Tag: statistics

Transplant Proc. 2022 Dec 23:S0041-1345(22)00777-1. doi: 10.1016/j.transproceed.2022.10.062. Online ahead of print.

ABSTRACT

BACKGROUND: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients.

METHODS: We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis.

RESULTS: Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04).

CONCLUSIONS: Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.

PMID:36567173 | DOI:10.1016/j.transproceed.2022.10.062

Acad Radiol. 2022 Dec 23:S1076-6332(22)00618-3. doi: 10.1016/j.acra.2022.11.012. Online ahead of print.

ABSTRACT

BACKGROUND: Running online training in mammography interpretation poses a challenge to radiologists and reporting radiographers due to the large size of digital mammograms in DICOM format and limited bandwidth capabilities of the users for image transmission. This study aims to compare image quality between the full-quality with minimal compressed JPEG and DICOM format of mammograms on a diagnostic monitor through the evaluation of radiologists and radiographers.

METHODS: Twelve participants including six radiologists and six radiographers participated as observers in this study. The observers viewed 60 2D digital mammography screening cases (22 cancer and 38 normal cases) in DICOM and minimal compressed JPEG formats on a 5MP diagnostic monitor. A 5-point Likert scale was provided for observers to compare the quality of mammograms between the two formats, with text anchors indicating to one image being significantly better, slightly better or of equal quality in terms of technical and diagnostic aspects. Nonparametric descriptive statistics were used to evaluate the ratings of radiologists and radiographers in different characteristics of mammograms of two image formats.

RESULTS: The DICOM and JPEG images were statistically equivalent through ratings from radiographers in brightness, contrast, dynamic range, sharpness, no significant distortion, no significant noise, and background homogeneity in all mammograms. Similarly, most radiologists rated DICOM and JPEG images clinically and statistically equivalent with respect to difficulty of interpretation, brightness, contrast, dynamic range, sharpness, the appearance of Cooper’s ligaments, visibility of subtle microcalcifications, visibility of structures at the margins of the breast. Normal cases were marginally favored by radiologists in DICOM format (ranging from 0.4% to 5.3%) while cancer cases in JPEG (ranging from 0.8% to 7.6%) received slightly higher rating.

CONCLUSIONS: Findings showed that baseline full-quality with minimal compression JPEG was equivalent to the DICOM format of full-field digital mammograms which suggests that this type of JPEG could be used for online training and education in radiology.

PMID:36567143 | DOI:10.1016/j.acra.2022.11.012

JMIR Aging. 2022 Dec 25. doi: 10.2196/43106. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults experiencing disabilities such as loss of autonomy face the decision of whether to stay at home or move to a healthcare facility such as a nursing home. Thus, they may need support for this difficult decision.

OBJECTIVE: We assessed Canadian older adults’ intention to use an electronic decision aid (eDA) for making housing decisions and identified the factors that influenced their intention.

METHODS: We conducted a cross-sectional study using an online survey targeting older adults across the 10 Canadian provinces and 3 territories. We included respondents from an online panel who were aged 65 years or older, understood English or French, had access to an electronic device with an internet connection and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the online survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents’ intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence and facilitating conditions). We also assessed e-Health literacy using subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify factors influencing the intention to use the eDA.

RESULTS: Of the 11,972 eligible panellists, 1,176 met the eligibility criteria and 1,000 (85%) respondents completed the survey. The mean age was 72.5 ± 5.59 years. Most respondents were male (54.8%), white (90.6%), English-speakers (62.9%) and living in Ontario or Quebec (62.8%) in urban areas (85%). Mean scores for subjective e-Health literacy were 27.8 ± 5.88 out of 40 and for objective e-Health literacy, 3.00 ± 0.97 out of 5. In our sample, the intention score was 4.74 ± 1.7 out of 7. Mean scores of intention constructs out of 7 were 5.63 ± 1.28 for facilitating conditions, 4.94 ± 1.48 for performance expectancy, 5.61 ± 1.35 for effort expectancy and 4.76 ± 1.59 for social influence. In the final model, factors associated with intention included mother tongue (β = .30; P <.001), objective e-Health literacy (β = -.06; P =.03), performance expectancy (β = .55; P <.001), social influence (β = .37; P <.001) and facilitating conditions (β = .15; P <.001).

CONCLUSIONS: Findings from this pan-Canadian online survey suggest that Canadian older adults’ intention to use an eDA to make housing decisions are similar to findings in other studies using UTAUT. Factors identified as influencing intention were mother tongue, objective e-Health literacy, performance expectancy, social influence and facilitating conditions. These will guide future strategies for implementing the eDA.

PMID:36566499 | DOI:10.2196/43106

Radiat Prot Dosimetry. 2022 Dec 24:ncac262. doi: 10.1093/rpd/ncac262. Online ahead of print.

ABSTRACT

This study presents a new idea for estimating the number of measurements required for determining the uncertainty in obtaining the desired water absorbed dose using the variation obtained from multicenter absorbed dose measurement data. The number of dose measurements depends on the performance of each linear accelerator (LINAC) tested and the dosimetry equipment and procedure used. However, optimising the number of data collected for the absorbed dose to water has been inadequately reported. Using the absorbed dose measurement data collected 10 times as a reference value, we will compare the changes in the variation of the measurement results caused by the difference in the number of repeated measurements of the absorbed dose. The number of measurements is determined statistically such that this variation would be smaller than the change in absorbed dose. Thus, we can determine the optimum number of measurements suitable for the variability of each LINAC.

PMID:36566494 | DOI:10.1093/rpd/ncac262

J Cosmet Dermatol. 2022 Dec 25. doi: 10.1111/jocd.15566. Online ahead of print.

ABSTRACT

BACKGROUND: Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking.

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of topical agents for melasma.

METHODS: The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations.

RESULTS: A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [-1.6 to -1.0]), HQ-containing combination therapy (-1.4, [-1.7 to -1.1]), cysteamine (-1.6, [-2.0 to -1.2]), tranexamic acid (-1.5, [-2.0 to -1.1]), azelaic acid (-1.3, [-1.7 to -1.0]), and kojic acid (-0.9, [-1.3 to -0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (-1.2, [-2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk.

CONCLUSIONS: In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient’s tolerance, availability, and physicians’ experience.

PMID:36566490 | DOI:10.1111/jocd.15566

J Diabetes Investig. 2022 Dec 25. doi: 10.1111/jdi.13966. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: Although several noninvasive predictive markers for fatty liver and metabolic markers have been used for fatty liver prediction, whether such markers can also predict metabolic-associated fatty liver disease (MAFLD) remains unclear. We aimed to examine the ability of existing fatty liver or metabolic markers to predict MAFLD.

MATERIALS AND METHODS: Participants in a high-volume center in Tokyo were classified into groups with and without MAFLD, based on the presence of metabolic abnormalities and fatty liver diagnosed through abdominal ultrasonography, between 2008 and 2018. The diagnostic abilities of three fatty liver markers: fatty liver index (FLI), hepatic steatosis index (HSI), and lipid accumulation product (LAP), and three common metabolic markers: waist-to-height ratio (WHR), body mass index (BMI), and waist circumference (WC), for predicting MAFLD, were evaluated. Analyses stratified by MAFLD subtypes were performed.

RESULTS: Of 92,374 individuals, 19,392 (36.1%) had MAFLD. The diagnostic performances for MAFLD prediction, measured as c-statistics, for FLI, HSI, LAP, WHR, BMI, and WC were 0.906, 0.892, 0.878, 0.844, 0.877, and 0.878, respectively. Optimal cutoff values for diagnosing MAFLD for FLI, HSI, LAP, WHR, BMI, and WC were 20.3, 32.7, 20.0, 0.49, 22.9, and 82.1, respectively. Analyses stratified by MAFLD subtypes, based on BMI and metabolic/glycemic abnormalities, suggested that FLI and HSI had acceptable (c-statistics >0.700) diagnostic abilities throughout all the analyses.

CONCLUSIONS: All six markers were excellent predictors of MAFLD in diagnosing among the general population, with FLI and HSI particularly useful among all sub-populations.

PMID:36566480 | DOI:10.1111/jdi.13966

J Rural Health. 2022 Dec 25. doi: 10.1111/jrh.12735. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to describe the characteristics of Rural Residency Planning and Development (RRPD) Programs, compare the characteristics of counties with and without RRPD programs, and identify rural places where future RRPD programs could be developed.

METHODS: The study sample comprised 67 rural sites training residents in 40 counties in 24 US states. Descriptive statistics were used to describe RRPD programs and logistic regression to predict the probability of a county being an RRPD site as a function of population, primary care physicians (PCP) per 10,000 population, and the social vulnerability index (SVI) compared to a control sample of nonmetro counties without RRPD sites.

FINDINGS: Most RRPD grantees (78%) were family medicine programs affiliated with medical schools (97%). RRPD counties were more populous (P<.01), had a higher population density (P<.05), and a higher percent of the non-White or Hispanic population (P = .05) compared to non-RRPD counties. Both higher population (P<.001) and PCP ratio (P = .046) were strong predictors, while SVI (P = .07) was a weak predictor of being an RRPD county.

CONCLUSIONS: RRPD sites appear to represent a “sweet spot” of rural counties that have the population and physician supply to support a training program but also are relatively more socially vulnerable with high-need populations. Additional counties fitting this “sweet spot” could be targeted for funding to address health disparities and health workforce maldistribution.

PMID:36566476 | DOI:10.1111/jrh.12735

J Thromb Thrombolysis. 2022 Dec 25. doi: 10.1007/s11239-022-02752-z. Online ahead of print.

ABSTRACT

The purpose of this study was to evaluate and compare clinical outcomes in patients who experienced intracranial hemorrhage (ICH) while taking apixaban or rivaroxaban and were reversed with four-factor prothrombin complex concentrates (4F-PCC) or andexanet alfa (AA). This retrospective cohort included adult patients that received 4F-PCC or AA for the initial management of an apixaban- or rivaroxaban-associated ICH. A primary outcome of excellent or good hemostatic efficacy at 12 h post-reversal was assessed. Secondary outcomes evaluated were change in hematoma volume size at 12 h, functional status at discharge, need for surgical intervention or additional hemostatic agents post-reversal, new thrombotic event within 28 days, 28-day all-cause mortality, discharge disposition, and hospital and intensive care unit lengths of stay. A total of 70 patients were included (4F-PCC, n = 47; AA, n = 23). For the primary outcome analysis, 21 patients were included in the 4F-PCC group and 12 in the AA group. The rate of effective hemostasis was similar between the 4F-PCC and AA groups (66.7% vs 75%, p = 0.62). There were no statistically significant differences between the groups for secondary outcomes, including 28-day mortality (40.4% vs 39.1%, p = 0.92) and thrombotic complications within 28 days of reversal (17.0% vs 21.7%, p = 0.63). In patients who experienced an ICH while taking apixaban or rivaroxaban, 4F-PCC and AA were found to have similar rates of excellent or good hemostatic efficacy.

PMID:36566473 | DOI:10.1007/s11239-022-02752-z

J Robot Surg. 2022 Dec 25. doi: 10.1007/s11701-022-01514-6. Online ahead of print.

ABSTRACT

The robotic platform can overcome technical difficulties associated with laparoscopic colon surgery. Transitioning from laparoscopic right colectomy with extracorporeal anastomosis (ECA) to robotic right colectomy with intracorporeal anastomosis (ICA) is associated with a learning phase. This study aimed at determining the length of this learning phase and its associated morbidity. We retrospectively analyzed all laparoscopic right colectomies with ECA (n = 38) and robotic right colectomies with ICA (n = 67) for (pre)malignant lesions performed by a single surgeon between January 2014 and December 2020. CUSUM-plot analysis of total procedure time was used for learning curve determination of robotic colectomies. Non-parametric tests were used for statistical analysis. Compared to laparoscopy, the learning phase robotic right colectomies (n = 35) had longer procedure times (p < 0.001) but no differences in anastomotic leakage rate, length of stay or 30-day morbidity. Conversion rate was reduced from 16 to 3 percent in the robotic group. This study provides evidence that robotic right colectomy with ICA can be safely implemented without increasing morbidity.

PMID:36566471 | DOI:10.1007/s11701-022-01514-6

Arch Environ Contam Toxicol. 2022 Dec 25. doi: 10.1007/s00244-022-00973-0. Online ahead of print.

ABSTRACT

The epiphytic lichen Pseudevernia furfuracea was exposed to a simulation of drift deposition rate of the fungicide Fosetyl-Al in an indoor controlled environment by testing two exposure factors: pesticide concentrations (based on the application rates of 4 kg ha^-1 and 1.6 kg ha^-1) and drop sizes (anti-drift nozzle: 386-484 μm; non-anti-drift nozzle: 159-231 μm) for a total of four treatments. Drift for higher application rate was simulated once and that for the lower one twice to reproduce agricultural practices. Following fungicide spraying, we measured the concentration of Fosetyl and phosphonic acid in lichen thalli, and the response of ecophysiological status parameters. No trace of Fosetyl was quantifiable 4 days after each treatment, being detected only phosphonic acid whose concentrations stayed substantially unchanged for the whole duration of the experiment (40 days) and resulting affected by application rate and not by drop size. Both pesticide concentrations caused a remarkable harmful effect that, however, was statistically significant vs control group only starting from the 20th day of stay in the climatic chamber. The drift associated with the higher rate resulted, on average, to be 83% more effective, with the most affected parameters being membrane integrity, lipid peroxidation and photosynthetic pigments. Because the selected lower rate can be considered a quite low value when compared with the rank of used rates for crop protection, the Fosetyl-Al formulate is classifiable as hazardous for its effect on non-target organisms.

PMID:36566463 | DOI:10.1007/s00244-022-00973-0