Tag: statistics

Curr Pain Headache Rep. 2023 Dec 2. doi: 10.1007/s11916-023-01189-0. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: This systematic review aims to inform the current state of evidence about the efficacy and effectiveness of medical cannabis use for the treatment of LBP, specifically on pain levels and overall opioid use for LBP. Searches were conducted in MEDLINE (PubMed), Embase, and CINAHL. The search was limited to the past 10 years (2011-2021). Study inclusion was determined by the critical appraisal process using the Joanna Briggs Institute framework. Only English language articles were included. Participant demographics included all adult individuals with LBP who were prescribed medical cannabis for LBP and may be concurrently using opioids for their LBP. Study quality and the risk of bias were both evaluated. A narrative synthesis approach was used.

RECENT FINDINGS: A total of twelve studies were included in the synthesis: one randomized controlled trial (RCT), six observational studies (one prospective, four retrospective, and one cross-over), and five case studies. All study results, except for the RCT, indicated a decrease in LBP levels or opioid use over time after medical cannabis use. The RCT reported no statistically significant difference in LBP between cannabis and placebo groups. Low back pain (LBP) affects 568 million people worldwide. In the United States, LBP treatment represents more than half of regular opioid users. With the opioid epidemic, alternative methods, particularly medical cannabis, is now increasingly sought by practicing physicians and patients. Due to its infancy, there is minimal high-quality evidence to support medical cannabis use as a first line treatment for LBP.

PMID:38041708 | DOI:10.1007/s11916-023-01189-0

Br J Ophthalmol. 2023 Nov 27:bjo-2023-323480. doi: 10.1136/bjo-2023-323480. Online ahead of print.

ABSTRACT

BACKGROUND: Orbital decompression is commonly performed to correct proptosis in patients with Graves’ orbitopathy (GO). In literature, the incidence of new-onset constant diplopia after orbital decompression varies. Few studies have evaluated changes in duction and cyclodeviation after orbital decompression. We evaluated the changes in duction, cyclodeviation, eye position and degree of diplopia after orbital decompression.

METHODS: We retrospectively analysed data from patients who underwent orbital decompression at our hospital between January 2016 and July 2020. Data regarding the type of decompression, eye position, duction, cyclodeviation and level of diplopia according to the Gorman score were recorded.

RESULTS: Data from 281 eyes/orbits of 156 patients were analysed. Proptosis decreased from 23.8±2.5 to 20.9±2.5 mm. Horizontal and vertical duction range decreased (horizontal d=0.40 and vertical 0.30; p=0.000) after surgery; however, the change was not clinically significant (≤5°). Horizontal deviation changed towards esodeviation (d=-0.45; p=0.000), whereas vertical deviation remained stable (d=0.15; p=0.161). Preoperative cyclotorsion in the primary and downgaze positions changed towards incyclodeviation (primary: d=0.30, p=0.021; downgaze d=0.30, p=0.039). Diplopia improved in 22% (18 patients), whereas new-onset constant diplopia developed in 11% (12 patients). Elevation has an excellent predictive value of causing new-onset constant diplopia when measured preoperatively as <19°, sensitivity 88.0%, specificity 41.7% (area under the curve 0.812 (95% CI 0.660 to 0.963); p=0.000).

CONCLUSION: After orbital decompression, incidence of new-onset constant diplopia was 11% and 22% of the patients had partial or complete improvement of their diplopia. The changes in duction, cyclodeviation and horizontal deviation showed a statistical but not clinical difference. Patients with GO and a preoperatively restricted elevation of <19° are at risk of developing new-onset constant diplopia. In addition, preoperative incyclodeviation may worsen after decompression surgery.

PMID:38041682 | DOI:10.1136/bjo-2023-323480

Br J Ophthalmol. 2023 Nov 28:bjo-2023-324318. doi: 10.1136/bjo-2023-324318. Online ahead of print.

ABSTRACT

AIMS: To evaluate the efficacy and safety of intravitreal triamcinolone acetonide (TA) injection at the end of emergency surgery for open globe injury (OGI) to suppress traumatic proliferative vitreoretinopathy (TPVR).

METHODS: A single-centre, participant-masked, prospective, randomised controlled clinical trial. A total of 68 globe rupture patients with zone III were randomised to the control group (n=34) or the TA group (n=34) in 1:1 allocation ratio. Patients were treated with 0.1 mL TA in the TA group and 0.1 mL balanced salt solution in the control group at the end of emergency surgery. The primary outcome was the assessment of TPVR during vitrectomy 10±3 days later. Secondary outcomes included visual acuity (VA), retinal attachment rate, macular attachment rate, proliferative vitreoretinopathy (PVR) recurrent rate, side effects 6 months after vitrectomy.

RESULTS: During vitrectomy, the TPVR grade of the control group was significantly more severe than the TA group (p=0.028). The TPVR score was significantly better in the TA group (9.30±0.82) than in the control group (6.44±1.06) (p=0.036). The final VA improved in 23 eyes (92%) in the TA group and in 14 eyes (63.64%) in the control group (p=0.008). The retinal attachment rates were 88% and 63.64% in the TA and control group, respectively (p=0.049). The two groups showed no significant difference in macular repositioning and PVR recurrent rate (p=0.215, 0.191). Temporary intraocular pressure elevation occurred in one eye in the TA group after emergency surgery.

CONCLUSIONS: Early intravitreal TA injection for OGI effectively reduces TPVR, increases surgical success and improves visual prognosis.

PMID:38041678 | DOI:10.1136/bjo-2023-324318

J Oral Rehabil. 2023 Dec 2. doi: 10.1111/joor.13614. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this investigation is to assess the relationship between the utilisation of orthodontic intermaxillary elastics and temporomandibular disorder (TMD) symptoms in clear aligner patients and to examine the correlation between the elastic usage time with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)-Axis II Evaluation Forms.

METHODS: This study was carried out on a total of 40 clear aligner patients using intermaxillary elastics in the experimental group and 30 clear aligner patients who did not use any intermaxillary elastics in the control group. The data were evaluated using the Mann-Whitney U, chi-square, Fisher’s exact chi-square, and Fisher Freeman Halton exact chi-square tests.

RESULTS: The characteristic pain intensity, mastication, mobility, communication, global and PHQ-9 scores of the experimental group were significantly higher than those of the control group (p < .05). The characteristic pain intensity score, interference score and chronic pain grade score of patients using Class III elastics were statistically significantly higher than those of patients using Class II elastics (p < .05). Patients who used elastics for less than 6 months had statistically significantly higher PHQ-9 scores than those who used elastics for more than 6 months (p < .05).

CONCLUSIONS: Orthodontic treatment may affect occlusion, bite force and jaw movement, which may cause or worsen TMD symptoms, and the DC/TMD questionnaires can determine if orthodontic patients acquire TMD by assessing their psychosocial state and pain-related problems.

PMID:38041596 | DOI:10.1111/joor.13614

J Adv Nurs. 2023 Dec 2. doi: 10.1111/jan.16009. Online ahead of print.

ABSTRACT

AIMS: Fear of cancer recurrence (FCR) is a multifaceted concept influenced by individual characteristics, social support, psychological factors. This study aims to identify distinct FCR profiles among breast cancer patients and explore the associated variables with these patterns.

DESIGN: A cross-sectional study was conducted from April 2022 to March 2023.

METHODS: A convenience sample of 339 patients completed a questionnaire that assessed general and disease-related data, including the Fear of Progression Questionnaire-Short Form, Social Support Rating Scale, Medical Coping Modes Questionnaire. Statistical analysis involved latent profile analysis (LPA) and multinomial logistic regression.

RESULTS: Three latent patterns of FCR were found: the low fear (28.9%), the moderate fear (51.3%), and the high fear (18.0%). The study identified the social support, family monthly income, employment status, utilization of confrontation coping mode and avoidance coping mode, as factors that impacted the FCR.

CONCLUSIONS: Social support, family monthly income, employment status, and medical coping modes have been found to impact the FCR among newly diagnosed breast cancer patients. Healthcare professionals should focus on addressing FCR at diagnosis and implement effective interventions, such as promoting social support and encouraging adaptive coping, to alleviate this concern.

IMPACT: Urgently addressing the FCR in Chinese breast cancer patients is imperative due to its profound influence on their holistic health. Through advanced LPA, we categorized the FCR progression, highlighting risks. These findings have implications for healthcare strategies, offering new insights to manage the FCR and improve patient well-being. Our study adds a fresh perspective to the factors underlying the FCR in breast cancer patients, contributing to the broader comprehension and management of this complex survivorship issue.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:38041587 | DOI:10.1111/jan.16009

J Adolesc. 2023 Dec 2. doi: 10.1002/jad.12280. Online ahead of print.

ABSTRACT

INTRODUCTION: Self-completed checklists measuring youth mental health problems produce dimensional scale scores and can be converted to categorical classifications representing the presence/absence of psychopathology. We test whether categorical classifications from scale scores are equivalent psychometrically to categorical classifications of the same problems obtained by lay-administered standardized structured diagnostic interviews.

METHODS: The sample of n = 325 youth aged 12-18 (44% male) and their parent/caregivers come from combined test-retest reliability studies conducted in Ontario, Canada, from 2011 to 2015. Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) scores converted to categorical classifications of emotional and behavioral problems were compared with interview classifications. We test hypotheses of statistical equivalence and inferiority, using a confidence interval approach to detect if differences lie within the smallest effect size of interest of ±0.18. We compare categorical classifications on: (1) test-retest reliability (ҡ), (2) content validity (between-instrument agreement), and (3) construct validity (strength of association with three mental health-related constructs).

RESULTS: Average test-retest reliabilities were 0.695 (checklists) and 0.670 (interviews). The reliability of checklist emotional problem classifications was not inferior to interview classifications and the difference in reliability between instruments for behavioral problems was small (-0.036). Average between-instrument agreement was ҡ = 0.586 (observed) and ҡ = 0.841 (corrected for attenuation due to measurement error) indicating high content overlap. Statistical equivalence criteria were met in 5 of 6 construct validity comparisons.

CONCLUSIONS: Categorical classifications of emotional and behavioral problems from youth-reported checklists are, on balance, equivalent to interview classifications. Checklists represent a simple, brief, inexpensive alternative to interviews.

PMID:38041580 | DOI:10.1002/jad.12280

Urologia. 2023 Dec 2:3915603231216141. doi: 10.1177/03915603231216141. Online ahead of print.

ABSTRACT

INTRODUCTION: The presence of ureteral stones can cause pain, infections of urinary tract and hydronephrosis, resulting in the loss of renal function. For two decades, Ureteroscopy and laser stone fragmentation (URSL) attained a big rise and is the first line management for large ureteric stones and renal stones up to 2 cm. The present study was conducted to assess the success rate of ureteroscopic lithotripsy in treatment of ureteric calculus after local administration of aminophylline.

MATERIALS AND METHODS: 100 patients having ureteric calculi <20 mm in size, aged 20-60 years were included in the study and randomly divided into Group A (n = 50) with administration of local aminophylline and Group B (n = 50) with administration of saline infusion. Ureteroscopy was performed after 5 min of administration of the solution. URSL was done using pneumatic lithoclast and/or laser. Various parameters like duration of procedure, ease of ureteral access, requirement of DJ Stent and need of further operative interventions were compared between case and control groups. The data was collected and then subjected to statistical analysis using IBM SPSS 20.0 version at significance level of p < 0.05.

RESULTS: The mean age of study subjects having ureteral stones was found to be between 31 and 40 years of age with males being more affected. We observed less mean duration of surgery, higher success rate, easy ureteral access (p-value < 0.05) with aminophylline use than control group. The need of ureteral stent and Auxiliary procedures was significantly higher in the control than in the case group (38%).

CONCLUSION: The use of aminophylline has been found to be highly useful and effective in reducing the need of stents and secondary surgery, decreased pain, and increased success rate. Thus, the use of aminophylline is recommended during URSL procedure for the successful management of ureteral calculi.

PMID:38041571 | DOI:10.1177/03915603231216141

Epilepsia. 2023 Dec 2. doi: 10.1111/epi.17844. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to identify risk factors associated with surgery-related neurological morbidity in patients with drug-resistant epilepsy undergoing supra-sylvian operculo-insular resections. As secondary outcomes, we also analyzed the risk factors for ischemic lesions (IL) of corona radiata and seizure recurrence.

METHODS: A retrospective analysis was conducted on a cohort of patients underwent supra-sylvian operculo-insular resections for drug-resistant epilepsy. The association of several presurgical, surgical and post-surgical factors with both primary (persistent neurological deficits) and secondary (structural abnormalities on postoperative MR imaging and seizure recurrence) postoperative outcomes, were investigated with univariate and multivariate statistical analysis.

RESULTS: The study included a total of 65 patients. 46.2% of patients exhibited postoperative neurological deficits only 12.3% experienced persistent deficits. On postoperative MRI, IL in the corona radiata and cortico-spinal tract Wallerian degeneration (CSTWd) were seen in 68% and 29% of cases, respectively. Only CSTWd was significantly associated with persistent neurological deficits (RR 2.6). Combined operculo-insular resection (RR 3.62) and surgery performed on left hemisphere (RR 0.37) were independently associated with IL in the corona radiata. Variables independently associated with CSTWd were the presence of malacic components in the IL (RR 1.96), right central operculum resection (RR 1.79) and increasing age at surgery (RR 1.03). Sixty-two patients had a postoperative follow-up >12 months [median 56 (IQR 30.75-73.5)] and 62.9% were in Engel’s class I at last outpatient control. The risk of seizure recurrence was reduced by selective opercular resection (RR 0.25) and increased by the histological diagnosis of aspecific gliosis (RR 1.39).

SIGNIFICANCE: This study provides insights into the risk factors associated with surgery-related neurological morbidity, as well as further evidence on the postoperative occurrence of subcortical injury and seizure recurrence in epileptic patients undergoing supra-sylvian operculo-insular resections. The findings highlighted in this study may be useful to better understand the processes supporting the increased surgical risk in the operculo-insular region.

PMID:38041557 | DOI:10.1111/epi.17844

J Eur Acad Dermatol Venereol. 2023 Dec 2. doi: 10.1111/jdv.19669. Online ahead of print.

ABSTRACT

BACKGROUND: Baricitinib treatment in adults with moderate-to-severe atopic dermatitis (AD) has demonstrated rapid improvements in itch as well as AD sign severity and affected body surface area as assessed by the Eczema Area and Severity Index (EASI) total score, whether administered as monotherapy or in combination with topical corticosteroids (TCS). As EASI clinical signs differ in time course and associated antecedents, the effects of baricitinib on each individual clinical sign are of interest.

OBJECTIVES: In this post hoc analysis, we aimed to investigate the effects of baricitinib on individual EASI subscores, namely excoriation, oedema/papulation, erythema and lichenification, in both monotherapy and TCS combination therapy trials.

METHODS: We analysed the percent change from baseline in individual EASI subscores from three phase-III, double-blind, 16-week trials of baricitinib in monotherapy (BREEZE-AD1/BREEZE-AD2) and TCS combination therapy (BREEZE-AD7) cohorts via mixed model repeated measures (MMRM).

RESULTS: Baricitinib 4 mg showed rapid and sustained improvements in all four clinical signs in both cohorts. Significant effects emerged at week 1 for excoriation, oedema/papulation and erythema scores in monotherapy (p < 0.001) and TCS combination therapy (p < 0.001, p < 0.01, p < 0.001), plateaued at week 4, and remained significant versus placebo through week 16. The effect on lichenification scores also emerged early, at week 1 in monotherapy (p < 0.05) and week 2 in combination therapy (p < 0.001), with scores continuously improving without a clear plateau. Effect magnitude was highest in excoriation scores, exhibiting near-maximal reduction in week 1 of monotherapy and remaining highest across all timepoints in combination therapy.

CONCLUSIONS: Rapid and sustained improvements were observed across clinical signs of inflammation and particularly on excoriation following baricitinib treatment. Our findings suggest that selective inhibition of janus kinases 1 and 2 leads to rapid and sustained control of skin inflammation, and that rapid reductions in itch translate into early disruption of the itch-scratch cycle.

PMID:38041556 | DOI:10.1111/jdv.19669

Mol Ecol Resour. 2023 Dec 2. doi: 10.1111/1755-0998.13898. Online ahead of print.

ABSTRACT

Testing the association between objects is central in ecology, evolution, and quantitative sciences in general. Two types of variables can describe the relationships between objects: point variables (measured on individual objects), and distance variables (measured between pairs of objects). The Mantel test and derived methods have been extensively used for distance variables. Yet, these methods have been criticized due to low statistical power and inflated type I error when spatial autocorrelation is present. Here, we assessed the statistical power between different types of tested variables and the type I error rate over a wider range of autocorrelation intensities than previously assessed, both on univariate and multivariate data. We also illustrated the performance of distance matrix statistics through computational simulations of genetic diversity. We show that the Mantel test and derived methods are not affected by inflated type I error when spatial autocorrelation affects only one variable when investigating correlations, or when either the response or the explanatory variable(s) is affected by spatial autocorrelation while investigating causal relationships. As previously noted, with autocorrelation affecting more variables, inflated type I error could be reduced by modifying the significance threshold. Additionally, the Mantel test has no problem of statistical power when the hypothesis is formulated in terms of distance variables. We highlight that transformation of variable types should be avoided because of the potential information loss and modification of the tested hypothesis. We propose a set of guidelines to help choose the appropriate method according to the type of variables and defined hypothesis.

PMID:38041538 | DOI:10.1111/1755-0998.13898