Tag: statistics

Clin Pharmacokinet. 2022 Aug 10. doi: 10.1007/s40262-022-01161-y. Online ahead of print.

ABSTRACT

BACKGROUND: The combination of polymyxins, meropenem, and sulbactam demonstrated efficacy against multi-drug-resistant bacillus Acinetobacter baumannii. These three antibiotics are commonly used against major blood, skin, lung, and heart muscle infections.

OBJECTIVE: The objective of this study was to predict drug disposition and extrapolate the efficacy in these tissues using a physiologically based pharmacokinetic modeling approach that linked drug exposures to their target pharmacodynamic indices associated with antimicrobial activities against A. baumannii.

METHODS: An adult physiologically based pharmacokinetic model was developed for meropenem, colistin, and sulbactam and scaled to pediatrics accounting for both renal and non-renal clearances. The model reliability was evaluated by comparing simulated plasma and tissue drug exposures to observed data. Target pharmacodynamic indices were used to evaluate whether pediatric and adult dosing regimens provided sufficient coverage.

RESULTS: The modeled plasma drug exposures in adults and pediatric patients were consistent with reported literature data. The mean fold errors for meropenem, colistin, and sulbactam were in the range of 0.710-1.37, 0.981-1.47, and 0.647-1.39, respectively. Simulated exposures in the blood, skin, lung, and heart were consistent with reported penetration rates. In a virtual pediatric population aged from 2 to < 18 years, the interpretive breakpoints were achieved in 85-90% of subjects for their targeted pharmacodynamic indices after administration of pediatric dosing regimens consisting of 30 mg/kg of meropenem, and 40 mg/kg of sulbactam three times daily as a 3-h or continuous infusion and 5 mg/kg/day of colistin base activity.

CONCLUSIONS: The physiologically based pharmacokinetic modeling supports pediatric dosing regimens of meropenem/colistin/sulbactam in a co-administration setting against infections in the blood, lung, skin, and heart tissues due to A. baumannii.

PMID:35947360 | DOI:10.1007/s40262-022-01161-y

Int J Clin Pharm. 2022 Aug 10. doi: 10.1007/s11096-022-01462-z. Online ahead of print.

ABSTRACT

BACKGROUND: Procalcitonin is a serum biomarker used to distinguish bacterial infection from viral or noninfectious syndromes. Primary literature shows mixed data on use of procalcitonin for de-escalation of antimicrobials. Delays in test results of send-out procalcitonin assays may result in prolonged antimicrobial durations. It is unknown whether availability of rapid-result assays may shorten time to antibiotic de-escalation.

AIM: This retrospective, cohort study compared antibiotic durations of treatment between groups with rapid-result versus delayed send-out, procalcitonin test modality. This study was exempt from Ethics Committee Approval, as determined by the Institutional Review Board at the study site.

METHOD: Adult hospitalized patients were included if they had at least one procalcitonin test performed during the study period. The primary outcome compared mean duration of antimicrobial therapy between groups receiving a rapid-result procalcitonin test and a send-out test. Secondary outcomes included incidence of Clostridiodes difficile infection, mention of procalcitonin testing in the electronic medical record in reference to antimicrobial therapy decision making, and presence of comorbidities which affect procalcitonin levels independent of infection.

RESULTS: A total of 350 lab results were analyzed. The duration of antimicrobial treatment between groups was not statistically different with the median duration of treatment in the send-out group being 2.95 days compared to 3.35 in the rapid result group, p = 0.856. Patient comorbidities with potential to lead to a noninfectious elevation or falsely high level of procalcitonin were common.

CONCLUSION: Use of a rapid-result procalcitonin assay does not reduce hospital antimicrobial therapy duration as compared with send-out testing.

PMID:35947325 | DOI:10.1007/s11096-022-01462-z

J Immigr Minor Health. 2022 Aug 10. doi: 10.1007/s10903-022-01388-8. Online ahead of print.

ABSTRACT

Newly resettled refugee populations often have significant health care needs including pregnancy complications; yet research is lacking on pregnancy complications among refugees in Illinois. This was a retrospective analysis of the 2016-2017 hospital discharge data of refugee women of childbearing age (15-44 years) in Illinois. There were 3,355 hospital encounters by refugee women in our analysis, and 19.1% (n = 640) were associated with complications mainly related to pregnancy. The majority of hospital encounters associated with complications mainly related to pregnancy occurred after the first 8 months of US arrival (85.2%) and were among women who had Medicaid insurance (90.3%), ≥ 5 hospital encounters (60.2%), and who were most commonly from Iraq (23.3%) or Burma (19.4%). Refugee women may benefit from increased awareness and education about prenatal care, support in access, and prompt referrals.

PMID:35947321 | DOI:10.1007/s10903-022-01388-8

J Interv Card Electrophysiol. 2022 Aug 10. doi: 10.1007/s10840-022-01332-8. Online ahead of print.

ABSTRACT

BACKGROUND: Advances in technology and workflows have facilitated substantial reductions in fluoroscopy utilization and procedure times for atrial fibrillation (AF) ablations. A recently available steerable sheath, visualizable on a 3D electroanatomical map (EAM), may further simplify low/zero fluoroscopy ablation workflows by facilitating understanding of the relative positions of the catheter and sheath. The objective of this study was to demonstrate feasibility, safety, procedural efficiency, and clinical effectiveness of incorporating the new visualizable sheath into a low-fluoroscopy workflow.

METHODS: Consecutive de novo paroxysmal AF procedures were performed with a porous tip contact force catheter at a high-volume site between January 2018 and May 2019. Procedures performed with and without the VIZIGO™ EAM-visualizable sheath (Vizigo) were compared. All ablations employed the same standardized low-fluoroscopy workflow. Statistical analyses employed stabilized inverse probability of treatment weights (IPTW) to balance cohorts by operator and key patient characteristics.

RESULTS: Cohorts of 142 Vizigo and 173 non-Vizigo patients were similar at baseline. Use of the Vizigo sheath was associated with approximately 10% improvement in catheter stability (p = 0.0005), 16% reduction in radiofrequency time (p < 0.0001), and 7% fewer ablations that used fluoroscopy (p = 0.0030). There was one cardiac tamponade in each cohort and no deaths, atrioesophageal fistulas, or strokes. Single-procedure freedom from atrial arrhythmia recurrence through 12 months was similar between cohorts (p = 0.9556).

CONCLUSIONS: Use of a 3D EAM-visualizable sheath resulted in improved catheter stability, reduced radiofrequency time, and more procedures performed without fluoroscopy, without compromise to safety or effectiveness.

PMID:35947317 | DOI:10.1007/s10840-022-01332-8

Lasers Med Sci. 2022 Aug 10. doi: 10.1007/s10103-022-03614-z. Online ahead of print.

ABSTRACT

To verify the effect of photobiomodulation therapy (PBMT) in individuals with chronic tinnitus without hearing loss, 20 patients who met the inclusion criteria were randomly divided into group 1: active low-level laser (LLL) and group 2: equipment without laser (placebo). Upon anamnesis, data collection, and audiological exams, the Tinnitus Handicap Inventory (THI) and the Visual-Analog Scale (EVA) were applied to measure the level of discomfort with tinnitus and the level of discomfort before and after laser treatment. The protocol used included 12 active LLL sessions for group 1 and not active for group 2, varying red and infrared wavelengths. There was a reduction in the disadvantage of individuals with tinnitus after the intervention and between the initial and final sessions, regardless of the intervention, although group 1 showed a greater reduction than group 2, regardless of point in time of assessment and number of session. There was no statistical difference as to group and point in time for the high-frequency audiometry and acuphenometry outcomes. Individuals with chronic tinnitus reduced the complaint, regardless of point in time and group of intervention; however, the group that received PBMT improved the level of satisfaction, regardless of point in time of assessment and number of session.

PMID:35947315 | DOI:10.1007/s10103-022-03614-z

Environ Geochem Health. 2022 Aug 10. doi: 10.1007/s10653-022-01345-2. Online ahead of print.

ABSTRACT

More has yet to be investigated on the increased efficiency of microbes for the removal of heavy metals from industrial wastewaters. The objective was to determine the Cr (VI) bioabsorption and bioreduction ability of biofilm-producing bacteria supported on clinoptilolite from contaminated aqueous solutions. Chromium (VI)-tolerant bacteria, namely Pseudomonas aeruginosa ATHA23, were identified by biochemical methods and 16S rDNA sequencing and were deposited in NCBI (accession number: KF680991). Preparation of clinoptilolite, bacterial growth and isolation, biofilm production including extracellular polysaccharides (EPS) and Cr (VI) removal efficiency, affected by the experimental treatments, were investigated. The use of FTIR characterized clinoptilolite properties with and without biofilm in the presence and absence of Cr (IV). Higher Cr (VI) levels in the bacterial growth medium, increased EPS production with the highest value (0.171 mg L^-1), produced 18 h after treating the bacteria with Cr (VI) (100 mg L^-1). However, in the absence of Cr (VI), EPS significantly decreased to 0.117 mg L^-1. Plackett-Burman and Taguchi statistical analyses were used to optimize the experimental treatments affecting the removal efficiency of Cr (VI). Among the anions (nitrate, sulfate, and chloride), sulfate decreased Cr removal efficiency. The absorption data were best fitted to the pseudo-second order, and the data of Cr adsorption by clinoptilolite-biofilm were also better fitted to Freundlich isotherm model. The Cr (VI) bioremediation potential of P. aeruginosa ATHA23 by the production of biofilm supported on clinoptilolite has been shown for the first time, which is of significance for the environment and the industry.

PMID:35947311 | DOI:10.1007/s10653-022-01345-2

Teach Learn Med. 2022 Aug 10:1-12. doi: 10.1080/10401334.2022.2107528. Online ahead of print.

ABSTRACT

Problem: High-quality communication improves patient satisfaction and clinical outcomes, yet formal communication training in residency is often minimal. Many studies on empathic communication show mixed results and are often hindered and skewed by brief study lengths, insufficiently and ambiguously defined concepts, and limited methods for objective measurements. Intervention: The FAN Curriculum is a unique communication curriculum, based on the conceptual frameworks of patient-centered communication, reflective practice, mindfulness, and attunement using the Facilitating Attuned Interactions (FAN) model. The first part of the FAN Curriculum was delivered as a 3-hour interactive workshop involving didactics, group discussion, and role play with pediatric residents. Residents then completed weekly self-reflections, a follow-up one-hour training to reinforce concepts, and five monthly mentor sessions, all emphasizing reflective practice. Context: This longitudinal, mixed-methods study examined the effects of the FAN Curriculum on residents’ empathy levels and ability to communicate with parents in the clinical setting. The study was conducted at two urban, academic, medium-sized pediatric residency programs in Chicago between October 2016 and November 2017. First- and second-year pediatric residents whose continuity clinic site was located at their home institution participated. Residents received training in the use of the FAN Communication Tool using a delayed-start crossover study design. Impact: At five time points, residents and parents completed instruments validated for measuring physician empathy and mindfulness. Post-study interviews were conducted for one institution’s residents and mentors and were evaluated using open and focused coding. Participants (n = 23) demonstrated a high degree of use of the FAN Communication Tool six months post-training and a significant rise in self-reported comfort with four of five FAN core processes. One parent-completed survey (Consultation and Relational Empathy, CARE) showed a statistically significant rise of 3.26% in resident relational empathy and collaboration after training (p = 0.02). In qualitative analysis of interviews, residents and mentors found the FAN Communication Tool beneficial, making clinic visits more efficient and collaborative. Both groups noted improvement in the residents’ relationship-building skills; residents were able to use enhanced communication skills to better approach challenging encounters and work through parent concerns. Lessons Learned: Family-centered communication training can improve physician-perceived empathy and mindfulness. Effective communication for pediatric residents incorporates an empathic approach, and introduction to this formal curriculum supported their growth in connecting and engaging with children and parents. The FAN Curriculum may provide a useful method for improving resident communication skills with a positive impact on pediatricians’ collaboration with patients and families.

PMID:35946430 | DOI:10.1080/10401334.2022.2107528

Orthop Surg. 2022 Aug 10. doi: 10.1111/os.13397. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the functional and alignment outcomes of intramedullary nail fixation using suprapatellar and infrapatellar approaches in treating distal tibial fractures.

METHODS: In this retrospective study, 132 patients with distal tibial fractures (87 men, 45 women) ranging in age from 20 to 66 years were treated with intramedullary nails using the suprapatellar (69 patients) or infrapatellar (63 patients) approach. The radiographic alignment outcomes and ankle function were compared between the two groups. Multivariate logistic regression analyses were performed to determine which variety influenced ankle functional scores and whether the suprapatellar approach intervention demonstrated a protective effect.

RESULTS: The mean follow-up time was 14.22 ± 2.31 months. The mean sagittal section angle of the fracture in the suprapatellar and infrapatellar approach groups was 3.20° ± 1.20° and 5.31° ± 1.23°, respectively (P < 0.001). The mean coronal section angle was 3.51° ± 0.89° and 5.42° ± 1.05°, respectively (P < 0.001). Three patients (4.3%) in the suprapatellar approach group and 15 patients (23.8%) in the infrapatellar approach group had poor fracture reduction (P < 0.001). The mean hind foot functional score and ankle pain score were 95.91 ± 4.70 and 35.91 ± 4.70 points, respectively, in the suprapatellar approach group and 85.20 ± 5.61 and 25.20 ± 5.61 points, respectively, in the infrapatellar approach group (P < 0.001 for both). In the comparison of ankle function, the multivariate logistic regression analyses demonstrated that the odds ratio in the suprapatellar approach group was about 7 times that in the infrapatellar approach group (odds ratio, 7.574; 95% confidence interval, 2.148-28.740; P = 0.002). Of the variants measured, the statistically significant risk factors for poor ankle function were AO type A3 (P = 0.016) and diabetes mellitus (P = 0.006). Sex and the operation interval were not statistically significant risk factors for poor ankle function.

CONCLUSION: Intramedullary nailing using the suprapatellar approach facilitates simple fracture reduction, excellent postoperative fracture alignment, and few complications, giving it obvious advantages over the conventional infrapatellar approach. Additionally, the suprapatellar approach is a prognostic factor associated with postoperative ankle joint function.

PMID:35946437 | DOI:10.1111/os.13397

Food Funct. 2022 Aug 10. doi: 10.1039/d1fo03204f. Online ahead of print.

ABSTRACT

Objective: To investigate the effect of oligosaccharides on the markers of glycemic control, including fasting blood glucose (FBG), fasting blood insulin (FBI), glycated hemoglobin (HbA_1c), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity index (QUICKI). Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched to find randomized controlled trials (RCTs) on the effect of oligosaccharide intervention on FBG, FBI, HbA_1c, HOMA-IR, and QUICKI up to 7 June 2021. Data were pooled using weighted mean difference (WMD) and 95% confidence intervals (95% CI), with a p-value ≤0.05 indicating statistical significance. Risk of bias was assessed with the Cochrane tool and the quality of the literature with the new Jadad scale. Results: A total of 46 randomized controlled trials were included. Oligosaccharides significantly reduced FBG (WMD: -0.295 mmol L^-1; 95% CI: -0.396 to -0.193; p < 0.001; I² = 90.9%; 46 trials; 2412 participants), FBI (WMD: -0.559 pmol L^-1; 95% CI: -0.939 to -0.178; p < 0.01; I² = 99.1%; 29 trials; 1462 participants), HbA_1c (WMD: -0.365; 95% CI: -0.725 to -0.005; p < 0.05; I² = 86.6%; 11 trials; 661 participants), and HOMA-IR (WMD: -0.793; 95% CI: -1.106 to -0.480; p < 0.001; I² = 96.1%; 24 trials; 1382 participants). Oligosaccharides were more beneficial for the participants with obesity or diabetes than for healthy participants. Multiple interventions per day consolidated the effectiveness of oligosaccharides. Regardless of the processing manner (starch-modified or naturally extracted) of the oligosaccharides, their intervention was overall beneficial for the patients with diabetes. Conclusions: This study is by far the most extensive systematic review to evaluate the role of oligosaccharides on the markers of glycemic control. Oligosaccharide interventions can exert beneficial effects on FBG, FBI, HbA_1c, and HOMA-IR.

PMID:35946428 | DOI:10.1039/d1fo03204f

J Dent Educ. 2022 Aug 10. doi: 10.1002/jdd.13066. Online ahead of print.

ABSTRACT

PURPOSE: Research has demonstrated that learners who practice self-testing have superior long-term retention compared to those rereading the material alone, a phenomenon called test-enhanced learning. This testing effect can be leveraged by spacing out the testing practice over time, a technique called spaced repetition. In 2017, we provided dental students at the school with access to Osmosis, a web-based platform that supports test-enhanced learning and spaced repetition through flashcards. This exploratory study examined students’ adoption of self-testing with flashcards and its impact on learning performance in basic sciences.

METHODS: Participants were 143 first-year predoctoral students at a dental school in the US. The platform analytics revealed the number of flashcards students answered throughout the first academic year (2019-2020). Regression analyses examined how self-testing with flashcards impacted students’ exam scores in basic sciences. Analysis of variance (ANOVA) tests examined the difference in students’ exam performance among the non, minimal, occasional, and regular flashcard users who answered 0, 1-99, 100-499, and over 500 flashcards, respectively.

RESULTS: Students answered 82,766 flashcards during the year. Additionally, they created 17,973 flashcards using the platform’s flashcard authoring tool. Regression analyses showed that self-testing with flashcards correlated positively with students’ exam performance in anatomy, biochemistry, nutrition, and physiology. ANOVA results revealed a statistically significant difference in students’ exam performance in anatomy, biochemistry, and nutrition among the four groups.

CONCLUSIONS: This study is the first in dental education to examine students’ self-testing on the Osmosis platform. Results revealed that there was widespread adoption of self-testing with flashcards. The study provided additional evidence to support the value of self-testing for dental students. It has practical implications of how test-enhanced learning can be incorporated into dental education to support student learning. The study contributed to the test-enhanced learning literature in dental education, an area that has been underexplored.

PMID:35946422 | DOI:10.1002/jdd.13066