Tag: statistics

Neuropsychopharmacol Rep. 2022 Mar 22. doi: 10.1002/npr2.12247. Online ahead of print.

ABSTRACT

OBJECTIVES: Understanding how local “psychiatry clinic” characteristics shape research findings is essential for applying research into evolution, outcomes, and costs of mental health. However, a paucity of “psychiatry clinics” details has implications for the interpretation and utilization of this research.

METHODS: We reviewed data of 746 patients with new-onset schizophrenia on antipsychotic monotherapy seen over four years in an “adult psychiatry clinic” at Jazan Health, Saudi Arabia. Protocol-driven interviews and investigations were recorded prospectively and extracted from the medical records for the study. Summary statistics and logistic regression analyses were applied to assess patients’ characteristics and outcomes.

RESULTS: The median patient age was 32 (IQR 27-39) years. Of patients, 589 (79.0%) were male, and 679 (91.0%) had a low-level education. The median follow-up duration was 51.4 (IQR 27.4-96.3) weeks. The most used initial antipsychotic drugs were olanzapine (48.8%), haloperidol (13.9%), and aripiprazole (11.3%). The numbers of patients who retained the initial drug at 24 and 52 weeks were 539 (72.3%) and 325 (43.6%), respectively. The initial drug was changed in 246 (33.0%) patients. The median time to initial drug change was 43.9 (IQR 14.8-85.0) weeks. The logistic regression demonstrated that male sex (P < 0.004), young adult age group (P < 0.027), predominant positive symptoms (P < 0.021), treatment with haloperidol (P < 0.024), and khat use (P < 0.006) were significant factors for drug change.

CONCLUSIONS: This clinical records study demonstrated substantial individual variations in characteristics and in responding to initial antipsychotic medication. Insight into these findings will facilitate the planning for comprehensive research programs.

PMID:35318823 | DOI:10.1002/npr2.12247

Int Wound J. 2022 Mar 23. doi: 10.1111/iwj.13785. Online ahead of print.

ABSTRACT

Virtual reality (VR) technology has been widely used in clinical nursing care in recent years. We aimed to systematically evaluate the effect and safety of VR technology on pain control in wound care, to provide evidence and support for clinical wound care. We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal databases for randomised controlled trials (RCTs) on the application of VR technology in wound care up to December 20, 2021. Two researchers independently assessed the quality of the included RCTs and extracted associated data. RevMan5.3 statistical software was used for data analysis. 13 RCTs involving 1258 adult patients were included, of whom 588 patients underwent VR intervention. VR technology intervention could reduce the VAS score(MD = -1.13, 95%CI:-2.01~-0.26, P < .001), pain cognition score(MD = -3.94, 95%CI:-4.59 ~ -3.30, P < .001), pain emotion score(MD = -5.21, 95%CI: -10.46 ~ -0.04, P < .001), pain sensation score (MD = -4.94, 95%CI: -9.46 ~ -0.42, P = .03) and blood pressure(MD = -4.66, 95%CI: -8.63 ~ -0.69, P = .02) during would care. There were no significant differences on the heart rate (MD = -1.85, 95%CI: -5.71 ~ -2.01, P = .45) and VR interestingness (MD = 28.96, 95%CI: -22.10 ~ 80.02, P = .27) of the VR group and control group. No publication biases among the synthesised outcomes were found (all P > .001). VR technology can effectively reduce the pain degree and sensation of patients during wound care, which may be an effective auxiliary non-drug method used for pain relief during wound care.

PMID:35318806 | DOI:10.1111/iwj.13785

Int J Urol. 2022 Mar 22. doi: 10.1111/iju.14871. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the quality information on testicular cancer uploaded on YouTube™ videos.

METHODS: YouTube™ videos were searched using “Testicular cancer” as a keyword. The Patient Education Materials Assessment Tool, the Misinformation scale, and the DISCERN tool were used to assess the quality information of YouTube™ videos on testicular cancer.

RESULTS: According to the selection criteria, 121 YouTube™ videos were collected for the analysis and stratified according to uploading year (2009-2014 vs 2015-2020). According to the Patient Education Materials Assessment Tool for audio-visual content, the overall Understandability score was 60% (interquartile range 45.5-75) and the overall Actionability score was 100% (interquartile range 66.7-100). According to the Misinformation scale, the lowest median was recorded for item 6 (“Effects on fertility”) and the overall median Misinformation score was 2 (interquartile range 1.3-2.8). No statistically significant differences were observed according to uploading year (all P > 0.05). Of all, only 54 (44.6%) videos mentioning treatment were subsequently analyzed. Of these videos, the overall Understandability was 71.4% (interquartile range 56.3-84.6) and the overall Actionability was 100% (interquartile range 66.7-100). The overall Misinformation score was 2.8 (interquartile range 2.2-3.5). The median DISCERN score recorded for question 16 was 5 (interquartile range 3-5).

CONCLUSIONS: YouTube™ is a fast and open-access source for mass information. The overall quality of the testicular cancer contents provided is sadly unsatisfactory, in the present likewise in the past. However, YouTube™ videos mentioning treatment options showed higher quality content, than the remaining one. Nevertheless, all the videos analyzed underestimated the testicular cancer effects on fertility. Nowadays, YouTube™ cannot be recommended as a reliable source of information on testicular cancer.

PMID:35318754 | DOI:10.1111/iju.14871

J Clin Lab Anal. 2022 Mar 22:e24356. doi: 10.1002/jcla.24356. Online ahead of print.

ABSTRACT

BACKGROUND: The aspartate transaminase (AST)-to-alanine aminotransferase (ALT) ratio, which is used to measure liver injury, has been found to be associated with some chronic diseases and mortality. However, its relevance to cancer incidence resulting from population-based prospective studies has rarely been reported. In this study, we investigated the correlation of the AST/ALT ratio as a possible predictor of mortality and cancer incidence.

METHODS: A total of 9,946 participants fulfilled the inclusion criteria for a basic public health service project of the Health Checkup Program conducted by the BaiYun Community Health Service Center, Taizhou. Deceased participants and cancer incident cases were from The Taizhou Chronic Disease Information Management System. Odds ratios (ORs) and interval of quartile range (IQR) computed by logistic regression analysis and cumulative incidence rate were calculated by the Kaplan-Meier survival method and compared with log-rank test statistics.

RESULTS: Serum ALT and AST levels were both increased in patients with chronic diseases, but the ratio of AST/ALT was generally decreased. The cancer incident cases (488 new cases) had a greater baseline ratio (median =1.23, IQR: 0.96-1.54) than noncancer cases (median =1.15, IQR: 0.91-1.44). Compared to the first quartile of the AST/ALT ratio, the population in the top quartile had a higher cumulative cancer incidence rate (7.54% vs. 4.44%) during follow-up period. Furthermore, an elevated AST/ALT ratio increased the risk of all-cause mortality.

CONCLUSIONS: The ratio of AST/ALT is a potential biomarker to assess healthy conditions and long-term mortality. Especially for cancer, the AST/ALT ratio not only increases at baseline but also predicts the future development of cancer. The clinical value and potential mechanism deserve further research.

PMID:35318741 | DOI:10.1002/jcla.24356

J Vet Intern Med. 2022 Mar 23. doi: 10.1111/jvim.16414. Online ahead of print.

ABSTRACT

BACKGROUND: Ultrasonographic gastrointestinal wall changes in dogs with acute pancreatitis (AP) are not well characterized in the literature. No detailed studies have described their prevalence, characteristics, distribution, or clinical relevance.

HYPOTHESIS/OBJECTIVES: Describe the prevalence of ultrasonographic gastrointestinal wall changes in a population of dogs with AP and evaluate for associations between the presence of gastrointestinal wall changes and clinical or clinicopathological variables.

ANIMALS: Referral population of 66 client-owned dogs with AP.

METHODS: Retrospective search of clinical records to identify dogs with AP. Clinical variables, clinicopathological variables and ultrasonographic findings were reported using descriptive statistics. A binary logistic regression model was used to evaluate for associations between the presence of gastrointestinal wall changes and clinical or clinicopathological variables.

RESULTS: Sixty-six dogs were included. Forty-seven percent of dogs (95% confidence interval [CI], 35.0%-59.0%; n = 31) with AP had ultrasonographic gastrointestinal wall changes. Gastrointestinal wall changes were most common in the duodenum and identified in 71% (n = 22) of affected dogs. Of dogs with gastrointestinal wall changes, 74.2% (n = 23) had wall thickening, 61.3% (n = 19) had abnormal wall layering, and 35.5% (n = 11) had wall corrugation. In the multivariable model, only heart rate remained an independent predictor of ultrasonographic gastrointestinal wall changes (P = .02).

CONCLUSIONS AND CLINICAL IMPORTANCE: Ultrasonographic gastrointestinal wall changes in this population of dogs with AP were common. Increased heart rate was the only independent predictor of gastrointestinal wall changes, which might imply more severe disease. Additional studies are required to elucidate whether ultrasonographic gastrointestinal wall changes reflect disease severity in AP.

PMID:35318742 | DOI:10.1111/jvim.16414

Phytother Res. 2022 Mar 22. doi: 10.1002/ptr.7446. Online ahead of print.

ABSTRACT

Experimental and some clinical studies have shown beneficial effects of rosemary leaf on liver function and biochemical parameters. The present study aimed to examine the impact of rosemary leaf powder with a weight loss diet in patients with nonalcoholic fatty liver disease. In a randomized double-blinded clinical trial, 110 patients were randomly assigned to receive either 4 g rosemary leaf or placebo (starch) powders for 8 weeks. In addition, all participants in the study were given weight loss diet and physical activity recommendations. Compared with baseline, alanine aminotransferase (p < .001), aspartate aminotransferase (p < .001), alkaline phosphatase (p < .001), gamma glutamyltransferase (p < .001), fasting blood glucose (p < .001), fasting insulin (p < .001), insulin resistance (p < .001), total cholesterol (p = .003), triglyceride (p < .001), low-density lipoprotein cholesterol (p < .001), and anthropometric indices (weight, body mass index, and waist circumferences) decreased significantly in the rosemary and placebo group with weight loss. However, after 8 weeks, no significant difference between the rosemary and placebo groups was detected in the variables as mentioned above except homeostasis model assessment of β-cell dysfunction (p = .014). The findings of the current clinical trial study revealed that rosemary group did produce changes, but they were not statistically different from those produced by the diet/activity intervention alone.

PMID:35318738 | DOI:10.1002/ptr.7446

Stat Med. 2022 Mar 22. doi: 10.1002/sim.9387. Online ahead of print.

ABSTRACT

Provider profiling has been recognized as a useful tool in monitoring health care quality, facilitating inter-provider care coordination, and improving medical cost-effectiveness. Existing methods often use generalized linear models with fixed provider effects, especially when profiling dialysis facilities. As the number of providers under evaluation escalates, the computational burden becomes formidable even for specially designed workstations. To address this challenge, we introduce a serial blockwise inversion Newton algorithm exploiting the block structure of the information matrix. A shared-memory divide-and-conquer algorithm is proposed to further boost computational efficiency. In addition to the computational challenge, the current literature lacks an appropriate inferential approach to detecting providers with outlying performance especially when small providers with extreme outcomes are present. In this context, traditional score and Wald tests relying on large-sample distributions of the test statistics lead to inaccurate approximations of the small-sample properties. In light of the inferential issue, we develop an exact test of provider effects using exact finite-sample distributions, with the Poisson-binomial distribution as a special case when the outcome is binary. Simulation analyses demonstrate improved estimation and inference over existing methods. The proposed methods are applied to profiling dialysis facilities based on emergency department encounters using a dialysis patient database from the Centers for Medicare & Medicaid Services.

PMID:35318706 | DOI:10.1002/sim.9387

J Clin Ultrasound. 2022 Mar 22. doi: 10.1002/jcu.23198. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and explore its value in the diagnosis of pediatric juvenile polyps.

METHODS: One hundred and eleven children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS) and CFCUS prior to undergoing colonoscopy. Pathologic findings were used as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis.

RESULTS: Forty-five children with fifty-two colorectal polyps were confirmed via pathological examination. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs. CTUS were 92.3% versus 80.7%, 100% versus 100%, 100% versus 100%, and 93.3% versus 84.8%, respectively. The missed polyps were significantly smaller than the polyps detected in diameter (7.50 ± 2.12 mm vs. 19.62 ± 7.89 mm, p < 0.0001) by CTUS. A significant difference between CTUS and CFCUS was observed in the detection rate of polyps with a diameter < 1 cm (p = 0.031) and pedicles (p < 0.001). The kappa values for the assessment of Yamada’s classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Moreover, CFCUS incidentally revealed a punctate hyperechoic area on the surface of colonic polyps in six cases, which may be suggestive of a correlation with erosion and bleeding findings.

CONCLUSION: CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada’s classification, providing useful preoperative information for colonoscopy.

PMID:35318682 | DOI:10.1002/jcu.23198

Med Phys. 2022 Mar 22. doi: 10.1002/mp.15621. Online ahead of print.

ABSTRACT

PURPOSE: The constrained One-Step Spectral CT Image Reconstruction (cOSSCIR) algorithm with a non-convex alternating direction method of multipliers (ADMM) optimizer is proposed for addressing CT metal artifacts caused by beam hardening, noise, and photon starvation. The quantitative performance of cOSSCIR is investigated through a series of photon-counting CT simulations.

METHODS: cOSSCIR directly estimates basis material maps from photon-counting data using a physics-based forward model that accounts for beam hardening. The cOSSCIR optimization framework places constraints on the basis maps, which we hypothesize will stabilize the decomposition and reduce streaks caused by noise and photon starvation. Another advantage of cOSSCIR is that the spectral data need not be registered, so that a ray can be used even if some energy window measurements are unavailable. Photon-counting CT acquisitions of a virtual pelvic phantom with low-contrast soft tissue texture and bilateral hip prostheses were simulated. Bone and water basis maps were estimated using the cOSSCIR algorithm and combined to form a virtual monoenergetic image for evaluation of metal artifacts. The cOSSCIR images were compared to a ‘two-step’ decomposition approach that first estimated basis sinograms using a maximum likelihood algorithm and then reconstructed basis maps using an iterative total variation constrained least squares optimization (MLE+TV_min ). Images were also compared to a nonspectral TV_min reconstruction of the total number of counts detected for each ray with and without Normalized Metal Artifact Reduction (NMAR) applied. The simulated metal density was increased to investigate the effects of increasing photon starvation. The quantitative error and standard deviation in regions of the phantom were compared across the investigated algorithms. The ability of cOSSCIR to reproduce the soft-tissue texture, while reducing metal artifacts, was quantitatively evaluated.

RESULTS: Noiseless simulations demonstrated convergence of the cOSSCIR and MLE+TV_min algorithms to the correct basis maps in the presence of beam hardening effects. When noise was simulated, cOSSCIR demonstrated quantitative error of -1 HU, compared to 2 HU error for the MLE+TV_min algorithm and -154 HU error for the nonspectral TV_min +NMAR algorithm. For the cOSSCIR algorithm, the standard deviation in the central iodine ROI was 20 HU, compared to 299 HU for the MLE+TV_min algorithm, 41 HU for the MLE+TV_min +Mask algorithm that excluded rays through metal, and 55 HU for the nonspectral TV_min +NMAR algorithm. Increasing levels of photon starvation did not impact the bias or standard deviation of the cOSSCIR images. cOSSCIR was able to reproduce the soft-tissue texture when an appropriate regularization constraint value was selected.

CONCLUSIONS: By directly inverting photon-counting CT data into basis maps using an accurate physics-based forward model and a constrained optimization algorithm, cOSSCIR avoids metal artifacts due to beam hardening, noise, and photon starvation. The cOSSCIR algorithm demonstrated improved stability and accuracy compared to a two-step method of decomposition followed by reconstruction. This article is protected by copyright. All rights reserved.

PMID:35318699 | DOI:10.1002/mp.15621

J Anim Ecol. 2022 Mar 23. doi: 10.1111/1365-2656.13692. Online ahead of print.

ABSTRACT

Genetic adaptation to future environmental conditions is crucial to help species persist as the climate changes. Genome scans are powerful tools to understand adaptive landscapes, enabling us to correlate genetic diversity with environmental gradients while disentangling neutral from adaptive variation. However, low gene flow can lead to both local adaptation and highly structured populations, and is a major confounding factor for genome scans, resulting in an inflated number of candidate loci. Here, we compared candidate locus detection in a marine mollusc (Onithochiton neglectus), taking advantage of a natural geographic contrast in the levels of genetic structure between its populations. O. neglectus is endemic to New Zealand and distributed throughout an environmental gradient from the sub-tropical north to the subantarctic south. Due to a brooding developmental mode, populations tend to be locally isolated. However, adult hitchhiking on rafting kelp increases connectivity among southern populations. We applied two genome scans for outliers (Bayescan and PCAdapt) and two genotype-environment association (GEA) tests (BayeScEnv and RDA). To limit issues with false positives, we combined results using the geometric mean of q-values and performed association tests with random environmental variables. This novel approach is a compromise between stringent and relaxed approaches widely used before, and allowed us to classify candidate loci as low- or high-confidence. Genome scans for outliers detected a large number of significant outliers in strong and moderately structured populations. No high-confidence GEA loci were detected in the context of strong population structure. However, 86 high-confidence loci were associated predominantly with latitudinally-varying abiotic factors in the less structured southern populations. This suggests that the degree of connectivity driven by kelp-rafting over the southern scale may be insufficient to counteract local adaptation in this species. Our study supports the expectation that genome scans may be prone to errors in highly structured populations. Nonetheless, it also empirically demonstrates that careful statistical controls enable the identification of candidate loci that invite more detailed investigations. Ultimately, genome scans are valuable tools to help guide further research aiming to determine the potential of non-model species to adapt to future environments.

PMID:35318661 | DOI:10.1111/1365-2656.13692