Tag: statistics

J Nurs Res. 2021 Mar 19. doi: 10.1097/JNR.0000000000000425. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse practitioners (NPs) in Taiwan have practiced mainly in acute care hospitals since 2006. Although organizational support and level of support have been associated with the successful integration of NP roles and effective practice outcomes, organizational support in the context of NPs in inpatient settings is an area that has been rarely explored in the literature.

PURPOSE: The purpose of this study was to investigate the relationship between organizational support and the practice outcomes of job satisfaction, care effectiveness, and intention to leave in NPs.

METHODS: A national survey of 512 NPs was conducted that included a demographic characteristics datasheet, the Nurse Practitioner Primary Care Organizational Climate Questionnaire, the Misener Nurse Practitioner Job Satisfaction Scale, and the Nurse Practitioner Care Effectiveness Scale. Multiple regression analysis was applied to explore the specific factors associated with job satisfaction. The statistical significance level was set at .05 with a two-tailed test. All statistical analyses were conducted using SPSS Statistics Version 22.0 software.

RESULTS: More than half of the participants were found to be dissatisfied with their hospital managers (54.8%) and with each dimension of organizational support. Overall, 82.1% of the participants were satisfied with their current practice. A multiple regression analysis showed that the participants who perceived higher levels of organizational support in the workplace (β = .53, p < .001), expressed satisfaction with working with their managers (β = .25, p < .001), or perceived better care outcomes (β = .10, p < .001) reported higher job satisfaction. In addition, the participants who expressed intention to leave within 1 year (β = -.09, p < .001) and those with higher patient loads (β = -.09, p < .001) reported lower job satisfaction. Organizational support was found to explain 50% of the variance in job satisfaction.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study highlight organizational support as the most important factor affecting job satisfaction in NPs. Therefore, administrators work to promote organizational support and improve the work environment to enhance the job satisfaction, increase the clinical practice retention, and improve the care outcomes of NPs.

PMID:33756519 | DOI:10.1097/JNR.0000000000000425

Med Sci Sports Exerc. 2021 Mar 19. doi: 10.1249/MSS.0000000000002648. Online ahead of print.

ABSTRACT

PURPOSE: Males have larger blood pressure (BP) responses to relative intensity static handgrip exercise compared to females. Controlling for absolute load (maximal voluntary contraction [MVC]) abolishes these differences. Whether similar observations exist during large muscle mass exercise or dynamic contractions, and the mechanisms involved, remain unknown.

METHODS: BP, heart rate, muscle oxygenation (near-infrared spectroscopy), and rectus femoris electromyography (EMG) were recorded in 28 males and 17 females during 10% and 30% MVC static (120s) and isokinetic dynamic (180s; 1:2 work-to-rest ratio; angular velocity: 60°/s) knee extensor exercise. Static and dynamic exercises were completed on separate visits, in a randomized order. Sex differences were examined with and without statistical adjustment of MVC (ANCOVA).

RESULTS: Males had larger systolic BP responses (interaction, P<0.0001) and muscle deoxygenation (interaction, P<0.01) than females during 10% static exercise, with no difference in EMG (interaction, P=0.67). Peak systolic BP was correlated to MVC (r=0.55, P=0. 0001), and adjustment for MVC abolished sex differences in systolic BP (interaction, P=0.3). BP, heart rate, muscle oxygenation/deoxygenation, and EMG responses were similar between sexes during 30% static exercise (interaction, All P>0.2), including following adjustment for MVC (All P>0.1). Males had larger systolic BP responses during dynamic exercise at 10% and 30% (interaction, Both P=0.01), which were abolished after adjustment for MVC (interaction, Both P>0.08). Systolic BP responses were correlated with absolute MVC and stroke volume responses during 10% (r=0.31, P=0.04; r=0.61, P<0.0001, respectively) and 30% (r=0.4, P=0.007; r=0.59, P<0.0001, respectively).

CONCLUSIONS: Absolute contraction intensity can influence systolic BP responses to 10% but not 30% MVC static, as well as 10% and 30% MVC dynamic knee extensor exercise, and should be considered in cross-sectional comparisons of BP.

PMID:33756524 | DOI:10.1249/MSS.0000000000002648

AIDS. 2021 Mar 22. doi: 10.1097/QAD.0000000000002894. Online ahead of print.

ABSTRACT

OBJECTIVE: Zidovudine (ZDV) has been extensively used in pregnant women to prevent vertical transmission of human immunodeficiency virus (HIV), but few studies have evaluated potential mutagenic effects of ZDV during fetal development.

DESIGN: Our study investigated clonal hematopoiesis in HIV-exposed uninfected (HEU) newborns, 94 of whom were ZDV-exposed and 91 antiretroviral therapy (ART)-unexposed and matched for potential confounding factors.

METHODS: Utilizing high depth sequencing and genotyping arrays, we comprehensively examined blood samples collected during the first week after birth for potential clonal hematopoiesis (CH) associated with fetal ZDV exposure, including clonal single nucleotide variants (SNVs), small insertions and deletions (indels), and large structural copy number or copy neutral alterations.

RESULTS: We observed no statistically significant difference in the number of SNVs and indels per person in ZDV exposed children (adjusted ratio (95% confidence interval) for expected number of mutations=0.79 [0.50, 1.22], P = 0.3), and no difference in the number of large structural alterations. Mutations in common CH driver genes were not found in the study population. Mutational signature analyses on SNVs detected no novel signatures unique to the ZDV-exposed children and the mutational profiles were similar between the two groups.

CONCLUSIONS: Our results suggest that CH at levels detectable in our study is not strongly influenced by in utero ZDV exposure; however, additional follow-up studies are needed to further evaluate the safety and potential long-term impacts of in utero ZDV exposure in HEU children as well as better investigate genomic aberrations occurring late in pregnancy.

PMID:33756513 | DOI:10.1097/QAD.0000000000002894

Shock. 2021 Mar 23. doi: 10.1097/SHK.0000000000001782. Online ahead of print.

ABSTRACT

BACKGROUND: The base excess (BE) parameter can be used as an indicator of mortality. However, study results on the influence of alcohol on the validity of BE as a prognostic parameter in alcohol-intoxicated patients are controversial. Thus, this study examined the hypothesis: An increasing blood alcohol level reduces the prognostic value of the Base Excess parameter on mortality.

MATERIAL METHODS: In a retrospective analysis of the multi-centre database of the TraumaRegister DGU®, patients from 2015 to 2017 were grouped depending on their blood alcohol level (BAL) into a BAL+ and BAL- group. The hypothesis was verified using logistic regression with an assumed significance level of 1% (p < 0.01).

RESULTS: 11889 patients were included; 9472 patients in the BAL- group and 2417 patients in the BAL+ group. Analysis of the BE showed lower values in the BAL+ group (BAL-: -1.8 ± 4.4 mmol/l vs. BAL+: -3.4 ± 4.6 mmol/l). There is a trend towards lower BE levels when BAL increases. Assuming a linear relationship, then BE decreases by 0.6 points per mille alcohol (95%CI: 0.5-0.7; p < 0.001). The mortality rate was significantly lower in the BAL+ group (BAL-: 11.1% vs. BAL+: 7.9%). The logistic regression analysis showed a significant beneficial influence of BAL+ on the mortality rate (OR 0.706, 95% CI 0.530 – 0.941, p = 0.018). To analyse whether a low BE (≤ -6 mmol/l) has different prognostic effects in patients with and without alcohol, logistic regression models were calculated. However, the effect of BE ≤ -6 mmol/l was similar in both models (regression coefficients in BAL-/+ patients: 0.379 / 0.393).

CONCLUSIONS: The data demonstrate an existing influence of alcohol on the BE parameter; however, this does not negatively affect the BE as a prognostic parameter at a threshold of ≤ -6 mmol/l.

PMID:33756506 | DOI:10.1097/SHK.0000000000001782

AIDS. 2021 Mar 22. doi: 10.1097/QAD.0000000000002887. Online ahead of print.

ABSTRACT

OBJECTIVE: There are an estimated 38 million people living with HIV, with significant economic consequences. We aimed to collate global lifetime costs for managing HIV.

DESIGN: We conducted a systematic review (PROSPERO:CRD42020184490) using five databases from 1999-2019.

METHODS: Studies were included if they reported primary data on lifetime costs for people living with HIV. Two reviewers independently assessed the titles and abstracts, and data were extracted from full texts: lifetime cost, year of currency, country of currency, discount rate, time horizon, perspective, method used to estimate cost, and cost items included. Descriptive statistics were used to summarize the discounted lifetime costs (2019 USD).

RESULTS: Of 505 studies found, 260 full-texts were examined and 75 included. Fifty (67%) studies were from high-income, 22 (29%) from middle-income and 3 (4%) from low-income countries. Of 65 studies which reported study perspective, 45 (69%) were healthcare provider and the remainder were societal. The median lifetime costs for managing HIV differed according to: 1) country income level: $5,221 (IQR:2,978-11,177) for low-income to $377,820 (IQR:260,176-541,430) for high-income; 2) study perspective: $189,230 (IQR:14,794-424,069) for healthcare provider, to $508,804 (IQR:174,781-812,418) for societal; and 3) decision model: $190,255 (IQR:13,588-429,772) for Markov cohort, to $283,905 (IQR:10,558-453,779) for microsimulation models.

CONCLUSIONS: Estimating the lifetime costs of managing HIV is useful for budgetary planning and to ensure HIV management is affordable for all. Furthermore, HIV prevention strategies need to be strengthened to avert these high costs of managing HIV.

PMID:33756510 | DOI:10.1097/QAD.0000000000002887

Oncol Res Treat. 2021 Mar 23:1-8. doi: 10.1159/000515112. Online ahead of print.

ABSTRACT

BACKGROUND: Synovial sarcomas (SS) are malignant mesenchymal neoplasms that account for about 10% of all sarcomas. Complete surgical excision is the mainstay of primary treatment for localized disease, but SS have a high tendency for local relapse and metastases. Metastatic disease is commonly treated with systemic chemotherapy.

METHODS: We designed a retrospective analysis to describe the clinical presentation, course of treatment, outcome, and prognosis of patients with SS. Univariate and multivariate analyses were performed for potential prognostic factors.

RESULTS: We identified 134 patients treated between 1987 and 2018, with a cutoff date of December 2018. Demographics, disease characteristics, treatment, and survival rates were collected and analyzed. The median overall survival (mOS) from the date of diagnosis was 96.7 months. The median progression-free survival was 6.37 months. Disease-free survival was 26 months. Age over 65 years was found to be a prognostic factor with statistically significant value in the univariate analysis regarding mOS (p = 0.015) and mOS after local relapse (p = 0.0228).

CONCLUSIONS: Even though our study is limited by the retrospective nature of the analysis, it adds an important amount of clinical data regarding the treatment and outcome of SS.

PMID:33756486 | DOI:10.1159/000515112

ORL J Otorhinolaryngol Relat Spec. 2021 Mar 23:1-6. doi: 10.1159/000514134. Online ahead of print.

ABSTRACT

PURPOSE: Our study aimed to quantify the impact of submandibular gland (SMG) resection during Level I neck dissection (ND) on stimulated salivary output (SSO) and xerostomia-related quality of life in patients with head and neck cancer (HNC).

METHODS: A retrospective cohort was formed from 32 patients that underwent unilateral or bilateral Level I ND and a control group of 23 patients that had level II-IV ND. SSO (Saxon test) and University of Washington Quality of Life survey results for both groups were compared.

RESULTS: Mean SSO was 3.41 g in the SMG resection group and 3.86 g in the control group, with no significant statistical difference. There was no difference in mean SSO between patients with 2 SMGs, a single remaining SMG, or no glands. The mean SSO of SMG resection cases with a history of adjuvant RT was 2.61 g which was below the xerostomia threshold for the Saxon test (2.75 g) and control group patients with RT had a significantly higher mean SSO (4.07 g). The lowest UW-QoL saliva domain score average (53.8) was in the SMG-resected, RT-positive group.

CONCLUSION: Results indicate unilateral or bilateral resection of SMG does not reduce SSO to a significant extent. Adjuvant radiotherapy and SMG resection are additive risk factors for xerostomia and the related loss in quality of life. SMG sparing may be necessary in HNC patients with higher risk for the need of adjuvant radiation.

PMID:33756490 | DOI:10.1159/000514134

Chemotherapy. 2021 Mar 23:1-9. doi: 10.1159/000515344. Online ahead of print.

ABSTRACT

Respiratory and gastrointestinal symptoms are the predominant clinical manifestations of the coronavirus disease 2019 (COVID-19). Infecting intestinal epithelial cells, the severe acute respiratory syndrome coronavirus-2 may impact on host’s microbiota and gut inflammation. It is well established that an imbalanced intestinal microbiome can affect pulmonary function, modulating the host immune response (“gut-lung axis”). While effective vaccines and targeted drugs are being tested, alternative pathophysiology-based options to prevent and treat COVID-19 infection must be considered on top of the limited evidence-based therapy currently available. Addressing intestinal dysbiosis with a probiotic supplement may, therefore, be a sensible option to be evaluated, in addition to current best available medical treatments. Herein, we summed up pathophysiologic assumptions and current evidence regarding bacteriotherapy administration in preventing and treating COVID-19 pneumonia.

PMID:33756475 | DOI:10.1159/000515344

Am J Nephrol. 2021 Mar 23:1-11. doi: 10.1159/000513951. Online ahead of print.

ABSTRACT

BACKGROUND: Risk factors of mortality in chronic hemodialysis patients have not yet been sufficiently evaluated. In particular, chronological transits and interactions of the impact of risk factors have rarely been described.

METHODS: This study is a post hoc analysis of the participants in the Olme-sartan Clinical Trial in Okinawan Patients under OKIDS (OCTOPUS) study conducted between June 2006 and June 2011. We additionally followed up on the prognosis of the participants until July 31, 2018. Standardized univariable and multivariable Cox regression analyses were used to evaluate the influences of the participants’ baseline characteristics on all-cause mortality. We also evaluated chronological changes in the impacts of risk factors, interactions among predictors, and the influence of missing values using sensitivity analyses.

RESULTS: Of the 469 original trial participants, 461 participants were evaluated. The median time of follow-up was 10.2 years. A total of 211 (45.8%) participants were deceased. The leading causes of death were infection (n = 72, 34.1%) and cardiovascular disease (n = 66, 31.3%). Univariate and multivariate Cox regression analyses revealed that the impact of diabetes mellitus, history of coronary intervention, and hypoalbuminemia were significant risk factors for mortality during the whole follow-up period. During the early follow-up period (≤3 years), standardized univariate Cox regression analyses revealed that history of amputation (hazard ratio [HR] = 4.61, p < 0.001), lower dry weight, higher cardiothoracic ratio, and lower potassium levels were statistically significant risks. In those who survived for longer than 3 years, a history of stroke (HR = 1.73, p = 0.006), higher systolic blood pressure, lower serum sodium levels, and higher levels of hemoglobin, and serum phosphate were significant risks. We also observed a stable interaction between the impacts of serum phosphate and albumin on all-cause mortality.

CONCLUSION: In chronic hemodialysis patients, targets to improve the short-term prognosis and long-term prognosis are not equivalent. Hyperphosphatemia was a significant risk factor for the all-cause mortality among patients with normal serum albumin levels but not among patients with compromised albumin levels.

PMID:33756478 | DOI:10.1159/000513951

Gerontology. 2021 Mar 23:1-7. doi: 10.1159/000514450. Online ahead of print.

ABSTRACT

INTRODUCTION: Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients.

METHODS: This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period.

RESULTS: The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (β = 0.231, p = 0.013 and β = 0.314, p = 0.001, respectively).

CONCLUSIONS: The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.

PMID:33756483 | DOI:10.1159/000514450