Tag: statistics

J Am Acad Orthop Surg. 2022 Jul 12. doi: 10.5435/JAAOS-D-21-01143. Online ahead of print.

ABSTRACT

INTRODUCTION: Socioeconomic factors may introduce barriers to telemedicine care access. This study examines changes in clinic absenteeism for orthopaedic trauma patients after the introduction of a telemedicine postoperative follow-up option during the COVID-19 pandemic with attention to patient socioeconomic status (SES).

METHODS: Patients (n = 1,060) undergoing surgical treatment of pelvic and extremity trauma were retrospectively assigned to preintervention and postintervention cohorts using a quasi-experimental design. The intervention is the April 2020 introduction of a telemedicine follow-up option for postoperative trauma care. The primary outcome was the missed visit rate (MVR) for postoperative appointments. We used Poisson regression models to estimate the relative change in MVR adjusting for patient age and sex. SES-based subgroup analysis was based on the Area Deprivation Index (ADI) according to home address.

RESULTS: The pre-telemedicine group included 635 patients; the post-telemedicine group included 425 patients. The median MVR in the pre-telemedicine group was 28% (95% confidence interval [CI], 10% to 45%) and 24% (95% CI, 6% to 43%) in the post-telemedicine group. Low SES was associated with a 40% relative increase in MVR (95% CI, 17% to 67%, P < 0.001) compared with patients with high SES. Relative MVR changes between pre-telemedicine and post-telemedicine groups did not reach statistical significance in any socioeconomic strata (low ADI, -6%; 95% CI, -25% to 17%; P = 0.56; medium ADI, -18%; 95% CI, -35% to 2%; P = 0.07; high ADI, -12%; 95% CI, -28% to 7%; P = 0.20).

CONCLUSIONS: Low SES was associated with a higher MVR both before and after the introduction of a telemedicine option. However, no evidence in this cohort demonstrated a change in absenteeism based on SES after the introduction of the telemedicine option. Clinicians should be reassured that there is no evidence that telemedicine introduces additional socioeconomic bias in postoperative orthopaedic trauma care.

LEVEL OF EVIDENCE: III.

PMID:35834815 | DOI:10.5435/JAAOS-D-21-01143

J Pediatr Orthop B. 2022 Jul 14. doi: 10.1097/BPB.0000000000000999. Online ahead of print.

ABSTRACT

The role of the iliopsoas as an obstructing and re-dislocating factor in developmentally dislocated hips is unclear. The purpose of this article is to determine the change in the iliopsoas’ tension during flexion and extension when performing an open reduction. We evaluated 34 hips undergoing an anterior open reduction for a developmental dislocation. At the time of surgery, we identified the iliopsoas, and before sectioning it as part of the open reduction, we measured the tension while cycling the reduced hip through flexion and extension. We performed statistical analysis using Pearson and Spearman correlation tests. We created an initial tension artificially at 20 N with the hip held in 90º of flexion, which then doubled to a mean of 42 N when placed in extension. We found a significant increase in tension when the hip went below 20º of flexion. We also found the correlation between the angle of the hip and the force of tension to be statistically significant (P = 0.003). This study provides quantitative support that the tension of the iliopsoas tendon increases significantly in extension when performing an open reduction of a developmentally dislocated hip.

PMID:35834787 | DOI:10.1097/BPB.0000000000000999

J Clin Oncol. 2022 Jul 14:JCO2101604. doi: 10.1200/JCO.21.01604. Online ahead of print.

ABSTRACT

PURPOSE: The phase III POLO study demonstrated significant progression-free survival (PFS) benefit for active olaparib maintenance therapy versus placebo for patients with metastatic pancreatic adenocarcinoma and a germline BRCA mutation. Here, we report the final analysis of overall survival (OS) and other secondary end points.

PATIENTS AND METHODS: Patients with a deleterious or suspected deleterious germline BRCA mutation whose disease had not progressed after ≥ 16 weeks of first-line platinum-based chemotherapy were randomly assigned 3:2 to active maintenance olaparib (300 mg twice daily) or placebo. The primary end point was PFS; secondary end points included OS, time to second disease progression or death, time to first and second subsequent cancer therapies or death, time to discontinuation of study treatment or death, and safety and tolerability.

RESULTS: In total, 154 patients were randomly assigned (olaparib, n = 92; placebo, n = 62). No statistically significant OS benefit was observed (median 19.0 v 19.2 months; hazard ratio [HR], 0.83; 95% CI, 0.56 to 1.22; P = .3487). Kaplan-Meier OS curves separated at approximately 24 months, and the estimated 3-year survival after random assignment was 33.9% versus 17.8%, respectively. Median time to first subsequent cancer therapy or death (HR, 0.44; 95% CI, 0.30 to 0.66; P < .0001), time to second subsequent cancer therapy or death (HR, 0.61; 95% CI, 0.42 to 0.89; P = .0111), and time to discontinuation of study treatment or death (HR, 0.43; 95% CI, 0.29 to 0.63; P < .0001) significantly favored olaparib. The HR for second disease progression or death favored olaparib without reaching statistical significance (HR, 0.66; 95% CI, 0.43 to 1.02; P = .0613). Olaparib was well tolerated with no new safety signals.

CONCLUSION: Although no statistically significant OS benefit was observed, the HR numerically favored olaparib, which also conferred clinically meaningful benefits including increased time off chemotherapy and long-term survival in a subset of patients.

PMID:35834777 | DOI:10.1200/JCO.21.01604

Semin Ophthalmol. 2022 Jul 14:1-7. doi: 10.1080/08820538.2022.2100714. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this paper was to evaluate the ring amplitudes in diabetic patients and to evaluate the effect of the risk factors for diabetic retinopathy on the ring amplitudes. We also aimed to investigate the success of ring amplitudes in classifying diabetic retinopathy.

METHODS: The study included 32 eyes of 32 diabetic patients without retinopathy (DM), 34 eyes of 34 patients with mild non-proliferative diabetic retinopathy (NPDR) without macular edema, and 62 eyes of 62 age- and sex-matched controls (CG). All subjects were evaluated using mfERG. The relationship between age, diabetes duration, HbA1c and ring amplitudes and the effect of diabetes and hypertension on ring amplitudes were evaluated. Three-way ROC analysis was performed to evaluate the discrimination power of the ring amplitudes.

RESULTS: In the comparison of the ring amplitudes, the amplitudes of the DM and NPDR groups were statistically significantly decreased compared to the CG (p < .05). A moderate to strong correlation was found between the duration of diabetes, HbA1c and ring amplitudes (p < .05). The effect of diabetes decreased towards the peripheral rings and hypertension did not affect ring amplitudes. Volume under the ROC surface of R1 = 0.65 had p < .05 and 95% CI [0.50-0.72], and the best cut-off point pair to differentiate the three classes was found to be c₁ = 217.3, c₂ = 151.2 in three-way ROC analysis.

CONCLUSION: In conclusion, the effects of diabetes are unevenly distributed on the retina topographically. Diabetes affects the central rings more than peripheral rings in multifocal ERG. Both ring densities and ring ratios are effective ways to identify early changes in retinal function.

PMID:35834721 | DOI:10.1080/08820538.2022.2100714

J Athl Train. 2022 Jul 14. doi: 10.4085/1062-6050-0703.21. Online ahead of print.

ABSTRACT

CONTEXT: Assessment of running mechanics has traditionally been conducted in laboratory settings; the advancement of wearable technology permits data collection during outdoor training sessions. Exploring changes in running mechanics across training session types may assist runners, coaches, and sports medicine clinicians in improving performance and managing injury risk.

OBJECTIVE: The purpose of this investigation was to examine changes in running mechanics based on routine training session types.

DESIGN: Descriptive observational study.

SETTING: Field-based, university.

METHODS: Running mechanics data (i.e., impact g (PI), stride length(SL), braking g (BF), total shock, and cadence, and ground contact time (GCT)) for National Collegiate Athletic Association (NCAA) Division 1 distance runners (males, n=20) were collected using RunScribe™ sensors mounted to the laces during training sessions (long run (LR), interval run (IR), and/or recovery run (RR)) during a one-week period.

RESULTS: Repeated measures ANCOVA with Greenhouse Geisser correction, with training session pace as a covariate, determined no statistically significant differences in spatiotemporal or kinetic measures across the three training session types. Cadence and SL were inversely related in all training sessions (LR: r=-0.673, p=0.004; IR: r=-0.893, p=<0.001; RR: r=-0.549, p=0.023). Strong positive correlations were seen between PI and total shock in all training sessions (LR: r=0.894, p<0.001; IR: r=0.782, p=<0.001; RR: r=0.922, p<0.001). GCT increased with SL during LR training sessions (r=0.551, p=0.027) and decreased with BF in IR training sessions (r=-0.574, p=0.016) and cadence in RR training sessions (r=-0.487, p=0.048).

CONCLUSION: Running mechanics were not statistically different between training session type in collegiate distance runners when controlling for training session pace. The use of wearable technology provides a tool to provide necessary data during overland training to inform training and program design.

PMID:35834715 | DOI:10.4085/1062-6050-0703.21

J Athl Train. 2022 Jul 14. doi: 10.4085/1062-6050-0227.22. Online ahead of print.

ABSTRACT

CONTEXT: Work-life balance continues to be a focal point of athletic training research, particularly due to the job challenges and demands of healthcare providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance.

OBJECTIVE: Examine the relationship between work-family conflict (WFC), family role performance (FRP) and various demographic variables among athletic trainers employed in the collegiate setting.

DESIGN: Cross-sectional online survey.

SETTING: Collegiate setting.

PATIENTS OR OTHER PARTICIPANTS: 586 collegiate athletic trainers (females=374, males=210, gender variant/non-conforming=1, preferred not to answer=1).

MAIN OUTCOME MEASURE(S): Data were collected through an online survey (Qualtrics) where participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptives and frequencies. Mann-Whitney U tests were performed to identify differences among groups.

RESULTS: Participants mean scores were 28.19±6.01 and 45.86±11.55 for the FRP and WFC scales respectively. Mann Whitney-U tests revealed statistically different differences between men and women for WFC scores (U=344667, p=.021). Family role performance was moderately negatively correlated with WFC total score (rs[584] = -.497, p<.001) and predicted WFC scores (b=72.02, t582=-13.30, p=.001). Mann Whitney-U test demonstrated married athletic trainers (47.20±11.92) had statistically significantly higher WFC scores (U=19847.00, p=.003) than those who were not married (43.48±11.78). Mann Whitney U analysis (U=32096.00 p=.001) also found a significant difference between college athletic trainers with children (48.16±12.44) and those without children (44.68±10.90).

CONCLUSIONS: Collegiate athletic trainers experience more WFC with marriage and having children. These findings indicate that time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to engage in their family roles, when this is limited WFC increases.

PMID:35834711 | DOI:10.4085/1062-6050-0227.22

Vector Borne Zoonotic Dis. 2022 Jul;22(7):402-407. doi: 10.1089/vbz.2021.0092.

ABSTRACT

Background: Jingmen tick virus (JMTV) has attracted great attention due to its potential pathogenicity in humans and its transmission by ticks. Dermacentor silvarum (D. silvarum) is one of the dominant tick species in northeastern China, and can transmit many pathogens to humans and animals. However, there have been no report of transmission of JMTV by D. silvarum. Materials and Methods: Ticks were collected from vegetation at the Aershan Port in Inner Mongolia in April 2019. And we do attempt to infect D. silvarum with JMTV by the immersion technique in laboratory conditions. The transmission of JMTV was examined by reverse transcriptase PCR, fluorescence in situ hybridization, and indirect immunofluorescence assay. Statistical analysis was performed using SPSS 24.0. Results: We found that JMTV may only be maintained in the tick without replication, and could not be transmitted to a host following transstadial transmission. Moreover, no virus colonization was found in the midgut or salivary glands of unfed D. silvarum; therefore, D. silvarum may not be susceptible to JMTV infection and therefore unlikely to carry and transmit JMTV. Conclusion: Our study has to some extent filled the knowledge gap regarding the possibility of JMTV transmission by a medically important tick vector, D. silvarum.

PMID:35834662 | DOI:10.1089/vbz.2021.0092

Crit Care Med. 2022 Jul 15. doi: 10.1097/CCM.0000000000005624. Online ahead of print.

ABSTRACT

OBJECTIVES: We aim to describe incidence and outcomes of cardiopulmonary resuscitation (CPR) efforts and their outcomes in ICUs and their changes over time.

DESIGN: Retrospective cohort analysis.

SETTING: Patient data documented in the Austrian Center for Documentation and Quality Assurance in Intensive Care database.

PATIENTS: Adult patients (age ≥ 18 yr) admitted to Austrian ICUs between 2005 and 2019.

INTERVENTIONS: None.

MEASUREMENTS ANDN MAIN RESULTS: Information on CPR was deduced from the Therapeutic Intervention Scoring System. End points were overall occurrence rate of CPR in the ICU and CPR for unexpected cardiac arrest after the first day of ICU stay as well as survival to discharge from the ICU and the hospital. Incidence and outcomes of ICU-CPR were compared between 2005 and 2009, 2010 and 2014, and 2015 and 2019 using chi-square test. A total of 525,518 first admissions and readmissions to ICU of 494,555 individual patients were included; of these, 72,585 patients (14.7%) died in hospital. ICU-CPR was performed in 20,668 (3.9%) admissions at least once; first events occurred on the first day of ICU admission in 15,266 cases (73.9%). ICU-CPR was first performed later during ICU stay in 5,402 admissions (1.0%). The incidence of ICU-CPR decreased slightly from 4.4% between 2005 and 2009, 3.9% between 2010 and 2014, and 3.7% between 2015 and 2019 (p < 0.001). A total of 7,078 (34.5%) of 20,499 patients who received ICU-CPR survived until hospital discharge. Survival rates varied slightly over the observation period; 59,164 (12.0%) of all patients died during hospital stay without ever receiving CPR in the ICU.

CONCLUSIONS: The incidence of ICU-CPR is approximately 40 in 1,000 admissions overall and approximately 10 in 1,000 admissions after the day of ICU admission. Short-term survival is approximately four out of 10 patients who receive ICU-CPR.

PMID:35834661 | DOI:10.1097/CCM.0000000000005624

Microb Drug Resist. 2022 Jul;28(7):806-818. doi: 10.1089/mdr.2022.0074.

ABSTRACT

Background: Multidrug-resistant (MDR) bacteremia is a serious health care-associated infection with significant morbidity and excess hospitalization costs. Our aim is to study the association between incidences of MDR bacteremia, antibiotic consumption, and infection control measures in a hospital from 2013 to 2018. Methods: We analyzed the following indices: (1) incidence of bacteremia (carbapenem-resistant Acinetobacter baumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci); (2) use of antibiotics; (3) consumption of disinfectant solutions for hand hygiene; and (4) isolation rates of MDR carrier patients. Findings: The use of advanced antibiotics (p = 0.001) and carbapenems (p = 0.008) decreased significantly in all hospital departments but the incidence of total MDR bacteremia did not change significantly. Increased use of hand disinfectant solutions was statistically associated with decreased incidence of total MDR bacteremia (incidence rate ratio [IRR]: 0.94, confidence interval [95% CI]: 0.90-0.99, p: 0.020) in all hospital. Also, increased isolation rates of MDR carrier patients 2 months before correlated with decreased incidence of bacteremia due to carbapenem-resistant gram-negative pathogens (IRR: 0.35, 95% CI: 0.18-0.66, p: 0.001) in adults intensive care unit. Conclusion: In our hospital, hand hygiene and isolation of MDR carrier patients controlled MDR bacteremia.

PMID:35834622 | DOI:10.1089/mdr.2022.0074

PLoS Med. 2022 Jul 14;19(7):e1003939. doi: 10.1371/journal.pmed.1003939. eCollection 2022 Jul.

ABSTRACT

Kenji Shibuya and coauthors discuss the potential contribution of East Asian countries to global health in the light of COVID-19.

PMID:35834572 | DOI:10.1371/journal.pmed.1003939