Tag: statistics

J Esthet Restor Dent. 2022 Apr 14. doi: 10.1111/jerd.12909. Online ahead of print.

ABSTRACT

OBJECTIVES: To test whether or not a chairside workflow (CHAIR) is similar to a labside workflow (LAB) in terms of efficacy (primary outcome) and efficiency (secondary outcome).

MATERIAL AND METHODS: Eighteen subjects in need of a single-tooth restoration in the posterior region of the maxilla or mandible were consecutively recruited and randomly assigned to the CHAIR or LAB workflow. Patient-reported outcome measures (PROMs; efficacy) were assessed using a questionnaire with visual analog scale. The white AEsthetic score (WES) was applied to evaluate the AEsthetic outcome objectively. The clinical and laboratory time (efficiency) were recorded. Nonparametric methods were applied for the group comparisons.

RESULTS: The overall median AEsthetic evaluation after treatment was 10 (interquartile range = IQR: 9.5-10) in group CHAIR and 10 (IQR: 9.5-10) in-group LAB (Mann-Whitney [MW] test p = 1.000). The WES amounted to 4 (IQR: 3-5) (CHAIR) and to 8 (IQR: 7-9) (LAB) (MW test p < 0.0001). The median total working time for the clinician in-group CHAIR was 49.9 min. (IQR: 40.9-63.7) and 41.4 min. (IQR: 37.2-58.2) in-group LAB (MW test p = 0.387).

CONCLUSIONS: Subjective PROMs of single-tooth supported restorations fabricated in a CHAIR or LAB workflow led to similar scores of patients’ satisfaction and a moderate negative correlation for the objective evaluation of the clinician in the LAB workflow.

CLINICAL SIGNIFICANCE: PROMs can be considered a key element in the decision-making process for restoring single-tooth restorations. The patients’ perception of AEsthetics was similar for the CHAIR or LAB workflows. The additional efforts undertaken with the LAB workflow did not result in a patient benefit when compared to a CHAIR workflow.

PMID:35421283 | DOI:10.1111/jerd.12909

Microsc Res Tech. 2022 Apr 14. doi: 10.1002/jemt.24109. Online ahead of print.

ABSTRACT

The purpose of this study was to introduce antibacterial property to pits and fissure sealant (PFS) in order to mitigate the major clinical problems associated with PFS, such as microleakage and secondary caries. We prepared a pH reliant cobalt oxide nanoparticle incorporated with minocycline (MNC@CO) and characterized to investigate its antibacterial potential against Streptococcus sobrinus. The physiochemical, morphological, and drug release kinetics at different pH (7.4, 5.0, and 3.5) from nanoparticles were investigated. The MNC@CO were added at 2.5% and 5.0% into experimental PFS and characterized for their antibiofilm capacity, biocompatibility, and mechanical properties including compressive and flexural strength. The groups 2.5% and 5.0% has shown statistically significant antimicrobial capacity against S. sobrinus compared to control (p < .05). The highest percentage of MNC release at different pH (especially at pH 5.0 and 3.5) was observed from 5.0% MNC@CO doped PFS. The PFS doped with 2.5% MNC@CO showed a highest compressive strength (110 MPa) over a period of 70 days as compared to 5.0% MNC@CO (75 MPa) and control (80 MPa). The flexural strength of both experimental groups was lower for both time points (24 h and 30 days) than control. In conclusion, the present study found that 2.5% MNC@CO doped PFS showed considerable anti-biofilm potential without compromising mechanical properties.

PMID:35421274 | DOI:10.1002/jemt.24109

Fam Med. 2022 Apr;54(4):298-303. doi: 10.22454/FamMed.2022.652106.

ABSTRACT

BACKGROUND AND OBJECTIVES: Teaching medical trainees evidence-based medicine (EBM) is required by the Accreditation Council for Graduate Medical Education. Most published graduate EBM curricula focus on critical appraisal over point-of-care information mastery. Faculty at the University of Rochester Family Medicine Residency implemented a clinically integrated, cyclical EBM curriculum juxtaposing information mastery with expert-level skills such as critical appraisal. We administered the Evidence-Based Medicine Environment Survey (EBMES) to learners before and after the yearlong curriculum.

METHODS: Two cohorts of participating third-year residents completed the EBMES before and after an EBM curriculum.

RESULTS: Over 2 years, 21 residents completed pre- and postevaluations. Resident perception of the EBM educational and practice environment was high at baseline and improved for 15 of 36 survey items (P&lt;.05).

CONCLUSIONS: Resident perception of the EBM learning environment improved after participation in a yearlong curriculum. Nearly all of the content covered in the “Science of Family Medicine” curriculum and measured by EBMES improved in a statistically significant manner. We propose that EBM curricula should combine traditional literature search and critical appraisal skills with information mastery to maximize effectiveness. Our curriculum can be modified to fit other graduate family medicine contexts.

PMID:35421246 | DOI:10.22454/FamMed.2022.652106

Fam Med. 2022 Apr;54(4):270-276. doi: 10.22454/FamMed.2022.526799.

ABSTRACT

BACKGROUND AND OBJECTIVES: Burnout impacts medical students, residents, and practicing physicians. Existing research oversimplifies characteristics associated with burnout. Our study examined relationships between burnout, depressive symptoms, and evidence-based risk factors.

METHODS: Our study questions were part of a larger survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA), from May 9-23, 2020. Three emails were used to recruit a national sample of family medicine residents (n=283; questions completed via Survey Monkey). We determined descriptive statistics (frequency, means) for demographic and work environment characteristics, UCLA Loneliness Scale items, health behaviors, burnout (emotional exhaustion, depersonalization), and depressive symptoms. Multivariate data analysis included developing three logistic regression (LR) equations (emotional exhaustion, depersonalization, depressive symptoms) based on four blocks of potential risk factors (demographics, work environment characteristics, UCLA Loneliness items, and health behaviors).

RESULTS: Rates of psychological distress included 33.1% emotional exhaustion, 31.1% depersonalization, and 53.0% depressive symptoms. We determined stepwise forward-entry LR models for emotional exhaustion (feel isolated OR=6.89, low quality of wellness program OR=5.91, and low companionship OR=4.82); depersonalization (feel isolated OR=5.59, low quality of wellness program OR=15.11, graduate US osteopathic medical school OR=0.329, and African American OR=7.55); and depressive symptoms (feel isolated OR=5.31, inadequate time for restful sleep OR=0.383, and no dependent children OR=2.14).

CONCLUSIONS: Current findings document substantial social disconnection, substandard residency wellness programs, inadequate time for exercise, sleep, and other forms of self-care in addition to substantial levels of emotional exhaustion, depersonalization, and depressive symptoms. We explore implications for the design of future burnout prevention efforts and research.

PMID:35421241 | DOI:10.22454/FamMed.2022.526799

PLoS One. 2022 Apr 14;17(4):e0267116. doi: 10.1371/journal.pone.0267116. eCollection 2022.

ABSTRACT

BACKGROUND: Understanding of COVID-19 acquisition and severity risk in minoritized groups is limited by data collection on race and ethnicity; very little is known about COVID-19 risk among Arab Americans in the United States.

PURPOSE: To quantify whether Arab Americans in the El Cajon region of California experienced differential levels of SARS-CoV-2 infection, severity and mortality when compared to other racial/ethnic groups.

METHODS: A retrospective study was conducted using Sharp Grossmont Hospital’s electronic medical records. Patients were included in the study if they were: 18 years of age or older, tested for SARS-CoV-2, admitted for COVID-19 infection, or had COVID-19 listed as a cause of death between March 1, 2020 and January 31, 2021. The primary outcomes of interest were a positive COVID-19 test result, admission to the hospital due to COVID-19, and in hospital COVID-19 related mortality. Comparisons were made across racial/ethnic groups using chi-squared statistics and logistic regression models adjusted for sociodemographics, comorbidities, and time from March 2020.

RESULTS: Arab Americans had greater odds of testing positive for SARS-CoV-2 than non-Hispanic White (adjusted odds ratio, AOR: 3.83, 95% confidence interval, CI: 3.29, 4.46) and non-Hispanic Black (AOR: 2.34, 95% CI: 1.91, 2.88) patients but lower odds of admission (AOR: 0.47, 95% CI: 0.36, 0.63) and in-hospital mortality (AOR: 0.43, 95% CI: 0.28, 0.65) than Hispanic patients.

CONCLUSIONS: There were distinct patterns for COVID-19 infection, severity, and mortality for Arab Americans in Southern California. Without a dedicated ethnic identifier, COVID-19 disparities facing Arab Americans will continue to go undocumented.

PMID:35421208 | DOI:10.1371/journal.pone.0267116

Phys Ther. 2022 Apr 11:pzac040. doi: 10.1093/ptj/pzac040. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to assess the current evidence for the effects of neural mobilization (NM) treatments.

METHODS: Three umbrella reviews with meta-meta-analyses (MMAs) were conducted to determine the effects of NM on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in participants who were asymptomatic. The study used the grading criteria proposed by the Physical Activity Guidelines Advisory Committee to assess the quality of evidence.

RESULTS: One MMA revealed a statistically significant moderate effect on pain intensity (standardized mean difference [SMD] = -0.75; 95% CI = -1.12 to -0.38) but with evidence of heterogeneity (Q = 14.13; I2 = 65%). The study found a significantly large effect of NM on disability (SMD = -1.22; 95% CI = -2.19 to -0.26), again with evidence of heterogeneity (Q = 31.57; I2 = 87%). The third MMA showed a statistically significant moderate effect of NM on mechanosensitivity (SMD = 0.96; 95% CI = 0.35 to 1.57), with no evidence of heterogeneity (Q = 2.73; I2 = 63%). For all examined outcomes, the quality of evidence was limited.

CONCLUSIONS: Overall, the results indicated that although NM treatment had a moderate to large beneficial clinical effect on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in individuals who were asymptomatic, the quality of evidence was limited.

IMPACT: Neural mobilization treatments showed positive results on the pain intensity and disability in patients with musculoskeletal conditions. Neural mobilization could be integrated into the physical therapy management, although more research is needed.

PMID:35421227 | DOI:10.1093/ptj/pzac040

PLoS One. 2022 Apr 14;17(4):e0266934. doi: 10.1371/journal.pone.0266934. eCollection 2022.

ABSTRACT

BACKGROUND: Decision-making in healthcare policy involves assessing both costs and benefits. In determining the cost-effectiveness (CE) threshold, willingness to pay (WTP) per quality-adjusted life year (QALY), GDP per capita, and other factors are important. However, the relationship between WTP/QALY or GDP per capita and the CE threshold is unclear. It is important to clarify the relationship between WTP/QALY and GDP to provide a clear basis for setting the CE threshold.

OBJECTIVE: The purpose of this study was to compare WTP/QALY and GDP per capita, and to develop a new CE threshold range based on WTP using GDP per capita. The relationship between WTP/QALY and healthy life expectancy (HALE) was also investigated.

METHODS: We searched MEDLINE, EMBASE and Web of Science from 1980/01/01 to 2020/12/31 using the following selection criteria (latest search: Dec 2021):1, studies that estimated WTP/QALY; 2, the general population was surveyed; 3, the article was in English. From the collected articles, we obtained average values of WTP/QALY for various countries and compared WTP/QALY with GDP per capita. The correlation between WTP/QALY and HALE was also examined.

RESULTS: We identified 20 papers from 17 countries. Comparison of mean WTP/QALY values with GDP per capita showed that most WTP/QALY values were in the range of 0.5-1.5 times GDP per capita, though the median values were less than 0.5 times. Comparison of WTP/QALY with HALE showed a statistically significant positive correlation when Taiwan was excluded as an outlier.

CONCLUSIONS: Our results suggest a CE threshold range of 0.5-1.5 times GDP per capita is appropriate but lower than the WHO-recommended range of 1-3 times. The correlation between WTP/QALY and HALE suggests that investment in healthcare is reflected in an increased healthy life expectancy. Since WTP is based on consumer preferences, this range could be used to set a generally acceptable criterion.

PMID:35421181 | DOI:10.1371/journal.pone.0266934

PLoS One. 2022 Apr 14;17(4):e0267120. doi: 10.1371/journal.pone.0267120. eCollection 2022.

ABSTRACT

A previously developed joint-space metabolic energy expenditure (MEE) model includes subject-specific parameters and was validated using level walking gait data. In this work, we determine how well this joint-space model performs during various walking grades (-8%, 0%, and 8%) at 0.8 m·s ⁻1 and 1.3 m·s ⁻1 using published gait data in the literature. In response to those results, we formulate an optimization problem and solve it through the particle swam method plus fmincon function in MATLAB to identify a new optimal weighting parameter set for each grade that produces more accurate predicted MEE and we compare our new findings with seven other MEE models in the literature. The current study matched the measured MEE the best with the lowest RMSE values for level (0.45 J·kg ⁻1·m ⁻1) and downhill (0.82 J·kg ⁻1·m ⁻1) walking and the third lowest RMSE value for uphill (1.56 J·kg ⁻1·m ⁻1) walking, where another MEE model, Looney et al., had the lowest RMSE for uphill (1.27 J·kg ⁻1·m ⁻1) walking. Bland-Altman plots and three independent-samples t-tests show that there was no statistical significant difference between experimentally measured MEE and estimated MEE during the three walking conditions, meaning that the three new optimal weighting parameter sets can be used with 6 degree of freedom (DOF) lower extremity motion data to better estimate whole body MEE in those scenarios. We believe that this work is a step towards identifying a single robust parameter set that allows for accurate estimation of MEE during any task, with the potential to mitigate a limitation of indirect calorimetry requiring lengthy steady state motion.

PMID:35421206 | DOI:10.1371/journal.pone.0267120

PLoS One. 2022 Apr 14;17(4):e0267050. doi: 10.1371/journal.pone.0267050. eCollection 2022.

ABSTRACT

BACKGROUND: Prognostic information is important for patients with cancer, their families, and clinicians. In practice, survival predictions are made by clinicians based on their experience, judgement, and intuition. Previous studies have reported that clinicians’ survival predictions are often inaccurate. This study reports a secondary analysis of data from the Prognosis in Palliative care Study II (PiPS2) to assess the accuracy of survival estimates made by doctors and nurses.

METHODS AND FINDINGS: Adult patients (n = 1833) with incurable, locally advanced or metastatic cancer, recently referred to palliative care services (community teams, hospital teams, and inpatient palliative care units) were recruited. Doctors (n = 431) and nurses (n = 777) provided independent prognostic predictions and an agreed multi-professional prediction for each patient. Clinicians provided prognostic estimates in several formats including predictions about length of survival and probability of surviving to certain time points. There was a minimum follow up of three months or until death (whichever was sooner; maximum follow-up 783 days). Agreed multi-professional predictions about whether patients would survive for days, weeks or months+ were accurate on 61.9% of occasions. The positive predictive value of clinicians’ predictions about imminent death (within one week) was 77% for doctors and 79% for nurses. The sensitivity of these predictions was low (37% and 35% respectively). Specific predictions about how many weeks patients would survive were not very accurate but showed good discrimination (patients estimated to survive for shorted periods had worse outcomes). The accuracy of clinicians’ probabilistic predictions (assessed using Brier’s scores) was consistently better than chance, improved with proximity to death and showed good discrimination between groups of patients with different survival outcomes.

CONCLUSIONS: Using a variety of different approaches, this study found that clinicians predictions of survival show good discrimination and accuracy, regardless of whether the predictions are about how long or how likely patients are to survive. Accuracy improves with proximity to death. Although the positive predictive value of estimates of imminent death are relatively high, the sensitivity of such predictions is relatively low. Despite limitations, the clinical prediction of survival should remain the benchmark against which any innovations in prognostication are judged.

STUDY REGISTRATION: ISRCTN13688211. http://www.isrctn.com/ISRCTN13688211.

PMID:35421168 | DOI:10.1371/journal.pone.0267050