Tag: statistics

J Neurodev Disord. 2022 Oct 5;14(1):54. doi: 10.1186/s11689-022-09462-w.

ABSTRACT

BACKGROUND: Anxiety symptomatology is common in individuals with intellectual disability (ID). Symptomatology includes both traditional Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) anxiety disorders and autism spectrum disorder (ASD)-related anxiety traits. Some genetic disorders such as Cornelia de Lange (CdLS) and fragile X syndromes (FXS) are at very high risk of anxiety and afford the opportunity to examine prevalence, profiles and associated person characteristics. However, prevalence and associated characteristics of anxiety in these high-risk groups remain poorly described and understood. The aim of the current study was to examine the prevalence and profile of DSM-5 and ASD-related anxiety symptomatology in individuals with CdLS and FXS and associated behavioural and cognitive characteristics.

METHODS: Questionnaires and interviews assessing DSM-5 and ASD-related anxiety were conducted with caregivers of individuals with CdLS (n = 49) and FXS (n = 36).

RESULTS: DSM-5 anxiety symptomatology was present in both groups with high co-morbidity across anxiety diagnoses. ASD-related anxiety was also prevalent with specific difficulties related to intolerance of uncertainty identified in both groups. Symptomatology was persistent over the lifespan for both groups. Anxiety type was partially associated with repetitive behaviour but not measures of overall ASD phenomenology in CdLS.

CONCLUSIONS: DSM-5 and ASD-related anxiety are common in these high-risk syndromes associated with ID. Prospective syndrome specific presentations and associations, which may implicate specific underlying mechanisms, are discussed. Clinicians should be aware of the risk and difficulties involved in assessment of anxiety in individuals with ID, including atypical types, to ensure these individuals do not “miss” diagnoses and support in general clinical practice.

PMID:36199025 | DOI:10.1186/s11689-022-09462-w

Acta Med Port. 2022 Oct 4. doi: 10.20344/amp.18284. Online ahead of print.

ABSTRACT

INTRODUCTION: The benefits of the multimodal Enhanced Recovery After Surgery® (ERAS) program have been described all over the world. The adoption of several perioperative strategies translates into an improvement in the quality of the healthcare provided. The aim of this study was to report the results of the implementation of the ERAS® program for colorectal surgery in a tertiary hospital.

MATERIAL AND METHODS: In this single-center observational study, 534 patients who underwent colorectal surgery between December 2018 and May 2021 were included. Two groups were considered: before and after the implementation of the ERAS® program. The primary outcome measure was 30-day morbidity. The length of hospital stay, readmission rate, reintervention and mortality among the two groups were also evaluated.

RESULTS: The pre-ERAS group included 102 patients and the ERAS group included 432 patients. There was a statistically significant reduction in morbidity at 30 days (37.3% vs 26.5%, p < 0.05), length of stay (7 days vs 5 days, p < 0.001) and readmission rate (12.9% vs 6%, p < 0.05) after the implementation of the ERAS program.

CONCLUSION: The ERAS® protocol for colorectal surgery was successfully and safely implemented in our hospital, contributing to an improvement in perioperative care provided to patients.

PMID:36198199 | DOI:10.20344/amp.18284

Acad Med. 2022 Oct 1;97(10):1546-1553. doi: 10.1097/ACM.0000000000004761. Epub 2022 Sep 23.

ABSTRACT

PURPOSE: To assess the impact of virtual interviewing during the COVID-19 pandemic on the residency application process and to compare applicant costs and time spent interviewing during the 2020-2021 application cycle with prior years.

METHOD: Fourth-year medical students at the University of Kansas School of Medicine applying for first-year residency positions via the National Resident Matching Program Match completed an electronic 46-item survey after submitting their rank lists during each application cycle from 2015-2016 to 2020-2021. The authors used descriptive statistics and t tests to analyze and compare responses to demographics questions and questions regarding number of submitted applications, offered and completed interviews, ranked programs, costs, and time spent interviewing. They used thematic analysis to code respondents’ narrative comments about the virtual interviewing experience.

RESULTS: From 2015-2016 to 2020-2021, 994 (of 1,190; 83.5%) respondents completed the survey. From 2019-2020 to 2020-2021, the average total cost of applying to residency per applicant dropped by $3,566 (P < .001) and the average time spent interviewing dropped by 13.3 days (P < .001). At the same time, the average number of applications per applicant dropped by 3.4, and applicants completed the same number of interviews and ranked 2.3 fewer programs, none of which were statistically significant differences. Narrative comments from 113 (79%) respondents in 2020-2021 revealed 4 themes related to virtual interviewing: convenience of time and cost, positive aspects of the process, negative aspects of the process, and overall impressions of the program.

CONCLUSIONS: Virtual interviewing during the 2020-2021 application cycle resulted in an approximately 80% reduction in cost for applicants and an approximately 50% decrease in time spent interviewing compared with previous years but was not associated with large increases in number of submitted applications, completed interviews, or ranked programs. Applicants generally perceived virtual interviewing as positive although they raised notable concerns.

PMID:36198163 | DOI:10.1097/ACM.0000000000004761

Acad Med. 2022 Oct 1;97(10):1427-1428. doi: 10.1097/ACM.0000000000004910. Epub 2022 Sep 23.

NO ABSTRACT

PMID:36198148 | DOI:10.1097/ACM.0000000000004910

Egypt J Immunol. 2022 Oct;29(4):94-105.

ABSTRACT

Psoriasis is a chronic debilitating skin disease with an estimated prevalence reaching 2% of the worldwide population. Psoriatic disease is driven by the interactions among innate and adaptive immune systems with structural components of the skin. Interleukin (IL)-22 mediates keratinocyte proliferation and epidermal hyperplasia, and changes in the structure of skin flora can play a role in the secretion of IL-22. The aim of this study was to correlate serum levels of IL-22 and Staphylococcus aureus toxins with disease activity in plaque psoriasis. The study group included 50 patients with mild, moderate, and severe psoriasis. The control group comprised 20 sex- and age-matched apparently healthy volunteers. IL-22 concentration was assessed in sera of patients and the control group by using the ELISA technique. The serum levels of IL-22 in patients were higher than in the control group, but the difference was statistically insignificant (P=0.413). Serum IL-22 levels were positively correlated with the Psoriasis Area and Severity Index (PASI) score of psoriasis patients (P=0.0003). The IL-22 serum levels in patients colonized with toxigenic strains of S. aureus were significantly higher than in patients colonized with non-toxigenic strains (P= 0.028). In conclusion, IL-22 plays a role in the pathogenesis of psoriasis, and its secretion can be triggered by the toxins produced by S. aureus colonizing the skin of patients.

PMID:36198107

Clin J Pain. 2022 Oct 3. doi: 10.1097/AJP.0000000000001076. Online ahead of print.

ABSTRACT

OBJECTIVES: People living with chronic pain may use wearable health technology (WHT) in conjunction with an expert-directed pain management program for up to one year. WHT use may be associated with improvements in key patient outcomes.

METHODS: A 12-month study of WHT use among people with chronic pain was conducted, consisting of iPhone and Apple Watch applications to measure movement, sleep, and self-reported pain. Clinical outcomes among 105 patients enrolled in a multidisciplinary pain program that included WHT use were compared to 146 patients in the same program but without WHT, and to 161 patients receiving medical pain management without WHT.

RESULTS: Participants used the WHT on average 143.0 (SD 117.6) out of 365 days. Mixed-effects models revealed participants who used WHT had decreases in depression scores (-7.83, P<0.01) and prescribed morphine milligram equivalents (-21.55, P=0.04) over one year. Control groups also showed decreases in depression scores (-5.08, P=0.01; -5.68, P<0.01) and morphine milligram equivalents (-18.67, P=0.01; -10.99, ns). The estimated slope of change among the WHT was not statistically different than control groups.

DISCUSSION: Patients who used WHT as part of their pain management program demonstrated a willingness to do so for extended periods of time despite living with chronic pain and other comorbidities. Data trends suggest that WHT use may positively impact depression and prescribed medication. Additional research is warranted to investigate the potential of WHT to improve the negative consequences of chronic pain.

PMID:36198095 | DOI:10.1097/AJP.0000000000001076

Echocardiography. 2022 Oct 5. doi: 10.1111/echo.15445. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary vasomotion abnormalities have been described in small studies but not studied systematically. We aimed to review the present literature and analyze it to improve our understanding of chronic kidney disease (CKD) related-coronary microvascular dysfunction.

OBJECTIVE: Coronary flow reserve (CFR) is a well-known measure of coronary vasomotion. We aimed to assess the difference in CFR among participants with and without CKD.

METHODS: PubMed, Embase, and Cochrane CENTRAL were systematically reviewed to identify studies that compared CFR in participants with and without CKD. We estimated standardized mean differences in mean CFR reported in these studies. We performed subgroup analyses according to imaging modality, and the presence of significant epicardial coronary artery disease.

RESULTS: In 14 observational studies with 5966 and 1410 patients with and without CKD, the mean estimated glomerular filtration rate (eGFR) was 29 ± 04 and 87 ± 25 ml/min/1.73 m² , respectively. Mean CFR was consistently lower in patients with CKD in all studies and the cumulative mean difference was statistically significant (2.1 ± .3 vs. 2.7 ± .5, standardized mean difference -.8, 95% CI -1.1, -.6, p < .05). The lower mean CFR was driven by both significantly higher mean resting flow velocity (.58 cm/s, 95% CI .17, .98) and lower mean stress flow velocity (-.94 cm/s, 95% CI -1.75, -.13) in studies with CKD. This difference remained significant across diagnostic modalities and even in absence of epicardial coronary artery disease. In meta-regression, there was a significant positive relationship between mean eGFR and mean CFR (p < .05).

CONCLUSION: Patients with CKD have a significantly lower CFR versus those without CKD, even in absence of epicardial coronary artery disease. There is a linear association between eGFR and CFR. Future studies are required to understand the mechanisms and therapeutic implications of these findings.

KEY POINTS: In this meta-analysis of observational studies, there was a significant reduction in coronary flow reserve in studies with chronic kidney disease versus those without. This difference was seen even in absence of epicardial coronary artery disease. In meta-regression, a lower estimate glomerular filtration rate was a significant predictor of lower coronary flow reserve. Coronary microvascular dysfunction, rather than atherosclerosis-related epicardial disease may underly increase cardiovascular risk in a patient with chronic kidney disease.

PMID:36198077 | DOI:10.1111/echo.15445

J Speech Lang Hear Res. 2022 Oct 5:1-11. doi: 10.1044/2022_JSLHR-22-00157. Online ahead of print.

ABSTRACT

OBJECTIVE: Currently, no clinically feasible objective measures exist that are specific to the signs of adductor laryngeal dystonia (LD), deterring effective diagnosis and treatment. This project sought to establish concurrent validity of a new automated acoustic outcome measure, designed to be specific to adductor laryngeal dystonia (AdLD): the spectral aggregate of the high-passed fundamental frequency contour (SAHf _o).

METHOD: Twenty speakers with AdLD read voiced phoneme-loaded (more symptomatic) and voiceless phoneme-loaded (less symptomatic) sentences. LD discontinuities (defined as phonatory breaks, frequency shifts, and creak), the acoustic ramifications of laryngeal spasms, were manually identified. The frequency content of the f _o contour was examined as a function of time, and content above 1000 Hz was summed to automatically calculate SAHf _o. Multiple linear regression analysis was applied to SAHf _o based on LD discontinuities and sentence type (voiced or voiceless phoneme-loaded).

RESULTS: The regression model accounted for 41.1% of the variance in SAHf _o. Both the LD discontinuities and sentence type were statistically related to SAHf _o.

CONCLUSION: Results of this study provide evidence of concurrent validity. SAHf _o is an automatic outcome measure specific to acoustic signs of AdLD that may be useful to track treatment progress.

PMID:36198059 | DOI:10.1044/2022_JSLHR-22-00157

J Clin Psychiatry. 2022 Oct 3;83(6):22m14447. doi: 10.4088/JCP.22m14447.

ABSTRACT

Objective: Determine if sublingual dexmedetomidine, a selective α₂ adrenergic receptor agonist, reduces symptoms of acute agitation associated with schizophrenia or schizoaffective disorder.

Methods: This phase 3, randomized, double-blind, placebo-controlled study was conducted in adults diagnosed with schizophrenia or schizoaffective disorder per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The study was conducted at 15 US sites between January 23, 2020, and May 8, 2020. Participants were randomized to sublingual dexmedetomidine 180 μg, 120 μg, or matching placebo. The primary efficacy endpoint was mean change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PEC) total score at 2 hours postdose.

Results: Altogether, 380 participants (mean age 45.6 years, 63.4% identifying as male, 77.9% identifying as Black or African American) were randomized; 380 (100%) self-administered study medication, and 372 (97.9%) completed the study. The mean PEC total score at baseline (17.6) indicated mild to moderate agitation. At 2 hours postdose, the least squares mean changes (SE) from baseline were -10.3 (0.4) for sublingual dexmedetomidine 180 μg, -8.5 (0.4) for 120 μg, and -4.8 (0.4) for placebo. Least squares mean differences (97.5% confidence intervals) in the sublingual dexmedetomidine groups were -5.5 (-6.7 to -4.3) for 180 μg and -3.7 (-4.9 to -2.5) for 120 μg (both P < .001 vs placebo). The most commonly encountered adverse events with dexmedetomidine (incidence ≥ 5% and ≥ 2× rate observed with placebo) were somnolence, dry mouth, and hypotension for the 120 μg dose, and somnolence, dizziness, orthostatic hypotension, and oral hypoesthesia for the 180 μg dose.

Conclusions: Treatment with sublingual dexmedetomidine 180 μg or 120 μg was more efficacious than placebo in reducing acute agitation associated with schizophrenia as measured by PEC scores at 2 hours postdose.

Trial Registration: ClinicalTrials.gov identifier: NCT04268303.

PMID:36198061 | DOI:10.4088/JCP.22m14447

J Speech Lang Hear Res. 2022 Oct 5:1-11. doi: 10.1044/2022_JSLHR-22-00136. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated whether listener processing of dysarthric speech requires the recruitment of more cognitive resources (i.e., higher levels of listening effort) than neurotypical speech. We also explored relationships between behavioral listening effort, perceived listening effort, and objective measures of word transcription accuracy.

METHOD: A word recall paradigm was used to index behavioral listening effort. The primary task involved word transcription, whereas a memory task involved recalling words from previous sentences. Nineteen listeners completed the paradigm twice, once while transcribing dysarthric speech and once while transcribing neurotypical speech. Perceived listening effort was rated using a visual analog scale.

RESULTS: Results revealed significant effects of dysarthria on the likelihood of correct word recall, indicating that the transcription of dysarthric speech required higher levels of behavioral listening effort relative to neurotypical speech. There was also a significant relationship between transcription accuracy and measures of behavioral listening effort, such that listeners who were more accurate in understanding dysarthric speech exhibited smaller changes in word recall when listening to dysarthria. The subjective measure of perceived listening effort did not have a statistically significant correlation with measures of behavioral listening effort or transcription accuracy.

CONCLUSIONS: Results suggest that cognitive resources, particularly listeners’ working memory capacity, are more taxed when deciphering dysarthric versus neurotypical speech. An increased demand on these resources may affect a listener’s ability to remember aspects of their conversations with people with dysarthria, even when the speaker is fully intelligible.

PMID:36198057 | DOI:10.1044/2022_JSLHR-22-00136