Tag: statistics

Agri. 2021 Jul;33(3):148-154. doi: 10.14744/agri.2020.00907.

ABSTRACT

OBJECTIVE: This study aimed to compare the effect of heat and cold therapy on the intensity of nitroglycerine induced migraine type headache in cardiac inpatients.

METHODS: This randomized controlled trial was conducted on a total of 75 cardiac inpatients in three groups design (heat or cold therapy,and control group) as pre-test and post-test. Patients in the intervention group received heat or cold therapy for25 minutes, two times (at 1-hour interval), Patients in the control group did not receive any heat or cold therapy. Headache intensity was measured by the numeric rating scale for pain (NRS Pain), in three groups of study for 3 times (just before the study, at the end of applying the first therapy, and at the end of applying the second therapy).

RESULTS: No baseline differences existed among the three groups for the mean pain scale score (P=0.781) just before the study; but the difference between three groups after applying heat and cold therapy was statistically significant (p=0.000).

CONCLUSION: This study demonstrated applying heat and cold therapy may reduce the intensity of nitrate induced migraine type headache in cardiac inpatients. Considering this fact that approximately 10% of patients cannot tolerate nitrate therapies due to unbearable headache, applying heat or cold therapy in patients with nitrate induced migraine type headache is recommended to improve patient’s adherence to treatment.

PMID:34318912 | DOI:10.14744/agri.2020.00907

Scand J Pain. 2021 Jul 27. doi: 10.1515/sjpain-2021-0023. Online ahead of print.

ABSTRACT

OBJECTIVES: Opioid analgesics are essential in clinical practice, but their excessive use is associated with addiction risk. Increases in opioid prescription rates have fuelled an epidemic of opioid addiction in the USA, making statistics on medical opioid use a critical warning signal. A dramatic 150% increase in Swedish opioid access 2001-2013 was recently reported based on data from the International Narcotics Control Board (INCB; Berterame et al. 2016) in conflict with other studies of opioid use in the Nordic countries. This article aims to analyse to what degree published INCB statistics on opioids in Scandinavia (Denmark, Norway and Sweden) reflect actual medical use and study the methodological reasons for putative discrepancies.

METHODS: Data on aggregated total national sales of opioids for the whole population, including hospitals, were collected from the Swedish e-Health Authority. Total sales data for Denmark and drugs dispensed at pharmacies in Norway are publicly available through the relevant authorities’ websites.

RESULTS: INCB opioid statistics during the period 2001-2013 were markedly inconsistent with sales data from Scandinavia, calling the reliability of INCB data into question. INCB-data were flawed by (a) over-representing the volume of fentanyl, (b) under-reporting of codeine, and (c) by not including tramadol.

CONCLUSIONS: Opioid availability, as expressed by INCB statistics, does not reflect medical opioid use. It is crucial to underline that INCB statistics are based on the manual compilation of national production, import and export data from manufacturers and drug companies. This is not the same amount that is prescribed and consumed within the health care system. Moreover, there are methodological problems in the INCB reports, in particular concerning fentanyl, codeine and tramadol. We suggest that INCB should carefully review the quality of their data on medical opioids.

PMID:34315195 | DOI:10.1515/sjpain-2021-0023

J Korean Neurosurg Soc. 2021 Jul 28. doi: 10.3340/jkns.2020.0320. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the correlations among various radiological parameters used to determine cervical alignment from cervical spine radiographs (X-CS) and cervical spine computed tomography (CT-CS), both within and between modalities.

METHODS: This study included 168 patients (≤60 years old) without a definite whole spine deformity who underwent CT-CS and X-CS. We measured occipital slope (O-s), C1 slope, C2 slope, C7 slope, sella turcica – C7 sagittal vertical axis (StC7-SVA), spinocranial angle, T1 slope, and C27-SVA. We calculated the O-C2 angle, O-C7 angle, and C2-7 angle from the measured parameters and conducted correlation analyses among multiple parameters.

RESULTS: The intrinsic correlation features among multiple cervical parameters were very similar for both X-CS and CT-CS. The two SVA parameters (C27-SVA and StC7-SVA) were mainly influenced by the upper cervical slope parameters (r=|0.13-0.74|) rather than the lower slope cervical parameters (r=|0.08-0.13|). The correlation between X-CS and CT-CS for each radiological parameter was statistically significant (r=0.26-0.44) except for O-s (r=0.10) and StC7-SVA (r=0.11).

CONCLUSION: The correlation patterns within X-CS and CT-CS were very similar in this study. The correlation between X-ray and CT was statistically significant for most radiological parameters, and the correlation score increased when the horizontal gaze was consistently maintained. The lower cervical parameters were not statistically associated with translation-related parameters (C2-7 SVA and StC7-SVA). Therefore, the upper cervical segment may be a better predictor for determining head and neck translation.

PMID:34315198 | DOI:10.3340/jkns.2020.0320

J Osteopath Med. 2021 Jul 27. doi: 10.1515/jom-2021-0052. Online ahead of print.

ABSTRACT

CONTEXT: Emergency medicine (EM) physicians commonly stabilize patients with acute psychiatric distress, such as suicidal ideation. Research has shown that suicidal ideation is difficult to manage in emergency department (ED) settings and that patients in psychiatric distress are often “boarded” in the ED while awaiting more definitive care.

OBJECTIVES: To examine the attitudes and experiences of emergency physicians regarding the care of patients in psychiatric distress. Special attention is given to suicidal ideation due to its prevalence in the United States.

METHODS: A 19 question anonymous survey was sent via email to 55 emergency medicine residency directors throughout Michigan, Ohio, Indiana, and Illinois, who were identified using an Internet search of residency programs in the region. The program directors were asked to distribute the survey to their colleagues and residents. The intent of this procedure was to generate as many survey responses as possible, while obscuring the identities of the respondents. Responses were gathered from October 29, 2019 until January 16, 2020. The survey was designed to assess respondents’ self-reported demographic data as well as their experiences with the boarding process, initial examination, final disposition, reevaluation of the patient, physician training and resources, and follow up care. Statistical analysis was performed using a Mann-Whitney U test, significance was set at p<0.01.

RESULTS: In total, 47 EM physicians responded to the survey; however, not all of the respondents completed all 19 questions. Ten of 44 respondents (22.7%) reported that they do not perform the initial psychiatric examination themselves and instead defer to a nurse or social worker. Twenty-two of 44 respondents (50.0%) reported that they defer to a social worker when determining the final disposition of psychiatric patients. Respondents reevaluated patients in psychiatric distress statistically significantly less often (p=0.01) compared with patients with cardiac pathology. Additionally, 15 of 38 respondents (39.5%) reported that they did not feel adequately trained to handle psychiatric emergencies, and 36 of 39 respondents (92.3%) of physicians felt that their facility would benefit from additional mental health resources. Thirty five of 39 respondents (89.7%) reported that their facility did not have a system in place to follow up with suicidal patients upon discharge.

CONCLUSIONS: Caring for patients who are acutely suicidal or in psychiatric distress is complex and more research is needed to optimize treatment strategies. The results of this study indicate that EM physicians may regularly defer to nonphysician providers when evaluating and treating patients in psychiatric distress. A perceived lack of training in psychiatry may contribute to this practice. The results of this study are in accord with previous research that indicated a need for additional psychiatry training in EM residencies.

PMID:34315193 | DOI:10.1515/jom-2021-0052

J Perinat Med. 2021 Jul 27. doi: 10.1515/jpm-2021-0054. Online ahead of print.

ABSTRACT

OBJECTIVES: Early diagnosis of gestational diabetes can lead to greater optimization of glucose control. We evaluated associations between maternal serum analytes (alpha-fetoprotein [AFP], free beta-human chorionic gonadotropin [beta-hCG], inhibin, and estriol) and the development of gestational diabetes mellitus (GDM).

METHODS: This retrospective cohort study identified single-ton pregnancies with available second trimester serum analytes between 2009 and 2017. GDM was identified by ICD-9 and -10 codes. We examined the associations between analyte levels and GDM and to adjust for potential confounders routinely collected during genetic serum screening (maternal age, BMI, and race) using logistic regression. Optimal logistic regression predictive modeling for GDM was then performed using the analyte levels and the above mentioned potential confounders. The performance of the model was assessed by receiver operator curves.

RESULTS: Out of 5,709 patients, 660 (11.6%) were diagnosed with GDM. Increasing AFP and estriol were associated with decreasing risk of GDM, aOR 0.76 [95% CI 0.60-0.95] and aOR 0.67 [95% CI 0.50-0.89] respectively. Increasing beta-hCG was associated with a decreasing risk for GDM(aOR 0.84 [95% CI 0.73-0.97]). There was no association with inhibin. The most predictive GDM predictive model included beta-hCG and estriol in addition to the clinical variables of age, BMI, and race (area under the curve (AUC 0.75), buy this was not statistically different than using clinical variables alone (AUC 0.74) (p=0.26).

CONCLUSIONS: Increasing second trimester AFP, beta-hCG, and estriol are associated with decreasing risks of GDM, though do not improve the predictive ability for GDM when added to clinical risk factors of age, BMI, and race.

PMID:34315194 | DOI:10.1515/jpm-2021-0054

Biomed Phys Eng Express. 2021 Jul 27. doi: 10.1088/2057-1976/ac182e. Online ahead of print.

ABSTRACT

Insulin signaling pathways in muscle tissue play a major role in maintaining glucose homeostasis. Dysregulation in these pathways results in the onset of serious metabolic disorders like type 2 diabetes. Robustness is an essential characteristic of insulin signaling pathways that ensures reliable signal transduction in the presence of perturbations as a result of several feedback mechanisms. Integral control, according to control engineering, provides reliable setpoint tracking and disturbance rejection. The presence of negative feedback and integrating process is crucial for biological processes to achieve integral control. The existence of an integral controller leads to the rejection of perturbations which resulted in the robust regulation of biochemical entities within acceptable levels. In the present in silico research work, the presence of integral control in the protein kinase C ζ – insulin receptor substrate-1 (PKC ζ-IRS1) pathway is identified, verified mathematically and model is simulated in Cell Designer. The data is exported to Minitab software and robustness analysis is carried out statistically using the Mann-Whitney test. The p-value of the results obtained with given parameters perturbed by ±1% is greater than the significance level of 0.05 (0.2132 for 1% error in k7(rate constant of IRS1 phosphorylation), 0.2096 for -1% error in k7, 0.9037 for both ±1% error in insulin and 0.9037 for ±1% error in k1(association rate constant of the first molecule of insulin to bind the insulin receptor), indicated that our hypothesis is proved The results satisfactorily indicate that even when perturbations are present, glucose homeostasis in muscle tissue is robust due to the presence of integral regulation in the PKC ζ-IRS1 insulin signaling pathways. In this paper, we have analysed the findings from the framework of robust control theory, which has allowed us to examine that how PKC ζ-IRS1 insulin signaling pathways produces desired output in presence of perturbations.

PMID:34315137 | DOI:10.1088/2057-1976/ac182e

Physiol Meas. 2021 Jul 27. doi: 10.1088/1361-6579/ac184c. Online ahead of print.

ABSTRACT

OBJECTIVE: The physiological activity of the heart is controlled and modulated mostly by the parasympathetic and sympathetic nervous systems. Heart rate variability (HRV) analysis is therefore used to observe fluctuations that reflect changes in the activity in these two branches. Knowing that acceleration and deceleration patterns in heart rate fluctuations are asymmetrically distributed, the ability to analyze heart rate variability asymmetry was introduced into MMA.

APPROACH: The new method is called Asymmetric Multiscale Multifractal Analysis (AMMA) and the analysis involved six groups: 61 healthy persons, 104 cases with aortic valve stenosis, 42 with hypertrophic cardiomyopathy, 36 with atrial fibrillation, 70 patients with coronary artery disease and 19 with congestive heart failure.

MAIN RESULTS: Analyzing the results obtained for the 6 groups of patients based on the AMMA method, i.e. comparing the Hurst surfaces for heart rate decelerations and accelerations, it was noticed that these surfaces differ significantly. And differences occur in most groups for large fluctuations (multifractal parameter q>0). In addition, a similarity was found for all groups for the AMMA Hurst surface for decelerations to the MMA Hurst surface – heart rate decelerations (lengthening of the RR intervals) appears to be the main factor determining the shape of the complete Hurst surface and so the multifractal properties of heart rate variability. The differences between the groups, especially for coronary artery disease, hypertrophic cardiomyopathy and aortic valve stenosis, are more visible if the Hurst surfaces are analyzed separately for accelerations and decelerations.

SIGNIFICANCE: The AMMA results presented here may provide additional input for heart rate variability analysis and create a new paradigm for future medical screening. Note that the heart rate variability analysis using MMA (without distinguishing accelerations from decelerations) gave satisfactory screening statistics in our previous studies.

PMID:34315141 | DOI:10.1088/1361-6579/ac184c

Oncol Res Treat. 2021 Jul 27:1-9. doi: 10.1159/000517409. Online ahead of print.

ABSTRACT

OBJECTIVES: FOLFIRINOX, gemcitabine/nab-paclitaxel (gem-nab/P), and gemcitabine-capecitabine (gem-cap) demonstrated superiority over gemcitabine monotherapy for pancreatic cancer (PC). It is still unclear which chemotherapy regimen is the most optimal. This study aimed to conduct a systematic review (SR) and indirect comparison to compare safety and efficacy of FOLFIRINOX versus gem-nab/P and gem-cap in PC.

METHODS: An SR was conducted in several databases from inception to November 2020. RCTs investigating resectable or advanced PC were included. Primary outcomes including overall survival (OS), disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS), and grade 3/4 adverse events (AEs) were pooled using a random effects model. Indirect comparisons were done to compare FOLFIRINOX versus gem-cap and gem-nab/P. Heterogeneity was evaluated using Cochran’s Q test and I2 statistics.

RESULTS: Nine studies were identified involving 6,564 patients. Indirect comparisons showed FOLFIRINOX had significantly better OS (resectable: HR 0.78 [0.61-0.99]; advanced: HR 0.71 [0.60-0.85]) and RFS/DFS/PFS (resectable: HR 0.67 [0.55-0.82]; advanced: HR 0.65 [0.57-0.74]) compared to gem-cap as well as OS (resectable: HR 0.78 [0.61-1.00]; advanced: HR 0.73 [0.54-0.98]) and DFS/PFS (resectable: HR 0.66 [0.53-0.82]; advanced: HR 0.64 [0.49-0.83]) compared to gem-nab/P. FOLFIRINOX increased grade 3/4 AE risk compared to gem-cap and gem-nab/P.

CONCLUSIONS: FOLFIRINOX is associated with significant survival benefits compared to gem-nab/P and gem-cap. However, it is important to consider the increased grade 3/4 AE risk associated with FOLFIRINOX.

PMID:34315166 | DOI:10.1159/000517409

J Affect Disord. 2021 Jul 18;294:382-390. doi: 10.1016/j.jad.2021.07.020. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined the global association between the Traditional Japanese Diet Score and suicide rate.

METHODS: Average food supply and energy supply by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database (FAOSTAT). Traditional Japanese Diet Score (TJDS) was calculated from food group classifications. Age-standardized suicide rates per 100,000 people by country were obtained from the Global Burden of Disease 2017 database. The 26-year associations between TJDS and suicide rates were examined controlling for covariates using a mixed-effects model in 138 countries with populations of 1 million or greater.

RESULTS: A significant negative association was found in the analysis of the relationship between TJDS and the prevalence of suicide [β (se) = -0.126 (0.031), p < 0.001]. The interaction term between TJDS and year was also significant [β (se) = -0.011 (0.003), p < 0.001]. The change in the effect of TJDS on suicide rates by year was examined. The effect of TJDS was not significant from 1991 to 1999 but became significant after 2000; the slope of the TJDS to suicide rate in 2017 was -0.270 (95% confidence interval -0.382, -0.169, p < 0.001).

LIMITATIONS: This was a national ecological study and did not consider individual differences in sex, age, and lifestyle.

CONCLUSIONS: TJDS may be is a protective factor for depression, which may prevent suicide. The association between TJDS and suicide rates became stronger over time and was inversely associated with suicide rates after 2000.

PMID:34315100 | DOI:10.1016/j.jad.2021.07.020

Phys Med Biol. 2021 Jul 27. doi: 10.1088/1361-6560/ac1834. Online ahead of print.

ABSTRACT

Cardiac radioablation offers non-invasive treatments for refractory arrhythmias. However, treatment delivery for this technique remains challenging. In this paper, we introduce the first method for real-time image guidance during cardiac radioablation for refractory atrial fibrillation on a standard linear accelerator. Our proposed method utilizes direct diaphragm tracking on intrafraction images to estimate the respiratory component of cardiac substructure motion. We compare this method to treatment scenarios without real-time image guidance using the 4D-XCAT digital phantom. Pre-treatment and intrafraction imaging was simulated for 8 phantoms with unique anatomies programmed using cardiorespiratory motion from healthy volunteers. As every voxel in the 4D-XCAT phantom is labelled precisely according to the corresponding anatomical structure, this provided ground-truth for quantitative evaluation. Tracking performance was compared to the ground-truth for simulations with and without real-time image guidance using the left atrium as an exemplar target. Differences in target volume size, mean volumetric coverage, minimum volumetric coverage and geometric error were recorded for each simulation. We observed that differences in target volume size were statistically significant (p < 0.001) across treatment scenarios and that real-time image guidance enabled reductions in target volume size ranging from 11 – 24%. Differences in mean and minimum volumetric coverage were statistically insignificant (both p = 0.35) while differences in geometric error were statistically significant (p = 0.039). The results of this study provide proof-of-concept for x-ray based real-time image guidance during cardiac radioablation.

PMID:34315136 | DOI:10.1088/1361-6560/ac1834