Tag: statistics

Catheter Cardiovasc Interv. 2023 Mar 6. doi: 10.1002/ccd.30613. Online ahead of print.

ABSTRACT

PURPOSE: The contribution of thoracic duct obstruction to lymphatic flow disorders has not been well-characterized. We describe imaging findings, interventions, and outcomes in patients with suspected duct obstruction by imaging or a lympho-venous pressure gradient (LVPG).

MATERIALS AND METHODS: Clinical, imaging, and interventional data, including the LVPG, of patients with flow disorders and imaging features of duct obstruction who underwent lymphatic intervention were retrospectively reviewed, collated, and analyzed with descriptive statistics.

RESULTS: Eleven patients were found to have obstruction, median age 10.4 years (interquartile range: 8-14.9 years). Pleural effusions were seen in 8/11 (72%), ascites in 8/11 (72%), both in 5/11 (45%), and protein-losing enteropathy in 5 (45%). Eight patients (72%) had congenital heart disease. The most common site of obstruction was at the duct outlet in 7/11 patients (64%). Obstruction was secondary to extrinsic compression or ligation 4 patients (36%). Nine patients (82%) underwent interventions, with balloon dilation in 7/9 (78%), massive lymphatic malformation drainage and sclerotherapy in 1, and lympho-venous anastomosis in 1. There was resolution of symptoms in 7/9 (78% who underwent intervention, with worsening in 1 patient and no change in 1. In these patients, preprocedure mean LVPG was 7.9 ± 5.7 mmHg and postprocedure gradient was 1.6 ± 1.9 mmHg (p = 0.014). Five patients in this series underwent intervention solely to alleviate duct obstruction and in 4/5 (80%) this led to resolution of symptoms (p = 0.05).

CONCLUSION: Duct obstruction may be seen in lymphatic flow disorders and can occur from intrinsic and extrinsic causes. Stenosis at the outlet was most common. Obstruction can be demonstrated by an elevated LVPG, and interventions to alleviate the obstruction can be beneficial.

PMID:36877806 | DOI:10.1002/ccd.30613

JMIR Form Res. 2023 Feb 28. doi: 10.2196/43759. Online ahead of print.

ABSTRACT

BACKGROUND: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia patients who require ICU level care are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high-risk for unanticipated healthcare utilization post discharge. Common to this group of patients are increased readmission rates, long term decreased mobility, and overall poorer outcomes. Multidisciplinary post-ICU clinics for ICU survivors are usually located in large urban academic medical centers providing in-person consultation. Data is lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors.

OBJECTIVE: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on healthcare utilization post hospital discharge.

METHODS: This randomized, unblinded, single-center, parallel-group exploratory study was conducted at a rural, academic, tertiary-care medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a six-minute walk test (6MWT), a EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs (VSL) were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of these review and tests. The control group (CG) received a telemedicine visit within six weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit.

RESULTS: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72.2% agreed to follow up in the pulmonary clinic compared to 50.0% of CG participants (P=.31). Unanticipated visits to the emergency department were 11.1% in the SG compared to 5.6% CG (not sig.). The rate of pain/discomfort was noted to be 66.7% in the SG compared to 61.1% in the CG (P=.72). The anxiety/depression rate was 72.2% vs. 61.1% (P=.59) in the SG compared to the CG. Participants’ self-assessed health rating scores was M=73.9, SD 16.1 in the SG compared to M=70.6, SD 20.9 in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for post-discharge critical illness follow-up in an open-ended questionnaire regarding care.

CONCLUSIONS: This exploratory study found no statistically significant results in reducing healthcare utilization post-discharge and health related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for post-discharge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated post-discharge healthcare utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors which may show improvement in healthcare utilization in a larger population.

PMID:36877802 | DOI:10.2196/43759

J Comput Assist Tomogr. 2023 Mar 4. doi: 10.1097/RCT.0000000000001446. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study is to evaluate the role of sublingual nitrate in improving vessel visualization on peripheral computed tomography angiography (CTA).

METHODS: Fifty patients clinically diagnosed with peripheral arterial disease of the lower limb were prospectively included in this study: Twenty-five underwent CTA after sublingual nitrate administration (nitrate group) and 25 without (non-nitrate group). Two blinded observers qualitatively and quantitatively assessed the data thus generated. The mean luminal diameter, intraluminal attenuation, site, and percentage of stenosis were evaluated in all segments. Assessment of collateral visualization at sites of significant stenosis was also done.

RESULTS: Patients in the nitrate and non-nitrate groups were similar in age and sex characteristics (P > 0.05).On subjective evaluation, there was significantly improved visualization of the femoropopliteal and tibioperoneal vasculature of the lower limb in the nitrate group compared with the non-nitrate group (P < 0.05). Quantitative evaluation showed a statistically significant difference in the measured arterial diameters for all evaluated segments in the nitrate group versus the non-nitrate group (P < 0.05). Intra-arterial attenuation was significantly greater for all segments in the nitrate group resulting in better contrast opacification in these studies. Collateral visualization around segments with more than 50% stenosis/occlusion was also better in the nitrate group.

CONCLUSIONS: Our study suggests that nitrate administration before peripheral vascular CTA can improve visualization, especially in the distal segments by increasing the vessel diameter and intraluminal attenuation along with better delineation of the collateral circulation around stenotic areas. It may also improve the number of evaluable segments of vasculature in these angiographic studies.

PMID:36877793 | DOI:10.1097/RCT.0000000000001446

J Comput Assist Tomogr. 2023 Mar 4. doi: 10.1097/RCT.0000000000001421. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to compare 3 computed tomography perfusion (CTP) software packages in the estimation of infarct core volumes, hypoperfusion volumes, and mismatch volumes.

METHODS: Forty-three patients with large vessel occlusion in the anterior circulation who underwent CTP imaging were postprocessed by 3 software packages: RAPID, advantage workstation (AW), and NovoStroke Kit (NSK). Infarct core volumes and hypoperfusion volumes were generated by RAPID with default settings. The AW and NSK threshold settings were the following: infarct core (cerebral blood flow [CBF] <8 mL/min/100 g, CBF <10 mL/min/100 g, CBF <12 mL/min/100 g, and cerebral blood volume [CBV] <1 mL/100 g) and hypoperfusion (Tmax >6 seconds). Mismatch volumes were then obtained for all the combinations of the settings. Bland-Altman, intraclass correlation coefficient (ICC), and Spearman ρ or Pearson correlation coefficient were applied for statistical analysis.

RESULTS: In the estimation of infarct core volumes, good agreement was observed between AW and RAPID when CBV <1 mL/100 g (ICC, 0.767; P < 0.001). For hypoperfusion volumes, good agreement (ICC, 0.811; P < 0.001) and strong correlation (r = 0.856; P < 0.001) were observed between NSK and RAPID. For mismatch volumes, the setting of CBF <10 mL/min/100 g combined with hypoperfusion with NSK resulted in moderate agreement (ICC, 0.699; P < 0.001) with RAPID, which was the best among all other settings.

CONCLUSIONS: The estimation results varied among different software packages. Advantage workstation had the best agreement with RAPID in the estimation of infarct core volumes when CBV <1 mL/100 g. NovoStroke Kit had better agreement and correlation with RAPID in the estimation of hypoperfusion volumes. NovoStroke Kit also had moderate agreement with RAPID in estimating mismatch volumes.

PMID:36877792 | DOI:10.1097/RCT.0000000000001421

Environ Sci Technol. 2023 Mar 6. doi: 10.1021/acs.est.3c00263. Online ahead of print.

ABSTRACT

Plastics are one of the most widely used materials on the planet, owing to their usefulness, durability, and relatively low cost. Yet, making, using, and disposing of plastics create important environmental impacts, most notably greenhouse gas emissions and waste pollution. Reducing these impacts while still enjoying the benefits of plastic use requires an integrated assessment of all of the life cycles of plastics. This has rarely been attempted due to the wide variety of polymers and the lack of knowledge on the final uses and applications of plastics. Using trade statistics for 464 product codes, we have mapped the flows of the 11 most widely used polymers from production into six end-use applications for the United Kingdom (UK) in 2017. With a dynamic material flow analysis, we have anticipated demand and waste generation until 2050. We found that the demand for plastics seems to have saturated in the UK, with an annual demand of 6 Mt, responsible for approximately 26 Mt CO₂e/a. Owing to a limited recycling capacity in the UK, only 12% of UK plastic waste is recycled domestically, leading to 21% of the waste being exported, labeled as recycling, but mostly to countries with poor practices of waste management. Increasing recycling capacity in the UK could both reduce GHG emissions and prevent waste pollution. This intervention should be complemented with improved practices in the production of primary plastics, which currently accounts for 80% of UK plastic emissions.

PMID:36877788 | DOI:10.1021/acs.est.3c00263

J Comput Assist Tomogr. 2023 Mar 7. doi: 10.1097/RCT.0000000000001415. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study is to determine whether the use of diffusion-weighted imaging (DWI) provides incremental increase in performance in the osseous-tissue tumor reporting and data system (OT-RADS) with the hypothesis that use of DWI improves interreader agreement and diagnostic accuracy.

METHODS: In this multireader cross-sectional validation study, multiple musculoskeletal radiologists reviewed osseous tumors with DW images and apparent diffusion coefficient maps. Four blinded readers categorized each lesion using the OT-RADS categorizations. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. These measures were then compared with the previously published work that validated OT-RADS but did not include incremental value assessment of DWI.

RESULTS: One hundred thirty-three osseous tumors of the upper and lower extremities (76 benign, 57 malignant) were tested. Interreader agreement for OT-RADS with DWI (ICC = 0.69) was slightly lower (not statistically different) from the previously published work that did not incorporate DWI (ICC = 0.78, P > 0.05). The mean sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve including DWI of the 4 readers were 0.80, 0.95, 0.96, 0.79, and 0.91, respectively. In the previously published work without DWI, the mean values of the readers were 0.96, 0.79, 0.78, 0.96, and 0.94, respectively.

CONCLUSIONS: The addition of DWI to the OT-RADS system does not allow significantly improved area under the curve diagnostic performance measure. Conventional magnetic resonance imaging can be prudently used for OT-RADS for reliable and accurate characterization of bone tumors.

PMID:36877760 | DOI:10.1097/RCT.0000000000001415

Plast Reconstr Surg. 2023 Mar 8. doi: 10.1097/PRS.0000000000010357. Online ahead of print.

ABSTRACT

OBJECTIVE: The contour of the cheek is the main determinant of facial attractivity. The aim of this study is to evaluate the relationship between age, gender and BMI and cheek fat volume in a large cohort to better understand and treat facial aging.

MATERIALS AND METHODS: This study was performed by a retrospective review of the archives of the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen. Epidemiological data and medical history were assessed. The patients´ cheek superficial and deep fat compartment volumes were measured on magnetic resonance (MR) images. Statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 27) and SAS statistical software package (Version 9.1; SAS Institute, Inc, Cary, NC).

RESULTS: 87 patients with a mean age of 46.0 years (range: 18-81 years) were included. The superficial and deep fat compartment volumes of the cheek increase with BMI (p< 0.001 and p=0.005), but there was no significant relationship between age and volume. The ratio of superficial versus deep fat does not change with age. No significant difference of the superficial or deep fat compartments was found between men and women in a regression analysis (p=0.931 and p=0.057).

CONCLUSION: Cheek fat volume measurements on MRI scans using reconstruction software suggest that the fat volume of the cheek increases with BMI but does not significantly change with age. Further studies will have to elucidate the role of age-related changes of bone structures or sagging of the fat compartments.

LEVEL OF EVIDENCE: II (Exploratory cohort study developing diagnostic criteria (with “gold” standard as reference) in a series of consecutive patients).

PMID:36877747 | DOI:10.1097/PRS.0000000000010357

Nurs Educ Perspect. 2023 Feb 21. doi: 10.1097/01.NEP.0000000000001105. Online ahead of print.

ABSTRACT

New graduate nurses are unprepared for patient death, leading to a potential negative impact on patient care and an increase in turnover. This study investigated the use of high-fidelity simulation to teach about patient death. Senior nursing students (n = 124) were randomly assigned to rescue or failure-to-rescue scenarios. Outcomes included knowledge and emotional affect. Data analyses included comparative statistics, t-tests, and two-way analysis of variance. Both groups had equal knowledge gain. The failure-to-rescue group had significantly lower emotional affect following simulation but was equal to the rescue group following debriefing.

PMID:36877724 | DOI:10.1097/01.NEP.0000000000001105

PLoS One. 2023 Mar 6;18(3):e0282509. doi: 10.1371/journal.pone.0282509. eCollection 2023.

ABSTRACT

This study compared the accuracy (trueness and precision) of stone models fabricated using two brands of CAD/CAM optimized stones Cerec Stone (BC) and Elite Master (EM), and a conventional type IV stone Elite Rock Fast (ERF). 30 conventional Type IV and scannable stone complete-arch models were scanned with a blue LED extraoral scanner, and root mean square values were obtained. 6 abutments were used in complete-arch models. The digital models were compared with the master model to evaluate their trueness using model superimposition with Geomagic software. Precision was determined for each case by superimposing combinations of the 10 datasets in each group. The point cloud density of each model was calculated with MeshLab software. Kruskal-Wallis and Mann-Whitney non-parametric tests were used for the statistical analysis. The trueness of the stone models was 96 μm for the BC, 88.2 μm for the EM, and 87.6 μm for the ERF. There were no significant differences between the tested dental stones (p = .768). However, the EM models (35.6 μm) were more precise than the BC (46.9 μm) and ERF (56.4 μm) models (p = .001, p < .001). EM models also showed the highest point cloud density. There were significant differences in point cloud density (p = .003). The EM models showed significant differences in precision but no significant differences in terms of trueness. Although EM was more precise and had the highest point cloud density, all models were within the clinically acceptable limit.

PMID:36877717 | DOI:10.1371/journal.pone.0282509

PLoS One. 2023 Mar 6;18(3):e0282733. doi: 10.1371/journal.pone.0282733. eCollection 2023.

ABSTRACT

INTRODUCTION: Tuberculosis remains a major health problem globally and in Malaysia, particularly in the state of Sabah. Delayed sputum conversion is associated with treatment failure, drug-resistant tuberculosis and mortality. We aimed to determine the prevalence of delayed sputum conversion among smear positive pulmonary tuberculosis (PTB) patients and its associated factors in Sabah, Malaysia.

METHODS: A retrospective follow up study on all patients newly diagnosed with smear positive pulmonary tuberculosis from 2017 to 2019 was conducted at three government health clinics in Sabah, utilizing data from a national electronic tuberculosis database and medical records. Descriptive statistics and binary logistic regression were applied for data analysis. The outcome of the study was the sputum conversion status at the end of the two-month intensive treatment phase with either successful conversion to smear negative or non-conversion.

RESULTS: 374 patients were included in the analysis. Our patients were generally younger than 60 years old with no medical illness and varying proportions of tuberculosis severity as judged by radiographic appearance and sputum bacillary load upon diagnosis. Foreigners constituted 27.8% of our sample. 8.8% (confidence interval: 6.2-12.2) did not convert to smear negative at the end of the intensive phase. Binary logistic regression showed that older patients ≥60 years old (adjusted odds ratio, AOR = 4.303), foreigners (AOR = 3.184) and patients with higher sputum bacillary load at diagnosis [2+ (AOR = 5.061) and 3+ (AOR = 4.992)] were more likely to have delayed sputum smear conversion.

CONCLUSION: The prevalence of delayed sputum conversion in our study was considerably low at 8.8% with age ≥60 years old, foreigners and higher pre-treatment sputum bacillary load associated with delayed conversion. Healthcare providers should take note of these factors and ensure the patients receive proper follow up treatment.

PMID:36877714 | DOI:10.1371/journal.pone.0282733