Tag: statistics

Ann Fam Med. 2022 Apr 1;20(20 Suppl 1). doi: 10.1370/afm.20.s1.3139.

ABSTRACT

CONTEXT: Although chronic pain and high-risk alcohol use are prevalent in primary care and associated with more severe pain and functional impairment, current approaches address them separately and often neglect risky alcohol use among those with chronic pain. Treatments tailored to patient preferences increase utilization, yet little is known about patient treatment preferences for chronic pain and high-risk alcohol use.

OBJECTIVE: Describe treatment barriers and preferences of primary care patients with chronic musculoskeletal pain and past-year alcohol use and test for differences based on alcohol use (no risk, low risk, high risk).

STUDY DESIGN: Chart review and patient survey.

SETTING: VA primary care clinics. Inclusion criteria: ≥ 18 years old, past year VA primary care visit, chronic musculoskeletal condition, past year alcohol use. Exclusion criteria: psychotic or neurocognitive disorder diagnosis. Eligible participants were identified via chart review and mailed a survey packet.

POPULATION STUDIED: Participants (N = 371) were primarily White (74.7%) male (88.4%) veterans.

MAIN AND SECONDARY OUTCOME MEASURES: Readiness to change, alcohol treatment barriers, pain-alcohol beliefs, attitudes toward behavioral health and medical treatment, and treatment preferences were assessed.

RESULTS: Chi-square tests revealed statistically significant preferences for: face-to-face (70.3% preferred), individual (68.7% preferred), VA primary care, (69.2% preferred), and chronic pain focus (38.4% preferred). Patients with high-risk alcohol use reported more readiness to change alcohol use, stronger pain-alcohol beliefs, and more favorable attitudes toward behavioral health treatment than those with low- or no-risk alcohol use.

CONCLUSIONS: Primary care patients with chronic musculoskeletal pain and alcohol use showed clear preferences for individual, face-to-face behavioral health treatment focused on chronic pain in a VA primary care clinic. Those with co-occurring high-risk alcohol use may experience differences in treatment barriers that may impede treatment engagement (i.e., stronger pain-alcohol beliefs), and in other cases, may facilitate treatment engagement (i.e., more readiness to change, more favorable treatment attitudes) compared to those with low- or no-risk alcohol use. Incorporating patient perspectives may help clinicians provide optimal behavioral health treatment for chronic pain and/or hazardous alcohol use in primary care.

PMID:35905462 | DOI:10.1370/afm.20.s1.3139

Ann Fam Med. 2022 Apr 1;20(20 Suppl 1). doi: 10.1370/afm.20.s1.2881.

ABSTRACT

CONTEXT: Primary care providers can ask men about intimate partner violence (IPV) perpetration or victimization using validated questions, yet physicians feel unprepared to screen men for IPV. Few studies examine men’s physical IPV categories of perpetration-only, both perpetration and victimization, and victimization-only, or their associations with technology-facilitated abuse (TFA).

OBJECTIVE: Assess (1) prevalence of men’s physical IPV and (2) associations of physical IPV with demographics, children, health services use, self-reported physical or mental health diagnoses, substance use problems, and TFA.

STUDY DESIGN: Survey with survey-weighted descriptive statistics and multinomial logistic regression.

SETTING: Community-based nationally representative sample of U.S. men using IPSOS KnowledgePanel August-September 2014.

POPULATION STUDIED: 2,889 men age 18-35 with response rate 47% (1346/2889). Inclusion criteria “ever in a romantic relationship” yielded analysis sample 1074 men.

OUTCOME MEASURE: Physical IPV categories: perpetration-only, both perpetration and victimization, and victimization-only.

RESULTS: Among young U.S. men, physical IPV was reported by 2.5% perpetration only, 16.7% both perpetration and victimization, and 10.0% victimization only. Multivariate analyses showed physical IPV perpetration-only associated with primary care use (AOR 0.25, 95%CI 0.09-0.70), chronic pain (AOR 6.92, 95%CI 1.74-27.55), and prescription opioid misuse (AOR 2.31, 95%CI 1.53-3.47); IPV both perpetration and victimization associated with belief that children who do not witness parental IPV are still harmed (AOR 0.59, 95%CI 0.43-0.82), primary care use (AOR 0.54, 95%CI 0.31-0.94), alcohol misuse (AOR 1.08, 95%CI 1.01-1.15), prescription opioid misuse (AOR 1.58, 95%CI 1.09-2.29), TFA delivered only (AOR 3.64, 95%CI 1.23-10.80), TFA both delivered and received (AOR 6.08, 95%CI 3.32-11.13), TFA received only (AOR 4.95, 95%CI 1.54-15.91); IPV victimization-only associated with mental healthcare visits (AOR 2.34, 95%CI 1.19-4.64), TFA both delivered and received (AOR 2.31, 95%CI 1.16-4.58), and TFA received only (AOR 5.26, 95%CI 2.24-12.38).

CONCLUSIONS: Among young U.S. men, physical IPV was reported by 1 in 40 for perpetration only, 1 in 6 for both perpetration and victimization, and 1 in 10 for victimization only. Primary care physicians can consider assessing physical IPV among male patients. Limitations include self-report and no context for IPV.

PMID:35905460 | DOI:10.1370/afm.20.s1.2881

Jpn J Clin Oncol. 2022 Jul 30:hyac120. doi: 10.1093/jjco/hyac120. Online ahead of print.

ABSTRACT

BACKGROUND: Risk-reducing mastectomy is one option for women with hereditary breast and ovarian cancer to reduce the risk of breast cancer.

PATIENTS AND METHODS: We analyzed data of the Japanese Organization of Hereditary Breast and Ovarian Cancer on women who were diagnosed as hereditary breast and ovarian cancer by BRCA germline genetic testing between 2010 and 2019 to reveal the rate and likelihood of risk-reducing mastectomy.

RESULTS: There were 412 women with BRCA1, 271 with BRCA2 and 4 with both female pathogenic variants. Ninety (13.1%) received risk-reducing mastectomy. The rates of risk-reducing mastectomy were statistically significantly higher in women with BRCA1 pathogenic variants than BRCA2, in women who had breast cancer than those who did not, in women with a breast cancer family history than in those without, in mothers than in those without children, in women who were receiving surveillance with MRI than those who were not and in women who received risk-reducing salpingo-oophorectomy than in those who did not on univariate analyses. The ages when they received the genetic testing were statistically significantly younger in the women receiving risk-reducing mastectomy than those who did not receive it. The women with BRCA1 pathogenic variants, personal history of breast cancer, mothers, those receiving MRI surveillance and younger women were independently significantly more likely to receive risk-reducing mastectomy based on multivariate analysis.

CONCLUSIONS: The rate of risk-reducing mastectomy was not high in Japan; however, risk-reducing surgery was approved by the Japanese National Medical Insurance for hereditary breast and ovarian cancer patients with breast and/or ovarian cancer in 2020, so this rate will increase.

PMID:35905458 | DOI:10.1093/jjco/hyac120

J Chem Inf Model. 2022 Jul 29. doi: 10.1021/acs.jcim.2c00620. Online ahead of print.

ABSTRACT

Tandem mass spectrometry (MS/MS) is a primary tool for the identification of small molecules and metabolites where resultant spectra are most commonly identified by matching them with spectra in MS/MS reference libraries. The high degree of variability in MS/MS spectrum acquisition techniques and parameters creates a significant challenge for building standardized reference libraries. Here we present a method to improve the usefulness of existing MS/MS libraries by augmenting available experimental spectra data sets with statistically interpolated spectra at unreported collision energies. We find that highly accurate spectral approximations can be interpolated from as few as three experimental spectra and that the interpolated spectra will be consistent with true spectra gathered from the same instrument as the experimental spectra. Supplementing existing spectral databases with interpolated spectra yields consistent improvements to identification accuracy on a range of instruments and precursor types. Applying this method yields significant improvements (∼10% more spectra correctly identified) on large data sets (2000-10 000 spectra), indicating this is a quick yet adept tool for improving spectral matching in situations where available reference libraries are not yet sufficient. We also find improvements of matching spectra across instrument types (between an Agilent Q-TOF and an Orbitrap Elite), at high collision energies (50-90 eV), and with smaller data sets available through MassBank.

PMID:35905451 | DOI:10.1021/acs.jcim.2c00620

J Phys Chem A. 2022 Jul 29. doi: 10.1021/acs.jpca.2c01114. Online ahead of print.

ABSTRACT

A new efficient method for calculating the enthalpies of salt formation is proposed. The method is based on a fundamentally new cocrystal model, consisting of a mixture of cations and anions and a “quasi-salt” of neutral components, in fact, of the salt itself, and the enthalpy of formation is calculated as the average value between the enthalpies of formation of these two structural components. Unlike correlation and additive schemes, this method is based on the construction of a real physical model of a salt crystal, for which the molecular geometry of the ions and neutral salt components is preliminarily optimized by quantum chemistry methods. Further, based on the obtained data, the initial models of crystal lattices in the statistically most probable structural classes are constructed with their subsequent optimization by the method of Atom-Atom potentials. For a number of compounds of various chemical classes, the effectiveness of the method for estimating the enthalpy of salts is shown, which surpasses the known methods in terms of calculation accuracy.

PMID:35905437 | DOI:10.1021/acs.jpca.2c01114

Dimens Crit Care Nurs. 2022 Sep-Oct 01;41(5):274-280. doi: 10.1097/DCC.0000000000000542.

ABSTRACT

BACKGROUND: Critical care nurses experience moral distress, the phenomenon of knowing the “right” thing to do but being unable to do so, at high rates; this contributes to attrition and has severe mental health impacts on nurses.

OBJECTIVE: The purpose of this integrative review was to determine if interventions to reduce moral distress have an effect on intensive care unit (ICU) nurses’ moral distress levels.

METHODS: Three databases were searched, PubMed, APA PsycNet, and CINAHL, using the keywords “moral distress” AND nurs* AND reduc* AND (“intensive care” OR “critical care” OR ICU). Only experimental studies involving adult ICU nurses were included for a total of 6 studies.

RESULTS: Interventions fell into 3 categories: (1) educational interventions, (2) interventions to enhance the ICU environment, and (3) interventions to help nurses cope. Two studies detailing educational interventions demonstrated some reduction in moral distress. One study aimed to improve the ICU environment and showed some statistically significant reduction in moral distress. All 6 studies included some focus on coping, and 2 showed statistically significant reductions in moral distress.

DISCUSSION: Only a few studies have been conducted examining this issue. These studies had severe limitations, such as small sample sizes, attrition, and inadequate control groups. There were also few statistically significant results. These interventions should be reexamined using larger sample sizes, and other interventions should also be trialed. COVID-19 may have had a significant impact on this issue, and interventions may need to be refocused in the wake of the pandemic.

PMID:35905430 | DOI:10.1097/DCC.0000000000000542

Dimens Crit Care Nurs. 2022 Sep-Oct 01;41(5):256-263. doi: 10.1097/DCC.0000000000000539.

ABSTRACT

INTRODUCTION: Patients discharged from the intensive care unit (ICU) suffer from long-term symptoms affecting the physical, psychological, and cognitive well-being and cannot understand memories and dreams. Intensive care unit diaries describe daily events about the patient and may allow them to reconstruct their experience.

OBJECTIVE: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effects of ICU diaries on posttraumatic stress disorder (PTSD), depression, and anxiety.

METHODS: Five electronic databases were searched up to May 6, 2022. We included RCTs comparing patients admitted to the ICU who received a diary to those who did not receive a diary. The primary outcome was the rate of PTSD. Secondary outcomes were rates of depression and anxiety.

RESULTS: We included 7 RCTs. Patients who received a diary during the ICU admission had reduced rate of PTSD (78/432 [18%] vs 106/422 [25%]; risk ratio [RR], 0.73; 95% confidence interval [CI], 0.57-0.94; P = .02; I2 = 0%; trial sequential analysis-adjusted CI, 0.55-0.97) when compared with patients who did not receive a diary. We found a non-statistically significant difference toward a reduction in the rate of depression (38/232 [16%] vs 54/224 [24%]; RR, 0.70; 95% CI, 0.49-1.01; P = .06; I2 = 0%) and anxiety (63/232 [27%] vs 70/224 [31%]; RR, 0.64; 95% CI, 0.29-1.40; P = .26; I2 = 67%).

CONCLUSIONS: Providing an ICU diary to patients admitted to the ICU reduced the rate of PTSD symptoms compared with usual care.

PMID:35905428 | DOI:10.1097/DCC.0000000000000539

Clin Transl Gastroenterol. 2022 Jul 1;13(7):e00513. doi: 10.14309/ctg.0000000000000513. Epub 2022 Jun 15.

ABSTRACT

INTRODUCTION: There is increased risk of several malignancies in inflammatory bowel disease (IBD). However, evidence regarding risk of cervical cancer in IBD is conflicting. We aimed to investigate the risk of cervical cancer in IBD by undertaking a systematic review and meta-analysis of unselected, population-based studies.

METHODS: MEDLINE, EMBASE, and Cochrane Library were searched using Medical Subject Heading terms, and 2 reviewers independently screened results. Pooled hazard ratios (HRs) were calculated using random effects model meta-analysis for risk of cervical cancer in IBD. Subgroup meta-analysis was undertaken to assess risk of cervical cancer by IBD subtype (Crohn’s disease and ulcerative colitis), treatment exposure, and grade of lesion.

RESULTS: We screened 1,393 articles to identify 5 population-based studies, including 74,310 patients with IBD and 2,029,087 reference patients, across 5 different countries. Pooled random effects model meta-analysis of these studies did not show statistically significant increased risk for cervical cancer in IBD compared with reference populations (HR: 1.24; 95% confidence interval [CI]: 0.94-1.63). Meta-analysis by grade of lesion showed increased risk of low-grade cervical lesions (HR: 1.15; 95% CI: 1.04-1.28). Meta-analysis by disease subtype indicated no statistically significant increased risk in Crohn’s disease (HR: 1.36; 95% CI: 0.83-2.23) or ulcerative colitis (HR: 0.95; 95% CI: 0.72-1.25) or in patients treated with antitumor necrosis factor (HR: 1.19; 95% CI: 0.64-2.21) or thiopurines (HR: 0.96; 95% CI: 0.60-1.50).

DISCUSSION: This meta-analysis of high-quality, unselected population-based studies shows no statistically significant increased risk of cervical cancer in patients with IBD. There is, however, increased risk of low-grade cervical lesions compared with the general population.

PMID:35905421 | DOI:10.14309/ctg.0000000000000513

Clin Transl Gastroenterol. 2022 Jul 1;13(7):e00508. doi: 10.14309/ctg.0000000000000508. Epub 2022 Jun 7.

ABSTRACT

INTRODUCTION: Intragastric balloons (IGBs) are a safe and effective treatment for obesity. However, limited knowledge exists on the underlying biological changes with IGB placement.

METHODS: This single-institution study was part of an adjustable IGB randomized controlled trial. Subjects with obesity were randomized in a 2 is to 1 ratio to 32 weeks of IGB with diet/exercise counseling (n = 8) vs counseling alone (controls, n = 4). Diet/exercise counseling was continued for 24 weeks post-IGB removal to assess weight maintenance. We used mass spectrometry for nontargeted plasma lipidomics analysis and 16S rRNA sequencing to profile the fecal microbiome.

RESULTS: Subjects with IGBs lost 15.5% of their body weight at 32 weeks vs 2.59% for controls (P < 0.05). Maintenance of a 10.5% weight loss occurred post-IGB explant. IGB placement, followed by weight maintenance, led to a -378.9 μM/L reduction in serum free fatty acids compared with pre-IGB (95% confidence interval: 612.9, -145.0). This reduction was mainly in saturated, mono, and omega-6 fatty acids when compared with pre-IGB. Polyunsaturated phosphatidylcholines also increased after IGB placement (difference of 27 μM/L; 95% confidence interval: 1.1, 52.8). Compared with controls, saturated and omega-6 free fatty acids (linoleic and arachidonic acids) were reduced after IGB placement. The fecal microbiota changed post-IGB placement and weight maintenance vs pre-IGB (P < 0.05). Further analysis showed a possible trend toward reduced Firmicutes and increased Bacteroidetes post-IGB and counseling, a change that was not conclusively different from counseling alone.

DISCUSSION: IGB treatment is associated with an altered fecal microbiome profile and may have a better effect on obesity-related lipidome than counseling alone.

PMID:35905412 | DOI:10.14309/ctg.0000000000000508

J Craniofac Surg. 2022 Jul 28. doi: 10.1097/SCS.0000000000008745. Online ahead of print.

ABSTRACT

BACKGROUND: Spring-mediated cranioplasty (SMC) is an increasingly utilized technique to treat patients with nonsyndromic sagittal craniosynostosis, but variables impacting outcomes are incompletely understood. The purpose of this study was to determine variables most predictive of outcomes following SMC, primarily changes in cephalic index (CI).

METHODS: Patients with nonsyndromic sagittal craniosynostosis undergoing SMC at our institution between 2014 and 2021 were included. Cephalic index was measured from patient computed tomography scans, x-rays, or by caliper-based methods. Parietal bone thickness was determined from patient preoperative computed tomography. Stepwise multiple regression analysis, least absolute shrinkage and selection operator, and random forest machine learning methods were used to determine variables most predictive of changes in CI.

RESULTS: One hundred twenty-four patients were included. Stepwise multiple regression analysis identified duration of spring placement (P=0.007), anterior spring force (P=0.034), and anterior spring length (P=0.043) as statistically significant predictors for changes in CI. Least absolute shrinkage and selection operator analysis identified maximum spring force (β=0.035), anterior spring length (β=0.005), posterior spring length (β=0.004), and duration of spring placement (β=0.0008) as the most predictive variables for changes in CI. Random forest machine learning identified variables with greatest increase in mean squared error as maximum spring force (0.0101), anterior spring length (0.0090), and posterior spring length (0.0056).

CONCLUSIONS: Maximum and total spring forces, anterior and posterior spring lengths, and duration of spring placement were the most predictive variables for changes in CI following SMC. Age at surgery and other demographic variables were inferior predictors in these models.

PMID:35905391 | DOI:10.1097/SCS.0000000000008745