Categories
Nevin Manimala Statistics

A methodological framework for tackling confounding by indication when assessing the treatment effects of Chinese herbal injections in the real world

J Evid Based Med. 2022 Feb 24. doi: 10.1111/jebm.12462. Online ahead of print.

ABSTRACT

AIM: In the context of integrative medicine, whether Chinese herbal injections are effective in routine practice has become a question of broad interest. However, confounding by indication (i.e., indication bias) is a prevalent and highly challenging methodological issue when using routinely collected health care data to assess the real-world effectiveness of Chinese herbal injections.

METHODS AND RESULTS: We proposed a methodological approach to tackling confounding by indication in assessing the real-world effectiveness of Chinese herbal injections, incorporating empirical experiences, a literature review and interactive discussions, and a panel of external experts to finally achieve a consensus. This approach consisted of three cohesive steps, including a full understanding of treatment patterns, construction of fair comparisons by identifying appropriate combination treatments and comparators, and using statistical methods to further control for confounding. In the investigation of treatment patterns, we proposed five domains to identify treatment patterns with Chinese herbal injections, and we offered five patterns of combination treatments to characterize how Chinese herbal injections are used in conjunction with other treatments. In constructing fair comparisons, we suggested the use of both nonuse and active comparators; given the diverse combination treatments, we developed six scenarios that may form fair comparisons. In the statistical analysis, we discussed five statistical models for controlling confounding by indication, including their pros and cons. We also included a practical example to illustrate the usefulness of the methodological approach.

CONCLUSION: The proposed approach may serve as an effective tool to guide researchers to reliably assess the effectiveness of Chinese herbal injections in the context of integrative medicine.

PMID:35199965 | DOI:10.1111/jebm.12462

Categories
Nevin Manimala Statistics

Pairwise joint modeling of clustered and high-dimensional outcomes with covariate missingness in pediatric pneumonia care

Pharm Stat. 2022 Feb 24. doi: 10.1002/pst.2197. Online ahead of print.

ABSTRACT

Multiple outcomes reflecting different aspects of routine care are a common phenomenon in health care research. A common approach of handling such outcomes is multiple univariate analyses, an approach which does not allow for answering research questions pertaining to joint inference. In this study, we sought to study associations among nine pediatric pneumonia care outcomes spanning assessment, diagnosis and treatment domains of care, while circumventing the computational challenge posed by their clustered and high-dimensional nature and incompletely recorded covariates. We analyzed data from a cluster randomized trial conducted in 12 Kenyan hospitals. There were varying degrees of missingness in the covariates of interest, and these were multiply imputed using latent normal joint modeling. We used the pairwise joint modeling strategy to fit a correlated random effects joint model for the nine outcomes. This entailed fitting 36 bivariate generalized linear mixed models and deriving inference for the joint model using pseudo-likelihood theory. We also analyzed the nine outcomes separately before and after multiple imputation. We observed joint effects of patient-, clinician- and hospital-level factors on pneumonia care indicators before and after multiple imputation of missing covariates. In both pairwise joint modeling and separate univariate analysis methods, enhanced audit and feedback improved documentation and adherence to recommended clinical guidelines over time in six and five pneumonia care indicators, respectively. Additionally, multiple imputation improved precision of parameter estimates compared to complete case analysis. The strength and direction of association among pneumonia outcomes varied within and across the three domains of pneumonia care.

PMID:35199938 | DOI:10.1002/pst.2197

Categories
Nevin Manimala Statistics

AVONET: morphological, ecological and geographical data for all birds

Ecol Lett. 2022 Mar;25(3):581-597. doi: 10.1111/ele.13898.

ABSTRACT

Functional traits offer a rich quantitative framework for developing and testing theories in evolutionary biology, ecology and ecosystem science. However, the potential of functional traits to drive theoretical advances and refine models of global change can only be fully realised when species-level information is complete. Here we present the AVONET dataset containing comprehensive functional trait data for all birds, including six ecological variables, 11 continuous morphological traits, and information on range size and location. Raw morphological measurements are presented from 90,020 individuals of 11,009 extant bird species sampled from 181 countries. These data are also summarised as species averages in three taxonomic formats, allowing integration with a global phylogeny, geographical range maps, IUCN Red List data and the eBird citizen science database. The AVONET dataset provides the most detailed picture of continuous trait variation for any major radiation of organisms, offering a global template for testing hypotheses and exploring the evolutionary origins, structure and functioning of biodiversity.

PMID:35199922 | DOI:10.1111/ele.13898

Categories
Nevin Manimala Statistics

A test of Darwin’s naturalization conundrum in birds reveals enhanced invasion success in the presence of close relatives

Ecol Lett. 2022 Mar;25(3):661-672. doi: 10.1111/ele.13899.

ABSTRACT

Biological invasions pose one of the most severe environmental challenges of the twenty-first century. A longstanding idea is that invasion risk is predictable based on the phylogenetic distance – and hence ecological resemblance – between non-native and native species. However, current evidence is contradictory. To explain these mixed results, it has been proposed that the effect is scale-dependent, with invasion inhibited by phylogenetic similarity at small spatial scales but enhanced at larger scales. Analyzing invasion outcomes in a global sample of bird communities, we find no evidence to support this hypothesis. Instead, our results suggest that invaders are locally more successful in the presence of closely related and ecologically similar species, at least in human-altered environments where the majority of invasions have occurred. Functional trait analyses further confirm that the ecological niches of invaders are phylogenetically conserved, supporting the notion that successful invasion in the presence of close relatives is driven by shared adaptations to the types of niches available in novel environments.

PMID:35199921 | DOI:10.1111/ele.13899

Categories
Nevin Manimala Statistics

Effects of a modified Singh’s algorithm care bundle on cannulation success rate in patients with neurological sequelae

Jpn J Nurs Sci. 2022 Feb 23:e12478. doi: 10.1111/jjns.12478. Online ahead of print.

ABSTRACT

AIM: Prolonged tracheostomy tube placement leads to depression, communicative inconvenience, reduced life quality, and health complications. We retrospectively examined the effects of a modified Singh’s algorithm (MOSA) care bundle in tracheostomy tube removal in patients with neurological sequelae.

METHODS: We retrieved medical records of 22 tracheostomized patients admitted to our early rehabilitation ward from 1 January 2018 to 31 December 2020 and compared their clinical outcomes before and after the MOSA introduction. We used a decannulation checklist and outcomes of decannulation training to judge the decannulation opportunity in the intervention group. In the control group, the patients received decannulation based on professional judgments.

RESULTS: Age, gender, body mass index, and admission diagnosis were not significantly different between the two groups. While 10 of 13 patients (76.9%) successfully decannulated in the intervention group, only 1 of 9 patients in the control group succeeded (11.1%; p = 0.008). The decannulation evaluation checklist revealed no statistically significant difference between the two groups except that the intervention group received more airway patency evaluations (p = 0.027). None of the decannulated patients required tracheostomy tube reinsertion before discharge, and no complications appeared.

CONCLUSION: Our study supports the feasibility of MOSA in aiding decannulation among patients with neurological illnesses. Further cluster randomized controlled trials and studies of decision aids and shared decision-making are warranted to help promote active decannulation.

PMID:35199913 | DOI:10.1111/jjns.12478

Categories
Nevin Manimala Statistics

An exploration of optimal time and safety of 595-nm Pulsed Dye Laser for the treatment of early superficial infantile hemangioma

Dermatol Ther. 2022 Feb 24:e15406. doi: 10.1111/dth.15406. Online ahead of print.

ABSTRACT

Infantile hemangioma (IH) is the most common benign vascular tumor that occurs in infants and young children. Studies have shown laser therapy to reduce the proliferation of superficial IH and promote its regression, but the optimal timing for treatment has not been determined. Our study explores the timing and safety of 595-nm Pulsed Dye Laser (PDL) treatment for early superficial IH. We retrospectively analyzed 180 cases of superficial IH treated with 595-nm PDL. Data was organized according to patient age at the first visit. Six months after the initial treatment, patients were evaluated using a grade IV classification method, and the clinical curative effect of each group was calculated. The number of laser treatments and the occurrence of adverse reactions were recorded simultaneously. The overall effective and cure rates were 98.3% and 84.4%, respectively, with no significant difference in rates between groups (p > 0.05). There was a statistically significant difference in the number of laser treatments among the age groups (p < 0.05). The average laser frequency: “0-2 month group” < “2-4 month group” < “4-6 month group”. The overall incidence of adverse reactions was 11.1%, and 12 (6.7%) cases had short-term adverse reactions, with no statistically significant differences between groups (p > 0.05). Eight cases had long-term adverse reactions. This difference between groups was statistically significant (p < 0.05). Younger children (≤2 months of age) receiving 595-nm PDL treatment for IH require relatively fewer treatment times than other children (>2 months of age), have a shorter course of disease, experience better curative effect, and have fewer sequelae reactions. This article is protected by copyright. All rights reserved.

PMID:35199898 | DOI:10.1111/dth.15406

Categories
Nevin Manimala Statistics

Circulating inflammatory cell profiling and periodontitis: A systematic review and meta-analysis

J Leukoc Biol. 2022 Feb 24. doi: 10.1002/JLB.5RU1021-524R. Online ahead of print.

ABSTRACT

Inflammation is a key driver of common noncommunicable diseases. Among common triggers of inflammation, chronic gingival inflammation (periodontitis) triggers a consistent humoral host inflammatory response, but little is known on its impact on circulating inflammatory cell profiles. We aimed to systematically appraise all the evidence linking periodontitis and its treatment to circulating inflammatory cell profiles. From 6 databases, 157 studies were eligible for qualitative synthesis and 29 studies for meta-analysis. Our meta-analysis showed that participants with periodontitis exhibited a significant mean increase in circulating CD4+ , CD4+ CD45RO+ , IFNγ-expressing CD4+ and CD8+ T cells, CD19+ CD27+ and CD5+ B cells, CD14+ CD16+ monocytes, and CD16+ neutrophils but decrease in CD8+ T and CD14++ CD16 monocytes. Our qualitative synthesis revealed that peripheral blood neutrophils of patients with periodontitis consistently showed elevated production of reactive oxygen species (ROS) when compared with those of healthy controls. Some evidence suggested that the treatment of periodontitis reversed the exaggerated ROS production, but limited and inconclusive data were found on several circulating inflammatory cell profiling. We conclude that periodontitis and its treatment are associated with minor but consistent alterations in circulating inflammatory cell profiles. These changes could represent key mechanisms explaining the association of periodontitis with other comorbidities such as cardiovascular disease, diabetes, and rheumatoid arthritis.

PMID:35199874 | DOI:10.1002/JLB.5RU1021-524R

Categories
Nevin Manimala Statistics

Beyond Apnea-Hypopnea Index: how clinical and comorbidity are important in obstructive sleep apnea

Adv Respir Med. 2022 Feb 24. doi: 10.5603/ARM.a2022.0028. Online ahead of print.

ABSTRACT

INTRODUCTION: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comorbidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period.

MATERIAL AND METHODS: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A-D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy.

RESULTS: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6-15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO₂ < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statistical differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D.

CONCLUSIONS: The Baveno classification distributes patients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most symptomatic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision.

PMID:35199843 | DOI:10.5603/ARM.a2022.0028

Categories
Nevin Manimala Statistics

Surgical left atrial appendage occlusion in patients with left ventricular assist device

Pacing Clin Electrophysiol. 2022 Feb 24. doi: 10.1111/pace.14471. Online ahead of print.

ABSTRACT

BACKGROUND: Thromboembolic (TE) events are among the most common and devastating adverse events in patients with continuous-flow left ventricular assist device (cf-LVAD). Given the high burden of AF among cf-LVAD patients, we sought to evaluate the effect of concomitant surgical LAAO in patients receiving cf-LVAD.

METHODS: A systematic search using electronic databases was performed using the keywords: “left atrial appendage occlusion” and “left ventricular assist device.” Statistical analysis was performed using meta-package for R version 4.0 and Rstudio version 1.2. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data between two groups. The primary outcomes included: (a) stroke; (b) LVAD pump thrombosis; (c) all-cause mortality RESULTS: : Three studies with a total of 305 patients (LAAO=68 and No-LAAO=237) were included in the analysis. HeartMate II (39%) and Heartware (27.5%) were the two most common cf-LVADs utilized, while only 5% received HeartMate III. At a mean follow up of 1.47 years, LAAO group had a lower risk of stroke (8.8% vs 15.2%, RR 0.64; 95% CI 0.28 – 1.49), LVAD pump thrombosis (1.5% vs 3.8%, RR 0.28; 95% CI 0.05 – 1.55) and all-cause mortality (5.9% vs 20.2%, RR 0.69; 95% CI 0.19 – 2.52) when compared with no-LAAO group, but the difference did not reach statistical significance.

CONCLUSION: Concomitant surgical LAAO at the time of cf-LVAD implantation demonstrated a trend towards positive outcomes and was not associated with adverse outcomes during the follow-up period, though the results were not statistically significant This article is protected by copyright. All rights reserved.

PMID:35199863 | DOI:10.1111/pace.14471

Categories
Nevin Manimala Statistics

Admitted Cases of Dengue Fever among Dengue Positive Cases in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1272-1276. doi: 10.31729/jnma.5307.

ABSTRACT

INTRODUCTION: Dengue fever, a mosquito-borne disease, is one of the emerging tropical diseases that appear primarily in rainy seasons. The number of dengue cases was increased in recent years in Nepal. Chitwan is one of the risky areas of dengue. This aim of the study is to find out the prevalence of hospital admission among the dengue positive cases.

METHODS: The descriptive cross-sectional study was carried out among 323 serologically confirmed dengue fever positive patient admitted in Medicine Inpatients Department of Chitwan Medical College Teaching Hospital. Ethical approval was taken from the Institutional Review Committee (Reference number. 076/077-121 dated August 30, 2019). Data were collected from 1st September 2019 to 31st December 2019 using a structured interview schedule and record review. Convenience sampling was done. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage.

RESULTS: Among 1206 patient with dengue fever, 323 (26.78%) (24.29-29.27 at 95% confidence Interval) were admitted in the tertiary care hospital. Study findings revealed that out of 323 admitted patients with dengue fever, 182 (56.3%) patients were between 20-40 years of age and 179 (55.4%) were males. The highest number of patients were admitted in the months of September 192 (59.4%) and October 101 (31.2%).

CONCLUSIONS: Admission rate among dengue positive cases are comparable to other studies of the similar settings. Dengue fever is common among community people especially in young adult and males. Hence, screening of dengue fever in febrile illness is necessary for the early diagnosis and prompt treatment.

PMID:35199799 | DOI:10.31729/jnma.5307