Tag: statistics

Ann Fam Med. 2023 Jan 1;(21 Suppl 1). doi: 10.1370/afm.21.s1.4141.

ABSTRACT

Context: Antibiotics for suspected urinary tract infection (UTI) is appropriate only when an infection is present. Urine culture is definitive but takes >1 day to result. A machine learning urine culture predictor was recently devised for Emergency Department (ED) patients but requires use of urine microscopy (“NeedMicro” predictor), which is not routinely available in primary care (PC). Objective: To adapt this predictor to use only features available in primary care and determine if predictive accuracy generalizes to the primary care setting. We call this the “NoMicro” predictor. Study Design and Analysis: Multicenter, retrospective, observational, cross-sectional analysis. Machine learning predictors were trained using extreme gradient boosting, artificial neural networks, and random forests. Models were trained on the ED dataset and were evaluated on both the ED dataset (internal validation) and the PC dataset (external validation). Setting: United States (US) academic medical centers emergency department and family medicine clinic. Population Studied: 80387 (ED, previously described) and 472 (PC, newly curated) US adults. Instrument: Physicians performed retrospective chart review. The primary outcome extracted was pathogenic urine culture growing ≥100,000 colony forming units. Predictor variables included age; gender; dipstick urinalysis nitrites, leukocytes, clarity, glucose, protein, and blood; dysuria; abdominal pain; and history of UTI. Outcome Measures: Predictor overall discriminative performance (receiver operating characteristic area under the curve, ROC-AUC), performance statistics (e.g., sensitivity, negative predictive value, etc.), and calibration. Results: The “NoMicro” model performs similarly to the “NeedMicro” model in internal validation on the ED dataset: NoMicro ROC-AUC 0.862 (95% CI: 0.856-0.869) vs. NeedMicro 0.877 (95% CI: 0.871-0.884). External validation on the primary care dataset also yielded high performance (NoMicro ROC-AUC 0.850 [95% CI: 0.808-0.889]), despite being trained on Emergency Department data. Simulation of a hypothetical, retrospective clinical trial suggests the NoMicro model could be used to avoid antibiotic overuse by safely withhold antibiotics in low-risk patients. Conclusions: The hypothesis that the NoMicro predictor generalizes to both PC and ED contexts is supported. Prospective trials to determine the real-world impact of using the NoMicro model to reduce antibiotic overuse are appropriate.

PMID:36972528 | DOI:10.1370/afm.21.s1.4141

Lab Med. 2023 Mar 27:lmad001. doi: 10.1093/labmed/lmad001. Online ahead of print.

ABSTRACT

The quality of clinical experiences for students in health care professions relies heavily on clinical educators. Hence the quest to be informed on qualities that make great clinical educators in medical laboratory professions as well as teaching methods. A 48-question survey was developed, validated, and distributed to laboratory professionals in the American Society for Clinical Pathology database. Four questions pertaining to teaching and evaluation as well as clinical educators’ attributes were evaluated in the study. Responses were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed with the P value set at .05. The results revealed that communication and motivation to teach were most valued among clinical educators and empathy was the least valued attribute. Educators reported on different approaches to teaching and evaluating students. Clinical educators could benefit from training that highlights these attributes and teaching methods for great clinical experiences both for educators and students.

PMID:36972515 | DOI:10.1093/labmed/lmad001

World J Pediatr Congenit Heart Surg. 2023 Mar 27:21501351231162959. doi: 10.1177/21501351231162959. Online ahead of print.

ABSTRACT

BACKGROUND: In patients with tetralogy of Fallot and major aortopulmonary collaterals (MAPCAs), pulmonary blood supply is highly variable. Our approach to this condition emphasizes complete unifocalization of the pulmonary circulation, incorporating all lung segments and addressing stenoses out to the segmental level. Post-repair, we recommend serial lung perfusion scintigraphy (LPS) to assess short-term changes in pulmonary blood flow distribution.

METHODS: We reviewed post-discharge and follow-up LPS performed through three years post-repair and analyzed serial changes in perfusion, risk factors for change, and the relationship between LPS parameters and pulmonary artery reintervention.

RESULTS: Of 543 patients who had postoperative LPS results in our system, 317 (58%) had only a predischarge LPS available for review, while 226 had 1 (20%) or more (22%) follow-up scans within three years. Overall, pulmonary flow distribution prior to discharge was balanced, and there was minimal change over time; however, there was considerable patient-to-patient variation in both metrics. On multivariable mixed modeling, time after repair (P = .025), initial anatomy consisting of a ductus arteriosus to one lung (P < .001), and age at repair (P = .014) were associated with changes on serial LPS. Patients who had follow-up LPS were more likely to undergo pulmonary artery reintervention, but within that cohort, LPS parameters were not associated with reintervention risk.

CONCLUSION: Serial LPS during the first year after MAPCAs repair is a noninvasive method of screening for significant post-repair pulmonary artery stenosis that occurs in a small but important minority of patients. In patients who received follow-up LPS beyond the perioperative period, there was minimal change over time in the population overall, but large changes in some patients and considerable variability. There was no statistical association between LPS findings and pulmonary artery reintervention.

PMID:36972512 | DOI:10.1177/21501351231162959

Nutr Health. 2023 Mar 27:2601060231166163. doi: 10.1177/02601060231166163. Online ahead of print.

ABSTRACT

Background: Adequate energy and protein intakes are required to maintain nutritional status and prevent clinical deterioration in paediatric oncology patients. There are limited investigations of malnutrition and dietary intake adequacy during treatment in developing countries. Aim: This study aimed to assess the nutritional status and macro- and micronutrient intake adequacy in paediatric oncology patients undergoing therapy. Methods: This cross-sectional study was conducted at Dr Sardjito Hospital, Indonesia. Sociodemographic, anthropometry, dietary intake, and anxiety status were collected. Patients were grouped based on cancer aetiology (haematological malignancy (HM) or solid tumour (ST). Variables between groups were compared. P-values of <0.05 were considered statistically significant. Results: 82 patients aged 5-17 years (65.9% HM) were analysed. The prevalence of underweight was 24.4% (ST vs HM: 26.9% vs 23.2%), overweight 9.8% (ST vs HM: 11.5% vs 8.5%), and obesity 6.1% (ST vs HM: 0.0% vs 8.5%) according to BMI-for-age z-score. Mid-upper-arm circumference identified undernutrition in 55.7% and overnutrition in 3.7% of the patients. Stunted growth was found in 20.8% of the patients. Percentages of children with inadequate energy and protein intake were 43.9% and 26.8%, respectively. The percentages of participants meeting the national micronutrient requirements were low, ranging from 3.8% to 56.1%, with the highest adherence rate observed for vitamin A and the lowest for vitamin E. Appetite loss was associated with lower overall intake. Conclusion: This study confirmed that malnutrition is prevalent in paediatric patients treated for cancer. Inadequate intakes of macro- and micro-nutrients were also common, highlighting the need for early nutritional assessment and intervention.

PMID:36972507 | DOI:10.1177/02601060231166163

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231160748. doi: 10.1177/10760296231160748.

ABSTRACT

BACKGROUND: The efficacy and safety of thromboprophylaxis in pregnancy at intermediate to high risk of venous thrombo-embolism (VTE) is an area of ongoing research.

AIM: This study aimed to assess thrombosis and bleeding outcomes associated with thromboprophylaxis in women at risk of VTE.

METHODS: A cohort of 129 pregnancies, who received thromboprophylaxis for the prevention of VTE, were identified from a specialist obstetric clinic in Johannesburg, South Africa. Intermediate-risk pregnancies, with medical comorbidities or multiple low risks, were managed with fixed low-dose enoxaparin antepartum and for a median (interquartile range) of 4 (4) weeks postpartum. High-risk pregnancies, with a history of previous VTE, were managed with anti-Xa adjusted enoxaparin antepartum and for a median of 6 (0) weeks postpartum. Pregnancy-related VTE was objectively confirmed. Major bleeding, clinically relevant nonmajor bleeding (CRNMB) and minor bleeding were defined according to the International Society on Thrombosis and Hemostasis Scientific Subcommittee.

RESULTS: Venous thrombo-embolism occurred antepartum in 1.4% (95% CI: 0.04-7.7) of intermediate and 3.4% (95% CI: 0.4-11.7) of high-risk pregnancies. Bleeding events occurred in 7.1% (95% CI: 2.4-15.9) of intermediate and 8.5% (95% CI: 2.8-18.7) of high-risk pregnancies. Of these bleeding events, 3.1% (95% CI: 1.0-8.0) were classified as major bleeding. On univariate analysis, no independent predictors of bleeding were identified.

CONCLUSION: The rates of thrombosis and bleeding in this predominantly African population were consistent with similar studies and can be used to inform pregnant women of the benefits of anticoagulation and the risks of potential bleeding.

PMID:36972476 | DOI:10.1177/10760296231160748

Proc Natl Acad Sci U S A. 2023 Apr 4;120(14):e2302318120. doi: 10.1073/pnas.2302318120. Epub 2023 Mar 27.

NO ABSTRACT

PMID:36972458 | DOI:10.1073/pnas.2302318120

J Psychoactive Drugs. 2023 Mar 27:1-9. doi: 10.1080/02791072.2023.2192985. Online ahead of print.

ABSTRACT

The study aimed to assess and compare the serum brain derived neurotrophic factor (BDNF) levels in patients with alcohol dependence, depression and alcohol dependence with comorbid depression. Three groups each of 30 alcohol-dependent, depressive and alcohol-dependent with comorbid depressive patients seeking treatment were included. BDNF levels were estimated, and scales were administered to assess severity of alcohol dependence (using severity of alcohol dependence questionnaire, SADQ) and depressive symptoms (using Hamilton depression rating scale, HDRS). The mean BDNF value in ADS, depression and ADS with comorbid depression group was 16.4 ng/mL, 14.4 ng/mL and 12.29 ng/mL respectively, and the differences were statistically significant. In ADS group and ADS with comorbid depression groups significant negative association existed between BDNF and SADQ scores (r = -0.371, p = .043 and r = -0.0474, p = .008 respectively). There were significant negative association between BDNF and HDRS scores in depression and comorbid ADS and depression group (r = -0.400, p = .029 and r = -0.408, p = .025 respectively). The BDNF level was significantly lower in the ADS with comorbid depression group and was associated with severity of dependence and depression across the groups.

PMID:36972422 | DOI:10.1080/02791072.2023.2192985

J Agric Food Chem. 2023 Mar 27. doi: 10.1021/acs.jafc.2c08541. Online ahead of print.

ABSTRACT

A strategy for determining the bioaccessibility of bromine and iodine from edible seaweeds was proposed for the first time using microwave-induced combustion (MIC) and ion chromatography coupled to mass spectrometry (IC-MS) after in vitro digestion. The concentrations of bromine and iodine in edible seaweeds using the proposed methods (MIC and IC-MS) were not statistically different from those using MIC and inductively coupled plasma mass spectrometry (p > 0.05). Trueness was assessed by recovery experiments (101-110%, relative standard deviation <10%). Following an in vitro digestion protocol, MIC was proposed as sample preparation for bioaccessible and residual fractions. Using this strategy, the mass balance totaled from 97 to 111%. No statistical difference (p > 0.05) was observed between the total concentration of bromine or iodine and their concentration in bioaccessible and residual fractions for three edible seaweed species, indicating full analyte quantification in the fractions.

PMID:36972393 | DOI:10.1021/acs.jafc.2c08541

Hepatol Commun. 2023 Mar 24;7(4):e0079. doi: 10.1097/HC9.0000000000000079. eCollection 2023 Apr 1.

ABSTRACT

BACKGROUND: Using dynamic contrast-enhanced (DCE) MR perfusion and MR spectroscopy this study aimed to characterize the blood-brain barrier permeability and metabolite changes in patients with cirrhosis and without covert HE.

METHODS: Covert HE was defined using psychometric HE score (PHES). The participants were stratified into 3 groups: cirrhosis with covert HE (CHE) (PHES<-4); cirrhosis without HE (NHE) (PHES≥-4); and healthy controls (HC). Dynamic contrast-enhanced MRI and MRS were performed to assess KTRANS, a metric derivative of blood-brain barrier disruption, and metabolite parameters. Statistical analysis was performed using IBM SPSS (v25).

RESULTS: A total of 40 participants (mean age 63 y; male 71%) were recruited as follows: CHE (n=17); NHE (n=13); and HC (n=10). The KTRANS measurement in the frontoparietal cortex demonstrated increased blood-brain barrier permeability, where KTRANS was 0.01±0.02 versus 0.005±0.005 versus 0.004±0.002 in CHE, NHE, and HC patients, respectively (p = 0.032 comparing all 3 groups). Relative to HC with a value of 0.28, the parietal glutamine/creatine (Gln/Cr) ratio was significantly higher in both CHE 1.12 mmoL (p < 0.001); and NHE 0.49 (p = 0.04). Lower PHES scores correlated with higher glutamine/Cr (Gln/Cr) (r=-0.6; p < 0.001) and lower myo-inositol/Cr (mI/Cr) (r=0.6; p < 0.001) and lower choline/Cr (Cho/Cr) (r=0.47; p = 0.004).

CONCLUSION: The dynamic contrast-enhanced MRI KTRANS measurement revealed increased blood-brain barrier permeability in the frontoparietal cortex. The MRS identified a specific metabolite signature with increased glutamine, reduced myo-inositol, and choline, which correlated with CHE in this region. The MRS changes were identifiable in the NHE cohort.

PMID:36972380 | DOI:10.1097/HC9.0000000000000079

Oncologist. 2023 Mar 27:oyad062. doi: 10.1093/oncolo/oyad062. Online ahead of print.

ABSTRACT

INTRODUCTION: Chemotherapy-induced peripheral neuropathy (CIPN) can lead to chemotherapy dose reduction, delay, and discontinuation, and has limited effective prevention strategies. Our study aimed to identify patient characteristics associated with CIPN severity during weekly paclitaxel chemotherapy in people with early-stage breast cancer.

METHODS: We retrospectively collected baseline data including participants’ age, gender, race, body mass index (BMI), hemoglobin (regular and A1C), thyroid stimulating hormone, Vitamins (B6, B12, and D), anxiety, and depression up to 4 months prior to their first paclitaxel treatment. We also collected CIPN severity by Common Terminology Criteria for Adverse Events (CTCAE) after chemotherapy, chemotherapy relative dose density (RDI), disease recurrence, and mortality rate at the time of the analysis. Logistic regression was used for statistical analysis.

RESULTS: We extracted 105 participants’ baseline characteristics from electronic medical records. Baseline BMI was associated with CIPN severity (Odds Ratio [OR] 1.08; 95% CI, 1.01-1.16, P = .024). No significant correlations were observed in other covariates. At median follow-up (61 months), there were 12 (9.5%) breast cancer recurrences and six (5.7%) breast cancer-related deaths. Higher chemotherapy RDI was associated with improved disease-free survival (DFS, OR 1.025; 95% CI, 1.00-1.05; P = .028).

CONCLUSIONS AND RELEVANCE: Baseline BMI may be a risk factor for CIPN and suboptimal chemotherapy delivery due to CIPN may negatively impact disease-free survival in patients with breast cancer. Further study is warranted to identify mitigating lifestyle factors to reduce incidences of CIPN during breast cancer treatment.

PMID:36972359 | DOI:10.1093/oncolo/oyad062