Tag: statistics

Pediatr Emerg Care. 2021 Aug 23. doi: 10.1097/PEC.0000000000002523. Online ahead of print.

ABSTRACT

OBJECTIVES: Concussion is a commonly encountered diagnosis for pediatric emergency medicine (PEM) providers, yet little is known regarding referral patterns to specialists. Our goal was to assess PEM providers’ referral patterns and current usage of standardized evaluation tools.

METHODS: This study was conducted as cross-sectional survey of PEM providers recruited from the American Academy of Pediatrics Section on Emergency Medicine Listserv. Surveys were distributed at 3 time points between December 1, 2020, and February 28, 2021, and included multiple choice, Likert scale, and free text questions. Descriptive statistics and bivariate analyses were used to describe the sample and compare responses between those with variable experience and confidence in concussion management.

RESULTS: In total, 162 of 491 Listserv members (33.0%) completed the survey. The factors most often reported to assist in referral decisions were history of severe (92.6%) or multiple (90.7%) prior concussions, prolonged symptom duration (89.5%), and severity of current symptoms (84.6%). Most providers reported having large experience (63.0%) and confidence (54.9%) in managing concussion. Standardized symptom scales (8.0%), vestibular (11.7%) and balance assessments (13.0%), and prognostic tools (6.8%) were infrequently used. Most (64.2%) providers felt specialty referral was important. More than 80% reported high likelihood to use an accurate risk stratification tool to facilitate referral.

CONCLUSIONS: Although most PEM providers reported significant experience and confidence in managing pediatric concussion, standardized assessment tools were infrequently used. Most were likely to use a risk stratification tool to assist in specialty referral. Future studies should assess the ability of targeted referral strategies to improve recovery for concussed youth.

PMID:34432741 | DOI:10.1097/PEC.0000000000002523

Phytochem Anal. 2021 Aug 25. doi: 10.1002/pca.3085. Online ahead of print.

ABSTRACT

INTRODUCTION: Codonopsis Radix (CR) is an edible food and traditional Chinese herb medicine that is widely used in China and Southeast Asia. Saccharides, including fructo-oligosaccharides (FOS) and polysaccharides, are among the most important active substances in CR. However, a quality evaluation of CR based on oligosaccharides has not been conducted.

OBJECTIVE: This study aimed to establish a high-performance liquid chromatography coupled with charged aerosol detector method (HPLC-CAD) for the quality evaluation of CR and processed products based on analysis of monosaccharides and oligosaccharides.

METHOD: A sensitive and rapid HPLC-CAD method for the simultaneous determination of two monosaccharides (D-fructose and D-glucose), sucrose, and FOS (GF2-GF6) was established to evaluate the quality of CR for the first time. In the present study, 65 batches of CR from three species of the genus Codonopsis were analysed using multivariate statistical techniques. Furthermore, the effects of cultivation management measures (plant growth retardants supply, harvesting time, and growth period) and primary process (drying methods) in the production areas on the target compounds were studied by analysing 34 batches of processed samples.

RESULTS: Different varieties of CR resulted in considerably different saccharide contents. Cultivation management measures and processing method remarkably affected the quality of CR. Low concentration of plant growth retardants was recommended. The best harvest time is in October after 4 years of growth. Dryer-drying was suggested to meet the requirement for large-scale processing.

CONCLUSION: This method would provide an efficient analytical tool for monosaccharides and oligosaccharides of CR and contribute to the improvement of CR quality.

PMID:34431563 | DOI:10.1002/pca.3085

J Vet Pharmacol Ther. 2021 Aug 25. doi: 10.1111/jvp.13003. Online ahead of print.

ABSTRACT

Metamizole sodium (MT) is an analgesic and antipyretic drug molecule used in humans, horses, cattle, swine, and dogs. Metamizole rapidly hydrolyzes and turns into methylamino antipyrine (MAA), an active primary metabolite of MT. The present study aims to determine the pharmacokinetic (PK) profiles of MT metabolites after intravenous (IV) and intramuscular (IM) administration into sex of Arabian horses (Equus ferus caballus) using a cross-over study design. The plasma samples were extracted by solid-phase extraction (SPE) method, and plasma concentrations of MT metabolites were analyzed by high-performance liquid chromatography (HPLC). After administrations of MT, plasma concentrations of methylamino antipyrine (MAA), amino antipyrone (AA), and acetylamino antipyrone (AAA) were determined within range of 15 min-12 h. Plasma concentrations of AA and AAA were lower than the plasma concentrations of major metabolite MAA at each sampling point. The PK parameters were statistically evaluated for MT’s metabolites between male and female horses and also between IM and IV administrations of PK parameters such as C_max , t_max , t_1/2λz , AUC_0-t , AUC_0-∞ , λz, Cl and V_ss (p < .05). The AUC_IM /AUC_IV ratio in female and male horses for MAA was 1.19 and 1.13, respectively. The AUC_IM /AUC_IV ratio for AA was lower than those found for MAA. AUC_IM /AUC_IV ratio was statistically significantly different between male and female horses for AA (p < .05). According to these results, some PK parameters such as Cmax, AUC, and MRT, MAA and AA concentrations have shown statistically significant differences by MT administrations.

PMID:34431528 | DOI:10.1111/jvp.13003

Mov Disord. 2021 Aug 25. doi: 10.1002/mds.28773. Online ahead of print.

ABSTRACT

BACKGROUND: Neuropalliative care is an emerging field for those with neurodegenerative illnesses, but access to neuropalliative care remains limited.

OBJECTIVE: We sought to determine Movement Disorder Society (MDS) members’ attitudes and access to palliative care.

METHODS: A quantitative and qualitative survey instrument was developed by the MDS Palliative Care Task Force and e-mailed to all members for completion. Descriptive statistics and qualitative analysis were triangulated.

RESULTS: Of 6442 members contacted, 652 completed the survey. Completed surveys indicating country of the respondent overwhelmingly represented middle- and high-income countries. Government-funded homecare was available to 54% of respondents based on patient need, 25% limited access, and 21% during hospitalization or an acute defined event. Eighty-nine percent worked in multidisciplinary teams. The majority endorsed trigger-based referrals to palliative care (75.5%), while 24.5% indicated any time after diagnosis was appropriate. Although 66% referred patients to palliative care, 34% did not refer patients. Barriers were identified by 68% of respondents, the most significant being available workforce, financial support for palliative care, and perceived knowledge of palliative care physicians specific to movement disorders. Of 499 respondents indicating their training in palliative care or desire to learn these skills, 55% indicated a desire to gain more skills.

CONCLUSIONS: The majority of MDS member respondents endorsed a role for palliative care in movement disorders. Many members have palliative training or collaborate with palliative care physicians. Although significant barriers exist to access palliative care, the desire to gain more skills and education on palliative care is an opportunity for professional development within the MDS. © 2021 International Parkinson and Movement Disorder Society.

PMID:34431560 | DOI:10.1002/mds.28773

Public Health Nutr. 2021 Aug 25:1-22. doi: 10.1017/S1368980021003669. Online ahead of print.

ABSTRACT

OBJECTIVE: Neck circumference (NC) is currently used as an embryonic marker of obesity and its associated risks. But its use in clinical evaluations and other epidemiological purposes requires sex and age-specific standardized cut-offs which are still scarce for the Pakistani pediatric population. We therefore developed sex and age- specific growth reference charts for NC for Pakistani children and adolescents aged 2-18 years.

DESIGN: Cross-sectional multi-ethnic anthropometric survey (MEAS) study.

SETTING: Multan, Lahore, Rawalpindi and Islamabad.

PARTICIPANTS: The dataset of 10,668 healthy Pakistani children and adolescents aged 2 to 18 years collected in MEAS were used. Information related to age, sex and NC were taken as study variables. The lambda-mu-sigma (LMS) and quantile regression (QR) methods were applied to develop growth reference charts for NC.

RESULTS: The 5th, 10th, 25th, 50th, 75th, 90th and 95th smoothed percentile values of NC were presented. The centile values showed that neck size increased with age in both boys and girls. During 8 and 14 years of age, girls were found to have larger NC than boys. A comparison of NC median (50th) percentile values with references from Iranian and Turkish populations reveals substantially lower NC percentiles in Pakistani children and adolescents compared to their peers in the reference population.

CONCLUSION: The comparative results suggest that the uses of NC references of developed countries are inadequate for Pakistani children. A small variability between empirical centiles and centiles obtained by QR procedure recommends that growth charts should be constructed by QR as an alternative method.

PMID:34431474 | DOI:10.1017/S1368980021003669

J Forensic Sci. 2021 Aug 25. doi: 10.1111/1556-4029.14875. Online ahead of print.

ABSTRACT

A retrospective case-control study of 100 sepsis autopsy cases and 103 controls over a 9-year period was conducted to analyze patterns of neutrophils in small caliber vessels of the liver, heart, and lungs in relation to sepsis as the cause of death. Data extracted included demographics of the decedent, cause of death, presence of conditions that could interfere with an inflammatory response, history of hospitalization, and results of microbiology cultures. Histologic sections of the liver, heart, and lungs were assessed. Organs were scored for neutrophilic inflammation based upon a predetermined grading system. Scores of 0, 1, and 2 were assigned according to mild, moderate, and florid neutrophilic presence, respectively; a total score was also assigned based on the sum of the scores from all three organs. Comparing the histologic grading between cases and controls found a statistical difference with the neutrophil grading in the liver (p < 0.001), lung (p < 0.001), and heart (p < 0.001) and between the combined total scores (p < 0.001). Combined neutrophilic scores of 4 and greater showed high specificities (90% to 100%) for sepsis-related deaths. Examining the percentage of sepsis cases as the histologic neutrophilic score increased found a positive slope in all three organs. However, only the linear regression looking at the lung (p = 0.03) and the combined score (p = 0.001) were statistically significant. Despite the above results, sepsis cases with low scores and controls with moderate and florid neutrophilic infiltrates were also seen.

PMID:34431519 | DOI:10.1111/1556-4029.14875

Crit Rev Clin Lab Sci. 2021 Aug 25:1-20. doi: 10.1080/10408363.2021.1956423. Online ahead of print.

ABSTRACT

Peak stimulated growth hormone (GH) levels are known to decrease with increasing body mass index (BMI), possibly leading to overdiagnosis of GH deficiency (GHD) in children with overweight and obesity. However, current guidelines do not guide how to interpret the peak GH values of these children. This systematic review and meta-analysis aimed to study the effect of the BMI standard deviation score (SDS) on stimulated peak GH values in children, to identify potential moderators of this association, and to quantify the extent to which peak GH values in children with obesity are decreased. This systematic review was performed by the PRISMA guidelines. Medline, Embase, Cochrane, Web of Science, and Google Scholar databases were searched for studies reporting the impact of weight status on peak GH in children. Where possible, individual participant data was extracted and/or obtained from authors. Quality and risk of bias were evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) checklists. The primary outcome was the association between peak GH values and BMI SDS. The pooled correlation coefficient r, 95% confidence interval (CI), and heterogeneity statistic I² were calculated under a multilevel, random-effects model. In addition, exploratory moderator analyses and meta-regressions were performed to investigate the effects of sex, pubertal status, presence of syndromic obesity, mean age and mean BMI SDS on the study level. For the individual participant dataset, linear mixed-models regression analysis was performed with BMI SDS as the predictor and ln(peak GH) as the outcome, accounting for the different studies and GH stimulation agents used. In total, 58 studies were included, providing data on n = 5135 children (576 with individual participant data). Thirty-six (62%) studies had high, 19 (33%) medium, and 3 (5%) low risks of bias. Across all studies, a pooled r of -0.32 (95% CI -0.41 to -0.23, n = 2434 patients from k = 29 subcohorts, I² = 75.2%) was found. In meta-regressions, larger proportions of males included were associated with weaker negative correlations (p = 0.04). Pubertal status, presence of syndromic obesity, mean age, and mean BMI SDS did not moderate the pooled r (all p > 0.05). Individual participant data analysis revealed a beta of -0.123 (95% CI -0.160 to -0.086, p < 0.0001), i.e. per one-point increase in BMI SDS, peak GH decreases by 11.6% (95% CI 8.3-14.8%). To our knowledge, this is the first systematic review and meta-analysis to investigate the impact of BMI SDS on peak GH values in children. It showed a significant negative relationship. Importantly, this relationship was already present in the normal range of BMI SDS and could lead to overdiagnosis of GHD in children with overweight and obesity. With the ever-rising prevalence of pediatric obesity, there is a need for BMI (SDS)-specific cutoff values for GH stimulation tests in children. Based on the evidence from this meta-analysis, we suggest the following weight status-adjusted cutoffs for GH stimulation tests that have cutoffs for children with normal weight of 5, 7, 10, and 20 µg/L: for overweight children: 4.6, 6.5, 9.3, and 18.6 µg/L; and for children with obesity: 4.3, 6.0, 8.6, and 17.3 µg/L.

PMID:34431447 | DOI:10.1080/10408363.2021.1956423

Neurol Res. 2021 Aug 25:1-8. doi: 10.1080/01616412.2021.1959775. Online ahead of print.

ABSTRACT

BACKGROUND: : Various tools are currently available to quantify the risks of adverse clinical outcomes after an ischemic stroke. This study aimed to validate and compare prognostic scales among Chinese patients with ischemic stroke.

METHODS: : We compared three stroke prognostic scales (Stroke Prognostication using Age and the National Institutes of Health Stroke Scale-100 [SPAN-100], Totaled Health Risks in Vascular Events [THRIVE], and Acute Stroke Registry and Analysis of Lausanne [ASTRAL]) in 3870 Chinese patients with ischemic stroke from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The 2-year primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3).

RESULTS: : Among all the scales, the ASTRAL score had the best accuracy for predicting 2-year prognosis in Chinese patients with ischemic stroke. The C-statistic of the ASTRAL score for the 2-year primary outcome was 0.79 (95% confidence interval [CI]: 0.78-0.80), and the Hosmer-Lemeshow goodness-of-fit test showed that the ASTRAL score fitted Chinese patients with ischemic stroke well (χ² = 9.83, P = 0.277). The incidences of the primary outcome in the <5%, 5%-9.9%, 10%-19.9%, and ≥20% risk groups based on the ASTRAL scores were 3.93%, 7.55%, 14.29%, and 41.81%, respectively (odds ratio: 1.23; 95% CI: 1.21-1.26; P < 0.001).

CONCLUSION: : The ASTRAL score had higher efficacy than the SPAN-100 and THRIVE scores in predicting 2-year adverse outcomes among Chinese patients with ischemic stroke, suggesting that it could be a valuable risk assessment tool for the 2-year prognosis of such patients.

PMID:34431455 | DOI:10.1080/01616412.2021.1959775

Ann Med. 2021 Dec;53(1):1502-1508. doi: 10.1080/07853890.2021.1968027.

ABSTRACT

Objectives: Early fetal demise (absence of cardiac activity in a visible fetus) is a very common event, but there are no reliable biomarkers to predict it. The purpose of the study was to assess the association of platelet parameters with early fetal demise.Methods: In this case-control study, we included women with normal deliveries or those ultrasound diagnosed as early fetal demise. For those who were identified with early fetal demise, the platelet parameters were analyzed before the ultrasound diagnosis, which is based on the absence of either an embryo within a gestational sac or cardiac activity in a visible embryo in the 5-10 weeks of gestation. The association between the risk of early fetal demise with the women’s mean platelet volume (MPV) and platelet counts was calculated by logistic regression. Duplicate measurements of platelet aggregation were performed with VerifyNow. Results: In total, 99 women identified with early fetal demise and 170 women who had an uncomplicated pregnancy with normal delivery from January 2017 and August 2020 were included in the study. We found that platelet counts in the early fetal demise group were significantly higher than healthy pregnancies. In addition, platelet reactivity is higher in the normal delivery group than those in early fetal demise group (p < .05). High levels of platelet counts resulted in an adjusted odds ratio (OR) of 2.075 (95% confidence interval [95% CI], 1.215-3.544; p = .008) for early fetal demise. Conclusions: Increased platelet counts in the first trimester may be a predictor for the risk of early fetal demise.

PMID:34431412 | DOI:10.1080/07853890.2021.1968027

Neurol Res. 2021 Aug 25:1-10. doi: 10.1080/01616412.2021.1967678. Online ahead of print.

ABSTRACT

To systematically compare 27 ICH models with regard to mortality and functional outcome at 1-month, 3-month and 1-year after ICH. The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1-month, 3-month and 1-year after ICH, respectively. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. A total number of 1575 patients were included. The mean age was 57.2 ± 14.3 and 67.2% were male. The median NIHSS score on admission was 11 (IQR: 3-21). For predicting mortality at 3-month after ICH, AUROC of 27 ICH models ranged from 0.604 to 0.856. In pairwise comparison, the ICH-FOS (0.856, 95%CI = 0.835-0.878, P < 0.001) showed statistically better discrimination than other models for mortality at 3-month after ICH (all P < 0.05). For predicting poor functional outcome (mRS≥3) at 3-month after ICH, AUROC of 27 ICH models ranged from 0.602 to 0.880. In pairwise comparison with other prediction models, the ICH-FOS was superior in predicting poor functional outcome at 3-month after ICH (all P < 0.001). The ICH-FOS showed the largest Cox and Snell R-square. Similar results were verified for mortality and poor functional outcome at 1-month and 1-year after ICH. Several risk models are externally validated to be effective for risk stratification and outcome prediction after ICH, especially the ICH-FOS, which would be useful tools for personalized care and clinical trial in ICH.

PMID:34431446 | DOI:10.1080/01616412.2021.1967678