Tag: statistics

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007965. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of weight loss after bariatric surgery on eustachian tube (ET) function with video endoscopy.

MATERIALS AND METHODS: The present study was conducted as a prospective cohort and was completed with 19 patients. Three-step tympanometry (basal, Toynbee, Valsalva), dynamic slow-motion video endoscopy, and the Eustachian Tube Dysfunction Questionnaire-7 (ETDA-7) were applied to the patients preoperatively before bariatric surgery and in the postoperative 6th month. Dynamic slow-motion video endoscopy was graded between 0 and 3, or classified as patulous, as indicated in the literature.

RESULTS: The mean body mass index of 6 male and 13 female patients decreased from 47.3 ± 4.6 to 31.2 ± 5.4. Grade decline (median 2 ± 1) was experienced in all patients in DSVE, and 1 patient resulted as patulous ET. The ETDA-7 scores decreased in 11 patients, remained stable in 7 patients, and increased in 1 patient with patulous ET. The statistical analysis of the preoperative and postoperative DSVE grading and ETDA-7 scores, excluding the patulous ET patient, was found to be significant (P = 0.001 and P = 0.003, respectively). There was no significant change in any of the tympanometry parameters (P > 0.05).

CONCLUSIONS: Rapid weight loss with bariatric surgery results in an improvement in both the DSVE images and in the complaints of ET dysfunction in the majority of patients, but in some patients it may result in patulous ET. Therefore, preoperative evaluation of the ET with DSVE and questioning the patient’s complaints are important in predicting patients who may develop patulous ET.

PMID:34267142 | DOI:10.1097/SCS.0000000000007965

Pediatr Emerg Care. 2021 Jul 6. doi: 10.1097/PEC.0000000000002494. Online ahead of print.

ABSTRACT

BACKGROUND: Bacterial meningitis in low-risk febrile young infants (FYIs) aged >28 days has become increasingly rare. Routine performance of lumbar puncture (LP) in these infants is associated with adverse consequences and may be unnecessary. We modified our clinical practice guideline (CPG) to reduce the number of FYIs 29 to 56 days old who receive LP.

METHODS: This quality improvement project sought to modify a preexisting CPG to diagnose and manage FYIs 0 to 56 days old that eliminated routine performance of LP in children 29 to 56 days old who were considered low-risk for serious bacterial infection. The change was implemented by making adjustments to the online CPG. A statistical process control chart was used to assess the affect of the initiative on our primary outcome of LP rate in this population of FYIs.

RESULTS: Postimplementation of the CPG initiative, 71% of FYIs 29 to 56 days old did not receive LP, compared with 42% preimplementation. This practice change was also associated with fewer hospitalizations, lower median emergency department (ED) length of stay, and fewer 72-hour ED revisits. Over 3 years of sustained practice, 1/713 (0.1%; 95% confidence interval, 0%-0.8%) low-risk FYI returned within 72 hours and was subsequently treated for probable bacterial meningitis, although cerebrospinal fluid culture was negative for bacterial growth.

CONCLUSIONS: A change in CPG reduced the number of LPs performed in febrile infants 29 to 56 days old. This change resulted in fewer LPs, hospitalizations, ED revisits, and a lower ED length of stay for FYIs 29 to 56 days old.

PMID:34267159 | DOI:10.1097/PEC.0000000000002494

J Physician Assist Educ. 2021 Jul 14. doi: 10.1097/JPA.0000000000000366. Online ahead of print.

ABSTRACT

PURPOSE: Evaluating the effectiveness of supervised clinical practice experiences (SCPEs) is a primary responsibility of the clinical education team. Physician assistant (PA) education is unique because preceptors are not confined to one professional credential. This study evaluated the relationship between students’ perceptions of rotation experiences and the professional credentials of the preceptor of record.

METHODS: This retrospective data analysis evaluated data from 3 cohorts (2016-2018) across 4 PA programs. Preceptors of record were categorized as MDs/DOs or advanced practice providers (APPs).

RESULTS: Analysis of 209 SCPEs found 91 APP preceptors (43%) and 119 MD/DO preceptors (57%). APP preceptors were most prevalent in family medicine/primary care (57%), internal medicine (50%), and emergency medicine (49%). Students’ evaluation scores were higher for APP preceptors compared to MD/DO preceptors, but not statistically significant.

CONCLUSIONS: This study showed that a considerable number of APPs are serving as preceptors and were found to have similar student evaluation scores to those of MD/DO preceptors.

PMID:34267162 | DOI:10.1097/JPA.0000000000000366

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007836. Online ahead of print.

ABSTRACT

INTRODUCTION: An unsightly scar following cleft repair can undo the good work of even an experienced surgeon. A functioning orbicularis oris muscle beneath the lip scar maintains a zone of dynamic tension resulting in a stretched scar. Botulinum toxin type A (BTA) can be used to create a temporary paralysis of the orbicularis muscle during the healing phase. This may lead to better scar formation after a cleft lip repair.

METHOD: The present prospective randomized control trial enrolled 28 infants with unilateral cleft lip undergoing primary lip repair. They were randomized to receive injection of either BTA (botox group) or normal saline (control group) intraoperatively into adjacent orbicularis oris muscle immediately after completion of cleft lip repair. Blinded experts reassessed the scar after 6 months. Objective assessment was undertaken employing Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), and photographic scar width measurements.

RESULTS: Twenty-two subjects were able to complete a follow-up duration of 6 months. Children in the BTA (Botox Group) had a statistically significantly better VAS score and lesser scar width compared to the control group. However, the difference in the VSS score between both groups was not statistically significant. On comparing patients with cleft lip alone with cleft lip and palate, no statistically significant difference was found in VAS, VSS, and scar width. There were no complications associated with the use of botulinum toxin A.

CONCLUSIONS: Botulinum toxin type A injection is a safe and effective addition to improve scar appearance following cleft lip repair. There was improvement in appearance of the scar in terms of width, but no improvement was seen in the scar pigmentation. The scar outcome is independent of cleft lip classification.

PMID:34267122 | DOI:10.1097/SCS.0000000000007836

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007834. Online ahead of print.

ABSTRACT

It was aimed to examine the orbital region in children with autism spectrum disorder and comparison with the healthy controls in the present study. A total of 195 children and adolescents (101 of them were in the autism group, 94 of them were in healthy group) were evaluated. Anterior view photographs were taken, and endocanthion (en), exocanthion (ex), and pupil were determined bilaterally on the photographs. Outer canthal (ex-ex), intercanthal (ex-en), inner canthal (en-en) and interpupillary distances were measured and intercanthal index [(en-en / ex-ex) × 100] was calculated. There was a statistically significant difference between the groups for males for all parameters, while a statistically significant difference was not observed for females. All orbital region distances were higher in male autistic children. Although minor physical anomalies in children and adolescents with autism have been reported before, anthropometric measurements in individuals with autism may differ between genders. Further studies are needed to investigate the differences between genders in autism spectrum disorder.

PMID:34267125 | DOI:10.1097/SCS.0000000000007834

Eur J Cancer Prev. 2021 Jul 8. doi: 10.1097/CEJ.0000000000000702. Online ahead of print.

ABSTRACT

We estimated cancer mortality statistics for the current year in seven major Latin American countries, with a focus on colorectal cancer. We retrieved official death certification data and population figures from the World Health Organization and the Pan American Health Organization databases. We analysed mortality from all neoplasms combined and for selected cancer sites. We estimated numbers of deaths and age-standardized mortality rates for the year 2021 using a logarithmic Poisson count data joinpoint model. Total cancer mortality is predicted to decline in all countries considered for both sexes, with the exception of Argentinian women. The lowest total mortality rates were predicted in Mexico (65.4/100 000 men and 62.3 in women), the highest ones were in Cuba (133.3/100 000 men and 91.0 in women). Stomach cancer rates have been decreasing since 1970 in all countries; colorectal cancer started to decline over recent calendar periods. Rates for this cancer were unfavourable in the youngest age group. Lung cancer trends declined in males and remained comparatively low in all countries except Cuba. In Cuba, lung cancer rates in women overtook those for breast. Mortality from cancers of the breast, (cervix) uterus, ovary, prostate and bladder, as well as leukemia mostly showed favourable trends. A marked variability in rates across Latin American countries persists, and rates were relatively high for stomach, uterus, prostate and lung cancers, as compared to Europe and North America, suggesting the need to improve preventive strategies. Colorectal cancer mortality was relatively low in Latin America, except in Argentina, and short-term predictions remain moderately favourable.

PMID:34267112 | DOI:10.1097/CEJ.0000000000000702

Retina. 2021 Jul 10. doi: 10.1097/IAE.0000000000003260. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the study is to compare the efficacy, safety and globe akinesia between retrobulbar anesthesia, Sub-Tenon’s anesthesia and medial canthus episcleral anesthesia for 25-Gauge posterior vitrectomy.

METHODS: A total of 340 25-Gauge vitrectomy data sheets were retrospectively collected between November 2017 and June 2019. Ninety patients were included in the study. These patients were matched by sex and age to receive retrobulbar anesthesia (Group 1, n=30), Sub-Tenon’s anesthesia (Group 2, n=30) and medial canthus episcleral anesthesia (Group 3, n=30). Globe akinesia was recorded after the injection of anesthetic at 2, 5 and 10 minute time intervals. Patients were asked to rate the pain during administration of anesthesia, during surgery, and postoperatively using the visual analogue pain scale.

RESULTS: In terms of a perfect block, at 10 minutes retrobulbar outperformed both Sub-Tenon’s and medial cantus episcleral anesthesia which appeared quite similar. During administration, the three techniques did not show statistically different effects on pain. Regarding perioperative pain, retrobulbar outperformed medial cantus episcleral anesthesia.

CONCLUSIONS: All three techniques allowed for safe surgery. Retrobulbar obtained the best results, even though Sub-Tenon’s proved to be a valid alternative. Medial cantus episcleral anesthesia obtained mostly good and fair blocks and acceptable pain levels during surgery. Further studies should investigate whether optimal anesthetic efficacy can obtained with Sub-Tenon’s and medial cantus episcleral techniques when higher volumes are used.

PMID:34267116 | DOI:10.1097/IAE.0000000000003260

J Craniofac Surg. 2021 Jul 15. doi: 10.1097/SCS.0000000000007844. Online ahead of print.

ABSTRACT

OBJECTIVE: The goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients.

STUDY DESIGN: A retrospective, case-control study.

METHODS: In this prospective, randomized study, we evaluated the results of 258 rhinoplasty patients who underwent osteotomy by either conventional osteotomes or new designed saws called; “Magic Saws.” On postoperative days 2 and 7, the patients were photographed by the surgeon; photographs were evaluated by another otolaryngologist, blinded from the osteotomy procedure.

RESULTS: There were no statistically differences between the groups, in terms of age, sex, weight, or average arterial blood pressure (P > 0.05). The postoperative periorbital edema (days 2 and 7) and ecchymosis (day 2) scores were significantly higher in the conventional osteotomy group, as compared to Magic Saw group (P < 0.05). However, on postoperative day 7, the differences in the periorbital ecchymosis scores between the groups, were not statistically significant (P > 0.05).

CONCLUSIONS: As compared to conventional osteotomes, Magic Saws were reported to be associated with minimal soft tissue injury, as well as decreased edema and ecchymosis, in the early postoperative period after rhinoplasty.

PMID:34267120 | DOI:10.1097/SCS.0000000000007844

Eur J Cancer Prev. 2021 Jul 8. doi: 10.1097/CEJ.0000000000000704. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical cancer is a common malignant tumor of the female reproductive system in the world, which is a serious threat to women’s life and health. According to the latest report, the incidence of cervical cancer is 11.42 per 100 000, and the mortality rate is 3.77 per 100 000 in Yunnan Province, which is still higher than the national average. Although there have been some relevant studies on the risk factors of cervical cancer in recent years, research on ethnic minorities is lacking in Yunnan Province.

OBJECTIVE: To analyze and explore the related risk factors of cervical cancer in women of ethnic minorities in Yunnan Province, to provide the scientific basis for the development of cervical cancer prevention and control strategies and measures in this region.

METHODS: In total 1119 cervical cancer patients diagnosed by histopathology at the Yunnan Cancer Center (Yunnan Cancer Hospital) from January 2010 to December 2019 were selected as the case group. According to the 1:1 matching principle of the case-control study, 1119 patients with nonmalignant tumors of the same nationality, the same hospital, age difference less than 3 years old, were selected as the control group. Univariate and multivariate conditional logistic regression were used for statistical analysis.

RESULTS: Basic medical insurance for rural residents (OR = 3.659; P = 0.003), human papilloma virus (HPV) infection (OR = 90.030; P < 0.001) and concurrent reproductive tract infections (OR = 1.992; P = 0.047) were risk factors for cervical cancer. Late first marriage(OR = 0.881; P = 0.032), the number of normal childbirths ≤2 (OR = 0.480, P = 0.033) and contraception (OR = 0.291; P = 0.002) were positive factors for cervical cancer.

CONCLUSION: The high incidence of cervical cancer in Yunnan minority women is the result of many factors: HPV infection is the highest risk factor for cervical cancer, women with reproductive tract infections and basic medical insurance for rural residents have a higher risk for cervical cancer; Late first marriage, the number of deliveries ≤2 and contraception are positive factors for cervical cancer.

PMID:34267110 | DOI:10.1097/CEJ.0000000000000704

Eur J Cancer Prev. 2021 Jul 8. doi: 10.1097/CEJ.0000000000000706. Online ahead of print.

ABSTRACT

BACKGROUND: In Helicobacter pylori-driven gastric cancer, mucosal colonization induces chronic inflammation that may variably progress to cancer. Prospective studies of circulating inflammation-related proteins have suggested weak associations with gastric cancer risk. To assess potential utility as a screening tool in clinical settings, we examined circulating levels of a wide range of key inflammation molecules for associations with early-stage gastric cancer.

METHODS: We used pretreatment EDTA plasma from 239 individuals with early-stage noncardia gastric cancer (203 stage I and 36 stage II) and 256 age-frequency-matched H. pylori-seropositive cancer-free controls within the Hospital-based Epidemiologic Research Program at Aichi Cancer Center. Levels of 92 biomarkers were measured by proximity extension assays using Olink’s Proseek Immuno-oncology Panel. Odds ratios (ORs) for association with gastric cancer risk were calculated for quantiles (two to four categories) of each biomarker from unconditional logistic regression models, adjusted for age, sex, smoking and alcohol consumption. Two-sided P values <0.05 were considered as significant. The false discovery rate (FDR) was used to correct for multiple comparisons.

RESULTS: Of 83 evaluable biomarkers, lower levels of TNFRSF12A (per quartile OR, 0.82; nominal P-trend = 0.02) and ADGRG1 (per quartile OR, 0.84; nominal P-trend = 0.03) were associated with early-stage gastric cancer but were not statistically significant after FDR correction.

CONCLUSION: Our study did not identify any inflammation-related biomarkers that may be useful for early disease detection. To date, this is the first assessment of circulating inflammation-related proteins in early-stage gastric cancer. Given the complex inflammation processes preceding malignant transformation, further investigation of other biomarkers is warranted.

PMID:34267111 | DOI:10.1097/CEJ.0000000000000706