Tag: statistics

Pediatrics. 2022 Oct 12:e2021054307. doi: 10.1542/peds.2021-054307. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Discharge from the emergency department (ED) involves a complex series of steps to ensure a safe transition to home and follow-up care. Preventable, discharge-related serious safety events (SSEs) in our ED highlighted local vulnerabilities. We aimed to improve ED discharge by implementing a standardized discharge process with emphasis on multidisciplinary communication and family engagement.

METHODS: At a tertiary children’s hospital, we used the model for improvement to revise discharge care. Interventions included a new discharge checklist, a provider huddle emphasizing discharge vital signs, and a scripted discharge review of instructions with families. We used statistical process control to evaluate performance. Primary outcomes included elimination of preventable, discharge-related SSEs and Press Ganey survey results assessing caregiver information for care of child at home. A secondary outcome was number of days between preventable low-level (near-miss, no or minimal harm) events. Process measures included discharge checklist adoption and vital sign acquisition. Balancing measures were length of stay (LOS) and return rates.

RESULTS: Over the study period, there were no preventable SSEs and low-level event frequency improved to a peak of >150 days between events. Press Ganey responses regarding quality of discharge information did not change (62%). Checklist use was rapidly adopted, reaching 94%. Vital sign acquisition increased from 67% to 83%. There was no change in the balancing measures of median LOS or return visit rates.

CONCLUSIONS: The development and implementation of a standardized discharge process led to the elimination of reported discharge-related events, without increasing LOS or return visits.

PMID:36222092 | DOI:10.1542/peds.2021-054307

Endocrinol Metab (Seoul). 2022 Oct 12. doi: 10.3803/EnM.2022.1519. Online ahead of print.

ABSTRACT

BACKGROUND: The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients.

METHODS: A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders.

RESULTS: The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors.

CONCLUSION: Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.

PMID:36222086 | DOI:10.3803/EnM.2022.1519

Mil Med. 2022 Oct 12:usac293. doi: 10.1093/milmed/usac293. Online ahead of print.

ABSTRACT

INTRODUCTION: Medical physician residency program websites often serve as the first contact for any prospective applicant. No analysis of military residency program websites has yet been conducted, in contrast to their civilian counterparts. This study evaluated all military residency programs certified by the Accreditation Council for Graduate Medical Education (ACGME) 2021-2022 to determine program website comprehensiveness and accessibility and identify areas for improvement.

MATERIALS AND METHODS: A list of military residency programs in the USA was compiled using Defense Health Agency Graduate Medical Education resources together with the ACGME database. A total of 15 objective website criteria covering education and recruitment content were assessed by two independent evaluators. Accessibility was also scored. Programs’ website scores were compared by geographic location, specialty affiliation, type of institution partnership, and program size. Analysis was performed with descriptive statistics and comparison via an unpaired t-test or Kruskal-Wallis analysis, as appropriate.

RESULTS: A total of 124 military residency program websites were evaluated with a range of scores from 0 to 15 out of 15 possible points. Six programs had no identifiable website. All three services were represented with 43% joint-service programs. Content concerning physician education and development was more widely available than content directed toward the recruitment of applicants. The number of residency program websites reporting each content criterion varied greatly, but overall, no single service had a significantly higher score across their residencies’ websites. Significant variation occurred among individual specialties (P < .05) but there was no significant difference in surgical and nonsurgical specialties. Civilian-associated programs (18 programs, 14.5%) were associated with significantly greater website comprehensiveness scored best on informatics measures for recruitment and performed 64% better than military-only programs overall.

CONCLUSIONS: Program information in an accessible website platform allows prospective applicants to gain comprehensive perspectives of programs during the application process without reliance on personal visits and audition rotations. Limitations to in-person experiences, such as those caused by reductions in travel and concern for student safety during the global pandemic caused by the SARS-CoV-2 virus, may be alleviated by accessible virtual information. Our results indicate that there is opportunity for all military residency programs to improve their websites and better recruit applicants through understanding their audience and optimizing their reach online.

PMID:36222085 | DOI:10.1093/milmed/usac293

Dis Esophagus. 2022 Oct 11:doac071. doi: 10.1093/dote/doac071. Online ahead of print.

ABSTRACT

Few predictors of response to topical corticosteroid (tCS) treatment have been identified in eosinophilic esophagitis (EoE). We aimed to determine whether baseline gene expression predicts histologic response to tCS treatment for EoE. We analyzed prospectively collected samples from incident EoE cases who were treated with tCS for 8 weeks in a development cohort (prospective study) or in an independent validation cohort (clinical trial). Whole transcriptome RNA expression was determined from a baseline (pre-treatment) RNA-later preserved esophageal biopsy. Baseline expression was compared between histologic responders (<15 eos/hpf) and non-responders (≥15 eos/hpf), and differential correlation was used to assess baseline gene expression by response status. In 87 EoE cases analyzed in the development set, there were no differentially expressed genes associated with treatment response (at false discovery rate = 0.1). However, differential correlation identified a module of 22 genes with statistically significantly high pairwise correlation in non-responders (mean correlation coefficient = 0.7) compared to low correlation in responders (coefficient = 0.3). When this 22-gene module was applied to the 89 EoE cases in the independent cohort, it was not validated to predict tCS response at the 15 eos/hpf threshold (mean correlation coefficient = 0.32 in responders and 0.25 in nonresponders). Exploration of other thresholds also did not validate any modules. Though we identified a 22 gene differential correlation module measured pre-treatment that was strongly associated with subsequent histologic response to tCS in EoE, this was not validated in an independent population. Alternative methods to predict steroid response should be explored.

PMID:36222072 | DOI:10.1093/dote/doac071

Dis Esophagus. 2022 Oct 11:doac073. doi: 10.1093/dote/doac073. Online ahead of print.

ABSTRACT

Anastomotic leakage after esophagectomy is one of the most feared complications, which results in increased morbidity and mortality. Our aim was to evaluate the impact of a powered circular stapler on complications after esophagectomy with intrathoracic anastomosis for esophageal cancer. Between May 2019 and July 2021, all consecutive oesophagectomies for cancer with intrathoracic anastomosis in a high-volume center were included in this retrospective study. Surgeons were free to choose either a manual or a powered circular stapler. Preoperative characteristics and postoperative complications were recorded in a prospective database, according to EsoData. Propensity score matching (age, body mass index, Eastern cooperative oncology group (ECOG) performance and neoadjuvant therapy) was conducted to reduce potential confounding. We included 128 patients. Powered and manual circular staplers were used in 62 and 66 patients, respectively. Fewer anastomotic leakages were observed with the powered stapler group (OR = 7.3 (95%CI: 1.58-33.7); [3.2% (n = 2) vs 19.7% (n = 13), respectively; p = 0.004]). After propensity score matching, this remained statistically significant (OR = 8.5 (95%CI: 1.80-40.1); [4.1% (n = 2) vs 20.4% (n = 10), respectively; p = 0.013]). Additionally, anastomotic diameter was significantly higher with the powered stapler (median: 29 mm (63.3%) vs 25 mm (57.1%), respectively; p < 0.0001). There was no significant difference in comprehensive complication index (p = 0.146). A decreased mean length of stay was observed in the powered stapler group (11.1 vs 18.7 days respectively; p = 0.022). Postoperative anastomotic leakage after esophageal resection was significantly reduced after the introduction of the powered circular stapler, consequently resulting in a reduced length of stay. Further evaluation on long-term strictures and quality of life are warranted to support these results.

PMID:36222069 | DOI:10.1093/dote/doac073

Hum Brain Mapp. 2022 Oct 12. doi: 10.1002/hbm.26100. Online ahead of print.

ABSTRACT

Whether brain matter volume is correlated with cognitive functioning and higher intelligence is controversial. We explored this relationship by analysis of data collected on 193 healthy young and older adults through the “Leipzig Study for Mind-Body-Emotion Interactions” (LEMON) study. Our analysis involved four cognitive measures: fluid intelligence, crystallized intelligence, cognitive flexibility, and working memory. Brain subregion volumes were determined by magnetic resonance imaging. We normalized each subregion volume to the estimated total intracranial volume and conducted training simulations to compare the predictive power of normalized volumes of large regions of the brain (i.e., gray matter, cortical white matter, and cerebrospinal fluid), normalized subcortical volumes, and combined normalized volumes of large brain regions and normalized subcortical volumes. Statistical tests showed significant differences in the performance accuracy and feature importance of the subregion volumes in predicting cognitive skills for young and older adults. Random forest feature selection analysis showed that cortical white matter was the key feature in predicting fluid intelligence in both young and older adults. In young adults, crystallized intelligence was best predicted by caudate nucleus, thalamus, pallidum, and nucleus accumbens volumes, whereas putamen, amygdala, nucleus accumbens, and hippocampus volumes were selected for older adults. Cognitive flexibility was best predicted by the caudate, nucleus accumbens, and hippocampus in young adults and caudate and amygdala in older adults. Finally, working memory was best predicted by the putamen, pallidum, and nucleus accumbens in the younger group, whereas amygdala and hippocampus volumes were predictive in the older group. Thus, machine learning predictive models demonstrated an age-dependent association between subcortical volumes and cognitive measures. These approaches may be useful in predicting the likelihood of age-related cognitive decline and in testing of approaches for targeted improvement of cognitive functioning in older adults.

PMID:36222055 | DOI:10.1002/hbm.26100

Wei Sheng Yan Jiu. 2022 Sep;51(5):839-843. doi: 10.19813/j.cnki.weishengyanjiu.2022.05.027.

ABSTRACT

OBJECTIVE: To analyze and evaluate the testing capability of arsenic in drinking water in the laboratories of the provincial and municipal centers for disease control and prevention across the country by implementing the interlaboratory comparison project.

METHODS: The preparation method of the secondary standard materials were used as the reference for the sample preparation in the interlaboratory comparison project. The homogeneity and stability of the samples and short-term stability for simulated transportation were tested by single factor analysis of variance(ANOVA) and linear regression and mean consistency test(t test). On top of using the kernel density estimation to test the distribution of laboratory test result, we adopted precision statistical method to analyze the laboratory test result and used Z-score to evaluate the testing ability of each participating laboratory.

RESULTS: A total of 411 laboratories throughout the country participated in the proficiency testing program.389 laboratories(94.6%) of participating laboratories, obtained satisfactory result. Results provided by 2 laboratories(0.5%) of total participating laboratories, were found suspicious in their capacities. Finally, there were 20 laboratories(4.9%) of total participating laboratories, with result found to be outliers.

CONCLUSION: The testing capability of arsenic in drinking water has been ranked as satisfactory in the laboratories of the provincial and municipal centers for disease control and prevention across the country, and the testing capability of a small number of laboratories requires further improvement.

PMID:36222050 | DOI:10.19813/j.cnki.weishengyanjiu.2022.05.027

Wei Sheng Yan Jiu. 2022 Sep;51(5):834-838. doi: 10.19813/j.cnki.weishengyanjiu.2022.05.026.

ABSTRACT

OBJECTIVE: To analyze and evaluate the testing capability of cadmium in drinking water in the laboratories of the provincial and municipal centers for disease control and prevention across the country by implementing the interlaboratory comparison project.

METHODS: The preparation method of the secondary standard materials were used as the reference for the sample preparation in the interlaboratory comparison project. The homogeneity and stability of the samples and short-term stability for simulated transportation were tested by single factor analysis of variance(ANOVA) and linear regression and mean consistency test(t test). On top of using the kernel density estimation to test the distribution of laboratory test result, we adopted precision statistical method to analyze the laboratory test result and used Z-score to evaluate the testing ability of each participating laboratory.

RESULTS: A total of 409 laboratories throughout the country participated in the proficiency testing program.383 laboratories(93.6%) of participating laboratories, obtained satisfactory result. Results provided by 4 laboratories(1.0%) of total participating laboratories, were found suspicious in their capacities. Finally, there were 22 laboratories(5.4%) of total participating laboratories, with result found to be outliers.

CONCLUSION: The statistical result of the interlaboratory comparison project show that the testing capability of cadmium in drinking water has been ranked as satisfactory in the laboratories of the provincial and municipal centers for disease control and prevention across the country, and the testing capability of a small number of laboratories requires further improvement.

PMID:36222049 | DOI:10.19813/j.cnki.weishengyanjiu.2022.05.026

Wei Sheng Yan Jiu. 2022 Sep;51(5):829-833. doi: 10.19813/j.cnki.weishengyanjiu.2022.05.025.

ABSTRACT

OBJECTIVE: To analyze and evaluate the testing capability of lead in drinking water in the laboratories of the provincial and municipal centers for disease control and prevention across the country by implementing the interlaboratory comparison project.

METHODS: The preparation method of the secondary standard materials were used as the reference for the sample preparation in the interlaboratory comparison project. The homogeneity and stability of the samples and short-term stability for simulated transportation were tested by single factor analysis of variance(ANOVA) and mean consistency test(t test). On top of using the kernel density estimation to test the distribution of laboratory test result, we adopted a robust statistical method to analyze the laboratory test result and used Z-score to evaluate the testing ability of each participating laboratory.

RESULTS: A total of 448 laboratories throughout the country participated in the proficiency testing program.341 laboratories(76.1%) of participating laboratories, obtained satisfactory result. Results provided by 28 laboratories(6.3%) of total participating laboratories, were found suspicious in their capacities. Finally, there were 79 laboratories(17.6%) of total participating laboratories, with result found to be outliers.

CONCLUSION: The statistical result of the interlaboratory comparison project show that the testing capability of lead in drinking water has been ranked as satisfactory in the laboratories of the provincial and municipal centers for disease control and prevention across the country, and the testing capability of a small number of laboratories requires further improvement.

PMID:36222048 | DOI:10.19813/j.cnki.weishengyanjiu.2022.05.025

Wei Sheng Yan Jiu. 2022 Sep;51(5):791-807. doi: 10.19813/j.cnki.weishengyanjiu.2022.05.019.

ABSTRACT

OBJECTIVE: To investigate the renal injury induced by cadmium chloride(CdCl_2) and the protective effect of vitamin C(VC) in mice.

METHODS: Forty healthy clean grade male Kunming mice were randomly divided into 4 groups: control group(double distilled water gavage and intraperitoneal injection), VC group(200 mg/kg VC gavage and double distilled water intraperitoneal injection), CdCl_2 group(double distilled water gavage and 2 mg/kg CdCl_2 intraperitoneal injection), VC+CdCl_(2 )group(200 mg/kg VC gavage and 2 mg/kg CdCl_2 intraperitoneal injection). Exposure for 30 days.24 hours after the last exposure, the eyeballs were taken out for blood, and the renal tissue was immediately taken out to calculate kidney coefficient and then separate renal cells. The levels of reactive oxygen species(ROS) were detected by DCFH-DA kit and flow cytometry. Blood urea nitrogen(BUN), serum creatinine(Scr)and β2 microglobulin(β2-MG), cystatin C(Cys C), superoxide dismutase(SOD), glutathione peroxidase(GSH-Px), malondialdehyde(MDA), Caspase3 and Caspase9 kits were used to detect the corresponding indicators respectively. The contents of Cd~(2+) and Zn~(2+) in serum and kidney were detected by graphite furnace atomic absorption spectrometry.

RESULTS: The levels of kidney coefficient and BUN, Scr, β2-MG were 1.36±0.10, (19.34±0.63)mmol/L, (61.30±2.04)mmol/L and(1.02±0.10)g/mL respectively in CdCl_(2 )group, which were higher than those in the control group and VC group(P&lt;0.05). The levels of the above four indexes in VC+CdCl_(2 )group were 1.09±0.10, (9.65±0.50)mmol/L, (41.85±1.27)mmol/L and(0.61±0.01)g/mL respectively, which were lower than those in CdCl_2 group(P&lt;0.05). CdCl_2 exposure resulted in unclear glomerular contour, swelling of renal tubules, interstitial hyperemia, and exfoliated epithelial cells in the lumen. VC pretreatment could improve the above changes. The levels of Cd~(2+) in serum and renal tissue of mice in CdCl_2 group were(4.36±0.07)μg/L, (18.6±1.95)μg/g respectively, which were higher than that of control group and VC group(P&lt;0.05), in VC+CdCl_2 group, the level were(2.12±0.06)μg/L and(2.18±0.09)μg/g, they were lower than that of CdCl_2 group(P&lt;0.05). The level of serum Zn~(2+ )in CdCl_2 group was(11.35±1.03)μg/L, that was lower than control group(P&lt;0.05). The level of serum Zn~(2+) in VC+CdCl_2 group was(26.98±3.13)μg/L, which was higher than that of CdCl_2 group(P&lt;0.05). The levels of ROS, MDA, Caspase3 and Caspase9 in kidney tissue of mice in CdCl_2 group were(1.86±0.13), (4.78±0.15)nmol/mg, 1.50±0.24 and 1.69±0.17 respectively, which were higher than those in control group(P&lt;0.05). And the level of GSH-Px was(261.3±23.36)U/mg, it was lower than that in control group(P&lt;0.05). Compared with the CdCl_2 group, the levels of ROS, MDA, Caspase3 and Caspase9 in VC+CdCl_2 group decreased, and the level of GSH-Px increased, the difference was statistically significant(P&lt;0.05).

CONCLUSION: CdCl_2 exposure can lead to oxidative stress, damage of glomerulus and renal tubules, imbalance of zinc ion homeostasis, and damage of renal function. VC pretreatment can reduce the damage caused by CdCl_2 to a certain extent.

PMID:36222042 | DOI:10.19813/j.cnki.weishengyanjiu.2022.05.019