Tag: statistics

Folia Morphol (Warsz). 2021 Mar 29. doi: 10.5603/FM.a2021.0032. Online ahead of print.

ABSTRACT

We aimed to use the “SomnoMed MAS” device, which brings the mandible forward in Obstructive Sleep Apnea Syndrome patients due to mandibular retrognathia, and to examine its effects on facial soft tissues by stereophotogrammetry (3dMD) method. Thirty-one patients with a mean age of 44 years and 6 months were included in the study. SomnoMed MAS, one of the splint appliances that position the mandible in front, was applied to all patients and the changes in facial soft tissues were examined by overlapping the images taken at different times with the 3dMD Face system. The obtained data were analyzed statistically and the level of statistical significance was determined as p≤0.05.Mouth width decreased statistically during T0-T1 period. In T0-T2 period, while crista philtri and labiale inferius points moved backwards, Mouth width, nose width decreased and nasal base width increased. In the T0-T3 period, nasal base width increased statistically, the philtrum width and the mouth width decreased, and the soft tissue nasion point came to the fore.Splint treatment, which positions the mandible in front in adult OSAS patients, affected the middle and lower facial soft tissues with the forward and downward translational movement of the lower jaw.

PMID:33778939 | DOI:10.5603/FM.a2021.0032

Ann Surg Oncol. 2021 Mar 28. doi: 10.1245/s10434-021-09863-6. Online ahead of print.

ABSTRACT

BACKGROUND: Intraoperative blood cell salvage and autotransfusion (IBSA) during liver transplantation (LT) for hepatocellular carcinoma (HCC) is controversial for concern regarding adversely impacting oncologic outcomes.

OBJECTIVE: We aimed to evaluate the long-term oncologic outcomes of patients who underwent LT with incidentally discovered HCC who received IBSA compared with those who did not receive IBSA.

METHODS: Patients undergoing LT (January 2001-October 2018) with incidental HCC on explant pathology were retrospectively identified. A 1:1 propensity score matching (PSM) was performed. HCC recurrence and patient survival were compared. Kaplan-Meier survival analyses were performed, and univariable Cox proportional hazard analyses were performed for risks of recurrence and death.

RESULTS: Overall, 110 patients were identified (IBSA, n = 76 [69.1%]; non-IBSA, n = 34 [30.9%]). Before matching, the groups were similar in terms of demographics, transplant, and tumor characteristics. Overall survival was similar for IBSA and non-IBSA at 1, 3, and 5 years (96.0%, 88.4%, 83.0% vs. 97.1%, 91.1%, 87.8%, respectively; p = 0.79). Similarly, the recurrence rate at 1, 3, and 5 years was not statistically different (IBSA 0%, 1.8%, 1.8% vs. non-IBSA 0%, 3.2%, 3.2%, respectively; p = 0.55). After 1:1 matching (26 IBSA, 26 non-IBSA), Cox proportional hazard analysis demonstrated similar risk of death and recurrence between the groups (IBSA hazard ratio [HR] of death 1.26, 95% confidence interval [CI] 0.52-3.05, p = 0.61; and HR of recurrence 2.64, 95% CI 0.28-25.30, p = 0.40).

CONCLUSIONS: IBSA does not appear to adversely impact oncologic outcomes in patients undergoing LT with incidental HCC. This evidence further supports the need for randomized trials evaluating the impact of IBSA use in LT for HCC.

PMID:33778907 | DOI:10.1245/s10434-021-09863-6

Europace. 2021 Mar 29:euab013. doi: 10.1093/europace/euab013. Online ahead of print.

ABSTRACT

AIMS : The COVID-19 pandemic has led to a decline in hospitalizations for non-COVID-19-related conditions. We explored the impact of the COVID-19 pandemic on cardiac operations and interventions undertaken in England.

METHODS AND RESULTS : An administrative database covering hospital activity for England, the Health Episodes Statistics, was used to assess a total of 286 697 hospitalizations for cardiac operations and interventions, as well as 227 257 hospitalizations for myocardial infarction (MI) and 453 799 for heart failure (HF) from 7 January 2019 to 26 July 2020. Over the 3 months of ‘lockdown’, total numbers and mean reductions in weekly rates [n (-%)], compared with the same time period in 2019, were: coronary artery bypass grafting [-2507 (-64%)]; percutaneous coronary intervention [-5245 (-28%)]; surgical [-1324 (-41%)] and transcatheter [-284 (-21%)] aortic valve replacement; mitral valve replacement; implantation of pacemakers [-6450 (-44%)], cardiac resynchronization therapy with [-356 (-42%)] or without [-491 (-46%)] defibrillation devices, and implantable cardioverter-defibrillators [-501 (-45%)]; atrial fibrillation ablation [-1902 (-83%)], and other ablations [-1712 (-64%)] (all P < 0.001). Over this period, there were 21 038 fewer procedures than in the reference period in 2019 (P < 0.001). These changes paralleled reductions in hospitalizations for MI [-10 794 (-27%)] and HF [-63 058 (-28%)] (both P < 0.001).

CONCLUSIONS : The COVID-19 pandemic has led to substantial reductions in the number of cardiac operations and interventions undertaken. An alternative strategy for healthcare delivery to patients with cardiac conditions during the COVID-19 pandemic is urgently needed.

PMID:33778881 | DOI:10.1093/europace/euab013

J Rehabil Med. 2021 Mar 29. doi: 10.2340/16501977-2821. Online ahead of print.

ABSTRACT

OBJECTIVE: To perform a European survey of the evidence needs and training demands of insurance medicine professionals related to professional tasks and evidence-based practice.

DESIGN: International survey.

SUBJECTS: Professionals working in insurance medicine.

METHODS: Experts designed an online questionnaire including 26 questions related to 4 themes: evidence needs; training demands; evidence-seeking behaviour; and attitudes towards evidence-based medicine. Descriptive statistics were presented by country/conference and the total sample.

RESULTS: A total of 782 participants responded. Half of participants experienced evidence needs at least once a week, related to mental disorders (79%), musculoskeletal disorders (67%) and occupational health (65%). Guidelines (76%) and systematic reviews (60%) were the preferred types of evidence and were requested for assessment of work capacity (64%) and prognosis of return-to-work (51%). Evidence-based medicine was thought to facilitate decision-making in insurance medicine (95%). Fifty-two percent of participants felt comfortable finding, reading, interpreting, and applying evidence. Countries expressed similar needs for reviews on typical topics.

CONCLUSION: This study reveals evidence gaps in key areas of insurance medicine, supporting the need for further research, guidelines and training in evidence-based insurance medicine. Importantly, insurance medicine professionals should recognize that evidence-based practice is crucial in producing high-quality assessments.

PMID:33778897 | DOI:10.2340/16501977-2821

Alcohol Alcohol. 2021 Mar 29:agab016. doi: 10.1093/alcalc/agab016. Online ahead of print.

ABSTRACT

AIMS: This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up.

METHODS: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions.

RESULTS: Integrated CBI showed a small effect size for AOD (g = 0.188, P = 0.061; I2 = 86%, τ2 = 0.126, k = 18) and MHD (g = 0.169, P = 0.024; I2 = 58%, τ2 = 0.052, k = 18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI + usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3-6 months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes.

CONCLUSIONS: The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.

PMID:33778869 | DOI:10.1093/alcalc/agab016

J Appl Lab Med. 2021 Mar 29:jfab004. doi: 10.1093/jalm/jfab004. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic brain injury (TBI) is a significant public health issue affecting nearly 69 million patients worldwide per year. Reliable diagnostic biomarkers are urgently needed to aid in disease diagnosis and prognosis and to guide patient aftercare. Blood biomarkers represent an attractive modality to quickly, cheaply, and objectively evaluate clinical status. We hypothesize that deep and quantitative plasma proteomic profiling with a novel technology, proximity extension assay, may lead to the discovery of diagnostic and/or prognostic biomarkers of TBI.

METHODS: We used high-throughput proximity extension assays (PEA) to quantify the relative abundance of over 1000 unique proteins in plasma. PEA is a highly sensitive multiplex immunoassay capable of detecting very low-abundance proteins (down to fg/mL) in complex biological matrices. Our patient cohort consisted of severe TBI (sTBI) patients, matched healthy controls, and another non-TBI group that was included in the analysis to validate the specificity of the candidates during the selection process. The obtained protein quantification data was then filtered to identify candidate biomarkers through statistical analysis, literature searches, and comparison to our reference control groups.

RESULTS: Overall, we identified 6 novel candidate TBI biomarkers. Candidates exhibit a significant increase in plasma protein abundance in sTBI when comparing between healthy controls and sTBI patients. Candidates generally had low expression in our reference groups compared with the sTBI group.

CONCLUSIONS: Our preliminary findings represent a starting point for future validation. These biomarkers, either alone or in combination, may have significant clinical utility in aiding in TBI diagnosis, prognosis, and/or management.

PMID:33778875 | DOI:10.1093/jalm/jfab004

Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Mar 25:S2451-9022(21)00086-0. doi: 10.1016/j.bpsc.2021.03.009. Online ahead of print.

ABSTRACT

BACKGROUND: Stressful life events (SLEs) is an important causal factor in depression, the mechanism of which, however, remains unclear. Recent studies suggested that white matter (WM) micro-structures might be a potential mediator between SLEs and depression. Hence, we intended to investigate the concrete correspondence among them using the mediation effect models.

METHODS: WM micro-structures of 194 participants with SLEs experience prospectively recruited from 6 residential communities were detected with diffusion tensor imaging (DTI). The relationship with each other among SLEs, WM micro-structures and depression were respectively explored with multiple linear regression models and logistic regression models. Furthermore, the influence of WM micro-structures on the association between SLEs and depression was tested with the mediation effect models.

RESULTS: The successfully established mediation effect models showed the specific influence of fractional anisotropy (FA) of the corpus callosum and left uncinate fasciculus on the association between SLEs and depression onset (ab path = 0.032; ab path = 0.026) and depressive severity (ab path = 0.052; ab path = 0.067). The significantly total mediation effects on the association between SLEs and depression onset (ab path = 0.031) and severity (ab path = 0.075) through FA of the corpus callosum and left uncinate fasciculus also were found.

CONCLUSIONS: WM micro-structures alterations imposed a substantial mediation effect on the association between SLEs and depression, which suggested the changes in the WM micro-structures integrity might increase the risk of depression onset and unfavorable disease courses induced by the SLEs.

PMID:33775928 | DOI:10.1016/j.bpsc.2021.03.009

J Gynecol Obstet Hum Reprod. 2021 Mar 25:102126. doi: 10.1016/j.jogoh.2021.102126. Online ahead of print.

ABSTRACT

OBJECTIVE: Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also aim to identify perioperative factors associated with delayed time to void immediately following hysterectomy.

DESIGN: Retrospective cohort study SELECTION: Women undergoing laparoscopic hysterectomy between September 2012 to October 2018 at a single academic university hospital.

RESULTS: 450 minimally invasive hysterectomies were included in the final analysis; 274 (60.9%) robotically-assisted, and 176 (39.1%) conventional laparoscopy. The overall median postoperative time-to-void following a retrograde bladder filling of 150 mL normal saline was 179 minutes. Based on the 50^th percentile of the distribution of the time-to-void, two groups were created. Demographic characteristics between the groups were similar, except those who were above the 50^th percentile were more likely to be older, have a reported history of previous myomectomy, and had a longer postoperative PACU stay compared to those below or equal to the 50^th percentile. The mean time-to-void following conventional laparoscopic hysterectomy was less than that of robotic surgery (187.3 vs 200.5 minutes) however the difference was not statistically significant (p=0.22). The use of hydromorphone intraoperatively and the combination of oxycodone-acetaminophen postoperatively were more likely to be associated with the group of patients above the 50^th percentile but there was no significant difference in perioperative utilization of median morphine milliequivalents (MME) between the two groups.

CONCLUSIONS: Following laparoscopic hysterectomy (either conventional or with robotic-assistance) with a retrograde bladder fill of 150 mL normal saline most patients will void within 4 hours after surgery. This is consistent with historic data on normal voiding patterns facilitating safe same day discharge without prolonged time in the PACU.

PMID:33775918 | DOI:10.1016/j.jogoh.2021.102126

Acad Pediatr. 2021 Mar 25:S1876-2859(21)00156-X. doi: 10.1016/j.acap.2021.03.018. Online ahead of print.

ABSTRACT

OBJECTIVE: Ride-share services are increasingly used for transportation, but little is known about ride-share use and passenger safety behaviors among parents of children for whom child restraint systems (CRS) are recommended. Our objectives were to characterize ride-share use with children and examine passenger restraint use in ride-share.

METHODS: A cross-sectional survey, distributed to the TurkPrime Parent Panel using Amazon Mechanical Turk (MTurk), was designed to assess ride-share and passenger safety behaviors. After screening, adult parents of minor children were invited to complete the full survey about transportation behaviors. Descriptive and chi-square statistics were calculated. Logistic regression was conducted to test for characteristics associated with suboptimal restraint use in ride-share.

RESULTS: Of 655 screened parents, 162 had no minor children, 43 had incomplete responses or failed an attention check question. Of 450 parents with minor children, 309 (68.7%) used ride-share in the past year and 73.1% of parents who use ride-share did so with their child(ren). Ride-share use with children was most common on vacation. Among parents of children age ≤ 8 years, 49% reported always using their child’s CRS when traveling in ride-share. Suboptimal restraint use in rideshare was associated with child age (3-8 years compared with <3 years), larger family size, and attitudes and behaviors that tolerate suboptimal CRS use.

CONCLUSION: This study identifies an opportunity to promote use of CRS in ride-share services. Child passenger safety messaging, education, policy, enforcement of legislation, and CRS design will need to be adapted as ride-share services become more widely adopted.

PMID:33775920 | DOI:10.1016/j.acap.2021.03.018

Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Mar 25:S2451-9022(21)00087-2. doi: 10.1016/j.bpsc.2021.03.010. Online ahead of print.

ABSTRACT

BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomised controlled trials (RCT) have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected RCTs and examined the impact of different treatment parameters to generate hypotheses that would direct future RCTs.

METHODS: A database search was performed to identify studies published in English up to October 2020. Randomised, sham-controlled studies that used rTMS to treat OCD were included. Effect sizes were calculated using Hedges’ g for pre- to post-treatment Yale-Brown Obsessive Compulsive Scale (YBOCS) scores. Subgroup analyses were conducted to assess the effects of variations in rTMS treatment parameters.

RESULTS: A total of 26 studies with 781 participants were included. Overall, rTMS demonstrated a modest effect on reduction of YBOCS scores (Hedges’ g=0.77, 95% CI=0.41, 1.14; p<0.0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex (BL-DLPFC). High and low frequency rTMS showed comparable effects. Studies with follow-up data suggested that effects of active rTMS remain significantly superior to sham 4 weeks post-treatment.

CONCLUSIONS: The therapeutic effects of rTMS are superior to sham in the treatment of OCD. Targeting the BL-DLPFC was the most favourable approach in administering rTMS. Further research is required to determine the optimal frequency, total pulses per session and duration of treatment with rTMS for OCD.

PMID:33775927 | DOI:10.1016/j.bpsc.2021.03.010