Tag: statistics

Br J Neurosurg. 2022 Feb 8:1-6. doi: 10.1080/02688697.2022.2034741. Online ahead of print.

ABSTRACT

PURPOSE: Sagittal imbalance is common in degenerative and congenital spinal diseases. Some studies have examined spinal deformities in the spina bifida. However, sagittal spinopelvic parameters in tethered cord syndrome (TCS) and split cord malformation (SCM) have been poorly evaluated in the literature. In this study, we investigated sagittal spinopelvic differences in TCS due to fatty filum terminale and SCM patients.

MATERIAL AND METHODS: A total of 78 patients with spina bifida occulta (30 SCM and 48 TCS due to fatty filum terminale) were included in the study. Radiological images of these patients were retrospectively evaluated. We evaluated the pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 pelvic angle, lumbar lordosis (LL), thoracic kyphosis, thoracolumbar alignment, and change in those parameters with age.

RESULTS: Correlation coefficients between age and LL, T1 pelvic angle, and the SVA in patients with TCS due to fatty filum terminale were statistically significant. In addition, correlation coefficients between age and LL and the SVA in patients with SCM were statistically significant. Notably, LL was increased at a statistically significant level with age in patients with TCS and SCM.

CONCLUSION: Improved knowledge of spinal balance parameters in patients with TCS and SCM may be helpful in understanding the clinical course of these pathologies, and provide information regarding the success of surgery at the follow-up period.

PMID:35132932 | DOI:10.1080/02688697.2022.2034741

Med Teach. 2022 Feb 8:1-7. doi: 10.1080/0142159X.2022.2033189. Online ahead of print.

ABSTRACT

BACKGROUND: Repeated application of foundational science (FS) during medical reasoning results in encapsulation of knowledge needed to develop clinical expertise. Despite proven benefit of educating learners using a FS framework to anchor clinical decision making, how FS is integrated on clinical rotations has not been well characterized. This study examines how and when FS discussion occurs on internal medicine teaching rounds.

MATERIAL AND METHODS: We performed a convergent mixed method study. Six internal medicine teams at a quaternary hospital were observed during rounds and team members interviewed. Transcripts were analyzed using thematic analysis. Descriptive statistics provided a summary of the observations.

RESULTS: Our study revealed that rounds used a teacher-centered model where FS knowledge was transmitted as pearls external to the clinical context. FS content arose primarily when the patient was complex. Barriers preventing FS discussion were lack of time and perceived lack of personal FS knowledge.

CONCLUSION: Our study describes scenarios that commonly elicit discussion of FS on inpatient medicine rounds highlighting a ‘transmission’ model of FS knowledge. We suggest a learner-centered model that engages students in the practice of integrating FS into clinical reasoning.

PMID:35132917 | DOI:10.1080/0142159X.2022.2033189

Ann Med. 2022 Dec;54(1):484-494. doi: 10.1080/07853890.2022.2032820.

ABSTRACT

BACKGROUND: Novice nurses’ responsibilities are greater than what their actual level of competence can cope with. This can cause increased levels of stress, which many studies have shown is a factor resulting in reduced self-esteem, which affects not only the well-being of nurses but also the quality of care provided.

AIMS: To investigate the relationship between the self-assessment of nursing competencies and self-esteem among novice nurses and the moderation role of the sociodemographic variables and intention to leave the nursing profession on this relationship.

MATERIAL AND METHODS: A correlational cross-sectional study was performed using an online questionnaire. The study was conducted between July and October 2019 among 122 novice nurses. The study tool consisted of the Rosenberg Self-Esteem Scale, the Nurse Professional Competence Scale-Short Version, and metrics. Calculations were performed using SPSS Statistics, version 25. To approach research questions hierarchical multiple regression was performed.

RESULTS: The self-esteem level of novice nurses have been identified as low. Novice nurses who declared their willingness to leave their profession had a higher level of self-esteem than nurses who did not declare this willingness. The highest-rated competencies were in the fields of nursing care and value-based nursing care, while the lowest were in the areas of development, leadership, and the organisation of nursing care. Correlations between postgraduate education and competencies in the majority subscales were revealed. The results showed a negative correlation between self-esteem and all subscales of the competence scale. Seniority and postgraduate education were important moderators in the relationship between some competence subscales and self-esteem.

CONCLUSION: Novice nurses present a low level of self-esteem. Nurses with a higher competence level showed lower self-esteem. Developing competencies at the beginning of one’s nursing practice, which is crucial for patients’ outcomes, should be accompanied by the strengthening of novice nurses’ self-esteem.KEY MESSAGESNovice nurses with a higher level of self-esteem more often declared their willingness to leave their profession.The results showed a negative correlation between self-esteem and all subscales of the competence scale.Seniority and postgraduate education are important moderators in the relationship between some competence subscales and self-esteem.

PMID:35132927 | DOI:10.1080/07853890.2022.2032820

Global Spine J. 2022 Feb 8:21925682211053593. doi: 10.1177/21925682211053593. Online ahead of print.

ABSTRACT

STUDY DESIGN: Level III retrospective database study.

OBJECTIVES: The purpose of this study is to determine if machine learning algorithms are effective in predicting unplanned intubation following anterior cervical discectomy and fusion (ACDF).

METHODS: The National Surgical Quality Initiative Program (NSQIP) was queried to select patients who had undergone ACDF. Machine learning analysis was conducted in Python and multivariate regression analysis was conducted in R. C-Statistics area under the curve (AUC) and prediction accuracy were used to measure the classifier’s effectiveness in distinguishing cases.

RESULTS: In total, 54 502 patients met the study criteria. Of these patients, .51% underwent an unplanned re-intubation. Machine learning algorithms accurately classified between 72%-100% of the test cases with AUC values of between .52-.77. Multivariable regression indicated that the number of levels fused, male sex, COPD, American Society of Anesthesiologists (ASA) > 2, increased operating time, Age > 65, pre-operative weight loss, dialysis, and disseminated cancer were associated with increased risk of unplanned intubation.

CONCLUSIONS: The models presented here achieved high accuracy in predicting risk factors for re-intubation following ACDF surgery. Machine learning analysis may be useful in identifying patients who are at a higher risk of unplanned post-operative re-intubation and their treatment plans can be modified to prophylactically prevent respiratory compromise and consequently unplanned re-intubation.

PMID:35132907 | DOI:10.1177/21925682211053593

Hand (N Y). 2022 Feb 8:15589447211073829. doi: 10.1177/15589447211073829. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to determine the occurrence of patients undergoing primary trigger finger release (TFR) that underwent ulnar superficialis slip resection (USSR) for decompression and to determine which digit was most commonly affected.

METHODS: A retrospective chart review was conducted of all cases of open TFR performed by a single surgeon. The following data were obtained: age, sex, laterality, affected digit, and consideration for USSR. All patients failed nonoperative treatment of at least 1 steroid injection. The occurrence of patients who underwent TFR and USSR and which digit(s) most commonly underwent USSR were determined. The average patient age that underwent USSR, frequency by sex, and relative occurrence of USSR in each digit were computed. Statistical calculations were conducted using χ² analysis (P < .05).

RESULTS: A total of 911 primary open TFRs were performed in 631 patients over a 16-year period. A total of 20 TFRs in 20 patients underwent USSR (2.2%). The long finger was the most commonly affected digit (40%) that required simple decompression. Within all USSR cases, the long finger was the most commonly affected digit. The index finger was the second most affected (30%), and there were no cases in the small finger.

CONCLUSIONS: This study determined the occurrence of primary TFR cases that underwent USSR, with the long finger being the most commonly affected digit. Surgeons may consider this additional procedure to perform a larger decompression than simple A1 pulley release alone.

PMID:35132886 | DOI:10.1177/15589447211073829

J Oncol Pharm Pract. 2022 Feb 8:10781552221078934. doi: 10.1177/10781552221078934. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy.

PATIENTS AND METHODS: Patients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs.

RESULTS: Of 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium (p < 0.05), it was not clinically significant. A total of 226 ADRs were documented. Anaemia was the most frequently occurred ADR (14%) and Capecitabine caused the highest number of ADRs. Assessments of causality showed that the majority of cases are “possible” (63%). In evaluating the severity of ADRs, 99% ADRs were “mild” and 61% of ADRs were “probably” preventable. Upon assessing the DDIs, 82% of the prescriptions had “no known interaction”.

CONCLUSION: Metronomic chemotherapy in geriatric cancer patients exhibited grade 1 toxicity for haemoglobin. Anemia was the most common ADRs. The majority of cases were “possible” in causality, “mild” in severity, and “probably” preventable. The majority of the prescriptions have no known DDIs.

PMID:35132888 | DOI:10.1177/10781552221078934

J Endourol. 2022 Feb 8. doi: 10.1089/end.2021.0644. Online ahead of print.

ABSTRACT

PURPOSE: Robotic partial nephrectomies by their nature are associated with renal volume loss. Our goal from this study is to examine renal volume loss over time post partial nephrectomy.

MATERIALS AND METHODS: Fifty patients were followed for 1-year post robotic partial nephrectomy with two-layer renorrhaphy and the sliding clip technique. This was done with a preoperative computed tomography (CT) scan to assess renal mass and location. Post robotic partial nephrectomy patients were imaged at time points 3-days, 6-months, and 12-months.

RESULTS: Patient demographics were 82% male with a median (IQR) age of 57 (45-67) and all were of Japanese descent. The medians (IQR) for warm ischemia time: 18 minutes (14-22), total operative time: 181.5 minutes (169.3-218.5), and estimated blood loss: 20 mL (10-50). The tumor characteristics had a median (IQR) diameter of 2.8 cm (2.5-3.4) with a RENAL score of 7 (6-8). The renal CT volumes showed median (IQR) volume losses at 3-days: -1% (-7.1, 1.8), 6-months: -15.3% (-20.6, -11.2), and 12-months: -16.3% (-19.0, -12.8). Significance was seen at the 3-days to 6-months comparison for volume loss (p<0.0001). Mean (SD) eGFR losses were as follows: at discharge 0.5% (12.9), 1-month -6.4% (11.8), 6-months -4.6% (9.8), and 12-months -3.6% (11.9). Statistical analysis showed significance for GFR loss at the comparison between discharge to 1-month and 6-months (p=0.01, p=0.04).

CONCLUSION: The initial volume loss seen post-surgery from resected healthy tissue was not significant and only became relevant at longer time points suggesting that loss could be from atrophy. Volume loss over time supports the hypothesis that suture renorrhaphy is a primary cause of volume loss when warm ischemia time is <25minutes.

PMID:35132882 | DOI:10.1089/end.2021.0644

J Am Heart Assoc. 2022 Feb 8:e022232. doi: 10.1161/JAHA.121.022232. Online ahead of print.

ABSTRACT

Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD-specific health status around the time of diagnosis may prognosticate long-term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3-month, and change from baseline to 3-month follow-up. Kaplan-Meier using 3-month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5-year all-cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3-month, respectively), 141 (19.8%) died over a median follow-up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per-10-point increment; 95% CI, 0.84-0.97; P=0.008), 3-month (HR [95% CI], 0.87 [0.82-0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85-0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3-month PAQ was more strongly associated with mortality than either baseline (3-month HR [95% CI], 0.85 [0.78-0.92]; P<0.001; C-statistic, 0.77) or change (3-month HR [95% CI], 0.79 [0.72-0.87]; P<0.001). Conclusions PAD-specific health status is independently associated with 5-year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.

PMID:35132874 | DOI:10.1161/JAHA.121.022232

Cancer Commun (Lond). 2022 Feb 7. doi: 10.1002/cac2.12265. Online ahead of print.

NO ABSTRACT

PMID:35132829 | DOI:10.1002/cac2.12265

J Korean Med Sci. 2022 Feb 7;37(5):e36. doi: 10.3346/jkms.2022.37.e36.

ABSTRACT

BACKGROUND: This study aimed to assess the clinical relevance of the parsimonious Eurolung risk scoring system for predicting postoperative morbidity, mortality, and long-term survival in Korean patients with surgically resected non-small cell lung cancer.

METHODS: This retrospective analysis used the data of patients who underwent anatomical resection for non-small cell lung cancer between 2004 and 2018 at a single institution. The parsimonious aggregate Eurolung score was calculated for each patient. The Cox regression model was used to determine the ability of the Eurolung scoring system for predicting long-term outcomes.

RESULTS: Of the 7,278 patients in the study, cardiopulmonary complications and mortality occurred in 687 (9.4%) and 53 (0.7%) patients, respectively. The rate of cardiopulmonary complications and mortality gradually increased with the increase in the Eurolung risk scores (all P < 0.001). When risk scores were grouped into four categories, the Eurolung scoring system showed a stepwise deterioration of overall survival with the increase in risk scores, and this association was statistically significant (P < 0.001). Multivariate Cox analysis showed that the Eurolung scoring system, classified into four categories, was a significant prognostic factor of overall survival even after adjusting for covariates such as tumor histology and pathological stage (P < 0.001).

CONCLUSION: Stratification based on the parsimonious Eurolung scoring system showed good discriminatory ability for predicting postoperative morbidity, mortality, and long-term survival in South Korean patients with surgically resected non-small cell lung cancer. This might help clinicians to provide a detailed prognosis and decide the appropriate treatment option for high-risk patients with non-small cell lung cancer.

PMID:35132842 | DOI:10.3346/jkms.2022.37.e36