Tag: statistics

Int J Pediatr Otorhinolaryngol. 2022 Jan 29;154:111058. doi: 10.1016/j.ijporl.2022.111058. Online ahead of print.

ABSTRACT

INTRODUCTION: Within the UK, the majority of paediatric tracheostomy care is delivered by parents and carers at home. To facilitate this, extensive in-hospital training is delivered by a variety of health care professionals. Our goal was to assess carer perceptions of this process and highlight areas in which we can further improve our service and the training for other hospital providers of paediatric tracheostomy care.

METHODS: A mixed method approach was adopted. In Phase I, qualitative data from five semi-structured interviews with carers of children with a tracheostomy were thematically analysed and subsequently used to develop a questionnaire. In Phase II, the piloted questionnaire was distributed via telephone, email or post to all eligible caregivers who had been tracheostomy trained at GOSH in the last three years (n = 92). Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics respectively.

RESULTS: Thirty-five completed questionnaires were received (38% response rate). Overall participants were highly satisfied with the training provided (mean score 8.42 on a scale of 1 (lowest) to 10 (highest)). Carer identified areas requiring improvement were caregiver education pre-tracheostomy; emergency and complication training; supervision and training post hospital discharge; training schedule; emotional support; and support from community healthcare teams. These findings led to multiple subsequent interventions to further improve the carer training programme including training videos, psychology provision on request and increased community training.

CONCLUSION: Although the evaluation of the service revealed high participant satisfaction in home carer training overall, in-depth analysis of caregivers’ experiences indicated common themes in the tracheostomy training service where further support would be beneficial. A carer-centred rather than health professional focus on training needs will allow future attention to be directed to areas of need identified by carers themselves as important to improve the tracheostomy training programme.

PMID:35139446 | DOI:10.1016/j.ijporl.2022.111058

J Dent. 2022 Feb 6:104049. doi: 10.1016/j.jdent.2022.104049. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this RCT was to compare the caries preventive efficacy and the slowing down of previous caries lesions of toothpastes containing fluoride biomimetic hydroxyapatite (HA) complex compared to sodium monofluorophosphate fluoridated toothpastes in Italian schoolchildren. To validate this hypothesis a triple-blind randomized clinical trial was designed.

METHODS: In total 610 children (4-5 and 6-7 years) were enrolled. Four toothpastes, two containing fluoride-substituted hydroxyapatite (HAF) (1000 and 1450 ppmF) and magnesium-, strontium-, carbonate-substituted hydroxyapatite, in a chitosan matrix and two Mono fluoridated toothpastes (1000 and 1450 ppmF) were randomly administered during 24 months to two groups with younger children (G_young) and to two groups with older children (G_old), those containing 1450 ppmF. ICDAS was used to score lesions as initial (up to score 2), moderate (scores 3-4) and severe (scores 5-6). The children were instructed to brush for two minutes three times/day. Caries examination was repeated at 12 and 24 months. The efficacy of the treatment was assessed by calculating the reduction in Risk Ratio (RR) and the number needed to treat (NNT). Results; Overall, 518 patients (G_young=268; G_old=250) concluded the trial. The drop-rate was 11.84% for G_young and 17.22% for G_old. The caries increment at 24-month evaluation was statistically lower in the primary dentition in the HAF arms compared to the traditional fluoridated arms (0.18 vs 0.27 p=0.04 in G_young and 0.16 vs 0.30 p=0.01 in G_old for severe lesions). In the permanent dentition (G_old), caries increase was also statistically lower in the HAF arm, both for initial and severe lesions (0.09 vs 0.17 p=0.02 and 0.18 vs 0.28 p=0.01, respectively). In primary dentition, children receiving HAF Toothpaste had a RR of 39% (G_young) and 38% (G_old), compared to children receiving traditional Toothpastes. The RR in the permanent dentition was 29% in children treated with HAF toothpaste. Conclusions; The use of toothpastes containing biomimetic hydroxyapatite and fluoride reduces caries increment in children over a period of 2 years more than traditional fluoridated toothpastes.

PMID:35139410 | DOI:10.1016/j.jdent.2022.104049

Transplant Cell Ther. 2022 Feb 6:S2666-6367(22)00058-6. doi: 10.1016/j.jtct.2022.02.002. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary chronic graft versus host disease (p-cGvHD) is a highly morbid, late complication of haematopoietic stem cell transplantation (HSCT). The 2014 NIH cGvHD consensus criteria require a tissue biopsy or a drop in spirometry (with other features) to establish the diagnosis of p-cGvHD. Unfortunately, children are often incapable of performing spirometry, which can delay the diagnosis of this condition. Multiple breath washout testing (MBW) can detect abnormal pulmonary physiology in older children and adults after HSCT, but its feasibility and utility have not been assessed in younger children and in those who cannot perform spirometry.

OBJECTIVE: In this study, we assess the feasibility and sensitivity of MBW to detect p-cGvHD in children as young as 3 years of age following HSCT STUDY DESIGN: : We performed a cross sectional analysis of children age 3 to 18 years, between 100 days and 5 years after allogenic HSCT. Participants were recruited from the HSCT population at BC Children’s Hospital (Vancouver, Canada). All participants attempted nitrogen MBW and children age 6 years and over attempted spirometry. Non-parametric statistical techniques were employed; descriptive statistics used median (interquartile range [IQR]) and group medians were compared using Wilcoxon rank-sum test RESULTS: : Twenty-six children, median age 11.0 (range 3.6-18.5) years, were recruited a median of 26.4 (IQR 15.7, 51.8) months after HSCT. Six of the 26 children (23%) had a clinical diagnosis of p-cGvHD. MBW was successful in all (26/26, 100%) participants. The lung clearance index (LCI; the primary outcome of MBW) was higher in those with a history of p-cGvHD (median 11.8 [IQR 9.6, 18.7]) than in those with no history of cGvHD (median 7.7 [IQR 7.1, 8.0]; p=0.001) or a history of extra-pulmonary cGvHD (median 7.5 [IQR 6.9, 7.6], p=0.007). A threshold LCI=9 resulted in a sensitivity of 100% and specificity of 90% for the correct identification of clinically diagnosed p-cGvHD using MBW (area under the receiver operator characteristic curve is 0.97 [95%CI 0.80, 0.99]) Spirometry was successful in most (17/26, 65%) participants. Similar to LCI, FEV1/FVC could distinguish between p-cGvHD and no cGvHD (p=0.02) and extrapulmonary cGvHD (p=0.01). FEV1 alone could not distinguish between either of these groups (p=0.87, p=0.24 respectively).

CONCLUSIONS: MBW is feasible in young children after HSCT and in those who cannot perform spirometry. LCI has high discriminative power for correctly identifying p-cGvHD but these preliminary results require confirmation in a larger validation cohort.

PMID:35139399 | DOI:10.1016/j.jtct.2022.02.002

Am J Hum Genet. 2022 Feb 3:S0002-9297(22)00009-X. doi: 10.1016/j.ajhg.2022.01.009. Online ahead of print.

ABSTRACT

Genome-wide association studies (GWASs) have revolutionized human genetics, allowing researchers to identify thousands of disease-related genes and possible drug targets. However, case-control status does not account for the fact that not all controls may have lived through their period of risk for the disorder of interest. This can be quantified by examining the age-of-onset distribution and the age of the controls or the age of onset for cases. The age-of-onset distribution may also depend on information such as sex and birth year. In addition, family history is not routinely included in the assessment of control status. Here, we present LT-FH++, an extension of the liability threshold model conditioned on family history (LT-FH), which jointly accounts for age of onset and sex as well as family history. Using simulations, we show that, when family history and the age-of-onset distribution are available, the proposed approach yields statistically significant power gains over LT-FH and large power gains over genome-wide association study by proxy (GWAX). We applied our method to four psychiatric disorders available in the iPSYCH data and to mortality in the UK Biobank and found 20 genome-wide significant associations with LT-FH++, compared to ten for LT-FH and eight for a standard case-control GWAS. As more genetic data with linked electronic health records become available to researchers, we expect methods that account for additional health information, such as LT-FH++, to become even more beneficial.

PMID:35139346 | DOI:10.1016/j.ajhg.2022.01.009

Am J Obstet Gynecol. 2022 Feb 5:S0002-9378(22)00101-6. doi: 10.1016/j.ajog.2022.02.003. Online ahead of print.

ABSTRACT

BACKGROUND: The ARRIVE trial demonstrated the benefit of elective induction of labor at 39 weeks gestation. Obstetrics departments across the United States faced the conundrum of how best to adapt clinical practice in light of these data while managing logistical constraints.

OBJECTIVE: To determine if there were changes in obstetric practices and perinatal outcomes in the United States after the ARRIVE trial publication.

METHODS: This was a population based, retrospective cohort study of low-risk nulliparous women who initiated prenatal care by 12 weeks gestation with singleton, non-anomalous pregnancies that delivered at ≥ 39 weeks. Data were obtained from the US Natality database. The pre-ARRIVE group were women who delivered between January 1, 2015 and December 31, 2017. The post-ARRIVE group consisted of women who delivered between January 1 and December 31, 2019. Births that occurred in 2018 were excluded. Practice outcomes were rate of induction of labor, timing of delivery, and cesarean delivery rate. Adverse maternal outcomes were blood transfusion and admission to medical intensive care units (MICU). Adverse neonatal outcomes were need for assisted-ventilation (immediate and >6 hours), 5-minute APGAR score <3, neonatal intensive care unit (NICU) admission, seizures, and surfactant use. Univariate and multivariate analyses were performed. Trends were tested across the time period represented by the pre-ARRIVE group using Cochran-Armitage trend test.

RESULTS: There were 1,966,870 births in the pre-ARRIVE group and 609,322 in the post-ARRIVE group. The groups differed in age, race, body mass index, marital status, infertility treatment, and smoking history (p<0.001). After adjusting for these differences, the post-ARRIVE group was more likely to undergo induction (36.1% versus 30.2%; aOR=1.36 (1.36-1.37)) and deliver by 39+6 weeks of pregnancy (42.8% versus 39.9%; aOR=1.14 (1.14-1.15)). The post-ARRIVE group had a significantly lower rate of cesarean delivery than the pre-ARRIVE group (27.3 % versus 27.9%; aOR=0.94 (0.93-0.94)). Patients in the post-ARRIVE group were more likely to receive a blood transfusion (0.4% versus 0.3%; aOR=1.43 (1.36-1.50)), and be admitted to MICU (.09% versus .08%; aOR=1.20 (1.09-1.33)). Neonates in the post-ARRIVE group were more likely to need assisted ventilation at birth (3.5% versus 2.8%; aOR=1.28 (1.26-1.30)) and > 6 hours (0.6% versus 0.5%; aOR=1.36 (1.31-1.41)). The neonates in the post-ARRIVE group were more likely to have low 5-minute APGAR (0.4% versus 0.3%; aOR=0.91 (0.86-0.95)). NICU admission did not differ between the two groups (4.9% versus 4.9%; aOR=1.01 (0.99-1.03)). There were no differences in neonatal seizures (0.04% versus 0.04%; aOR=0.97 (0.84-1.13)), and surfactant use (0.08% versus 0.07%; aOR=1.05 (0.94-1.17)) between the two groups.

CONCLUSION: There were more inductions of labor, more deliveries at 39 weeks gestation, and fewer cesarean deliveries in the year after the ARRIVE trial publication. The small but statistically significant increase in some adverse maternal and neonatal outcomes should be explored to determine if there was a relationship with concurrent changes in obstetric practices.

PMID:35139334 | DOI:10.1016/j.ajog.2022.02.003

J Pediatr (Rio J). 2022 Feb 6:S0021-7557(22)00002-X. doi: 10.1016/j.jped.2021.12.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients’ medical records of those not submitted to CPR.

METHODS: Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children’s medical records in no-CPR group were researched by hand.

RESULTS: 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p = 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group.

CONCLUSION: Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.

PMID:35139342 | DOI:10.1016/j.jped.2021.12.008

Am J Manag Care. 2022 Feb 1;28(2):e35-e41. doi: 10.37765/ajmc.2022.88825.

ABSTRACT

OBJECTIVES: Procalcitonin (PCT) testing is FDA approved to guide antibiotic therapy in patients with lower respiratory tract infection (LRTI). However, its utilization and impact on real-world antibiotic prescribing behavior are unknown. We investigated the rate of PCT testing to evaluate an association between initial PCT level and antibiotic prescription patterns for patients with suspected LRTI within a large integrated health system.

STUDY DESIGN: Retrospective cohort study.

METHODS: A retrospective cohort study (January 1, 2016, through December 31, 2017) was performed in patients 18 years and older who were hospitalized with LRTI and had a PCT measurement. Antibiotic changes were noted before and 36 hours after initial PCT results. Antibiotic concordance was determined using a PCT cutoff value of 0.25 mcg/L. Concordance was defined as (1) patients received antibiotics after a PCT of at least 0.25 mcg/L resulted or (2) antibiotics were withheld after a PCT less than 0.25 mcg/L resulted.

RESULTS: PCT testing occurred in 18% of hospitalized patients with LRTI. Among 1606 patients, antibiotic concordance with PCT results was 55%. Among the discordant population, 77% of patients received antibiotics in the setting of a low PCT level compared with 23% who did not receive antibiotics at a high PCT level. There were no statistical differences between LRTI types between patients with PCT-discordant and PCT-concordant care.

CONCLUSIONS: Within a real-world environment of patients hospitalized with LRTI, PCT testing was low and the PCT levels did not appear to influence antibiotic prescribing behavior. Our findings suggest that clinicians continue to prioritize clinical judgment over initial PCT levels when prescribing antibiotics for suspected LRTIs.

PMID:35139294 | DOI:10.37765/ajmc.2022.88825

N Engl J Med. 2022 Feb 10;386(6):521-530. doi: 10.1056/NEJMoa2108337.

ABSTRACT

BACKGROUND: Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available.

METHODS: We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075).

RESULTS: A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups.

CONCLUSIONS: Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).

PMID:35139272 | DOI:10.1056/NEJMoa2108337

J Strength Cond Res. 2022 Jan 5. doi: 10.1519/JSC.0000000000004186. Online ahead of print.

ABSTRACT

Thompson, SW, Lake, JP, Rogerson, D, Ruddock, A, and Barnes, A. Kinetics and kinematics of the free-weight back squat and loaded jump squat. J Strength Cond Res XX(X): 000-000, 2021-The aim of this study was to compare kinetics and kinematics of 2 lower-body free-weight exercises, calculated from concentric and propulsion subphases, across multiple loads. Sixteen strength-trained men performed back squat 1 repetition maximum (1RM) tests (visit 1), followed by 2 incremental back squat and jump squat protocols (visit 2) (loads = 0% and 30-60%, back squat 1RM). Concentric phase and propulsion phase force-time-displacement characteristics were derived from force plate data and compared using analysis of variance and Hedges’ g effect sizes. Intrasession reliability was calculated using intraclass correlation coefficient (ICC) and coefficient of variation (CV). All dependent variables met acceptable reliability (ICC >0.7; CV < 10%). Statistically significant 3-way interactions (load x phase x exercise) and 2-way main effects (phase x exercise) were observed for mean force, velocity (30-60% 1RM), power, work, displacement, and duration (0%, 30-50% 1RM) (p < 0.05). A significant 2-way interaction (load x exercise) was observed for impulse (p < 0.001). Jump squat velocity (g = 0.94-3.80), impulse (g = 1.98-3.21), power (g = 0.84-2.93), and work (g = 1.09-3.56) were significantly larger across concentric and propulsion phases, as well as mean propulsion force (g = 0.30-1.06) performed over all loads (p < 0.001). No statistically significant differences were observed for mean concentric force. Statistically longer durations (g = 0.38-1.54) and larger displacements (g = 2.03-4.40) were evident for all loads and both subphases (p < 0.05). Ballistic, lower-body exercise produces greater kinetic and kinematic outputs than nonballistic equivalents, irrespective of phase determination. Practitioners should therefore use ballistic methods when prescribing or testing lower-body exercises to maximize athlete’s force-time-displacement characteristics.

PMID:35138069 | DOI:10.1519/JSC.0000000000004186

Brain Behav. 2022 Feb 9:e2517. doi: 10.1002/brb3.2517. Online ahead of print.

ABSTRACT

BACKGROUND: To improve understanding of gender differences on quality of life (QoL) in patients with Parkinson’s disease (PWP) of a different race, the differences of clinical features and health-related quality of life (HRQoL) between male and female PWP were studied in a small cohort early to middle stage of Chinese PWP.

METHODS: A cross-sectional study was carried out. PWP were consecutively included from April 2020 to July 2021 in Beijing Rehabilitation Hospital. HRQoL, motor symptoms, and nonmotor symptoms in each patient were evaluated. The differences of demographic, motor symptoms assessments, nonmotor symptoms assessments, and QoL between two gender groups were tested using t-test statistics, Mann-Whitney-Wilcoxon test, or χ² depending on the data type. To eliminate the possible factors contributing to the QoL, linear regression models were constructed to sort out the effect of gender.

RESULTS: One hundred and sixty-two Parkinson’s disease (PD) patients were included. Demographic, clinical characteristics, and symptom scale assessments had no statistical differences except for levodopa equivalent daily dose, Hamilton Anxiety Rating Score, REM sleep behavior disorder sleep questionnaire, and Hyposmia Rating Scale score. After baseline imbalance corrections, a significantly higher score of PD Questionnaire-39 (PDQ-39) in female than in male patients(p<.05) was found. In the questionnaire, summary Index and bodily discomfort, stigma, and emotional well-being subscores were the main contribution differences.

CONCLUSIONS: Gender differences are associated with the QoL in the early to middle stage PWP in China. Female patients have poorer QoL than male patients, especially bodily discomfort, stigma, and emotional well-being.

PMID:35138047 | DOI:10.1002/brb3.2517