Tag: statistics

CNS Neurosci Ther. 2023 Feb 16. doi: 10.1111/cns.14108. Online ahead of print.

ABSTRACT

BACKGROUND: Serum albumin to globulin ratio (A/G) has been widely used as a representative biomarker for assessing inflammation and nutrition status. However, in patients with acute ischemic stroke (AIS), the predictive value of serum A/G has rarely been reported. We aimed to evaluate whether serum A/G is associated with prognosis in stroke.

METHODS: We analyzed data from the Third China National Stroke Registry. The patients were categorized into quartile groups according to the serum A/G at admission. Clinical outcomes included poor functional outcomes (modified Rankin Scale [mRS] score of 3-6 or 2-6) and all-cause mortality at 3 months and1 year. Multivariable logistic regressions and Cox proportional hazards regressions were used to evaluate the association of serum A/G with the risk of poor functional outcomes and all-cause mortality.

RESULTS: A total of 11, 298 patients were included in this study. After adjustment for confounding factors, patients in the highest serum A/G quartile had a lower proportion of mRS score 2-6 (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.76-1.00) and mRS score 3-6 (OR, 0.87; 95% CI, 0.73-1.03) at 3 months follow-up. At 1 year follow-up, there was a significant association between higher serum A/G and mRS score 3-6 (OR, 0.68; 95% CI, 0.57-0.81). We also found that the highest serum A/G was related to decreased risk of all-cause mortality (hazard ratio [HR], 0.58; 95% CI, 0.36-0.94) at 3 months follow-up. Similar results were found at 1-year follow-up.

CONCLUSIONS: Lower serum A/G levels were associated with poor functional outcomes and all-cause mortality at 3 months and 1-year follow-up in patients with acute ischemic stroke.

PMID:36794538 | DOI:10.1111/cns.14108

J Appl Gerontol. 2023 Feb 16:7334648231158482. doi: 10.1177/07334648231158482. Online ahead of print.

ABSTRACT

Using the 2021 Occupational Employment and Wage Statistics (OEWS) dataset, we calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US. We find that there are, on average, 32.9 home health aides per 1000 older adults (age 65+) in rural areas and 50.4 home health aides per 1000 older adults in urban areas. There are, on average, 20.9 nursing assistants per 1000 older adults in rural areas and 25.3 nursing assistants per 1000 older adults in urban areas. There is substantial regional variation. Greater investment needs to be made in improving wages and job quality for direct care workers to attract workers to these critical occupations, especially in rural areas where the need for direct care is greater.

PMID:36794536 | DOI:10.1177/07334648231158482

Clin Rehabil. 2023 Feb 16:2692155231152417. doi: 10.1177/02692155231152417. Online ahead of print.

ABSTRACT

OBJECTIVES: To critically appraise the psychometric properties of light touch-pressure somatosensory assessments to provide guidance for tool selection for research or clinical purposes.

DATA SOURCES: MEDLINE, CINAHL, and PsycInfo were searched for research indexed from January 1990-November 2022. English language and human subject filters were applied. “Somatosensation”, “psychometric property”, and “nervous system-based health condition” search terms were combined. Grey literature and manual searches were conducted to ensure thoroughness.

REVIEW METHODS: The reliability, construct validity, and/or measurement error of light touch-pressure assessments was reviewed in adult populations with neurological disorders. Reviewers individually extracted and managed data including patient demographics, assessment characteristics, statistical methods, and psychometric properties. Methodological quality of results was evaluated using an adapted version of the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

RESULTS: Thirty-three of 1938 articles were included for review. Fifteen light touch-pressure assessments demonstrated good or excellent reliability. Further, five of those 15 assessments achieved adequate validity and one of the 15 assessments achieved adequate measurement error. Over 80% of the summarized study ratings were determined to be of low or very low quality.

CONCLUSION: We recommend using electrical perceptual tests, the Semmes-Weinstein Monofilaments, the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, and the Moving Touch Pressure Test given that they demonstrated good to excellent results in three psychometric properties. No other assessment achieved adequate ratings in more than two psychometric properties. This review highlights a fundamental need to develop sensory assessments that are reliable, valid, and sensitive to change.

PMID:36794517 | DOI:10.1177/02692155231152417

Expert Opin Drug Saf. 2023 Feb 16. doi: 10.1080/14740338.2023.2181341. Online ahead of print.

ABSTRACT

BACKGROUND: Safety issues for fluoroquinolones have been provided by regulatory agencies. This study was conducted to identify signals of fluoroquinolones reported in the Korea Adverse Event Reporting System (KAERS) using tree-based machine learning (ML) methods.

RESEARCH DESIGN AND METHODS: All adverse events (AEs) associated with the target drugs reported in the KAERS from 2013 to 2017 were matched with drug label information. A dataset containing label-positive and -negative AEs was arbitrarily divided into training and test sets. Decision tree, random forest (RF), bagging, and gradient boosting machine (GBM) were fitted on the training set with hyperparameters tuned using five-fold cross-validation and applied to the test set. The ML method with the highest area under the curve (AUC) scores was selected as the final ML model.

RESULTS: Bagging was selected as the final ML model for gemifloxacin (AUC score: 1) and levofloxacin (AUC: 0.9987). RF was selected in ciprofloxacin, moxifloxacin, and ofloxacin (AUC scores: 0.9859, 0.9974, and 0.9999 respectively). We found the final ML methods detected additional signals that were not detected using the disproportionality analysis (DPA) methods.

CONCLUSIONS: The bagging-or-RF-based ML methods performed better than DPA and detected novel AE signals previously unidentified using the DPA methods.

PMID:36794497 | DOI:10.1080/14740338.2023.2181341

J Magn Reson Imaging. 2023 Feb 16. doi: 10.1002/jmri.28619. Online ahead of print.

ABSTRACT

BACKGROUND: Epicardial adipose tissue (EAT) may have a paracrine effect on coronary microcirculation and myocardium. However, it is unclear whether EAT is linked to cardiac function and perfusion.

PURPOSE: To investigate the association of EAT with left ventricular (LV) strain and myocardial perfusion in patients with coronary artery disease (CAD).

STUDY TYPE: Retrospective.

POPULATION: A total of 78 patients with CAD and 20 healthy controls. The patients were further divided into high (n = 39) and low EAT volume (n = 39) groups according to median EAT volume.

FIELD STRENGTH/SEQUENCE: A 1.5 T, balanced steady-state free precession, inversion recovery prepared echo-planar, and segmented-turbo fast low-angle shot (FLASH) phase-sensitive inversion recovery (PSIR) sequences.

ASSESSMENT: EAT volume was measured by manually tracing the epicardial border and the visceral layer of pericardium on the short-axis cine stacks. LV strain parameters included global radial (GRS), circumferential (GCS), and longitudinal peak strain (GLS). Perfusion indices included upslope, perfusion index, time-to-maximum signal intensity (TTM), and maximum signal intensity (MaxSI).

STATISTICAL TESTS: One-way analysis of variance or Kruskal-Wallis rank tests, Chi-squared or Fisher exact tests. Multivariate linear regression analyses. A P value < 0.05 was considered statistically significant.

RESULTS: The parameters of GRS GCS, GLS, upslope, perfusion index, and MaxSI were significantly lower in the patients when compared to the controls. Moreover, the high EAT volume group presented significantly longer TTM values and lower GRS, GCS, GLS, upslope, perfusion index, and MaxSI than the low EAT volume group. Multivariate linear regression analyses demonstrated that EAT was independently associated with GRS, GCS, GLS, upslope, perfusion index, TTM, and MaxSI in patients. EAT and upslope were independently associated with GRS, while EAT and perfusion index were both independently associated with GCS and GLS.

DATA CONCLUSION: EAT was associated with parameters of LV function and perfusion, and myocardial perfusion was independently associated with LV strain in patients with CAD.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 3.

PMID:36794488 | DOI:10.1002/jmri.28619

Electromagn Biol Med. 2023 Feb 16:1-9. doi: 10.1080/15368378.2023.2179065. Online ahead of print.

ABSTRACT

The goal of this study was to biomechanically and morphologically research both the impact of mobile phone like radiofrequency radiations (RFR) on the tibia and the effects on skeletal muscle through oxidative stress parameters. Fifty-six rats (200-250 g) were put into groups: healthy sham (n = 7), healthy RFR (900, 1800, 2100 MHz) (n = 21), diabetic sham (n = 7) and diabetic RFR (900, 1800, 2100 MHz) (n = 21). Over a month, each group spent two hours/day in a Plexiglas carousel. The rats in the experimental group were exposed to RFR, but the sham groups were not. At the end of the experiment, the right tibia bones and skeletal muscle tissue were removed. The three-point bending test and radiological evaluations were performed on the bones, and CAT, GSH, MDA, and IMA in muscles were measured. There were differences in biomechanics properties and radiological evaluations between the groups (p < .05). In the measurements in the muscle tissues, significant differences were statistically found (p < .05). The average whole-body SAR values for GSM 900, 1800 and 2100 MHz were 0.026, 0.164, and 0.173 W/kg. RFRs emitted from mobile phone may cause adverse effects on tibia and skeletal muscle health, though further studies are needed.

PMID:36794487 | DOI:10.1080/15368378.2023.2179065

Clin Chem Lab Med. 2023 Feb 17. doi: 10.1515/cclm-2022-1290. Online ahead of print.

ABSTRACT

OBJECTIVES: Urine samples are frequently used in the clinical practice. In our study, we aimed to calculate the biological variations (BV) of analytes and analyte/creatinine ratios measured in spot urine.

METHODS: Second-morning spot urine samples were collected from 33 (16 female, 17 male) healthy volunteers once weekly for 10 weeks and analyzed in the Roche Cobas 6,000 instrument. Statistical analyzes were performed using BioVar, an online BV calculation software. The data were evaluated in terms of normality, outliers, steady state, homogeneity of the data, and BV values were obtained by analysis of variance (ANOVA). A strict protocol was established for within-subject (CV_I) and between-subject (CV_G) estimates for both genders.

RESULTS: There was a significant difference between female/male CV_I estimates of all analytes except potassium, calcium and magnesium. No difference was found in CV_G estimates. When the analytes that had a significant difference in CV_I estimates in spot urine analytes were compared to creatinine, it was observed that the significant difference between the genders disappeared. There was no significant difference between female/male CV_I and CV_G estimates in all spot urine analyte/creatinine ratios.

CONCLUSIONS: Since the CV_I estimates of analyte/creatinine ratios are lower, it would be more reasonable to use them in result reporting. Reference ranges should be used with caution, since II values of almost all parameters are between 0.6 and 1.4. The CV_I detection power of our study is 1, which is the highest value.

PMID:36794468 | DOI:10.1515/cclm-2022-1290

Orthop Surg. 2023 Feb 16. doi: 10.1111/os.13684. Online ahead of print.

ABSTRACT

OBJECTIVE: The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol.

METHODS: This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2- to 6-month, group 2: 6- to 12-month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease.

RESULTS: We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups (P = 0.21). For the mean LOS, the 6- to 12-month group had a significantly shorter LOS compared with the 2- to 6-month group (P < 0.01). There was also a significant decrease in Hct of the 2- to 6-month group compared with the 6- to 12-month group and the >12 months group (P = 0.02; P < 0.05, respectively).

CONCLUSION: Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period.

PMID:36794464 | DOI:10.1111/os.13684

J Appl Clin Med Phys. 2023 Feb 16:e13932. doi: 10.1002/acm2.13932. Online ahead of print.

ABSTRACT

ICRU 91, published in 2017, is an international standard for prescribing, recording, and reporting stereotactic treatments. Since its release, there has been limited research published on the implementation and impact of ICRU 91 on clinical practice. This work provides an assessment of the recommended ICRU 91 dose reporting metrics for their use in clinical treatment planning. A set of 180 intracranial stereotactic treatment plans for patients treated by the CyberKnife (CK) system were analyzed retrospectively using the ICRU 91 reporting metrics. The 180 plans comprised 60 trigeminal neuralgia (TGN), 60 meningioma (MEN), and 60 acoustic neuroma (AN) cases. The reporting metrics included the planning target volume (PTV) near-minimum dose ( $D_{\mathrm{near}–\min }$ ), near-maximum dose ( $D_{\mathrm{near}–\max }$ ), and median dose ( $D_{50\%}$ ), as well as the gradient index (GI) and conformity index (CI). The metrics were assessed for statistical correlation with several treatment plan parameters. In the TGN plan group, owing to the small targets, $D_{\mathrm{near}–\min }$ was greater than $D_{\mathrm{near}–\max }$ in 42 plans, whereas both metrics were not applicable in 17 plans. The $D_{50\%}$ metric was predominantly influenced by the prescription isodose line (PIDL). The GI was significantly dependent on target volume in all analyses performed, where the variables were inversely related. The CI was only dependent on target volume in treatment plans for small targets. The ICRU 91 $D_{\mathrm{near}–\min }$ and $D_{\mathrm{near}–\max }$ metrics breakdown in plans for small target volumes below 1 cm³ ; the Min and Max pixel should be reported in such cases. The $D_{50\%}$ metric is of limited use for treatment planning. Given their volume dependence, the GI and CI metrics could potentially serve as plan evaluation tools in the planning of the sites analyzed in this study, which would ultimately improve treatment plan quality.

PMID:36794436 | DOI:10.1002/acm2.13932

Pediatrics. 2023 Feb 16:e2022057330. doi: 10.1542/peds.2022-057330. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with limited English proficiency (LEP) benefit from the appropriate use of medical interpreters. A multidisciplinary quality improvement team sought to improve communication with patients with LEP within a pediatric emergency department (ED). Specifically, the team aimed to improve the early identification of patients and caregivers with LEP, the utilization of interpreter services for those identified, and documentation of interpreter use in the patient chart.

METHODS: Using clinical observations and data review, the project team identified key processes for improvement in the ED workflow and introduced interventions to increase identification of language needs and offer interpreter services. These include a new triage screening question, an icon on the ED track board that communicates language needs to staff, an electronic health record (EHR) alert with information on how to obtain interpreter services, and a new template to prompt correct documentation in the ED provider’s note. Outcomes were tracked using statistical process control charts.

RESULTS: All study measures met special cause for improvement during the 6-month study period and have been sustained during surveillance data collection. Identification rates for patients with LEP during triage increased from 60% to 77%. Interpreter utilization increased from 77% to 86%. The documentation of interpreter use increased from 38% to 73%.

CONCLUSION: Using improvement methods, a multidisciplinary team increased the identification of patients and caregivers with LEP in an ED. Integration of this information into the EHR allowed for the targeted prompting of providers to use interpreter services and to correctly document their use.

PMID:36794433 | DOI:10.1542/peds.2022-057330