Tag: statistics

Pain. 2022 Sep 15. doi: 10.1097/j.pain.0000000000002782. Online ahead of print.

ABSTRACT

This study investigated the tolerability and preliminary efficacy of duloxetine as an alternative nonopioid therapeutic option for the prevention of persistent musculoskeletal pain (MSP) among adults presenting to the emergency department with acute MSP after trauma or injury. In this randomized, double-blind, placebo-controlled study, eligible participants (n = 78) were randomized to 2 weeks of a daily dose of one of the following: placebo (n = 27), 30 mg duloxetine (n = 24), or 60 mg duloxetine (n = 27). Tolerability, the primary outcome, was measured by dropout rate and adverse effects. Secondary outcomes assessed drug efficacy as measured by (1) the proportion of participants with moderate to severe pain (numerical rating scale ≥ 4) at 6 weeks (pain persistence); and (2) average pain by group over the six-week study period. We also explored treatment effects by type of trauma (motor vehicle collision [MVC] vs non-MVC). In both intervention groups, duloxetine was well tolerated and there were no serious adverse events. There was a statistically significant difference in pain over time for the 60 mg vs placebo group (P = 0.03) but not for the 30 mg vs placebo group (P = 0.51). In both types of analyses, the size of the effect of duloxetine was larger in MVC vs non-MVC injury. Consistent with the role of stress systems in the development of chronic pain after traumatic stress, our data indicate duloxetine may be a treatment option for reducing the transition from acute to persistent MSP. Larger randomized controlled trials are needed to confirm these promising results.

PMID:36375173 | DOI:10.1097/j.pain.0000000000002782

Ann Intern Med. 2022 Nov 15. doi: 10.7326/M22-2058. Online ahead of print.

ABSTRACT

BACKGROUND: End-stage ankle osteoarthritis causes severe pain and disability. There are no randomized trials comparing the 2 main surgical treatments: total ankle replacement (TAR) and ankle fusion (AF).

OBJECTIVE: To determine which treatment is superior in terms of clinical scores and adverse events.

DESIGN: A multicenter, parallel-group, open-label randomized trial. (ISRCTN registry number: 60672307).

SETTING: 17 National Health Service trusts across the United Kingdom.

PATIENTS: Patients with end-stage ankle osteoarthritis, aged 50 to 85 years, and suitable for either procedure.

INTERVENTION: Patients were randomly assigned to TAR or AF surgical treatment.

MEASUREMENTS: The primary outcome was change in Manchester-Oxford Foot Questionnaire walking/standing (MOXFQ-W/S) domain scores between baseline and 52 weeks after surgery. No blinding was possible.

RESULTS: Between 6 March 2015 and 10 January 2019, a total of 303 patients were randomly assigned; mean age was 68 years, and 71% were men. Twenty-one patients withdrew before surgery, and 281 clinical scores were analyzed. At 52 weeks, the mean MOXFQ-W/S scores improved for both groups. The adjusted difference in the change in MOXFQ-W/S scores from baseline was -5.6 (95% CI, -12.5 to 1.4), showing that TAR improved more than AF, but the difference was not considered clinically or statistically significant. The number of adverse events was similar between groups (109 vs. 104), but there were more wound healing issues in the TAR group and more thromboembolic events and nonunion in the AF group. The symptomatic nonunion rate for AF was 7%. A post hoc analysis suggested superiority of fixed-bearing TAR over AF (-11.1 [CI, -19.3 to -2.9]).

LIMITATION: Only 52-week data; pragmatic design creates heterogeneity of implants and surgical techniques.

CONCLUSION: Both TAR and AF improve MOXFQ-W/S and had similar clinical scores and number of harms. Total ankle replacement had greater wound healing complications and nerve injuries, whereas AF had greater thromboembolism and nonunion, with a symptomatic nonunion rate of 7%.

PRIMARY FUNDING SOURCE: National Institute for Health and Care Research Heath Technology Assessment Programme.

PMID:36375147 | DOI:10.7326/M22-2058

Clin Exp Optom. 2022 Nov 14:1-8. doi: 10.1080/08164622.2022.2140031. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: The changes in various biomechanical and tomographic characteristics of the cornea associated with orthokeratology may allow us to identify potential mid- and long-term structural alterations, resulting in a better understanding of the governing mechanisms of this procedure and in its optimisation.

BACKGROUND: The study aimed at describing short and mid-term changes in CORVIS ST® parameters and indices in orthokeratology (ortho-k), and their diurnal variations.

METHODS: A prospective observational study was designed in which several CORVIS ST® parameters of 75 new adult participants successfully fitted with overnight ortho-k Seefree® (Conóptica – Hecht Contactlinsen) contact lenses were explored. Measurements were conducted in baseline (BL) conditions and in the morning and evening at the one-night (1 NM/1NT), one-week (1WM/1 WT) and 3-month (3 MM/3MT) follow-up visits.

RESULTS: Statistically significant differences were found in DARatio_2 mm, IntRad, ARTh, CBI and TBI following overnight ortho-k, when compared with BL values, with most values reaching stability at 1WM or reverting to BL values at 3 MM. The ARTh and CBI parameters showed some of the most significant temporal variations (both p < 0.001), probably reflecting the encountered differences in central corneal thickness between BL and 1WM (p = 0.010) and between BL and 3 MM (p = 0.016). In general, corneal rigidity was higher in the morning at all follow-up visits, and decreased during the day. No statistically significant changes in adjusted intraocular pressure values were found.

CONCLUSION: Ortho-k in adults may be considered a safe procedure in terms of short and mid-term changes in CORVIS ST® parameters. The observed alterations in most of the parameters provided by the Corvis ST® probably responded to the well-described changes in corneal pachymetry and tomography, rather than to actual alterations in corneal rigidity.

PMID:36375143 | DOI:10.1080/08164622.2022.2140031

Clin Exp Optom. 2022 Nov 14:1-8. doi: 10.1080/08164622.2022.2134763. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Horizontal fusional reserves are used in the diagnosis and monitoring of common vergence disorders, such as convergence insufficiency, which can cause asthenopia and impact near work. Infrared eyetracking technology shows promise for obtaining automated and objective measurements of fusional reserves, expanding options for screening, clinical testing, and at-home monitoring/vision training.

BACKGROUND: Current clinical tests for fusional reserves rely on subjective judgements made by patients (for diplopia) and clinicians (for eye movements). This paper describes an objective and automated “digital fusion-range test” pilot-tested in adults without current eye disease or binocular vision anomalies. This test combines a consumer-grade infrared eyetracker, a dichoptic display, and custom analyses programs to measure convergence and divergence reserves.

METHODS: Twenty-nine adult participants completed the study. Horizontal fusional reserves at 55 cm were measured using prism bars and with our computer-based digital fusion-range test. For the digital test, observers viewed dichoptic targets whose binocular disparity modulated over time (at speeds of 0.5, 1.0, or 2.0 Δ/s) while their eye movements were continuously recorded. Subjective reports of break and recovery (by keyboard button press) were compared to objective estimates extracted from eyetracking recordings (via automated analyses).

RESULTS: Objective and subjective measures of break and recovery agreed closely. Clinically small (0.3-2Δ) but statistically significant (p < 0.012) differences were found between measurement types for divergence breaks/recoveries and convergence recoveries. No significant differences were found for convergence breaks (p = 0.11). Such differences are consistent with an average 0.91 (SD 1.66) seconds delay between objective break/recovery and subjective responses. The digital test produced comparable results to the standard clinical prism bar method.

CONCLUSION: The digital fusion-range test supports an automated, reliable assessment of horizontal fusional reserves, which do not depend on subjective responses. This technology may prove useful in a variety of clinical and community-based settings.

PMID:36375141 | DOI:10.1080/08164622.2022.2134763

Rhinology. 2022 Nov 14. doi: 10.4193/Rhin22.329. Online ahead of print.

ABSTRACT

BACKGROUND: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus.

METHODS: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated.

RESULTS: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted.

CONCLUSIONS: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.

PMID:36375133 | DOI:10.4193/Rhin22.329

Int J Urol. 2022 Nov 14. doi: 10.1111/iju.15100. Online ahead of print.

ABSTRACT

BACKGROUND: Transurethral resection of bladder tumors (TURBT) surgeries requires post-resection catheterization for continuous irrigation of the bladder. This indwelling catheter is associated with distressing catheter-related bladder discomfort (CRBD) and increases postoperative pain and agitation.

OBJECTIVES: To prove the hypothesis that transurethral 100 mg lidocaine irrigation at the end of TURBT can reduce the frequency of moderate-to-severe postoperative CRBD.

METHODS: 116 patients scheduled for TURBT were screened, 94 were recruited and completed the study. American Society of Anesthesiologists Physical Status I-II adult patients, 20-75 years of age undergoing elective TURBT surgery under general anesthesia were included. Transurethral normal saline with 0.01% lidocaine (100 mg in 1 L NS) was used for irrigation 30 min before the completion of surgery in group L, while only normal saline was used for transurethral irrigation in group N. The main outcomes were frequency of CRBD, pain and patient satisfaction at 0, 1, 2, and 6 h postoperatively.

RESULTS: A total of 94 patients were analyzed in the study. The incidence of moderate-severe CRBD was significantly lower in group L as compared to group C at 0, 1, and 2 h (65.9% vs. 31.9%, p = 0.01; 31.9% vs. 10.6%, p = 0.012; 21.3% vs. 2.1%, p = 0.004, respectively). At the 6-h mark, the incidence of CRBD was lower in group L, although this did not achieve statistical significance (6.38% vs. 2.1%; p = 0.613).

CONCLUSION: Irrigation with 0.01% lidocaine (100 mg) towards the end of TURBT reduces the incidence of moderate-severe CRBD by 52% and increases patient satisfaction.

PMID:36375083 | DOI:10.1111/iju.15100

Proc Natl Acad Sci U S A. 2022 Nov 22;119(47):e2118589119. doi: 10.1073/pnas.2118589119. Epub 2022 Nov 14.

ABSTRACT

As a ubiquitous paradigm of instabilities and mixing that occur in instances as diverse as supernovae, plasma fusion, oil recovery, and nanofabrication, the Rayleigh-Taylor (RT) problem is rightly regarded as important. The acceleration of the fluid medium in these instances often depends on time and space, whereas most past studies assume it to be constant or impulsive. Here, we analyze the symmetries of RT mixing for variable accelerations and obtain the scaling of correlations and spectra for classes of self-similar dynamics. RT mixing is shown to retain the memory of deterministic conditions for all accelerations, with the dynamics ranging from superballistic to subdiffusive. These results contribute to our understanding and control of the RT phenomena and reveal specific conditions under which Kolmogorov turbulence might be realized in RT mixing.

PMID:36375067 | DOI:10.1073/pnas.2118589119

Proc Natl Acad Sci U S A. 2022 Nov 22;119(47):e2207536119. doi: 10.1073/pnas.2207536119. Epub 2022 Nov 14.

ABSTRACT

Trends in extreme 100-y events of temperature and rainfall amounts in the continental United States are estimated, to see effects of climate change. This is a nontrivial statistical problem because climate change effects have to be extracted from “noisy” weather data within a limited time range. We use nonparametric Bayesian methods to estimate the trends of extreme events that have occurred between 1979 and 2019, based on data for temperature and rainfall. We focus on 100-y events for each month in [Formula: see text] geographical areas looking at hourly temperature and 5-d cumulative rainfall. Distribution tail models are constructed using extreme value theory (EVT) and data on 33-y events. This work shows it is possible to aggregate data from spatial points in diverse climate zones for a given month and fit an EVT model with the same parameters. This surprising result means there are enough extreme event data to see the trends in the 41-y record for each calendar month. The yearly trends of the risk of a 100-y high-temperature event show an average 2.1-fold increase over the last 41 y of data across all months, with a 2.6-fold increase for the months of July through October. The risk of high rainfall extremes increases in December and January 1.4-fold, but declines by 22% for the spring and summer months.

PMID:36375064 | DOI:10.1073/pnas.2207536119

Proc Natl Acad Sci U S A. 2022 Nov 22;119(47):e2208024119. doi: 10.1073/pnas.2208024119. Epub 2022 Nov 14.

ABSTRACT

For countries to rapidly decarbonize, they need strong leadership, according to both academic studies and popular accounts. But leadership is difficult to measure, and its importance is unclear. We use original data to investigate the role of presidents, prime ministers, and monarchs in 155 countries from 1990 to 2015 in changing their countries’ gasoline taxes and subsidies. Our findings suggest that the impact of leaders on fossil fuel taxes and subsidies is surprisingly limited and often ephemeral. This holds true regardless of the leader’s age, gender, education, or political ideology. Rulers who govern during an economic crisis perform no better or worse than other rulers. Even presidents and prime ministers who were recognized by the United Nations for environmental leadership had no more success than other leaders in reducing subsidies or raising fuel taxes. Where leaders appear to play an important role-primarily in countries with large subsidies-their reforms often failed, with subsidies returning to prereform levels within the first 12 mo 62% of the time, and within 5 y 87% of the time. Our findings suggest that leaders of all types find it exceptionally hard to raise the cost of fossil fuels for consumers. To promote deep decarbonization, leaders are likely to have more success with other types of policies, such as reducing the costs and increasing the availability of renewable energy.

PMID:36375060 | DOI:10.1073/pnas.2208024119

JBI Evid Implement. 2022 Aug 12. doi: 10.1097/XEB.0000000000000318. Online ahead of print.

ABSTRACT

OBJECTIVES: The main objective was to improve the provision of clinical care in pressure injury prevention related to the use of medical devices focused on nasogastric probes.

INTRODUCTION: The insertion of nasogastric probes could lead to the formation of medical device-related pressure injuries (MDRPI). The risk increases with the length of the probe insertion and is higher in patients in intensive care. MDRPI prevention is mostly based on appropriate skin and mucosa membrane and tissue monitoring and positioning of the medical devices.

METHODS: The project has been conducted based on JBI Implementation approach for promoting change in healthcare practice. A baseline audit on MDRPI prevention was undertaken and involved 21 nurses and 12 patients using a questionnaire for nurses and a record sheet for patient’s monitoring. The intervention included education, clinical practice training, consultation, and other strategies. A follow-up audit was undertaken, including all original participants. Results data on changes in compliance were measured using descriptive statistics embedded in JBI-PACES in the form of percentage changes from baseline.

RESULTS: There were significantly improved outcomes across all best practice criteria. The level of knowledge of nurses increased. Skin barrier creams and mass-supplied fixation are now used to prevent skin injuries on the nose. The new monitoring and documentation is more accurate and in line with evidence-based practice.

CONCLUSION: Overall, the project achieved an improvement in evidence-based practice in the prevention of MDRPI in patients with nasogastric probes based on nurses’ increased level of knowledge and usage of appropriate preventative measures.

PMID:36375027 | DOI:10.1097/XEB.0000000000000318