Tag: statistics

Neurosurg Focus. 2021 Mar;50(3):E12. doi: 10.3171/2020.12.FOCUS20902.

ABSTRACT

OBJECTIVE: Gender disparities in neurosurgery have persisted even as the number of female medical students in many countries has risen. An understanding of the current gender distribution of neurosurgeons around the world and the possible factors contributing to country-specific gender disparities is an important step in improving gender equity in the field.

METHODS: The authors performed a systematic review of studies pertaining to women in neurosurgery. Papers listed in PubMed in the English language were collected. A modified grounded theory approach was utilized to systematically identify and code factors noted to contribute to gender disparities in neurosurgery. Statistical analysis was performed with IBM SPSS Statistics for Windows.

RESULTS: The authors identified 39 studies describing the density of women neurosurgeons in particular regions, 18 of which documented the proportion of practicing female neurosurgeons in a single or in multiple countries. The majority of these studies were published within the last 5 years. Eight factors contributing to gender disparity were identified, including conference representation, the proverbial glass ceiling, lifestyle, mentoring, discrimination, interest, salary, and physical burden.

CONCLUSIONS: The topic of women in neurosurgery has received considerable global scholarly attention. The worldwide proportion of female neurosurgeons varies by region and country. Mentorship was the most frequently cited factor contributing to noted gender differences, with lifestyle, the glass ceiling, and discrimination also frequently mentioned. Future studies are necessary to assess the influence of country-specific sociopolitical factors that push and pull individuals of all backgrounds to enter this field.

PMID:33789239 | DOI:10.3171/2020.12.FOCUS20902

Gerontology. 2021 Mar 31:1-9. doi: 10.1159/000514298. Online ahead of print.

ABSTRACT

BACKGROUND: Predisposing and precipitating factors for delirium for the elderly, over the age of 65 years, are known, but not for the very old, over 80 years. As the society is getting older and evermore patients will reach >80 years, more evidence of the factors and their contribution to delirium is required in this patient group.

METHODS: In the course of 1 year, 3,076 patients above 80 years were screened prospectively for delirium based on a Delirium Observation Screening (DOS) scale, Intensive Care Delirium Screening Checklist (ICDSC), and a DSM (Diagnostic and Statistical Manual)-5 nursing instrument (ePA-AC) construct. Relevant predisposing and precipitating factors for delirium were assessed with a multiple regression analysis.

RESULTS: Of 3,076 patients above 80 years, 1,285 (41.8%) developed a delirium, which led to twice prolonged hospitalization (p < 0.001), requirement for subsequent assisted living (OR 2.2, CI: 1.73-2.8, p < 0.001), and increased mortality (OR 24.88, CI: 13.75-45.03, p < 0.001). Relevant predisposing factors were dementia (OR 15.6, CI: 10.17-23.91, p < 0.001), pressure sores (OR 4.61, CI: 2.74-7.76, p < 0.001), and epilepsy (OR 3.65, CI: 2.12-6.28, p < 0.0001). Relevant precipitating factors were acute renal failure (4.96, CI: 2.38-10.3, p < 0.001), intracranial hemorrhage (OR 8.7, CI: 4.27-17.7, p < 0.001), and pleural effusions (OR 3.25, CI: 1.77-17.8, p < 0.001).

CONCLUSION: Compared to the general delirium rate of approximately 20%, the prevalence of delirium doubled above the age of 80 years (41.8%) due to predisposing factors uncommon in younger patients.

PMID:33789299 | DOI:10.1159/000514298

Dev Neurosci. 2021 Mar 31:1-8. doi: 10.1159/000513537. Online ahead of print.

ABSTRACT

Temporal lobe epilepsy (TLE) is considered to be the most common form of epilepsy, and it has been seen that most patients are refractory to antiepileptic drugs. A strong association of this ailment has been established with psychiatric comorbidities, primarily mood and anxiety disorders. The side of epileptogenic may contribute to depressive and anxiety symptoms; thus, in this study, we performed a systematic review to evaluate the prevalence of depression in TLE in surgical patients. The literature search was performed using PubMed/Medline, Web of Science, and PsycNet to gather data from inception until January 2019. The search strategy was related to TLE, depressive disorder, and anxiety. After reading full texts, 14 articles meeting the inclusion criteria were screened. The main method utilized for psychiatric diagnosis was Diagnostic and Statistical Manual of Mental Disorders/Structured Clinical Interview for DSM. However, most studies failed to perform the neuropsychological evaluation. For those with lateralization of epilepsy, focus mostly occurred in the left hemisphere. For individual depressive diagnosis, 9 studies were evaluated, and 5 for anxiety. Therefore, from the data analyzed in both situations, no diagnosis was representative in preoperative and postoperative cases. In order to estimate the efficacy of surgery in the psychiatry episodes and its relation to seizure control, the risk of depression and anxiety symptoms in epileptic patients need to be determined before surgical procedures. Rigorous preoperative and postoperative evaluation is essential for psychiatry conditions in patients with refractory epilepsy candidates for surgery.

PMID:33789300 | DOI:10.1159/000513537

Dermatology. 2021 Mar 31:1-9. doi: 10.1159/000514307. Online ahead of print.

ABSTRACT

BACKGROUND: Keloid scarring is a pathologic proliferation of scar tissue that often causes pruritus, pain, and disfigurement. Keloids can be difficult to treat and have a high risk of recurrence. Recent studies have shown promising results in the treatment of cutaneous metastases with intralesional calcium combined with electroporation (calcium electroporation). As calcium electroporation has shown limited side effects it has advantages when treating benign keloid lesions, and on this indication we performed a phase I study.

METHODS: Patients with keloids were treated with at least 1 session of calcium electroporation and followed up for 2 years. Calcium was administered intralesionally (220 mM) followed by the application of eight 100-µs pulses (400 V) using linear-array electrodes and Cliniporator (IGEA, Italy). Treatment efficacy was evaluated clinically (size, shape, erythema), by patient self-assessment (pruritus, pain, other) and assessed histologically.

RESULTS: Six patients were included in this small proof of concept study. Treatment was well tolerated, with all patients requesting further treatment. Two out of 6 patients experienced a decrease in keloid thickness over 30%. A mean reduction of 11% was observed in volume size, and a mean flattening of 22% was observed (not statistically significant). Five out of 6 patients reported decreased pain and pruritus. No serious adverse effects or recurrences were observed over a mean follow-up period of 338 days.

CONCLUSION: In this first phase I clinical study on calcium electroporation for keloids, treatment was found to be safe with minor side effects. Overall, patients experienced symptom relief, and in some patients keloid thickness was reduced.

PMID:33789301 | DOI:10.1159/000514307

Neurosurg Focus. 2021 Mar;50(3):E13. doi: 10.3171/2020.12.FOCUS20959.

ABSTRACT

OBJECTIVE: Although the past decades have seen a steady increase of women in medicine in general, women continue to represent a minority of the physician-training staff and workforce in neurosurgery in Canada and worldwide. As such, the aim of this study was to analyze the experiences of women faculty practicing neurosurgery across Canada to better understand and address the factors contributing to this disparity.

METHODS: A historical, cross-sectional, and mixed-method analysis of survey responses was performed using survey results obtained from women attending neurosurgeons across Canada. A web-based survey platform was utilized to collect responses. Quantitative analyses were performed on the responses from the study questionnaire, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding.

RESULTS: A total of 19 of 31 respondents (61.3%) completed the survey. Positive enabling factors for career success included supportive colleagues and work environment (52.6%); academic accomplishments, including publications and advanced degrees (36.8%); and advanced fellowship training (47.4%). Perceived barriers reported included inequalities with regard to career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Quantitative analyses demonstrated emerging themes of an increased need for women mentors as well as support and recognition of the contributions to career advancement of personal and family-related factors.

CONCLUSIONS: This study represents, to the authors’ knowledge, the first analysis of factors influencing career success and satisfaction in women neurosurgeons across Canada. This study highlights several key factors contributing to the low representation of women in neurosurgery and identifies specific actionable items that can be addressed by training programs and institutions. In particular, female mentorship, opportunities for career advancement, and increased recognition and integration of personal and professional roles were highlighted as areas for future intervention. These findings will provide a framework for addressing these factors and improving the recruitment and retention of females in this specialty.

PMID:33789236 | DOI:10.3171/2020.12.FOCUS20959

Orthop Traumatol Surg Res. 2021 Mar 28:102906. doi: 10.1016/j.otsr.2021.102906. Online ahead of print.

ABSTRACT

INTRODUCTION: The gold standard (GS) for treating chronic infections following reverse total shoulder arthroplasty (RTSA) is a complete exchange of the prosthesis carried out in one or two stages. This surgical procedure, which may damage the bone stock, can result in poor functional outcomes due to intraoperative complications. The purpose of this study was to compare the GS to a surgical technique that retained osseointegrated implants: the partial one-stage exchange.

HYPOTHESIS: Partial one-stage exchange was effective in treating chronic infections after RTSA (no recurrent infection) and resulted in better functional outcomes than the GS.

MATERIALS AND METHODS: This retrospective single-center study included 18 patients with chronic infection after a primary RTSA. Two treatments were compared in a non-randomized fashion. The first included 11 patients who underwent a partial one-stage exchange with implant retention in case of macroscopic osseointegration. The second included seven patients who were treated with the GS: six patients with a complete one-stage exchange and one patient with a two-stage surgical approach. The absence of recurrent infection and functional outcomes were assessed after a minimum of two years.

RESULTS: There were no statistically significant differences in treatment efficacy between the two strategies: 91% vs. 100%, respectively. The partial one-stage exchange resulted in a significantly improved shoulder function compared to the GS with postoperative Constant scores of 55 ± 14.58 vs. 44 ± 14.45, respectively (P = .03). In the partial one-stage exchange group, there was a significantly improved shoulder function with a preoperative Constant score of 40 [28-55] ± 9.04 preoperatively vs. 55 [25-75] ± 14.58 postoperatively (P = .01). The GS treatment did not significantly improve the postoperative function (P = .09).

DISCUSSION: Partial one-stage exchange does not compromise treatment efficacy of chronic infections after RTSA. This technique resulted in better shoulder function than a conventional GS-type management. A study with greater statistical power is required.

LEVEL OF EVIDENCE: III; clinical series, retrospective, single-center.

PMID:33789197 | DOI:10.1016/j.otsr.2021.102906

J Glob Antimicrob Resist. 2021 Mar 28:S2213-7165(21)00079-5. doi: 10.1016/j.jgar.2021.03.013. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Antimicrobial resistance (AMR) is a major health concern worldwide. To rationalize antibiotic use, community pharmacist plays an important role. This study aimed to evaluate the perceptions and practices of community pharmacists regarding antimicrobial stewardship (AMS) in Lahore, Pakistan.

METHOD: A descriptive cross-sectional study was conducted among community pharmacists in Lahore, Pakistan from November 1, 2017, to December 31, 2017. A self-administered questionnaire was used for data collection. Nonprobability convenient sampling was done to select community pharmacies. Descriptive statistics were applied and Mann-Whitney U tests and Kruskal-Wallis tests were performed to compare independent groups by using SPSS version 20.0.P-value less than0.05 was considered statistically significant. Perception and practice scores were determined to access community pharmacist knowledge regarding antimicrobial stewardship. The score of 0.5-1 was considered to be very good.

RESULTS: The overall response rate was 71 %. Gender, age, work experience and education level did not significantly influence the perception and practices of the community pharmacist. Experienced pharmacist showed better response towards antibiotic stewardship. Majority of the pharmacists strongly agreed that they educate patients on the use of antimicrobial and resistance-related issues.

CONCLUSION: It was concluded that community pharmacists in Lahore, Pakistan, have good perception regarding AMS and they are practicing it well. But there are few gaps in their practices that must be filled such as dispensing without prescription and dispensing for duration more than prescribed. In addition, there should be strict implantation of guidelines for dispensing antibiotics in order to rationalize antibiotic use and decreasing antibiotic resistance.

PMID:33789207 | DOI:10.1016/j.jgar.2021.03.013

Comput Methods Programs Biomed. 2021 Mar 21;204:106058. doi: 10.1016/j.cmpb.2021.106058. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Computer aided diagnostics of Pulmonary Tuberculosis in chest radiographs relies on the differentiation of subtle and non-specific alterations in the images. In this study, an attempt has been made to identify and classify Tuberculosis conditions from healthy subjects in chest radiographs using integrated local feature descriptors and variants of extreme learning machine.

METHODS: Lung fields in the chest images are segmented using Reaction Diffusion Level Set method. Local feature descriptors such as Median Robust Extended Local Binary Patterns and Gradient Local Ternary Patterns are extracted. Extreme Learning Machine (ELM) and Online Sequential ELM (OSELM) classifiers are employed to identify Tuberculosis conditions and, their performances are analysed using standard metrics.

RESULTS: Results show that the adopted segmentation method is able to delineate lung fields in both healthy and Tuberculosis images. Extracted features are statistically significant even in images with inter and intra subject variability. Sigmoid activation function yields accuracy and sensitivity values greater than 98% for both the classifiers. Highest sensitivity is observed with OSELM for minimal significant features in detecting Tuberculosis images.

CONCLUSION: As ELM based method is able to differentiate the subtle changes in inter and intra subject variations of chest X-ray images, the proposed methodology seems to be useful for computer-based detection of Pulmonary Tuberculosis.

PMID:33789212 | DOI:10.1016/j.cmpb.2021.106058

Neuroimage. 2021 Mar 28:117998. doi: 10.1016/j.neuroimage.2021.117998. Online ahead of print.

ABSTRACT

The pressing call to detect sensitive cognitive markers of frontal lobe epilepsy (FLE) remains poorly addressed. Standard frameworks prove nosologically unspecific (as they reveal deficits that also emerge across other epilepsy subtypes), possess low ecological validity, and are rarely supported by multimodal neuroimaging assessments. To bridge these gaps, we examined naturalistic action and non-action texts comprehension, combined with structural and functional connectivity measures, in 19 FLE patients, 19 healthy controls, and 20 posterior cortex epilepsy (PCE) patients. Our analyses integrated inferential statistics and data-driven machine-learning classifiers. FLE patients were selectively and specifically impaired in action comprehension, irrespective of their neuropsychological profile. These deficits selectively and specifically correlated with (a) reduced integrity of the anterior thalamic radiation, a subcortical structure underlying motoric and action-language processing as well as epileptic seizure spread in this subtype; and (b) hypoconnectivity between the primary motor cortex and the left-parietal/supramarginal regions, two putative substrates of action-language comprehension. Moreover, machine-learning classifiers based on the above neurocognitive measures yielded 75% accuracy rates in discriminating individual FLE patients from both controls and PCE patients. Briefly, action-text assessments, combined with structural and functional connectivity measures, seem to capture ecological cognitive deficits that are specific to FLE, opening new avenues for discriminatory characterizations among epilepsy types.

PMID:33789131 | DOI:10.1016/j.neuroimage.2021.117998

Neuroimage. 2021 Mar 28:117997. doi: 10.1016/j.neuroimage.2021.117997. Online ahead of print.

ABSTRACT

Functional neuroimaging research in the non-human primate (NHP) has been advancing at a remarkable rate. The increase in available data establishes a need for robust analysis pipelines designed for NHP neuroimaging and accompanying template spaces to standardize the localization of neuroimaging results. Our group recently developed the NIMH Macaque Template (NMT), a high-resolution population average anatomical template and associated neuroimaging resources, providing researchers with a standard space for macaque neuroimaging (Seidlitz et al., 2018a). Here, we release NMT v2, which includes both symmetric and asymmetric templates in stereotaxic orientation, with improvements in spatial contrast, processing efficiency, and segmentation. We also introduce the Cortical Hierarchy Atlas of the Rhesus Macaque (CHARM), a hierarchical parcellation of the macaque cerebral cortex with varying degrees of detail. These tools have been integrated into the neuroimaging analysis software AFNI (Cox, 1996) to provide a comprehensive and robust pipeline for fMRI processing, visualization and analysis of NHP data. AFNI’s new @animal_warper program can be used to efficiently align anatomical scans to the NMT v2 space, and afni_proc.py integrates these results with full fMRI processing using macaque-specific parameters: from motion correction through regression modeling. Taken together, the NMT v2 and AFNI represent an all-in-one package for macaque functional neuroimaging analysis, as demonstrated with available demos for both task and resting state fMRI.

PMID:33789138 | DOI:10.1016/j.neuroimage.2021.117997