Tag: statistics

Health Serv Res. 2023 Apr 19. doi: 10.1111/1475-6773.14162. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether expanded access to Veterans Affairs (VA)-purchased care increased overall utilization or induced a shift from other payers to VA for emergency care among VA enrollees.

DATA SOURCES AND STUDY SETTING: This study included all emergency department (ED) encounters in 2019 from hospitals in the state of New York.

STUDY DESIGN: We conducted a difference-in-differences analysis comparing VA enrollees to the general population before and after the implementation of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act in June 2019.

DATA COLLECTION/EXTRACTION METHODS: We included all ED visits with individuals aged 30 or older at the time of the encounter. Individuals were considered eligible for the policy change if they were enrolled with VA at the beginning of 2019.

PRINCIPAL FINDINGS: Of the 5,577,199 ED visits in the sample, 4.9% (n = 253,799) were made by VA enrollees. Of these, 44.9% of visits were paid by Medicare, 32.8% occurred in VA facilities, and 7% were paid by private health insurance. There was a 6.4% (2.91 percentage points; std. error = 0.18; p < 0.01) decrease in the proportion of ED visits paid by Medicare among VA enrollees relative to the general population after the implementation of the MISSION Act in June 2019. This decrease was larger for ED visits with a subsequent inpatient admission (-8.4%; 4.87 percentage points; std. error = 0.33; p < 0.01). There was no statistically significant change in the total volume of ED visits (0.06%; std. error = 0.08; p = 0.45).

CONCLUSIONS: Leveraging a novel dataset, we demonstrate that MISSION Act implementation coincided with a shift in the financing of non-VA ED visits from Medicare to VA without any increase in overall ED utilization. These findings have important implications for VA health care financing and delivery.

PMID:37076113 | DOI:10.1111/1475-6773.14162

Nurs Health Sci. 2023 Apr 19. doi: 10.1111/nhs.13021. Online ahead of print.

ABSTRACT

This study aimed to identify sociodemographic and academic factors associated with unhealthy lifestyles among Brazilian undergraduate nursing students. A cross-sectional study was completed by 286 nursing students in Brazil. Multinomial logistic regression was conducted to examine the association between sociodemographic and academic variables with the latent lifestyle indicator. The model fit’s validity was assessed using Akaike information coefficient estimation, Hosmer-Lemeshow test, and the ROC curve. A high health risk lifestyle was 2.7 times more likely among students aged 18-24 years than students aged 25 years or older (OR = 2.7, 95% CI = [1.18, 6.54] p = 0.02); 2.3 times more likely among students with ≥400 h of semester time (OR = 2.3, 95% CI = [0.93, 5.90], p = 0.07); and 3.8 times more likely among female students (OR = 3.8, 95% CI = [0.82, 8.12], p = 0.09). A moderate health risk lifestyle was 1.8 times more likely among students from the 6th to 10th semesters (OR = 1.8, 95% CI = [-0.95, 3.75], p = 0.07). Sociodemographic and academic factors were associated with unhealthy lifestyles. Health promotion efforts are necessary to improve nursing students’ health behaviors.

PMID:37076112 | DOI:10.1111/nhs.13021

Appl Clin Inform. 2023 Apr 19. doi: 10.1055/a-2077-4419. Online ahead of print.

ABSTRACT

BACKGROUND: Implementing an electronic health record (EHR) is one of the most disruptive operational tasks a health system can undergo. Despite anecdotal reports of adverse events around the time of EHR implementations, there is limited corroborating research, particularly in pediatrics. We utilized data from Solutions for Patient Safety (SPS), a network of 145+ children’s hospitals that share data and protocols to reduce harm in pediatric care delivery, to study the impact of EHR implementations on patient safety.

OBJECTIVE: Determine if there is an association between the time immediately surrounding an EHR implementation and hospital-acquired conditions (HAC) rates in pediatrics.

METHODS: A survey of IT leaders at pediatric institutions identified EHR implementations occurring between 2012 and 2022. This list was cross-referenced with the SPS database to create an anonymized dataset of 27 sites comprising monthly HAC and care bundle compliance rates in the 7 months preceding and succeeding the transition. Six HACs were analyzed: central-line associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), adverse drug events (ADE), surgical site infections (SSI), pressure injuries (PI), and falls, in addition to four associated care bundle compliance rates: CLABSI and CAUTI maintenance bundles, SSI bundle and PI bundle. To determine if there was a statistically significant association with EHR implementation, the observation period was divided into three eras: “before” (months -7 to -3), “during” (months -2 to +2), and “after” go-live (months +3 to +7). Average monthly HAC and bundle compliance rates were calculated across eras. Paired t-tests were performed to compare rates between the eras.

RESULTS: No statistically significant increase in HAC rates or decrease in bundle compliance rates were observed across the EHR implementation eras.

CONCLUSIONS: This multi-site study detected no significant increase in hospital-acquired conditions and no decrease in preventive care bundle compliance in the months surrounding an EHR implementation.

PMID:37075806 | DOI:10.1055/a-2077-4419

Stat Med. 2023 Apr 19. doi: 10.1002/sim.9745. Online ahead of print.

ABSTRACT

The National Alzheimer’s Coordinating Center Uniform Data Set includes test results from a battery of cognitive exams. Motivated by the need to model the cognitive ability of low-performing patients we create a composite score from ten tests and propose to model this score using a partially linear quantile regression model for longitudinal studies with non-ignorable dropouts. Quantile regression allows for modeling non-central tendencies. The partially linear model accommodates nonlinear relationships between some of the covariates and cognitive ability. The data set includes patients that leave the study prior to the conclusion. Ignoring such dropouts will result in biased estimates if the probability of dropout depends on the response. To handle this challenge, we propose a weighted quantile regression estimator where the weights are inversely proportional to the estimated probability a subject remains in the study. We prove that this weighted estimator is a consistent and efficient estimator of both linear and nonlinear effects.

PMID:37075804 | DOI:10.1002/sim.9745

Phys Biol. 2023 Apr 19. doi: 10.1088/1478-3975/acce8d. Online ahead of print.

ABSTRACT

This paper concerns the identification of gene co-expression modules in transcriptomics data, i.e., collections of genes which are highly co-expressed and potentially linked to a biological mechanism. WGCNA (Weighted Gene Co-expression Network Analysis) is a widely used method for module detection based on the computation of eigengenes, the weights of the first principal component for the module gene expression matrix. This eigengene has been used as a centroid in a $k$-means algorithm to improve module memberships. In this paper, we present four new module representatives: the eigengene subspace, flag mean, flag median and module expression vector. The eigengene subspace, flag mean and flag median are subspace module representatives which capture more variance of the gene expression within a module. The module expression vector is a weighted centroid of the module which leverages the structure of the module gene co-expression network. We use these module representatives in LBG (Linde-Buzo-Gray) clustering algorithms to refine WGCNA module membership. We evaluate these methodologies on two transcriptomics data sets. We find that most of our module refinement techniques improve upon the WGCNA modules by two statistics: 1) module classification between phenotype and 2) module biological significance according to Gene Ontology (GO) terms.

PMID:37075776 | DOI:10.1088/1478-3975/acce8d

Chin Med J (Engl). 2023 Apr 19. doi: 10.1097/CM9.0000000000002600. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma (MM) in China; therefore, this study determined the characteristics of the disease burden of MM at national and provincial levels in China.

METHODS: The burden of MM, including incidence, mortality, prevalence, and disability-adjusted life years (DALYs), with a 95% uncertainty interval (UI), was determined in China following the general analytical strategy used in the Global Burden of Disease, Injuries, and Risk Factors Study 2019. The trends in the burden of MM from 1990 to 2019 were also evaluated.

RESULTS: There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05 (95% UI, 12.31-20.77) per 100,000 in 2019. The estimated number of incident case and deaths of MM were 18,793 and 13,421, with age-standardized incidence and mortality rates of 0.93 (95% UI, 0.67-1.15) and 0.67 (95% UI, 0.50-0.82) per 100,000, respectively. The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak (93.82) in the 70 to 74 years age group. Males had a higher burden than females, with approximately 1.5 to 2.0-fold sex difference in age-specific DALY rates in all age groups. From 1990 to 2019, the DALYs of MM increased 134%, from 148,479 in 1990 to 347,453 in 2019.

CONCLUSION: The burden of MM has doubled over the last three decades, which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.

PMID:37075767 | DOI:10.1097/CM9.0000000000002600

Chin Med J (Engl). 2023 Apr 19. doi: 10.1097/CM9.0000000000002655. Online ahead of print.

ABSTRACT

BACKGROUND: Three-dimensional shear wave elastography ((3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules recently. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.

METHODS: All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young’s modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t-test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.

RESULTS: Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young’s modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.

CONCLUSIONS: Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.

PMID:37075764 | DOI:10.1097/CM9.0000000000002655

ESC Heart Fail. 2023 Apr 19. doi: 10.1002/ehf2.14376. Online ahead of print.

ABSTRACT

AIMS: Left ventricular assist devices (LVADs) support the hearts of patients with advanced heart failure. Following LVAD implantation, patients face a complex regimen of self-care behaviours including self-care maintenance, self-care monitoring and self-care management. However, during the COVID-19 pandemic, symptoms of anxiety and depression may have interfered with their self-care. Currently, little is known on how specific self-care behaviours of LVAD-implanted patients changed during the COVID-19 pandemic. We aim to describe the changes in self-care behaviours among patients with an implanted LVAD in Israel during the COVID-19 pandemic and explore the factors related to self-care behaviour change.

METHODS: A prospective observational cross-sectional study design. A convenience sample of 27 Israeli LVAD-implanted patients (mean age 62.4 ± 9, 86% male, 78.6% living with a partner) completed the LVAD Self-Care Behaviour Scale (1 = never to 5 = always) and Hospital Anxiety and Depression Scale (0 = not at all to 3 = most of the time). Data were collected before and after the onset of the COVID-19 pandemic in Israel. Statistical analyses included paired t-tests, Pearson’s correlations, and one-way repeated measures ANOVAs.

RESULTS: During the COVID-19 pandemic, a significant decrease was found in patients’ adherence to checking and recording their LVAD speed, flow, power and PI (Pulsatility Index) (P = 0.05), checking their INR (P = 0.01), and daily weighing (P < 0.01). The prevalence of some behaviours (e.g. regularly exercising) increased in some patients and decreased in others. Patients living without a partner worsened their adherence to some of the self-care behaviours (e.g. taking medicines as prescribed), compared with those living with a partner (M_b = 5.0 ± 0 and M_d = 5.0 ± 0, delta = 0 vs. M_b = 5.0 ± 0 and M_d = 4.6 ± 0.9, delta = -0.4, respectively; F = 4.9, P = 0.04). Women, and not men, tended to improve their adherence to the self-care behaviour such as avoiding kinking, pulling, or moving the LVAD driveline at the exit site (M_b = 4.0 ± 1.0 and M_d = 5.0 ± 0, delta = 1.0 vs. M_b = 4.5 ± 0.9 and M_d = 4.4 ± 1.2, delta = -0.1, F = 4.7, P = 0.04, respectively). In total, 41% (11) patients reported neither anxiety nor depression, 11% (3) reported anxiety, 15% (4) reported depression, and 44% (12) reported both anxiety and depression. No associations between anxiety and/or depression and self-care behaviours were found.

CONCLUSIONS: Priorities in self-care behaviours among patients with implanted LVAD changed after the onset of the COVID-19 pandemic. Factors that assisted with adherence to self-care behaviours included living with a partner and being female. The current results may guide further research on identifying behaviours that are at risk of not being maintained during a time of emergency.

PMID:37075748 | DOI:10.1002/ehf2.14376

Ann Clin Psychiatry. 2023 May;35(2):110-117. doi: 10.12788/acp.0110.

ABSTRACT

BACKGROUND: Transcranial magnetic stimulation (TMS) is a neuro-modulation technique for treatment-resistant major depressive disorder (MDD). Standard TMS protocols for MDD involve once-daily treatment for 6 to 9 weeks. We report a case series of an accelerated TMS protocol for outpatient MDD treatment.

METHODS: From July 2020 through January 2021, patients deemed appropriate candidates for TMS treatment were offered an accelerated TMS protocol consisting of intermittent theta burst stimulation (iTBS) applied to the left dorsolateral prefrontal cortex, localized by the Beam F3 method, and consisting of 5 treatments daily for 5 days. Assessment scales were obtained as part of standard clinical care.

RESULTS: A total of 19 veterans received the accelerated protocol and 17 completed treatment. Statistically significant mean reductions from baseline to end of treatment were observed across all assessment scales. Remission and response rates, as defined by changes in Montgomery-Åsberg Depression Rating Scale scores, were 47.1% and 64.7%, respectively. Treatments were well tolerated without unexpected or serious adverse events.

CONCLUSIONS: This case series details the safety and efficacy of an accelerated iTBS TMS protocol consisting of 25 treatments over 5 days. Improved depressive symptoms were observed, with remission and response rates similar to standard TMS protocols of daily TMS for ≥6 weeks.

PMID:37074971 | DOI:10.12788/acp.0110

Ann Clin Psychiatry. 2023 May;35(2):103-108. doi: 10.12788/acp.0107.

ABSTRACT

BACKGROUND: Although major depressive disorder (MDD) and bipolar depression can present with similar symptoms, biological differences exist. One difference is the possible variance in adverse effects associated with treatment. This study examined the association of cognitive impairment and delirium in patients treated with electroconvulsive therapy (ECT) plus lithium for MDD or bipolar depression.

METHODS: The Nationwide Inpatient Sample included 210 adults receiving ECT plus lithium. Descriptive statistics and a Chi-square test were used to evaluate the differences between mild cognitive impairment and drug-induced delirium for those with MDD or bipolar depression. We calculated the odds ratio (OR) for drug-induced delirium in inpatients with MDD (compared to inpatients with bipolar depression) using a binomial logistic regression model.

RESULTS: Mild cognitive impairment was observed in 9.1% of patients with MDD (n = 110), compared to 0 in bipolar depression (n = 100) (P = .002). Drug-induced delirium was more prevalent in MDD (OR 1.19; 95% CI, 1.11 to 1.30).

CONCLUSIONS: ECT plus lithium is associated with less cognitive impairment and drug-induced delirium in bipolar depression compared to MDD. This study may also support biological differences between the 2 types of depression.

PMID:37074968 | DOI:10.12788/acp.0107