Tag: statistics

J Breast Imaging. 2022 Apr 15;4(2):168-176. doi: 10.1093/jbi/wbab095.

ABSTRACT

OBJECTIVE: To assess whether changes in quantitative parameters on breast MRI better predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer than change in volume.

METHODS: This IRB-approved retrospective study included women with newly diagnosed breast cancer who underwent 3T MRI before and during NAC from January 2013 to December 2019 and underwent surgery at our institution. Clinical data such as age, histologic diagnosis and grade, biomarker status, clinical stage, maximum index cancer dimension and volume, and surgical pathology (presence or absence of in-breast pCR) were collected. Quantitative parameters were calculated using software. Correlations between clinical features and MRI quantitative measures in pCR and non-pCR groups were assessed using univariate and multivariate logistic regression.

RESULTS: A total of 182 women with a mean age of 52 years (range, 26-79 years) and 187 cancers were included. Approximately 45% (85/182) of women had pCR at surgery. Stepwise multivariate regression analysis showed statistical significance for changes in quantitative parameters (increase in time to peak and decreases in peak enhancement, wash out, and Kep [efflux rate constant]) for predicting pCR. These variables in combination predicted pCR with 81.2% accuracy and an area under the curve (AUC) of 0.878. The AUCs of change in index cancer volume and maximum dimension were 0.767 and 0.613, respectively.

CONCLUSION: Absolute changes in quantitative MRI parameters between pre-NAC MRI and intra-NAC MRI could help predict pCR with excellent accuracy, which was greater than changes in index cancer volume and maximum dimension.

PMID:38422427 | DOI:10.1093/jbi/wbab095

J Breast Imaging. 2022 Apr 15;4(2):161-167. doi: 10.1093/jbi/wbab100.

ABSTRACT

OBJECTIVE: This study assessed mentorship interest within the breast radiologist community to guide development of a mentorship program through the Society of Breast Imaging (SBI).

METHODS: A 19-question survey developed by the SBI mentorship committee was distributed electronically to its members March 16, 2021, to May 7, 2021, to gauge interest in forming a society-sponsored mentorship program. Responses were analyzed, with subgroups compared using chi-square analysis.

RESULTS: There was an 18% response rate (598/3277), and 65% (381/588) professed interest in an SBI-sponsored mentorship. Respondents were evenly distributed between academic (241/586, 41%) and private practice (242/586, 41%). Most were breast imaging fellowship-trained (355/593, 60%) and identified as female (420/596, 70%). For practice years, 50% (293/586) were late career (11+ years) with the remainder early-mid career (201/586, 34%) or trainees (92/586, 16%). For mentorship content areas, work/life balance was the most popular choice (275/395, 70%) followed by leadership (234/395, 59%). Most respondents were not currently mentors (279/377, 74%) or mentees (284/337, 84%). Those interested in a mentorship relationship were statistically younger (<45 years old, 234/381, 61% vs 31/207, 15%, P < 0.00001), female (289/381, 76% vs 123/207, 59%, P = 0.00003), academics (189/381, 50% vs 48/207, 23%, P < 0.00001), identified as a racial/ethnic minority (138/381, 64% vs 121/297, 15%, P < 0.00001), and fellowship-trained (262/381, 69% vs 88/207, 43%, P < 0.00001).

CONCLUSION: There is demand, especially among the society’s young and minority members, for an SBI-sponsored mentorship program. Work/life balance and leadership were the most popular choices for guidance.

PMID:38422426 | DOI:10.1093/jbi/wbab100

J Infus Nurs. 2024 Mar-Apr 01;47(2):120-131. doi: 10.1097/NAN.0000000000000538.

ABSTRACT

Complications of peripheral intravenous catheters (PIVCs) remain a major contributor to health care costs and are a patient safety problem. The objective of this cross-sectional descriptive study was to examine the prevalence of complications and factors associated with complications from peripheral intravenous fluid administration. The study was conducted at a tertiary care hospital in Thailand. The instruments were developed from the literature review. Data were analyzed using SPSS statistics, version 22. The study examined 441 patients with a total of 497 PIVC sites. Phlebitis (level 1 and 2 only) occurred at 2.41% of all sites; infiltration (level 1 and 2 only) occurred at 1.01% of all sites, and extravasation (mild and moderate only) occurred at 0.60% of all sites. Factors associated with the occurrence of infiltration complications included receiving intravenous (IV) crystalloids (P = .03) and receiving IV analgesic drugs (P = .001). Age was statistically significantly related to extravasation complications (P = .001). Nurses should be aware of possible complications from peripheral intravenous fluid administration, especially in older patients and those receiving IV crystalloids or analgesic drugs.

PMID:38422405 | DOI:10.1097/NAN.0000000000000538

J Infus Nurs. 2024 Mar-Apr 01;47(2):108-119. doi: 10.1097/NAN.0000000000000539.

ABSTRACT

Peripheral intravenous cannulation and venipuncture are among the most common invasive procedures in health care and are not without risks or complications. The aim of this study was to evaluate the current training provided to nursing and midwifery undergraduate students. Student knowledge, attitude, practice, and performance regarding these procedural skills were assessed. A knowledge, attitude, and practices survey was disseminated to final year nursing and midwifery students as the first phase of this study. For the second phase of the study, nursing students were video recorded and then observed performing the skill of peripheral intravenous cannulation in a simulated environment. Thirty-eight nursing and midwifery students completed the survey, and 66 nursing students participated in the observation study. Descriptive statistics were performed. The mean knowledge score was 7.2 out of 15.0, (standard deviation [SD] = 2.4), and the mean attitude score was 10.20 out of 18.00 (SD = 4.79). Qualitative data from the survey were categorized to demonstrate specific areas of focus for improving the training. The mean performance score was 16.20 out of 28.00 (SD = 2.98). This study provides valuable input to developing and enhancing evidence-based curricula. It can help educators and supervisors, in both academic and clinical settings, identify areas where clinical performance and education could be enhanced.

PMID:38422404 | DOI:10.1097/NAN.0000000000000539

J Infus Nurs. 2024 Mar-Apr 01;47(2):75-95. doi: 10.1097/NAN.0000000000000540.

ABSTRACT

Ultrasound-guided insertion of peripheral intravenous catheters (PIVCs) is recommended for patients with difficult intravenous access, but access to ultrasound equipment is often limited to specialty departments. Compact, affordable handheld ultrasound devices are available, but the extent of their clinical adoption and impact on patient outcomes is unknown. This scoping review aimed to explore evidence regarding handheld and pocket ultrasound devices for PIVC insertion. Databases were searched for studies published in English between January 2000 and January 2023 evaluating handheld or pocket ultrasound devices weighing ≤3 kg for PIVC insertion. Data were extracted using standardized forms and summarized using descriptive statistics. Seventeen studies reporting the use of handheld or pocket ultrasound devices were identified. Most studies were conducted in adult inpatient facilities; 3 included pediatrics, and 2 reported out-of-hospital use. Participants with difficult intravenous access featured in 9 studies. Ultrasound training programs were described in 12 studies, with competency defined by number of successful PIVC insertions. Five studies reported clinician and/or patient perspectives. Ultrasound for PIVC insertion is not widely accessible in nonspecialist areas, but more compact and affordable handheld models could provide a solution, especially for patients with difficult access. More research evidence using handheld ultrasound is needed.

PMID:38422403 | DOI:10.1097/NAN.0000000000000540

Arq Bras Oftalmol. 2024 Feb 23;87(2):e20230038. doi: 10.5935/0004-2749.2023-0038. eCollection 2024.

ABSTRACT

PURPOSE: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency.

METHODS: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated.

RESULTS: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator’s cataract challenges (p<0.696).

CONCLUSION: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic.

PMID:38422361 | DOI:10.5935/0004-2749.2023-0038

Arq Bras Oftalmol. 2024 Feb 23;87(2):e20230028. doi: 10.5935/0004-2749.2023-0028. eCollection 2024.

ABSTRACT

PURPOSE: Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Müller’s muscle conjunctival resection surgery in unilateral ptosis.

METHODS: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Müller’s muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position’s mean distance was compared preoperatively, postoperatively, and with the fellow eyelid.

RESULTS: Sixteen patients underwent external levator advancement and 16 patients had Müller’s muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Müller’s muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11).

CONCLUSIONS: Both techniques provide effective lid elevation, however, the external levator advancement’s effect lessens toward the canthi while Müller’s muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.

PMID:38422360 | DOI:10.5935/0004-2749.2023-0028

Arq Bras Oftalmol. 2024 Feb 23;87(2):e20210435. doi: 10.5935/0004-2749.2021-0435. eCollection 2024.

ABSTRACT

PURPOSE: This study aimed to analyze the association between magnetic resonance imaging apparent diffusion coefficient map value and histopathological differentiation in patients who underwent eye enucleation due to retinoblastomas.

METHODS: An observational chart review study of patients with retinoblastoma that had histopathology of the lesion and orbit magnetic resonance imaging with apparent diffusion coefficient analysis at Hospital de Clínicas de Porto Alegre between November 2013 and November 2016 was performed. The histopathology was reviewed after enucleation. To analyze the difference in apparent diffusion coefficient values between the two major histopathological prognostic groups, Student’s t-test was used for the two groups. All statistical analyses were performed using SPSS version 19.0 for Microsoft Windows (SPSS, Inc., Chicago, IL, USA). Our institutional review board approved this retrospective study without obtaining informed consent.

RESULTS: Thirteen children were evaluated, and only eight underwent eye enucleation and were included in the analysis. The others were treated with photocoagulation, embolization, radiotherapy, and chemotherapy and were excluded due to the lack of histopathological results. When compared with histopathology, magnetic resonance imaging demonstrated 100% accuracy in retinoblastoma diagnosis. Optic nerve invasion detection on magnetic resonance imaging showed a 66.6% sensitivity and 80.0% specificity. Positive and negative predictive values were 66.6% and 80.0%, respectively, with an accuracy of 75%. In addition, the mean apparent diffusion coefficient of the eight eyes was 0.615 × 103 mm2/s. The mean apparent diffusion coefficient value of poorly or undifferentiated retinoblastoma and differentiated tumors were 0.520 × 103 mm2/s and 0.774 × 103 mm2/s, respectively.

CONCLUSION: This study revealed that magnetic resonance imaging is useful in the diagnosis of retinoblastoma and detection of optic nerve infiltration, with a sensitivity of 66.6% and specificity of 80%. Our results also showed lower apparent diffusion coefficient values in poorly differentiated retinoblastomas with a mean of 0.520 × 103 mm2/s, whereas in well and moderately differentiated, the mean was 0.774 × 103 mm2/s.

PMID:38422355 | DOI:10.5935/0004-2749.2021-0435

Arq Bras Cardiol. 2024 Feb 26;121(1):e20230214. doi: 10.36660/abc.20230214. eCollection 2024.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) frequently coexist, resulting in adverse outcomes. However, controversies remain regarding the efficacy of catheter ablation (CA) in AF patients with severe left ventricular dysfunction.

OBJECTIVES: The purpose of this study was to perform a meta-analysis of prospective randomized controlled trials to evaluate the efficacy of CA versus medical therapy (MT) in AF patients with left ventricular ejection fraction (LVEF) ≤45%.

METHODS: We searched the literature for studies that compared CA to MT in AF patients with LVEF ≤45%. A meta-analysis of 7 clinical trials was performed, including 1163 patients with AF and HF. Subgroup analysis was performed based on baseline LVEF. All tests were 2-sided; only the p-value <0.05 was considered statistically significant.

RESULTS: We found that CA was associated with lower all-cause mortality (risk ratio: 0.52, 95% CI: 0.37 to 0.72; p<0.01) and greater improvements in LVEF (mean difference: 4.80%, 95% CI: 2.29% to 7.31%; p<0.01) compared to MT. Patients in the CA group had a lower risk of HF hospitalization and AF recurrence and a significantly better quality of life than those in the MT group. The results of subgroup analysis indicated that patients with milder left ventricular dysfunction improved LVEF after AF ablation (mean difference: 6.53%, 95% CI: 6.18% to 6.88%; p<0.01) compared to patients with more severe disease (mean difference: 2.02%, 95% CI: 0.87% to 3.16%; p<0.01).

CONCLUSIONS: Our meta-analysis demonstrated that CA was associated with significant improvements in outcomes of AF patients with LVEF ≤45%. Additionally, AF patients with milder left ventricular dysfunction could benefit more from CA.

PMID:38422349 | DOI:10.36660/abc.20230214

J Med Internet Res. 2024 Feb 27. doi: 10.2196/47125. Online ahead of print.

ABSTRACT

BACKGROUND: The adoption of predictive algorithms in healthcare comes with the potential for algorithmic bias, which could exacerbate existing disparities. Fairness metrics were proposed to measure algorithmic bias, but the application to real-world tasks is limited.

OBJECTIVE: This study aims to evaluate the algorithmic bias between racial and income groups associated with the application of common 30-day hospital readmission models and assesses the usefulness and interpretability of selected fairness metrics.

METHODS: This retrospective study used 10.6 million adult inpatient discharges from Maryland and Florida from 2016-2019. Models predicting 30-day hospital readmissions were evaluated: LACE Index, modified HOSPITAL score, and modified CMS readmission measure, which was applied “as-is” (using existing coefficients) and “retrained” (recalibrated with 50% of the data). Predictive performances and bias measures were evaluated for all population, and between Black and white populations and between low- and other-income groups. Bias measures included the parity of false negative rate (FNR), false positive rate (FPR), zero-one-loss, and generalized entropy index. Racial bias represented by FNR and FPR differences were stratified by individual hospital and population composition to explore shifts of algorithmic bias in different populations.

RESULTS: The retrained CMS model demonstrated the best predictive performance (AUC: 0.74 in Maryland and 0.68-0.70 in Florida) and modified HOSPITAL score demonstrated the best calibration (Brier score: 0.16-0.19 in Maryland and 0.19-0.21 in Florida) across subpopulations in both states. Calibration was better in white (compared to Black) and other-income (compared to low income) populations; and AUC was higher or similar in Black population (compared to white). Retrained CMS and modified HOSPITAL score had the lowest racial and income bias in Maryland. In Florida, modified HOSPITAL score showed the lowest racial bias; and modified HOSPITAL score and retrained CMS overall had the lowest income bias. In both states, white and higher income patient groups showed a higher FNR while Black and low-income patient groups resulted in a higher FPR and higher zero-one-loss. When stratified by hospital and population composition, these models demonstrated heterogenous algorithmic bias in different context and populations.

CONCLUSIONS: Caution must be taken when interpreting fairness measures’ face value. A higher FNR or FPR could potentially reflect missed opportunities or wasted resources, but these measures could also reflect healthcare utilization patterns and gaps in care. Simply relying on the statistical notions of bias could obscure or underplay the causes of health disparity. The imperfections of health data, analytic frameworks, and the underlying health systems must be carefully considered. Fairness measures can serve as a useful routine assessment to detect disparate model performances but are insufficient to inform mechanisms or policy changes. Such assessment, however, is an important first step toward data-driven improvement to address existing health disparities.

PMID:38422347 | DOI:10.2196/47125