Tag: statistics

J Pediatr Surg. 2022 Feb 1:S0022-3468(22)00105-1. doi: 10.1016/j.jpedsurg.2022.01.030. Online ahead of print.

ABSTRACT

PURPOSE: Pediatric patients with Crohn’s disease often require colectomies. The laparoscopic approach is considered safe, but there is little national data on outcomes and readmissions in this population.

METHODS: The Nationwide Readmissions Database was queried from 2010 to 2014 for patients ≤ 18 years who underwent colectomy for Crohn’s disease during index admission. Patients were stratified by operative approach: laparoscopic versus open. Outcomes were compared with standard statistical methods.

RESULTS: There were 2833 patients (47% female) who underwent a colectomy via laparoscopic (58%) vs. open (42%) approach. Index admissions were elective 55% of the time. Most operations were right hemicolectomy (86%), followed by total colectomy (8%). Of the study population, 489 (17%) were diverted with an ostomy. Readmission rates at 30 days and 1 year were 9% and 18%, respectively. The most common diagnoses at readmission were intra-abdominal infection (16%), small bowel obstruction (16%), and surgical site infection (9%). Laparoscopy was more commonly performed during elective admissions (63% vs. 44%), for patient with private insurance (72% vs. 39%), and for patients in the highest income quartile (66% vs. 48% in the lowest income quartile), all p<0.001. Length of stay was longer on index admission for open colectomy (8[5-12] days vs. 6[4-11] days, p<0.001), while cost was similar ($17,754[$12,375-$30,625] vs. $17,017[$11,219-$27,336], p = 0.104). There were no differences in readmission rate, intraabdominal infection or small bowel obstruction.

CONCLUSION: In pediatric patients, laparoscopic colectomy for Crohn’s disease is safe and is associated with shorter hospitalization and equivalent hospital costs compared to the open procedure. Socioeconomic disparities in laparoscopic utilization exist and warrant future investigation.

LEVEL OF EVIDENCE: Level III.

PMID:35232601 | DOI:10.1016/j.jpedsurg.2022.01.030

Am J Surg. 2022 Feb 21:S0002-9610(22)00134-9. doi: 10.1016/j.amjsurg.2022.02.054. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescents with blunt solid organ injuries (BSOI) are cared for at both pediatric trauma centers (PTC) and adult trauma centers (ATC). Over the past decade, treatment strategies have shifted towards non-operative management with reported favorable outcomes. The aim of this study was to compare management strategies and outcomes between PTC and ATC.

METHODS: We queried the 2016-2018 Trauma Quality Improvement Program (TQIP) datasets to identify adolescents between the ages of 16 and 19 with BSOI. Characteristics were stratified by center type (pediatric or adult) for comparative analyses. Separate logistic regressions were used to assess the association of hospital type, location of injury, age, gender, weight, Glascow Coma Score (GCS), Injury Severity Score (ISS), and intensive care unit (ICU) admissions for outcomes of interest.

RESULTS: Among the 3,011,310 patients enrolled in the 2016-2018 TQIP datasets, 106,892 (3.5%) had a BSOI ICD9/10 code. Of those, 9,193 (8.6%) were between 16 and 19 years of age and included in this analysis. Within this cohort, 6,073 (66.1%) were managed at an ATC and 3,120 (33.9%) were managed at a PTC. While statistically different, there were no clinically relevant differences for age, weight, and sex between groups. A significantly higher ISS and lower GCS score were observed among those admitted to ATC compared to PTC. ICU admissions were more frequent at ATC. Number of blood transfusions by 4 h after presentation were also higher among those admitted to an ATC. Despite a lower ISS and higher GCS at presentation, mortality was higher among those treated at a PTC with an odds ratio (95% confidence interval) of 2.42 (1.31-4.53). After excluding adolescents with a traumatic brain injury, a common cause of mortality among adolescent trauma patients, these differences in outcomes persisted.

CONCLUSIONS: Our data suggest that adolescents with BSOI managed at a PTC are less likely to receive blood transfusions by 4 h of admission or be admitted to the ICU than those managed at an ATC. However, this more conservative approach may come at the expense of higher overall mortality. Further work is needed to understand these differences and determine if PTC need to be more aggressive in managing BSOI.

PMID:35232541 | DOI:10.1016/j.amjsurg.2022.02.054

Med Eng Phys. 2022 Mar;101:103769. doi: 10.1016/j.medengphy.2022.103769. Epub 2022 Feb 10.

ABSTRACT

Three-dimensional bone reconstructions from medical imaging are essential for biomechanical modelling and are growing tools in clinics. Several methods of lower limbs reconstruction from biplanar radiographs have been proposed in the literature but with significant operator dependence. A novel reconstruction method based on reduced manual annotation, statistical shape models and fully automatic adjustments was proposed in this study. While significantly reducing operator intervention, the proposed method demonstrated similar or better precision than previous approaches on clinical parameters. Meanwhile, shape accuracy was improved to around 1mm. By quasi-automating the 3D reconstruction without loss of accuracy and precision, the proposed approach is a considerable step towards extensive use of 3D personalized models in clinical routine and large cohort biomechanical studies.

PMID:35232549 | DOI:10.1016/j.medengphy.2022.103769

Pediatr Dent. 2022 Jan 15;44(1):25-31.

ABSTRACT

Purpose: The purpose of this study was to compare video modelling (VM) to a Picture Exchange Communication System (PECS) aimed at improving the oral hygiene of children with autism spectrum disorder (ASD). Methods: This prospectively stratified randomized controlled trial was conducted on 50 children with mild and moderate ASD. Children were assigned into two balanced groups. The control group was educated through PECS, and the intervention group was exposed to VM. Oral hygiene was assessed using the Oral Hygiene Index-simplified (OHI-s) on four occasions (at baseline and at three, six, and 12 months). Quantitative data were analyzed using Fisher’s exact test and a t-test at a five percent significance level and 95 percent confidence interval (95% CI), respectively. Spearman’s rank correlation coefficient (r) was used to correlate baseline characteristics in both groups to obtain average OHI-s scores. Results: The VM group showed a statistically significant reduction in average OHI-s scores compared to the PECS group over the follow-up period (P<0.001). At three, six, and 12 months, the OHI-s mean differences were 0.30 (95% CI equals 0.14 to 0.47), 0.58 (95% CI equals 0.39 to 0.77), and 0.57 (95% CI equals 0.30 to 0.84), respectively. For both groups, the severity of ASD was moderately associated with OHI-s scores at 12 months. Conclusion: Video modelling showed superior results in improving the oral hygiene of children with autism spectrum disorder compared to the Picture Exchange Communication System.

PMID:35232533

Pediatr Dent. 2022 Jan 15;44(1):58-66.

ABSTRACT

Purpose: To investigate improvement in iron and iron-related nutritional status of children with severe-early childhood caries (S-ECC) following dental rehabilitation under general anesthesia (GA). Methods: Children with S-ECC were recruited into a prospective study investigating changes in nutritional status before and after surgery. Parents completed a questionnaire, as their child had a venipuncture while under GA. Children returned for follow-up at a minimum of three months postsurgery, and parents completed a follow-up questionnaire and their child had an additional venipuncture and dental examination. Statistical analyses included descriptive, bivariate, and multivariable regression analyses. Results: A total of 150 children participated (mean age 47.7±14.1 months). The mean baseline ferritin concentration was 27.9±19.1 μg/L, while mean iron and hemoglobin levels were 12.3±4.3 μmol/L and 107.5±9.2 g/L, respectively. Overall, 53 percent were anemic, 30 percent had iron deficiency (ID), and 20 percent had iron deficiency anemia (IDA) at baseline. In total, 106 participants returned for follow-up. Paired t-tests revealed significant improvements in ferritin (27.0±18.4 μg/L versus 34.3±18.2 μg/L, P<0.001) and hemoglobin (108.2±8.3 g/L versus 123.7±9.4 g/L, P<0.001) levels. There was a 16 percent reduction in children with ID (P<0.001) and a 20 percent reduction in children experiencing IDA (P=0.011) from baseline to follow-up. Multivariable regression revealed that follow-up ferritin levels were associated with baseline ferritin concentrations, red meat intake, and difficulty purchasing food because of cost. Conclusions: Improvements in iron and iron-related nutritional status were observed post GA. Dental surgery for S-ECC may contribute to improved children’s eating practices and resolve oral inflammation, thus leading to better nutritional status.

PMID:35232538

Psychol Med. 2022 Mar 2:1-7. doi: 10.1017/S0033291722000253. Online ahead of print.

ABSTRACT

BACKGROUND: People with severe mental illness (SMI) have an elevated risk of obesity but the causes and mechanisms are unclear. We explored the familial association between parental SMI and body mass index (BMI) in middle-aged offspring. Our objective was to determine if the offspring of either parent with SMI have an increased risk for obesity.

METHODS: The Northern Finland Birth Cohort 1966 is a cohort study of offspring with expected date of birth in 1966. The data include originally 12 068 mothers and 12 231 children from the provinces of Lapland and Oulu in Finland. The final study sample included 5050 middle-aged offspring. Parental SMI was used as exposure in the study. BMI measured at the age of 46 years was used as a primary outcome.

RESULTS: Risk for obesity was elevated in the offspring of mothers with SMI [overweight: adjusted odds ratio (OR) 1.93 (1.29-2.90), obese class I: 1.97 (1.20-3.25), obese classes II-III: 2.98 (1.67-5.33)]. For the offspring of either parent with SMI, statistically significant results were found in obese class I and obese classes II-III [overweight: adjusted OR 1.21 (0.94-1.54), obese class I: 1.52 (1.03-1.08), obese classes II-III: 1.53 (1.01-2.32)].

CONCLUSIONS: We found an elevated risk of obesity in the middle-aged offspring of either parent with SMI, especially in the offspring of mothers with SMI. Thus, there might be a common familial pathway leading to the co-occurrence of obesity and SMI.

PMID:35232502 | DOI:10.1017/S0033291722000253

J Pharm Policy Pract. 2022 Mar 1;15(1):13. doi: 10.1186/s40545-022-00409-z.

ABSTRACT

BACKGROUND: The consistency and the quality of medicine labels are sought through the regulatory frameworks. This study aims at investigating the secondary labels of medicines based on the labeling regulations and guidelines issued by the National Medicines Regulatory Authority (NMRA), Sri Lanka.

METHODS: A descriptive cross-sectional study was conducted on 53 commonly used prescription-only oral medicines selected using the price regulations published for most commonly used drugs. High-resolution images of 216 brands/branded generics/generic products’ secondary labels were collected in April 2021 from six community pharmacies in six districts chosen as a convenience sample. Each label was manually assessed using a checklist prepared based on the regulatory requirements by four trained investigators. The status of registration of each product was assessed using the NMRA website. Descriptive statistics were performed.

RESULTS: There was a variation observed in labeling regulations and information present on packages. Among the 216 products evaluated, only 148 (68%) products appeared as registered medicines on the NMRA website, and 2.3% of medicines fulfilled all stipulated labeling parameters set out by the NMRA, 3% of products abided by the general labeling requirements, and 76% of the products complied with labeling requirements for API. Major deficiencies were observed in the presentation of registration numbers and the details of the local agent, which were unaccounted for in 210 (97%) and 131 (61%) products, respectively. The highest consistency (100%) of information was noted with the dosage form, date of manufacture, date of expiry, and batch numbers. Among the restricted information, attractive pictures (2%), web addresses (6%), and over-stickers (34%) were found.

CONCLUSIONS: The results highlighted a gap between regulatory requirements and practice in medicine labeling information. Regular post-market examination of medicinal labels is highly advised in a country that relies largely on imports. Similarly, careful adherence to the labeling regulations is required. Furthermore, suppliers and local agents should be held accountable for ensuring accurate medicine labeling through increased awareness, education, and sanctions.

PMID:35232496 | DOI:10.1186/s40545-022-00409-z

J Foot Ankle Res. 2022 Mar 2;15(1):18. doi: 10.1186/s13047-022-00523-w.

ABSTRACT

BACKGROUND: There is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection.

METHODS: Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis.

RESULTS: 29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways.

CONCLUSIONS: Most vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection.

PMID:35232476 | DOI:10.1186/s13047-022-00523-w

Chiropr Man Therap. 2022 Mar 1;30(1):10. doi: 10.1186/s12998-022-00419-3.

ABSTRACT

BACKGROUND: Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients’ needs more comprehensively.

METHODS: This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes.

RESULTS: 201 participants were enrolled. The largest reductions in pain intensity occurred at the end of treatment and were 43% for CC and 47% for IC. The primary analysis found IC to be significantly superior to CC over the 1-year period (P = 0.02). The long-term profile for pain intensity which included data from weeks 4 through 52, showed a significant advantage of 0.5 for IC over CC (95% CI 0.1 to 0.9; P = 0.02; 0 to 10 scale). The short-term profile (weeks 4 to 12) favored IC by 0.4, but was not statistically significant (95% CI – 0.02 to 0.9; P = 0.06). There was also a significant advantage over the long term for IC in some secondary measures (disability, improvement, satisfaction and low back symptom frequency), but not for others (medication use, quality of life, leg symptom frequency, fear avoidance beliefs, self-efficacy, active pain coping, and kinesiophobia). Importantly, no serious adverse events resulted from either of the interventions.

CONCLUSIONS: Participants in the IC group tended to have better outcomes than the CC group, however the magnitude of the group differences was relatively small. Given the resources required to successfully implement multidisciplinary integrative care teams, they may not be worthwhile, compared to monodisciplinary approaches like chiropractic care, for treating LBP. Trial registration NCT00567333.

PMID:35232482 | DOI:10.1186/s12998-022-00419-3

BMC Health Serv Res. 2022 Mar 1;22(1):277. doi: 10.1186/s12913-022-07637-8.

ABSTRACT

BACKGROUND: Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

METHODS: A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

RESULTS: We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

CONCLUSIONS: While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how “value co-creation” could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

PMID:35232456 | DOI:10.1186/s12913-022-07637-8