Tag: statistics

Int Urogynecol J. 2022 May 2. doi: 10.1007/s00192-022-05212-7. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: At our institution, every patient seen by the gynecologic oncology service is screened for pelvic floor dysfunction. This study was aimed at determining if a combined surgical approach by gynecologic oncology and urogynecology services at our institution was feasible and safe for this patient population.

METHODS: We performed a retrospective review of patients undergoing combined surgery by gynecologic oncology and urogynecology services at our institution from 2013 to 2021. Perioperative variables, postoperative adverse events, and long-term outcomes were assessed, and descriptive statistics were performed.

RESULTS: From 20 December 2013 to 29 January 2021, a total of 102 patients underwent concurrent surgical repair of pelvic organ prolapse and/or stress urinary incontinence. Seventy-three patients (71.6%) had normal/benign pathologic conditions, and 29 (28.4%) had premalignant/malignant pathologic conditions. Ten patients (9.8%) had a postoperative complication, including reoperation for exposed midurethral sling (4.9%), urinary retention requiring midurethral sling release (2.9%), reoperation for hemoperitoneum (1.0%), and anemia requiring blood transfusion (1.0%). Nine complications occurred in patients with benign/normal pathologic conditions (12.3%), and one complication occurred in patients with pre-malignant/malignant pathologic conditions (3.4%).

CONCLUSIONS: In our single-institution experience, concurrent gynecologic oncology and pelvic floor reconstructive surgery were safe and feasible in combination with no reported major morbidity events.

PMID:35501570 | DOI:10.1007/s00192-022-05212-7

Int Urogynecol J. 2022 May 2. doi: 10.1007/s00192-022-05208-3. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Staging of pelvic organ prolapse (POP) is important in clinical practice and research. Pelvic organ descent on Valsalva can be confounded by levator co-activation, which may be avoided by assessment on coughing. We evaluated the performance of a three consecutive coughs maneuver in the assessment of POP compared with standardised 6-second Valsalva.

METHODS: This was a retrospective observational study carried out in women attending a tertiary urogynaecological service in 2017-2019. Patients underwent a standardised interview and clinical examination. Clinical assessment was performed twice, with both 6-s Valsalva and three consecutive coughs performed in random order. Main outcomes were Ba, C and Bp as defined by Pelvic Organ Prolapse-Quantification (POP-Q). Association between coordinates and prolapse symptoms was investigated with receiver-operating characteristic (ROC) statistics.

RESULTS: Datasets of 855 women were analysed. POP symptoms were reported by 447 patients (52%) with a mean bother of 6.1 (SD 3.0). On clinical assessment, relevant prolapse was found in 716 (84%) patients on Valsalva and in 730 (85%) on coughing (p=0.109). Clinically relevant prolapse in the apical compartment was more likely to be detected on Valsalva (p<0.0001). Mean POP-Q measurements were not significantly different between maneuvers, except for Ba (p=0.004). ROC curve analysis yielded an area under the curve of 0.74 (95% CI, 0.70-0.77) for maximum POP-Q stage on Valsalva and 0.72 (95% CI, 0.69-0.75) after three consecutive coughs, with a similar performance of both maneuvers in predicting prolapse symptoms (p=0.95).

CONCLUSIONS: Clinical assessment of POP by consecutive coughing seems complementary to standardised Valsalva, especially if Valsalva performance is poor.

PMID:35501568 | DOI:10.1007/s00192-022-05208-3

Neurol Ther. 2022 May 3. doi: 10.1007/s40120-022-00353-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Observational studies have indicated widespread comorbidity of white matter (WM) lesions and Alzheimer’s disease (AD) in the elderly, but the causality and direction of their relationship remained unclear. Our study aims to examine the bidirectional causal relationship between WM change and AD using a genetically informed method.

METHODS: We performed a bidirectional two-sample mendelian randomization (MR) study to investigate the correlation of three WM phenotypes-white matter hyperintensities (WMH, N = 18,381), fractional anisotropy (FA, N = 17,673), and mean diffusivity (MD, N = 17,467)-with AD (N = 63,926) using summary statistics from genome-wide association studies (GWAS). The inverse variance weighted method (IVW) was used to evaluate the causal estimate and alternative methods to test the heterogeneity, horizontal pleiotropy, and outliers.

RESULTS: There was no significant causal evidence of WM MRI markers on AD across all MR methods. We identified significant evidence of causal effects of AD on the risk of WMH (OR 1.06, 95% CI 1.03-1.10, p < 0.01). The same direction of effects was observed in MR-Egger, weighted median, and weighted mode analysis. Besides, we also observed a risk causal relationship between AD with MD in MR-Egger, weighted median, and weighted mode-based methods (MR-Egger OR 1.38, 95% CI 1.07-1.79, p = 0.02; weighted median OR 1.21, 95% CI 1.02-1.45, p = 0.03; weighted mode-based OR 1.32, 95% CI 1.14-1.53, p < 0.01). However, the general significance of the causal effect of AD on WMH and MD disappeared when we removed the single nucleotide polymorphisms (SNPs) near the APOE regions, revealing that the ability of AD to increase the risk of white matter damage might be mediated by APOE to some extent. Unfortunately, we did not observe significant causal evidence of AD on FA across all MR analyses.

CONCLUSIONS: In this bidirectional MR study, we did not observe that WM injuries were associated with a higher risk of AD. Likewise, genetically predicted AD did not result in a causal effect on white matter damage. However, our research revealed that underlying mechanisms linking AD and white matter lesions might be related to the SNPs near APOE regions.

PMID:35501561 | DOI:10.1007/s40120-022-00353-9

Psychon Bull Rev. 2022 May 2. doi: 10.3758/s13423-022-02098-w. Online ahead of print.

ABSTRACT

A fundamental goal of scientific research is to generate true positives (i.e., authentic discoveries). Statistically, a true positive is a significant finding for which the underlying effect size (δ) is greater than 0, whereas a false positive is a significant finding for which δ equals 0. However, the null hypothesis of no difference (δ = 0) may never be strictly true because innumerable nuisance factors can introduce small effects for theoretically uninteresting reasons. If δ never equals zero, then with sufficient power, every experiment would yield a significant result. Yet running studies with higher power by increasing sample size (N) is one of the most widely agreed upon reforms to increase replicability. Moreover, and perhaps not surprisingly, the idea that psychology should attach greater value to small effect sizes is gaining currency. Increasing N without limit makes sense for purely measurement-focused research, where the magnitude of δ itself is of interest, but it makes less sense for theory-focused research, where the truth status of the theory under investigation is of interest. Increasing power to enhance replicability will increase true positives at the level of the effect size (statistical true positives) while increasing false positives at the level of theory (theoretical false positives). With too much power, the cumulative foundation of psychological science would consist largely of nuisance effects masquerading as theoretically important discoveries. Positive predictive value at the level of theory is maximized by using an optimal N, one that is neither too small nor too large.

PMID:35501547 | DOI:10.3758/s13423-022-02098-w

Qual Life Res. 2022 Apr 30. doi: 10.1007/s11136-022-03145-8. Online ahead of print.

ABSTRACT

PURPOSE: We sought to explore the Health-Related Quality of Life (HRQoL) of Breast Cancer (BC) and Colorectal Cancer (CRC) patients receiving active chemotherapy.

METHODS: A cross-sectional study was conducted among a convenient sample of BC and CRC patients between May 2018 and June 2019. HRQoL was measured with the Functional Assessment of Cancer Therapy-Breast (FACT-B; 36 items, score range 0-144)) and the Functional Assessment of Cancer Therapy-Colon (FACT-C; 34 items, score range 0-136) scales. Both scales measured Physical Well-Being (PWB), Social Well-Being (SWB), emotional well-being, Functional Well-Being (FWB), and an additional disease-specific HRQoL items.

RESULTS: A total of 209 BC and 159 CRC patients were included, with a mean age 49.73 ± 10.41 and 55.38 ± 11.35 years, respectively. 110 (52.6%) of BC and 86 (54.1%) CRC patients were dependent on caregivers, and 115 (55%) of BC and 92 (57.9%) CRC patients slept > 7 h/night. Reported HRQoL mean scores of BC (FACT-B) and CRC (FACT-C) were 85.53 ± 14.81 and 87.69 ± 20.21, respectively. For BC, the PWB score of patients aged >49 years (postmenopausal) was statistically significantly (p = 0.013) worse than those aged ≤49 years (premenopausal). Patients dependent on caregivers had statistically significant better PWB and worse EWB (p = 0.041; p = 0.027, respectively). CRC patients’ dependent on caregivers had better statistically significant differences scoring in FACT-C (p = <0.001), PWB (p = 0.001), EWB (p = <0.001), and FWB (p = 0.001).

CONCLUSION: In this study, BC and CRC patients who received active chemotherapy were more likely to have poor HRQoL. BC and CRC HRQoL should be addressed early and continuously, to limit their effects on treatment plan.

PMID:35501529 | DOI:10.1007/s11136-022-03145-8

Environ Geochem Health. 2022 Apr 30. doi: 10.1007/s10653-022-01280-2. Online ahead of print.

ABSTRACT

The aimed of the work was estimated the value (level) of mean annual ²²²Rn activity concentration in an underground space based on monthly (k_1m) and quarterly (k_3m) correction factors. The calculations of factors were developed with the assumption that measurements will be conducted for at least 1 month or a quarter of a year. Radon monitoring to confirm the calculated values was carried out continuously from 2008 to 2019 and verification was made on real data obtained in 2020. The estimated mean annual ²²²Rn activity concentration for spaces with natural air exchange depends on factors k_1m and for mechanically ventilated spaces-k_3m. The k_1m for the first group varies from 1.2 to 3.3 between January and March, and between October and December. In the remaining months, k_1m assumes the values from 0.6 to 0.8. In spaces where natural air exchange with the atmosphere is not impeded by airlocks, the k_1m takes the values of 1.0-1.5 (I-III and X-XII), 0.7-0.8 (V-IX), and 1.0 (IV). For spaces with mechanical ventilation, the k_3m is characterized by values in the range of 1.3-1.4 (I and IV quarter), and 0.9 in the others. In spaces with an unknown ventilation method or when the methods are mixed, the averages for both groups of correction factors can be used: k_1m in the range of ≥ 1.0-1.6 (I-III and IX-XII) and < 1.0-0.7 (IV-XI), and k_3m-in the range of 1.3-1.4 (I and IV quarter) and 0.9 in the others.

PMID:35501524 | DOI:10.1007/s10653-022-01280-2

Oral Maxillofac Surg. 2022 Apr 30. doi: 10.1007/s10006-022-01068-9. Online ahead of print.

ABSTRACT

This study was conducted to identify and study the prevalence of post traumatic stress disorder (PTSD) in patients, who had sustained traumatic facial and dental injuries along with other variables that may affect the psychological response.

MATERIAL AND METHODS: 241 patients suffering from traumatic facial and dental injuries presenting to the Ahmadabad Municipal Dental College and Hospital were included in the study. 110 patients (males – 87, females – 23) suffered disfiguring injuries and/or loss of multiple front teeth (DF). 131 patients (males – 102, females – 29) suffered no disfigurement (NDF). Assessment was carried out on day of discharge (D.O.D), 1 month, and 6 months. Impact of Event Scale (I.E.S-R) was used to assess the presence of post traumatic stress disorder in the patients.

RESULTS: Patients with DF injuries had statistically significant higher mean scores than patients suffering NDF injuries. Female patients had comparatively higher scores at D.O.D, 1 month, and 6 months. Patients treated with maxillomandibular fixation and between ages 18 and 40 years also had significantly higher scores.

CONCLUSION: Patients with DF facial injuries including multiple anterior teeth loss had significantly higher mean (I.E.S-R) scores for PTSD in comparison with patients with NDF facial injuries.

PMID:35501526 | DOI:10.1007/s10006-022-01068-9

Childs Nerv Syst. 2022 May 3. doi: 10.1007/s00381-022-05547-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Cerebrospinal fluid (CSF) diversion for the treatment of hydrocephalus is one of the most common neurosurgical procedures. Over the years, the development of the neuronavigation system has allowed the surgeon to be guided in real time during the procedures. Nevertheless, to date, the revision rate remains as high as 30-40%. The aim of this study was to investigate the role of intraoperative image guidance in the prevention of shunt failure. We herein report the first literature meta-analysis of image guidance and shunt revision rate in the pediatric population.

METHODS: Principal online databases were searched for English-language articles published between January, 1980, and December, 2021. Analysis was limited to articles that included patients younger than 18 years of age at the time of primary V-P shunt. Articles reporting combined results of free-hand and image-guided placement of ventricular catheter (VC) were included. The main outcome measure of the study was the revision rate in relation to the intraoperative tools. Secondary variables collected were the age of the patient and ventricle size. Statistical analyses and meta-analysis plots were done via R and RStudio. Heterogeneity was formally assessed using Q, I², and τ² statistics. To examine publication bias was performed a funnel plot analysis.

RESULT: A total of 9 studies involving 2017 pediatric patients were included in the meta-analysis. 55.9% of procedures were carried out with the aid of intraoperative tools, while 44.1% procedures were conducted free hand. The intraoperative tools used were ultrasound (9.1%), electromagnetic neuronavigation (21.07%), endoscope (67.32%), and combined images (2.4%).The image-guided placement of VC was not statistically associated with a lower revision rate. The pooled OR was 0.97 [CI 95% 0.88-1.07] with an I² statistics of 34%, t² of 0.018 and a p-value of 0.15 at heterogeneity analysis.

CONCLUSION: Our analysis suggest images guidance during VC shunt placement does not statistically affect shunt survival. Nevertheless, intraoperative tools can support the surgeon especially in patients with difficult anatomy, slit ventricles or complex loculated hydrocephalus.

PMID:35501511 | DOI:10.1007/s00381-022-05547-y

J Neurol. 2022 May 3. doi: 10.1007/s00415-022-11135-6. Online ahead of print.

ABSTRACT

BACKGROUND: The understanding of fatal familial insomnia (FFI), a rare neurodegenerative autosomal dominant prion disease, has improved in recent years as more cases were reported. This work aimed to propose new diagnostic criteria for FFI with optimal sensitivity, specificity, and likelihood ratio.

METHODS: An international group of experts was established and 128 genetically confirmed FFI cases and 281 non-FFI prion disease controls are enrolled in the validation process. The new criteria were proposed based on the following steps with two-round expert consultation: (1) Validation of the 2018 FFI criteria. (2) Diagnostic item selection according to statistical analysis and expert consensus. (3) Validation of the new criteria.

RESULTS: The 2018 criteria for possible FFI had a sensitivity of 90.6%, a specificity of 83.3%, with a positive likelihood ratio (PLR) of 5.43, and a negative likelihood ratio (NLR) of 0.11; and the probable FFI criteria had a sensitivity of 83.6%, specificity of 92.9%, with a PLR of 11.77, and a NLR of 0.18. The new criteria included more specific and/or common clinical features, two exclusion items, and summarized a precise and flexible diagnostic hierarchy. The new criteria for possible FFI had therefore reached a better sensitivity and specificity (92.2% and 96.1%, respectively), a PLR of 23.64 and a NLR of 0.08, whereas the probable FFI criteria showed a sensitivity of 90.6%, a specificity of 98.2%, with a PLR of 50.33 and a NLR of 0.095.

CONCLUSIONS: We propose new clinical diagnostic criteria for FFI, for a better refining of the clinical hallmarks of the disease that ultimately would help an early recognition of FFI and a better differentiation from other prion diseases.

PMID:35501502 | DOI:10.1007/s00415-022-11135-6

Eur J Clin Pharmacol. 2022 May 3. doi: 10.1007/s00228-022-03329-8. Online ahead of print.

ABSTRACT

PURPOSE: To assess the feasibility and acceptance of the semi-automated meta-analysis (SAMA). The objectives are twofold, namely (1) to compare expert opinion on the quality of protocols, methods, and results of one conventional meta-analysis (CMA) and one SAMA and (2) to compare the time to execute the CMA and the SAMA.

METHODS: Experts evaluated the protocols and manuscripts/reports of the CMA and SAMA conducted independently on the safety of metronidazole in pregnancy. Expert opinion was collected using AMSTAR 2 checklist. Time spent was recorded using case report forms.

RESULTS: The overall scores of the opinion of all experts for protocols, methods, and results for SAMA (6.75) and CMA (6.87) were not statistically different (p = 0.88). The experts’ confidence in the results of each MA was 7.89 ± 1.17 and 8.11 ± 0.92, respectively. The time to completion was 14 working days for SAMA and 24.7 for CMA. MA tasks such as calculation of effect estimates, subgroup/sensitivity analysis, and publication bias investigation required no investment in time for SAMA.

CONCLUSION: In conclusion, our study demonstrated the feasibility of SAMA and suggests acceptance for risk assessment by an expert committee. Our results suggest that SAMA reduces the time required for a MA without altering expert confidence in the methodological and scientific rigor. As our study was limited to one example, the generalization of our results requires confirmation by other studies.

PMID:35501476 | DOI:10.1007/s00228-022-03329-8