Tag: statistics

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003624. Online ahead of print.

ABSTRACT

INTRODUCTION: Endoscopic procedures are increasingly performed for children and adolescents and these interventions represent a central element of both pediatric gastroenterology (GI) care and revenues. It remains unclear, however, which scheduling paradigm maximizes efficiency of resource utilization and delivery of care in this arena. In this study, we evaluate the impact of shifting from shared endoscopy blocks to individual, provider-specific endoscopy blocks for scheduling endoscopic procedures in our tertiary care academic center.

METHODS: The implemented endoscopy block system involves a single endoscopist performing procedures in an allocated room for the entire ½ day period of time, with most providers having 1-3 ½ day blocks per month. We analyzed block fragmentation (multiple providers in a single block), block utilization and procedure volume, comparing the 8-month period prior to implementation of the block system (pre-implementation period) with the 8-month period following implementation of the block system (post-implementation period). Provider satisfaction and perceptions were assessed by survey pre- and post-implementation. Standard descriptive statistics were utilized for analysis.

RESULTS: In the pre- and post-implementation periods, 22 half-day blocks were allocated to pediatric GI. In the pre-implementation period, mean utilization of these blocks was 65.9% (range: 47%-77%). In the post-implementation period, mean % utilization was 79.8% (range: 64%-89%). Overall endoscopy procedure volume increased from 279 in the pre-implementation period to 419 in the post-implementation period. Provider perception of endoscopy efficiency was enhanced by the block system, with 68.4% of pediatric GI respondents rating endoscopy as ‘efficient’ post-implementation (vs. 19% pre-implementation) and 63.2% indicating that the block system directly enhanced efficiency. 63.2% reported increased personal procedure volume and 84.2% reported perceived increase in overall procedure volume with block system implementation.

CONCLUSIONS: Strategic approaches for scheduling endoscopic procedures carry the potential to enhance efficiency and experience for both providers and patients. Implementation of the endoscopy block system was associated with increased procedure volumes and block utilization as well as a more positive experience for the majority of providers. Schedule adjustments with analysis of associated efficiency and satisfaction metrics can optimize pediatric endoscopy practice.

PMID:36123768 | DOI:10.1097/MPG.0000000000003624

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003625. Online ahead of print.

ABSTRACT

BACKGROUND: Estimation of the dimensions of endoscopic findings such as stricture diameter is largely subjective. Accurate assessment of stricture dimensions has multiple benefits including facilitating the choice of appropriately sized endoscopic therapies for treating stricture, properly tracking response to endoscopic therapies between procedures, and potentially even predicting outcomes of endoscopic therapy.

METHODS: Endoscopies performed in children with repaired esophageal atresia between August 2019 through August 2021 for which both 1) an endoscopic estimate of esophageal stricture diameter obtained by visual comparison with the known dimensions of the biopsy forceps and 2) an intraoperative esophageal fluoroscopy study were performed were included for analysis. Fluoroscopic stricture diameter measurements were manually obtained using a software ruler tool calibrated to the known dimensions of the intraluminal endoscope. Statistical concordance was calculated between the visual diameter estimates and the standard fluoroscopic stricture measurements.

RESULTS: One-hundred ninety one endoscopies were included for analysis. Lin’s concordance correlation coefficient was 0.92 (95% confidence interval: 0.89, 0.94) between the visual diameter estimates and the fluoroscopic stricture measurements. Correlation was strongest for smaller to mid-sized stricture diameters.

CONCLUSIONS: Use of the biopsy forceps as a visual reference of known dimensions enables accurate visual estimation of esophageal stricture diameter during endoscopy using commonly available tools, with high concordance with standard fluoroscopic measurement techniques.

PMID:36123760 | DOI:10.1097/MPG.0000000000003625

Diabetol Metab Syndr. 2022 Sep 19;14(1):133. doi: 10.1186/s13098-022-00901-1.

ABSTRACT

BACKGROUND: Diabetic foot ulcer (DFU) is a common diabetes mellitus (DM) complication. Individuals with DM and a DFU achieved significantly lower scores in cognitive tests than those without a DFU. We investigated whether baseline cognitive function in individuals with a DFU is a determinant of mortality.

METHODS: A prospective study using data collected during a case-control study conducted in 2010-2012 whereby 90 participants with a DFU (mean age at baseline 58.28 ± 6.95 years, 75.6% male) took the paper and pencil and the NeuroTrax battery of cognitive tests. Depression was assessed, and the DFU status was evaluated. In 2020, information pertaining to participants’ vital status (dead/alive) was collected and the relationship between baseline cognitive status and vital status was assessed.

RESULTS: During a median follow-up of 6.8 years (range 0.2-9.5), 39 participants died (43.3%). Individuals alive vs. those who had died during follow-up had a higher global cognitive score at baseline (92.16 ± 10.95 vs. 87.18 ± 12.24, p = 0.045), but increased risk was not found. Individuals who were alive vs. those who had died during follow-up had statistically significantly higher baseline executive function, reaction time and digit symbol substitution test results. However, after adjustment for glycosylated hemoglobin (HbA1c), microvascular and macrovascular complications, no relationship between cognitive tests and mortality remained significant.

CONCLUSIONS: The higher mortality rate among people with type 2 DM and a DFU was not significant after adjustment for HbA1c, micro- and macrovascular complications. There may be common pathophysiological pathways to both DM complications and cognitive impairment, which may contribute to increased mortality. Further studies are warranted.

PMID:36123752 | DOI:10.1186/s13098-022-00901-1

BMC Nutr. 2022 Sep 19;8(1):104. doi: 10.1186/s40795-022-00603-x.

ABSTRACT

BACKGROUND: The consequences of undernutrition have serious implication for the health and future reproductive periods of adolescent girls and young women aged 15-24 years. Inspite of this, they are neglected age groups and there is limited information about the nutritional status of this age group in Ethiopia. Therefore, estimating the extent and associated factors of undernutrition among adolescent girls and young women in a national context using multilevel analysis is essential.

METHODS: Secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016. A total sample weight of 5362 adolescent girls and young women was included in this study. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was fitted to determine the associated factors of undernutrition among adolescent girls and young women in Ethiopia. Finally, the odds ratios along with the 95% confidence interval was generated to determine the individual and community level factors of undernutrition. A p-value less than 0.05 was declared as the level of statistical significance.

RESULTS: Overall, 25.6% (95%CI: 24.5-26.9) of adolescent girls and young women were undernourished. Statistically significant individual level factors includes adolescent girls and young women aged 15-19 years (AOR: 1.53, 95%CI: 1.32-1.77), individual media exposure (AOR: 0.82, 95%CI: 0.69-0.97), and unprotected drinking water source (AOR: 1.24, 95%CI: 1.04-1.48). Whereas, Southern Nations, Nationalities, and Peoples’ Region (AOR: 0.33, 95%CI: 0.13-0.83) and rural residence (AOR: 1.69, 95%CI: 1.24-2.32), were community level factors for adolescent girls and young women undernutrition.

CONCLUSION: One quarter of the Ethiopian adolescent girls and young women were undernourished. Therefore, the Ethiopian government should better engage this age group in different aspects of the food system. To improve nutritional status, public health interventions such as increased media exposure for rural residents and interventions that improve access to protected water sources will be critical.

PMID:36123733 | DOI:10.1186/s40795-022-00603-x

Respir Res. 2022 Sep 19;23(1):256. doi: 10.1186/s12931-022-02177-5.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were transferred not only between hospitals by ambulance but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the physiological impact of helicopter transport on critically ill patients and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated patients with severe COVID-19, with special focus on take-off, midflight, and landing.

METHODS: All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch ‘Lifeliner 5’ HEMS team and who were fully monitored, including noninvasive cardiac output, were included in this study. Three 10-min timeframes (take-off, midflight and landing) were defined for analysis. Continuous data on the vital parameters heart rate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO₂ and noninvasive cardiac output using electrical cardiometry were collected and stored at 1-min intervals. Data were analyzed for differences over time within the timeframes using one-way analysis of variance. Significant differences were checked for clinical relevance.

RESULTS: Ninety-eight patients were included in the analysis. During take-off, an increase was noticed in cardiac output (from 6.7 to 8.2 L min^-1; P < 0.0001), which was determined by a decrease in systemic vascular resistance (from 1071 to 739 dyne·s·cm^-5, P < 0.0001) accompanied by an increase in stroke volume (from 88.8 to 113.7 mL, P < 0.0001). Other parameters were unchanged during take-off and mid-flight. During landing, cardiac output and stroke volume slightly decreased (from 8.0 to 6.8 L min^-1, P < 0.0001 and from 110.1 to 84.4 mL, P < 0.0001, respectively), and total systemic vascular resistance increased (P < 0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians.

CONCLUSIONS: Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs.

PMID:36123727 | DOI:10.1186/s12931-022-02177-5

BMC Oral Health. 2022 Sep 19;22(1):408. doi: 10.1186/s12903-022-02452-3.

ABSTRACT

OBJECTIVE: Myofascial pain syndrome with trigger points is the most common cause of nonodontogenic pain. Although injection of the trigger points is the most effective pain reduction treatment, many patients exhibit recurrence after a short period. Therefore, the aim of the current study was to evaluate the clinical efficacy of magnesium sulfate injections in the treatment of the masseter muscle trigger points when compared to saline injections.

MATERIAL AND METHOD: This study randomly (1:1) assigned 180 patients to one of two treatment groups based on whether their trigger points were injected with 2 ml of saline or magnesium sulfate. Pain scores, maximum mouth opening (MMO), and quality of life were measured at the pre-injection and 1, 3, and 6 months post-injection.

RESULTS: The pain scores were significantly higher in the saline group during all follow-up assessments, whereas the MMO was significantly higher in the magnesium sulfate group up to 3 months of follow-up (p < 0.001). However, the difference in MMO ceased to be statistically significant after 6 months of follow-up (p = 0.121). Additionally, the patient’s quality of life score was significantly higher in the magnesium sulfate group compared to the saline group (p < 0.001).

CONCLUSION: Injection of magnesium sulfate is an effective treatment measure for myofascial trigger points. However, further studies with a proper design addressing the limitations of the current study are necessary.

CLINICALTRIALS: org (ID: NCT04742140) 5/2/2021.

PMID:36123724 | DOI:10.1186/s12903-022-02452-3

Parasit Vectors. 2022 Sep 19;15(1):329. doi: 10.1186/s13071-022-05430-4.

ABSTRACT

BACKGROUND: An innovative approach has been introduced for identifying and developing novel potent and safe anti-Babesia and anti-Theileria agents for the control of animal piroplasmosis. In the present study, we evaluated the inhibitory effects of Malaria Box (MBox) compounds (n = 8) against the growth of Babesia microti in mice and conducted bioinformatics analysis between the selected hits and the currently used antibabesial drugs, with far-reaching implications for potent combinations.

METHODS: A fluorescence assay was used to evaluate the in vivo inhibitory effects of the selected compounds. Bioinformatics analysis was conducted using hierarchical clustering, distance matrix and molecular weight correlation, and PubChem fingerprint. The compounds with in vivo potential efficacy were selected to search for their target in the piroplasm parasites using quantitative PCR (qPCR).

RESULTS: Screening the MBox against the in vivo growth of the B. microti parasite enabled the discovery of potent new antipiroplasm drugs, including MMV396693 and MMV665875. Interestingly, statistically significant (P < 0.05) downregulation of cysteine protease mRNA levels was observed in MMV665875-treated Theileria equi in vitro culture in comparison with untreated cultures. MMV396693/clofazimine and MMV665875/atovaquone (AV) showed maximum structural similarity (MSS) with each other. The distance matrix results indicate promising antibabesial efficacy of combination therapies consisting of either MMV665875 and AV or MMV396693 and imidocarb dipropionate (ID).

CONCLUSIONS: Inhibitory and hematology assay results suggest that MMV396693 and MMV665875 are potent antipiroplasm monotherapies. The structural similarity results indicate that MMV665875 and MMV396693 have a similar mode of action as AV and ID, respectively. Our findings demonstrated that MBox compounds provide a promising lead for the development of new antibabesial therapeutic alternatives.

PMID:36123705 | DOI:10.1186/s13071-022-05430-4

Infect Agent Cancer. 2022 Sep 19;17(1):50. doi: 10.1186/s13027-022-00463-x.

ABSTRACT

BACKGROUND: Bladder cancer is a challenging public health concern in South of Iran because of its high prevalence and the related medical expenses. Although the exact etiology of bladder cancer remains unknown, given the cell transforming ability and oncogenic potential of the members of Polyomaviridae families, this study was conducted to evaluate the magnitude of BK polyomavirus (BKPyV) and John Cunningham polyomavirus (JCPyV) among patients with bladder cancer residents in the northern shores of the Persian Gulf, South of Iran.

METHODS: Totally 211 patients with bladder cancer were enrolled in this study. Bladder biopsy samples of these patients and patients with interstitial cystitis as well as autoptic samples of healthy bladder were tested for detection of BKPyV and JCPyV by semi-nested PCR-RFLP followed by sequencing.

RESULTS: BKPyV and JCPyV were detected in 1.7% and 6.1% of bladder cancer samples, respectively. These samples were infected with JCPyV genotypes 2, 3 and 6 and BKPyV genotypes I and IV. BKPyV and JCPyV coinfection was detected in 2 samples. Moreover, one of the healthy bladder samples was positive for BKPyV, and one of the interstitial cystitis samples was positive for JCPyV. Although the majority of infected patients were in the age group 70-79 years, male, residents in Tangestan, stage Ta-T1, and low-grade and high-grade papillary urothelial carcinoma, the prevalence of BKPyV and JCPyV among patients with bladder cancer was not statistically associated with age, gender, place of residency, and stage and grade of the tumor.

CONCLUSION: Despite identifying BKPyV and JCPyV in a number of bladder cancer biopsy specimens and the high prevalence of bladder cancer among people resident in South of Iran, it is suggested that these viruses are unlikely to be effective causative factors in bladder carcinogenesis in this region. Therefore, environmental risk factors and genetic backgrounds may have a more prominent role than human polyomaviruses in the development of bladder cancer in South of Iran.

PMID:36123699 | DOI:10.1186/s13027-022-00463-x

Microb Cell Fact. 2022 Sep 19;21(1):197. doi: 10.1186/s12934-022-01922-1.

ABSTRACT

BACKGROUND: CYP725A4 catalyses the conversion of the first Taxol® precursor, taxadiene, to taxadiene-5α-ol (T5α-ol) and a range of other mono- and di-hydroxylated side products (oxygenated taxanes). Initially known to undergo a radical rebound mechanism, the recent studies have revealed that an intermediate epoxide mediates the formation of the main characterised products of the enzyme, being T5α-ol, 5(12)-oxa-3(11)-cyclotaxane (OCT) and its isomer, 5(11)-oxa-3(11)-cyclotaxane (iso-OCT) as well as taxadienediols. Besides the high side product: main product ratio and the low main product titre, CYP725A4 is also known for its slow enzymatic activity, massively hindering further progress in heterologous production of Taxol® precursors. Therefore, this study aimed to systematically explore the key parameters for improving the regioselectivity and activity of eukaryotic CYP725A4 enzyme in a whole-cell eukaryotic biocatalyst, Saccharomyces cerevisiae.

RESULTS: Investigating the impact of CYP725A4 and reductase gene dosages along with construction of self-sufficient proteins with strong prokaryotic reductases showed that a potential uncoupling event accelerates the formation of oxygenated taxane products of this enzyme, particularly the side products OCT and iso-OCT. Due to the harmful effect of uncoupling products and the reactive metabolites on the enzyme, the impact of flavins and irons, existing as prosthetic groups in CYP725A4 and reductase, were examined in both their precursor and ready forms, and to investigate the changes in product distribution. We observed that the flavin adenine dinucleotide improved the diterpenoids titres and biomass accumulation. Hemin was found to decrease the titre of iso-OCT and T5α-ol, without impacting the side product OCT, suggesting the latter being the major product of CYP725A4. The interaction between this iron and the iron precursor, δ-Aminolevulinic acid, seemed to improve the production of these diterpenoids, further denoting that iso-OCT and T5α-ol were the later products. While no direct correlation between cellular-level oxidative stress and oxygenated taxanes was observed, investigating the impact of salt and antioxidant on CYP725A4 further showed the significant drop in OCT titre, highlighting the possibility of enzymatic-level uncoupling event and reactivity as the major mechanism behind the enzyme activity. To characterise the product spectrum and production capacity of CYP725A4 in the absence of cell growth, resting cell assays with optimal neutral pH revealed an array of novel diterpenoids along with higher quantities of characterised diterpenoids and independence of the oxygenated product spectra from the acidity effect. Besides reporting on the full product ranges of CYP725A4 in yeast for the first time, the highest total taxanes of around 361.4 ± 52.4 mg/L including 38.1 ± 8.4 mg/L of T5α-ol was produced herein at a small, 10-mL scale by resting cell assay, where the formation of some novel diterpenoids relied on the prior existence of other diterpenes/diterpenoids as shown by statistical analyses.

CONCLUSIONS: This study shows how rational strain engineering combined with an efficient design of experiment approach systematically uncovered the promoting effect of uncoupling for optimising the formation of the early oxygenated taxane precursors of Taxol®. The provided strategies can effectively accelerate the design of more efficient Taxol®-producing yeast strains.

PMID:36123694 | DOI:10.1186/s12934-022-01922-1

BMC Health Serv Res. 2022 Sep 19;22(1):1172. doi: 10.1186/s12913-022-08550-w.

ABSTRACT

BACKGROUND: This study aims to identify the relationship between health literacy competencies and patient-centered care by clinical nurses.

METHODS: The participants were 180 nurses working at three university hospitals located in G City and J Province, South Korea. Self-evaluation questionnaires were used to collect data that were collected from June 1 to 30, 2021. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression with SPSS 26.0.

RESULTS: The mean of health literacy competencies was 3.19 (4 point scale) and the mean of patient-centered care was 3.48 (5 point scale). There were significant positive relationships between health literacy competencies and patient-centered care by clinical nurses (r = .50, p < .001). Factors influencing the health literacy competencies of clinical nurses were identified as education level (university) (β = .82), education level (masters) (β = .74), prior health literacy knowledge (β = .52), and health literacy competencies (β = .44). The explanatory power of this regression model was 36%, which was statistically significant (F = 17.65, p < .001).

CONCLUSION: Clinical nurses’ health literacy competencies should be developed to improve patient-centered care. Nursing education programs should emphasize the integration of health literacy into the nursing school curriculum.

PMID:36123686 | DOI:10.1186/s12913-022-08550-w