Tag: statistics

J Clin Anesth. 2022 Feb 19;78:110682. doi: 10.1016/j.jclinane.2022.110682. Online ahead of print.

ABSTRACT

IMPORTANCE: Mild cognitive impairment (MCI) is a high-risk precursor to dementia, post-operative delirium, and prolonged hospitalization. There is a need for preoperative rapid cognitive screening tools.

STUDY OBJECTIVE: To evaluate the predictive parameters of rapid MCI screening tools in different clinical settings for preoperative application.

DESIGN: Systematic review and meta-analyses searching Medline, and other databases from inception to May 26, 2021. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for data curation and quality assessment. Title and abstract screening were conducted independently via Rayyan. Data was curated through a random-effects model and statistical analysis used R-software.

SETTING: Community, memory clinic, emergency, long-term care, and in-patient settings. There were no studies in the preoperative setting.

PATIENTS: Twenty-three studies with 9973 patients (≥ 60 years old) undergoing rapid MCI screening.

INTERVENTION: Rapid (≤ 5 min) MCI screening tools.

MEASUREMENTS: Pooled predictive parameters (sensitivity, specificity) of screening tests.

MAIN RESULTS: Eighteen screening tools, compared to neuropsychological tests, were identified. The overall prevalence of MCI among the Rapid Cognitive Screen (RCS), Six-item Screener (SIS), Mini-Cog, and Clock Drawing Test (CDT) studies were 24.6%, 28.3%, 40.9%, and 20.7%, respectively. RCS has 82% sensitivity and 79% specificity in detecting MCI. SIS has 61% sensitivity and 89% specificity. Mini-Cog has 52% sensitivity and 80% specificity. CDT has 56% sensitivity and 59% specificity. Seven other index tools had high sensitivities of 97%-82% and specificities of 90%-73% but were studied only once.

CONCLUSION: No rapid screening tools had been validated in the surgical population. In other populations, RCS may be a promising screening tool for MCI with stronger sensitivity and specificity than Mini-Cog, SIS, and CDT. CDT alone is ineffective for MCI detection. Further validation in the preoperative setting is required to determine the efficacy of these screening tools.

PMID:35193049 | DOI:10.1016/j.jclinane.2022.110682

Spectrochim Acta A Mol Biomol Spectrosc. 2022 Feb 15;273:121036. doi: 10.1016/j.saa.2022.121036. Online ahead of print.

ABSTRACT

HIAM technique allows the extraction of the original constant signal of each single component out of interference signals of a mixture and further transformed into basic spectrum (D⁰). It includes the methods: ratio subtraction coupled with unified constant subtraction (RS-UCS), constant center (CC) and constant extraction (CE). The technique was introduced for the analysis of two pharmaceutical formulations used to treat cardiovascular diseases. The formulations are binary combinations of Amlodipine (AML) with either Atorvastatin (ATR) or Candesartan (CND) which shows interefernce absorbance signals. The technique was valid over the linearity range of (5.0-35.0 µg/ml) for AML, ATR and CND with recovery percentage 100.40 ± 1.88 , 100.00 ± 0.86 and 99.83 ± 1.07, respectively . The extracted signals were tested for its purity by spectral contrast angle (cos θ) to illustrate the efficency of the HIAM technique where cos θ values ranges from (0.9902 to 0.9986). The presented technique was fully validated regarding ICH guidelines and were statistically compared using one-way ANOVA at 95% confidence.

PMID:35193003 | DOI:10.1016/j.saa.2022.121036

J Stomatol Oral Maxillofac Surg. 2022 Feb 19:S2468-7855(22)00039-8. doi: 10.1016/j.jormas.2022.02.011. Online ahead of print.

ABSTRACT

The aim of this study was to examine whether ultrasonography and three-dimensional radiological procedures produce significantly different measurement results with respect to fracture dislocation. This was a retrospective study of patients who were admitted to the department for oral and maxillofacial surgery of the Medical Highschool Hannover with facial skull fracture and underwent high-resolution computed tomography and ultrasonography imaging during a period from 1 January 2019 to 31 August 2019. A 10 mHz transducer was used for fracture imaging, and the largest dislocation of each fracture was measured. A paired t-test for dependent samples was used for statistical evaluation of the measured differences, and the p-value was set at 0.05. A total of 16 patients with 29 fractures were included. The fractures were characterized as follows: zygomatic arch (n=7), lateroorbital region (n=4), maxilla/zygomatic bone (n=15), mandible (n=2), and frontal sinus (n=1). Regardless of the fracture location, we found no statistical difference in fracture measurements between the ultrasonography and the computed tomography (p=0.17 (fractures of the zygomatic arch) to p=0.85 (all fractures)). The study findings suggest that ultrasonography not only allows basic detection but also a quantification of the dislocation in facial skull fractures. The ultrasonography results are not significantly different from those of the computed tomography. In everyday clinical practice, ultrasonography of facial fractures can be considered an adequate imaging procedure. If used correctly, additional radiation exposure to the patient can be avoided, thus representing a diagnostic alternative to computed tomography.

PMID:35192967 | DOI:10.1016/j.jormas.2022.02.011

World Neurosurg. 2022 Feb 19:S1878-8750(22)00213-3. doi: 10.1016/j.wneu.2022.02.066. Online ahead of print.

ABSTRACT

INTRODUCTION: The emergence of C8 radiculopathy is a known complication following cervicothoracic osteotomies. However, the clinical profile of C8 radiculopathy is not well understood.

OBJECTIVE: To investigate the rate of C8 radiculopathy following cervicothoracic osteotomies and to form a clinical profile describing the characteristics through a systematic review of the literature to date.

METHODS: An electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on indications for cervicothoracic osteotomies, surgical approaches, mean follow-up time, and significant complications, including C8 radiculopathy.

RESULTS: Our literature search resulted in 2,135 articles, of which 12 studies qualified to be included in the analysis. From the 12 articles, 451 patients across various osteotomy approaches were included. The mean age of subjects was 51.0 years (ranging from 11.4 to 63.2 years), and the majority of patients were males (66%, n = 298). Ankylosing spondylitis was the most frequent indication for surgery (44.8%, n = 202). The number of patients with post-operative C8 radiculopathy was found to be decreasing over time (1997-2020) by showing statistical significance (r=-0.65; p=0.021) CONCLUSION: There were 53 patients from the 451 total patient population with C8 radiculopathy (11.8% of the total patient population). Moreover, the rate of C8 radiculopathy decreased over time in a statistically significant manner. An understanding of the factors associated with the incidence of C8 radiculopathy is essential for the future improvement of patient outcomes.

PMID:35192973 | DOI:10.1016/j.wneu.2022.02.066

J Gynecol Obstet Hum Reprod. 2022 Feb 19:102336. doi: 10.1016/j.jogoh.2022.102336. Online ahead of print.

ABSTRACT

OBJECTIVE: – To evaluate whether ultrasound assessment of fetal head position and station though head perineum distance (HPD), is more predictive of a difficult operative vaginal delivery (OVD) than digital examination.

METHODS: – Retrospective, monocentric case control study including all singleton OVD at ≥34 weeks gestation. The principal criteria for a difficult OVD were based on a composite criterion of: an OVD considered “difficult” by the birth attendant, and/or two vacuum device detachments if a vacuum was used, and/or change of instrument, and/or a cesarean delivery for OVD failure.

RESULTS: – Two hundred eighty-six OVDs were included, among which 65 (22.7%) were difficult. The area under the curve (AUC) for predicting difficult OVD according to fetal position from digital examination or ultrasound was 0.62 (95% CI: 0.54-0.70) and 0.66 (95% CI: 0.58-0.73), respectively. Regarding fetal station, the AUCs of HPD without and with pressure were 0.59 (95% CI: 0.51-0.66) and 0.60 (95% CI: 0.51-0.68), respectively. Factors associated with difficult OVD were posterior and transverse positions (OR: 2.931, 95% CI: 1.640-5.239; p = 0.0003), HPD without pressure (threshold of 37 mm, OR: 2.327, 95% CI: 1.247-4.245; p = 0.0080), and HPD with pressure (threshold of 17 mm, OR: 2.594, 95% CI: 1.230-5.429; p = 0.0114).

CONCLUSION: – Ultrasound assessment of fetal head position and station before OVD moderately predicts difficult OVD. Ultrasound assessment of posterior or transverse positions and HPD with a threshold of 37 mm (without compression of soft tissue) and 17 mm (with compression) were factors associated with difficult OVD.

PMID:35192950 | DOI:10.1016/j.jogoh.2022.102336

Neuroimage. 2022 Feb 19:118993. doi: 10.1016/j.neuroimage.2022.118993. Online ahead of print.

ABSTRACT

Resting-state functional connectivity is typically modeled as the correlation structure of whole-brain regional activity. It is studied widely, both to gain insight into the brain’s intrinsic organization but also to develop markers sensitive to changes in an individual’s cognitive, clinical, and developmental state. Despite this, the origins and drivers of functional connectivity, especially at the level of densely sampled individuals, remain elusive. Here, we leverage novel methodology to decompose functional connectivity into its precise framewise contributions. Using two dense sampling datasets, we investigate the origins of individualized functional connectivity, focusing specifically on the role of brain network “events” – short-lived and peaked patterns of high-amplitude cofluctuations. Here, we develop a statistical test to identify events in empirical recordings. We show that the patterns of cofluctuation expressed during events are repeated across multiple scans of the same individual and represent idiosyncratic variants of template patterns that are expressed at the group level. Lastly, we propose a simple model of functional connectivity based on event cofluctuations, demonstrating that group-averaged cofluctuations are suboptimal for explaining participant-specific connectivity. Our work complements recent studies implicating brief instants of high-amplitude cofluctuations as the primary drivers of static, whole-brain functional connectivity. Our work also extends those studies, demonstrating that cofluctuations during events are individualized, positing a dynamic basis for functional connectivity.

PMID:35192942 | DOI:10.1016/j.neuroimage.2022.118993

Photodiagnosis Photodyn Ther. 2022 Feb 19:102764. doi: 10.1016/j.pdpdt.2022.102764. Online ahead of print.

ABSTRACT

Oral potentially malignant disorders (OPMD) represent a group of lesions with increased risk for malignant transformation. The management of such injuries is based on surgical treatment or detailed follow-up throughout the patient’s lifetime. This systematic review and meta-analysis investigated and critically evaluated the use of autofluorescence and fluorescent probes as potential techniques for the early detection of OPMD. A comprehensive search was performed on Pubmed, Scopus, Web of Science and LIVIVO databases. The gray literature was also consulted and included Google Scholar, Proquest and Open Grey databases. 2715 articles were retrieved, and after the different stages of critical evaluation, were reduced to 25 articles that fully met the inclusion criteria. VELscope® was the most used equipment for autofluorescence, while aminolevulinic acid (5-ALA) was the main representative of the probes. The meta-analysis performed included 10 articles that used VELscope® as a method to detect oral disorders. A 95% confidence interval (CI) with a p value significance <0.05 was considered as a criterion for the statistical analysis. The combined sensitivity was 74% (CI95 60-76%, p = 0.0001) and the specificity was 57% (CI95 52-60%, p = 0.0000). The inclusion of these adjunct methods in clinical practice is very promising, since they are able to help both the clinician and the specialist in the early detection of potentially malignant oral disorders, favoring a better prognosis. However, it is still necessary to carry out further studies, with the aim of establishing a protocol for use and qualification of results.

PMID:35192945 | DOI:10.1016/j.pdpdt.2022.102764

Hand Surg Rehabil. 2022 Feb 19:S2468-1229(22)00070-6. doi: 10.1016/j.hansur.2022.01.013. Online ahead of print.

ABSTRACT

This study aimed to assess the influence of the surgeon’s position on procedure time in MIPO (Minimally Invasive Plate Osteosynthesis) for distal radius fracture. The hypothesis was that there was a correlation between procedure time and the surgeon’s position in relation to the operated side. Thirteen surgeons (12 right-handed, 1 left-handed) operated on 421 distal radius fractures: 208 right-sided (R) and 213 left-sided (L). Surgeons stood either at the patient’s head (H) or the feet (F). Procedure time and scar size were measured. Regardless of operated side (right or left), mean surgery time was 35.5 min (range, 14-71) with the surgeon at the head and 40.5 min (range, 11-119) with the surgeon at the feet. The difference (5 min) was statistically significant. When the right side was operated on, surgery time was 34.2 min (range, 14-66) with surgeon at the head and 41.1 min (range, 11-86) at the feet. The difference (6 min) was statistically significant. No other comparisons were significant. There was no correlation with surgeon’s experience. Given that 1 min of operating room time costs between €10.80 and €29, savings of €54 to €145 per procedure can be achieved. The study hypothesis was confirmed, with a correlation between the surgeon’s position in relation to the operated side and the duration of the operation. In conclusion, we recommend that surgeons position themselves at the patient’s head for of distal radius fracture MIPO.

PMID:35192940 | DOI:10.1016/j.hansur.2022.01.013

Neurosci Biobehav Rev. 2022 Feb 19:104591. doi: 10.1016/j.neubiorev.2022.104591. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis aims to identify and quantify the current available evidence of hypnosis efficacy to manage pain in patients with chronic musculoskeletal and neuropathic pain. Randomized Control Trials (RCTs) with hypnosis and/or self-hypnosis treatment used to manage musculoskeletal and/or neuropathic chronic pain in adults and assessing pain intensity were included. Reviews, meta-analyses, non-randomized clinical trials, case reports and meeting abstracts were excluded. Five databases, up until May 13^th 2021, were used to search for RCTs using hypnosis to manage chronic musculoskeletal and/or neuropathic pain. The protocol is registered on PROSPERO register (CRD42020180298) and no specific funding was received for this review. The risk of bias asessement was conducted according to the revised Cochrane risk of bias tool for randomized control trials (RoB 2.0). Nine eligible RCTs including a total of 530 participants were considered. The main analyses showed a moderate decrease in pain intensity (Hedge’s g: -0.42; p=0.025 after intervention, Hedge’s g: -0.37; p=0.027 after short-term follow-up) and pain interference (Hedge’s g: -0.39; p=0.029) following hypnosis compared to control interventions. A significant moderate to large effect size of hypnosis compared to controls was found for at 8 sessions or more (Hedge’s g: -0.555; p=0.034), compared to a small and not statistically significant effect for fewer than 8 sessions (Hedge’s g: -0.299; p=0.19). These findings suggest that a hypnosis treatment lasting a minimum of 8 sessions could offer an effective complementary approach to manage chronic musculoskeletal and neuropathic pain. Future research is needed to delineate the relevance of hypnosis in practice and its most efficient prescription.

PMID:35192910 | DOI:10.1016/j.neubiorev.2022.104591

Am J Infect Control. 2022 Feb 19:S0196-6553(22)00095-5. doi: 10.1016/j.ajic.2022.02.015. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have established that vaccination plays a significant role in reducing COVID-19-related deaths. Here, we investigated differences in COVID-19 case fatality rates (CFRs) among vaccinated and unvaccinated populations, and analyzed whether the age composition of confirmed cases has a significant effect on the variations in the observed CFRs across these groups.

METHODS: The study considered 59,853 confirmed cases and 1,687 deaths from COVID-19, reported between January 1^st to October 20^th, 2021, by the Health Department of Londrina, a city in Southern Brazil. We used Negative Binomial regression models to estimate CFRs according to vaccination status and age range.

RESULTS: There are significant differences between the CFR for fully vaccinated and unvaccinated populations (IRR=0.596, 95% CI [0.460 – 0.772], p<0.001). Vaccinated populations experience fatality rates 40.4% lower than non-vaccinated. In addition, the age composition of confirmed cases explains more than two-thirds of the variation in the CFR between these two groups.

CONCLUSION: Our novel findings reinforce the importance of vaccination as an essential public health measure for reducing COVID-19 fatality rates in all age groups. The results also provide means for accurately assessing differences in CFRs across vaccinated and unvaccinated populations. Such assessment is essential to inform and determine appropriate containment and mitigation interventions in Brazil and elsewhere.

PMID:35192917 | DOI:10.1016/j.ajic.2022.02.015