Tag: statistics

Clin Orthop Relat Res. 2022 Oct 5. doi: 10.1097/CORR.0000000000002440. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported outcome measures (PROMs) are frequently used to assess the impact of total knee arthroplasty (TKA) on patients. However, mere statistical comparison of PROMs is not sufficient to assess the value of TKA to the patient, especially given the risk profile of arthroplasty. Evaluation of treatment effect sizes is important to support the use of an intervention; this is often quantified with the minimum clinically important difference (MCID). MCIDs are unique to specific PROMs, as they vary by calculation methodology and study population. Therefore, a systematic review of calculated MCID values, their respective ranges, and assessment of their applications is important to guide and encourage their use as a critical measure of effect size in TKA outcomes research.

QUESTIONS/PURPOSES: In this systematic review of MCID calculations and reporting in primary TKA, we asked: (1) What are the most frequently reported PROM MCIDs and their reported ranges in TKA? (2) What proportion of studies report distribution- versus anchor-based MCID values? (3) What are the most common methods by which these MCID values are derived for anchor-based values? (4) What are the most common derivation methods for distribution-based values? (5) How do the reported medians and corresponding interquartile ranges (IQR) compare between calculation methods for each PROM?

METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted using the PubMed, EMBASE, and MEDLINE databases from inception through March 2022 for TKA articles reporting an MCID value for any PROMs. Two independent reviewers screened articles for eligibility, including any article that calculated new MCID values for PROMs after primary TKA, and extracted these data for analysis. Overall, 576 articles were identified, 38 of which were included in the final analysis. These studies had a total of 710,128 patients with a median age of 67.7 years and median BMI of 30.9 kg/m2. Women made up more than 50% of patients in most studies, and the median follow-up period was 17 months (range 0.25 to 72 months). The overall risk of bias was assessed as moderate using the Jadad criteria for one randomized controlled trial (3 of 5 ideal global score) and the modified Methodological Index for Non-randomized Studies criteria for comparative studies (mean 17.2 ± 1.8) and noncomparative studies (mean 9.6 ± 1.3). There were 49 unique PROMs for which 233 MCIDs were reported. Calculated values were classified as anchor-based, distribution-based, or not reported. MCID values for each PROM, MCID calculation method, number of patients, and study demographics were extracted from each study. Anchor-based and distribution-based MCIDs were compared for each unique PROM using a Wilcoxon rank sum test given non-normal distribution of values.

RESULTS: The WOMAC Function and Pain subscores were the most frequently reported MCID value, comprising 9% (22 of 233) and 9% (22 of 233), respectively. The composite Oxford Knee Score (OKS) was the next most frequently reported (9% [21 of 233]), followed by the WOMAC composite score (6% [13 of 233]). The median anchor-based values for WOMAC Function and Pain subscores were 23 (IQR 16 to 33) and 25 (IQR 14 to 31), while the median distribution-based values were 11 (IQR 10.8 to 11) and 22 (IQR 17 to 23), respectively. The median anchor-based MCID value for the OKS was 6 (IQR 4 to 7), while the distribution-based value was 7 (IQR 5 to 10). Thirty-nine percent (15 of 38) used an anchor-based method to calculate a new MCID, while 32% (12 of 38) used a distribution-based technique. Twenty-nine percent of studies (11 of 38) calculated MCID values using both methods. For studies reporting an anchor-based calculation method, a question assessing patient satisfaction, pain relief, or quality of life along a five-point Likert scale was the most commonly used anchor (40% [16 of 40]), followed by a receiver operating characteristic curve estimation (25% [10 of 40]). For studies using distribution-based calculations, all articles used a measure of study population variance in their derivation of the MCID, with the most common method reported as one-half the standard deviation of the difference between preoperative and postoperative PROM scores (45% [14 of 31]). Most reported median MCID values (15 of 19) did not differ by calculation method for each unique PROM (p > 0.05) apart from the WOMAC Function component score and the Knee Injury and Osteoarthritis Outcome Score Pain and Activities of Daily Living subscores.

CONCLUSION: Despite variability of MCIDs for each PROM, there is consistency in the methodology by which MCID values have been derived in published studies. Additionally, there is a consensus about MCID values regardless of calculation method across most of the PROMs we evaluated.

CLINICAL RELEVANCE: Given their importance to treatment selection and patient safety, authors and journals should report MCID values with greater consistency. We recommend using a 7-point increase as the MCID for the OKS, consistent with the median reported anchor-based value derived from several high-quality studies with large patient groups that used anchor-based approaches for MCID calculation, which we believe are most appropriate for most applications in clinical research. Likewise, we recommend using a 10-point to 15-point increase for the MCID of composite WOMAC, as the median value was 12 (IQR 10 to 17) with no difference between calculation methods. We recommend use of median reported values for WOMAC function and pain subscores: 21 (IQR 15 to 33) and 23 (IQR 13 to 29), respectively.

PMID:36200846 | DOI:10.1097/CORR.0000000000002440

Magy Onkol. 2022 Oct 5;66(3):175-184. Epub 2022 Aug 3.

ABSTRACT

Evaluation of cancer incidence and mortality is essential for the design and development of oncology networks. In Hungary the population-based epidemiological data collection in oncology is executed by the Hungarian National Cancer Registry, whilst, mortality statistics are compiled by the Hungarian Central Statistical Office. In this review, Hungarian cancer epidemiology of 2010s was presented, using population- based morbidity and mortality data, and positioning the country in European cancer statistics. According to GLOBOCAN estimations, Hungary suffers from the highest cancer incidence and mortality rates in Europe. We have reported a steady increase in the number of new cases, while mortality stagnated. Lung and colorectal cancers showed the highest incidence, which was followed by breast cancer. These three malignancies are responsible for almost half of the cancer-related deaths. Improving the quality of population- based disease registries, such as the Hungarian Cancer Registry, requires wide and extensive multidisciplinary collaborative work from many stakeholders.

PMID:36200497

Phys Ther. 2022 Oct 6:pzac133. doi: 10.1093/ptj/pzac133. Online ahead of print.

ABSTRACT

OBJECTIVES: The purposes of this study were to (1) describe and summarize the use of simulation-based education (SBE) with student physical therapists in the international literature and (2) describe the application and integration of standards of best practice (SOBP) for SBE reported in published physical therapy education research.

METHODS: Ovid MEDLINE, CINAHL, Web of Science, and ERIC databases were searched. The search included any study published that involved the use of SBE with student physical therapists. Because this was a scoping review, only descriptive statistics were compiled; no methodologic quality assessment was performed.

RESULTS: This scoping review revealed a significant increase in literature describing SBE with student physical therapists in the past 10 years. Simulation was used to address learning objectives across a variety of content areas and clinical settings. Communication skills were the most common objectives for simulation. Limited use of SOBP, published in 2016, was reported and use of author-generated outcome measures without validation was common.

CONCLUSIONS: Although there has been an increase in literature reporting the use of SBE with student physical therapists across many practice areas and settings, many articles reported limited use and integration of published SOBP and frequently utilized outcome measures that had not been validated.

PMID:36200401 | DOI:10.1093/ptj/pzac133

Fam Pract. 2022 Oct 6:cmac110. doi: 10.1093/fampra/cmac110. Online ahead of print.

ABSTRACT

BACKGROUND: Glucagon-like peptide-1 receptor (GLP-1) agonists carry benefits and risks that must be evaluated prior to use and monitored throughout weight management therapy. Pharmacists possess the accessibility and extensive medication knowledge to evaluate and monitor the use of GLP-1 therapy in weight management patients.

OBJECTIVE: Evaluate the clinical and financial impact of a pharmacist-directed weight management service utilizing GLP-1 receptor agonists in a family practice setting.

METHODS: A retrospective cohort study including patients at 2 family practices, aged 18 and older, prescribed a weight management GLP-1 between October 1, 2021 and March 1, 2022 was performed. Patients who met inclusion and were prescribed a weight loss GLP-1 but were not managed by the clinical pharmacist were compared with the pharmacist cohort. Descriptive statistics and inferential statistics including an independent t-test were used in the data analysis.

RESULTS: There were 46 and 39 patients identified in the clinical pharmacist and primary care physician cohorts respectively. Patients in the clinical pharmacist cohort achieved a mean body weight reduction of 9.32% compared to 5.11% body weight reduction for patients in the primary care physician cohort (P = 0.01). There were 63 months identified of inappropriate GLP-1 therapy deprescribed in the clinical pharmacist cohort resulting in an estimated cost savings of $101,985.66.

CONCLUSIONS: The implementation of a pharmacist-led weight management clinic in 2 family medicine offices resulted in a significant reduction in body weight and reduction in total costs to the healthcare system compared to patients receiving weight management services from their primary care physician alone.

PMID:36200484 | DOI:10.1093/fampra/cmac110

Pediatr Pulmonol. 2022 Oct 6. doi: 10.1002/ppul.26191. Online ahead of print.

ABSTRACT

BACKGROUND: Health related quality of life(HRQoL) scales are now widely used in children with Cystic Fibrosis(cwCF) which reflects the course of the disease. In this cross-sectional study,our primary aim was to compare the Pediatric Oral Health-Related Quality of Life(POQL) and Oral Health Score(OHS) between cwCF and healthy group. Our secondary aim was to evaluate the association between Pseudomonas Aeruginosa(PA) colonization, pulmonary function test, OHS and POQL in cwCF.

METHODS: The study population (age ranging 6-14) included 55 cwCF followed at the Marmara University Division of Pediatric Pulmonology compared with 50 healthy peers. A survey consisted of general questions(age, sex etc.) and the POQL instrument were filled by parents.The decayed, missing and filled teeth for both primary(dft) and permanent dentition(DMFT) was detected according to WHO criteria.Data like current body mass index(BMI z score), colonization status with PA, predicted value for forced expiratory volume in one second(FEV1pp) and any hospitalizations during the previous year were obtained from their medical.Differences between the groups were evaluated using Chi-square and Mann-Whitney U test with a significance level set at 0.05 RESULTS: There was no significant difference between PA colonized cwCF and healthy controls in DMFT(p = 0.916). For all domains of POQL(emotional function, social function, role function), scores of cwCF were significantly better than healthy controls(p<0.05).There were no statistically significant differences between all domains of POQL scores in PA colonized and non-PA colonized cwCF’ POQL scores(p>0.05).

CONCLUSION: Evethough POQL scores of cwCF were encouraging,dental caries prevention and regular follow-ups should be taken into consideration. This article is protected by copyright. All rights reserved.

PMID:36200396 | DOI:10.1002/ppul.26191

Phys Ther. 2022 Oct 6:pzac134. doi: 10.1093/ptj/pzac134. Online ahead of print.

ABSTRACT

OBJECTIVES: The purposes of this study were to describe the current use of: (1) simulation in student physical therapist professional education programs; (2) standards of best practice (SOBP) for simulation-based education (SBE) in physical therapist education.

METHODS: Two surveys were created about current use of SBE in student physical therapist professional education programs in the United States. The first survey contained questions about the program, including the best contact person regarding simulation. The second survey investigated simulation use within the context of SOBP. Survey data were analyzed using descriptive statistics.

RESULTS: Survey 1 was sent to the program director at all fully accredited physical therapist programs (N = 236), and 143 responses were returned (61% response rate). Survey 2 was sent to the 136 individuals identified in Survey 1 and we received 81 completed surveys (60%). Over 90% of programs reported including SBE in their curricula with 86% providing 3 or more experiences. A median of 1 core faculty at each program reported training in SBE, but 23% reported no training. A lack of training in specific elements of the SOBP for SBE was reported by 40% to 50% of faculty. Limited use of SOBP was reported and use of outcome measures without validation was common.

CONCLUSION: Although SBE is used commonly in physical therapist education, many faculties: (1) do not have training in SBE; (2) do not consistently follow the SOBP; and (3) utilize outcome measures that are not validated. Limited faculty training in SBE and inconsistent inclusion of the SOBP suggests student learning in simulation is not optimized.

IMPACT: These results show that, despite increased use of simulation in physical therapist education programs, there is a dearth of faculty trained in SBE and inconsistent use of SOBP. Addressing these deficiencies could help to optimize the benefits of SBE in physical therapist education.

PMID:36200392 | DOI:10.1093/ptj/pzac134

Infect Control Hosp Epidemiol. 2022 Oct 6:1-5. doi: 10.1017/ice.2022.239. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether discontinuing active screening for vancomycin-resistant Enterococcus (VRE) in Alberta, Canada, acute-care facilities had an associated impact on the rate of rise of hospital-acquired (HA) VRE bloodstream infection (VRE-BSI).

SETTING: Acute-care facilities in Alberta, Canada.

PATIENTS: All patients who were admitted to Alberta Health Services or Covenant Health acute-care facilities between January 1, 2013, and March 31, 2020, and who met the definition for hospital-acquired VRE-BSI were included in the analyses.

METHODS: An intervention time-series Poisson regression was used to determine the slope change in VRE incidence between the pre- and postintervention (screening) periods. The patient population was separated into 3 cohorts: group 1 (low risk, VRE screening stopped), group 2 (high risk, VRE screening stopped), and group 3 (high risk, VRE screening continued). For all groups, a level- and slope-change model was used.

RESULTS: We did not find a statistically significant difference in the slope change or rate of rise in VRE-BSI before and after the intervention, with incidence rate ratio (IRRs) of 1.015 (95% confidence interval [CI], 0.982-1.049), 1.025 (95% CI, 0.967-1.086), and 0.989 (95% CI, 0.924-1.059) for groups 1, 2 and 3, respectively.

CONCLUSIONS: In Alberta, the rate of HA VRE-BSI has remained consistent, and our findings indicate that there has been no increase in the rate of rise of HA VRE-BSI in sites or units that discontinued screening for VRE, regardless of patient risk group.

PMID:36200345 | DOI:10.1017/ice.2022.239

Cardiol Young. 2022 Oct 6:1-6. doi: 10.1017/S1047951122003110. Online ahead of print.

ABSTRACT

BACKGROUND: Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.

METHODS: This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.

RESULTS: In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.

CONCLUSION: Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.

PMID:36200342 | DOI:10.1017/S1047951122003110

Mol Ecol. 2022 Oct 6. doi: 10.1111/mec.16714. Online ahead of print.

ABSTRACT

Coastal refugia during the Last Glacial Maximum (~21 ka) have been hypothesized at high latitudes in the North Atlantic, suggesting marine populations persisted through cycles of glaciation and are potentially adapted to local environments. Here, whole-genome sequencing was used to test whether North Atlantic marine coastal populations of the kelp Alaria esculenta survived in the area of Southwestern Greenland during the Last Glacial Maximum. We present the first annotated genome for A. esculenta and call variant positions in 54 individuals from populations in Atlantic Canada, Greenland, Faroe Islands, Norway, and Ireland. Differentiation across populations was reflected in ~1.9 million single nucleotide polymorphisms, which further revealed mixed ancestry in the Faroe Islands individuals between putative Greenlandic and European lineages. Time calibrated organellar phylogenies suggested Greenlandic populations were established during the last interglacial period more than 100 ka ago, and that Faroe Islands were likely established following the Last Glacial Maximum. Patterns in population statistics, including nucleotide diversity, minor allele frequencies, heterozygosity, and linkage disequilibrium decay, nonetheless suggested glaciation reduced Canadian Atlantic and Greenlandic populations to small effective sizes during the most recent glaciation. Functional differentiation was further reflected in exon read coverage, which revealed expansions unique to Greenland in 337 exons representing 162 genes, and a modest degree of exon loss (103 exons from 56 genes). Altogether, our genomic results provide strong evidence that A. esculenta populations were resilient to past climatic fluctuations related to glaciations and that high latitude populations are potentially already adapted to local conditions as a result.

PMID:36200326 | DOI:10.1111/mec.16714

Photochem Photobiol. 2022 Oct 6. doi: 10.1111/php.13733. Online ahead of print.

ABSTRACT

The Antarctic region is a place of increasing interest. A growing number of personnel are working outdoors in extreme environmental conditions. They receive significant exposure to solar Ultraviolet radiation and are thereby at increased risk of adverse consequences. The aim of this study was to evaluate the UVR dose received by the outdoor workers at the Bulgarian Antarctic Base. Ten Caucasian healthy subjects, 8 male and 2 female with a mean age of 38 years (29-51) were enrolled. Of them 5 were scientists and 5 were logistic workers. We measured the accumulated daily dose of UVR assessed by Standard Erythemal Dose in the two groups. All subjects wore personal dosimeters located near the face – the only non-covered skin area. The dosimeters were factory calibrated for use in the Antarctic region. No statistical difference (p=0.441) could be revealed between the SEDs in the two groups. The maximum UVR dose detected in a single day was 67.9 SEDs and the highest cumulative dose was 548.03 SEDs. Study results are showing extreme measurements of UVR received by the members of the expeditions. We suggest meticulous UV protection for outdoor workers.

PMID:36200321 | DOI:10.1111/php.13733