Tag: statistics

Arch Argent Pediatr. 2022 Apr;120(2):111-117. doi: 10.5546/aap.2022.eng.111. Epub 2022 Jan 22.

ABSTRACT

INTRODUCTION: Prescription errors are the most common cause of preventable errors. Electronic prescription (EP) systems may help to reduce errors and improve the quality of care.

OBJECTIVES: To assess the effect of EP on the prevalence of prescription errors and related adverse events (AE) among hospitalized pediatric patients. To assess EP adherence, acceptability, and suitability among users.

METHODS: Hybrid, descriptive, and quasi-experimental, before-and-after design. Prescriptions made to hospitalized patients were included, estimating the prevalence of prescription errors and related AE in the pre- and post- EP implementation periods at a children’s hospital (CH) and a general hospital (GH) used as control. Adherence was assessed based on the proportion of EP among all prescriptions registered in the post-implementation period. The acceptability and suitability of EP implementation was assessed via a user survey.

RESULTS: The prevalence of prescription errors pre- and post-EP implementation at the CH was compared and a statistically significant reduction was observed in both hospitals: CH: 29.1 versus 19.9 prescription errors/100 prescriptions (OR: 1.65; 95% CI: 1.34-2.02; p < 0.01). GH: 24.9 versus 13.6 prescription errors/100 prescriptions (OR: 2.1; 95% CI: 1.5-2.8; p < 0.01). The rate of overall adherence to EP was 83%. The implementation of EP was adequately acceptable and suitable.

CONCLUSION: The prevalence of prescription errors reduced 30% after the implementation of EP. The overall adherence to EP was adequate.

PMID:35338815 | DOI:10.5546/aap.2022.eng.111

Vet Comp Oncol. 2022 Mar 26. doi: 10.1111/vco.12815. Online ahead of print.

ABSTRACT

One radiotherapy (RT) protocol used for canine oral melanoma (OM) gives 36 Gy total, in six weekly or biweekly fractions (6 Gy x 6). This retrospective study characterizes oncologic outcomes for a relatively large group of dogs treated with this protocol and determines whether radiation dose intensity (weekly versus biweekly) affected either progression-free or overall survival (PFS and OS). Dogs were included if 6 Gy x 6 was used to treat grossly-evident OM, or if RT was used postoperatively in the subclinical disease setting. Kaplan-Meier statistics and Cox regression modeling were used to determine the predictive or prognostic value of mitotic count, bony lysis, WHO stage (I, II, III, or IV), using systemic anti-cancer therapies, tumour burden at the time of RT (macroscopic vs. subclinical), radiation dose intensity (weekly versus biweekly), and treatment planning type (manual versus computerized). The median PFS and OS times for all dogs (n = 101) were 171 and 232 days, respectively. On univariate analysis PFS and OS were significantly longer (p = <0.05) with subclinical tumour burden, WHO stages I or II, and weekly irradiation. On multivariable analysis, only tumor stage remained significant; therefore, cases were grouped by WHO stage (I/II versus III/IV). With low WHO stage (I/II), PFS and OS were longer when irradiating subclinical disease (PFS: risk ratio = 0.449, p = 0.032; OS: risk ratio = 0.422, p = 0.022); this was not true for high WHO stage (III/IV). When accounting for other factors, radiation dose intensity had no measurable impact on survival in either staging group.

PMID:35338766 | DOI:10.1111/vco.12815

J Magn Reson Imaging. 2022 Mar 26. doi: 10.1002/jmri.28180. Online ahead of print.

ABSTRACT

BACKGROUND: Acquisition of magnetic resonance first-pass perfusion images is synchronized to the patient’s heart rate (HR) and governs the temporal resolution. This is inherently linked to the process of myocardial blood flow (MBF) quantification and impacts MBF accuracy but to an unclear extent.

PURPOSE: To assess the impact of temporal resolution on quantitative perfusion and compare approaches for accounting for its variability.

STUDY TYPE: Prospective phantom and retrospective clinical study.

POPULATION AND PHANTOM: Simulations, a cardiac perfusion phantom, and 30 patients with (16, 53%) or without (14, 47%) coronary artery disease.

FIELD STRENGTH/SEQUENCE: 3.0 T/2D saturation recovery spoiled gradient echo sequence.

ASSESSMENT: Dynamic perfusion data were simulated for a range of reference MBF (1 mL/g/min-5 mL/g/min) and HR (30 bpm-150 bpm). Perfusion imaging was performed in patients and a phantom for different temporal resolutions. MBF and myocardial perfusion reserve (MPR) were quantified without correction for temporal resolution or following correction by either MBF scaling based on the sampling interval or data interpolation prior to quantification. Simulated data were quantified using Fermi deconvolution, truncated singular value decomposition, and one-compartment modeling, whereas phantom and clinical data were quantified using Fermi deconvolution alone.

STATISTICAL TESTS: Shapiro-Wilk tests for normality, percentage error (PE) for measuring MBF accuracy in simulations, and one-way repeated measures analysis of variance with Bonferroni correction to compare clinical MBF and MPR. Statistical significance set at P < 0.05.

RESULTS: For Fermi deconvolution and an example simulated 1 mL/g/min, the MBF PE without correction for temporal resolution was between 55.4% and -62.7% across 30-150 bpm. PE was between -22.2% and -6.8% following MBF scaling and between -14.2% and -14.2% following data interpolation across the same HR. An interpolated HR of 240 bpm reduced PE to ≤10%. Clinical rest and stress MBF and MPR were significantly different between analyses.

DATA CONCLUSION: Accurate perfusion quantification needs to account for the variability of temporal resolution, with data interpolation prior to quantification reducing MBF variability across different resolutions.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 1.

PMID:35338754 | DOI:10.1002/jmri.28180

Paediatr Anaesth. 2022 Mar 26. doi: 10.1111/pan.14447. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have shown Proseal LMA, and I gel similar to endotracheal intubation in ventilatory ability in pediatric laparoscopic surgeries.

AIMS: The primary aim of this study was to assess whether there is a significant difference in the oropharyngeal leak pressure between Ambu Auragrain, I-gel, and Proseal LMA during pediatric laparoscopic surgery.

METHODS: In this randomized controlled trial, 90 male patients of American Society of Anesthesiologists physical status I aged between 6 months and 10 years who were scheduled for laparoscopic single-sided inguinal hernia repair were recruited and randomly allocated to three groups in which airway was secured with Ambu Auragain, I gel or Proseal LMA. The primary outcome was oropharyngeal leak pressure. The secondary outcomes were peak pressures before and after pneumoperitoneum, fiberoptic view, insertion attempts, insertion time, manipulations, perioperative and postoperative anaesthesia-related problems. Continuous variables were compared using the one way Analysis of variance or the Kruskal-Wallis test with post hoc Turkey analysis. Categorical and ordinal data were compared using the chi-square test or Fisher’s exact test.

RESULTS: Oropharyngeal leak pressure before pneumoperitoneum was higher with I gel as compared to Ambu Auragain (27.36 ± 5.72 cm of H₂ O vs 23.56 ± 5.72 cm of H₂ O) (p-value 0.021) and PLMA (27.36 ± 5.72 cm of H₂ O vs 23.24 ± 4.35 cm of H₂ O) (p-value 0.011) and was statistically significant. Oropharyngeal leak pressure after pneumoperitoneum was also higher with I gel as compared to Ambu Auragain (31.58 ± 4.35 cm of H₂ O vs 26.83 ± 5.00 cm of H₂ O) (p-value 0.001) and Proseal LMA (31.58 ± 4.35 cm of H₂ O vs 27.03 ± 3.80 cm of H₂ O) (p-value 0.002) and was statistically significant. Oropharyngeal leak pressures of Ambu Auragain and Proseal LMA were comparable. Postoperative complications were similar in all the supraglottic airway devices. No regurgitation or aspiration related problem was observed in our study.

CONCLUSION: I gel had a higher oropharyngeal leak pressure than the other two supraglottic airway devices and therefore may represent a better choice in situations where higher ventilatory pressures may be necessary, for example, in extremes of weight trendelenburg position etc.

PMID:35338764 | DOI:10.1111/pan.14447

Med Phys. 2022 Mar 26. doi: 10.1002/mp.15615. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed at examining the synergistic impact of motion and acquisition/reconstruction parameters on ¹⁸ F-FDG PET image radiomic features in non-small cell lung cancer (NSCLC) patients, and investigating the robustness of features performance in differentiating NSCLC histopathology subtypes.

METHODS: An in-house developed thoracic phantom incorporating lesions with different sizes was used with different reconstruction settings, including various reconstruction algorithms, number of subsets and iterations, full-width at half-maximum (FWHM) of post-reconstruction smoothing filter and acquisition parameters, including injected activity, test-retest with and without motion simulation. To simulate motion, a special motor was manufactured to simulate respiratory motion based on a normal patient in two directions. The lesions were delineated semi-automatically to extract 174 radiomic features. All radiomic features were categorized according to the coefficient of variation (COV) to select robust features. A cohort consisting of 40 NSCLC patients with adenocarcinoma (n = 20) and squamous cell carcinoma (n = 20) was retrospectively analyzed. Statistical analysis was performed to discriminate robust features in differentiating histopathology subtypes of NSCLC lesions.

RESULTS: Overall, 29% of radiomic features showed a COV ≤ 5% against motion. Forty-five percent and 76% of the features showed a COV ≤ 5% against the test-retest with and without motion in large lesions, respectively. Thirty-three percent and 45% of the features showed a COV ≤ 5% against different reconstruction parameters with and without motion, respectively. For NSCLC histopathological subtype differentiation, statistical analysis showed that 31 features were significant (p-value<0.05). Two out of the 31 significant features, namely, the joint entropy of GLCM (AUC = 0.71, COV = 0.019) and median absolute deviation of intensity histogram (AUC = 0.7, COV = 0.046), were robust against the motion (same reconstruction setting).

CONCLUSIONS: Motion, acquisition, and reconstruction parameters significantly impact radiomic features, just as their synergies. Radiomic features with high predictive performance (statistically significant) in differentiating histopathological subtype of NSCLC may be eliminated due to non-reproducibility. This article is protected by copyright. All rights reserved.

PMID:35338722 | DOI:10.1002/mp.15615

J Ultrasound Med. 2022 Mar 26. doi: 10.1002/jum.15981. Online ahead of print.

ABSTRACT

OBJECTIVES: The present study aims to evaluate the clinical application values of ultrasound real-time shear wave elastography (SWE) in the diagnosis and differential diagnosis of cervical cancer (CC).

METHODS: A total of 285 married female patients were screened and divided into three groups according to the results of the pathological examination and the cervical ThinPrep cytologic test: 1) the CC group (n = 94); 2) the cervical intraepithelial neoplasia (CIN) group (n = 91); and 3) the normal control group (n = 100). The maximum Young’s modulus (Emax), mean Young’s modulus (Emean), minimum Young’s modulus (Emin), and Young’s modulus stability (Esd) in each group were measured and statistically analyzed.

RESULTS: There were no statistically significant differences in Emax, Emean, Emin, and Esd values between the anterior and posterior cervical walls, premenopausal and postmenopausal women, and nonparturient and parturient women in the normal control group. The Emax, Emean, Emin, and Esd values in the CIN group showed no statistically significant differences in different periods when compared with the control group. The differences between the normal control group and the CC group were statistically significant; the CC group showed no statistically significant differences in Emax, Emean, Emin, and Esd values at different clinical stages and in different pathological types. The cutoff value of Emax for CC diagnosis, which was of the highest accuracy (89.7%), was 43.48 kpa.

CONCLUSION: Ultrasound real-time SWE can be applied to CC diagnosis.

PMID:35338721 | DOI:10.1002/jum.15981

Mol Oncol. 2022 Mar 26. doi: 10.1002/1878-0261.13216. Online ahead of print.

ABSTRACT

Neoadjuvant chemotherapy (NACT) outcomes vary according to breast cancer (BC) subtype. Since pathologic complete response is one of the most important target endpoints of NACT, further investigation of NACT outcomes in BC is crucial. Thus, identifying sensitive and specific predictors of treatment response for each phenotype would enable early detection of chemoresistance and residual disease, decreasing exposures to ineffective therapies and enhancing overall survival rates. We used liquid chromatography-high-resolution mass spectrometry (LC-HRMS)-based untargeted metabolomics to detect molecular changes in plasma of three different BC subtypes following the same NACT regimen, with the aim of searching for potential predictors of response. The metabolomics dataset was analyzed by combining univariate and multivariate statistical strategies. By using ANOVA-simultaneous component analysis (ASCA), we were able to determine the prognostic value of potential biomarker candidates of response to NACT in the triple-negative (TN) subtype. Higher concentrations of docosahexaenoic acid and secondary bile acids were found at basal and pre-surgery samples, respectively, in the responders group. In addition, the glycohyocholic and glycodeoxycholic acids were able to classify TN patients according to response to treatment and overall survival with an AUC model >0.77. In relation to luminal B (LB) and HER2+ subjects, it should be noted that significant differences were related to time and individual factors. Specifically, tryptophan was identified to be decreased over time in HER2+ patients, whereas LysoPE(22:6) appeared to be increased, but could not be associated with response to NACT. Therefore, the combination of untargeted-based metabolomics along with longitudinal statistical approaches may represent a very useful tool for the improvement of treatment and in administering a more personalized BC follow-up in the clinical practice.

PMID:35338693 | DOI:10.1002/1878-0261.13216

Transfusion. 2022 Mar 26. doi: 10.1111/trf.16864. Online ahead of print.

ABSTRACT

BACKGROUND: Allogenic blood transfusions can lead to immunomodulation. Our purpose was to investigate whether perioperative transfusions were associated with postoperative infections and any other adverse events (AEs), after adjusting for potential confounding factors, following common elective lumbar spinal surgery procedures.

STUDY DESIGN AND METHODS: We performed a multivariate, propensity-score matched, regression-adjusted retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database between 2012 and 2016. All lumbar spinal surgery procedures were identified (n = 174,891). A transfusion group (perioperative transfusion within 72 h before, during, or after principal surgery; n = 1992) and a control group (no transfusion; n = 1992) were formed. Following adjustment for between-group baseline features, adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated using a multivariate logistic regression model for any surgical site infection (SSI), superficial SSI, deep SSI, wound dehiscence, pneumonia, urinary tract infection, sepsis, any infection, mortality, and any AEs.

RESULTS: Transfusion was associated with an increased risk of each specific infection, mortality, and any AEs. Statistically significant between-group differences were demonstrated with respect to any SSI (aOR: 1.48; 95% CI: 1.01-2.16), deep SSI (aOR: 1.66; 95% CI: 0.98-2.85), sepsis (aOR: 2.69; 95% CI: 1.43-5.03), wound dehiscence (aOR: 2.27; 95% CI: 0.86-6.01), any infection (aOR: 1.46; 95% CI: 1.13-1.88), any AEs (aOR: 1.80; 95% CI: 1.48-2.18), and mortality (aOR: 2.17; 95% CI: 0.77-6.36).

CONCLUSION: We showed an association between transfusion and infection in lumbar spine surgery after adjustment for various applicable covariates. Sepsis had the highest association with transfusion. Our results reinforce a growing trend toward minimizing perioperative transfusions, which may lead to reduced infections following lumbar spine surgery.

PMID:35338708 | DOI:10.1111/trf.16864

ANZ J Surg. 2022 Mar 26. doi: 10.1111/ans.17594. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias.

METHODS: Preferred reporting items for systematic reviews and meta-analyses guidelines were employed. We analysed primary outcomes: pain, quality of life, pain during daily activities and visual analogue scale (VAS that measures pain at rest and on movement) and secondary outcomes: postoperative complications and recurrence.

RESULTS: Pain and quality of life were not comparable due to differences in the parameters used in different articles. Pain interfering with normal daily activity was evaluated in one study and appears more favourable in the post-repair group respect to the watchful waiting (WW) group (5.1% versus 2.2%). VAS, measured in one study, at 6 months was more favourable in the surgery group (37% versus 44%). After 12 months the outcome was better in the control group than in the repair group (28% versus 30%). Conversion rate of the patient cohorts from watchful waiting to elective surgery was between 35.03% and 57.8%. The meta-analysis did not find significant statistical differences in the two groups examined for postoperative complications [RR = 0.95, 95% CI (0.50, 1.80), P = 0.88], as for hernia recurrence [RR = 1.01, 95% CI (0.50, 2.02), P = 0.98].

CONCLUSION: WW seems to be an acceptable option for the patient with asymptomatic or minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms appear is safe. Acute hernia incarcerations are not particularly frequent. The incidence of chronic pain after the repair is high. Physicians must select patients carefully and explain to them the risks and benefits of surgery.

PMID:35338686 | DOI:10.1111/ans.17594

Acta Anaesthesiol Scand. 2022 Mar 26. doi: 10.1111/aas.14063. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed at investigating the incidence, characteristics and outcome of ventilator-associated pneumonia (VAP) in patients after cardiac arrest (CA) and its potential association with mild therapeutic hypothermia (MTH). We hypothesised, that MTH might increase the risk of VAP.

METHODS: Prospective observational study including comatose adult patients after successful resuscitation from out-of-hospital or in-hospital CA with presumed cardiac cause admitted to ICU and treated with MTH at 33°C for 24h or normothermia (NT) with treatment of fever ≥ 38°C by pharmacological means. The primary outcome measure was the development of VAP. VAP diagnosis included mechanical ventilation >48h combined with clinical and radiologic criteria. For a microbiologically confirmed VAP (mcVAP) a positive respiratory culture was required.

RESULTS: 23% of 171 patients developed VAP, 6% presented with mcVAP. VAP was associated with increased ICU-LOS (9 (IQR 5-14) vs. 6 (IQR 3-9) days; p<0.01), ventilator-dependent days (6 (IQR 4-9) vs. 4 (IQR 2-7) days; p<0.01) and duration of antibiotic treatment (9 (IQR 5-13) vs. 5 (IQR 2-9) days; p<0.01), but not with mortality (OR 0.88 (95% CI: 0.43-1.81); p=0.74). Patients treated with MTH (47%) presented higher VAP (30 vs. 17%; p=0.04) and mcVAP rates (11 vs. 2%; p=0.03). MTH was associated with VAP in multivariable logistic regression analysis with an OR of 2.67 (95% CI: 1.22-5.86); p=0.01.

CONCLUSIONS: VAP appears to be a common complication in patients after CA, accompanied by more ventilator-dependent days, prolonged antibiotic treatment and ICU-LOS. Treatment with MTH is significantly associated with development of VAP.

PMID:35338658 | DOI:10.1111/aas.14063