Tag: statistics

J Sep Sci. 2023 Feb 26:e2201004. doi: 10.1002/jssc.202201004. Online ahead of print.

ABSTRACT

Epilepsy is a complex neurological disease characterized by spontaneous recurrent seizures that affects around 1% of the global population. Despite the significant progress in the mechanisms of epileptogenesis, there is still about 60% of cases in which the cause is unknown. Thus, revealing the molecular mechanisms of epileptogenesis will greatly improve the development of epilepsy treatment. Since comprehensive characterization of amino acids and water-soluble vitamins is important in understanding the underlying mechanisms of epilepsy or seizures, we developed two liquid chromatography-tandem mass spectrometry methods to quantify 17 water-soluble vitamins and 46 amino acids and applied them to our pentylenetetrazole-induced kindling rat model. All water-soluble vitamins were detected with a linearity of r > 0.992 and limits of quantitation between 0.1 and 5 ng/ml except for nicotinic acid. For amino acids, the linearities obtained were good with correlation coefficients higher than 0.99, and matrix effects were between 85.3 and 110%. To handle the multidimensional data more effectively, multivariate statistical analysis approaches used in non-targeted metabolomics were creatively exploited in the visualization, interpretation, and exploration of the results. This article is protected by copyright. All rights reserved.

PMID:36841992 | DOI:10.1002/jssc.202201004

Isr Med Assoc J. 2023 Feb;25(2):91-95.

ABSTRACT

BACKGROUND: Several approaches are used to access the hip joint; most common are the direct lateral and posterior. Little consensus exists on which to use when treating hip fractures.

OBJECTIVES: To compare short-term complications, postoperative ambulation, and patient-reported outcome measures (PROMS) of direct lateral vs. posterior approaches in hemiarthroplasty for acute hip fractures.

METHODS: We conducted a retrospective clinical trial with 260 patients who underwent bipolar hemiarthroplasty in the direct lateral or posterior approach (166 and 94, respectively) between January 2017 and December 2018. The clinical data included short-term complications: prosthetic dislocation, periprosthetic fractures, and infection. Postoperative ambulation was collected 6 weeks postoperatively; PROMS were collected for 173 patients at 2 years follow-up.

RESULTS: There were six dislocations overall, average time to dislocation was 22 days postoperative (range 4-34). Five dislocations were after the posterior approach (5.3%) and one after direct lateral (0.6%) (P = 0.01). At 6 weeks follow-up, inability to walk was found in 16.9% of the direct lateral group and 6.4% of the posterior approach group (P = 0.02). In the posterior approach group, 76% could walk more than 20 meters; only half of the direct lateral group could (P = 0.0002). At 2 years follow-up, PROMS did not show a statistically significant difference between the groups.

CONCLUSIONS: Posterior approach for hemiarthroplasty following femoral neck fractures allows superior ambulation to the direct lateral approach only for the short-term. However, no long-term clinical advantage was found. This short-term benefit does not justify the increased dislocation rate in the posterior approach.

PMID:36841975

Isr Med Assoc J. 2023 Feb;25(2):88-90.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has severe consequences in terms of mortality and morbidity. Knowledge of factors that impact COVID-19 may be useful in the search for treatments.

OBJECTIVES: To determine the effect of glucose-6-phosphate dehydrogenase (G6PD) deficiency on morbidly and mortality associated with COVID-19.

METHODS: All patients admitted to Hadassah Hebrew University Medical Center between 01 March 2020 and 03 May 2021 with a diagnosis of COVID-19 were included. We retrospectively retrieved demographic, clinical, and laboratory data from the hospital’s electronic medical records. The main outcomes were mortality, intensive care unit (ICU) admission, and severity of COVID-19.

RESULTS: The presence of G6PD deficiency emerged as an independent protective predictor for ICU admission (odds ratio [OR] 0.258, 95% confidence interval [95%CI] 0.077-0.619, P = 0.003) and the development of critical illness (OR 0.121, 95%CI 0.005-0.545, P = 0.006). Moreover, patients with G6PD deficiency had a trend toward lower mortality rates that did not reach statistical significance (OR 0.541, 95%CI 0.225-1.088, P = 0.10).

CONCLUSIONS: Patients with G6PD deficiency were less likely to have a severe disease, had lower rates of ICU admission, and trended toward lower mortality rates.

PMID:36841974

JMIR Med Educ. 2023 Feb 25. doi: 10.2196/43792. Online ahead of print.

ABSTRACT

BACKGROUND: Scoring and awarding credit on multiple-select items is more complex than on single-choice items. Forty-one different scoring methods were retrospectively applied to two multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF] items) from existing exam data.

OBJECTIVE: This study aimed to calculate and compare mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above pass-level (≥0.6).

METHODS: Items and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing exam data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using Kruskal Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P<.05).

RESULTS: 1,931 marking events on 48 Pick-N items and 828 marking events on 18 MTF items were analysed. For both item types, scoring results widely differed between scoring methods (min: 0.02, max: 0.98, P<.001). Both the use of an inappropriate item type (N = 34 items) and presence of cues (N = 30 items) impacted on the scoring results: Pick-N items used inappropriately resulted in lower mean raw scores (0.88 vs 0.93, P<.001), while inappropriately used MTF items resulted in higher mean raw scores (0.88 vs 0.85, P=.001). MTF items with cues resulted in higher mean raw scores than items without cues (0.91 vs 0.8, P<.001) while mean raw scores from Pick-N items with and without cues did not differ (0.89 vs 0.90, P=.09). Item quality also impacted on the likelihood of resulting scores at or above pass-level (OR≤6.977).

CONCLUSIONS: Educators should pay attention when using multiple-select multiple-choice items and select the most appropriate item type. Different item types, scoring methods, and presence of cues are likely to impact on examinees’ scores and overall examination results.

PMID:36841970 | DOI:10.2196/43792

J Clin Nurs. 2023 Feb 26. doi: 10.1111/jocn.16657. Online ahead of print.

ABSTRACT

AIMS: To gain a comprehensive understanding of nurses’ infection control practices, antibiotics stewardship attitudes and self-efficacy when caring for patients with multidrug-resistant bacterial infections in a hospital setting.

BACKGROUND: Multidrug-resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self-efficacy can inform professional behaviour. Nurses’ attitudes and self-efficacy concerning multidrug-resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe.

DESIGN: A descriptive and convergent mixed-methods design involving quantitative and qualitative approaches was used.

METHODS: Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug-Resistant Bacteria Attitude Questionnaire and the General Perceived Self-Efficacy Scale (n = 131) and four focus group interviews (n = 22). The data were analysed using descriptive statistics and systematic text condensation.

RESULTS: Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self-efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses’ role were potential explanations.

CONCLUSION: Nurses report moderate attitudes and high self-efficacy when caring for patients with multidrug-resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution.

RELEVANCE TO CLINICAL PRACTICE: Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses’ role in antibiotic stewardship is needed.

PMID:36841961 | DOI:10.1111/jocn.16657

Catheter Cardiovasc Interv. 2023 Feb 25. doi: 10.1002/ccd.30598. Online ahead of print.

ABSTRACT

BACKGROUND: Target lumen enlargement (TLE) or “late lumen enlargement” is often encountered after percutaneous coronary intervention (PCI) with drug-coated balloons (DCB). To date, the prognosis of coronary arterial lesions with or without TLE has not been clearly elucidated.

AIMS: This study aimed to assess the long-term prognosis of coronary arterial lesions with or without TLE observed within 1 year (early TLE) after DCB angioplasty using serial quantitative angiographic follow-up.

METHODS: One hundred and ninety-three consecutive patients (de novo coronary arterial lesions, 251) who underwent follow-up angiography within 1 year after DCB angioplasty (early follow-up, median: 6 months) were retrospectively evaluated. Of these, 97 patients (125 lesions) also underwent angiography more than 1 year after DCB angioplasty (late follow-up, median: 37 months). TLE was defined as an increase in minimal lumen diameter (MLD) after PCI at each follow-up.

RESULTS: Early TLE was detected in 142 lesions (56.6%). Of these, 76 lesions were also evaluated at late follow-up. TLE persisted even at late follow-up in 67 of the 76 lesions (88.2%). An increase in MLD in early TLE (+) lesions was observed in the period between post-PCI and early follow-up (1.84 ± 0.06 vs. 2.12 ± 0.07 mm, p < 0.001) but not between early and late follow-up (2.12 ± 0.07 vs. 2.16 ± 0.07 mm, p = 0.74). In contrast, 49 of 109 lesions without early TLE were evaluated at late follow-up, of which 28 lesions (57.1%) showed TLE at late follow-up. The MLD of early TLE (-) lesions (n = 49) significantly increased from early (1.63 ± 0.061 mm) to late follow-up (1.84 ± 0.06 mm) (p < 0.001). No aneurysms were found in any of these cases.

CONCLUSION: Early TLE was observed in more than half of the lesions, with the majority remaining at late follow-up. Alternatively, half of the lesions without early TLE showed late TLE, occurring biphasically after DCB angioplasty.

PMID:36841946 | DOI:10.1002/ccd.30598

Med Phys. 2023 Feb 25. doi: 10.1002/mp.16331. Online ahead of print.

ABSTRACT

BACKGROUND: Reducing the radiation dose from computed tomography (CT) can significantly reduce the radiation risk to patients. However, low-dose CT (LDCT) suffers from severe and complex noise interference that affects subsequent diagnosis and analysis. Recently, deep learning-based methods have shown superior performance in LDCT image-denoising tasks. However, most methods require many normal-dose and low-dose CT image pairs, which are difficult to obtain in clinical applications. Unsupervised methods, on the other hand, are more general.

PURPOSE: Deep learning methods based on GAN networks have been widely used for unsupervised LDCT denoising, but the additional memory requirements of the model also hinder its further clinical application. To this end, we propose a simpler multi-stage denoising framework trained using unpaired data, the Progressive Cyclical Convolutional Neural Network (PCCNN), which can remove the noise from CT images in latent space.

METHODS: Our proposed PCCNN introduces a noise transfer model that transfers noise from LDCT to NDCT, denoised CT images generated from unpaired CT images, and noisy CT images. The denoising framework also contains a progressive module that effectively removes noise through multi-stage wavelet transforms without sacrificing high-frequency components such as edges and details.

RESULTS: Compared with seven LDCT denoising algorithms, we perform a quantitative and qualitative evaluation of the experimental results and perform ablation experiments on each network module and loss function. On the AAPM dataset, compared with the contrasted unsupervised methods, Our denoising framework has excellent denoising performance increasing the peak signal-to-noise ratio (PSNR) from 29.622 to 30.671, and the structural similarity index (SSIM) was increased from 0.8544 to 0.9199. The PCCNN denoising results were relatively optimal and statistically significant. In the qualitative result comparison, PCCNN without introducing additional blurring and artifacts, the resulting image has higher resolution and complete detail preservation, and the overall structural texture of the image is closer to NDCT. In visual assessments, PCCNN achieves a relatively balanced result in noise suppression, contrast retention, and lesion discrimination.

CONCLUSIONS: Extensive experimental validation shows that our scheme achieves reconstruction results comparable to supervised learning methods and has performed well in image quality and medical diagnostic acceptability. This article is protected by copyright. All rights reserved.

PMID:36841936 | DOI:10.1002/mp.16331

Spinal Cord. 2023 Feb 25. doi: 10.1038/s41393-023-00874-6. Online ahead of print.

ABSTRACT

BACKGROUND: Secondary conditions may reduce function and participation in individuals with chronic Spinal Cord Injury (SCI). The knowledge of reasons for readmission to the hospital may be enlightening to prevent them and remodel the health services.

STUDY DESIGN: Multicenter prospective observational study of all consecutive readmissions of persons with SCI after rehabilitation completion.

OBJECTIVES: To explore the characteristics of individuals with SCI readmitted to the hospital, the reasons for readmissions and the burden on hospitalization in terms of length of stay (LoS) for different conditions.

SETTING: 31 Italian specialized SCI centers.

METHODS: Data on people with traumatic SCI readmitted to SCI centers were recorded about: age, sex, SCI level and severity group, geographical origin, readmission causes, clinical interventions during hospitalization, LoS and discharge destination. Linear and multiple logistic regression analyses were performed considering LoS (days) as dependent variable for correlations with independent variables. All tests were two-sided.

RESULTS: Among 1039 persons with traumatic SCI enrolled (mean age 46, males 85%, tetraplegia 43%), 59.09% of the readmissions were caused by urological problems, 39.74% by pressure injury and 35.41% by spasticity (68% readmitted for ≥2 causes, associated with longer LoS). The mean LoS was 48 days: pressure injury, rehabilitative needs, sexual, bowel, and pain problems were associated with longer and urological problems with shorter LoS. People from the South of the country were frequently (68%) readmitted to the northern centers.

CONCLUSIONS: Urological problems, pressure injury and spasticity were the most frequent causes of re-hospitalization in individuals with traumatic SCI. The migration trend seeking SCI-specific treatments suggests geographic areas to which health care organizations need to pay more attention.

PMID:36841915 | DOI:10.1038/s41393-023-00874-6

Eur J Orthop Surg Traumatol. 2023 Feb 25. doi: 10.1007/s00590-023-03492-3. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing double-button suture fixation to hook plate fixation for types III-IV acromioclavicular joint dislocation.

METHODS: Systematic review of Medline, Embase, Scopus, and Google Scholar, including all levels 1-3 studies from 2000 to 2022. Clinical outcome scores, range of motion, and complications were included. Risk of bias was assessed using the Cochrane Collaboration’s ROB2 tool and ROBINs-I tool. MINORS and modified Coleman Methodology Score (CMS) were used to assess within study quality. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ² and I² statistics.

RESULTS: Fifteen studies were included. Three of the four included LOE II and eleven of the LOE III studies had a high risk of bias. Study quality was considered poor and fair for 67% by MINORS criteria and 93% for CMS criteria. The pooled estimate (SMD 0.662) for all clinical outcomes was statistically significant and in favor of button repair (p = 0.0001). The pooled estimate (SMD 0.662) for all VAS pain scores was statistically significant, again in favor of button repair (p = 0.001).

CONCLUSIONS: The results of this meta-analysis demonstrated significantly better outcomes of button repair for acute ACJ dislocations when compared to clavicle hook plate. Button repair is also associated with a 2.2 times lower risk for complications. However, risk of bias is high, and study quality within and between studies was low. These results, therefore, must be viewed with caution.

LEVEL OF EVIDENCE: Level III; systematic review and meta-analysis.

PMID:36841909 | DOI:10.1007/s00590-023-03492-3

Br J Cancer. 2023 Feb 25. doi: 10.1038/s41416-023-02207-z. Online ahead of print.

ABSTRACT

BACKGROUND: Overweight and obesity are common amongst women attending breast cancer Family History, Risk and Prevention Clinics (FHRPCs). Overweight increases risk of breast cancer (BC) and conditions including¹ cardiovascular disease (CVD) and type-2 diabetes (T2D). Clinics provide written health behaviour advice with is likely to have minimal effects. We assessed efficacy of two remotely delivered weight loss programmes vs. written advice.

METHOD: 210 women with overweight or obesity attending three UK FHRPCs were randomised to either a BC prevention programme (BCPP) framed to reduce risk of BC (n = 86), a multiple disease prevention programme (MDPP) framed to reduce risk of BC, CVD and T2D (n = 87), or written advice (n = 37). Change in weight and health behaviours were assessed at 12-months.

RESULTS: Weight loss at 12 months was -6.3% (-8.2, -4.5) in BCPP, -6.0% (-7.9, -4.2) in MDPP and -3.3% (-6.2, -0.5) in the written group (p = 0.451 across groups). The percentage losing ≥10% weight in these groups were respectively 34%, 23% and 14% (p = 0.038 across groups).

DISCUSSION: BCPP and MDPP programmes resulted in more women achieving ≥10% weight loss, but no evidence of additional benefits of MDPP. A multicentre RCT to test the BCPP across UK FHRPCs is warranted. Clinical Trial Registration ISRCTN16431108.

PMID:36841908 | DOI:10.1038/s41416-023-02207-z