Tag: statistics

Pediatr Infect Dis J. 2023 Sep 7. doi: 10.1097/INF.0000000000004090. Online ahead of print.

ABSTRACT

BACKGROUND: In Europe, influenza vaccination coverage in the pediatric population is low. This study describes the influenza incidence and associated healthcare utilization in the pediatric population in Italy.

METHODS: Deidentified data from electronic medical records for children 0-14 years old seen by >150 family pediatricians in the Pedianet network in Italy were evaluated for 10 influenza seasons spanning 2010-2020. Incidence of influenza (cases per 1000 person-months), related sequelae and associated healthcare resource use were determined using diagnostic, prescription and medical examination data.

RESULTS: Over 10 seasons, an average of 8892 influenza cases (range, 4700-12,419; total 88,921) were diagnosed in a cohort of 1,432,384 children 0-14 years of age. Influenza vaccination coverage was 3.6% among children with an influenza diagnosis and 6.8% among children without. Influenza-related healthcare resource utilization included 1.58 family pediatrician visits per influenza episode and 220 ED and 111 hospital admissions, with the highest resource usage among children 1-4 years and lowest among children <6 months old. The most common influenza complications were acute otitis media (2.9% of influenza cases) and pneumonia (0.5%). Antibiotics were prescribed in 38.7% of influenza cases; no antiviral agents were prescribed. One intensive care unit admission and 2 cases requiring ventilatory support were documented. No influenza-related deaths were reported.

CONCLUSION: Pediatric influenza vaccination was low despite the burden and healthcare use related to seasonal influenza in the pediatric population during a 10-year period in Italy.

PMID:37725811 | DOI:10.1097/INF.0000000000004090

Pediatr Infect Dis J. 2023 Sep 7. doi: 10.1097/INF.0000000000004097. Online ahead of print.

ABSTRACT

BACKGROUND: While infections caused by rhinoviruses and enteroviruses are common among children, the entirety of their clinical impact remains elusive. We compared the clinical outcomes of children with rhinovirus/enterovirus infections to other common respiratory viruses in outpatient settings.

METHODS: We conducted a retrospective analysis of nasopharyngeal samples singly positive for human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU) or respiratory syncytial virus (RSV) from patients ≤17 years submitted for clinical testing via multiplex polymerase chain reaction between 2016 and 2019. We evaluated the following outpatient outcomes: days of respiratory symptoms before testing; visits for respiratory symptoms; receipt of a breathing treatment; receipt of antibiotics and hospital admission. Statistical analyses were conducted controlling for age and comorbid conditions.

RESULTS: There were 1355 positive samples included in this analysis (HRV/ENT: n = 743, FLU: n = 303 and RSV: n = 309). Compared to HRV/ENT, children with FLU had 28% fewer days of respiratory symptoms (β: -0.32; 95% confidence interval: -0.46 to -0.18; P < 0.001), fewer visits for respiratory symptoms, and significantly decreased odds of receiving a breathing treatment or antibiotics, and admission to the hospital. Children with RSV had a similar number of days of respiratory symptoms, outpatient visits and odds of hospital admission, but significantly increased odds of receiving a breathing treatment and antibiotics compared to those with HRV/ENT.

CONCLUSION: Clinicians should have a high level of vigilance when managing children with positive respiratory viral testing for HRV/ENT given the potential for clinical outcomes similar to and, in some instances, worse than known highly pathogenic viruses.

PMID:37725805 | DOI:10.1097/INF.0000000000004097

J Glaucoma. 2023 Sep 13. doi: 10.1097/IJG.0000000000002310. Online ahead of print.

ABSTRACT

PRCIS: Capillary and neuronal tissue loss occur both globally and with regional specificity in pre-perimetric glaucoma patients at the level of the optic nerve and macula, with perifovea regions affected earlier than parafovea areas.

PURPOSE: To investigate optic nerve head (ONH) and macular vessel densities (VD) and structural parameters assessed by optical coherence tomography angiography (OCTA) in pre-perimetric open-angle glaucoma (ppOAG) patients and healthy controls.

METHODS: 113 healthy and 79 ppOAG patients underwent global and regional (hemispheric/quadrants) assessments of retinal, ONH, and macular vascularity and structure, including ONH parameters, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness. Comparisons between outcomes in ppOAG and controls were adjusted for age, sex, race, BMI, diabetes, and hypertension, with P<0.05 considered statistically significant.

RESULTS: In ppOAG compared to healthy controls: RNFL thicknesses was statistically significantly lower for all hemispheres, quadrants and sectors (P<0.001-0.041); whole image peripapillary all and small blood vessels VD were statistically significantly lower for all the quadrants (P<0.001-0.002), except for the peripapillary small vessels in the temporal quadrant (ppOAG: 49.66 (8.40), healthy: 53.45 (4.04); P=0.843); GCC and inner and full macular thicknesses in the parafoveal and perifoveal regions were significantly lower in all the quadrants (P=0.000-P=0.033); several macular VD were significantly lower (P=0.006-0.034), with the exceptions of macular center, parafoveal superior and inferior quadrant, and perifoveal superior quadrant (P>0.05).

CONCLUSIONS: In ppOAG patients, VD biomarkers in both the macula and ONH, alongside RNFL, GCC, and macular thickness were significantly reduced prior to detectable VF loss with regional specificity. The most significant VD reduction detected was in the peripheric (perifovea) regions. Macular and ONH decrease in VD may serve as early biomarker of glaucomatous disease.

PMID:37725789 | DOI:10.1097/IJG.0000000000002310

Chem Res Toxicol. 2023 Sep 19. doi: 10.1021/acs.chemrestox.3c00197. Online ahead of print.

ABSTRACT

Cigarette smoking is an established cause of chronic obstructive pulmonary disease (COPD). Numerous studies implicate acrolein, which occurs in relatively high concentrations in cigarette smoke and reacts readily with proteins, as one causative factor for COPD in smokers. Far less is known about the possible roles in COPD of the related α,β-unsaturated carbonyl compounds of cigarette smoke crotonaldehyde, methacrolein, and methyl vinyl ketone. In the study reported here, we analyzed mercapturic acids of these α,β-unsaturated compounds in the urine of 413 confirmed cigarette smokers in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)─202 with COPD and 211 without COPD. The mercapturic acids analyzed were 3-hydroxypropyl mercapturic acid (3-HPMA) from acrolein, 3-hydroxy-1-methylpropyl mercapturic acid (HMPMA-1) from crotonaldehyde, 3-hydroxy-2-methylpropyl mercapturic acid (HMPMA-2) from methacrolein, and 3-hydroxy-3-methylpropyl mercapturic acid (HMPMA-3) from methyl vinyl ketone. In models adjusting for age, sex, race, pack years of tobacco use, and BMI, all four mercapturic acids were increased in individuals with COPD but not significantly. Stratified by the GOLD status, there were increased levels of the metabolites associated with GOLD 3-4 compared to that with GOLD 0, with the methacrolein metabolite HMPMA-2 reaching statistical significance (adjusted odds ratio 1.23 [95% CI: 1.00-1.53]). These results highlight the possible role of methacrolein, which has previously received little attention in this regard, as a causative factor in COPD in cigarette smokers.

PMID:37725788 | DOI:10.1021/acs.chemrestox.3c00197

J Glaucoma. 2023 Sep 12. doi: 10.1097/IJG.0000000000002311. Online ahead of print.

ABSTRACT

PRCIS: Significant reductions in IOP and number of medications are sustained up to 6 years postoperatively for eyes that underwent ab-interno canaloplasty using the iTrack microcatheter, either as a standalone procedure or combined with cataract surgery.

PURPOSE: To evaluate the long-term effectiveness of iTrack (Nova Eye Medical, Inc.) ab-interno canaloplasty for reducing intraocular pressure (IOP) and number of glaucoma medications in patients with primary open-angle (POAG) and pseudoexfoliative (PEX) glaucoma.

METHODS: A retrospective single-center consecutive case series. Patients were treated with either ab-interno canaloplasty performed as a standalone procedure, or combined with cataract surgery, and were followed for up to 6 years. iTrack was used to circumferentially catheterize and viscodilate Schlemm’s canal over 360°. Primary efficacy endpoints included intraocular pressure (IOP) and number of glaucoma medications at 12, 24, 36, 48, 60, and 72 months after surgery.

RESULTS: 27 eyes of 22 patients, with a mean age of 76.9±6.3 years, were recruited. Mean IOP was reduced significantly from 19.9±5.2 mmHg (n=27) at baseline (no washout) to 14.6±3.3 mmHg at the 6-year follow-up (n=18; P<0.001). The number of medications was significantly reduced from 1.9±1 at baseline to 0.9±0.9 at 6 years (n=18; P=0.005). At all timepoints there was no statistical difference between POAG (n=16) and PEX (n=11) eyes, nor between standalone procedures (n=4) and those combined with phacoemulsification (n=23). At 72 months, the mean reduction in IOP was 27% while 53% in the number of medications. No serious complications were recorded.

CONCLUSION: iTrack ab-interno canaloplasty performed as a standalone procedure, or in combination with cataract surgery, significantly reduced IOP and number of medications in patients with POAG up to 6 years after the procedure. To the authors’ knowledge, this is the longest ab-interno canaloplasty follow-up available in the literature.

PMID:37725787 | DOI:10.1097/IJG.0000000000002311

Fam Med. 2023 Sep 13. doi: 10.22454/FamMed.2023.973082. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Research on preparedness for independent clinical practice typically uses surveys of residents and program directors near graduation, which can be affected by several biases. We developed a novel approach to assess new graduates more objectively using physician and staff member assessors 3 months after graduates started their first job.

METHODS: We conducted a literature review and key informant interviews with physicians from varying practice types and geographic regions in the United States to identify features that indicate a lack of preparedness for independent clinical practice. We then held a Clinical Preparedness Measurement Summit, engaging measurement experts and family medicine education leaders, to build consensus on key indicators of readiness for independent clinical practice and survey development strategies. The 2015 entrustable professional activities for family medicine end-of-residency training provided the framework for assessment of clinical preparedness by physician assessors. Sixteen published variables assessing interpersonal communication skills and processes of care delivery were identified for staff assessors. We assessed frequencies and compared survey findings between physician and staff assessors in 2016 to assist with survey validation.

RESULTS: The assessment of frequencies demonstrated a range of responses, supporting the instrument’s ability to distinguish readiness for independent practice of recent graduate hires. No statistical differences occurred between the physician and staff assessors for the same physician they were evaluating, indicating internal consistency.

CONCLUSIONS: To learn about the possible impact of length of training, we developed a novel approach to assess preparedness for independent clinical practice of family medicine residency graduates.

PMID:37725776 | DOI:10.22454/FamMed.2023.973082

Fam Med. 2023 Sep 11. doi: 10.22454/FamMed.2023.261011. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Improving training and confirming the acquisition of gynecological procedure skills for family physicians (FPs) is crucial for safe health care delivery. The objectives of this study were to (a) develop performance rating instruments for four gynecological procedures, and (b) pilot them to provide preliminary validity evidence using modern validity theory.

METHODS: Sixteen academic FPs and gynecologists participated in a modified Delphi technique to develop procedure-specific checklists (PSCs) for four procedures: intrauterine device insertion, endometrial biopsy, punch biopsy of the vulva, and routine pessary care. We modified a previously validated global rating scale (GRS) for ambulatory settings. Using prerecorded videos, 19 academic FPs piloted instruments to rate one first-year and one second-year family medicine resident’s performance. They were blinded to the level of training. We compared the mean scores for PSCs and GRS for each procedure using paired samples t tests and Cohen’s d to estimate effect sizes.

RESULTS: Consensus on items for the final PSCs was reached after two Delphi rounds. PSC and GRS scores were numerically higher for the second-year resident than the first-year resident for every procedure, with statistically significant differences for six of eight comparisons (P&lt;.05). All comparisons demonstrated large effect sizes (Cohen’s d&gt;0.8). Both instruments received high scores for ease of use by raters.

CONCLUSIONS: We developed novel performance rating instruments for four gynecological procedures and provided preliminary validity evidence for their use for formative feedback in a simulation setting. This pilot study suggests that these instruments may facilitate the training and documentation of family medicine trainees’ skills in gynecological procedures.

PMID:37725774 | DOI:10.22454/FamMed.2023.261011

Fam Med. 2023 Sep 11. doi: 10.22454/FamMed.2023.346131. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Most research in residency training has focused on quality improvement within a single program. We explored resident involvement in curricular and clinical practice change, the learning environment, and resident satisfaction in 3-year family medicine residencies compared to matched 4-year residencies.

METHODS: We used two surveys to capture data. One was for program directors, which assessed the level of resident involvement in curricular and practice transformation. The second was a resident survey, which asked residents to rate their involvement in curricular change and practice transformation, the learning environment, and satisfaction with training. Both were administered annually between 2013 and 2019. Response rates ranged from 84.6% to 100%.

RESULTS: Findings revealed no overall difference in resident involvement in curricular change, but the program director survey findings indicated that a higher proportion of residents in 4-year programs were using a broader diversity of approaches to working on quality improvement (QI) projects compared to those in 3-year programs. We also found statistical differences in the number of QI projects completed per year, with 34.1% completing three or more in 4-year programs compared to 13.3% in 3-year programs (P&lt;.001). We found a positive correlation between resident involvement, learning environment, and satisfaction with training for both 3-year (range 0.489-0.666; P=.001) and 4-year residents (range 0.441-0.529; P=.001).

CONCLUSIONS: Four-year residents were involved in a greater number of quality improvement projects and had a more diverse profile of involvement than those in 3-year residency programs. Involvement in practice and curricular change and the learning environment were associated with greater levels of resident satisfaction with training in both 3-year and 4-year programs.

PMID:37725772 | DOI:10.22454/FamMed.2023.346131

Fam Med. 2023 Sep 8. doi: 10.22454/FamMed.2023.914274. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Social and structural factors play a critical role in driving inequitable health outcomes, resulting in the need for undergraduate medical education to include important care components such as team-based care to address social determinants of health. Research shows that learning strategies such as case-based initiatives are valuable opportunities to impact knowledge of population health, health disparities, and social determinants that impact care. The purpose of this study was to assess the impact of a clinical case-based experience on medical students’ self-efficacy and future intent to use the team-based care necessary to address social determinants of health.

METHODS: We used a retrospective analysis of program data from 640 third-year medical students who engaged in a case-based experience and small-group debriefing around the impact of team-based care and social determinants of health on patient care during their family medicine clerkship between July 2020 and April 2022.

RESULTS: We found a statistically significant improvement in students’ reported self-efficacy and intent to collaborate with other health care workers (team-based care) to address patient care needs in rural and urban underserved community settings.

CONCLUSIONS: Our students reported that a case-based experience coupled with a small-group debriefing was an effective method for teaching them how to use a team-based approach to address social determinants of health.

PMID:37725770 | DOI:10.22454/FamMed.2023.914274

Ultrasound Obstet Gynecol. 2023 Sep 19. doi: 10.1002/uog.27485. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the performance of two-dimensional ultrasound (2D-US) three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) at 36 weeks of gestation (WG) in the prediction of Large-for-Gestational-Age (LGA) fetuses defined as birthweight > 95^th percentile in a high- and low-risk groups for macrosomia.

METHODS: This was a prospective observational study conducted between January 2017 and February 2019. Women with singleton pregnancy at 36 WG underwent simultaneously 2D-US, 3D-US, and MRI. By plotting the weight estimations and the birthweight on the growth curve, a percentile was obtained, and it was used for comparison. The study population was divided into high- and low-risk groups, according to at least one of the following risk factors: the presence of diabetes, suspicion of macrosomia during the third trimester (> 90^th percentile at the ultrasound routine scan), obesity (body mass index, BMI, > 30 kg/m² ), and excessive weight gain. The outcome was the measurement of the performance of each diagnostic modality in the prediction of birthweight > 95^th percentile. Statistical analysis was performed by calculating the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive and negative predictive values for each modality.

RESULTS: Out of 988 patients, 965 were eligible: 533 (55.23%) in the high-risk group and 432 (44.77%) in the low-risk group. In the low-risk group, the AUCs were 0.982 for MRI, 0.964 for 2D-US, and 0.962 for 3D-US. No statistical significance was found among these three methods. In the high-risk group, the AUCs were 0.959 for MRI, 0.909 for 2D-US, and 0.894 for 3D-US. A statistically significant difference between MRI and both 2D-US (p = 0.002) and 3D-US (p = 0.002) was found. MRI had the highest sensitivity (65.79%) compared with both 2D-US (36.84%) and 3D-US (21.05%) ultrasound (p = 0.002 and p < 0.001, respectively). The 3D-US had the highest specificity (98.99%) compared to both methods (2D-US: 96.77%, p = 0.005, and MRI: 96.97%, p = 0.004).

CONCLUSION: At 36 WG, MRI performs better than 2D-US and 3D-US in predicting birthweight > 95^th percentile at birth, especially in patients at high-risk for macrosomia, while 2D-US and 3D-US are comparable. For low-risk patients, the three modalities perform similarly. This article is protected by copyright. All rights reserved.

PMID:37725758 | DOI:10.1002/uog.27485