Tag: statistics

JAMA Neurol. 2022 Feb 21. doi: 10.1001/jamaneurol.2021.5420. Online ahead of print.

ABSTRACT

IMPORTANCE: Early posttraumatic seizures (EPS) that may occur following a traumatic brain injury (TBI) are associated with poorer outcomes and development of posttraumatic epilepsy (PTE).

OBJECTIVE: To evaluate risk factors for EPS, associated morbidity and mortality, and contribution to PTE.

DESIGN, SETTING, AND PARTICIPANTS: Data were collected from an Australian registry-based cohort study of adults (age ≥18 years) with moderate to severe TBI from January 2005 to December 2019, with 2-year follow-up. The statewide trauma registry, conducted on an opt-out basis in Victoria (population 6.5 million), had 15 152 patients with moderate to severe TBI identified via Abbreviated Injury Scale (AIS) head severity score, with an opt-out rate less than 0.5% (opt-out n = 136).

MAIN OUTCOMES AND MEASURES: EPS were identified via International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes recorded after the acute admission. Outcome measures also included in-hospital metrics, 2-year outcomes including PTE, and post-discharge mortality. Adaptive least absolute shrinkage and selection operator (LASSO) regression was used to build a prediction model for risk factors of EPS.

RESULTS: Among the 15 152 participants (10 457 [69%] male; median [IQR] age, 60 [35-79] y), 416 (2.7%) were identified with EPS, including 27 (0.2%) with status epilepticus. Significant risk factors on multivariable analysis for developing EPS were younger age, higher Charlson Comorbidity Index, TBI sustained from a low fall, subdural hemorrhage, subarachnoid hemorrhage, higher Injury Severity Score, and greater head injury severity, measured using the AIS and Glasgow Coma Score. After adjustment for confounders, EPS were associated with increased ICU admission and ICU length of stay, ventilation and duration, hospital length of stay, and discharge to inpatient rehabilitation rather than home, but not in-hospital mortality. Outcomes in TBI admission survivors at 24 months, including mortality (relative risk [RR] = 2.14; 95% CI, 1.32-3.46; P = .002), development of PTE (RR = 2.91; 95% CI, 2.22-3.81; P < .001), and use of antiseizure medications (RR = 2.44; 95% CI, 1.98-3.02; P < .001), were poorer for cases with EPS after adjustment for confounders. The prediction model for EPS had an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.66-0.79), sensitivity of 66%, and specificity of 73% in the validation set.

DISCUSSION: We identified important risk factors for EPS following moderate to severe TBI. Early posttraumatic seizures were associated with longer ICU and hospital admissions, ICU ventilation, and poorer 24-month outcomes including mortality and development of PTE.

PMID:35188950 | DOI:10.1001/jamaneurol.2021.5420

J Am Acad Orthop Surg Glob Res Rev. 2022 Feb 21;6(2). doi: 10.5435/JAAOSGlobal-D-22-00002.

ABSTRACT

INTRODUCTION: Fasciotomy is the standard of care to treat acute compartment syndrome (ACS). Although fasciotomies often prevent serious complications, postoperative complications can be notable. Surgical site infection (SSI) in these patients is as high as 30%. The objective of this study was to determine factors that increase the risk of SSI in patients with ACS.

METHODS: A retrospective review of 142 patients with compartment syndrome over 10 years was done. We collected basic demographics, mechanism of trauma, time to fasciotomy, incidence of SSI, use of prophylactic antibiotics, and type and time to wound closure. Statistical analysis of continuous variables was done using the Student t-test, ANOVA, multivariable regression model, and categorical variables were compared using the chi-square test.

RESULTS: Twenty-five patients with ACS (17.6%) developed infection that required additional treatment. In the multivariate regression model, there were significant differences in median time to closure in patients with infection versus those without, odds ratio: 1.06 (Confidence Interval 95% [1.00 to 1.11]), P = 0.036. No differences were observed in infection based on the mechanism of injury, wound management modality, or the presence of associated diagnoses.

CONCLUSION: In patients with ACS, the time to closure after fasciotomy is associated with the incidence of SSI. There seems to be a golden period for closure at 4 to 5 days after fasciotomy. The ability to close is often limited by multiple factors, but the correlation between time to closure and infection in this study suggests that it is worth exploring different closure methods if the wound cannot be closed primarily within the given timeframe.

PMID:35188898 | DOI:10.5435/JAAOSGlobal-D-22-00002

J Patient Saf. 2022 Mar 1;18(2):102-110. doi: 10.1097/PTS.0000000000000819.

ABSTRACT

OBJECTIVE: This study aimed to cross-culturally adapt, validate, and pilot the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire for its use in Spain.

METHODS: After setting up an expert panel to determine its content validity, the questionnaire was translated and back-translated, and subjected to cognitive testing. The questionnaire was piloted in a cross-sectional study in 10 primary health care centers in Spain. Fifty patients per center completed the questionnaire while waiting for an appointment. We estimated (i) the acceptability of the questionnaire (response rate), (ii) scores distribution (floor and ceiling effects), (iii) internal consistency (Cronbach α), and (iv) construct validity (exploratory factor analyses and correlation between scales). To examine patients’ evaluations of patient safety, we followed a mixed-methods approach: (i) statistical analyses at the scale and item levels based on responses to standardized items and (ii) qualitative content analysis based on responses to open-ended questions.

RESULTS: Complete data were collected from 493 patients (participation rate, 77%). A ceiling effect was observed for 3 scales (“safety problems,” “harm severity,” “harm needs”). The internal consistency was adequate (α > 0.7) for the majority of scales. Exploratory factor analysis and correlation between scales suggested an appropriate construct validity. Two hundred twenty-six (45.8%) respondents experienced at least 1 safety problem, and 109 (23.2%) reported harm in the previous 12 months.

CONCLUSIONS: The multidimensional primary health care patient safety instrument Patient Reported Experiences and Outcomes of Safety in Primary Care is now available for its use in Spain. Initial testing demonstrates its potential for use in primary care. Future developments will further address its use in actual clinical practice.

PMID:35188925 | DOI:10.1097/PTS.0000000000000819

Psychother Res. 2022 Feb 21:1-12. doi: 10.1080/10503307.2022.2038803. Online ahead of print.

ABSTRACT

Objective: The Relational Depth Frequency Scale (RDFS) is a 6-item measure to assess the impact of relational depth experiences on psychotherapeutic outcomes. To date, the RDFS has only been validated in online samples of clinical and non-clinical individuals. This study aimed to examine the psychometric properties of the RDFS in clinical dyads of clients and psychotherapists.Method: A total of 86 psychotherapy dyads-86 psychotherapists (18 male, 68 female, mean age = 44.34) and 86 clients (17 male, 69 female, mean age = 34.22)-completed the RDFS, and the Scale to Assess the Psychotherapeutic Relationship (STAR), mid-psychotherapy.Results: CFA showed acceptable fit statistics for a one-factor model. The partial measurement invariance across both partners of the psychotherapeutic dyad was positively verified. The RDFS had good internal consistency for psychotherapists and clients (α = .90 and .81, respectively). Actor-partner interdependence model confirmed moderate to high levels of convergent validity against the STAR. Relational depth in both partners was predicted by their own perceptions of the quality of the psychotherapeutic relationship. Psychotherapist frequency of relational depth was also related to client perceptions of the psychotherapeutic relationship.Conclusion: The RDFS is a promising tool measuring relational depth both from psychotherapist and client perspectives.

PMID:35188882 | DOI:10.1080/10503307.2022.2038803

Subst Use Misuse. 2022 Feb 21:1-13. doi: 10.1080/10826084.2022.2040030. Online ahead of print.

ABSTRACT

Men who have sex with men (MSM) account for two-thirds of new HIV diagnoses. Pre-exposure prophylaxis (PrEP), a highly efficacious HIV preventive medication, is underutilized. Identifying correlates of PrEP awareness and attitudes may help increase PrEP use. Thus, we evaluated (1) PrEP awareness; (2) differences in awareness related to substance use and sociodemographics; (3) initial PrEP information sources; and (4) possible associations between information sources and PrEP-related attitudes.

Young adult (ages 18-30) HIV-negative MSM from Southern U.S. undertook a web survey including questions about substance use, sexual behaviors, perceived HIV risk, and PrEP. Participants were recruited using in-person and online approaches between January 2018-January 2020.

Of 506 participants, 89% were aware of PrEP. Participants with high alcohol consumption and greater perceived HIV risk had higher odds of PrEP unawareness with a trend for minority race/ethnicity. PrEP-aware participants reported high overall perceived safety, confidence in PrEP’s efficacy, and low perceived difficulties with adherence though those with higher perceived HIV risk and individuals who used tobacco had less favorable attitudes. Most participants first heard about PrEP from the internet. There were no statistically significant differences in PrEP-related attitudes across initial information sources.

Associations between substance use and racial/ethnic minority status and lack of PrEP awareness suggest priority subgroups for educational campaigns. Future campaigns may tailor outreach materials to the respective audience (e.g., Spanish materials for Hispanic people) and disseminate where individuals who use substances may be more likely to see them (e.g., liquor and convenience stores).Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2040030.

PMID:35188880 | DOI:10.1080/10826084.2022.2040030

J Man Manip Ther. 2022 Feb 21:1-8. doi: 10.1080/10669817.2022.2041285. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine if there are any statistically significant associations between: 1) randomized clinical trials (RCTs) investigating physical therapy musculoskeletal interventions, 2) journal impact factor (JIF), 3) frequency of RCT citation, 4) whether prospective intent was identifiable, and 5) the Physiotherapy Evidence Database (PEDro) scores.

METHODS: MEDLINE indexed RCTs addressing musculoskeletal interventions published between January 2016 and July 2020 in physical therapy journals were included. Two blinded reviewers identified the RCTs and extracted the variables of interest.

RESULTS: With a familywise alpha adjustment, there was no statistically significant correlation between JIF and number of citations (rho = 0.187; p = 0.0280). Statistically significant weak positive correlations were identified between the JIF and prospectively registered RCTs (rho = 0.240; p = 0.0046), JIF and PEDro scores (rho = 0.250; p = 0.0031), and PEDro scores and prospectively registered RCTs (rho = 0.335; p < 0.0001).

CONCLUSION: The findings of this study suggest that JIF and PEDro scores may not be accurate measures of RCT quality. Failing to ensure that published RCTs followed their prospective intent and using bibliometrics that fail to accurately measure what they propose appears to create untrustworthy preprocessed resources for practicing physical therapists during the evidence-based practice process.

LEVEL OF EVIDENCE: 1a.

PMID:35188881 | DOI:10.1080/10669817.2022.2041285

Violence Against Women. 2022 Feb 21:10778012221079372. doi: 10.1177/10778012221079372. Online ahead of print.

ABSTRACT

Self-reported survey data on the extent and nature of rape and sexual assault experienced by a population represent an important source of information because these crimes often go unreported, and are thus undercounted in law enforcement or other official statistics. This article compares Campus Climate Survey Validation Study (CCSVS) data to Clery Act data in an effort to (1) assess the validity of the CCSVS data and the Clery Act data based on the extent to which they corroborate one another, and (2) estimate the extent to which Clery Act data potentially underestimate the true incidence of rape. The results help to establish the extent to which self-report surveys on sexual victimization are needed to understand the magnitude of the problem among a given population.

PMID:35188846 | DOI:10.1177/10778012221079372

Comput Methods Biomech Biomed Engin. 2022 Feb 21:1-14. doi: 10.1080/10255842.2022.2039640. Online ahead of print.

ABSTRACT

This study is relevant to present the numerical form of the nonlinear dengue fever SIR system are presented using the artificial neural networks along with the Levenberg-Marquardt backpropagation technique, i.e. ANNs-LMB. The procedures of ANNs-LMB are applied with three different sample data scales based on testing, training and authentication. The statistics to solve three cases of the nonlinear dengue fever based on susceptible, infected and recovered system are selected with 75%, 15% and 10% for training, validation and testing, respectively. To find the numerical results of the nonlinear dengue fever system, the reference dataset is designed on the basis of Adams scheme for the numerical solution. The numerical results based on the nonlinear dengue fever system are obtained through the ANNs-LMB to reduce the mean square error. In order to check the exactness, reliability, effectiveness and competence of the proposed ANNs-LMB, the numerical outcomes are proficient to the proportional measures using the topographies of the fitness attained in mean squared error sense, correlation, error histograms and regression.

PMID:35188837 | DOI:10.1080/10255842.2022.2039640

J Clin Oncol. 2022 Feb 21:JCO2102085. doi: 10.1200/JCO.21.02085. Online ahead of print.

ABSTRACT

PURPOSE: The survival impact of secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer was studied.

METHODS: We identified published studies from 1983 to 2021 following our inclusion criteria from MEDLINE, EMBASE, and Cochrane library. To integrate the effect size of single-arm studies, meta-analysis was performed using death rate as a primary outcome. The effect of complete cytoreduction and optimal cytoreduction on survival was evaluated using meta-regression. The pooled death rate was presented with a 95% CI. The publication bias was evaluated with the funnel plot and Egger’s test, and sensitivity analysis was performed. To overcome missing death rates, the linear regression model was performed on log-transformed median overall survival (OS) time using study size as a weight.

RESULTS: Thirty-six studies with 2,805 patients reporting death rates were used for this meta-analysis of the 80 eligible studies. There was strong heterogeneity, with the P value of the Cochrane Q test of < 0.0001 and Higgins’s I² statistics of 86%; thus, we considered a random effect model. The pooled death rate was 44.2% (95% CI, 39.0 to 49.5), and both the complete and optimal cytoreductions were associated with better survival outcomes as significant moderators in the meta-regression model (P < .001 and P = .005, respectively). Although 14 studies were located outside the funnel plot, Egger’s test indicated no publication bias (P = .327). A sensitivity analysis excluding 14 studies showed similar results. In the linear regression model on the basis of 57 studies, the median OS time increased by 8.97% and 7.04% when the complete and optimal cytoreduction proportion increased by 10%, respectively, after adjusting other variables.

CONCLUSION: Secondary cytoreductive surgery, resulting in maximal tumor resection, significantly prolongs OS in platinum-sensitive recurrent ovarian cancer.

PMID:35188810 | DOI:10.1200/JCO.21.02085

J Telemed Telecare. 2022 Feb 21:1357633X221077869. doi: 10.1177/1357633X221077869. Online ahead of print.

ABSTRACT

INTRODUCTION: Pharmacy students should be eHealth literate by being skilful in searching, evaluating and applying online health information. Mobile health applications should be utilised when making clinical decisions to achieve optimal patient care with the ever-changing pharmacy practice. This study aims to explore the eHealth literacy and mobile health application utilisation amongst pharmacy undergraduates.

METHODS: A cross-sectional study was conducted from March to April 2021. An online survey, consisting of socio-demographic characteristics, Internet use, eHealth Literacy Scale and mobile health application utilisation, was distributed amongst pharmacy undergraduates in public and private universities in Malaysia. Data analysis included descriptive statistics, one-way analysis of variance test, Mann-Whitney U test and Kruskal-Wallis test.

RESULTS: A total of 415 participants completed the survey (response rate = 82.5%). The median eHealth Literacy Scale score (out of 40) was 31.0 ± 3.0 (interquartile range). More than one-third of participants (34.7%) were found to have low eHealth literacy. Many lacked confidence in making health decisions from online information (42.4%) and skills in distinguishing between high-quality and low-quality health resources (35.2%). Only 70.4% of the participants had mobile health applications installed on their smartphones and/or tablets. Some students felt that they were neither knowledgeable nor skilful enough to utilise mobile health applications (24.8%), whereas 23.9% were unaware of the mobile health applications available.

CONCLUSION: In summary, the eHealth literacy of Malaysian pharmacy students can be further enhanced by incorporating eHealth literacy-focused programmes into the curriculum. Moreover, pharmacy students’ mobile health application utilisation can be improved through increased awareness and support from universities.

PMID:35188826 | DOI:10.1177/1357633X221077869