Tag: statistics

J Addict Nurs. 2021 Apr-Jun 01;32(2):95-106. doi: 10.1097/JAN.0000000000000395.

ABSTRACT

PURPOSE/BACKGROUND/SIGNIFICANCE: The purpose of this feasibility study was to make system level change using motivational interviewing (MI), tailored discharge education, and electronic medical record (EMR) flow sheet intervention in patients with alcohol use disorder (AUD). Alcohol is known to be one of the most commonly misused addictive substances.

METHODS: It is a feasibility study with a descriptive exploratory design of an intervention with MI, tailored discharge education, and EMR flow sheet documentation. Participants were patients with AUD chosen over 3 months from two medical surgical floors. Instruments used were the readiness and confidence rulers (reliability/validity = .84 and .77, respectively). Analysis included descriptive statistics, estimation of effect size, and hypothesis generation.

RESULTS: Of 14 participants, EMR flow sheet documentation was completed and the mean post readiness and confidence scores were 8.86 (1.167) and 8.07 (1.639), respectively.

CONCLUSION: The pre/post confidence scores were statistically significant (p = .095) using the .10 significance level, indicating the intervention was effective in raising the confidence level for behavior change. High scores indicated patients were in contemplation and intending to change. Seven scores increased postintervention suggesting a future hypothesis that MI, tailored education, and EMR flow sheet documentation intervention is feasible for patients with AUD contemplating change in the near future.

PMID:34060760 | DOI:10.1097/JAN.0000000000000395

J Addict Nurs. 2021 Apr-Jun 01;32(2):115-120. doi: 10.1097/JAN.0000000000000397.

ABSTRACT

PURPOSE: Nurse practitioners (NPs) are in a unique position to address the problem of opioid use disorders (OUDs) because they provide a large percentage of primary care services (Agency for Healthcare Research and Quality, 2014). This study aimed to increase doctoral NP students’ beliefs/attitudes about their ability to care for and about individuals with OUDs through a multifaceted educational approach, guided by social cognitive theory.

METHODS: Researchers used a quasi-experimental pre/post design. Five doctoral students attended lectures and 16 hours of direct clinical exposure to individuals with OUDs at a medication-assisted treatment center. The 22-item Drug and Drug Problems Perception Questionnaire examined students’ attitudes toward individuals with OUDs before and after receiving this multifaceted education. Students completed reflective writings. Descriptive statistics and effect sizes were computed, and reflective writings were reviewed.

RESULTS: Changes in Drug and Drug Problems Perception Questionnaire scores before and after intervention showed a fairly large effect size. This suggests that the intervention may have clinical significance for practice and is likely to attain statistical significance with a larger sample size. Greatest changes occurred in students’ perceptions of role adequacy and self-esteem scores, indicative of higher self-efficacy. Measured score increases correspond to increases in confidence, knowledge, and skills to therapeutically engage with this population.

CONCLUSION: Doctoral NP students had more positive attitudes and beliefs about individuals with OUDs after the multifaceted intervention. Enhancement of self-esteem and adequacy in the caregiver role for this population were promising signals that education can reduce stigma. Further study is warranted with a larger and more diverse sample.

PMID:34060762 | DOI:10.1097/JAN.0000000000000397

J Addict Nurs. 2021 Apr-Jun 01;32(2):141-151. doi: 10.1097/JAN.0000000000000401.

ABSTRACT

Prescription opioid use disorder in the United States has increased to epidemic proportions and poses a challenging problem to health care providers. Motivational interviewing (MI) is a patient-centered counseling style that can effectively reduce substance abuse, but MI training has not been well incorporated into advanced practice nursing curricula. Standardized patient (SP) simulation is an educational tool that is growing in popularity because of its success in improving nursing skills. Medical students and residents who underwent a formalized MI training with an SP simulation showed positive results. This study aimed to determine whether an MI training with an SP simulation improved NP students’ knowledge, confidence, and skills in MI. A one-group pretest-posttest repeated measures design was used. Quantitative data were analyzed using descriptive statistics and repeated measures analysis of variance, and qualitative data were analyzed using content analysis. Results indicated that the MI training showed a significant impact on students’ confidence in MI and promising impacts on students’ MI knowledge and skills. Students valued the training, favoring the SP component, and plan to use MI in future practice. An MI training can be effectively incorporated into an advanced practice nursing program and would better prepare students to address prescription opioid use disorder and effectively encourage behavior change among their patients.

PMID:34060766 | DOI:10.1097/JAN.0000000000000401

Matern Child Nutr. 2021 Jun 1:e13222. doi: 10.1111/mcn.13222. Online ahead of print.

ABSTRACT

The health benefits of breastfeeding are well recognised, but breastfeeding rates worldwide remain suboptimal. Breastfeeding outcomes have yet to be explored among women who give birth to macrosomic (birthweight ≥4000 g) infants, a cohort for whom the benefits of breastfeeding may be particularly valuable, offering protection against later-life morbidity associated with macrosomia. This longitudinal prospective cohort study aimed to identify whether women who give birth to macrosomic infants are at greater risk of breastfeeding non-initiation or exclusive breastfeeding (EBF) cessation. A total of 328 women in their third trimester were recruited from hospital and community settings and followed to 4 months post-partum. Women gave birth to 104 macrosomic and 224 non-macrosomic (<4000 g) infants between 2018 and 2020. Longitudinal logistic regression models calculated odds ratios (ORs) and 95% confidence intervals (CIs) to assess likelihood of EBF at four timepoints post-partum (birth, 2 weeks, 8 weeks, and 4 months) between women who gave birth to macrosomic and non-macrosomic infants, adjusted for maternal risk (obesity and/or diabetes), ethnicity and mode of birth. Macrosomic infants were more likely to be exclusively breastfed at birth and 2 weeks post-partum than non-macrosomic infants with adjusted OR = 1.94 (95% CI: 0.90, 4.18; p = 0.089) and 2.13 (95% CI: 1.11, 4.06; p = 0.022), respectively. There were no statistically significant associations between macrosomia and EBF at 8 weeks or 4 months post-partum. Macrosomia may act as a protective factor against early formula-milk supplementation, increasing the likelihood of EBF in the early post-partum period, but rates of exclusive breastfeeding continued to decline over the first 4 months post-partum.

PMID:34060713 | DOI:10.1111/mcn.13222

Oral Health Prev Dent. 2021 Jan 7;19(1):321-326. doi: 10.3290/j.ohpd.b1492771.

ABSTRACT

PURPOSE: Pigmentation of gingiva is an aesthetic problem. Until now, various methods have been introduced for removal of gingival pigmentation. The purpose of this study was to compare bur abrasion and CO2 laser methods in removing gingival pigmentation.

MATERIALS AND METHODS: Twelve patients aged 20-40 years old with the chief complaint of physiologic gingival pigmentation participated in this study. For these patients, gingival depigmentation was performed using two treatment modalities including bur abrasion and CO2 laser in a split-mouth design. Gingival depigmentation was performed in the right half of the anterior maxillary and mandibular sextants using bur abrasion method by means of diamond bur on a high-speed headpiece with vigorous water irrigation and the left half of the anterior maxillary and mandibular sextants using a CO2 laser. CO2 laser was set at: peak power 252 watts, repeat time 20 ms and pulse duration 200 microsecond which was used in a non-contact position. The area of pigmentation was calculated via gridlines in the Microsoft Paint software 1 and 6 months after the procedure. Gingival recession was also determined before, and at 1 and 6 months after the procedure.

RESULTS: The area of gingival pigmentation was not statistically significantly different between the two treatment modalities before the procedure (p = 0.452), 1 month (p = 0.443) and 6 months after the procedure (p = 0.202). There was no statistically significant difference in the variance of pigmented area at different times in the two methods. In both CO2 laser and bur abrasion methods, the mean area of pigmentation was statistically significantly different in the follow-up period (p < 0/001), in a way that the change in the area of pigmentation was statistically significant 1 month after treatment (p <0.001) and also 6 months after treatment (p < 0.001) compared to before. The change in the area of pigmentation between 1 and 6 months after treatment was not statistically significant in both CO2 laser (p = 0.157) and bur abrasion method (p = 0.150). No increase in gingival recession was observed in any of the patients.

CONCLUSION: Both treatment modalities can effectively treat gingival pigmentation. No increase in gingival recession was observed. Conventional method and CO2 laser were not statistically significantly different during a follow-up period of 1 and 6 months.

PMID:34060733 | DOI:10.3290/j.ohpd.b1492771

J Public Health Res. 2021 May 31;10(s1). doi: 10.4081/jphr.2021.2331.

ABSTRACT

BACKGROUND: The prevalence of obesity increases year by year. Sleep quality is considered to be one of the obesity causes. The current average sleep range of children in Indonesia was 6-7 hours. This study aims to analyze whether sleep quality affects the prevalence of obesity in children.

DESIGN AND METHODS: This study used a prospective cohort as the research method. The samples consisted of 37 primary school-age children (4th-6th grade) from West Java and Sumatra, which were selected using the snowball sampling technique. The data were collected by using PSQI and sleep logs (within a month).

RESULT: The statistical results showed that most of the obese children, 12 out of 19, had poor sleep quality (63.2%), while most of the non-obese children (normal),15 out of 18, had good sleep quality (83.3%). Based on the chi-square statistic, the p-value =0.011 <a (0.05) indicating that H0 was rejected, which means there was a correlation between sleep quality and obesity, with OR=8.571 (95% CI: 1.818-40.423), which means the children with poor sleep quality were likely to experience obesity 8.6 times greater than those who had good sleep quality.

CONCLUSIONS: This study found there were correlations between dietary intake, physical activity, sleep quality, and obesity in school-age children. The most dominant factor related to obesity in school-age children is the habitual sleep efficiency (OR=12.354).

PMID:34060737 | DOI:10.4081/jphr.2021.2331

J Thromb Haemost. 2021 Jun 1. doi: 10.1111/jth.15415. Online ahead of print.

ABSTRACT

BACKGROUND: Oral anticoagulation (OAC) in atrial fibrillation (AF) reduces the risk of stroke/systemic embolism (SE). The impact of OAC discontinuation is less well documented.

OBJECTIVE: Investigate outcomes of patients prospectively enrolled in GARFIELD-AF who discontinued OAC.

METHODS: OAC discontinuation was defined as cessation of treatment for ≥7 consecutive days. Adjusted outcome risks were assessed in 23,882 patients with 511 days of median follow-up after discontinuation.

RESULTS AND CONCLUSIONS: Patients who discontinued (n=3,114, 13.0%) had a higher risk (Hazard ratio [95% CI]) of all-cause death (1.62 [1.25-2.09]), stroke/systemic embolism (SE) (2.21 [1.42-3.44]) and myocardial infarction (MI) (1.85 [1.09-3.13]) than patients who did not, whether OAC was restarted or not. This higher risk of outcomes after discontinuation was similar for patients treated with vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) (p for interactions range=0.145-0.778). Bleeding history (1.43 [1.14-1.80]), paroxysmal vs. persistent AF (1.15 [1.02-1.29]), emergency room care setting vs. office (1.37 [1.18-1.59]), major, clinically relevant non-major, and minor bleeding (10.02 [7.19-13.98], 2.70 [2.24-3.25] and 1.90 [1.61-2.23]), stroke/SE (4.09 [2.55-6.56]), MI (2.74 [1.69-4.43]), and left atrial appendage procedures (4.99 [1.82-13.70]) were predictors of discontinuation. Age (0.84 [0.81-0.88], per 10-year increase), history of stroke/TIA (0.81 [0.71-0.93]), diabetes (0.88 [0.80-0.97]), weeks from AF onset to treatment (0.96 [0.93-0.99] per week), and permanent vs. persistent AF (0.73 [0.63-0.86]) were predictors of lower discontinuation rates. Discontinuation for ≥7 consecutive days was associated with significantly higher all-cause mortality, stroke/SE and MI risk. Caution should be exerted when considering any OAC discontinuation beyond 7 days.

PMID:34060704 | DOI:10.1111/jth.15415

NPJ Breast Cancer. 2021 May 31;7(1):68. doi: 10.1038/s41523-021-00272-2.

ABSTRACT

Percent mammographic density (PMD) is a strong breast cancer risk factor, however, other mammographic features, such as V, the standard deviation (SD) of pixel intensity, may be associated with risk. We assessed whether PMD, automated PMD (APD), and V, yielded independent associations with breast cancer risk. We included 1900 breast cancer cases and 3921 matched controls from the Nurses’ Health Study (NHS) and the NHSII. Using digitized film mammograms, we estimated PMD using a computer-assisted thresholding technique. APD and V were determined using an automated computer algorithm. We used logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs). Median time from mammogram to diagnosis was 4.1 years (interquartile range: 1.6-6.8 years). PMD (OR _{per SD}:1.52, 95% CI: 1.42, 1.63), APD (OR _{per SD}:1.32, 95% CI: 1.24, 1.41), and V (OR _{per SD}:1.32, 95% CI: 1.24, 1.40) were positively associated with breast cancer risk. Associations for APD were attenuated but remained statistically significant after mutual adjustment for PMD or V. Women in the highest quartile of both APD and V (OR _{vs Q1/Q1}: 2.49, 95% CI: 2.02, 3.06), or PMD and V (OR _{vs Q1/Q1}: 3.57, 95% CI: 2.79, 4.58) had increased breast cancer risk. An automated method of PMD assessment is feasible and yields similar, but somewhat weaker, estimates to a manual measure. PMD, APD and V are each independently, positively associated with breast cancer risk. Women with dense breasts and greater texture variation are at the highest relative risk of breast cancer.

PMID:34059687 | DOI:10.1038/s41523-021-00272-2

BMJ Open. 2021 May 31;11(6):e047040. doi: 10.1136/bmjopen-2020-047040.

ABSTRACT

OBJECTIVES: We compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births.

DESIGN: We used population linked data from New South Wales, Australia (2001-2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age.

RESULTS: Of 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years.

CONCLUSION: IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.

PMID:34059509 | DOI:10.1136/bmjopen-2020-047040

BMJ Open. 2021 May 31;11(5):e047627. doi: 10.1136/bmjopen-2020-047627.

ABSTRACT

INTRODUCTION: Hangeshashinto has been employed for oral mucositis prevention in patients receiving cancer treatment, but the evidence has not been sufficiently robust to guide clinical decision-making. This study will therefore be undertaken to assess the effectiveness of Hangeshashinto for preventing oral mucositis in patients with cancer who are receiving treatment.

METHODS AND ANALYSIS: The databases will include PubMed, Embase, the Cochrane Library, Chinese databases and Japanese databases. The literature will be searched from the databases’ inception until May 2021. Other sources, such as potential grey literature, reference lists from included studies and relevant systematic reviews and conference papers, will also be searched. The primary outcome is the incidence of mucositis of any severity, and the secondary outcomes are interruptions to cancer treatment, oral pain and nutritional status. The risk of bias of eligible studies will be assessed using the Cochrane Collaboration’s ‘risk of bias’ tool. Both the Q test and I² statistic will be performed to assess statistical heterogeneity. If I² >50%, sensitivity and subgroup analysis will be conducted. The quality of evidence will be rated according to the Grading of Recommendations, Assessment, Development and Evaluation approach. Egger’s test will be used to assess reporting bias.

ETHICS AND DISSEMINATION: This systematic review will evaluate only published data; therefore, ethical approval is not required.

PROSPERO REGISTRATION NUMBER: CRD42020216145.

PMID:34059515 | DOI:10.1136/bmjopen-2020-047627