Tag: statistics

BMC Public Health. 2022 May 21;22(1):1027. doi: 10.1186/s12889-022-13335-1.

ABSTRACT

BACKGROUND: Physical activity is important to maintain health in older age, with physical activity in the outdoors providing mental and physical health benefits for all age groups. One way by which older people can engage in physical activity in the outdoors is through using suitable age-friendly outdoor exercise equipment, the Seniors Exercise Park. The ENJOY MAP for HEALTH aims to evaluate the effect of the Seniors Exercise Park installation and associated capacity building activities on park visitation, park-based physical activity by older people and delivery of community physical activity programs.

METHOD: This study is a quasi-experimental (natural experiment) with pre and post study design evaluating the effect of age-friendly outdoor spaces with specialised outdoor exercise equipment on older people’s physical activity and wellbeing in six Victorian municipalities (local governments/councils). Each council will undergo four stages (site construction and development, promotion and marketing, capacity building and training, evaluation and sustainability). Several activities and methods will be employed from stage one through stage four to evaluate the potential impact of the age-friendly outdoor spaces on physical activity and wellbeing and will comprise the following elements: site observation and equipment utilisation, face to face intercept surveys, development of an online access monitor and community building activities.

DISCUSSION: The project is expected to result in a significant change in the physical outdoor environment for the participating councils and communities whereby older people and other community members will be able to engage in safe physical and social activity programs, socialise more and hence improve the overall wellbeing of older people.

TRIAL REGISTRATION: This trial is retrospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808 . Date registered 23/07/2021.

PMID:35597934 | DOI:10.1186/s12889-022-13335-1

BMC Surg. 2022 May 21;22(1):202. doi: 10.1186/s12893-022-01648-2.

ABSTRACT

BACKGROUND: Gastrointestinal stromal tumors (GIST) are rare abdominal tumors. Pretreatment biopsies may be used to diagnose a GIST and enable tailored treatment. Some experts are skeptical about biopsies because they fear tumor cell seeding. The objective of this study was to determine if pretreatment biopsy is associated with increased tumor recurrence.

METHODS: We performed a systematic literature search and included studies assessing the oncological outcome of GIST patients who underwent a pre-treatment core needle biopsy or fine needle aspiration. We assessed methodological quality with the Newcastle-Ottawa-Scale for non-randomized studies. This review was registered in the PROSPERO database (CRD42021170290).

RESULTS: Three non-randomized studies and eight case reports comprising 350 patients were eligible for inclusion. No prospective study designed to answer the review question was found. One case of needle tract seeding after percutaneous core needle biopsy of GIST was reported. None of the studies reported an increased rate of abdominal recurrence in patients with pretreatment biopsy.

CONCLUSIONS: The existing evidence does not indicate a relevant risk of needle tract seeding or abdominal recurrence after pre-treatment biopsy of GIST. Biopsy can safely be done to differentiate GIST from other tumors and to select the most appropriate treatment.

PMID:35597932 | DOI:10.1186/s12893-022-01648-2

Alcohol Alcohol. 2022 May 22:agac021. doi: 10.1093/alcalc/agac021. Online ahead of print.

ABSTRACT

AIM: To examine whether in Europe perceptions of ‘alcoholism’ differ in a discrete manner according to geographical area.

METHOD: Secondary analysis of a data set from a European project carried out in 2013-2014 among 1767 patients treated in alcohol addiction units of nine countries/regions across Europe. The experience of all 11 DSM-4 criteria used for diagnosing ‘alcohol dependence’ and ‘alcohol abuse’ were assessed in patient interviews. The analysis was performed through Multiple Correspondence Analysis.

RESULTS: The symptoms of ‘alcohol dependence’ and ‘alcohol abuse’, posited by DSM-IV, were distributed according to three discrete geographical patterns: a macro-area mainly centered on drinking beer and spirit, a culture traditionally oriented toward wine and a mixed intermediate alcoholic beverage situation.

CONCLUSION: These patterns of perception seem to parallel the diverse drinking cultures of Europe.

PMID:35596950 | DOI:10.1093/alcalc/agac021

Oncologist. 2022 Feb 19:oyab069. doi: 10.1093/oncolo/oyab069. Online ahead of print.

ABSTRACT

BACKGROUND: In the past decade, several successful clinical trials provided new therapeutic agents approved for advanced gastric cancer (AGC). This study evaluated whether these practice-changing results actually altered the clinical practice.

PATIENTS AND METHODS: We retrospectively reviewed medical records of treatment-naive AGC patients who received combination chemotherapy of fluoropyrimidine and platinum between 2007 and 2018 and divided them into three groups: Groups A (2007-10), B (2011-14), and C (2015-2018), respectively. We compared the clinicopathological features, treatment details, and clinical outcomes among the three groups.

RESULTS: In total, 1004 consecutive patients were enrolled (A; n = 254, B; n = 300, and C; n = 450). The number of patients with poor performance status, older age, esophagogastric junction adenocarcinoma, and primary tumor increased during the study period. All groups had similar median overall survival (OS); ~16 months) without any statistical difference but steady prolongation of survival was observed in the adjusted with imbalance prognostic factors among groups (B/A; hazard ratio, HR 0.82, 95% C.I 0.68-0.98, C/A; HR 0.72, 95% CI 0.60-0.86); OS of HER2-positive AGC patients was clearly improved (HER2-positive vs HER2-negative in Group B, HR 0.80, 95% CI 0.60-1.06; Group C, HR 0.68, 95% CI 0.51-0.90) but that of diffuse-type AGC patients remained dismal.

CONCLUSIONS: The increasing availability of chemotherapy options potentially contributed to improved survival of AGC patients, but expanded chemotherapeutic indications made the survival benefit inconspicuous in the whole population. Future therapeutic development for the AGC subset not adequately receiving benefit from previous clinical trials is warranted.

PMID:35596939 | DOI:10.1093/oncolo/oyab069

Rheumatol Ther. 2022 May 21. doi: 10.1007/s40744-022-00454-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Belimumab is a recombinant human monoclonal antibody that binds to soluble B-lymphocyte stimulator and inhibits its biological activity. Since receiving approvals for the treatment of systemic lupus erythematosus (SLE), several observational studies have investigated the effectiveness of belimumab in the real-world setting. This study reports a systematic review and meta-analysis of the literature to evaluate the real-world effectiveness of belimumab for the treatment of SLE.

METHODS: A literature search following PRISMA Guidelines and limited to studies in English was performed (2014-2020) to identify relevant studies reporting effectiveness outcomes of belimumab in patients with SLE. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. Outcomes, including SLE Disease Activity Index (SLEDAI) score, prednisone-equivalent use, and SLE flare were pooled and analyzed using statistical aggregation methods.

RESULTS: The literature search identified 514 articles for initial review. Of these, 17 articles were suitable for data extraction and summary. Baseline characteristics of patients in real-world studies were generally similar to those of relevant clinical trials, including age, sex, disease duration, SLEDAI score, and prednisone-equivalent use. Real-world use of belimumab was associated with reductions in SLEDAI score (mean baseline score to month 6: 10.1-4.4; 57% reduction), prednisone-equivalent dosing (mean baseline dose to month 6: 12.1 mg/day to 6.9 mg/day; 43% reduction), and flare frequency (12 months prior to belimumab to 12 months after belimumab: 1.15-0.39 mean flares per patient per year; 66% reduction). Long-term data (up to 2 years post-treatment initiation) for SLEDAI score and prednisone-equivalent dose indicated that improvements in both outcomes continue over time among patients remaining on therapy.

CONCLUSIONS: In the real-world setting, observed outcomes with belimumab for the treatment of SLE are consistent with those reported from randomized clinical trials. Improvements persist long-term for SLEDAI activity and prednisone-equivalent use with belimumab.

PMID:35596922 | DOI:10.1007/s40744-022-00454-9

BJOG. 2022 May 21. doi: 10.1111/1471-0528.17225. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the peri-operative characteristics associated with an increased risk of post-operative urinary retention (POUR) following vaginal pelvic floor surgery.

DESIGN: A retrospective cohort study using multivariable prediction modelling.

SETTING: A tertiary referral urogynaecology unit.

POPULATION: Patients undergoing vaginal pelvic floor surgery from January 2015 to February 2020.

METHODS: Eighteen variables (24 parameters) were compared between those with and without POUR and then included as potential predictors in statistical models to predict POUR. The final model was chosen as the one with the largest c-index from internal cross-validation. This was then externally validated using a separate data set (n=94) from another surgical centre.

MAIN OUTCOME MEASURES: Diagnosis of POUR following surgery while the patient was in hospital.

RESULTS: Among the 700 women undergoing surgery, 301 (43%) experienced POUR. Pre-operative variables with statistically significant univariate relationships with POUR included age, menopausal status, prolapse stage, and uroflow parameters. Significant peri-operative factors included estimated blood loss, amount of intravenous fluid administered, operative time, length of stay, and specific procedures including vaginal hysterectomy with intraperitoneal vault suspension, anterior colporrhaphy, posterior colporrhaphy, and colpocleisis. The lasso logistic regression model had the best combination of internally cross-validated c-index (0.73; 95% CI:071-0.74) and a calibration curve that showed good alignment of observed and predicted risks. Using this data, a POUR risk calculator was developed (https://pourrisk.shinyapps.io/POUR/).

CONCLUSIONS: This POUR risk calculator will allow physicians to counsel patients pre-operatively on their risk of developing POUR after vaginal pelvic surgery and help focus discussion around potential management options.

PMID:35596931 | DOI:10.1111/1471-0528.17225

Transl Stroke Res. 2022 May 21. doi: 10.1007/s12975-022-01036-1. Online ahead of print.

ABSTRACT

This study aimed to develop a supervised deep learning (DL) model for grading collateral status from dynamic susceptibility contrast magnetic resonance perfusion (DSC-MRP) images from patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) and compare its performance against experts’ manual grading. Among consecutive LVO-AIS at three medical center sites, DSC-MRP data were processed to generate collateral flow maps consisting of arterial, capillary, and venous phases. With the use of expert readings as a reference, a DL model was developed to analyze collateral status with output classified into good and poor grades. The resulting model was externally validated in a later-collected population from one medical center site. The model was trained on 255 patients and externally validated on 72 patients. In the all-site internal validation population, DL grading of good collateral probability yielded a c statistic of 0.91; in the external validation population, the c statistic was 0.85. In the external validation population, there was moderate agreement between the experts’ grades and DL grades (kappa = 0.53, 95% CI = 0.32-0.73, p < 0.0001). Day 7 infarct growth volume was higher in DL-graded poor collateral group than good collateral group patients (median volume [26 mL vs. 6 mL], p = 0.01) in patients with successful reperfusion (modified treatment in cerebral infarction (mTICI) = 2b-3). In all patients with a 90-day modified Rankin Scale (mRS) score, there was a shift to more favorable outcomes in the good collateral group, with a common odds ratio of 2.99 (95% CI = 1.89-4.76, p < 0.0001). The DL-based collateral grading was in good agreement with expert manual grading in both development and validation populations. After exclusion of patients with large infarct volume, early reperfusion is more likely to benefit patients with the poor collateral flow, and the DL method has the potential to aid the assessment of collateral status.

PMID:35596910 | DOI:10.1007/s12975-022-01036-1

J Med Syst. 2022 May 21;46(7):45. doi: 10.1007/s10916-022-01825-z.

ABSTRACT

An early identification of prehospital phenotypes may allow health care workers to speed up and improve patients’ treatment. To determine emergency phenotypes by exclusively using prehospital clinical data, a multicenter, prospective, and observational ambulance-based study was conducted with a cohort of 3,853 adult patients treated consecutively and transferred with high priority from the scene to the hospital emergency department. Cluster analysis determined three clusters with highly different outcome scores and pathological characteristics. The first cluster presented a 30-day mortality after the index event of 45.9%. The second cluster presented a mortality of 26.3%, while mortality of the third cluster was 5.1%. This study supports the detection of three phenotypes with different risk stages and with different clinical, therapeutic, and prognostic considerations. This evidence could allow adapting treatment to each phenotype thereby helping in the decision-making process.

PMID:35596887 | DOI:10.1007/s10916-022-01825-z

Endocr Pathol. 2022 May 21. doi: 10.1007/s12022-022-09721-5. Online ahead of print.

ABSTRACT

Conventional cytology-based diagnosis for thyroid cancer is limited with more than 30-45% of nodules categorized as indeterminate, necessitating surgery for confirming or refuting the diagnosis. This systematic review and meta-analysis were aimed at identifying immunocytochemical markers effective in delineating benign from malignant thyroid lesions in fine needle aspiration cytology (FNAC) samples, thereby improving the accuracy of cytology diagnosis. A systematic review of relevant articles (2000-2021) from online databases was carried out and the search protocol registered in PROSPERO database (CRD42021229121). The quality of studies was assessed using QUADAS-2. Review Manager 5.4.1 from Cochrane collaboration and MetaDisc Version 1.4 was used to conduct the meta-analysis. Bias in the studies were visually analyzed using funnel plots, and statistical significance was evaluated by Egger’s test. Systematic review identified 64 original articles, while meta-analysis in eligible articles (n = 41) identified a panel of 5 markers, Galectin-3, HBME-1, CK-19, CD-56, and TPO. Assessment of the diagnostic performance revealed that Gal-3 (sensitivity: 0.81; CI: 0.79-0.83; specificity: 0.84; CI: 0.82-0.85) and HBME-1 (sensitivity: 0.83; Cl: 0.81-0.86; specificity: 0.85; CI: 0.83-0.86) showed high accuracy in delineating benign from malignant thyroid nodules. Efficacy analysis in indeterminate nodules showed Gal-3 and HBME-1 have high specificity of 0.86 (CI 0.84-0.89) and 0.82 (CI 0.78-0.86), respectively, and low sensitivity of 0.76 (CI 0.72-0.80) and 0.75 (CI 0.70-0.80), respectively. Diagnostic odds ratio (DOR) of Galectin-3 and HBME-1 were 39.18 (CI 23.38-65.65) and 24.44 (CI 11.16-53.54), respectively. Significant publication bias was observed for the markers Galectin-3 and CK-19 (p < 0.05). The panel of 5 markers identified from this meta-analysis are high-confidence candidates that need to be validated in thyroid cytology to establish their efficacy and enable clinical applicability.

PMID:35596875 | DOI:10.1007/s12022-022-09721-5

Environ Sci Pollut Res Int. 2022 May 21. doi: 10.1007/s11356-022-20865-z. Online ahead of print.

ABSTRACT

In settlements, special attention is given to the study of anthropogenic aerosol pollution, and insufficient attention is given to natural sources of pollution, especially from active zones of the Earth. The aim of this work was to study atmospheric pollution (the Srednyaya Akhtuba village (Volgograd region, Russia)) using indicators (pH; EC, μS/cm) of aerosol suspensions (washing off aerosols from the leaves of Prunus armeniaca L.) during 2018-2020 and the forecast of pollution sources. Research hypothesis: low mineralization and close to neutral acidity of aerosol suspensions indicate the purity of the atmospheric air, and there is no load of anthropogenic and natural sources. Acid mineralized aerosols were found in the residential area of Srednyaya Akhtuba, which indicates air pollution during 2018-2020. The correlation relationship between pH and EC in μS/cm was investigated using standard least squares regression. The results obtained indicate statistically significant differences between the experimental territory and the (relatively) clean location from 2018 to 2020 in terms of the studied indicators, as well as the revealed correlation between them in Srednyaya Akhtuba village, which indicates the revealed patterns and the influence of the system factor. Anthropogenic and natural sources were the system factors. The authors predict an active underground ancient volcanic zone in the area of Srednyaya Akhtuba with a possible natural load on the residential areas of the village, the assumption of which is based on analysis of heat anomaly maps using the Landsat-8 program and other programs.

PMID:35596864 | DOI:10.1007/s11356-022-20865-z