Tag: statistics

Obstet Gynecol. 2021 Jul 1;138(1):59-65. doi: 10.1097/AOG.0000000000004428.

ABSTRACT

OBJECTIVE: To explore whether two-layer laparoscopic vaginal cuff closure at the time of laparoscopic hysterectomy is associated with a lower rate of postoperative complications compared with a standard one-layer cuff closure.

METHODS: A retrospective cohort study of total laparoscopic hysterectomies performed by fellowship-trained minimally invasive gynecologic surgeons between 2011 and 2017 was performed. Surgeons sutured the vaginal cuff laparoscopically, either in a two- or one-layer closure. The primary outcome was a composite of total postoperative complications, including all medical and surgical complications within 30 days and vaginal cuff complications within 180 days. Factors known to influence laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, and immunosuppressant medications were examined and controlled for, while surgeon skill, colpotomy technique, and suture material remained standardized. We conducted statistical analyses including χ2, Fisher exact test, logistic regression, and post hoc power calculations.

RESULTS: Of the 2,973 women who underwent total laparoscopic hysterectomies, 40.8% (n=1,213) of vaginal cuffs were closed with a two-layer closure and 59.2% (n=1,760) with a one-layer technique. Two-layer vaginal cuff closure was associated with decreased numbers of total postoperative complications (3.5% vs 5.7%; P<.01). The primary difference stemmed from lower vaginal cuff complications within 180 days (0.9% vs 2.6%; P<.01); no differences in 30-day medical and surgical postoperative complications were observed between the two groups (2.6% vs 3.1%; P=.77). No patients in the two-layer vaginal cuff closure cohort experienced a vaginal cuff dehiscence or mucosal separation compared with 1.0% in the one-layer group (P<.01). Compared with a one-layer closure, a two-layer closure was protective from postoperative complications (adjusted odds ratio 0.38, 95% CI 0.19-0.74).

CONCLUSION: Although postoperative complications with laparoscopic hysterectomies are rare, two-layer laparoscopic vaginal cuff closure is associated with lower total postoperative complications compared with a one-layer closure. The difference was primary driven by cuff complications.

PMID:34259464 | DOI:10.1097/AOG.0000000000004428

Obstet Gynecol. 2021 Jul 1;138(1):95-99. doi: 10.1097/AOG.0000000000004420.

ABSTRACT

BACKGROUND: Obliteration of the posterior cul-de-sac is a challenging, often unexpected surgical finding. Developing the dissection skills required to manage this finding during laparoscopy is essential for optimizing treatment of many pain disorders during hysterectomy or ovarian surgery; however, exposure of trainees to cul-de-sac dissection is variable. Currently, there are no widely available simulation models for teaching and practicing this technique.

METHOD: Our aim is to design a low-cost and high-fidelity laparoscopic simulation model that represents key anatomical structures and emphasizes skills for laparoscopic dissection of an obliterated posterior cul-de-sac.

EXPERIENCE: A three-dimensional model was created and is described. Nine experts (gynecologic surgery fellows and attendings) and 17 residents completed a single 30-minute simulation session and completed several assessments to begin establishing the face validity of this model.

CONCLUSION: Experts and residents rated the obliterated cul-de-sac simulation as highly realistic and useful. Residents showed a statistically significant increase in comfort with the dissection, from a median Likert score of 1 out of 5 (interquartile range 1-1) to 3 out of 5 (interquartile range 2-3) (P<.001). Experts scored better than residents on blinded video grading of model performance (P<.001). This low-cost and easily reproducible model fills a critical gap in gynecologic surgery education.

PMID:34259469 | DOI:10.1097/AOG.0000000000004420

Obstet Gynecol. 2021 Jul 1;138(1):21-31. doi: 10.1097/AOG.0000000000004424.

ABSTRACT

OBJECTIVE: To evaluate the association of race-ethnicity and neighborhood socioeconomic status with adherence to National Comprehensive Cancer Network guidelines for endometrial carcinoma.

METHODS: Data are from the SEER (Surveillance, Epidemiology, and End Results) cancer registry of women diagnosed with endometrial carcinoma for the years 2006-2015. The sample included 83,883 women after inclusion and exclusion criteria were applied. Descriptive statistics, bivariate analyses, univariate, and multivariate logistic regression models were performed to evaluate the association between race-ethnicity and neighborhood socioeconomic status with adherence to treatment guidelines.

RESULTS: After controlling for demographic and clinical covariates, Black (odds ratio [OR] 0.89, P<.001), Latina (OR .92, P<.001), and American Indian or Alaska Native (OR 0.82, P=.034) women had lower odds of receiving adherent treatment and Asian (OR 1.14, P<.001) and Native Hawaiian or Pacific Islander (OR 1.19 P=.012) women had higher odds of receiving adherent treatment compared with White women. After controlling for covariates, there was a gradient by neighborhood socioeconomic status: women in the high-middle (OR 0.89, P<.001), middle (OR 0.84, P<.001), low-middle (OR 0.80, P<.001), and lowest (OR 0.73, P<.001) neighborhood socioeconomic status categories had lower odds of receiving adherent treatment than the those in the highest neighborhood socioeconomic status group.

CONCLUSIONS: Findings from this study suggest there are racial-ethnic and neighborhood socioeconomic disparities in National Comprehensive Cancer Network treatment adherence for endometrial cancer. Standard treatment therapies should not differ based on sociodemographics. Interventions are needed to ensure that equitable cancer treatment practices are available for all individuals, regardless of racial-ethnic or socioeconomic background.

PMID:34259460 | DOI:10.1097/AOG.0000000000004424

Crit Care Med. 2021 Jul 2. doi: 10.1097/CCM.0000000000005149. Online ahead of print.

ABSTRACT

OBJECTIVES: To report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome.

DESIGN: Retrospective cohort study SETTING:: Nine centers across the U.S. part of the chimeric antigen receptor-ICU initiative.

PATIENTS: Adult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019.

INTERVENTIONS: Demographics, toxicities, specific interventions, and outcomes were collected.

RESULTS: One-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3-4 toxicities (66.7%); 15.2% had grade 3-4 cytokine release syndrome and 64% grade 3-4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64-not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival.

CONCLUSIONS: This is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population.

PMID:34259446 | DOI:10.1097/CCM.0000000000005149

Crit Care Med. 2021 Jul 1. doi: 10.1097/CCM.0000000000005169. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe the epidemiology of sepsis in critical care by applying the Sepsis-3 criteria to electronic health records.

DESIGN: Retrospective cohort study using electronic health records.

SETTING: Ten ICUs from four U.K. National Health Service hospital trusts contributing to the National Institute for Health Research Critical Care Health Informatics Collaborative.

PATIENTS: A total of 28,456 critical care admissions (14,332 emergency medical, 4,585 emergency surgical, and 9,539 elective surgical).

MEASUREMENTS AND MAIN RESULTS: Twenty-nine thousand three hundred forty-three episodes of clinical deterioration were identified with a rise in Sequential Organ Failure Assessment score of at least 2 points, of which 14,869 (50.7%) were associated with antibiotic escalation and thereby met the Sepsis-3 criteria for sepsis. A total of 4,100 episodes of sepsis (27.6%) were associated with vasopressor use and lactate greater than 2.0 mmol/L, and therefore met the Sepsis-3 criteria for septic shock. ICU mortality by source of sepsis was highest for ICU-acquired sepsis (23.7%; 95% CI, 21.9-25.6%), followed by hospital-acquired sepsis (18.6%; 95% CI, 17.5-19.9%), and community-acquired sepsis (12.9%; 95% CI, 12.1-13.6%) (p for comparison less than 0.0001).

CONCLUSIONS: We successfully operationalized the Sepsis-3 criteria to an electronic health record dataset to describe the characteristics of critical care patients with sepsis. This may facilitate sepsis research using electronic health record data at scale without relying on human coding.

PMID:34259454 | DOI:10.1097/CCM.0000000000005169

Crit Care Med. 2021 Apr 26. doi: 10.1097/CCM.0000000000005051. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia.

DESIGN: Secondary data analysis using de-identified data from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation linked to the publicly available area-level Index of Relative Socioeconomic Advantage and Disadvantage from the Australian Bureau of Statistics.

SETTING: Adult ICUs from 35 hospitals in Queensland, Australia, from 2006 to 2015.

PATIENTS: A total of 218,462 patient admissions.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The outcome measure was inhospital mortality. The main study variable was decile of Index of Relative Socioeconomic Advantage and Disadvantage. The overall crude inhospital mortality was 7.8%; 9% in the most disadvantaged decile and 6.9% in the most advantaged decile (p < 0.001). Increasing socioeconomic disadvantage was associated with increasing severity of illness as measured by Acute Physiology and Chronic Health Evaluation III score, admission with a diagnosis of sepsis or trauma, cardiac, respiratory, renal, and hepatic comorbidities, and remote location. Increasing socioeconomic advantage was associated with elective surgical admission, hematological and oncology comorbidities, and admission to a private hospital (all p < 0.001). After excluding patients admitted after elective surgery, in the remaining 106,843 patients, the inhospital mortality was 13.6%, 13.3% in the most disadvantaged, and 14.1% in the most advantaged. There was no trend in mortality across deciles of socioeconomic status after excluding elective surgery patients. In the logistic regression model adjusting for severity of illness and diagnosis, there was no statistically significant difference in the odds ratio of inhospital mortality for the most disadvantaged decile compared with other deciles. This suggests variables used for risk adjustment may lie on the causal pathway between socioeconomic status and outcome in ICU patients.

CONCLUSIONS: Socioeconomic status as defined as Index of Relative Socioeconomic Advantage and Disadvantage of the area in which a patient lives was associated with ICU admission diagnosis, comorbidities, severity of illness, and crude inhospital mortality in this study. Socioeconomic status was not associated with inhospital mortality after excluding elective surgical patients or when adjusted for severity of illness and admission diagnosis. Commonly used measures for risk adjustment in intensive care improve understanding of the pathway between socioeconomic status and outcomes.

PMID:34259436 | DOI:10.1097/CCM.0000000000005051

Crit Care Med. 2021 Jul 2. doi: 10.1097/CCM.0000000000005189. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients suffering from spontaneous subarachnoid hemorrhage frequently require mechanical ventilation. Here, we aimed to identify factors associated with prolonged mechanical ventilation in subarachnoid hemorrhage patients and to create a new predictive score for prolonged mechanical ventilation.

DESIGN: Prospective cohort study with retrospective data analysis.

SETTING: Neurocritical care unit at a tertiary academic medical center.

PATIENTS: Two hundred ninety-seven consecutive nontraumatic adult subarachnoid hemorrhage patients.

METHODS: In patients with mechanical ventilation, we identified factors associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days compared with mechanical ventilation less than or equal to 48 hours, less than or equal to 7 days, or less than or equal to 14 days in multivariable generalized linear models. Ventilated patients who died before 48 hours, 7 days, or 14 days and those never ventilated were excluded from the respective analysis. We incorporated those factors into a new prognostic score (the RAISE score) to predict prolonged mechanical ventilation greater than 7 days. The calculation was based on a random dataset of 60% of subarachnoid hemorrhage patients and was internally validated.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Patients were 57 years old (interquartile range, 47-68 yr) and presented with a median Hunt and Hess grade of 3 (1-5). Two hundred forty-two patients (82%) required mechanical ventilation for 9 days (2-20 d). In multivariable analysis, a higher Acute Physiology Score was associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days, a higher Hunt and Hess grade with greater than 7 days and greater than 14 days. Early neuroimaging findings were associated with mechanical ventilation greater than 48 hours (hydrocephalus; high-grade Subarachnoid Hemorrhage Early Brain Edema Score), greater than 7 days (high-grade Subarachnoid Hemorrhage Early Brain Edema Score, co-occurrence of intracerebral bleeding) but not with prolonged mechanical ventilation greater than 14 days. The RAISE score, including age, Acute Physiology Score, Hunt and Hess grade, Subarachnoid Hemorrhage Early Brain Edema Score, and the co-occurrence of intracerebral hemorrhage accurately stratified patients by prolonged mechanical ventilation greater than 7 days (C-statistic 0.932). A RAISE score of 12 predicted 60% likelihood of mechanical ventilation greater than 7 days.

CONCLUSIONS: Initial disease severity and neuroimaging findings detected within 24 hours after ICU admission were associated with the need for prolonged mechanical ventilation in patients with subarachnoid hemorrhage. These results may be helpful for patient families and caregivers to better anticipate the course of therapy.

PMID:34259444 | DOI:10.1097/CCM.0000000000005189

Oral Health Prev Dent. 2021 Jan 7;19(1):383-389. doi: 10.3290/j.ohpd.b1749707.

ABSTRACT

PURPOSE: To investigate the practices, knowledge and opinions of French dental students (FDSs) in various domains of minimal intervention (MI) in cariology.

MATERIALS AND METHODS: A cross-sectional, questionnaire-based study was conducted in spring 2018 among all fifth-year French dental students (FDSs) from the 16 French dental schools. The present article focuses on restorative management. Statistical analyses (descriptive, chi-squared) were performed.

RESULTS: The response rate was 84.5%. Overall, 97.4% of respondents would have operatively intervened for proximal and 83% for occlusal carious lesions, respectively, while non-or micro-invasive intervention would have been possible. Interestingly, 15% would completely open the occlusal fissures. For both occlusal and proximal lesions requiring a restoration, composite resin was indicated by over 95% of the respondents. In a clinical case, 51.6% of FDSs who rightly diagnosed an enamel carious lesion would operatively intervene. When FDSs could not diagnose the type of carious lesions, a high proportion of invasive actions were also reported (40%). FDSs who read scientific articles were more likely to consider the high importance of not filling sound teeth unnecessarily (p = 0.033).

CONCLUSION: FDSs do not have sufficient awareness of MI guidelines regarding occlusal and proximal restorative thresholds. Efforts are required in dental schools to teach FDSs to postpone invasive/restorative strategies to later stages of carious progression. There is a need to strengthen prevention techniques and non-invasive options in the teaching of MI in cariology.

PMID:34259431 | DOI:10.3290/j.ohpd.b1749707

Oral Health Prev Dent. 2021 Jan 7;19(1):405-409. doi: 10.3290/j.ohpd.b1749761.

ABSTRACT

PURPOSE: Tongue coating is one of the primary causes of halitosis and some diseases such as aspiration pneumonia. However, to date, an effective method for reducing the bacterial count of tongue coating has not been established. We conducted a randomised-controlled study to compare the efficacy of three types of disinfectants approved for oral use in Japan in reducing the bacterial count of tongue coating.

MATERIALS AND METHODS: Thirty-two participants were randomly assigned to the following four groups according to the solution used: 1. benzethonium chloride; 2. povidone iodine; 3. hydrogen peroxide; 4. tap water (control group). Tongue cleaning with the three test disinfectants and water was performed using a toothbrush, and the bacterial count on the tongue dorsum before and after tongue cleaning was measured using the Rapid Oral Bacteria Quantification System.

RESULTS: The bacterial count decreased statistically significantly after tongue brushing using povidone iodine and hydrogen peroxide solutions (both p = 0.012), but not after brushing using 0.2% benzethonium chloride and tap water.

CONCLUSION: Tongue brushing with povidone iodine or hydrogen peroxide was the most effective method for reducing the bacterial count of tongue coating.

PMID:34259433 | DOI:10.3290/j.ohpd.b1749761

Oral Health Prev Dent. 2021 Jan 7;19(1):353-363. doi: 10.3290/j.ohpd.b1693873.

ABSTRACT

PURPOSE: To assess the knowledge, attitude and perception of dentists (dental students, dental school graduates/interns, postgraduate dentists) of the role of robotics (R) and artificial intelligence (AI) in oral health and preventive dentistry. The null hypothesis was that dentists would not be aware of R and AI use in dentistry and would not be ready to accept them in oral health and preventive dentistry for dental care management and training.

MATERIALS AND METHODS: This was an observational cross-sectional study in which data was collected from a representative population in Saudi Arabia. 570 participants answered 26 closed-ended questions. The questionnaire’s validity and reliability were evaluated for vetting and remarks. The questionnaire collected demographic data of participants and their knowledge, perception and attitude about R and AI. Questions were to be answered with ‘yes’, ‘no’ and ‘I don’t know’. Descriptive statistical analysis was performed using the control chart technique and the chi-squared test, with statistical significance set at p < 0.05.

RESULTS: The majority of the participants (n = 313; 54.6%) were males. Dental students, dentist school graduates/interns, and postgraduate dentists comprised of 58.8%, 18.2%, and 23.0% respectively. Most of the respondents gave affirmative answers for knowledge, attitude and perception of R and AI (58.3%, 67.4%, and 60.3%, respectively). Participants agreed that R and AI is beneficial in dentistry and would provide better results. Most (83.3%) would be willing to be treated using R/AI and would recommend (84.5%) treatment with R/AI, as shown in the control chart by affirmative answers. These were significantly above the overall affirmative answers, as the corresponding point lies above 95% UCL (upper confidence limit).

CONCLUSION: Most dentists were unacquainted with R and AI. Dentists had a positive attitude towards R/AI, but due to inadequate knowledge and understanding, its use and applications were very limited. There is significant need in the near future to increase awareness of this concept, as it may increase treatment efficiency and effectiveness.

PMID:34259428 | DOI:10.3290/j.ohpd.b1693873