as belonging to YES or NO class. For each implant pIT and VTW were also recorded.

RESULTS: The correspondence between surgeon and AIT evaluation was 99,3% with only one false-negative reported by the algorithm analysis. The sensitivity resulted 98.95%, the specificity 100%, positive predictive value 100% and negative predictive value 97.8%. Mean pIT of the whole sample was 34.19 + 19.43 Ncm while mean VTW was 2266.89 + 1993.73 Ncm. Statistically significant differences were found between implant systems in the whole sample and when divided by polyurethane block density.

CONCLUSIONS: AIT showed a high level of accuracy in the prediction of immediate loading suitability of insertion curves examined. All the implants used in the in vitro test were able to reach good levels of primary stability, excluding when inserted in the less dense polyurethane block. Clinical studies conducted in larger samples and with more surgeons involved are necessary to confirm these results.

PMID:37910835 | DOI:10.11607/jomi.10597

Int J Oral Maxillofac Implants. 2023 Nov 1;0(0):1-24. doi: 10.11607/jomi.10613. Online ahead of print.

ABSTRACT

INTRODUCTION: Different surgical procedures have been proposed to achieve successful horizontal ridge reconstruction of the anterior maxilla, most of these procedures require complex surgical stages with morbidity and are time-consuming.

AIM: The purpose of this study is to evaluate the efficacy of using a customized xenograft shell with a 1:1 mixture of particulates xenograft and autogenous bone for the reconstruction of horizontally deficient anterior maxillary alveolar ridges.

METHODS: Cone beam computed tomography (CBCT) images of the atrophic maxilla of eight patients were acquired and generated into 3D models. The data were transferred to a 3D printer and solid models were fabricated. During the surgery, the xenograft blocks were manually sliced and customized on the 3D printed models and fixed then the gap was augmented with a 1:1 xenograft autograft mixture.

RESULTS: Clinical assessment showed no adverse effects. However, one patient exhibited wound dehiscence. The mean difference between the preoperative and the six months postoperative showed a net average bone gain by 4.06 mm at 2 mm from the crest and 4.34 mm at 5 mm from the crest, which was statistically significant. On the other hand, a statistically significant graft resorption by 1.41 mm and 2.19 mm at 2 and 5 mm from the crest was found when the mean difference between the immediate and the six months postoperative was calculated.

CONCLUSIONS: Within the limitations of the study, the use of xenograft shells as a barrier for maxillary alveolar ridge reconstruction is predictable technique however, further investigations regarding the required time for graft consolidation is required.

PMID:37910833 | DOI:10.11607/jomi.10613

Int J Oral Maxillofac Implants. 2023 Nov 1;0(0):1-29. doi: 10.11607/jomi.10584. Online ahead of print.

ABSTRACT

PURPOSE: The structural and compositional similarities between dentin and alveolar bone formed the basis for utilizing dentin for bone regeneration. Various authors recommended using treated mineralized, partially demineralized, and demineralized dentin grafts over xenografts because of their comparable clinical and radiographic results and lower costs. Therefore, the current study aimed at comparing the effect of untreated mineralized dentin grafts (UMDG) versus xenografts in vertical and horizontal augmentation around dental implants that were immediately placed in the mandibular anterior region.

MATERIALS AND METHODS: A total of 56 patients who required immediate dental implant placement in the lower anterior region were randomly allocated to group I (study), where ground dentin was washed with normal saline and placed around the dental implants, and to group II (control), where xenograft was used. The primary implant stability was measured at the time of implant placement. Secondary stability, plaque index (PI), bleeding index (BI), probing depth (PD), and keratinized mucosa width (KMW) were assessed at baseline (time of definitive abutment and temporary crown placement) and then at 3, 6, and 12 months. Pain and the number of analgesics consumed were assessed daily during the first postoperative week. Marginal bone loss (MBL) and radiodensity were assessed radiographically.

RESULTS: There were no significant differences between both groups in terms of postoperative pain, the number of analgesic tablets consumed, peri-implant mucositis, or peri-implantitis. Both groups showed comparable results for the PI, BI, and BD. Moreover, there was no statistical difference between both groups with regard to primary implant stability and secondary stability at baseline and 12 months. Group I showed significantly lower secondary stability after loading at 3 and 6 months and significantly greater bone loss and lower bone density before exposure. KMW and MBL after exposure were significantly higher in group I at all time points.

CONCLUSION: Although UMDG showed similar clinical results as xenografts, including primary and secondary implant stability, they had higher resorption rates than xenografts. Therefore, treatment of the dentin graft is required. Thus, the authors do not recommend using untreated mineralized dentin grafts.

PMID:37910831 | DOI:10.11607/jomi.10584

Int J Oral Maxillofac Implants. 2023 Nov 1;0(0):1-25. doi: 10.11607/jomi.10595. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of the study is to investigate the screw loosening and fracture resistance of different hybrid abutment crown restorations after thermomechanical aging.

MATERIALS AND METHODS: Restorations were produced from zirconia, lithium disilicate, and hybrid ceramics with CAD-CAM system (n=10). Restorations and titanium bases (Tibases) were cemented and the abutment screws were torqued to 30 Ncm. They were retorqued after 10 minutes, and removal torque values (RTV) were measured. When 250000 and 500000 cycles of thermomechanical aging were completed, the RTVs were measured again and removal torque loss (RTL) ratios were calculated. The specimens were subjected to fracture resistance test after 750000 cycles of thermomechanical aging. The load at failure was recorded as the fracture resistance (N). The results were statistically analyzed (α=0.05).

RESULTS: Aging was effective on the RTVs and RTL ratios (P<0.001). The highest RTV was observed before aging; however, the RTVs significantly decreased and RTL ratios significantly increased after aging (P<0.05). The fracture resistance values significantly differed among the ceramic materials. All lithium disilicate and hybrid ceramic specimens showed restoration fracture, while most of the zirconia specimens were displayed Tibase related failure.

CONCLUSION: Hybrid abutment crowns made of zirconia, lithium disilicate, and hybrid ceramics can withstand the average occlusal forces in the molar region; however ceramic type may affect the failure type. Retightening of the abutment screws after 10 minutes after first tightening and annually may be beneficial to prevent the adverse effects of screw loosening on the integrity of implant-abutment connection.

PMID:37910830 | DOI:10.11607/jomi.10595

Int J Oral Maxillofac Implants. 2023 Nov 1;0(0):1-33. doi: 10.11607/jomi.10381. Online ahead of print.

ABSTRACT

PURPOSE: Dental implants are a common method for the treatment of tooth loss, and its accuracy directly affects forward efficacy and stability. This study compared the accuracy of different modalities of dental implant placement (dynamic navigation [DN], fully guided [FG] static navigation, partially guided [PG] static navigation, and free handed [FH]) through a network meta-analysis.

MATERIALS AND METHODS: This study followed the Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines and conducted an electronic literature search (Inception-Oct 2, 2022). The comparison of implant accuracy in all the included randomized controlled trials (RCTs) conformed to at least one of the following: deviation at the crown of the implant, deviation at the apical portion of the implant, or angular deviation of the implant.

RESULTS: Twenty-six articles were included for the qualitative analysis (17 RCTs; 3 prospective studies; 6 retrospective studies), and 17 RCTs of which were included for network meta-analysis. The data included in this study had high consistency, and the funnel plot showed that the articles had low publication bias. Compared with FH, FG and DN had higher accuracy in coronal deviation (P<0.05), and FG, DN, and PG had higher accuracy in apical deviation and angular deviation (P<0.05). According to the SUCRA value, FG had the highest accuracy in coronal deviation, while DN had the highest accuracy in apical deviation and angular deviation.

CONCLUSIONS: According to the results of this literature review, the accuracy of DN, FG, and PG were higher than those of FH. DN showed the highest accuracy in terms of apical deviation and angular deviation. FG had the best control over the coronal deviation. There was no statistical difference between DN and FG in terms of accuracy. Given the limitations of the current study, further validation is required in the future.

PMID:37910829 | DOI:10.11607/jomi.10381