Tag: statistics

Circ Cardiovasc Qual Outcomes. 2022 Nov;15(11):e009333. doi: 10.1161/CIRCOUTCOMES.122.009333. Epub 2022 Nov 15.

ABSTRACT

BACKGROUND: Cardiovascular disease is the leading cause of death in the United States; however, women and rural residents face notable health disparities compared with male and urban counterparts. Community-engaged programs hold promise to help address disparities through health behavior change and maintenance, the latter of which is critical to achieving clinical improvements and public health impact.

METHODS: A cluster-randomized controlled trial of Strong Hearts, Healthy Communities-2.0 conducted in medically underserved rural communities examined health outcomes and maintenance among women aged ≥40 years, who had a body mass index >30 or body mass index 25 to 30 and also sedentary. The multilevel intervention provided 24 weeks of twice-weekly classes with strength training, aerobic exercise, and skill-based nutrition education (individual and social levels), and civic engagement components related to healthy food and physical activity environments (community, environment, and policy levels). The primary outcome was change in weight; additional clinical and functional fitness measures were secondary outcomes. Mixed linear models were used to compare between-group changes at intervention end (24 weeks); subgroup analyses among women aged ≥60 years were also conducted. Following a 24-week no-contact period, data were collected among intervention participants only to evaluate maintenance.

RESULTS: Five communities were randomized to the intervention and 6 to the control (87 and 95 women, respectively). Significant improvements were observed for intervention versus controls in body weight (mean difference: -3.15 kg [95% CI, -4.98 to -1.32]; P=0.008) and several secondary clinical (eg, waist circumference: -3.02 cm [-5.31 to -0.73], P=0.010; systolic blood pressure: -6.64 mmHg [-12.67 to -0.62], P=0.031; percent body fat: -2.32% [-3.40 to -1.24]; P<0.001) and functional fitness outcomes; results were similar for women aged ≥60 years. The within-group analysis strongly suggests maintenance or further improvement in outcomes at 48 weeks.

CONCLUSIONS: This cardiovascular disease prevention intervention demonstrated significant, clinically meaningful improvements and maintenance among rural, at-risk older women.

REGISTRATION: URL: https://www.

CLINICALTRIALS: gov; Unique identifier: NCT03059472.

PMID:36378768 | DOI:10.1161/CIRCOUTCOMES.122.009333

Am J Community Psychol. 2022 Nov 15. doi: 10.1002/ajcp.12633. Online ahead of print.

ABSTRACT

This study fills a methodological gap in racial justice research by assessing the utility and validity of the Black Community Activism Orientation Scale (BCAOS) in a racially and ethnically diverse sample of college-going young adults (N = 624, M = 19.4 years, SD = 1.89) from 10 colleges in the United States. Confirmatory factor analysis was conducted to estimate the goodness of fit of the proposed three-factor model and assess the validity of the BCAOS. Findings from the confirmatory factor analysis provide statistical support for use of the BCAOS as a measure of racial justice activism in support of Black communities among racially and ethnically diverse college-going young adults. Findings from the study also suggest that White college students and men are less oriented toward racial justice activism than women and racially marginalized students. Convergent and discriminant validity were established through bivariate correlations of the BCAOS factors with other civic development measures. As more and more young people consider the importance of standing against racial oppression, the BCAOS has utility as an assessment instrument in future racial justice research, education, intervention, and youth programming efforts.

PMID:36378747 | DOI:10.1002/ajcp.12633

JMIR Perioper Med. 2022 Nov 15;5(1):e34600. doi: 10.2196/34600.

ABSTRACT

BACKGROUND: Patients with early breast cancer undergoing primary surgery, who have low axillary nodal burden, can safely forego axillary node clearance (ANC). However, routine use of axillary ultrasound (AUS) leads to 43% of patients in this group having ANC unnecessarily, following a positive AUS. The intersection of machine learning with medicine can provide innovative ways to understand specific risks within large patient data sets, but this has not yet been trialed in the arena of axillary node management in breast cancer.

OBJECTIVE: The objective of this study was to assess if machine learning techniques could be used to improve preoperative identification of patients with low and high axillary metastatic burden.

METHODS: A single-center retrospective analysis was performed on patients with breast cancer who had a preoperative AUS, and the specificity and sensitivity of AUS were calculated. Standard statistical methods and machine learning methods, including artificial neural network, naive Bayes, support vector machine, and random forest, were applied to the data to see if they could improve the accuracy of preoperative AUS to better discern high and low axillary burden.

RESULTS: The study included 459 patients; 142 (31%) had a positive AUS; among this group, 88 (62%) had 2 or fewer macrometastatic nodes at ANC. Logistic regression outperformed AUS (specificity 0.950 vs 0.809). Of all the methods, the artificial neural network had the highest accuracy (0.919). Interestingly, AUS had the highest sensitivity of all methods (0.777), underlining its utility in this setting.

CONCLUSIONS: We demonstrated that machine learning improves identification of the important subgroup of patients with no palpable axillary disease, positive ultrasound, and more than 2 metastatically involved nodes. A negative ultrasound in patients with no palpable lymphadenopathy is highly indicative of low axillary burden, and it is unclear whether sentinel node biopsy adds value in this situation. Further studies with larger patient numbers focusing on specific breast cancer subgroups are required to refine these techniques in this setting.

PMID:36378516 | DOI:10.2196/34600

JMIR Med Inform. 2022 Nov 15;10(11):e37976. doi: 10.2196/37976.

ABSTRACT

BACKGROUND: Since the use of electronic health records (EHRs) in an automated way, pharmacovigilance or pharmacoepidemiology studies have been used to characterize the therapy using different algorithms. Although progress has been made in this area for monotherapy, with combinations of 2 or more drugs the challenge to characterize the treatment increases significantly, and more research is needed.

OBJECTIVE: The goal of the research was to develop and describe a novel algorithm that automatically returns the most likely therapy of one drug or combinations of 2 or more drugs over time.

METHODS: We used the Information System for Research in Primary Care as our reference EHR platform for the smooth algorithm development. The algorithm was inspired by statistical methods based on moving averages and depends on a parameter Wt, a flexible window that determines the level of smoothing. The effect of Wt was evaluated in a simulation study on the same data set with different window lengths. To understand the algorithm performance in a clinical or pharmacological perspective, we conducted a validation study. We designed 4 pharmacological scenarios and asked 4 independent professionals to compare a traditional method against the smooth algorithm. Data from the simulation and validation studies were then analyzed.

RESULTS: The Wt parameter had an impact over the raw data. As we increased the window length, more patient were modified and the number of smoothed patients augmented, although we rarely observed changes of more than 5% of the total data. In the validation study, significant differences were obtained in the performance of the smooth algorithm over the traditional method. These differences were consistent across pharmacological scenarios.

CONCLUSIONS: The smooth algorithm is an automated approach that standardizes, simplifies, and improves data processing in drug exposition studies using EHRs. This algorithm can be generalized to almost any pharmacological medication and model the drug exposure to facilitate the detection of treatment switches, discontinuations, and terminations throughout the study period.

PMID:36378514 | DOI:10.2196/37976

J Gerontol A Biol Sci Med Sci. 2022 Nov 15:glac230. doi: 10.1093/gerona/glac230. Online ahead of print.

ABSTRACT

BACKGROUND: A systematic review and network meta-analysis was undertaken to examine the effectiveness of different modes of resistance exercise velocity in fast walking speed, timed-up and go, five-times sit-to-stand, 30-sec sit-to-stand and 6-min walking tests in older adults.

METHODS: CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to February 2022. Eligible randomised trials examined the effects of supervised high-velocity or traditional resistance exercise in older adults (i.e., ≥ 60 years). The primary outcome for this review was physical function measured by fast walking speed, timed up and go, five times sit-to-stand, 30-sec sit-to-stand and 6-minute walking tests, while maximal muscle power and muscle strength were secondary. A random-effects network meta-analysis was undertaken to examine the effects of different resistance exercise interventions.

RESULTS: Eighty articles describing 79 trials (n= 3,575) were included. High-velocity resistance exercise was the most effective for improving fast walking speed [standardised mean difference (SMD) -0.44, 95% CI: 0.00 to 0.87], timed-up and go (SMD -0.76, 95% CI: -1.05 to -0.47) and five times sit-to-stand (SMD -0.74, 95% CI: -1.20 to -0.27), while traditional resistance exercise was the most effective for 30-sec sit-to-stand (SMD 1.01, 95% CI: 0.68 to 1.34) and 6-min walking (SMD 0.68, 95% CI: 0.34 to 1.03).

CONCLUSION: Our study provides evidence that resistance exercise velocity effects are specific in older adults as evidenced by physical function test dependence. We suggest that prescription based on the velocity of contraction should be individualised to address specific functional needs of participants.

PMID:36378500 | DOI:10.1093/gerona/glac230

Nicotine Tob Res. 2022 Nov 15:ntac258. doi: 10.1093/ntr/ntac258. Online ahead of print.

ABSTRACT

INTRODUCTION: To help offset the increased price of cigarettes and promote brand loyalty, tobacco companies distribute coupons, particularly to price-sensitive consumers. Few studies, however, have examined the longitudinal association between coupon receipt and smoking cessation.

METHODS: Using adult data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study, we examined the longitudinal association between coupon receipt and short-term smoking cessation. Multivariable discrete time survival models were fit to an unbalanced person-period dataset for adult respondents (18+) with current established smoking status at baseline (person n=9472, risk period n=29,784). Short-term smoking cessation was measured as discontinued cigarette use (no past 30-day cigarette use at follow-up) and self-reported complete quitting. Coupon receipt was measured as a time-varying exposure, measured in the wave preceding the outcome. Tobacco dependence and time-varying cigarette use intensity were controlled as potential confounders. Effect modification by age, sex, race/ethnicity, and education was assessed by examining interaction terms.

RESULTS: We found that adults who received a coupon were 19% less likely to quit smoking compared to adults who did not receive a coupon, adjusting for covariates (adjusted hazard rate (aHR): 0.81, 95% CI: 0.74-0.89). None of the interaction terms were statistically significant, suggesting that the association between coupon receipt and short-term smoking cessation may not differ across the sociodemographic groups that we examined.

CONCLUSIONS: Taken together, our results reveal that coupon receipt reduces the likelihood of short-term smoking cessation, and that this association does not differ by age, sex, race/ethnicity, or education.

IMPLICATIONS: Tobacco companies distribute coupons for tobacco products to price-sensitive customers in the US, and these coupons can be particularly effective in partly offsetting the impact of a tax increases and promoting brand loyalty. This study provides longitudinal evidence that coupon receipt is associated with a decrease in short-term smoking cessation among US adults who smoke cigarettes after adjusting for covariates and tobacco-related confounders. The findings from this study suggest that coupons are an effective tool for tobacco companies to prevent adults who smoke from quitting, and a national ban on coupons may help to facilitate smoking cessation.

PMID:36378499 | DOI:10.1093/ntr/ntac258

Methods Mol Biol. 2023;2596:177-199. doi: 10.1007/978-1-0716-2831-7_14.

ABSTRACT

Two-dimensional difference gel electrophoresis (2D-DIGE) is an elegant gel electrophoretic analytical tool for comparative protein assessment. It is based on two-dimensional gel electrophoresis (2D-GE) separation of fluorescently labeled protein extracts. The tagging procedures are designed to not interfere with the chemical properties of proteins with respect to their pI and electrophoretic mobility, once a proper labeling protocol is followed. The use of an internal pooled standard makes 2D-DIGE a highly accurate quantitative method enabling multiple protein samples to be separated on the same two-dimensional gel. Technical limitations of this technique (i.e., underrating of low abundant, high molecular mass and integral membrane proteins) are counterbalanced by the incomparable separation power which allows proteoforms and unknown PTM (posttranslational modification) identification. Moreover, the image matching and cross-gel statistical analysis generates robust quantitative results making data validation by independent technologies successful.

PMID:36378440 | DOI:10.1007/978-1-0716-2831-7_14

Sports Med. 2022 Nov 15. doi: 10.1007/s40279-022-01792-y. Online ahead of print.

ABSTRACT

Return-to-play decision making should be based on all the advantages and disadvantages of return to play for athletes, not just the risk of injury. For competitive athletes, this includes the effect of early versus delayed return to sport on performance. In this paper, we address the questions “How can I estimate the effect of injury on the individual’s performance at return to play?” and “What is the effect of delaying return to sport on the individual’s performance?”. To address these questions, we describe (1) some foundational concepts, design and analytical challenges related to estimating the causal effect of return to play timing on performance in the athlete, (2) additional challenges if one is interested in the effects of delaying return to play and (3) differences when the questions relate to the team’s performance. Although the analytical strategies described appear complicated, coaches and athletes make these judgements informally every day without explicitly stating their assumptions. Using a formal approach should help analysts provide the most valid answers to the questions asked by athletes and coaches. In brief, the choice of a comparison group depends on the research question and requires that one consider the hypothetical performance trajectory of the athlete had they never been injured. Thus, the optimal comparison group depends on the shape of the expected trajectory and the specific research question being asked.

PMID:36378413 | DOI:10.1007/s40279-022-01792-y

Int J Clin Pharm. 2022 Nov 15. doi: 10.1007/s11096-022-01506-4. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications.

AIM: To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting.

METHOD: Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65-94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC).

RESULTS: 94.5% of patients had at least one other health condition (median 3, IQR 2-5). The median number of medications increased from five (IQR 3-7) seven days before death, to 11 medications on the day of death (IQR 9-15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13-1.37), version 2: 1.30 (1.16-1.48)); OncPal 1.13 (1.01-1.27); PIP-CPC 0.70 (0.61-0.82)).

CONCLUSION: This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.

PMID:36378404 | DOI:10.1007/s11096-022-01506-4

Emerg Radiol. 2022 Nov 15. doi: 10.1007/s10140-022-02100-x. Online ahead of print.

ABSTRACT

PURPOSE: The increased utilization, and potential overutilization, of computed tomography pulmonary angiography (CTPA) is a well-recognized issue within emergency departments (EDs). The objective of this study is to determine the impact of performance feedback reports on CTPA ordering behavior among ED physicians.

METHODS: We conducted a prospective study of the impact of individualized performance feedback reports on the ordering behavior of physicians working at two high-volume community EDs in Ontario, Canada. We generated individualized reports (or “Dashboards”) for each ED physician containing detailed feedback and peer comparison for each physician’s CTPA ordering. Our baseline pre-intervention period was January 1 to December 31, 2018, and our intervention period was January 1, 2019, to December 31, 2021. We tracked individual and group ordering behavior through the study period. Our primary outcomes are impact of feedback on (1) overall group ordering rate and (2) overall diagnostic yield. Secondary analysis was done to determine the impact of the intervention on those physicians with the highest CTPA utilization rate.

RESULTS: There was no statistically significant difference in the diagnostic yield of the included physicians in either of the years of the intervention period. There was a statically significant increase in the utilization rate for CTPA from 2018 to 2020 and 2021 from 5.9 to 7.9 and 11.4 CTPAs per 1000 ED visits respectively (p < 0.5).

CONCLUSION: Our study found no consistent significant impact of individualized feedback and peer comparison on physician ordering of CTPAs. This points to a potentially greater impact of environmental and institutional factors, as opposed to physician-targeted quality improvement measures, on physician ordering behavior.

PMID:36378395 | DOI:10.1007/s10140-022-02100-x