Tag: statistics

Comput Inform Nurs. 2022 Oct 14. doi: 10.1097/CIN.0000000000000956. Online ahead of print.

ABSTRACT

The adoption of smartphone-based electronic medical records is increasing in the healthcare sector. Nurses are the largest group using mobile electronic medical records. This study examined the system quality, information quality, service quality, usefulness, and ease of using mobile electronic medical records, the effects of the three qualities of the mobile electronic medical records on the usefulness and ease of use, and nurses’ preference for using mobile electronic medical records. The participants were 210 nurses using a mobile electronic medical record system for over a month. An instrument modified from existing instruments was used. The data were analyzed using descriptive statistics and multiple regression analysis. The participants perceived the system and information quality more positively than the service quality of the mobile electronic medical records. They perceived the mobile electronic medical records as being useful and easy to use. System quality and information quality significantly affected the perception of the usefulness and ease of using the mobile electronic medical record. They preferred to use it as a means to identify patients’ conditions at any time. For user satisfaction and the implications for nursing practice, the usability and functionality of a mobile electronic medical record system should be continuously assessed.

PMID:36731012 | DOI:10.1097/CIN.0000000000000956

Am J Ther. 2022 Oct 18. doi: 10.1097/MJT.0000000000001569. Online ahead of print.

ABSTRACT

BACKGROUND: Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography.

STUDY QUESTION: In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography?

STUDY DESIGN: This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5-5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks.

MEASURES AND OUTCOMES: Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY).

RESULTS: Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm3, NCP 69.7 mm3, and LD-NCP 27.2 mm3; rivaroxaban: CP 22.9 mm3, NCP 66.3 mm3, and LD-NCP 11.0 mm3) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban (P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant (P = 0.04).

CONCLUSIONS: In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs.

PMID:36731003 | DOI:10.1097/MJT.0000000000001569

J Clin Gastroenterol. 2022 Oct 20. doi: 10.1097/MCG.0000000000001784. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVE: Patients with metabolic syndrome (MetS) are likely to have nonalcoholic fatty liver disease (NAFLD), which can progress to advanced fibrosis. Early recognition of those at highest risk may ameliorate outcomes. Noninvasive liver fibrosis assessment through validated scoring systems such as the fibrosis-4 (FIB-4) index is helpful to identify these high-risk patients, with the process ideally beginning in the primary care setting. The primary objective of this study was to determine rates of disease recognition and initial management of patients with NAFLD and advanced fibrosis in a diverse primary care setting. The secondary objective was to define demographic and clinical predictors of NAFLD identification and management in this population.

METHODS: Medical charts from patients seen at three university-based primary care practices in New York City from January 2016 to December 2019 were reviewed. Inclusion criteria consisted of: age 18 years and above, persistent alanine transaminase (ALT) elevation (2 values ≥40 IU/mL ≥6 mo apart), and body mass index ≥30 kg/m2. Patients with viral hepatitis or alcohol misuse were excluded. Patients were defined as likely having NAFLD if they met 2 of the following criteria indicating MetS: systolic blood pressure >135 mm Hg or diastolic blood pressure >85 mm Hg or active treatment for hypertension; high-density lipoprotein <40 g/dL; triglycerides >150 mg/dL or active treatment for hyperlipidemia; or hemoglobin A1c ≥5.7% or active treatment for insulin resistance. The primary study endpoints were the frequency of providers’ recognition of NAFLD and referral to specialist and/or for imaging based on visit diagnosis codes or chart documentation. The secondary endpoints were frequency of detecting those with NAFLD and advanced fibrosis utilizing previously defined FIB-4 index cutoffs as well as predictors of disease recognition and management. Analysis was completed using descriptive statistics and logistical regression modeling.

RESULTS: A total of 295 patients were identified as having persistently elevated ALT, a body mass index ≥30 kg/m2, and MetS consistent with likely NAFLD diagnosis. In patients meeting these criteria, ALT elevation was documented by primary care providers in 129 patients (43.7%), NAFLD was noted in chart documentation in 76 patients (25.8%), and a NAFLD ICD-10 diagnosis was assigned to 7 patients (2.4%). 50 patients (16.9%) were referred for ultrasound. Among 51 patients (17.2%) at high risk for advanced fibrosis based on FIB-4 >3.25, 23 patients (45.1%) had NAFLD recognized by their provider and 3 (5.9%) were referred to a specialist. On logistic regression, female gender, dyslipidemia, and private insurance were predictors of disease identification by the primary care physician.

CONCLUSION: ALT elevation and NAFLD are under recognized among patients with MetS in the primary care setting. Importantly, while 17.2% of patients with likely NAFLD in our cohort were high risk for advanced fibrosis, less than half of this group had a NAFLD diagnosis recognized by their primary care provider and only three were referred to a liver specialist. Further investigation of disease recognition and management algorithms in the primary care setting are necessary to enhance NAFLD detection, implement clinical care pathways, and reduce disease progression and complications.

PMID:36731002 | DOI:10.1097/MCG.0000000000001784

Chin Med J (Engl). 2022 Oct 20. doi: 10.1097/CM9.0000000000002099. Online ahead of print.

ABSTRACT

BACKGROUND: Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.

METHODS: Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.

RESULTS: A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing) and 100 unspecified. Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = -2.18, P < 0.01) and KSS (MD = -2.61, P < 0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = -2.21, P < 0.01) and KSS (MD = -2.44, P < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.

CONCLUSION: For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).

PMID:36730986 | DOI:10.1097/CM9.0000000000002099

J Pediatr Hematol Oncol. 2022 Oct 19. doi: 10.1097/MPH.0000000000002581. Online ahead of print.

ABSTRACT

Cancer-related long-term complications such as cardiovascular disease, fatigue, weight-related problems, and emotional disturbances are found to be increased in pediatric cancer survivors (PCSs). The relationship between daily living activities (DLAs) and such complications is still being investigated. Our aim in this study was to investigate the relationship between the cancer-related fatigue and DLA in PCS. Cancer-related fatigue was assessed by “PedsQL Multidimensional Fatigue Scale (MFS)” and “visual analog scale (VAS).” The DLA was evaluated by WeeFIM. There were 77 PCS (44 boys) with a mean age of 10.76 years. The mean value of fatigue scales were VAS 2.48, and MFS total score 71.14. WeeFIM total result was 118.64. While there was a statistically significant relationship between VAS fatigue score and WeeFIM total score (r=-0.387; P=0.007), there was no such correlation between WeeFIM total score with MFS total score (r=0.250; P=0.080). It is established that there is a relationship between level of fatigue and DLA. Risk factors like tumor type or treatment modalities for fatigue should be investigated in larger samples of specific survivor groups. Fatigue and its association with DLA should be screened clinically as a routine surveillance in PCS and treatment options be planned.

PMID:36730985 | DOI:10.1097/MPH.0000000000002581

PLoS One. 2023 Jan 27;18(1):e0281070. doi: 10.1371/journal.pone.0281070. eCollection 2023.

ABSTRACT

Genome-wide association studies have greatly increased the number of T2DM associated risk variants but most of them have focused on populations of European origin. There is scarcity of such studies in developing countries including Pakistan. High prevalence of T2DM in Pakistani population prompted us to design this study. We have devised a two stage (the discovery stage and validation stage) case-control study in Pashtun ethnic population in which 500 T2DM cases and controls each have been recruited to investigate T2DM genetic risk variants. In discovery stage Whole Exome Sequencing (WES) was used to identify and suggest T2DM pathogenic SNPs, based on SIFT and Polyphen scores; whereas in validation stage the selected variants were confirmed for T2DM association using MassARRAY genotyping and appropriate statistical tests. Results of the study showed the target positive association of rs1801282/PPARG (OR = 1.24, 95%Cl = 1.20-1.46, P = 0.010), rs745975/HNF4A (OR = 1.30, 95%Cl = 1.06-1.38, P = 0.004), rs806052/GLIS3 (OR = 1.32, 95%Cl = 1.07-1.66, P = 0.016), rs8192552/MTNR1B (OR = 1.53, 95%Cl = 0.56-1.95, P = 0.012) and rs1805097/IRS-2 (OR = 1.27, 95%Cl = 1.36-1.92, P = 0.045), with T2DM; whereas rs6415788/GLIS3, rs61788900/NOTCH2, rs61788901/NOTCH2 and rs11810554/NOTCH2 (P>0.05) showed no significant association. Identification of genetic risk factors/variants can be used in defining high risk subjects assessment, and disease prevention.

PMID:36730981 | DOI:10.1371/journal.pone.0281070

J Acquir Immune Defic Syndr. 2022 Dec 12. doi: 10.1097/QAI.0000000000003147. Online ahead of print.

ABSTRACT

BACKGROUND: Early antiretroviral treatment (ART) improves outcomes in children, but few studies have comprehensively evaluated the impact of ART started from the first week of life.

METHODS: Children diagnosed with HIV within 96 hours of life were enrolled into the Early Infant Treatment Study in Botswana and followed on ART for 96 weeks. Nevirapine, zidovudine, and lamivudine were initiated; nevirapine was switched to lopinavir/ritonavir between weeks 2-5 in accordance with gestational age. Clinical and laboratory evaluations occurred at weeks 1, 2, 4, 8, 12, 24, 36, 48, 60, 72, 84, and 96.

FINDINGS: Forty children-initiated ART at a median of 2 (IQR 2, 3) days of life; 38 (95%) completed follow-up through 96 weeks, and 2 (5%) died between 12 and 24 weeks. ART was well tolerated; 9 (24%) children experienced a grade 3 or 4 hematologic event, and 2 (5%) required treatment modification for anemia. The median 96-week CD4 count was 1625 (IQR 1179, 2493) cells/mm3 with only 5/38 (13%) having absolute counts <1000 cells/mm3. Although 23 (61%) had at least one visit with HIV-1 RNA ≥40 copies/mL at or after 24 weeks, 28 (74%) had HIV-1 RNA <40 copies/mL at the 96-week visit. Median cell-associated HIV-1 DNA at 84/96-week PBMCs was 1.9 (IQR 1.0, 2.6) log10 copies/106 cells. Pre-ART reservoir size at birth was predictive of the viral reservoir at 84/96 weeks.

INTERPRETATION: Initiation of ART in the first week of life led to favorable clinical outcomes, preserved CD4 cell counts, and low viral reservoir through 96 weeks of life.

PMID:36729692 | DOI:10.1097/QAI.0000000000003147

J Acquir Immune Defic Syndr. 2022 Dec 12. doi: 10.1097/QAI.0000000000003149. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescent girls and young women (AGYW) living with HIV who have higher stress levels may be at risk for stress-related biological alterations, which could influence HIV progression and adherence to antiretroviral therapy (ART).

SETTING: We aimed to estimate associations among stress-responsive biomarkers, ART adherence and viral suppression in AGYW living with HIV in South Africa. We also hypothesized that psychosocial stressors (e.g., depression, food insecurity, low socioeconomic status (SES), HSV-2) would be associated with higher biomarker levels.

METHODS: We utilized 2018/2019 data from the HIV Prevention Trials Network (HPTN) 068 cohort to assess associations between stress-responsive biomarkers and viral suppression (<1000 copies/mL) and ART adherence measured using dried blood spot (DBS) cards. Stress-responsive biomarkers included C-reactive protein (CRP), Herpes simplex virus type 1 (HSV-1), and cytomegalovirus (CMV) infection and reactivation. Associations were estimated using unadjusted log-binomial or ordinal logistic regression models.

RESULTS: In 166 AGYW living with HIV, there was no association between stress-responsive biomarkers and viral suppression or ART adherence. However, increased CRP levels were associated with higher HSV-2 infection (odds ratio (OR) 1.98; 95% confidence interval (CI) 1.11, 3.52), being a government grant recipient (OR 3.21; 95% CI 1.30, 7.92), lower food insecurity (OR 0.34; 95% CI 0.13, 0.90) and increased BMI (OR 1.07; 95% CI 1.01, 1.14).

CONCLUSIONS: High prevalence of psychosocial stressors and persistent herpesviruses in AGYW living with HIV has the potential to lead to poorer health outcomes. More research is needed to untangle relationships between economic stability, chronic disease, and chronic stress.

PMID:36729676 | DOI:10.1097/QAI.0000000000003149

J Acquir Immune Defic Syndr. 2022 Dec 12. doi: 10.1097/QAI.0000000000003145. Online ahead of print.

ABSTRACT

BACKGROUND: To collect and compare selected hearing measures in a pilot study of young adults with perinatally-acquired HIV (YAPHIV), and those with perinatal HIV-exposure, who are uninfected (YAPHEU).

SETTING: Cross-sectional hearing measures in YAPHIV and YAPHEU enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) for Participants 18 Years of Age and Older (AMP Up).

METHODS: Pure-tone air conduction audiometry and distortion product otoacoustic emission (DPOAE) data were collected in one visit. A low-frequency pure-tone average (PTA) (LFPTA, at 0.25, 0.5, 1, and 2 kHz), a speech-frequency PTA (SFPTA, at 0.5, 1, 2, and 4 kHz), and a high-frequency PTA (HFPTA, at 3, 4, 6, and 8 kHz) were calculated. Hearing loss was defined as worse ear SFPTA ≥20 dB HL. Separate linear regression models were fit for worse ear LFPTA, SFPTA, and HFPTA to assess associations with PHIV status. DPOAE signal-to-noise ratios (SNRs) were obtained at three frequencies in each ear.

RESULTS: Forty-seven YAPHIV and 9 YAPHEU completed hearing testing. All adjusted mean PTAs were similar between YAPHIV and YAPHEU. Hearing loss occurred more in YAPHIV (7/47, 15.2%, 95% CI: 6.3%-28.9%), compared to YAPHEU (0/9, 0%). No associations were detected between HIV disease severity measures and worse ear SFPTA. DPOAE SNRs were similar between YAPHIV and YAPHEU.

CONCLUSIONS: In this pilot study, peripheral hearing (i.e., PTAs) and cochlear function (i.e., DPOAEs) were similar between YAPHIV and YAPHEU. A larger study is warranted to confirm these findings.

PMID:36729663 | DOI:10.1097/QAI.0000000000003145

Cornea. 2022 Dec 13. doi: 10.1097/ICO.0000000000003201. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to compare the performance of Kerasave and Optisol-GS for hypothermic corneal storage for 14 days.

METHODS: This study was a prospective laboratory investigation. Mate corneas were recovered into Kerasave or Optisol-GS (27 pairs) and stored at 2°C to 8°C for 14 days. Corneas were evaluated by trained eye bank technicians, and study parameters were compared between the initial and final evaluations. Endothelial cell density (ECD), hexagonality (HEX), and coefficient of variation (CV) were evaluated by specular microscopy, and central corneal thickness (CCT) was examined by optical coherence tomography after 1, 3, 7, and 14 days of storage. Corneal transparency was scored using slit lamp examination at days 1 and 14.

RESULTS: Average ECD, HEX, and CV for the Kerasave (2653 ± 303 cells/mm2, 57 ± 4%, and 36 ± 3%) and Optisol-GS (2623 ± 306 cells/mm2, 57 ± 5%, and 36 ± 4%) groups were not significantly different at day 1. There was also no difference at any other study time points (all P > 0.05). ECD did not significantly change from day 1 to day 14 in either group (P > 0.05), but a statistically significant change in HEX and CV was observed between day 1 and day 14 in both groups (P < 0.01). Average CCT measured at day 1 for corneas stored in Kerasave was 622 ± 49 μm and those stored in Optisol-GS was 580 ± 35 μm (P < 0.01). The difference in CCT measurements was not significantly different at day 14 (Kerasave: 674 ± 46 μm vs. Optisol-GS: 647 ± 58 μm, P > 0.05). Corneal transparency was not significantly different between the 2 groups at day 1 or day 14.

CONCLUSIONS: The corneal quality and clinically relevant parameters including ECD, endothelial morphometry, and corneal transparency were not different in corneas stored in Kerasave or Optisol-GS for 14 days. The initial difference in CCT between the 2 groups decreased at day 14. These results demonstrated that Kerasave corneal storage solution preserves the corneal endothelium similarly to Optisol-GS.

PMID:36729660 | DOI:10.1097/ICO.0000000000003201