Tag: statistics

Matern Child Health J. 2023 Feb 13. doi: 10.1007/s10995-023-03603-w. Online ahead of print.

ABSTRACT

BACKGROUND: An episiotomy is a surgical technique that widens the perineum during the second stage of childbirth. Therefore, the goal of this study was to assess the prevalence of episiotomy and the variables that affect it among women who gave birth in the town of Debre Tabor, in 2021.

METHODS: In the Debre Tabor municipality’s four designated health center regions, 402 women who gave birth were included in a cross-sectional study. Systematic random selection was used to choose the study subjects. In SPSS version 23, data were entered, cleaned up, and analyzed using descriptive and inferential statistics. The use of binary and multivariable logistic regression models allowed the researchers to identify characteristics related to episiotomy magnitude. Using a 0.05 p value, the level of statistically significant variables was also calculated.

RESULT: Out of a total of 402 deliveries for this inquiry, the magnitude of the episiotomy was calculated to be 35.1% of those deliveries. About 127 women, or the bulk of respondents, were between the ages of 25 and 29 (33.1%). Face presentation was 4.7 times more common among primiparous women than breech and vertex presentation, and midwifery professionals and midwifery students were 5.5 times higher than internship medicine and health officer students. The odds of performing an episiotomy were 3.7 times higher among primiparous women compared to multiparous women (AOR = 3.754 (1.382-15.108)).

CONCLUSION: The magnitude of episiotomy in this study was somewhat larger than the World Health Organization’s recommendation of 10% .Instrumental delivery, neonatal presentation, experts allocated to the delivery ward, and the mother’s parity were all shown to be strongly linked with the practice of episiotomy.

PMID:36781696 | DOI:10.1007/s10995-023-03603-w

Matern Child Health J. 2023 Feb 13. doi: 10.1007/s10995-023-03596-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess changes in mental health and social risk factors in pregnant women in counties affected by Hurricane Michael (October 2018).

METHODS: Data from the Universal Perinatal Risk Screen (UPRS) and vital statistics for the state of Florida were obtained. Prenatal risk factors (unplanned pregnancy, mental health services, high stress, use of tobacco or alcohol, young children at home or with special needs, trouble paying bills) were compared in the year before and year after Hurricane Michael in affected counties (n = 18,887). Log-Poisson regression with robust variance was used for binary outcomes, adjusting for maternal age, race, BMI, and education.

RESULTS: A smaller proportion of pregnant women were screened in the months after the hurricane. No changes were seen in overall scores. The proportion referred was lower in the 1 month after Michael compared to that in 1 month before Michael (RR 0.78, 95% CI = 0.71, 0.86), but greater in the year after (RR = 1.07, 95% CI: 1.04, 1.10). Most individual risk factors on the screener did not change significantly, except having an illness that required ongoing medical care was less common in the short term (3 months after vs. 3 months before: aRR = 0.76, 95% CI: 0.66, 0.87), and more common in the longer term (1 year after vs. 1 year before, aRR = 1.09, 95% CI: 1.02, 1.18). Birth certificate data suggested smoking during pregnancy was higher among women who experienced Michael during their pregnancies (aRR = 1.15, 95% CI: 1.01, 1.32).

DISCUSSION: Perinatal screening and referral declined in the short-term aftermath of Hurricane Michael.

PMID:36781693 | DOI:10.1007/s10995-023-03596-6

Acad Med. 2023 Feb 10. doi: 10.1097/ACM.0000000000005170. Online ahead of print.

ABSTRACT

PURPOSE: Simulation-based mastery learning (SBML) is a rigorous form of competency-based learning. Components of SBML include a pretest, deliberate practice, and a posttest; all learners must meet or exceed a minimum passing standard (MPS) on the posttest before completing training. The authors aimed to explore whether a modified SBML curriculum (without a pretest assessment) was as effective as the standard SBML curriculum (with a pretest assessment).

METHOD: The authors performed a randomized controlled trial of internal medicine residents who participated in an internal jugular central venous catheter insertion SBML curriculum at a tertiary care academic medical center in Chicago, Illinois, from December 2018 through December 2021. Residents were randomly assigned to complete the usual SBML intervention (pretest group) or to complete a modified SBML intervention without a pretest (no pretest group). The authors compared initial posttest performance and training time between groups.

RESULTS: Eighty-nine of 120 eligible residents (74.1%) completed the study: 43 in the pretest group and 46 in the no pretest group. Median (IQR) initial posttest scores were not statistically different between the pretest group (96.6 [93.1-100]) and the no pretest group (96.6 [92.4-100]). However, all 43 residents (100%) in the pretest group reached the MPS at the initial posttest compared with 41 of the 46 (89%) in the no pretest group (p = .06). Residents in the pretest group required 16.5 hours more faculty and learning time than the no pretest group.

CONCLUSIONS: More residents who completed a pretest reached the MPS at initial posttest. However, incorporating a pretest during the internal jugular central venous catheter SBML curriculum required substantially more learner and faculty time without clear performance benefits.

PMID:36780693 | DOI:10.1097/ACM.0000000000005170

N Engl J Med. 2023 Feb 9;388(6):489-498. doi: 10.1056/NEJMoa2212083.

ABSTRACT

BACKGROUND: The increased detection of small-sized peripheral non-small-cell lung cancer (NSCLC) has renewed interest in sublobar resection in lieu of lobectomy.

METHODS: We conducted a multicenter, noninferiority, phase 3 trial in which patients with NSCLC clinically staged as T1aN0 (tumor size, ≤2 cm) were randomly assigned to undergo sublobar resection or lobar resection after intraoperative confirmation of node-negative disease. The primary end point was disease-free survival, defined as the time between randomization and disease recurrence or death from any cause. Secondary end points were overall survival, locoregional and systemic recurrence, and pulmonary functions.

RESULTS: From June 2007 through March 2017, a total of 697 patients were assigned to undergo sublobar resection (340 patients) or lobar resection (357 patients). After a median follow-up of 7 years, sublobar resection was noninferior to lobar resection for disease-free survival (hazard ratio for disease recurrence or death, 1.01; 90% confidence interval [CI], 0.83 to 1.24). In addition, overall survival after sublobar resection was similar to that after lobar resection (hazard ratio for death, 0.95; 95% CI, 0.72 to 1.26). The 5-year disease-free survival was 63.6% (95% CI, 57.9 to 68.8) after sublobar resection and 64.1% (95% CI, 58.5 to 69.0) after lobar resection. The 5-year overall survival was 80.3% (95% CI, 75.5 to 84.3) after sublobar resection and 78.9% (95% CI, 74.1 to 82.9) after lobar resection. No substantial difference was seen between the two groups in the incidence of locoregional or distant recurrence. At 6 months postoperatively, a between-group difference of 2 percentage points was measured in the median percentage of predicted forced expiratory volume in 1 second, favoring the sublobar-resection group.

CONCLUSIONS: In patients with peripheral NSCLC with a tumor size of 2 cm or less and pathologically confirmed node-negative disease in the hilar and mediastinal lymph nodes, sublobar resection was not inferior to lobectomy with respect to disease-free survival. Overall survival was similar with the two procedures. (Funded by the National Cancer Institute and others; CALGB 140503 ClinicalTrials.gov number, NCT00499330.).

PMID:36780674 | DOI:10.1056/NEJMoa2212083

Ann Am Thorac Soc. 2023 Feb 13. doi: 10.1513/AnnalsATS.202207-577OC. Online ahead of print.

ABSTRACT

RATIONALE: Craniofacial and pharyngeal morphology are risk factors for Obstructive Sleep Apnea (OSA). Quantitative photography provides phenotypic information about these anatomic risk factors and is feasible in large samples. However, whether associations between morphology and OSA severity are influenced by genetic ancestry is unknown.

OBJECTIVE: The aim of this study was to examine this question in a large sample encompassing people from distinct ancestral backgrounds.

METHODS: Participants of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) cohort with available genomic data were included (N=2,393). Associations between photography-based measures and OSA severity were assessed using linear regression models, controlling for age, sex, and BMI. Statistical interaction tests were used to assess if genetically-determined ancestry (based on 1000 Genomes reference populations) influenced the relationship of anatomy with OSA severity.

RESULTS: Cluster analysis of genetic ancestry proportions identified four ancestry groups: East Asian (48.3%), European (33.6%), Mixed (11.7%) and African (6.4%). Multiple anatomic traits were associated with more severe OSA independent of ancestry, including larger cervicomental angle (standardized β [95%CI] = 0.11 [0.06, 0.16], p<0.001), mandibular width (0.15 [0.10, 0.20], p<0.001), and tongue thickness (0.06 [0.02, 0.10], p=0.001) and smaller airway width (-0.08 [-0.15, -0.002]). Other traits, including maxillary and mandibular depth angles and lower face height, demonstrated stronger/weaker associations with OSA severity based on genetic ancestry.

CONCLUSIONS: We confirm multiple facial and intraoral photographic measurements are associated with OSA severity independent of ancestral background, while others differ in their association.

PMID:36780658 | DOI:10.1513/AnnalsATS.202207-577OC

Georgian Med News. 2022 Dec;(333):77-85.

ABSTRACT

The purpose of the study – to conduct an analysis of the disability of ATO/JFO participants in 2014-2021 with a detailed comparative analysis of data of 2021 and determination of the needs of the mentioned contingent in rehabilitation devices. Operational information was collected according to the statistic form of ATO/OOS participants examined at the medical and social expert commissions: developed by the authors statistical form “Report on the causes of disability, indications for medical, professional and social rehabilitation in ATO participants for _____ year”, which was summarized and processed. Materials were collected from 2014 to 2021. More than a half of those recognized for the first time as disabled, 2,997 people in 2021 (86.0%), 2,624 people in 2020 (81.2%), 3,297 people in 2019 (79.3%), 2,848 people (75.5%) in 2018 and 1,859 people (65.0%) in 2017 – received the disability group not as a result of traumatic injuries, but for other unspecified reasons that did not have a traumatization factor. The main causes of disability were diseases of the circulatory system (47.9%), musculoskeletal system (13.4%), mental and behavioral disorders (7.2%), neoplasms (3.8%), diseases of the nervous system (3.3%), endocrine diseases, nutritional disorders, and metabolic disorders (3.2%), diseases of the digestive organs (2.0%), some infectious and parasitic diseases (1.6%), respiratory diseases (1.3%) and other reasons (0.7%). In 2021, less than ¼ (14.0%) of ATO/JFO participants were initially recognized as disabled due to various traumatic injuries, which is 25.5% less than in 2020. Among the patients with injuries of the musculoskeletal system, prevailed the victims with injuries of the lower extremities – 92 people, with injuries of the upper extremities – 44 people, polytraumas 38 people, combined injuries – 22 people. Traumatic lesions of the spinal cord led to the onset of disability in 7 persons, traumatic eye lesions in 12 persons. Medical rehabilitation services, including restorative treatment, reconstructive surgery, and orthotics, were the most needed among the examined ATO/JFO participants. More than half of the participants of ATO/JFO received the disability group due to other reasons that did not have a trauma factor, not traumatic injuries. Traumatic brain lesions accounted for 6.9% of the total number of ATO/JFO participants recognized as disabled, musculoskeletal injuries – 3.9%. 1.1% were recognized as disabled due to polytraumas, 0.2% due to combined injuries. Traumatic lesions of the spinal cord led to the onset of disability in 0.2%. With a traumatic eye injury, 0.3% were recognized as disabled. Complicated limb injuries with damage to peripheral nerves accounted for 0.1% and blood vessels – 0.1%. Medical rehabilitation services, including restorative treatment, reconstructive surgery, and orthotics, were the most needed among ATO/JFO participants examined. The increase in the number of ATO/JFO participants initially recognized as disabled due to reasons not related to traumatic lesions requires further careful analysis, determination of the reasons for such a situation and the development of effective measures for the prevention of disability and the return of lost functionality in the specified contingent, which will become the topic of further research.

PMID:36780628

Georgian Med News. 2022 Dec;(333):42-45.

ABSTRACT

Nowadays, the reduction of widespread dental diseases (caries and periodontitis) is still crucial and appears to be both a medical and social concern. The aim of this study was an investigation of dental health status, determination of leading risk factors, and determination of preventive measures among the students of the Adjara region. Clinical studies were conducted on 392 students aged 18-25 years. The methodology provided by WHO was used to determine the epidemiological data on the prevalence of dental caries. The BOP (Bleeding on probing) method was used to determine the prevalence of inflammatory periodontal diseases. Oral hygiene status was assessed by OHI-S (Simplified Oral Hygiene Index). A survey of students was conducted to determine the impact of various factors. In the study group, caries prevalence equaled 97.04%, the intensity was 5.68±0.21, gingivitis prevalence was 75.4%, and oral hygiene condition was 1.9±0.06. Hygienic condition is correlated with caries and periodontal diseases (p<0.05). A statistically reliable relationship was revealed with hygiene knowledge, nutritional factors, etc. It is necessary to improve treatment and prevention measures among students and adolescents in the region through the implementation of social programs and sanitary educational measures.

PMID:36780621

Georgian Med News. 2022 Dec;(333):6-12.

ABSTRACT

Following increased cultural awareness, expanded access to care, and decreased stigmatization, the number of transgender individuals seeking gender affirmation surgery such as gender-affirmation mastectomy (GAM) continues to rise. While post-mastectomy breast tissue is often sent for pathologic evaluation, few studies address the utility and standardization of this practice. This literature review evaluates the pathology findings in GAM specimens reported in the medical literature. A systematic review following PRISMA guidelines was performed to evaluate all medical publications related to pathology reports following GAM. The overall type and incidence of benign and malignant breast lesions were analyzed to elucidate which patient characteristics significantly affect the pathology findings. Overall, eight of 488 identified studies met inclusion criteria (1278 patients). The incidence of pre-malignant lesions was 2.42%, including flat epithelial atypia (0.08%), atypical hyperplasia (0.23%), atypical ductal hyperplasia (1.33%), atypical lobular hyperplasia (0.39%), and lobular carcinoma in situ (0.39%).Patient age, hormonal therapy, and family / patient history of breast cancer were inconsistently reported among included studies. Lack of standardized pathologic classification did not permit further statistical analysis. Although patients who undergo GAM are unlikely to have premalignant or malignant findings on breast pathology examination, pathologic evaluation of breast tissue remains common practice. Additional studies, which include a standardized method of pathologic evaluation, are necessary before practice guidelines can be recommended.

PMID:36780614

J Clin Oncol. 2023 Feb 13:JCO2202447. doi: 10.1200/JCO.22.02447. Online ahead of print.

ABSTRACT

PURPOSE: The US Food and Drug Administration approved fam-trastuzumab deruxtecan-nxki (DS-8201a, T-DXd) for the treatment of adult patients with unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-low (immunohistochemistry 1 + or immunohistochemistry 2+/in situ hybridization-) breast cancer who have received a prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy.

PATIENTS AND METHODS: Approval was based on DESTINY-Breast04, a phase III, randomized, open-label, multicenter trial in patients with unresectable or metastatic HER2-low breast cancer, determined at a central laboratory. A total of 557 patients were randomly assigned (2:1) to receive either T-DXd 5.4 mg/kg intravenously once every 3 weeks (n = 373) or physicians’ choice of chemotherapy (n = 184).

RESULTS: The study met its primary efficacy end point of progression-free survival (PFS) by blinded independent central review assessment in the hormone receptor-positive (HR+) cohort (N = 494) with an estimated hazard ratio (HR) of 0.51(95% CI, 0.40 to 0.64; P < .0001). Key secondary end points were also met, including PFS in the intent-to-treat population with an HR of 0.50 (95% CI, 0.40 to 0.63; P < .0001), overall survival (OS) in the HR+ cohort with an HR of 0.64 (95% CI, 0.48 to 0.86; P = .0028) and OS in the intent-to-treat with an HR of 0.64 (95% CI, 0.49 to 0.84; P = .0010). The safety profile of T-DXd was consistent with previously approved indications, and no new safety signals were observed in this study population.

CONCLUSION: The approval of T-DXd in HER2-low metastatic breast cancer was based on statistically significant and clinically meaningful PFS and OS improvements observed in the DESTINY-Breast04 trial and represents the first approved therapy specifically for the treatment of HER2-low metastatic breast cancer.

PMID:36780610 | DOI:10.1200/JCO.22.02447

Med Ultrason. 2022 Jun 3. doi: 10.11152/mu-3594. Online ahead of print.

ABSTRACT

AIM: Despite several studies and reviews reporting data accuracy of ultrasonography for confirmation of endotracheal intubation, there has been limited pooled evidence summarizing the diagnostic accuracy of this imaging modality, especially based on recent evidence. Hence, the current study reviews the recent literature and conducts a meta-analysis to compare the accuracy of ultrasonography for the confirmation of endotracheal tube placement.

MATERIAL AND METHODS: We conducted a systematic search for all studies reporting the diagnostic accuracy of ultrasonography in the databases of Medline, EMBASE,PubMed Central, ScienceDirect, Google Scholar & Cochrane library from inception till December 2021. Meta-analysis was performed using STATA software “midas” package.

RESULTS: Thirty-eight studies with 3,268 participants were included. Thepooled sensitivity was 98% (95% CI, 97%-99%) and specificity was 95% (95% CI, 90%-98%), respectively. The AUC was 0.98 (95%CI: 0.96-1.00). The pooled DOR was 1090 (95% CI, 408-2910). Pooled LRP was 19 (95% CI, 9-39) and pooled LRN was 0.02 (0.01-0.03). There was significant heterogeneity found in the outcome with significant chi-square tests and I2 statistics > 75%.

CONCLUSION: Findings from our review demonstrate promise in the applicability of ultrasonography as a major diagnostic tool for confirming the endotracheal tube intubation.

PMID:36780595 | DOI:10.11152/mu-3594