Tag: statistics

J Hand Ther. 2023 Mar 11:S0894-1130(22)00091-6. doi: 10.1016/j.jht.2022.09.004. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort.

BACKGROUND: The QuickDASH is a commonly used questionnaire for the assessment of carpal tunnel patients, although it is unclear whether the questionnaire has suitable structural validity PURPOSE: This study aimed to evaluate the structural validity of the QuickDASH patient-reported outcome measure (PROM), when used in CTS, through exploratory factor analysis (EFA) and structural equation modelling (SEM).

METHODS: Between 2013 and 2019, we recorded preoperative QuickDASH scores of 1916 patients undergoing carpal tunnel decompressions at a single unit. One hundred and eighteen patients with incomplete datasets were excluded leaving a final study group of 1798 patients with complete data. EFA was undertaken using the R statistical computing environment. We then conducted SEM in a random sample of 200 patients. Model fit was assessed using the chi-square (χ²) test, comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA) and standardized root mean square residuals (SRMR). A second “validation” SEM analysis was undertaken by repeating the analysis with a separate sample of 200 randomly-selected patients.

RESULTS: EFA revealed a 2-factor model: items 1-6 represented the first factor (“function”) and items 9-11 measured a different factor (“symptoms”). SEM demonstrated excellent fit (χ² p value 0.167, CFI 0.999, TLI 0.999, RMSEA 0.032, SRMR 0.046) and this was supported in our “validation” sample.

CONCLUSIONS: This study demonstrates that the QuickDASH PROM measures 2 distinct factors in CTS. This is comparable with the findings of a previous EFA that assessed the full-length Disabilities of the Arm, Shoulder and Hand PROM in patients with Dupuytren’s disease.

PMID:36914493 | DOI:10.1016/j.jht.2022.09.004

J Hand Ther. 2023 Mar 11:S0894-1130(22)00105-3. doi: 10.1016/j.jht.2022.10.009. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to identify the relationship between age, body mass index (BMI), weight, height, and wrist circumference and median nerve cross-sectional area (CSA). The study also aimed to examine the difference between CSA in individuals reporting a high amount (>4 hours per day) of electronic device use compared to those reporting a low amount (≤4 hours per day).

MATERIALS/METHODS: One hundred twelve healthy individuals volunteered to participate in the study. Anthropometric, demographic, and self-reported electronic device usage data were collected. A transverse image of the median nerve was captured using ultrasonography from the dominant wrist at the carpal tunnel inlet . A Spearman’s rho correlation coefficient was used to examine correlations between participant characteristics (age, BMI, weight, height, and wrist circumference) and CSA. Separate Mann-Whitney U tests were used to examine differences in CSA in those younger and older than age 40, in those with BMI <25 kg/m2 and BMI ≥25 kg/m2, and in high and low-frequency device users.

RESULTS: BMI, weight, and wrist circumference showed fair correlations with CSA. There were significant differences in CSA between individuals younger than 40 and those older than 40 and between individuals with BMI <25kg/m² and those with BMI ≥25kg/m². There were no statistically significant differences in CSA in the low- and high-use electronic device groups.

DISCUSSION: Anthropometric and demographic characteristics including age and BMI or weight should be considered when examining the CSA of the median nerve, especially when determining cut-off points for establishing a diagnosis of carpal tunnel syndrome.

PMID:36914492 | DOI:10.1016/j.jht.2022.10.009

J Hand Ther. 2023 Mar 11:S0894-1130(22)00101-6. doi: 10.1016/j.jht.2022.10.005. Online ahead of print.

ABSTRACT

BACKGROUND: Paraffin bath therapy is noninvasive and is widely used in various hand diseases. Paraffin bath therapy is easy to use, has fewer side effects, and can be applied to various diseases with different etiologies. However, there are few large-scale studies of paraffin bath therapy, and there is insufficient evidence of its efficacy.

PURPOSE: The purpose of the study was to investigate the effectiveness of paraffin bath therapy for pain relief and functional improvement in various hand diseases through a meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials.

METHODS: We searched for studies using PubMed and Embase. Eligible studies were selected based on the following criteria: (1) patients with any diseases of the hand; (2) comparison between paraffin bath therapy and no paraffin bath therapy; and (3) sufficient data on changes in the visual analog scale (VAS) score, grip strength, pulp-to-pulp pinch strength, or Austrian Canadian (AUSCAN) Osteoarthritis Hand index before and after paraffin bath therapy. Forest plots were drawn to visualize the overall effect. Jadad scale score, I² statistics, and subgroup analyses were used to assess the risk of bias.

RESULTS: A total of five studies included 153 patients who were treated and 142 who were not treated with paraffin bath therapy. The VAS were measured in all 295 patients included in the study, while the AUSCAN index was measured in the 105 patients with osteoarthritis. Paraffin bath therapy significantly reduced the VAS scores (mean difference [MD], -1.27; 95% confidence interval [CI] -1.93 to -0.60). In osteoarthritis, paraffin bath therapy significantly improved grip and pinch strength (MD -2.53; 95% CI 0.71-4.34; MD 0.77; 95% CI 0.71-0.83) and reduced the VAS and AUSCAN scores (MD -2.61; 95% CI -3.07 to -2.14; MD -5.02; 95% CI -8.95 to -1.09).

DISCUSSION: Paraffin bath therapy significantly reduced the VAS and AUSCAN scores, and improved grip and pinch strength in patients with various hand diseases.

CONCLUSIONS: Paraffin bath therapy is effective for alleviating pain and improving function in hand diseases, thereby improving quality of life. However, owing to the small number of patients included in the study and its heterogeneity, a further large-scale, well-structured study is needed.

PMID:36914488 | DOI:10.1016/j.jht.2022.10.005

J Am Acad Dermatol. 2023 Mar 11:S0190-9622(23)00174-3. doi: 10.1016/j.jaad.2023.01.036. Online ahead of print.

ABSTRACT

BACKGROUND: Topical corticosteroids (TCS) are commonly prescribed to treat inflammatory skin diseases, and appropriate prescription is necessary for treatment success.

OBJECTIVE: To quantify differences between TCS prescribed by dermatologists at consultation and family physicians for patients treated for any skin condition.

METHODS: Using administrative health data in Ontario, we included all Ontario Drug Benefit recipients who filled at least one TCS prescription from a dermatologist at consultation and a family physician in the year prior between January 2014 and December 2019. We estimated mean differences and 95% confidence intervals in amount (in grams) and potency between the index dermatologist prescription and the highest and most recent family physician prescription amounts and potencies in the preceding year using linear mixed-effect models.

RESULTS: A total of 69,335 persons were included. The mean dermatologist amount was 34% larger than the highest amount and 54% larger than the most recent amount prescribed by family physicians. There were small but statistically significant differences in potency using established 7-category and 4-category potency classification systems.

CONCLUSIONS: Compared to family physicians, dermatologists prescribed substantially larger amounts and similarly potent TCS at consultation. Further research is needed to determine the effect of these differences on clinical outcomes.

PMID:36914480 | DOI:10.1016/j.jaad.2023.01.036

Asian J Surg. 2023 Mar 11:S1015-9584(23)00301-9. doi: 10.1016/j.asjsur.2023.03.009. Online ahead of print.

ABSTRACT

BACKGROUND: To analyze and compare the clinical efficacy of transumbilical single-incision laparoscopic surgery TAPP(SILS-TAPP) and conventional laparoscopic TAPP(CL-TAPP) in the treatment of senile inguinal hernia.

METHODS: From January 2019 to June 2021, a total of 221 elderly patients (≥60 years old) with inguinal hernia received SILS-TAPP and CL-TAPP in General Surgery Department of Affiliated Hospital of Nantong University. The perioperative indicators, postoperative complications and follow-up of the two groups were compared to explore the feasibility and superiority of SILS-TAPP in the treatment of inguinal hernia in the elderly.

RESULTS: There was no difference in demographic characteristics between the two groups. The mean operation time (28.6 ± 4.2 min vs 28.2 ± 5.3 min) in the SILS-TAPP group was not significantly different from that in the CL-TAPP group (Ρ = 0.623), and there was no significant increase in hospital costs(Ρ = 0.748). The intraoperative blood loss (7.4 ± 3.4 ml), VAS score on the postoperative day (2.2 ± 0.7), mean time of resuming activity (8.2 ± 1.9 h) and mean postoperative hospital stay (0.8 ± 0.2 d) in the SILS-TAPP group were better than those in the CL-TAPP group (Ρ < 0. 05).There was no statistical difference in the overall incidence of intraoperative (Ρ = 0.128) and postoperative complications (Ρ = 0.125) between the two groups.

CONCLUSION: Single-incision laparoscopic surgery TAPP (SILS-TAPP) is feasible and effective in elderly patients, providing a new alternative surgical method for patients who can tolerate general anesthesia.

PMID:36914474 | DOI:10.1016/j.asjsur.2023.03.009

J Pediatr Health Care. 2023 Mar 11:S0891-5245(22)00340-6. doi: 10.1016/j.pedhc.2022.11.008. Online ahead of print.

ABSTRACT

INTRODUCTION: This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with developmental disabilities.

METHOD: We conducted a national online survey of LGBTQ parents of children with developmental disabilities using social media and professional networks. Descriptive statistics were compiled. Open-ended responses were coded using inductive and deductive approaches.

RESULTS: Thirty-seven parents completed the survey. Most participants identified as highly educated, White, lesbian or queer, cisgender women and reported positive experiences. Some reported bias and discrimination, including heterosexist forms, LGBTQ disclosure challenges, and, because of their LGBTQ identity, feeling mistreated by their children’s providers or being refused needed HC for their child.

DISCUSSION: This study advances knowledge around LGBTQ parents’ experiences of bias and discrimination while accessing children’s HC. Findings highlight the need for additional research, policy change, and workforce development to improve HC for LGBTQ families.

PMID:36914456 | DOI:10.1016/j.pedhc.2022.11.008

J Adolesc Health. 2023 Mar 11:S1054-139X(23)00071-X. doi: 10.1016/j.jadohealth.2023.01.024. Online ahead of print.

ABSTRACT

PURPOSE: Weight stigma is a prevalent problem in adolescents and a risk factor for disordered eating behaviors (DEBs). This study examined whether positive family/parenting factors were protective for DEBs among an ethnically/racially and socioeconomically diverse sample of adolescents with and without weight stigmatizing experiences.

METHODS: In Project Eating and Activity over Time (EAT) 2010-2018, 1,568 adolescents (mean age = 14.4 ± 2.0 years) were surveyed and followed into young adulthood (mean age = 22.2 ± 2.0 years). Modified Poisson regression models examined the relationships between three weight-stigmatizing experiences and four DEBs (e.g., overeating and binge eating) in models adjusted for sociodemographic characteristics and weight status. Interaction terms and stratified models examined whether family/parenting factors were protective for DEBs based on weight stigma status.

RESULTS: Higher family functioning and support for psychological autonomy were cross sectionally protective for DEBs. However, this pattern was primarily observed in adolescents who did not experience weight stigma. For example, among adolescents who did not experience peer weight teasing, high support for psychological autonomy was associated with lower prevalence of overeating (high support: 7.0%, low support: 12.5%, p = .003). Whereas, in participants who experienced family weight teasing, the difference in prevalence of overeating based on support for psychological autonomy was not statistically significant (high support: 17.9%, low support: 22.4%, p = .260).

DISCUSSION: General positive family and parenting factors did not entirely offset the effects of weight-stigmatizing experiences on DEBs, which may reflect the strength of weight stigma as a risk factor for DEBs. Future research is needed to identify effective strategies family members can use to support youth who experience weight stigma.

PMID:36914449 | DOI:10.1016/j.jadohealth.2023.01.024

Curr Pharm Teach Learn. 2023 Mar 11:S1877-1297(23)00001-1. doi: 10.1016/j.cptl.2023.02.001. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluated student reported achievement of essential elements (EE) across three required advanced pharmacy practice experiences (APPEs) to identify differences in the frequency of each EE during different delivery modalities.

METHODS: APPE students from three different programs were assigned a self-assessment EE inventory after required acute care, ambulatory care, and community pharmacy APPEs between May 2018 and December 2020. Using a four-point frequency scale, students reported exposure to and completion of each EE. Pooled data were analyzed to compare differences in frequencies of EE during standard and disrupted delivery. All standard delivery APPEs were in-person, but during the study period APPEs shifted to a disrupted delivery using hybrid and remote formats. Frequency changes were reported as combined data and compared between programs.

RESULTS: A total of 2191 of 2259 (97%) evaluations were completed. Acute care APPEs had a statistically significant change in frequency of evidence-based medicine elements. Ambulatory care APPEs had a statistically significant decrease in the frequency of reported pharmacist patient care elements. Community pharmacy had a statistically significant decrease in frequency in each category of EE except practice management. Statistically significant differences between programs were observed for select EEs.

CONCLUSIONS: The frequency of EE completion during disrupted APPEs revealed minimal change. Acute care was the least impacted whereas community APPEs experienced the greatest change. This may be attributable to shifts in direct patient interactions during the disruption. Ambulatory care was impacted to a lesser degree, potentially due to utilization of telehealth communications.

PMID:36914444 | DOI:10.1016/j.cptl.2023.02.001

Burns. 2023 Feb 24:S0305-4179(23)00031-1. doi: 10.1016/j.burns.2023.02.010. Online ahead of print.

ABSTRACT

BACKGROUND: Severely burned patients suffer from both coagulopathy and hypothermia, with a lack of international consensus and appropriate treatment guidelines. This study examines recent developments and trends in coagulation and temperature management in European burn centers.

METHODS: A survey was sent to burn centers in Switzerland, Austria and Germany in 2016 and again in 2021. The analysis was performed using descriptive statistics, with categorical data reported in absolute numbers (n) and percentages (%) and numerical data reported as mean and standard deviation.

RESULTS: The rate of completed questionnaires was 84 % (16 of 19 questionnaires) in 2016 and 91 % (21 of 22 questionnaires) in 2021. The number of global coagulation tests performed has decreased over the observation period in favor of single factor determination and bed-side point-of-care coagulation tests. This has also led to increased administration of single factor concentrates in therapy. Although many centers had a defined treatment protocol for hypothermia in 2016, coverage increased such that in 2021 all centers surveyed had such a protocol. The body temperature was measured more consistently in 2021; thus, hypothermia was more actively sought, detected and treated.

CONCLUSION: A point-of-care guided, factor-based coagulation management and the maintenance of normothermia have gained importance in the care of burn patients in recent years.

PMID:36914441 | DOI:10.1016/j.burns.2023.02.010

Dent Mater. 2023 Mar 11:S0109-5641(23)00070-2. doi: 10.1016/j.dental.2023.03.015. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate crystallography, translucency, phase content, microstructure and flexural strength of two commercial strength-gradient multilayered dental zirconia grades.

METHODS: Two zirconia grades, i.e., KATANA Zirconia YML (Kuraray Noritake; referred to as “YML”; composed of four layers: enamel, body 1-3) and IPS e.max ZirCAD Prime (Ivoclar Vivadent; referred to as “Prime”; composed of three layers: enamel, transition, body) were investigated. Fully sintered square-shaped zirconia specimens from each layer were prepared. Microstructure, chemical composition, translucency parameter and zirconia-phase composition of each layer were characterized. Four-point and biaxial flexural strength of each layer was measured using fully sintered bar- and square-shaped specimens. Square-shaped samples were used to measure strength across the layers.

RESULTS: For both multilayer zirconia grades, the ‘enamel’ layer contains a higher amount of c-ZrO₂, which resulted in higher translucency but lower flexural strength than the ‘body’ layers. The characteristic 4-point flexural strength of the YML ‘body 2’ (923 MPa) and ‘body 3’ (911 MPa) layers, and of the Prime ‘body’ (989 MPa) layer were comparable and higher than for the YML ‘enamel’ (634 MPa), Prime ‘transition’ (693 MPa) and ‘enamel’ (535 MPa) layers. The biaxial strength of specimens sectioned across the layers was in-between that of the ‘enamel’ and ‘body’ layers for both YML and Prime, implying the interfaces did not form a weak link.

SIGNIFICANCE: The difference in yttria content affects the phase composition and mechanical properties of each layer of the multi-layer zirconia. The strength-gradient approach allowed to integrate monoliths with irreconcilable properties.

PMID:36914432 | DOI:10.1016/j.dental.2023.03.015