Tag: statistics

Am J Speech Lang Pathol. 2022 Jan 4:1-13. doi: 10.1044/2021_AJSLP-21-00175. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India.

METHOD: We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle-Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the I² index.

RESULTS: A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], p < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], p < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], p < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented.

CONCLUSIONS: Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022.

PMID:34982940 | DOI:10.1044/2021_AJSLP-21-00175

Neurosurgery. 2022 Jan 1;90(1):148-153. doi: 10.1227/NEU.0000000000001756.

ABSTRACT

BACKGROUND: With increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation.

OBJECTIVE: To investigate costs associated with ASD and frailty.

METHODS: Patients with ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥ 25°, or thoracic kyphosis ≥ 60°) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated.

RESULTS: Five hundred ninety-two patients with ASD were included (59.8 ± 14.0 yr, 80% F, body mass index: 27.7 ± 6.0 kg/m2, Adult Spinal Deformity-Frailty Index: 3.3 ± 1.6, and Charlson Comorbidity Index: 1.8 ± 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149).

CONCLUSION: Despite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.

PMID:34982882 | DOI:10.1227/NEU.0000000000001756

Oper Neurosurg (Hagerstown). 2022 Jan 1;22(1):14-19. doi: 10.1227/ONS.0000000000000011.

ABSTRACT

BACKGROUND: Facial nerve palsy is a rare presenting symptom of vestibular schwannomas and has not been investigated in detail.

OBJECTIVE: To investigate the incidence, clinical features, and postoperative long-term outcomes of facial nerve function in patients with vestibular schwannomas causing preoperative facial nerve palsy.

METHODS: After excluding patients with neurofibromatosis type 2 and those with prior treatment, 1228 consecutive patients who underwent vestibular schwannoma surgery were retrospectively investigated. Patients with and without preoperative facial nerve palsy were compared statistically to clarify their clinical features.

RESULTS: Preoperative tumoral facial nerve palsy was seen in 34 patients (2.8%). Their clinical features included older age, having large cystic tumors with significant meatal extension, and showing abnormal electrogustometric responses, compared with patients without preoperative facial nerve palsy. Owing to the frequent insufficient intraoperative responses on facial nerve electromyography, the tumor resection rate was lower in the group with preoperative facial nerve palsy (mean: 95.2%). Among the 33 patients with sufficient follow-up data (mean: 63.9 mo), additional treatment was required only in 1 patient and facial nerve function improved in 25 patients (75.8%) within 2 yr postoperatively.

CONCLUSION: Facial nerve palsy is a rare preoperative symptom that occurs in less than 3% of patients with vestibular schwannoma. Tumor resection in such patients tends to be challenging owing to their advanced age, having large cystic tumors with significant meatal extension, and difficulties in intraoperative facial nerve monitoring, but surgical decompression of the facial nerve can assist in the improvement of their long-term functions.

PMID:34982900 | DOI:10.1227/ONS.0000000000000011

Neurosurgery. 2022 Jan 1;90(1):114-123. doi: 10.1227/NEU.0000000000001751.

ABSTRACT

BACKGROUND: Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.

OBJECTIVE: To determine factors that contribute to different clinical outcomes in racial populations.

METHODS: We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences.

RESULTS: Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival.

CONCLUSION: Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.

PMID:34982878 | DOI:10.1227/NEU.0000000000001751

Neurosurgery. 2022 Jan 1;90(1):39-50. doi: 10.1227/NEU.0000000000001737.

ABSTRACT

BACKGROUND: Traumatic brachial plexus injuries (BPIs) often lead to devastating upper extremity deficits. Treatment frequently prioritizes restoring elbow flexion through transfer of various donor nerves; however, no consensus identifies optimal donor nerve sources.

OBJECTIVE: To complete a meta-analysis to assess donor nerves for restoring elbow flexion after partial and total BPI (TBPI).

METHODS: Original English language articles on nerve transfers to restore elbow flexion after BPI were included. Using a random-effects model, we calculated pooled, weighted effect size of the patients achieving a composite motor score of ≥M3, with subgroup analyses for patients achieving M4 strength and with TBPI. Meta-regression was performed to assess comparative efficacy of each donor nerve for these outcomes.

RESULTS: Comparison of the overall effect size of the 61 included articles demonstrated that intercostal nerves and phrenic nerves were statistically superior to contralateral C7 (cC7; P = .025, <.001, respectively) in achieving ≥M3 strength. After stratification by TBPI, the phrenic nerve was still superior to cC7 in achieving ≥M3 strength (P = .009). There were no statistical differences among ulnar, double fascicle, or medial pectoral nerves in achieving ≥M3 strength. Regarding M4 strength, the phrenic nerve was superior to cC7 (P = .01) in patients with TBPI and the ulnar nerve was superior to the medial pectoral nerve (P = .036) for partial BPI.

CONCLUSION: Neurotization of partial BPI or TBPI through the intercostal nerve or phrenic nerve may result in functional advantage over cC7. In patients with upper trunk injuries, neurotization using ulnar, median, or double fascicle nerve transfers has similarly excellent functional recovery.

PMID:34982869 | DOI:10.1227/NEU.0000000000001737

Eur J Prosthodont Restor Dent. 2022 Jan 4. doi: 10.1922/EJPRD_2353Shono09. Online ahead of print.

ABSTRACT

Purpose/Aim: To determine the effect of translucency of four CAD/CAM materials and different curing modes on the degree of conversion of resin cements. Materials and Methods: Disks were fabricated from IPS e.max CAD, Vita Suprinity, Vita Enamic, and DD Cube X². Translucency was measured using a spectrophotometer. The degree of conversion of two resin cements Variolink Esthetic DC and LC were measured using a Fourier transform infrared spectrometer. For Esthetic DC, the degree of conversion was determined in self-cure and dual cure modes. ANOVA, Tukey HSD test, and /Linear Regression R2 were used to statistically analyze the data. Results: There was a significant difference in the translucency of the four materials (P ⟨ 0.0001). The mean translucency of Vita Suprinity was significantly higher, followed by Vita Enamic, DD Cube X², and IPS E.max CAD. Degree of conversion of resin cements cured under DD Cube X² had the highest values (25.22%), whereas those cured under Vita Suprinity showed the lowest values (17.86%). The self-cure mode had the lowest degree of conversion values (16.22%) and dual cure mode showed the highest values (26.12%). A negative linear relationship was found between degree of conversion and translucency of the CAD/CAM materials.

PMID:34982861 | DOI:10.1922/EJPRD_2353Shono09

Eur J Prosthodont Restor Dent. 2022 Jan 4. doi: 10.1922/EJPRD_2361Mohamed09. Online ahead of print.

ABSTRACT

PURPOSE: To compare the stresses induced on the supporting abutments by different secondary coping materials; zirconia, Polyetheretherketone (PEEK) and Polyetherketone ketone (PEKK) in tooth supported telescopic overdentures using strain gauge analysis.

MATERIALS AND METHODS: A virtual model simulating a completely edentulous mandibular arch with two telescopic overdenture abutments in the canine region was designed and printed. The abutments received a milled zirconia primary coping. The secondary coping was milled out of zirconia in the model ZR, PEEK in the model PE and PEKK in the model PK. Five overdentures were made for each model. Strain gauge rosettes were bonded mesial and distal to each abutment. Unilateral and bilateral loadings were applied. An ANOVA test was used for statistical analysis between the three models.(α=0.01).

RESULTS: Significant differences were found between the three models during unilateral and bilateral loading. Post Hoc Tukey tests showed significant difference between ZR and PE models, ZR and PK models in addition to PE and PK models during unilateral and bilateral loading.

CONCLUSION: Zirconia copings induced the highest stress while the lowest stress values were induced by the PEKK copings.

PMID:34982859 | DOI:10.1922/EJPRD_2361Mohamed09

Med Phys. 2022 Jan 4. doi: 10.1002/mp.15440. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this work was to develop and validate a deep convolutional neural network (CNN) approach for the automated pelvis segmentation in computed tomography (CT) scans to enable the quantification of active pelvic bone marrow by means of Fluorothymidine F-18 (FLT) tracer uptake measurement in positron emission tomography (PET) scans. This quantification is a critical step in calculating bone marrow dose for radiopharmaceutical therapy clinical applications as well as external beam radiation doses.

METHODS: An approach for the combined localization and segmentation of the pelvis in CT volumes of varying sizes, ranging from full-body to pelvis CT scans, was developed that utilizes a novel CNN architecture in combination with a random sampling strategy. The method was validated on 34 planning CT scans and 106 full-body FLT PET-CT scans using a cross-validation strategy. Specifically, two different training and CNN application options were studied, quantitatively assessed, and statistically compared.

RESULTS: The proposed method was able to successfully locate and segment the pelvis in all test cases. On all data sets, an average Dice coefficient of 0.9396±0.0182 or better was achieved. The relative tracer uptake measurement error ranged between 0.065 and 0.204%. The proposed approach is time efficient and shows a reduction in runtime of up to 95% compared to a standard U-Net-based approach without a localization component.

CONCLUSIONS: The proposed method enables the efficient calculation of FLT uptake in the pelvis. Thus, it represents a valuable tool to facilitate bone marrow preserving adaptive radiation therapy and radiopharmaceutical dose calculation. Furthermore, the method can be adapted to process other bone structures as well as organs. This article is protected by copyright. All rights reserved.

PMID:34982836 | DOI:10.1002/mp.15440

Aesthet Surg J. 2022 Jan 4:sjab435. doi: 10.1093/asj/sjab435. Online ahead of print.

ABSTRACT

BACKGROUND: Given the ongoing battle with opioid abuse and over-use in the United States new strategies are consistently being implemented in an attempt to reduce opioid use and over prescribing.

OBJECTIVES: The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken.

METHODS: Blinded randomized prospective study comparing a total of 110 (Group A=55, Group B=55) women undergoing elective outpatient bilateral breast reduction surgery by two different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain.

RESULTS: Patients in group B took on average 1.5 oxycodone while patients in group A took on average 5.7 oxycodone (p<0.01). Thirty-four patients in group B took no oxycodone. Patients in group B also had statistically significant lower subjective pain scores.

CONCLUSIONS: Based on these results it appears that standardizing how patients are instructed to treat their pain post-operatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

PMID:34982826 | DOI:10.1093/asj/sjab435

Pediatrics. 2021 Nov 1;148(5):e2020041566. doi: 10.1542/peds.2020-041566.

ABSTRACT

BACKGROUND: Midazolam is a benzodiazepine sedative used in NICUs. Because benzodiazepine’s effects include respiratory depression and potential detrimental developmental effects, minimizing exposure could benefit neonates. Dexmedetomidine is routinely used for sedation in older pediatric populations. We implemented a quality improvement initiative with the aim of decreasing midazolam infusions by 20% through use of dexmedetomidine.

METHODS: A multidisciplinary committee created a sedation guideline that included standardized dexmedetomidine dosing escalation and weaning. Baseline data collection occurred from January 2015 to February 2018, with intervention from March 2018 to December 2019. Percentage of sedation episodes with dexmedetomidine initiated was followed as a process measure. Outcomes measures were percentage of eligible infants receiving midazolam infusions and midazolam-free days per sedation episode. Bradycardia with dexmedetomidine, unplanned extubation rates, and morphine dosage were monitored as balancing measures.

RESULTS: Our study included 434 episodes of sedation in 386 patients. Dexmedetomidine initiation increased from 18% to 49%. The intervention was associated with a significant reduction in midazolam initiation by 30%, from 95% to 65%, with special cause variation on statistical process control chart analysis. Midazolam-free days per sedation episode increased from 0.3 to 2.2 days, and patients receiving dexmedetomidine had lower midazolam doses (1.3 mg/kg per day versus 2.2 mg/kg per day, P = 5.97 × 10-04). Bradycardia requiring discontinuation of dexmedetomidine, unplanned extubation rates, and morphine doses were unchanged.

CONCLUSIONS: Implementation of a quality improvement initiative was successful in reducing the percentage of patients receiving midazolam infusions and increased midazolam-free days per sedation episode, revealing an overall reduction in benzodiazepine exposure while maintaining adequate sedation.

PMID:34982832 | DOI:10.1542/peds.2020-041566