Tag: statistics

Int J Gynecol Cancer. 2023 Sep 11:ijgc-2023-004624. doi: 10.1136/ijgc-2023-004624. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare surgery and survival outcomes between neoadjuvant chemotherapy and primary debulking surgery in patients with advanced ovarian yolk sac tumor.

METHODS: In this retrospective cohort analysis, patients with stage III to IV ovarian yolk sac tumor or mixed germ cell tumors containing yolk sac tumor elements, and who underwent surgery at Peking Union Medical College Hospital between January 2011 and December 2021, were identified. Patient characteristics, treatment, and survival data were analyzed between the two groups.

RESULTS: A total of 40 patients were enrolled: 19 patients received neoadjuvant chemotherapy followed by interval surgery, and 21 patients were treated with primary debulking surgery. After neoadjuvant chemotherapy, the surgical conditions of patients were improved. All patients achieved cytoreduction to R0 or R1 at interval surgery. No statistical difference was found in 3-year disease-free survival and overall survival between the neoadjuvant chemotherapy group and the primary debulking surgery group (log rank p=0.4 and 0.94). Patients had less blood loss (328.4 vs 1285.7 mL, p=0.029), lower transfusion volume (1044.4 vs 3066.7 mL, p=0.011), and fewer peri-operative complications (15.8% vs 47.6%, p=0.032) at the interval debulking surgery after neoadjuvant chemotherapy compared with patients who underwent primary debulking surgery.

CONCLUSION: For patients with advanced-stage ovarian yolk sac tumor, neoadjuvant chemotherapy followed by interval surgery is an alternative option, especially for those who cannot tolerate the primary debulking surgery because of high tumor burden and vulnerable status.

PMID:37696647 | DOI:10.1136/ijgc-2023-004624

BMJ Open. 2023 Sep 11;13(9):e076261. doi: 10.1136/bmjopen-2023-076261.

ABSTRACT

OBJECTIVE: This study aimed to estimate the prevalence of comorbidity and its associated factors among Bangladeshi type-2 diabetes (T2D) patients.

DESIGN: A hospital-based cross-sectional study.

SETTING: This study was conducted in two specialised diabetic centres residing in the Jashore District of Bangladesh. A systematic random sampling procedure was applied to identify the T2D patients through a face-to-face interview.

PARTICIPANTS: A total of 1036 patients with T2D were included in this study. A structured questionnaire was administered to collect data on demographic, lifestyle, medical and healthcare access-related data through face-to-face and medical record reviews.

OUTCOME MEASURES AND ANALYSES: The main outcome variable for this study was comorbidities. The prevalence of comorbidity was measured using descriptive statistics. A logistic regression model was performed to explore the factors associated with comorbidity among Bangladeshi T2D patients.

RESULTS: The overall prevalence of comorbidity was 41.4% and the most prevalent conditions were hypertension (50.4%), retinopathy (49.6%), obesity (28.7%) and oral problem (26.2). In the regression model, the odds of comorbidities increased with gender (male: OR: 1.27, 95% CI 0.62 to 1.87), age (50-64 years: OR: 2.14, 95% CI 1.32 to 2.93; and above 65 years: OR: 2.96, 95% CI 1.83 to 4.16), occupation (unemployment: OR: 3.32, 95% CI 0.92 to 6.02 and non-manual worker: OR: 2.31, 95% CI 0.91 to 5.82), duration of diabetes (above 15 years: OR: 3.28, 95% CI 1.44 to 5.37), body mass index (obese: OR: 2.62, 95% CI 1.24 to 4.26) of patients. We also found that individuals with recommended moderate to vigorous physical activity levels (OR: 0.41, 95% CI 1.44 to 5.37) had the lowest odds of having comorbidity. Meanwhile, respondents with limited self-care practice, unaffordable medicine and financial problems had 1.82 times, 1.94 times and 1.86 times higher odds of developing comorbidities.

CONCLUSION: The findings could be useful in designing and implementing effective intervention strategies and programmes for people with T2D to reduce the burden of comorbidity.

PMID:37696641 | DOI:10.1136/bmjopen-2023-076261

BMJ Open. 2023 Sep 11;13(9):e070833. doi: 10.1136/bmjopen-2022-070833.

ABSTRACT

OBJECTIVES: Publicly funded adult social care (ASC) in England aims to improve quality of life through the provision of services for individuals with care needs due to physical and/or mental impairment or illness. Access to these services, however, is often restricted to contain public expenditure. With a fast-growing care need, information on whether extending eligibility is good value for money becomes policy-relevant.

PRIMARY AND SECONDARY OUTCOME MEASURES: This study investigates the effect of extending ASC eligibility on user care-related quality of life (CRQoL), a policy-relevant measure of quality of life.

DESIGN: We use English cross-sectional survey data from 2017/2018 to 2019/2020 on users receiving publicly funded long-term support including domiciliary and other community-based social care, as well as residential and nursing care from local authorities responsible for ASC. We employ the two-stage least square method to estimate the impact of ASC expenditure on CRQoL at various levels of ASC expenditure in each financial year. This includes the CRQoL effect of increasing expenditure from zero to some level, which captures the effect of extending ASC eligibility to new users.

RESULTS: We find that publicly funded ASC improves the CRQoL of both existing and newly eligible users, although the latter are likely to experience greater CRQoL gains. Moreover, from 2017/2018 to 2019/2020, spending as much as an average user for a newly eligible user costs between £54 224 and £77 778 per social care-quality-adjusted life year (SC-QALY) gained. These results are statistically significant at the 5% level. Compared with this finding, increasing expenditure for an existing user has always a higher cost per SC-QALY gained.

CONCLUSIONS: Extending ASC eligibility to new users is likely to be more cost-effective compared with using the same resources to increase expenditure for existing users.

PMID:37696632 | DOI:10.1136/bmjopen-2022-070833

J Neurointerv Surg. 2023 Sep 11:jnis-2023-020927. doi: 10.1136/jnis-2023-020927. Online ahead of print.

NO ABSTRACT

PMID:37696595 | DOI:10.1136/jnis-2023-020927

BMJ Glob Health. 2023 Sep;8(9):e013101. doi: 10.1136/bmjgh-2023-013101.

ABSTRACT

OBJECTIVE: To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education.

METHODS: The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ² test was performed to determine the association between gender and different violence forms.

RESULTS: A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance.

CONCLUSION: This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

PMID:37696546 | DOI:10.1136/bmjgh-2023-013101

Ecol Lett. 2023 Sep 11. doi: 10.1111/ele.14305. Online ahead of print.

ABSTRACT

Ecologists have long sought to understand variation in food chain length (FCL) among natural ecosystems. Various drivers of FCL, including ecosystem size, resource productivity and disturbance, have been hypothesised. However, when results are aggregated across existing empirical studies from aquatic ecosystems, we observe mixed FCL responses to these drivers. To understand this variability, we develop a unified competition-colonisation framework for complex food webs incorporating all of these drivers. With competition-colonisation tradeoffs among basal species, our model predicts that increasing ecosystem size generally results in a monotonic increase in FCL, while FCL displays non-linear, oscillatory responses to resource productivity or disturbance in large ecosystems featuring little disturbance or high productivity. Interestingly, such complex responses mirror patterns in empirical data. Therefore, this study offers a novel mechanistic explanation for observed variations in aquatic FCL driven by multiple environmental factors.

PMID:37696523 | DOI:10.1111/ele.14305

J Am Pharm Assoc (2003). 2023 Sep 9:S1544-3191(23)00294-7. doi: 10.1016/j.japh.2023.09.002. Online ahead of print.

ABSTRACT

BACKGROUND: Inpatient hypoglycemia is associated with increased morbidity and mortality. After a hypoglycemic event, the likelihood of additional episodes increases. The Joint Commission recommends evaluating all episodes of hypoglycemia for root-cause analysis. Studies have shown that pharmacists’ involvement with glycemic control protocols can prevent hypoglycemia.

OBJECTIVES: To assess whether the implementation of pharmacists’ real-time assessment of hypoglycemic events using an electronic alert messaging system contributes to the reduction of the number of recurrent hypoglycemia during hospitalization.

PRACTICE DESCRIPTION: A community hospital that provides a wide range of healthcare services. The pharmacy department provides fully decentralized clinical services as well as team-based specialist services.

PRACTICE INNOVATION: The pharmacist-led hypoglycemia stewardship initiative included a comprehensive review of hypoglycemic alerts received via an automated message. The alerts generated in the EHR every time a patient’s blood glucose resulted in less than 70mg/dL if there was a documented administration of a hypoglycemic agent 48 hours prior to the hypoglycemia event. Once the alert was received by the pharmacists via an EHR in-basket, a real time review was conducted to identify the potential causes of the event and opportunities for therapy modification.

EVALUATION METHODS: A single-center retrospective observational study including a pre and post-implementation phase from January 1st to June 30th, 2020 and January 1st to June 30th, 2021 respectively. Continuous data was analyzed using paired and equal variance t-test. Non-continuous data was analyzed using Fischer exact and chi-square test. Descriptive statistics were used to describe distribution and frequency of data.

RESULTS: There was a 5.1% absolute reduction in recurrent hypoglycemic events (p<0.001) and a 0.6% reduction of severe hypoglycemic days (p=0.269 in the post-implementation group). The average time to pharmacist intervention was 4 (+ 3.5) hours with a 92% acceptance rate.

CONCLUSION: This study demonstrated the utility of pharmacist-led hypoglycemia reviews in the reduction of recurrent hypoglycemic events in the inpatient setting.

PMID:37696492 | DOI:10.1016/j.japh.2023.09.002

World Neurosurg. 2023 Sep 9:S1878-8750(23)01288-3. doi: 10.1016/j.wneu.2023.09.020. Online ahead of print.

ABSTRACT

The topic of current research is the development of a new approach to the diagnosis and treatment tactics of severe brain injury, considering its main pathophysiological mechanism – intracranial hypertension syndrome. Transcranial doppler imaging is a perspective method, which allows quick and noninvasive assessment of the intracerebral blood flow dynamics right at the patient’s bedside. Due to the operator-dependent nature of this method, clinical interpretation can often be contradictory. As a result, no clear criteria for therapy correction have yet been formulated based on this neuroimaging method. This predefines the goal of the study – to identify Doppler patterns of unfavorable craniocerebral injury conditions to form a consistent algorithm of treatment measures on their basis, which will reduce secondary brain damage in patients with severe craniocerebral trauma. Analysis of the therapy performed allowed authors to specify the options for the hyperosmolar solutions for the correction of IIH syndrome and demonstrated no statistically significant difference in effectiveness between mannitol and hypertonic saline solutions.

PMID:37696434 | DOI:10.1016/j.wneu.2023.09.020

J Vasc Interv Radiol. 2023 Sep 9:S1051-0443(23)00663-2. doi: 10.1016/j.jvir.2023.09.007. Online ahead of print.

ABSTRACT

PURPOSE: To develop a reproducible in vitro model simulating central venous catheter (CVC) exchange with high potential for air embolization and test the hypothesis that a closed catheter clamp over Glidewire exchange technique will significantly reduce the volume of air introduced during CVC exchange.

MATERIALS & METHODS: The model consisted of a 16 Fr valved sheath, 240 mL container, and pressure transducer submerged in water in a 1200 mL suction canister system. Continuous wall suction was applied to the canister to maintain negative pressure at-7 mmHg or -11 mmHg. Each trial consisted of 0.035″ hydrophilic Glidewire introduction, over-the-wire catheter exchange, and wire removal following clinical protocol. A total of 256 trials were performed, 128 trials at each pressure with the catheter clamp open (n = 64) or closed (n = 64) around the Glidewire.

RESULTS: There was a statistically significant lower volume of air introduced with closed clamp over-the-wire exchanges compared to open clamp exchanges at both pressures (two-tailed t-test, p < 0.001). At -7 mmHg, 48.0 mL ± 9.3 of air was introduced with open clamp and 20.6 mL ± 4.7 with closed clamp. At -11 mmHg, 97.8 mL ± 11.9 of air was introduced with open clamp and 37.8 mL ± 6.3 with closed clamp.

CONCLUSION: This study demonstrates the use of a reproducible in vitro model mimicking conditions causing air embolism during CVC exchange. Results show that CVC exchange using closed catheter clamp over Glidewire exchange technique significantly reduces the volume of air introduced per exchange.

PMID:37696430 | DOI:10.1016/j.jvir.2023.09.007

Hellenic J Cardiol. 2023 Sep 9:S1109-9666(23)00155-0. doi: 10.1016/j.hjc.2023.09.006. Online ahead of print.

ABSTRACT

BACKGROUND: – Tricuspid regurgitation (TR) adversely affects prognosis following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a risk stratification tool for patients undergoing TEER for mitral regurgitation while exhibiting significant TR.

METHODS: – This is a single-center, retrospective analysis of 217 consecutive individuals referred to an isolated mitral TEER who had moderate-to-severe or greater TR at baseline. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75%-to-25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset.

RESULTS: – Overall, 81 (37.3%) patients experienced the primary outcome. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-to-3 scale, in which each point represented one of three baseline variables independently associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and cardiac implantable electronic device (CIED). C-statistic of the model was 0.66 (95% CI, 0.57-0.75, p=0.002) and 0.75 (95% CI, 0.61-0.89, p=0.004) in the train and test datasets, respectively – representing comparable performance to current, more complex tools. Neither this BNP-RV-CIED (BRC) score nor other models were prognostically meaningful in 32 patients excluded from the main analysis who underwent a combined mitral-tricuspid TEER.

CONCLUSION: – The BRC score is a simple clinical prediction tool that may aid in the triage of isolated mitral TEER candidates with significant pre-existing TR.

PMID:37696418 | DOI:10.1016/j.hjc.2023.09.006