Tag: statistics

Aesthetic Plast Surg. 2022 Nov 8. doi: 10.1007/s00266-022-03154-5. Online ahead of print.

ABSTRACT

BACKGROUND: Small-incisional double-eyelid surgery has increasingly gained popularity. In the published studies, the number of incisions, the debulking method, and the pretarsal fixation differ significantly among studies. Hence, this article was conducted to summarize the different techniques and compare their surgical results and complications.

METHODS: The literature review was conducted using the PubMed and Cochrane databases from their inception to June 1, 2022. Clinical studies of small-incisional blepharoplasty with available full-text and extractable data were included and were grouped depending on the number of incisions. The number, length and location of the incisions, debulking method, fixation technique, and skin closure were concluded. The complications were statistically analyzed and compared.

RESULTS: Finally, 13 articles and 4177 patients were eligible for reviewing, among which 5 studies (2460 patients) described single-incisional technique, 2 studies (645 patients) described two-incisional technique, 5 studies (700 patients) described three-incisional technique, and 1 study (372 patients) described four-incisional technique. Through the small incisions, the pretarsal soft tissue can be removed as appropriate, and the pretarsal fixation can be firm and exact. Both the single- and three-incisional studies had a pooled total complication rate of 5% and a pooled foldloss rate of 2%. No significant difference was found between groups.

CONCLUSIONS: The small-incisional techniques offer a simple, safe, and reproducible approach to double-eyelids. It reduces post-op recovery time and allows a tenacious fixation. The fold-loss rate and other complication rate are acceptable when compared with the non-incisional and full-incisional techniques.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

PMID:36348097 | DOI:10.1007/s00266-022-03154-5

J Appl Clin Med Phys. 2022 Nov 8:e13806. doi: 10.1002/acm2.13806. Online ahead of print.

ABSTRACT

PURPOSE: This manuscript describes the structure, management and outcomes of a multi-institutional clinical and research medical physics residency program (Harvard Medical Physics Residency Program, or HMPRP) to provide potentially useful information to the centers considering a multi-institutional approach for their training programs.

METHODS: Data from the program documents and public records was used to describe HMPRP and obtain statistics about participating faculty, enrolled residents, and graduates. Challenges associated with forming and managing a multi-institutional program and developed solutions for effective coordination between several clinical centers are described.

RESULTS: HMPRP was formed in 2009 and was accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) in 2011. It is a 3-year therapy program, with a dedicated year of research and the 2 years of clinical training at three academic hospitals. A CAMPEP-accredited Certificate Program is embedded in HMPRP to allow enrolled residents to complete a formal didactic training in medical physics if necessary. The clinical training covers the material required by CAMPEP. In addition, training in protons, CyberKnife, MR-linac, and at network locations is included. The clinical training and academic record of the residents is outstanding. All graduates have found employment within clinical medical physics, mostly at large academic centers and graduates had a 100% pass rate at the oral American Board of Radiology exams. On average, three manuscripts per resident are published during residency, and multiple abstracts are presented at conferences.

CONCLUSIONS: A multi-institutional medical physics residency program can be successfully formed and managed. With a collaborative administrative structure, the program creates an environment for high-quality clinical training of the residents and high productivity in research. The main advantage of such program is access to a wide variety of resources. The main challenge is creating a structure for efficient management of multiple resources at different locations. This report may provide valuable information to centers considering starting a multi-institutional residency program.

PMID:36347055 | DOI:10.1002/acm2.13806

J Radiol Prot. 2022 Nov 8. doi: 10.1088/1361-6498/aca0fe. Online ahead of print.

ABSTRACT

The Quality Assurance Program (QAP) implementation in mammography is a key aspect to guarantee image quality acquisition and, thus, an opportune diagnosis of breast cancer. A QAP involves planned and systematic actions as quality control tests (QC) that will produce consistently high-quality images considering a low radiation exposure for stakeholders. Currently, there is poor evidence of the current QAP implementation status in developing countries, particularly in Latin America. In this work, over the period of October 2021 to April 2022, 47 Mexican digital mammography facilities were evaluated in terms of QAP’s current status implementation. A survey of 3 key indicators of compliance / non-compliance of QAP was carried out. Also, 17 QC test parameters were assessed in all mammography units according to an international framework. Kruskal-Wallis, Mc Nemar’s tests, and Spearman correlation were used to identify the significant correlation between the QC tests and QAP indicators. The statistical analysis showed a significant positive correlation between the QAP indicators and the QC parameters evaluated, especially associated with an increase in image quality. Almost 90 % percent of the facilities evaluated failed in some QAP indicator and only 44.68 % of the facilities have an updated and current program implemented. The successful QAP implementation directly impacted the QC mammography test results, particularly in terms of image quality; thus, conditioning a successful mammography acquisitions chain. The results obtained in this work suggest that better regulations need to be implemented to guarantee QAP surveillance; which could mean an increase in opportune diagnosis and management of breast cancer with radiological safety for patients and occupational exposure personnel.

PMID:36347024 | DOI:10.1088/1361-6498/aca0fe

ACS Biomater Sci Eng. 2022 Nov 8. doi: 10.1021/acsbiomaterials.2c00456. Online ahead of print.

ABSTRACT

Electrotherapy plays a crucial role in regulating neuronal activity. Nevertheless, the relevant therapeutic mechanisms are still unclear; thus, the effects of electric fields on brain tissue’s mechanical properties and microstructure need to be explored. In this study, focusing on the changes in mechanical properties and microstructure of ex vivo porcine brain tissues under different types of electric fields, directional and alternating electric fields (frequencies of 5, 20, 50, and 80 Hz, respectively) integrate with a custom-designed indentation device. The experimental results showed that for the ex vivo brain tissue, the directional electric field (DEF) can reduce the elastic properties of brain tissue. Simultaneously, the DEF can increase the cell spacing and reduce the proteoglycan content. The transmission electron microscope (TEM) analysis observed that the DEF can reduce the integrity of the plasma membrane, the endoplasmic reticulum’s stress response, and the myelin lamella’s separation. The alternating electric field (AEF) can accelerate the stress relaxation process of brain tissue and change the time-dependent mechanical properties of brain tissue. Meanwhile, with the increase in frequency, the cell spacing decreased, and the proteoglycan content gradually approached the control group without electric fields. TEM analysis observed that with the increase in frequency, the integrity of the plasma membrane increases, and the separation of the myelin lamella gradually disappears. Understanding the changes in the mechanical properties and microstructure of brain tissue under AEF and DEF enables a preliminary exploration of the therapeutic mechanism of electrotherapy. Simultaneously, the essential data was provided to support the development of embedded electrodes. In addition, the ex vivo experiments build a solid foundation for future in vivo experiments.

PMID:36346997 | DOI:10.1021/acsbiomaterials.2c00456

JMIR Mhealth Uhealth. 2022 Nov 8;10(11):e43829. doi: 10.2196/43829.

ABSTRACT

[This corrects the article DOI: 10.2196/14487.].

PMID:36346991 | DOI:10.2196/43829

Qual Manag Health Care. 2022 Dec 7. doi: 10.1097/QMH.0000000000000375. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Central line-associated bloodstream infections (CLABSIs) are a common, preventable healthcare-associated infection. In our 3-hospital health system, CLABSI rates in non-intensive care unit (ICU) settings were above the internal target rate of zero. A robust quality improvement (QI) project to reduce non-ICU CLABSIs was undertaken by a team of Doctor of Nursing Practice (DNP)-prepared nurse leaders enrolled in a post-DNP Quality Implementation Scholars program and 2 QI experts. Based on a review of the literature and local root cause analyses, the QI team implemented the evidence-based practice of using 2% chlorhexidine gluconate (CHG) cloths for daily bathing for non-ICU patients with a central line.

METHODS: A pre-post-design was used for this QI study. CHG bathing was implemented using multifaceted educational strategies that included an e-learning module, printed educational materials, educational outreach, engagement of unit-based CLABSI champions, and an electronic reminder in the electronic health record. Generalized linear mixed-effects models were used to assess the change in CLABSI rates before and after implementation of CHG bathing. CLABSI rates were also tracked using statistical process control (SPC) charts to monitor stability over time. CHG bathing documentation compliance was audited as a process measure. These audit data were provided to unit-based leadership (nurse managers and clinical team leaders) on a monthly basis. A Qualtrics survey was also disseminated to nursing leadership to evaluate their satisfaction with the CHG bathing implementation processes.

RESULTS: Thirty-four non-ICU settings participated in the QI study, including general medical/surgical units and specialty areas (oncology, neurosciences, cardiac, orthopedic, and pediatrics). While the change in CLABSI rates after the intervention was not statistically significant (b = -0.35, P = .15), there was a clinically significant CLABSI rate reduction of 22.8%. Monitoring the SPC charts demonstrated that CLABSI rates remained stable after the intervention at all 3 hospitals as well as the health system. CHG bathing documentation compliance increased system-wide from 77% (January 2020) to 94% (February 2021). Overall, nurse leaders were satisfied with the CHG bathing implementation process.

CONCLUSIONS: To sustain this practice change in non-ICU settings, booster sessions will be completed at least on an annual basis. This study provides further support for using CHG cloths for daily patient bathing in the non-ICU setting.

PMID:36346987 | DOI:10.1097/QMH.0000000000000375

ASAIO J. 2022 Nov 9. doi: 10.1097/MAT.0000000000001846. Online ahead of print.

ABSTRACT

Current left ventricular assist devices (LVADs) are set to a fixed rpm and are unable to adjust to physiological demands irrespective of preload or afterload. Autonomous control of LVADs has the potential to reduce septal shift, preserve right ventricle function, and meet physiological demands. A highly innovative resonantly coupled regimen is presented which can achieve this goal. We introduce sensors based on a highly sensitive relationship between transmission coefficient and spatial separation in a resonantly coupled regimen. This relationship represents a polynomial regression. A regimen of an apical sensor and multiple outflow sensors is investigated. A range of separations varying from 50-200 mm was systematically investigated. These ranges consider anatomical & physiological variation(s) in cardiac chamber size. Validation was obtained in porcine heart preparation. The polynomial regression model predicted distance between the sensors with a mean absolute percentage error of 0.77%, 1.07%, and 5.75% for the thr ee putative positions of the outflow sensors and apical sensor when compared with experimental results. A high degree of accuracy (95%) between the predicted and observed distance was obtained. Continuous measurements were done over 90 days to examine drift, with no statistically detectable change in measurements over million sampling cycles. We have demonstrated a reliable sensor methodology without drift for assessing ventricular chamber size in an LVAD setup. This has the potential to allow autonomous control of LVAD based on ventricular chamber size to address some of the adverse events.

PMID:36346948 | DOI:10.1097/MAT.0000000000001846

J Telemed Telecare. 2022 Dec;28(10):733-739. doi: 10.1177/1357633X221123409.

ABSTRACT

In Australia, the COVID-19 pandemic has resulted in the exponential growth in the delivery of telehealth services. Medicare data indicates that the majority of telehealth consultations have used the telephone, despite the known benefits of using video. The aim of this study was to understand the perceived quality and effectiveness of in-person, telephone and videoconsultations for cancer care. Data was collected via online surveys with consumers (n = 1162) and health professionals (n = 59), followed by semi-structured interviews with telehealth experienced health professionals (n = 22) and consumers (n = 18). Data were analysed using descriptive statistics and significance was tested using the chi-square test. A framework analysis and thematic analysis were used for qualitative data. Results indicate telehealth is suitable for use across the cancer care pathway. However, consumers and health professionals perceived videoconsultations facilitated visual communication and improved patients’ quality of care. The telephone was appropriate for short transactional consultations such as repeat prescriptions. Consumers were rarely given the choice of consultation modality. The choice of modality depended on a range of factors such as the type of consultation and stage of cancer care. Hybrid models of care utilising in-person, video and telephone should be developed and requires further guidance to promote the adoption of telehealth in cancer care.

PMID:36346931 | DOI:10.1177/1357633X221123409

Blood Transfus. 2022 Nov 2. doi: 10.2450/2022.0130-22. Online ahead of print.

ABSTRACT

BACKGROUND: That lead is harmful to multiple systems of the human body has been known since antiquity and numerous recent studies have shown that blood transfusion may be an important source of exposure to lead in blood recipients. In this study factors influencing elevated lead levels in blood samples from donors in Qingdao, a city in northern China were investigated to provide screening procedures for blood donors and safer blood transfusions for blood recipients.

MATERIALS AND METHODS: In 2021, subjects from 15 blood donation sites in Qingdao were selected by stratified random sampling. Blood lead levels (BLL) were analyzed by graphite furnace atomic absorption spectrometry. Multiple linear regression and logistic regression models were used to analyze factors influencing BLL.

RESULTS: Of 2,142 blood donors, 1,434 were male and 708 were female, with an average age of 34.8 years. The geometric mean of BLL was 26.03 μg/L (95% confidence interval: 25.52-26.56), and donors in the high blood lead group (≥35 μg/L) accounted for 25.6% of the study population. Multiple linear regression results showed BLL was associated with gender, age, place of residence, duration of residence, and smoking status. Multivariate logistic regression analysis showed that male, increasing age, living in Jimo, duration of residence ≥30 years, and smoking were risk factors for high BLL, with odds ratios (95% confidence intervals) being 2.10 (1.61-2.73), 1.03 (1.01-1.04), 3.89 (1.09-13.86), 1.64 (1.22-2.20), and 1.76 (1.40-2.22), respectively.

DISCUSSION: Male, advanced age, living in Jimo, smoking, and duration of residence ≥30 years were associated with higher BLL. Infusion of blood with elevated lead concentration can be reduced by screening out donors presenting one or more of the above risk factors.

PMID:36346884 | DOI:10.2450/2022.0130-22

Blood Transfus. 2022 Oct 18. doi: 10.2450/2022.0131-22. Online ahead of print.

ABSTRACT

BACKGROUND: In the context of critical bleeding and massive transfusion (CB/MT), little is known about the development of new red blood cell (RBC) alloantibodies. We performed a retrospective, observational study to examine the frequency of RBC alloantibodies (pre-existent, anamnestic, or new) in patients with CB/MT, defined as transfusion of five or more RBC units in any 4-hour period, for any cause of CB.

MATERIALS AND METHODS: Data on 2,585 New Zealand patients (date/time of MT initiation, demographic data, blood group, clinical context, and transfused RBCs) were obtained from the Australian and New Zealand Massive Transfusion Registry. RBC alloantibody screening/identification data were extracted from the New Zealand Blood Service database. We calculated summary statistics, compared proportions between different independent groups using the Chi-squared test, and performed logistic regression analysis to examine the effects of variables on alloantibody presence or formation. We also determined the immunogenicities of selected RBC antigens in the context of CB/MT.

RESULTS: Of 1,234 assessable patients, 1,166 (94.5%) showed no evidence of any alloantibody. Pre-existent, anamnestic, and new alloantibodies were found, respectively, in 4.3%, 0.4%, and 7.2% of assessable patients. By multivariable regression analysis, transfusion of D-positive RBC to D-negative patients was independently associated with new alloantibody formation. Neither the quantum of RBC transfused nor trauma as clinical context were so associated although the latter trended towards a predisposition. “Antibodies of undetermined specificity” were the commonest pre-existent and new alloantibodies. The immunogenicity of Jk^a was the highest in this setting.

DISCUSSION: RBC alloantibodies of any type were rare in this CB/MT population. Patients undergoing CB/MT appear to have low risks of re-stimulating anamnestic alloantibodies, or of developing new RBC alloantibodies.

PMID:36346883 | DOI:10.2450/2022.0131-22