Tag: statistics

BMJ Open. 2023 May 25;13(5):e065068. doi: 10.1136/bmjopen-2022-065068.

ABSTRACT

OBJECTIVES: Respiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors affecting fitting outcomes are largely unknown. This study aimed to evaluate factors affecting respirator fitting outcomes.

DESIGN: This is a retrospective evaluation study. We conducted a secondary analysis of a national database of fit testing outcomes in England between July and August 2020.

SETTINGS: The study involves National Health Service (NHS) hospitals in England.

PARTICIPANTS: A total of 9592 observations regarding fit test outcomes from 5604 healthcare workers were included in the analysis.

INTERVENTION: Fit testing of FFP3 on a cohort of healthcare workers in England, working in the NHS.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was the fit testing result, that is, pass or fail with a specific respirator. Key demographics, including age, gender, ethnicity and face measurements of 5604 healthcare workers, were used to compare fitting outcomes.

RESULTS: A total of 9592 observations from 5604 healthcare workers were included in the analysis. A mixed-effects logistic regression model was used to determine the factors which affected fit testing outcome. Results showed that males experienced a significantly (p<0.05) higher fit test success than females (OR 1.51; 95% CI 1.27 to 1.81). Those with non-white ethnicities demonstrated significantly lower odds of successful respirator fitting; black (OR 0.65; 95% CI 0.51 to 0.83), Asian (OR 0.62; 95% CI 0.52 to 0.74) and mixed (OR 0.60; 95% CI 0.45 to 0.79.

CONCLUSION: During the early phase of COVID-19, females and non-white ethnicities were less likely to have a successful respirator fitting. Further research is needed to design new respirators which provide equal opportunity for comfortable, effective fitting of these devices.

PMID:37230519 | DOI:10.1136/bmjopen-2022-065068

Res Synth Methods. 2023 May 25. doi: 10.1002/jrsm.1636. Online ahead of print.

ABSTRACT

The laborious and time-consuming nature of systematic review production hinders the dissemination of up-to-date evidence synthesis. Well-performing natural language processing (NLP) tools for systematic reviews have been developed, showing promise to improve efficiency. However, the feasibility and value of these technologies have not been comprehensively demonstrated in a real-world review. We developed an NLP-assisted abstract screening tool that provides text inclusion recommendations, keyword highlights, and visual context cues. We evaluated this tool in a living systematic review on SARS-CoV-2 seroprevalence, conducting a quality improvement assessment of screening with and without the tool. We evaluated changes to abstract screening speed, screening accuracy, characteristics of included texts, and user satisfaction. The tool improved efficiency, reducing screening time per abstract by 45.9% and decreasing inter-reviewer conflict rates. The tool conserved precision of article inclusion (positive predictive value; 0.92 with tool vs. 0.88 without) and recall (sensitivity; 0.90 vs. 0.81). The summary statistics of included studies were similar with and without the tool. Users were satisfied with the tool (mean satisfaction score of 4.2/5). We evaluated an abstract screening process where one human reviewer was replaced with the tool’s votes, finding that this maintained recall (0.92 one-person, one-tool vs. 0.90 two tool-assisted humans) and precision (0.91 vs. 0.92) while reducing screening time by 70%. Implementing an NLP tool in this living systematic review improved efficiency, maintained accuracy, and was well-received by researchers, demonstrating the real-world effectiveness of NLP in expediting evidence synthesis.

PMID:37230483 | DOI:10.1002/jrsm.1636

Am J Perinatol. 2023 May 25. doi: 10.1055/a-2099-8611. Online ahead of print.

ABSTRACT

OBJECTIVE: To date, there is limited information about medical student duty hours, shelf scores, and overall clerkship performance in Obstetrics and Gynecology. As a result, we were curious to know whether spending more time in the clinical environment translated to an improved learning experience or, in contrast, translated to decreased study time and worse overall clerkship performance.

STUDY DESIGN: A retrospective cohort analysis was performed at a single academic medical center of all medical students on the Obstetrics and Gynecology clerkship from August 2018 to June 2019. Recorded student duty hours were tabulated per day and per week, by student. National Board of Medical Examiners (NBME) Subject Exam (Shelf) equated percentile scores for the quarter of year were used.

RESULTS: Our statistical analysis showed that working long hours did not translate to higher or lower shelf score, or higher overall clerkship grade. However, working longer hours in the last two weeks of the clerkship was associated with high shelf score.

CONCLUSION: Longer medical student duty hours did not correlate to higher shelf scores or overall clerkship grades. Future multi-center studies are necessary to evaluate the importance of medical student duty hours and continue optimizing the educational experience of the OB/GYN clerkship.

PMID:37230478 | DOI:10.1055/a-2099-8611

Am J Perinatol. 2023 May 25. doi: 10.1055/a-2099-8662. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine health care disparities in evaluation and admission among underserved racial and ethnic minority groups presenting with cardiovascular complaints during the first postpartum year according to patient and provider demographics.

STUDY DESIGN: A retrospective cohort study was performed of all postpartum patients who sought emergency care between 2/2012 and 10/2020 in a large urban care center in Southeastern Texas. Patient information was collected by ICD-10 codes and individual chart analysis. Race, ethnicity, and gender information was self-reported for both patients on hospital enrollment forms and ED providers on their employment records. Statistical analysis was performed with logistic regression and Pearson’s Chi-squared test.

RESULTS: Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were Black, Hispanic or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints. Baseline characteristics were similar between groups; however, Hispanic or Latina patients were more likely to have had GDM during the index pregnancy (6.2% vs 18.3%). There was no difference in hospital admission between groups (17.9% Black vs 16.2% Latina or Hispanic patients). There was no difference in hospital admission rate by provider race or ethnicity overall (p =0.82). There was no difference in hospital admission rate when a patient was evaluated by a provider of a different race or ethnicity (RR= 1.08, CI 0.6-1.97). There was no difference in rate of admission according to self-reported gender of the provider (RR= 0.97, CI 0.66-1.44).

CONCLUSION: This study illustrates that disparities did not exist in the management of racial and ethnic minority groups who presented to the ED with cardiovascular complaints during the first postpartum year. Patient-provider discordance in race or gender was not a significant source of bias or discrimination during the evaluation and treatment of these patients.

PMID:37230477 | DOI:10.1055/a-2099-8662

Am J Perinatol. 2023 May 25. doi: 10.1055/a-2099-8494. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to examine the relationship between obesity and risk of stillbirth among pregnant women with obesity in the United States, with a focus on racial and ethnic disparities.

STUDY DESIGN: We conducted a retrospective cross-sectional analysis of birth and fetal data from the 2014-2019 National Vital Statistics System (N=14,938,384 total births), to examine associations of maternal body mass index (BMI) and risk of stillbirth. Cox proportional-hazards regression model was used to compute adjusted hazard ratios (HR) as a measure of risk of stillbirth in relation to maternal BMI.

RESULTS: The stillbirth rate was 6.70 per 1,000 births among women with a pre-pregnancy obesity, while the stillbirth rate among women with a normal (non-obese) pre-pregnancy BMI was 3.85 per 1,000 births. The risk of stillbirth was greater among women with obesity compared to women without obesity (HR 1.39; 95% CI: 1.37-1.41). Compared to Non-Hispanic (NH) Whites, women identifying as NH-other (HR 1.66; 95% CI: 1.61-1.72) and NH-Black (HR 1.31; 95% CI: 1.26-1.35) were at higher risk of stillbirth, while Hispanic women had a decreased likelihood of stillbirth (HR 0.38; 95% CI: 0.37-0.40).

CONCLUSION: Obesity is a modifiable risk factor for stillbirth. Public health awareness campaigns and strategies targeting weight management in women of reproductive age and racial/ethnic populations at highest risk for stillbirth are needed.

PMID:37230474 | DOI:10.1055/a-2099-8494

J Equine Vet Sci. 2023 May 23:104823. doi: 10.1016/j.jevs.2023.104823. Online ahead of print.

ABSTRACT

This study aimed to analyze effect of physical exercise in hemogasometric and electrolytic profiles of young Mangalarga Marchador horses beginning training for gait competitions. Six Mangalarga Marchador gaited horses with 6 months of training were evaluated. The ages ranged from three and a half to five years and included four stallions and two mares, with mean (±S.D.) body weight of 435±30Kg. Venous blood samples were collected from the horses, rectal temperature and HR were measured before and immediately after the gait test, and blood samples were used for hemogasometric and laboratory analyses. The Wilcoxon signed-rank test was used in the statistical analysis, assigning statistical significance for values of (p≤0.05). Physical effort significantly affected HR (p≤0.027), temperature (T) (p≤0.028), oxygen pressure (pO₂) (p≤0.027), oxygen saturation (sO₂) (p≤0.046), calcium (Ca²⁺) (p≤0.046), and glucose levels (GLI) (p≤0.028). The heart rate, temperature, and pO_2, sO₂, Ca²⁺, and glucose levels were affected by exercise. There was no considerable dehydration in these horses, making it clear that, at this level of effort, they did not enter a state of, indicating that the animals, even young horses, were well conditioned to the submaximal effort required in gaiting tests. The horses showed good adaptation to exercise and did not enter a state of fatigue with the effort made, indicating that the animals in this study received adequate training and could perform the type of exercise proposed, characterized by a submaximal effort.

PMID:37230434 | DOI:10.1016/j.jevs.2023.104823

Int J Cardiol. 2023 May 23:S0167-5273(23)00731-3. doi: 10.1016/j.ijcard.2023.05.038. Online ahead of print.

ABSTRACT

BACKGROUND: HFA-PEFF and cardiopulmonary exercise testing (CPET) are comprehensive diagnostic tools for heart failure with preserved ejection fraction (HFpEF). We aimed to investigate the incremental prognostic value of CPET for the HFA-PEFF score among patients with unexplained dyspnea with preserved ejection fraction (EF).

METHODS: Consecutive patients with dyspnea and preserved EF (n = 292) were enrolled between August 2019 and July 2021. All patients underwent CPET and comprehensive echocardiography, including two-dimensional speckle tracking echocardiography in the left ventricle, left atrium and right ventricle. The primary outcome was defined as a composite cardiovascular event including cardiovascular-related mortality, acute recurrent heart failure hospitalization, urgent repeat revascularization/myocardial infarction or any hospitalization due to cardiovascular events.

RESULTS: The mean age was 58 ± 14.5 years, and 166 (56.8%) participants were male. The study population was divided into three groups based on the HFA-PEFF score: < 2 (n = 81), 2-4 (n = 159), and ≥ 5 (n = 52). HFA-PEFF score ≥ 5, VE/VCO₂ slope, peak systolic strain rate of the left atrium and resting diastolic blood pressure were independently associated with composite cardiovascular events. Furthermore, the addition of VE/VCO₂ and HFA-PEFF to the base model showed incremental prognostic value for predicting composite cardiovascular events (C-statistic 0.898; integrated discrimination improvement 0.129, p = 0.032; net reclassification improvement 1.043, p ≤0.001).

CONCLUSIONS: CPET could be exploited for the HFA-PEFF approach in terms of incremental prognostic value and diagnosis among patients with unexplained dyspnea with preserved EF.

PMID:37230429 | DOI:10.1016/j.ijcard.2023.05.038

Int J Cardiol. 2023 May 23:S0167-5273(23)00734-9. doi: 10.1016/j.ijcard.2023.05.041. Online ahead of print.

ABSTRACT

BACKGROUND: A correct and prompt diagnosis of coronary artery disease (CAD) is a crucial component of disease management to reduce the risk of death and improve the quality of life in patients with CAD. Currently, the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC) guidelines recommend selecting an appropriate pre-diagnosis test for an individual patient according to the CAD probability. The purpose of this study was to develop a practical pre-test probability (PTP) for obstructive CAD in patients with chest pain using machine learning (ML); also, the performance of ML-PTP for CAD is compared to the final result of coronary angiography (CAG).

METHODS: We used a database from a single-center, prospective, all-comer registry designed to reflect real-world practice since 2004. All subjects underwent invasive CAG at Korea University Guro Hospital in Seoul, South Korea. We used logistic regression algorithms, random forest (RF), supporting vector machine, and K-nearest neighbor classification for the ML models. The dataset was divided into two consecutive sets according to the registration period to validate the ML models. ML training for PTP and internal validation used the first dataset registered between 2004 and 2012 (8631 patients). The second dataset registered between 2013 and 2014 (1546 patients) was used for external validation. The primary endpoint was obstructive CAD. Obstructive CAD was defined as having a stenosis diameter of >70% on the quantitative CAG of the main epicardial coronary artery.

RESULTS: We derived an ML-based model consisting of three different models according to the subject used to obtain the information, such as the patient himself (dataset 1), the community’s first medical center (dataset 2), and doctors (dataset 3). The performance range of the ML-PTP models as the non-invasive test had C-statistics of 0.795 to 0.984 compared to the result of invasive testing via CAG in patients with chest pain. The training ML-PTP models were adjusted to have 99% sensitivity for CAD so as not to miss actual CAD patients. In the testing dataset, the best accuracy of the ML-PTP model was 45.7% using dataset 1, 47.2% using dataset 2, and 92.8% using dataset 3 and the RF algorithm. The CAD prediction sensitivity was 99.0%, 99.0%, and 98.0%, respectively.

CONCLUSION: We successfully developed a high-performance model of ML-PTP for CAD which is expected to reduce the need for non-invasive tests in chest pain. However, since this PTP model is derived from data of a single medical center, multicenter verification is required to use it as a PTP recommended by the major American societies and the ESC.

PMID:37230426 | DOI:10.1016/j.ijcard.2023.05.041

Int J Cardiol. 2023 May 23:S0167-5273(23)00732-5. doi: 10.1016/j.ijcard.2023.05.039. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have shown that arterial stiffness (AS) was a risk factor for heart failure (HF) in nondiabetic patients. We aimed to analyze this impact in a community-based diabetic population.

METHODS: Our study excluded those who had HF before brachial-ankle pulse wave velocity (baPWV) measurement and included 9041 participants finally. Subjects were divided into the normal (<14 m/s), intermediate (14-18 m/s), and elevated baPWV groups (>18 m/s) based on baPWV values. Multivariate Cox proportional hazard model was used to analyze the effect of AS on HF risk.

RESULTS: During the median follow-up of 4.19 years, 213 patients had HF. The results of Cox model showed that HF risk in the elevated baPWV group was 2.25 times higher than that in the normal baPWV group (95% confidence interval [CI]: 1.24-4.11). HF risk increased by 18% (95% CI:1.03-1.35) for every 1 additional standard deviation(SD)of baPWV. Restricted cubic spline results showed statistically significant overall and non-linear associations between AS and HF risk (P < 0.05). The subgroup analysis and sensitivity analysis were consistent with that of total population.

CONCLUSIONS: AS is an independent risk factor for developing HF in the diabetic population, and AS exhibits a dose-response relationship with HF risk.

PMID:37230424 | DOI:10.1016/j.ijcard.2023.05.039

J Pediatr Gastroenterol Nutr. 2023 May 25. doi: 10.1097/MPG.0000000000003847. Online ahead of print.

ABSTRACT

OBJECTIVES: In individuals with spina bifida (SB), bowel incontinence is associated with lower quality of life and lower likelihood of employment. In an effort to maximize bowel continence in children and adolescents, we created a bowel management assessment and follow up protocol in a multi-disciplinary clinic. Here we report the results of this protocol using quality-improvement methodology.

METHODS: Continence was defined as no unplanned bowel movements. Our protocol involved:1) a standardized 4-item questionnaire about bowel continence and consistency; 2) If the patient was not achieving continence, an intervention starting with oral medication (stimulant and/or osmotic laxatives), and/or suppositories (glycerin or bisacodyl) followed by an escalation to trans-anal irrigation, or continence surgery; and 3) follow up phone calls at regular intervals to monitor progress and make changes as needed. Quality improvement methodology was employed. Results are summarized with descriptive statistics.

RESULTS: We screened 178 eligible patients in the SB clinic. Eighty-eight agreed to participate in the bowel management program. Of those who did not participate, the majority (68/90, 76%) were already achieving continence with their bowel regimen. Of children in the program, most (68/88, 77%) had a diagnosis of meningomyelocoele. At 1 year, the proportion of patients who were bowel accident free improved to 46% (vs 22% initially, p=0.0007).

CONCLUSIONS: A standardized bowel management protocol, primarily the use of suppositories and trans-anal irrigation to achieve social continence, as well as frequent telephone follow up, can reduce bowel incontinence in children and adolescents with SB.

PMID:37229746 | DOI:10.1097/MPG.0000000000003847