Tag: statistics

JMIR Res Protoc. 2022 Jun 22;11(6):e37334. doi: 10.2196/37334.

ABSTRACT

BACKGROUND: Up-to-date and accurate information about the health problems encountered by primary care doctors is essential to understanding the morbidity pattern of the community to better inform health care policy and practice. Morbidity surveys of doctors allow documentation of actual consultations, reflecting the patient’s reason for seeking care as well as the doctor’s diagnostic interpretation of the illness and management approach. Such surveys are particularly critical in the absence of a centralized primary care electronic medical record database.

OBJECTIVE: With the changing sociodemographic profile of the population and implementation of health care initiatives in the past 10 years, the aim of this study is to determine the morbidity and management patterns in Hong Kong primary care during a pandemic and compare the results with the last survey conducted in 2007-2008.

METHODS: This will be a prospective, practice-based survey of Hong Kong primary care doctors. Participants will be recruited by convenience and targeted sampling from both public and private sectors. Participating doctors will record the health problems and corresponding management activities for consecutive patient encounters during one designated week in each season of the year. Coding of health problems will follow the International Classification of Primary Care, Second Edition. Descriptive statistics will be used to calculate the prevalence of health problems and diseases as well as the rates of management activities (referral, investigation, prescription, preventive care). Nonlinear mixed effects models will assess the differences between the private and public sectors as well as factors associated with morbidity and management patterns in primary care.

RESULTS: The data collection will last from March 1, 2021, to August 31, 2022. As of April 2022, 176 doctor-weeks of data have been collected.

CONCLUSIONS: The results will provide information about the health of the community and inform the planning and allocation of health care resources.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04736992; https://clinicaltrials.gov/ct2/show/NCT04736992.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37334.

PMID:35731566 | DOI:10.2196/37334

JMIR Med Inform. 2022 Jun 22;10(6):e34753. doi: 10.2196/34753.

ABSTRACT

BACKGROUND: Cervical cancer has been recognized as a preventable type of cancer. As the assessment of all the risk factors of a disease is challenging for physicians, information technology and risk assessment models have been used to estimate the degree of risk.

OBJECTIVE: The aim of this study was to develop a clinical decision support system to assess the risk of cervical cancer.

METHODS: This study was conducted in 2 phases in 2021. In the first phase of the study, 20 gynecologists completed a questionnaire to determine the essential parameters for assessing the risk of cervical cancer, and the data were analyzed using descriptive statistics. In the second phase of the study, the prototype of the clinical decision support system was developed and evaluated.

RESULTS: The findings revealed that the most important parameters for assessing the risk of cervical cancer consisted of general and specific parameters. In total, the 8 parameters that had the greatest impact on the risk of cervical cancer were selected. After developing the clinical decision support system, it was evaluated and the mean values of sensitivity, specificity, and accuracy were 85.81%, 93.82%, and 91.39%, respectively.

CONCLUSIONS: The clinical decision support system developed in this study can facilitate the process of identifying people who are at risk of developing cervical cancer. In addition, it can help to increase the quality of health care and reduce the costs associated with the treatment of cervical cancer.

PMID:35731549 | DOI:10.2196/34753

JAMA Surg. 2022 Jun 22. doi: 10.1001/jamasurg.2022.2234. Online ahead of print.

NO ABSTRACT

PMID:35731543 | DOI:10.1001/jamasurg.2022.2234

JAMA Surg. 2022 Jun 22. doi: 10.1001/jamasurg.2022.2229. Online ahead of print.

ABSTRACT

IMPORTANCE: Long-term results from randomized clinical trials comparing laparoscopic sleeve gastrectomy (LSG) with laparoscopic Roux-en-Y-gastric bypass (LRYGB) are limited.

OBJECTIVE: To compare long-term outcomes of weight loss and remission of obesity-related comorbidities and the prevalence of gastroesophageal reflux symptoms (GERD), endoscopic esophagitis, and Barrett esophagus (BE) after LSG and LRYGB at 10 years.

DESIGN, SETTING, AND PARTICIPANTS: This 10-year observational follow-up evaluated patients in the Sleeve vs Bypass (SLEEVEPASS) multicenter equivalence randomized clinical trial comparing LSG and LRYGB in the treatment of severe obesity in which 240 patients aged 18 to 60 years with median body mass index of 44.6 were randomized to LSG (n = 121) or LRYGB (n = 119). The initial trial was conducted from April 2008 to June 2010 in Finland, with last follow-up on January 27, 2021.

INTERVENTIONS: LSG or LRYGB.

MAIN OUTCOMES AND MEASURES: The primary end point was 5-year percentage excess weight loss (%EWL). This current analysis focused on 10-year outcomes with special reference to reflux and BE.

RESULTS: At 10 years, of 240 randomized patients (121 randomized to LSG and 119 to LRYGB; 167 women [69.6%]; mean [SD] age, 48.4 [9.4] years; mean [SD] baseline BMI, 45.9 [6.0]), 2 never underwent surgery and there were 10 unrelated deaths; 193 of the remaining 228 patients (85%) completed follow-up on weight loss and comorbidities, and 176 of 228 (77%) underwent gastroscopy. Median (range) %EWL was 43.5% (2.1%-109.2%) after LSG and 50.7% (1.7%-111.7%) after LRYGB. Mean estimate %EWL was not equivalent between the procedures; %EWL was 8.4 (95% CI, 3.1-13.6) higher in LRYGB. After LSG and LRYGB, there was no statistically significant difference in type 2 diabetes remission (26% and 33%, respectively; P = .63), dyslipidemia (19% and 35%, respectively; P = .23), or obstructive sleep apnea (16% and 31%, respectively; P = .30). Hypertension remission was superior after LRYGB (8% vs 24%; P = .04). Esophagitis was more prevalent after LSG (31% vs 7%; P < .001) with no statistically significant difference in BE (4% vs 4%; P = .29). The overall reoperation rate was 15.7% for LSG and 18.5% for LRYGB (P = .57).

CONCLUSIONS AND RELEVANCE: At 10 years, %EWL was greater after LRYGB and the procedures were not equivalent for weight loss, but both LSG and LRYGB resulted in good and sustainable weight loss. Esophagitis was more prevalent after LSG, but the cumulative incidence of BE was markedly lower than in previous trials and similar after both procedures.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00793143.

PMID:35731535 | DOI:10.1001/jamasurg.2022.2229

JAMA Surg. 2022 Jun 22. doi: 10.1001/jamasurg.2022.2233. Online ahead of print.

NO ABSTRACT

PMID:35731534 | DOI:10.1001/jamasurg.2022.2233

J Thromb Thrombolysis. 2022 Jun 22. doi: 10.1007/s11239-022-02672-y. Online ahead of print.

ABSTRACT

Monitoring for the anticoagulant effect of unfractionated (UFH) at the point of care using activated clotting time in real time is vital where risk of thrombosis is high. Although monitoring UFH effect is a routine and important task, changing from one ACT instrument type or technology to another must be preceded by a clinical and statistical evaluation to determine the suitability and repeatability and establish normal and treatable ranges of this newer instrument. In this multi-center prospective evaluation we tested 1236 paired ACT+ samples, and 463 paired ACT-LR samples (1699 total) from enrolled study subjects. Clinical settings included CVOR cardiopulmonary bypass, at the beside in extracorporeal life support (ELS), the Cardiac Catheterization Lab (CCL) during diagnostic studies and percutaneous coronary interventions (PCI), interventional radiology procedures and EP interventions. This study found more consistent clinical performance from the GEM Hemochron 100 as compared to the current clinical model, the Hemochron Signature Elite. The bias of GEM Hemochron 100 for ACT+ and ACT-LR was greatest in the setting of the CVOR where ACT levels were high. ACT-LR measurements by the GEM Hemochron 100 were comparable to the SE when performed in settings of CCL, ECM, EP and ICU. Results obtained for both ACT-LR and ACT+ in all clinical settings in this study using the GEM Hemochron 100 are as accurate and more repeatable as those with the current clinically available Signature Elite.

PMID:35731496 | DOI:10.1007/s11239-022-02672-y

JAMA Cardiol. 2022 Jun 22. doi: 10.1001/jamacardio.2022.1651. Online ahead of print.

ABSTRACT

IMPORTANCE: Guidelines recommend that cardiac rehabilitation (CR) exercise training should not start until 6 weeks after sternotomy, although this is not evidence based. Limited data suggest that starting earlier is not detrimental, but clinical trials are needed.

OBJECTIVE: To compare the effectiveness and safety of CR exercise training started either 2 weeks (early CR) or 6 weeks (usual-care CR) after sternotomy.

DESIGN, SETTING, AND PARTICIPANTS: This was an assessor-blind, noninferiority, parallel-group, randomized clinical trial that conducted participant recruitment from June 12, 2017, to March 17, 2020. Participants were consecutive cardiac surgery sternotomy patients recruited from 2 outpatient National Health Service rehabilitation centers: University Hospital, Coventry, UK, and Hospital of St Cross, Rugby, UK.

INTERVENTIONS: Participants were randomly assigned to 8 weeks of twice-weekly supervised CR exercise training starting either 2 weeks (early CR) or 6 weeks (usual-care CR) after sternotomy. Exercise training adhered to existing guidelines, including functional strength and cardiovascular components.

MAIN OUTCOMES AND MEASURES: Outcomes were assessed at baseline (inpatient after surgery), after CR (10 or 14 weeks after sternotomy), and 12 months after randomization. The primary outcome was the change in 6-minute walk test distance from baseline to after CR. Secondary outcomes included safety, functional fitness, and quality of life.

RESULTS: A total of 158 participants (mean [SD] age, 63 [11.5] years, 133 male patients [84.2%]) were randomly assigned to study groups; 118 patients (usual-care CR, 61 [51.7%]; early CR, 57 [48.3%]) were included in the primary analysis. Early CR was not inferior to usual-care CR (noninferiority margin, 35 m); the mean change in 6-minute walk distance from baseline to after CR was 28 m greater in the early CR group (95% CI, -11 to 66; P = .16). Mean differences for secondary outcomes were not statistically significant, indicating noninferiority of early CR. There were 46 vs 58 adverse events and 14 vs 18 serious adverse events in usual-care CR and early CR, respectively. There was no difference between the groups in the likelihood of participants having an adverse or serious adverse event.

CONCLUSIONS AND RELEVANCE: Starting exercise training from 2 weeks after sternotomy was as effective as starting 6 weeks after sternotomy for improving 6-minute walk distance. With appropriate precautions, clinicians and CR professionals can consider starting exercise training as early as 2 weeks after sternotomy.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03223558.

PMID:35731506 | DOI:10.1001/jamacardio.2022.1651

Environ Sci Pollut Res Int. 2022 Jun 22. doi: 10.1007/s11356-022-21410-8. Online ahead of print.

ABSTRACT

Evapotranspiration is an important quantity required in many applications, such as hydrology and agricultural and irrigation planning. Reference evapotranspiration is particularly important, and the prediction of its variations is beneficial for analyzing the needs and management of water resources. In this paper, we explore the predictive ability of hybrid ensemble learning to predict daily reference evapotranspiration (RET) under the semi-arid climate by using meteorological datasets at 12 locations in the Andalusia province in southern Spain. The datasets comprise mean, maximum, and minimum air temperatures and mean relative humidity and mean wind speed. A new modified variant of the grey wolf optimizer, named the PRSFGWO algorithm, is proposed to maximize the ensemble learning’s prediction accuracy through optimal weight tuning and evaluate the proposed model’s capacity when the climate data is limited. The performance of the proposed approach, based on weighted ensemble learning, is compared with various algorithms commonly adopted in relevant studies. A diverse set of statistical measurements alongside ANOVA tests was used to evaluate the predictive performance of the prediction models. The proposed model showed high-accuracy statistics, with relative root mean errors lower than 0.999% and a minimum R² of 0.99. The model inputs were also reduced from six variables to only two for cost-effective predictions of daily RET. This shows that the PRSFGWO algorithm is a good RET prediction model for the semi-arid climate region in southern Spain. The results obtained from this research are very promising compared with existing models in the literature.

PMID:35731435 | DOI:10.1007/s11356-022-21410-8

Dig Dis Sci. 2022 Jun 22. doi: 10.1007/s10620-022-07562-0. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic inflammation in IBD is postulated to drive NAFLD progression from steatosis to fibrosis.

AIMS: To study the histopathological spectrum of NAFLD in Crohn disease (CD) and Ulcerative colitis (UC).

METHODS: Patients with biopsy proven NAFLD at a quaternary center from 2008 to 2018 were included in this retrospective analysis. Inflammatory bowel disease (IBD) diagnosed either clinically and/or endoscopically at the time of liver biopsy. Multivariable regression and propensity score (PS) weighted analysis were conducted. Statistical analysis were performed using SAS statistical software.

RESULTS: Among 1009 patients with NAFLD a diagnosis of IBD was identified in 50 cases (34 CD and 16 UC). On multivariable analysis; CD was independently associated with significantly higher odds of advanced fibrosis (AF) on liver biopsy (adjusted OR = 4.09, 95% CI = 1.40-11.94) compared to NAFLD patients without IBD. Similar results were obtained with both the overlap PS weighted model (OR = 3.17, 95% CI = 1.55-6.49) and the PS matched model (OR = 3.49, 95% CI = 1.50-8.13).

CONCLUSION: In a large cohort of patients with histologically well characterized NAFLD, AF was more common in CD patients than NAFLD patients without IBD. These findings must be confirmed in a larger cohort, but suggest CD patients with NAFLD could be at greater risk for liver fibrosis.

PMID:35731428 | DOI:10.1007/s10620-022-07562-0

Dig Dis Sci. 2022 Jun 22. doi: 10.1007/s10620-022-07567-9. Online ahead of print.

ABSTRACT

BACKGROUND: Acute pancreatitis (AP) is a common gastrointestinal disease worldwide. Severe acute pancreatitis (SAP) is characterized as persistent organ failure with a mortality rate as high as 20-30%. Early assessment of the severity and screening out possible SAP is of great significance. Given that there is still a lack of both convenient and practical tools for evaluating SAP, we conducted this study to explore the association between TyG index and acute pancreatitis prognosis.

METHODS: A total of 353 in-patients diagnosed with acute pancreatitis in the Second Hospital of Shandong University were retrospectively enrolled from January 2018 to November 2021 in this study. According to the Atlanta Classification, they were divided into two groups based on the AP severity. Demographic information and clinical materials were retrospectively collected. The TyG index calculation formula is as follows: ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Statistical analyses were performed using SPSS software (IBM version 22.0) and Medcalc software. Multivariable logistic regression analyses were used to investigate independent predictors for SAP. ROC curve was plotted to assess the predictive ability and cutoffs of TyG index.

RESULTS: A total of 353 AP patients were respectively enrolled in this study, of which 47 suffered from SAP. Compared with the non-SAP group, TyG index was significantly higher in the SAP group (10.44 ± 1.55 vs 9.33 ± 1.44, P < 0.001). Multivariate logistic regression analysis showed that TyG index was an independent risk factor for SAP (OR 1.835, 95% CI 1.380-2.442 P < 0.001), with a cutoff of 8.76 for non-HTG/AAP and 11.81 for HTG/AAP by ROC curve. TyG index of patients who suffered from SIRS, OF, APFC, and ANC was higher than those without (P < 0.05).

CONCLUSIONS: The triglyceride-glucose index is an independent risk factor for SAP. High TyG index is closely related to SAP and AP-related complications.

PMID:35731427 | DOI:10.1007/s10620-022-07567-9