Tag: statistics

Indian J Ophthalmol. 2021 Apr;69(4):890-894. doi: 10.4103/ijo.IJO_1269_20.

ABSTRACT

PURPOSE: To assess patient experience of intravitreal injections using vital-signs, visual-experience, pain-rating and emotional response during intravitreal anti-VEGF injections.

METHODS: A prospective observational study of patient experience of intravitreal anti-VEGF injections done following metrics were collected pre-injection, during injection, and post-injection: pain assessment using visual analog score, fear-response rating, visual-experience questionnaire, and vital-signs.

RESULTS: A total of one-hundred-and-seventy-four patients undergoing intravitreal anti-VEGF injections for retinal pathologies were included in the study. Mean age was 58.8 ± 10.4 years in <5 injection group (n = 133) and 59.02 ± 9.0 years in ≥5 injection group (n = 41) (P = 0.90).During injection, 90.2% of patients in <5 injection group reported moderate or severe pain compared to 78% of patients in ≥5 injection group. In pre and post-injection phases, mild-to-moderate pain was reported in both groups (P = <0.001). Ninety-two (52.9%) patients reported having a mild frightening experience. There was no statistical significance in patients assessment of fear with respect to age, sex, or number of injections. The Systolic Blood Pressure (SBP) during and following injection ((SBP 171.7 ± 21.1,150.8 ± 16.2) procedures was significantly higher in cases with <5 injections when comparing to cases with >5 injections (SBP 159.7 ± 26.4, 143.2 ± 17.0) (P = 0.003), (P = 0.011). DBP, heart rate, pulse rate measurements were similar among patients in all phases of the study.

CONCLUSION: We report a large sample size with comprehensive assessments of the patient experience. Higher pain ratings in the <5 injection group, the increase in the SBP in the pre-and during injection phases, and the overall rating of mild-to-moderate fear during the procedure.

PMID:33727454 | DOI:10.4103/ijo.IJO_1269_20

Indian J Ophthalmol. 2021 Apr;69(4):923-926. doi: 10.4103/ijo.IJO_1019_20.

ABSTRACT

PURPOSE: This study compares the vital parameters and pain experienced during phacoemulsification under peribulbar and topical anesthesia to determine the incidence of OCR.

METHODS: One hundred six patients are enrolled for phacoemulsification in a prospective and randomized study. Fifty-two patients undergo surgery in a peribulbar block (Group PB) and 54 in topical anesthesia (Group TA). Mean arterial pressure (MAP) and pulse rate are recorded during a preoperative check-up and at four other steps of surgery. Pain experienced during surgery and on a postoperative day, 5, is graded with a verbal analogue scale. OCR defined as a decrease in pulse rate by greater than 20% is calculated. Chi-square test, Fisher’s exact test, paired t test and the comparison of means give the statistical analysis. A value of P < 0.05 was taken as significant.

RESULTS: MAP readings at baseline versus MAP at other steps of surgery show a trend towards rising with a P value of < 0.05 in both groups. Pulse rate measured at all steps of surgery versus baseline pulse rate in Group TA shows P < 0.05. OCR is present in nine patients in peribulbar block verses eleven patients in topical anesthesia with P value of 0.687. The pain scores using verbal analogue scale were higher in Group TA compared with Group PB with a P < 0.0001.

CONCLUSION: Oculocardiac reflex can occur during phacoemulsification under both peribulbar block and topical anesthesia, and the difference is not significant.

PMID:33727460 | DOI:10.4103/ijo.IJO_1019_20

Indian J Ophthalmol. 2021 Apr;69(4):865-870. doi: 10.4103/ijo.IJO_936_20.

ABSTRACT

PURPOSE: Obtaining a better understanding of the pathogenesis of primary angle-closure disease (PACD) still requires studies that provide measurements of anterior and posterior biometric characteristics together and that assess the relationship between them.

METHODS: In total, 201 eyes were enrolled in this cross-sectional study: 50 normal controls, 49 primary angle-closure suspect (PACS), 38 primary angle closure (PAC), and 64 primary angle-closure glaucoma (PACG) eyes. The anterior and posterior structural features were measured by anterior segment optical coherence tomography and swept-source optical coherence tomography.

RESULTS: All PACD groups had smaller anterior chamber depth (ACD), anterior chamber area (ACA), anterior chamber volume (ACV), angle opening distance at 750 μm from the scleral spur (AOD750), trabecular-iris space area at 750 μm from the scleral spur (TISA750), and angle recess area (ARA), as well as a larger lens vault (LV), than controls (all P < 0.001). The PACS and PAC groups had thicker iris thickness at 750 μm from the scleral spur (IT750) than controls (P = 0.017 and P = 0.002, respectively). Choroidal thickness (CT) was not statistically different among normal, PACS, PAC, and PACG eyes. Univariate and multivariate linear regression analysis revealed a significant association between thinner IT750 and increased CT in PACD eyes (P = 0.031, univariate analysis; P = 0.008, multivariate analysis).

CONCLUSION: Thinner iris thickness was associated with increased CT in PACD eyes; however, the underlying mechanism needs further investigation.

PMID:33727449 | DOI:10.4103/ijo.IJO_936_20

Nurs Crit Care. 2021 Mar 16. doi: 10.1111/nicc.12606. Online ahead of print.

ABSTRACT

BACKGROUND: Because of the coronavirus disease 2019 (COVID-19) pandemic, the use of prone positioning has dramatically increased in the intensive care unit (ICU). Because this manoeuvre is related to several complications, it must be performed in a protocolized manner by the appropriate personnel.

AIM: To determine the prevalence of adverse events (AEs) in patients admitted to the ICU with a diagnosis of COVID-19-related acute respiratory distress syndrome (C-ARDS) undergoing mechanical ventilation in prone position (PP).

DESIGN: Descriptive ambispective study of patients admitted to the ICU diagnosed with C-ARDS undergoing mechanical ventilation who were in the PP at least once. The number of PP manoeuvres and the time spent in the PP were recorded for each subject. AEs proportions and frequencies were calculated, and analysis of variance was used to assess mean differences in the number of manoeuvres and total hours in PP stratified by the number of facial pressure ulcers. IBM SPSS Statistics v.25.0. and EPIDAT 4.1 software were used.

RESULTS: Forty-four patients were analysed, and 130 PP manoeuvres were performed. The most frequently observed AEs were facial oedema in 26 patients (80.3%) and facial pressure ulcers in 20 (60.6%). There was a significant positive association between the time spent in PP and the development of facial pressure ulcers (P < .001). Enteral nutrition was well tolerated, and no serious AEs or sentinel events were noted.

DISCUSSION: Despite the stressful, demanding situation during the peak of the pandemic, the large number of PP manoeuvres, and long duration spent in this position, no serious AEs occurred. This study highlights the need to implement preventive measures to avoid the development of pressure ulcers secondary to prone positioning.

RELEVANCE TO PRACTICE: Prone positioning requires a nursing protocol to prevent the occurrence of AEs that may reduce the quality of nursing care.

PMID:33725746 | DOI:10.1111/nicc.12606

Chin Med J (Engl). 2020 Dec 16;134(6):655-661. doi: 10.1097/CM9.0000000000001300.

ABSTRACT

BACKGROUND: The antioxidant effects of bilirubin in Parkinson’s disease (PD) have recently gained much attention from the research community. However, results from these studies have been conflicting. This meta-analysis is conducted to assess the relationship between the serum bilirubin concentration and the risk of PD.

METHODS: Two reviewers performed a systematic literature search across five databases (MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials). The case-control studies regarding bilirubin levels in PD patients published up to April 2020 were included. These studies were subjected to rigorous scrutiny and data extraction to determine the standard mean difference (SMD) and the 95% confidence interval (CI), which were analyzed using the Stata V.12.0 statistical software.

RESULTS: A total of eight studies which included 1463 PD cases and 1490 controls were incorporated into our meta-analysis. SMD analysis showed that there was a higher total bilirubin (TBIL) and direct bilirubin (DBIL) levels in PD patients compared with controls (for TBIL, SMD: 0.300, 95% CI: 0.050-0.549, P = 0.018; for DBIL, SMD: 0.395, 95% CI: 0.102-0.688, P = 0.008). However, no significant relationship was found between the serum indirect bilirubin and PD patients (SMD: -0.223, 95% CI: -0.952-0.505, P = 0.548). A subgroup analysis based on ethnicity indicated that the serum TBIL was higher in PD patients of Caucasian descent in contrast to matched healthy controls (SMD: 0.511, 95% CI: 0.324-0.698, P = 0.000, I2 = 58.0%).

CONCLUSION: Higher serum bilirubin levels in PD patients suggest that bilirubin might play a role in the pathogenesis of PD and have the potential to be utilized as a biochemical marker for PD diagnosis and treatment.

PMID:33725704 | DOI:10.1097/CM9.0000000000001300

J Clin Virol. 2021 Mar 10;138:104791. doi: 10.1016/j.jcv.2021.104791. Online ahead of print.

ABSTRACT

BACKGROUND: Cycle threshold (Ct) values can be used in an attempt to semiquantify results in the qualitative real-time polymerase-chain-reaction (PCR) for the new coronavirus SARS-CoV-2. The significance of Ct values in epidemiological studies and large cohorts is still unclear.

OBJECTIVE: To monitor Ct values in a long-term study and compare the results with demographic data of patients who tested positive for SARS-CoV-2 by real-time PCR.

STUDY DESIGN: S gene SARS-CoV-2 Ct values were analyzed retrospectively from consecutive patients between March 15th to September 15th 2020 with special regard to age, gender, and in- or outpatient status.

RESULTS: In total, 65,878 patients were tested, 1103 (1.7 %) of whom were positive for SARS-CoV-2. Twenty-six positive patients were excluded, because the respective PCR runs did not meet the stability requirements (Ct value of the positive controls between 26 and 29). Of the remaining 1077 patients, females (n = 566; 53 %) were significantly older than males (n = 511; 47 %) (50.9 versus 45.1 years; p = 0.006) and had slightly higher mean Ct values than males (25.4 vs. 24.8; p = 0.04). Patients in the age groups >80 years had significantly higher Ct values than the remaining age groups (p < 0.001). Children (0-19 years) showed Ct values in the range of those found in adults (25.2 vs. 25.1, p = 0.9). There were no statistically different Ct values between in- and outpatients (p = 0.1), however, SARS-CoV-2 positive inpatients were significantly older than outpatients (p < 0.0001).

CONCLUSIONS: CT values are suitable for more detailed monitoring of the SARS-CoV-2 pandemic. Age is an important cofactor in SARS-CoV-2 positive patients and may have influence on Ct values in SARS-CoV-2-PCR.

PMID:33725648 | DOI:10.1016/j.jcv.2021.104791

Nanotechnology. 2021 Mar 16. doi: 10.1088/1361-6528/abef2d. Online ahead of print.

ABSTRACT

Producing defect-free and large-lateral-size 2D materials via cost-effective methods is important for mass application. Recently, shear exfoliation showed great promise for large-scale production due to its simple operation, environmental-benignity, and wide adaptability. However, a long-standing challenge is that with more nanosheets produced, a ceiling yield and shattered products are encountered, which significantly limit their wider application. The way and efficiency of energy transfer in fluid is undoubtedly the key point in determining the exfoliation efficiency, yet there has no in-deep mechanism elucidation so far. Thus, a thorough investigation regarding the turbulence energy transfer is critically necessary. Herein, we identify two main factors which critically determine the exfoliation yield and provide a statistical analysis on the relationship between these factors and exfoliation yield. In the initial shearing process, the coexistence of the 2D nanosheets and raw particles is the dominant factor; with time passes by, the dimensional change of raw materials gradually shows more influence on the energy transfer. These factors together lead to attenuated efficiency and a power function relationship between yield and exfoliation time. This investigation gives a statistical explanation regarding shear exfoliation technology for 2D materials preparation and provides valuable insights for mechanical exfoliating high-quality 2D materials.

PMID:33725678 | DOI:10.1088/1361-6528/abef2d

J Am Acad Orthop Surg Glob Res Rev. 2020 Dec 14;4(12):e20.00102. doi: 10.5435/JAAOSGlobal-D-20-00102.

ABSTRACT

OBJECTIVE: We surveyed Orthopaedic Surgery Residency (OSR) programs to determine international opportunities by the academic institutional region within the United States, location of the international experience, duration, residency program year (PGY), funding source, and resident participation to date.

DESIGN: We emailed a survey to all OSR programs in the United States to inquire about global opportunities in their residency programs. Further contact was made through an additional e-mail and up to three telephone calls. Data were analyzed using descriptive and chi-square statistics. This study was institutional review board exempt.

SETTING: This research study was conducted at the University of Nebraska Medical Center, a tertiary care facility in conjunction with the University of Nebraska Medical Center College of Medicine.

PARTICIPANTS: The participants of this research study included program directors and coordinators of all OSR programs (185) across the United States.

RESULTS: A total of 102 OSR programs completed the survey (55% response rate). Notably, 50% of the responding programs offered a global health opportunity to their residents. Of the institutions that responded, those in the Midwest or South were more likely to offer the opportunity than institutions found in other US regions, although regional differences were not significant. Global experiences were most commonly: in Central or South America (41%); 1 to 2 weeks in duration (54%); and during PGY4 or PGY5 (71%). Furthermore, half of the programs provided full funding for the residents to participate in the global experience. In 33% of the programs, 10 or more residents had participated to date.

CONCLUSIONS: Interest in global health among medical students is increasing. OSR programs have followed this trend, increasing their global health opportunities by 92% since 2015. Communicating the availability of and support for international opportunities to future residents may help interested students make informed decisions when applying to residency programs.

PMID:33725703 | DOI:10.5435/JAAOSGlobal-D-20-00102

Gait Posture. 2021 Mar 8;86:144-149. doi: 10.1016/j.gaitpost.2021.03.004. Online ahead of print.

ABSTRACT

BACKGROUND: Torsional deformities of the lower limbs in children and adolescents are a common cause of in-toeing gait and cause gait deviations. The purpose of this study was to examine the relationship of children and adolescents with suspected Idiopathic Torsional Deformities (ITD) and pain, gait function, activity and participation.

METHODS: A retrospective review of all children and adolescents who attended our Centre over a 5-year period for evaluation of the effect of ITD. All children completed three-dimensional gait analysis (3DGA), standardized physical examination, medical imaging and the Pediatric Outcomes Data Collection Instrument (PODCI). Statistical analysis was completed using two sample t-tests, Pearson’s Correlation and linear regression.

RESULTS: Fifty children and adolescents, 40 females and 10 males with a mean age of 13.5 years were included. Children reported a high prevalence of pain(86%), had increased internal hip rotation(p = 0.002) and decreased external hip rotation(p < 0.001) on physical examination when compared to published normative data. Medical imaging showed a mean(SD) femoral neck anteversion (FNA) of 38°(13°) and external tibial torsion of 39°(12°). Mean(SD) PODCI score was 32(16), indicating these children are functioning below their typically developing peers. The 3DGA kinematics show deviations from typical data including hip rotation, foot progression, pelvic tilt, hip flexion and knee extension. Observed mild kinetic deviations were within typical limits. The relationship between FNA and gait parameters, FNA and PODCI and gait and PODCI were weak.

SIGNIFICANCE: These children and adolescents have altered gait and experience pain leading to impaired function and diminished participation. Therefore, ITD is not purely a cosmetic issue.

PMID:33725582 | DOI:10.1016/j.gaitpost.2021.03.004

Gait Posture. 2021 Mar 6;86:150-156. doi: 10.1016/j.gaitpost.2021.03.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Previous studies showed that rocker shoes with a stiff forefoot rocker profile significantly reduce peak plantar flexion moment at the ankle (PFM) and peak ankle dorsiflexion (DF). Both parameters are related to Achilles tendon and Plantar Fascia unloading. The shape of an outsole with a forefoot rocker is described with multiple rocker design parameters. The aim of this research is, to determine the relation between different forefoot rocker radii on peak DF and peak PFM at a self-selected walking speed.

METHODS: 10 participants walked in standard shoes and three experimental pairs of shoes with different forefoot rocker radii. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with Statistical Parametric Mapping (SPM) (α = .05; post-hoc α = .05/6).

RESULTS: Peak value analyses showed significant decreases in peak DF, peak PFM, and peak ankle power generation for the rocker conditions. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle joint. SPM showed a significant decrease (% gait cycle) in DF (40-69 %), PFM (7-15 %; 41-68 %; 69-81 %), ankle power (10-15 %; 32-51 %; 55-64 %; 64-67 %; 72-80 %) and foot-to-horizontal angle (FHA) (0-4 %; 40-62 %; 92-100 %) and an increased shank-to-vertical angle (SVA) (44-84 %) for the rocker conditions.

CONCLUSION: The results of this study suggest that rocker shoes with a proximally placed apex significantly reduce DF and PFM during the third rocker compared with control shoes. This effect is mainly explained by a change in the FHA. Smaller radii cause the largest reductions in DF and PFM, so therefore, a uniform standardisation of the forefoot rocker radius is essential.

PMID:33725583 | DOI:10.1016/j.gaitpost.2021.03.008