Tag: statistics

Cardiovasc Revasc Med. 2022 Aug 6:S1553-8389(22)00704-7. doi: 10.1016/j.carrev.2022.08.008. Online ahead of print.

ABSTRACT

BACKGROUND: The Lipid Rich Plaque (LRP) Study established the association between high volume of lipidic content (maximum Lipid Core Burden Index [maxLCBI_4mm] >400) in the coronary arteries and subsequent non-culprit major adverse cardiac events (NC-MACE). This analysis sought to assess the clinical impact of more than one lipid-rich plaque in the coronary tree.

METHODS: The LRP patient population was divided into four cohorts: 1) patients with all segments with maxLCBI_4mm = 0; 2) patients with all coronary segments maxLCBI_4mm < 400, but >0; 3) patients with 1 segment maxLCBI_4mm > 400; and 4) patients with 2+ coronary segments with maxLCBI_4mm > 400. Baseline characteristics, plaque-level characteristics, and follow-up outcomes were described.

RESULTS: Among 1550 patients, only 3.2 % had all segments with maxLCBI_4mm = 0; 65.1 % had segments with maxLCBI_4mm > 0 but <400; 22.5 % had one segment with maxLCBI_4mm > 400; and 9.5 % had 2+ coronary segments with maxLCBI_4mm > 400. Distribution within the coronary tree (one versus multiple arteries) did not differ. Overall, 1269 patients were allocated to follow-up (per study design). The composite of all-cause death, cardiac death, any revascularization, and NC-MACE was statistically higher in patients with 1 segment maxLCBI_4mm > 400 and numerically even higher in patients with 2+ segments with maxLCBI_4mm > 400. Patients with maxLCBI_4mm = 0 had no events within two years.

CONCLUSION: There is a stepwise increased risk of all-cause death, cardiac death, any revascularization, and NC-MACE according to the number of coronary segments with maxLCBI_4mm > 400. In contrast, maxLCBI_4mm = 0 results in a low event rate.

CLINICAL TRIAL REGISTRATION: The Lipid-Rich Plaque Study (LRP), https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.

PMID:36058829 | DOI:10.1016/j.carrev.2022.08.008

Vet Anaesth Analg. 2022 Jul 31:S1467-2987(22)00110-6. doi: 10.1016/j.vaa.2022.07.007. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether dobutamine, norepinephrine or phenylephrine infusions alleviate hypotension in isoflurane-anaesthetized dogs administered dexmedetomidine with vatinoxan.

STUDY DESIGN: Balanced, randomized crossover trial.

ANIMALS: A total of eight healthy Beagle dogs.

METHODS: Each dog was anaesthetized with isoflurane (end-tidal isoflurane 1.3%) and five treatments: dexmedetomidine hydrochloride (2.5 μg kg^-1) bolus followed by 0.9% saline infusion (DEX-S); dexmedetomidine and vatinoxan hydrochloride (100 μg kg^-1) bolus followed by an infusion of 0.9% saline (DEX-VAT-S), dobutamine (DEX-VAT-D), norepinephrine (DEX-VAT-N) or phenylephrine (DEX-VAT-P). The dexmedetomidine and vatinoxan boluses were administered at baseline (T0) and the treatment infusion was started after 15 minutes (T15) if mean arterial pressure (MAP) was < 90 mmHg. The treatment infusion rate was adjusted every 5 minutes as required. Systemic haemodynamics were recorded at T0 and 10 (T10) and 45 (T45) minutes. A repeated measures analysis of covariance model was used.

RESULTS: Most dogs had a MAP < 70 mmHg at T0 before treatment. Treatments DEX-S and DEX-VAT all significantly increased MAP at T10, but systemic vascular resistance index (SVRI) was significantly higher and cardiac index (CI) lower after DEX-S than after DEX-VAT. CI did not significantly differ between DEX-S and DEX-VAT-S at T45, while SVRI remained higher with DEX-S. Normotension was achieved by all vasoactive infusions in every dog, whereas MAP was below baseline with DEX-VAT-S, and higher than baseline with DEX-S at T45. Median infusion rates were 3.75, 0.25 and 0.5 μg kg^-1 minute^-1 for dobutamine, norepinephrine and phenylephrine, respectively. Dobutamine and norepinephrine increased CI (mean ± standard deviation, 3.35 ± 0.70 and 3.97 ± 1.24 L minute^-1 m^-2, respectively) and decreased SVRI, whereas phenylephrine had the opposite effect (CI 2.13 ± 0.45 L minute^-1 m^-2).

CONCLUSIONS AND CLINICAL RELEVANCE: Hypotension in isoflurane-anaesthetized dogs administered dexmedetomidine and vatinoxan can be treated with either dobutamine or norepinephrine.

PMID:36058821 | DOI:10.1016/j.vaa.2022.07.007

Eur Urol. 2022 Sep 1:S0302-2838(22)02564-7. doi: 10.1016/j.eururo.2022.08.012. Online ahead of print.

ABSTRACT

BACKGROUND: Transurethral resection of recurrent low-grade intermediate-risk Ta bladder tumor (BT) in general anesthesia (GA) is burdensome to patients and health care system. Laser technologies enable treatment in office-based settings, reducing morbidity and costs.

OBJECTIVE: To compare 4-mo recurrence-free survival after outpatient department (OPD) diode laser coagulation of BT in local anesthesia and gold standard transurethral resection of BT (TUR-BT) in GA in intermediate-risk Ta low-grade BT, and to evaluate treatment-related morbidity.

DESIGN, SETTING, AND PARTICIPANTS: A prospective randomized noninferiority trial with 4-mo follow-up, in the hospital setting, was conducted in Capital Region of Denmark from 2016 to 2020. Participants were patients with histologically verified Ta low-grade BT recurrence. A total of 206 patients were randomized; 176 finished treatment and follow-up as per protocol.

INTERVENTION: Laser photocoagulation of bladder tumor (PC-BT) in OPD using a 980 nm diode laser compared with gold standard TUR-BT in GA, both performed with photodynamic diagnosis (PDD) guidance.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Four-month recurrence-free survival was assessed; predefined inferiority criterion was set at 15%. The secondary outcomes were pain during PC-BT, postoperative morbidity, postoperative complications, and patient’s preference.

RESULTS AND LIMITATIONS: Four-month recurrence-free survival was 8% higher after PC-BT (95% confidence interval [CI]: -8% to 24%). The predefined noninferiority criterion was met. Pain score (1-10) during PC-BT was 2.4 (interquartile range 0.8-3.3). Postoperative lower urinary tract symptom score (0-100) was 13.9 points higher (95% CI: 6.9-21.0, p < 0.001) in the group with transurethral resection of the bladder. The frequency of minor complications was 8.1% higher after TUR-BT (95% CI: 1.0-14.6%, p = 0.026). Of the patients, 98% (95% CI: 92-100%) preferred PC-BT.

CONCLUSIONS: PDD-guided PC-BT in OPD is as good as TUR-BT in GA to remove recurrent low-grade Ta BT. Postoperative quality of life is better after PC-BT and the frequency of minor complications was lower.

PATIENT SUMMARY: This study evaluates the efficacy of outpatient laser removal of low-grade noninvasive bladder tumor. Outpatient tumor removal with laser was as good as transurethral resection in general anesthesia and less burdensome to patients.

PMID:36058804 | DOI:10.1016/j.eururo.2022.08.012

Transfus Apher Sci. 2022 Aug 19:103525. doi: 10.1016/j.transci.2022.103525. Online ahead of print.

ABSTRACT

BACKGROUND: Hematopoietic stem cell (HSC) harvest apheresis and leukapheresis are performed in the pediatric intensive care unit (PICU) for high-risk pediatric patients who require procedural sedation. Patients need central access either with their own central lines, ports or require apheresis catheter (CVL) placement. Previously, patients were either awake or emerging from sedation on PICU admission. Uncertainty regarding procedural sedation plans caused delays initiating sedation and apheresis. A guideline was developed to standardize Dexmedetomidine (DEX) for procedural sedation. We investigated if guideline implementation would improve efficiency during PICU admission as demonstrated by shorter time intervals for initiation of sedation, apheresis, PICU length of stay and less alternative sedating medication.

METHODS: Data was collected retrospectively from electronic health records of preguideline and post-guideline patients who were admitted to the PICU for sedated apheresis. We compared demographic and clinical characteristics, time intervals for sedation, apheresis, PICU length of stay, and sedation agents between the two groups using Fisher Exact tests and Mann-Whitney tests, as appropriate.

RESULTS: The groups did not differ in age or weight at the time of apheresis. All intervals of time compared were shorter post-guideline. Time intervals from admission to start of sedation, admission to start of apheresis, and admission to end of apheresis were statistically significantly different. The type and number of alternative sedating medications administered did not differ between the two groups.

CONCLUSION: This guideline implementation improved efficiency during PICU admission. This study might have been too small to demonstrate statistically significant differences in other time intervals studied.

PMID:36058778 | DOI:10.1016/j.transci.2022.103525

Am J Surg. 2022 Aug 29:S0002-9610(22)00540-2. doi: 10.1016/j.amjsurg.2022.08.017. Online ahead of print.

ABSTRACT

BACKGROUND: While it is assumed adolescents receive comparable trauma care at pediatric trauma centers (PTC), adult trauma centers (ATC), and combined facilities (MTC), this remains understudied.

METHODS: We conducted a retrospective cohort study through the NTDB evaluating patients 14-18 years of age who presented to an ACS-verified level 1 or 2 trauma facility between 1/1/2016 and 12/31/2019. Multiple logistic regression analyses were performed to compare mortality risk among trauma facility verification types.

RESULTS: 91,881 adolescents presented after trauma over the four-years. Hypotension, severe TBI, firearm mechanism, and ISS >15 were associated with increased mortality. Compared to PTCs, the odds of trauma-related mortality were statistically higher at MTCs (OR 1.82, p = 0.004) and ATCs (OR 1.89-2.05, p = 0.001-0.002).

CONCLUSIONS: Injured adolescents receiving care at ATCs and MTCs have higher mortality risk than those cared for at PTCs. Further evaluation of factors associated with this observed difference is warranted and may help identify opportunities to improve outcomes in injured adolescents.

PMID:36058750 | DOI:10.1016/j.amjsurg.2022.08.017

Gynecol Oncol. 2022 Sep 1:S0090-8258(22)00542-X. doi: 10.1016/j.ygyno.2022.08.004. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of the present study was to define and validate an anastomotic leak prognostic score based on previously described and reported anastomotic leak risk factors (OVA-LEAK: https://n9.cl/ova-leakscore) and to establish if the use of OVA-LEAK score is better than clinical criteria (surgeon’s choice) selecting anastomosis to be protected with a diverting ileostomy.

MATERIAL & METHODS: This is a retrospective, multicentre cohort study that included patients who underwent cytoreductive surgery for primary advanced or relapsed ovarian cancer with colorectal resection and anastomosis between January 2011 and June 2021. Data from patients already included in the previous predictive model were not considered in the present analysis. To validate the performance of our logistic regression model, we used the OVA-LEAK formula (Annex I: https://n9.cl/ova-leakscore) for estimating leakage probabilities in a new independent cohort. Then, receiver operating characteristic (ROC) analysis was performed and area under the curve (AUC) was used to measure the performance of the model. Additionally, the Brier score was also estimated. 95% confidence intervals (CI) for each of the estimated performance measures were also calculated.

RESULTS: 848 out of 1159 recruited patients were finally included in the multivariable logistic regression model validation. The AUC of the new cohort was 0.63 for predicting anastomotic leak. Considering a cut-off point of 22.1% to be ‘positive’ (to get a leak) this would provide a sensitivity of 0.45, specificity of 0.80, positive predictive value of 0.09 and negative predictive value of 0.97 for anastomotic leak. If we consider this cut-off point to select patients at risk of leak for bowel diversion, up to 22.5% of the sampled patients would undergo a diverting ileostomy and 47% (18/40) of the anastomotic leaks would be ‘protected’ with the stoma. Nevertheless, if we consider only the ‘clinical criteria’ for performing or not a diverting ileostomy, only 12.5% (5/40) of the leaks would be ‘protected’ with a stoma, with a rate of diverting ileostomy of up to 24.3%.

CONCLUSIONS: Compared with subjective clinical criteria, the use of a predictive model for anastomotic leak improves the selection of patients who would benefit from a diverting ileostomy without increasing the rate of stoma use.

PMID:36058743 | DOI:10.1016/j.ygyno.2022.08.004

J Am Dent Assoc. 2022 Sep 1:S0002-8177(22)00433-0. doi: 10.1016/j.adaj.2022.07.007. Online ahead of print.

ABSTRACT

BACKGROUND: Obtaining thorough documentation of a patient’s medical history is important for dental care professionals, as oral health is connected intricately to systemic health. The purpose of this study was to assess the accuracy of parent-reported health history for pediatric patients in a dental setting.

METHODS: A retrospective chart review was conducted on 863 patients 17 years and younger. Parent-reported health history was compared with subsequent physician-to-dentist consultations. The most common diagnoses were grouped on the basis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, categories.

RESULTS: The sensitivity of parent report of health conditions was highest for reporting mental and behavioral disorders (75.1%; 95% CI, 69.6% to 80.0%), followed by nervous system diseases (63.0%; 95% CI, 47.5% to 76.8%), respiratory conditions (47.9%; 95% CI, 37.6% to 58.4%), congenital conditions (46.3%; 95% CI, 30.7% to 62.6%), and cardiovascular conditions (25.0%; 95% CI, 11.4% to 43.4%) and was lowest for hematologic conditions (12.2%; 95% CI, 4.1% to 26.2%). Parents of children 6 years and older and those with private insurance had higher sensitivity for reporting mental and behavioral conditions than those with children younger than 6 years or having Medicaid (P < .0001). The specificity of parent-reported health conditions ranged from 96.0% for mental and behavioral disorders to 99.8% for hematologic conditions.

CONCLUSIONS: Sensitivity varied widely, showing that parents may be unreliable in their report of children’s health histories and that dentists cannot rely solely on parents when obtaining health history.

PRACTICAL IMPLICATIONS: In advocating for patient safety, especially for those with special needs and complex medical conditions, this study supports the use of medical evaluation before dental treatment and for the integration of dental and electronic health records.

PMID:36058728 | DOI:10.1016/j.adaj.2022.07.007

J Card Surg. 2022 Sep 4. doi: 10.1111/jocs.16880. Online ahead of print.

ABSTRACT

OBJECTIVE: We investigated possible gender differences for hepatic fibrosis in extracardiac-Fontan patients.

METHODS: We identified extracardiac Fontan, performed between 2000 and 2016, who underwent cardiac catheterizations with transvenous hepatic biopsies between April 2012 and June 2022. We divided the patients by gender for analysis.

RESULTS: We identified 116 patients who underwent 145 transvenous biopsies, with 29 patients undergoing 2 biopsies at an average interval of 5 ± 1 years. We divided the 145 biopsies into two groups: 1) 98/145 (68%) males and 2) 47/145 (32%) females. For the 47 female liver biopsy specimens, the median total fibrosis score was 3 (0-8), and for the 98 male liver biopsy specimens, the median total fibrosis score was 2 (0-6), p = .007. The average age at surgery for females was 3 ± 1 years and for males 3 ± 1 years, p = .99. Average Fontan duration at biopsy for females was 11 ± 5 years and for males, 10 ± 4 years, p = .23. No other demographic, anatomic, echocardiographic, laboratory, or hemodynamic findings demonstrated statistically significant gender differences.

CONCLUSIONS: Females had statistically significantly higher median total fibrosis scores than males for the similar average age at extracardiac Fontan and average Fontan duration.

PMID:36057990 | DOI:10.1111/jocs.16880

West Afr J Med. 2022 Aug 31;39(8):836-843.

ABSTRACT

BACKGROUND: Alcoholic beverages come in various shades and flavours, often intensely advertised to the youthful population on various media channels within the state. Excessive intake is known to have deleterious effects on several dimensions of health. This study therefore assessed the prevalence and pattern of alcoholic beverage consumption among undergraduates in Remo division of Ogun State, Nigeria.

METHODS: A cross-sectional study was carried out among 420 students attending three tertiary institutions in Remo area, Ogun State, selected via multi-stage sampling. Data were collected using a validated self-administered, semi-structured questionnaire and analyzed with SPSS 20.0. Relevant descriptive and inferential statistics were calculated (p<0.05).

RESULTS: The mean age of respondents was 20.12±3.2 years, with 219 (54.3%) being female. Only 14 (3.5%) respondents believed alcoholic beverage consumption was good. One hundred and forty-two (35.2%) participants consumed alcoholic beverages. Of these, 58 (40.8%) engaged in binge drinking; 28 (19.7%) drank daily; 101 (70.9%) consumed wines and related drinks. One hundred and twenty (84.5%) of these respondents had difficulty controlling their intake; 25 (17.6%) got drunk; 16 (11.3%) got into fights; 35 (24.6%) skipped meals after drinking; 39 (27.5%) experienced some difficulty with memory; 52 (36.6%) had parents who consumed alcoholic beverages regularly. Alcohol consumption was significantly associated with: age; parents’ occupation; living arrangement and religion.

CONCLUSION: Alcoholic beverage consumption was slightly high, with majority of these respondents drinking at a moderate level. Targeted behaviour change communication and counseling services will be most beneficial to address this emerging public health concern.

PMID:36058005

Age Ageing. 2022 Sep 2;51(9):afac190. doi: 10.1093/ageing/afac190.

ABSTRACT

Approximately two-thirds of hospital admissions are older adults and almost half of these are likely to have some form of dementia. People with dementia are not only at an increased risk of adverse outcomes once admitted, but the unfamiliar environment and routinised practices of the wards and acute care can be particularly challenging for them, heightening their confusion, agitation and distress further impacting the ability to optimise their care. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress but how to embed this in the acute-care setting remains a challenge. In this article, we highlight the challenges that have been recognised in this area and put forward a set of evidence-based ‘pointers for service change’ to help organisations in the delivery of person-centred care. The DEMENTIA CARE pointers cover areas of: dementia awareness and understanding, education and training, modelling of person-centred care by clinical leaders, adapting the environment, teamwork (not being alone), taking the time to ‘get to know’, information sharing, access to necessary resources, communication, involving family (ask family), raising the profile of dementia care, and engaging volunteers. The pointers extend previous guidance, by recognising the importance of ward cultures that prioritise dementia care and institutional support that actively seeks to raise the profile of dementia care. The pointers provide a range of simple to more complex actions or areas for hospitals to help implement person-centred care approaches; however, embedding them within the organisational cultures of hospitals is the next challenge.

PMID:36057987 | DOI:10.1093/ageing/afac190