Tag: statistics

Psychiatriki. 2022 Apr 27. doi: 10.22365/jpsych.2022.079. Online ahead of print.

ABSTRACT

Theophrastus (381-278 B.C.), was the first to adopt the term character for the description of distinct inner psychological and moral features of an individual. In his classic book ‘Characters’ in a simple style wording he analyses some of his contemporary individuals. The character “Αναίσθητος” (Anaisthetos) has been translated in English as “The Obtuse Man” and in Modern Greek both as “Αναίσθητος”, meaning lack of appreciation and “Βραδύνους”, meaning slowness of mind. Theophrastus’ description of this particular character is compatible with the co-occurrence in an adult of two Neurodevelopmental Disorders: the Attention-Deficit Hyperactivity Disorder (ADHD) and the Social Pragmatic Communication Disorder (SPCD), according to the 5th Diagnostic and Statistical Manual of Mental Disorders. Ten out of the twelve statements support the possible occurrence of ADHD while five of them the occurrence of SPCD. The description does not justify a diagnosis of an intellectual disability; therefore, we consider that in the Modern Greek vocabulary the original term «Αναίσθητος» (“Anaisthetos”), meaning lack of appreciation, is more accurately corresponding to this particular Theophrastus’s character than “Βραδύνους” (“Obtuse”), which indicates the presence of low intellectual capacities. Also the lack of repetitive and restrictive interests and behaviours excludes Autism Spectrum Disorder as a possible diagnosis. Minor psychiatric disorders and traits according to the Peripatic School were attributed to the lack of rational control over appetites and behavior. Accordingly, «Αναίσθητος» is a phenomenological description of a stigmatizing inappropriate social behavior and the only help that might give is in increasing self-awareness. In our contemporary clinical practice, though, the early recognition and appropriate treatment of Neurodevelopmental Disorders in affected individuals, leads to a better clinical care and may diminish stigmatization. The co-existence of these two disorders in a character in such a different historical context reinforces their validity as diagnostic constructs and provides an example of co-occurrence of Neurodevelopmental Disorders.

PMID:35477088 | DOI:10.22365/jpsych.2022.079

Eur J Obstet Gynecol Reprod Biol. 2022 Apr 21;273:54-58. doi: 10.1016/j.ejogrb.2022.04.016. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the usefulness of Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) as an ovarian reserve marker in hypogonadotropic hypogonadism (HH) patients and to find a limit value for the gonadotropin levels in the diagnosis of HH patients.

STUDY DESIGN: It is a retrospective cross-sectional single-center study. One hundred ninety-nine women with HH and 171 healthy controls with no cycle disorders were included into this study. Continuous variables were expressed as mean ± standard deviation. Statistical comparisons were carried out according to the intention to treat by Student’s t-test, Mann-Whitney U test, where appropriate. Receiver operating characteristic curve-ROC was used to represent the sensitivity and specificity pair corresponding to decision threshold of FSH and LH levels in HH diagnosis. P < 0.05 was accepted to be statistically significant.

RESULTS: There was not any statistically significant difference between HH and control group regarding the age (23.94 ± 6.56 vs. 23.92 ± 3.01, respectively; p = 0.09). Serum AMH levels didn’t show statistically significant difference between HH and control group (3.26 ± 2.61 ng/mL vs. 3.15 ± 1.46 ng/mL, respectively; p = 0.11). The difference of AFC between HH and control group was statistically significant (6.67 ± 6.33 vs. 10.91 ± 2.92, respectively; p < 0.001). Follicle-stimulating hormone (FSH), Luteinizing-hormone (LH) and Estradiol (E₂) levels between the groups were found to be significantly different. Area under the receiver operating characteristic curve-ROC for FSH was 0.98 and for LH was 0.96. For the diagnosis of HH, FSH levels lower than 3.05 IU/L (with a sensitivity of 92% and specificity of 94%) and LH levels lower than 1.55 IU/L (with a sensitivity of 91% and specificity of 92%) can be used.

CONCLUSION: In conclusion, serum AMH levels reflect the follicle cohort in HH cases validly with negligible underestimation of ovarian reserve. FSH < 3.05 IU/L and LH < 1.55 IU/L could be used with high sensitivity and specificity for the diagnosis of HH.

PMID:35477042 | DOI:10.1016/j.ejogrb.2022.04.016

Orthop Traumatol Surg Res. 2022 Apr 24:103300. doi: 10.1016/j.otsr.2022.103300. Online ahead of print.

ABSTRACT

INTRODUCTION: Periprosthetic fractures have become one of the main reasons for revision of total hip arthroplasty, with the treatment strategy guided by the Vancouver and SOFCOT classification systems. The main objective of this work was to compare the functional outcomes and mortality rate in patients who suffered a periprosthetic hip fracture with femoral stem loosening and who were treated either by internal fixation with locking plate only, or in combination with revision of the existing femoral stem with a cemented stem. The secondary objective was to compare the blood loss, procedure duration, length of hospital stay, living arrangements, time to weight bearing and major complications between these two treatment strategies. The starting hypothesis was that there is no difference in the functional outcomes between these two groups.

MATERIALS AND METHODS: This was a single center, retrospective study of patients treated between 2013 and 2019. Thirty-six patients (54%) underwent femoral stem revision (FSR group) and 31 patients (46%) were treated by locking plate fixation only (ORIF group). In this population, 19 of the patients had been residing at a nursing home before the surgical treatment: 12 (33%) in the FSR group and 7 (23%) in the ORIF group (p = 0.33). The mean preoperative Parker score was 7.03 (± 1.48) in the FSR group versus 5.19 (± 1.92) in the ORIF group. The functional outcomes at the final review were evaluated using the Parker score, HHS (Harris Hip score), WOMAC (Western Ontario and McMaster Arthritis Index) and Oxford score. Fracture healing was determined on radiographs centered over the hip joint with the entire femur visible on AP and lateral views. All patients were reviewed at a minimum of 1 year for clinical and radiological assessments.

RESULTS: At a mean follow-up of 28 months [12-85], the Oxford score was 40.4 (± 10.6) in the FSR group versus 37.1 (± 13.5) in the ORIF group (p = 0.34), WOMAC of 45.5 (± 26.9) versus 50.5 (± 32.4) (p = 0.56), and HHS of 62.7 (± 25.5) versus 60.3 (± 28.6) (p = 0.79). The Parker score at the final assessment was 5.14 (± 1.96) in the FSR group versus 4.64 (± 2.17) in the ORIF group (p = 0.33). In the FSR group, 10 patients were at a nursing home (34%), 6 of whom were not there initially, versus 6 in the ORIF group (43%), 5 of whom were not there initially (p = 0.59). The mean operating time was 152 ± 41.4 minutes (minimum: 85; maximum: 254) in the FSR group versus 89.2 (± 44.1) minutes (minimum: 39; maximum: 280) in the ORIF group (p < 0.001). Resumption of full weight bearing occurred at 6 weeks in 21 patients (58%) in the FSR group versus 14 patients (47%) in the ORIF group (p = 0.023). There were 5 major complications (14%) in the FSR group versus 7 (23%) in the ORIF group (p = 0.35). Among the reviewed patients, the union rate was 86% on the latest radiographs in the FSR group versus 78% in the ORIF group.

DISCUSSION: There was no statistically significant difference between groups in the various functional scores, confirming our study hypothesis. Internal fixation with a locking plate appears to be an acceptable solution for treating periprosthetic hip fractures in which the femoral stem has loosened.

LEVEL OF EVIDENCE: III, comparative retrospective study.

PMID:35477038 | DOI:10.1016/j.otsr.2022.103300

Am J Audiol. 2022 Apr 27:1-11. doi: 10.1044/2022_AJA-21-00171. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this project was to assess subjective and objective benefit provided by several direct-to-consumer hearing devices for middle-aged adults. The primary goal of this study was to determine the extent to which this type of device can yield benefit when users are listening in a range of acoustic conditions, rather than to compare benefit among devices.

METHOD: Participants (M _age = 58 years, n = 40) completed a speech perception task with and without one of four direct-to-consumer devices. Stimuli were presented with three types of maskers (steady-state noise, modulated noise, and competing talkers) at two different signal-to-noise ratios and two target levels. Participants also rated the effort required to complete the task with and without the devices and completed a short questionnaire about device comfort and perceived effectiveness.

RESULTS: The amount of objective benefit (in terms of speech recognition accuracy) varied among the four products, with two of the four devices yielding statistically significant benefit with medium-to-large effect sizes. Reduction in self-rated listening effort was noted from the use of all four devices, with a moderate effect size. Degree of hearing loss (4-frequency pure-tone average) was not significantly associated with the amount of either subjective or objective benefit. Responses to the posttask questionnaire indicated that many of the participants would be willing to use these or similar devices in the “real world.”

CONCLUSIONS: Our findings support the concept that direct-to-consumer hearing devices have the potential to improve objective and/or subjective speech recognition in middle-aged adults, at least when fit to prescriptive targets. Benefit from these devices was not related to degree of hearing loss in this sample of participants.

PMID:35476927 | DOI:10.1044/2022_AJA-21-00171

Am J Hum Genet. 2022 Apr 21:S0002-9297(22)00151-3. doi: 10.1016/j.ajhg.2022.04.003. Online ahead of print.

ABSTRACT

Most disease-associated genetic variants are pleiotropic, affecting multiple genetically correlated traits. Their pleiotropic associations can be mechanistically informative: if many variants have similar patterns of association, they may act via similar pleiotropic mechanisms, forming a shared component of heritability. We developed pleiotropic decomposition regression (PDR) to identify shared components and their underlying genetic variants. We validated PDR on simulated data and identified limitations of existing methods in recovering the true components. We applied PDR to three clusters of five to six traits genetically correlated with coronary artery disease (CAD), asthma, and type II diabetes (T2D), producing biologically interpretable components. For CAD, PDR identified components related to BMI, hypertension, and cholesterol, and it clarified the relationship among these highly correlated risk factors. We assigned variants to components, calculated their posterior-mean effect sizes, and performed out-of-sample validation. Our posterior-mean effect sizes pool statistical power across traits and substantially boost the correlation (r²) between true and estimated effect sizes (compared with the original summary statistics) by 94% and 70% for asthma and T2D out of sample, respectively, and by a predicted 300% for CAD.

PMID:35477001 | DOI:10.1016/j.ajhg.2022.04.003

J Opioid Manag. 2022 Mar-Apr;18(2):161-166. doi: 10.5055/jom.2022.0706.

ABSTRACT

OBJECTIVE: To benchmark opioid abuse risk among student pharmacists attending three northeast pharmacy schools utilizing the opioid risk tool (ORT).

DESIGN: A cross-sectional, anonymous risk assessment questionnaire.

SETTING: Three pharmacy schools in the northeast United States.

PARTICIPANTS: Professional year 1 (P1) through professional year 3 (P3) student pharmacists.

METHODS: ORT was collected and scored by investigators and inputted into an electronic format for analysis. Students voluntarily participated, and 812 surveys were completed during one course meeting time and day at each school.

RESULTS: The majority of students were in the low-risk category (n = 581, 71.6 percent). Additionally, 137 (16.9 percent) patients were categorized as moderate risk and 94 (11.6 percent) as high risk. No statistically significant differences existed when comparing risk groups across the first through third professional year student pharmacist cohorts. There were no statistically significant differences in the proportion of risk groups among the three pharmacy cohorts between low-risk versus the high-risk groups. When comparing risk groups by gender, males were found to have a statistically significant higher proportion of being classified as moderate or high risk.

CONCLUSIONS: The results of this study demonstrate that there may be some student pharmacists with an increased risk for opioid abuse potential. There is potential need for education regarding opioid risk awareness and abuse prevention, which may serve as a call to action for professional school students and practitioners to understand baseline opioid abuse risk if they require chronic pain therapy.

PMID:35476885 | DOI:10.5055/jom.2022.0706

J Surg Oncol. 2022 Apr 27. doi: 10.1002/jso.26907. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Low anterior rectosigmoid resection for a gynecologic disease is usually performed in concert with other procedures and can result in significant morbidity should anastomotic complication occur. This study examined surgical outcomes of side-to-end reanastomosis after low anterior resection (STELAR) performed by gynecologic oncology service.

METHODS: This is a case series examining consecutive patients who underwent STELAR for gynecologic indications by a single gynecologic oncology group from 2009 to 2018. Prospectively collected institutional surgical database was searched for STELAR, and standard descriptive statistics were used to describe intraoperative and postoperative complications specific to reanastomosis.

RESULTS: A total of 69 women underwent STELAR, with median age and body mass index of 54 years and 24 kg/m² , respectively. 63.8% of patients had ovarian cancer and 84.4% had stage III-IV disease. The median estimated blood loss was 875 ml. Four (5.8%) women underwent protective loop colostomy at the time of STELAR. Postoperatively, there was 1 (1.4%) case of abscess formation within 30 days and 1 (1.4%) case of anastomotic leak 5 weeks after STELAR that required reoperation and diversion. No cases of fistula were clinically identified.

CONCLUSION: Side-to-end reanastomosis may be a safe and feasible procedure to accomplish low rectosigmoid anastomosis in women with gynecologic disease.

PMID:35476891 | DOI:10.1002/jso.26907

J Opioid Manag. 2022 Mar-Apr;18(2):151-159. doi: 10.5055/jom.2022.0705.

ABSTRACT

OBJECTIVE: This article overviews the current statistics and factors related to increased rates of opioid use disorder (OUD) in rural areas, uncovering factors that may contribute to increased vulnerability to opioid overdose. We qualitatively review opinions, feelings, and thoughts surrounding this issue in rural areas of Utah, analyzing participant stories in reference to three themes through qualitative interviews, including the solitude of addiction, the beguiling strength of addiction, and one way out of addiction.

DESIGN: In 2018, three focus groups were convened with 25 individuals from the rural area. Participants either currently or formerly (selfreported substance free for 6 months or more) experienced OUD with prescription opioids and heroin, or were family members of individuals who currently and formerly experienced OUD. These focus groups addressed current issues in OUDs in a rural Utah community related to person, place, and time. Following the focus groups, six individuals were invited to participate in semi-structured interviews. In-depth, semi-structured interviews queried individual experiences through a phenomenological approach, using a moderator guide with queries focused on identified themes related to the solitude, the intensity, and the difficulty escaping substance use disorder (SUD). Methodology included training community scholars with lived experience and member-checking to ensure phenomenological emphasis.

RESULTS: Our qualitative reviews of the experience of OUD and SUD in rural Utah discussed the relevance and the nuance of the three identified themes. The interviewee statements further underscore the solitude, intensity, and difficulty of an individual’s journey through SUD, the all-consuming nature of OUD, and the trouble that these factors cause in rural recovery.

CONCLUSIONS: We conclude that even during difficult situations in the rural experience with the opioid crisis, hope persists. OUD support in rurality may differ from the expected urban experience and include more coordination with criminal justice workers. Rural Americans have insights to share that could help turn the tide of this crisis.

PMID:35476884 | DOI:10.5055/jom.2022.0705

J Opioid Manag. 2022 Mar-Apr;18(2):133-141. doi: 10.5055/jom.2022.0703.

ABSTRACT

OBJECTIVE: The primary objective of this paper is to understand pharmacists’ naloxone offering and dispensing practices and factors affecting those practices. The secondary objective of this paper is to refine an existing survey instrument and use it to understand pharmacists’ naloxone offering and dispensing behaviors and factors affecting it.

DESIGN, SETTINGS, AND PARTICIPANTS: A statewide mail survey of pharmacists was conducted in Wisconsin using stratified random sampling. Survey data were analyzed using descriptive statistics to understand pharmacists’ naloxone offering and dispensing practices and multiple regression analysis to understand factors affecting these practices.

MAIN OUTCOMES: (1) Pharmacists’ practices about naloxone offering and dispensing; (2) factors affecting these practices.

RESULTS: Most pharmacies stocked naloxone (92.9 percent) and were under the Wisconsin standing order (80.1 percent). The majority of pharmacists reported that they occasionally (36.6 percent), rarely (29.3 percent), or never (21.5 percent) offer naloxone to patients. The majority reported that they occasionally (29.3 percent), rarely (52.4 percent), or never (15.2 percent) dispense naloxone. While most pharmacists were confident in their ability to initiate conversations about nalox-one, they were not confident on how to screen patients at risk for opioid overdose. Pharmacists offered naloxone more when they felt more confident initiating a conversation regarding the need for naloxone with patients (β = 0.50, p < 0.05). Pharmacists dispensed naloxone more when they have had more previous training about dispensing naloxone (β = 0.43, p < 0.05).

CONCLUSION: Many pharmacists hardly offer or dispense naloxone under the standing order. Pharmacists may benefit from standardized training and resources about screening patients for risk of overdose and overdose risk communication.

PMID:35476882 | DOI:10.5055/jom.2022.0703

J Opioid Manag. 2022 Mar-Apr;18(2):123-132. doi: 10.5055/jom.2022.0702.

ABSTRACT

AIM: To investigate adherence to discharge advice in a prescription opioid prescribing guideline (GL) post-orthopedic surgery.

METHODS: The guideline in draft form was introduced in February 2018. To assess longer-term adherence to discharge advice and to understand which components of that advice were adhered to, regular audits of discharge prescribing were performed after formal GL launch in February 2019, a year after the draft of the GL had been available. The post-GL audit was conducted for three months (March to May 2019) and results reviewed. When these audit results showed a need for improvement in prescribing practice, a 1-month education “booster” named prescription opioid practice improvement safe opioid supply (POPI SOS) took place. Audits for a further 3 months (July to Sept 2019) were then carried out to ascertain whether the additional effort improved adherence to the guideline.

RESULTS: On average, adherence to all elements of the guideline was low at only 23.1 percent at 12 months post-draft GL and 1 month after its formal launch. After POPI SOS, a statistically significant improvement was achieved with an average increase in adherence to 52.5 percent (ρ < 0.001). Greatest improvement was seen in the percentage of patients discharged with an opioid plan included in the discharge summary, increasing from 35.8 to 77.7 percent (ρ < 0.001). The second significant improvement observed was in the supply of opioids being limited to four days or less, an increase from 38.1 to 61.9 percent (ρ < 0.001).

CONCLUSION: Introduction of the guideline was not sufficient to promote sustained change in practice. Ongoing monitoring and education were required for its implementation. These findings highlight that comprehensive, locally adapted, evidence-based opioid stewardship is needed to increase the safety of patients and the community in relation to opioid therapy.

PMID:35476881 | DOI:10.5055/jom.2022.0702