Tag: statistics

World J Urol. 2022 Jan 22. doi: 10.1007/s00345-021-03910-3. Online ahead of print.

ABSTRACT

PURPOSE: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists’ experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice.

METHODS: A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used.

RESULTS: Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention.

CONCLUSION: The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.

PMID:35064800 | DOI:10.1007/s00345-021-03910-3

Int Urogynecol J. 2022 Jan 22. doi: 10.1007/s00192-021-05068-3. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: There has been renewed interest in the management of postoperative pain after benign gynecological surgery. The purpose of the study was to determine if the use of intraoperative and immediate postoperative pain medication differs between vaginal and laparoscopic surgery in women with pelvic organ prolapse.

METHODS: The study included women who had undergone pelvic organ prolapse repair between 2014 and 2019 in two tertiary care hospitals. We collected demographic data and pain medication used during and after surgery, including opioids, local anesthetics, gabapentin, ketorolac, ibuprofen, and acetaminophen. Data analyses were performed using STATA Version 16.1. A p value <0.05 was considered to indicate statistical significance.

RESULTS: A total of 195 women were included in the study, with 98 in the vaginal and 97 in the laparoscopic group. Intraoperative opioid use in the two groups was similar (25 morphine milligram equivalent [MME], p = 0.34). However, women in the laparoscopic group received significantly more intravenous and local anesthesia (lidocaine: 60 vs 40 mg; bupivacaine 49.6 vs 20 ml, p < 0.001). Postoperatively, although women in the vaginal group required almost twice as many narcotics as those in the laparoscopy group (MME = 28 vs 15, p < 0.001), after controlling for confounders in the multivariate analysis, there were no differences in postoperative pain requirements between the two groups. Recovery time had a significant impact on opioid and acetaminophen use (p < 0.05).

CONCLUSION: Use of pain medication was similar in the intraoperative and immediate postoperative period after pelvic organ prolapse surgery when comparing the vaginal and laparoscopic approaches after controlling for potential confounding factors.

PMID:35064788 | DOI:10.1007/s00192-021-05068-3

J Cosmet Dermatol. 2022 Jan 22. doi: 10.1111/jocd.14741. Online ahead of print.

ABSTRACT

AIM AND OBJECTIVES: Evaluation of the cumulative effect of Radiofrequency Microneedling and fractional Erbium: Glass 1565 laser in moderate to severe acne scars in skin of color.

MATERIAL AND METHODS: This retrospective study was conducted on 20 patients of skin types III -V having moderate to severe atrophic acne scars. The study was carried out over 1 year from March 2019 to March 2020.

PROCEDURE: All patients underwent 4 sessions of non-ablative Fractional Erbium: Glass 1565 laser to alternate with 4 sessions of Fractional Radiofrequency Microneedling once a month over 8 months.

RESULTS: Of the 20 patients enrolled, 18 completed treatment protocol. Two patients were withdrawn from the study because they were unable to attend follow-up treatment sessions. The subjective evaluation was performed using photographs at baseline, 8 months, and 12 months. A photographic evaluation was performed using the following numeric responses: <25%, 25-50%, 51-75%, and 76-100% difference in severity. None of the patients had worsening of their scars. The improvement in scars was statistically significant.

CONCLUSION: The combination of Fractional Erbium: Glass 1565 laser and Fractional Radiofrequency Microneedling can be used in the treatment of acne scars in skin of color. Our protocols helped achieve significant improvement of scars.

PMID:35064639 | DOI:10.1111/jocd.14741

Andrology. 2022 Jan 22. doi: 10.1111/andr.13157. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited data regarding the effects of systemic androgens on late-stage urethral wound healing.

OBJECTIVE: To evaluate the effects of systemic androgens on fibrosis, and scar formation in late-stage urethral wound healing.

MATERIALS AND METHODS: Forty-five male Sprague-Dawley rats were divided into 3 groups. First group consisted of 15 rats that were castrated on the 23 days of age and were given 5 mg/kg testosterone undecanoate with 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks. (CAS+T group). The CAS group included 15 castrated rats. The remaining 15 rats underwent sham surgery. CAS and Sham groups also received 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks. Furthermore, all groups were divided into 3 subgroups after testosterone/placebo administration (Urethroplasty performed after 1^st , 2^nd and 3^rd weeks) in accordance with the urethroplasty timing. All animals were sacrificed 6 weeks after urethroplasty. Serum testosterone level was measured, tissue samples were investigated using H&E and Masson’s trichrome. Alpha-SMA, Coll 1 and Coll 3 primary antibodies were applied for immunohistochemical examination. Expression of cytokines and growth factors such as Bax, Bcl2, IL-10, IP-10, TNF-alpha, TGFb1, MMP9, Col-I, Col-III, TIMP-1, Fibronectin, FGF-10, PDGF, alpha-SMA were also evaluated in the tissues.

RESULTS: The blood testosterone levels were significantly higher in CAS+T group at the time of urethroplasty compared with the levels in CAS group however, this difference was not observed at the time of sacrification (p<0.001 and p:0.97, respectively). Histological analysis with Hematoxylin and eosin, Masson’s trichrome staining revealed a significantly higher fibrosis in the sham group compared to the others. Significantly lower fibrosis was detected in the CAS group in the pairwise comparison of the pathological fibrosis area between the CAS, and CAS+T groups (p<0.001). Furthermore, tissue collagen-1, collagen-3 and alpha-SMA expression levels were statistically different between CAS and CAS+T groups (p<0.001, p<0.05 and p<0.001, respectively). The tissue levels of BAX, TIM-1, MMP-9, Coll-I, Coll-III, TGF-beta, TNF-alpha and IL-10 mRNA expressions in the CAS+T group were different than the levels in CAS group (as <0.5-fold and >1.5-fold changes, respectively). The expression of all these markers were significantly higher in the sham group. The sub-group analysis of CAS+T group (Urethroplasty performed after 1^st , 2^nd and 3^rd weeks) revealed similar histopathological wound healing findings.

DISCUSSION: Debate continues on the effects and benefits of androgen use regarding urethral healing. There are two main routes for administration as systemic or local. This study focuses on the late-stage histologic and biochemical effects of systemic androgens.

CONCLUSION: Systemic androgens adversely affect wound healing, and cause abnormal ECM as well as scar formation. This article is protected by copyright. All rights reserved.

PMID:35064654 | DOI:10.1111/andr.13157

Photodermatol Photoimmunol Photomed. 2022 Jan 21. doi: 10.1111/phpp.12774. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to compare the efficacy of photobiomodulation after non-surgical mechanical debridement (MD) on cortisol levels (CL) in periimplant sulcular fluid (PISF) among patients with peri-implant mucositis.

METHODS: Patients with peri-implant mucositis were encompassed. All patients underwent non-surgical MD with (test-group) and without (control-group) a single application of photobiomodulation. Demographic data was collected and PISF was collected. Peri-implant modified plaque-index (mPI), modified gingival-index (mGI), probing depth and crestal bone loss were measured and CL in PISF were recorded. All clinical parameters and PISF CL were re-assessed at 4-months of follow-up. P<0.05 showed statistical significance.

RESULTS: Seventeen (14males and 3females) and 17 (15males and 2females) patients with peri-implant mucositis were recruited in test- and control-groups. The mean age of patients in the test and control-groups were 46.1 ± 6.5 and 50.2 ± 2.7 years, respectively. At baseline, mPI, mGI, PD and PISF volume and CL in control and test-groups were similar. At follow-up, there was a significant reduction in mPI(P<0.001), mGI(P<0.001), PD(P<0.001) and PISF volume(P<0.001) and CL(P<0.001) in both groups compared with baseline. There was no difference in mPI, mGI, PD and PISF volume and CL in test- and control-groups at follow-up.

CONCLUSION: In short-term, non-surgical MD with photobiomodulation does not offer additional benefits in terms of reducing soft-tissue inflammatory parameters and PISF CL in patients with peri-implant mucositis.

PMID:35064588 | DOI:10.1111/phpp.12774

J Food Biochem. 2022 Jan 21:e14081. doi: 10.1111/jfbc.14081. Online ahead of print.

ABSTRACT

Food industry has been investing in bringing to the market coffee-based drinks enriched in compounds that promise weight loss, which consequently influences diabetes risk. However, there are no clinical trials showing the effects of brewed coffee (with or without caffeine) enriched with bioactive compounds on body fat and glycemic control in healthy individuals. Therefore, we have evaluated the effect of consuming two coffee formulas enriched with cocoa and fructo-oligosaccharides (FOS) on glycemic and anthropometric biomarkers and blood pressure in non-diabetic adults for 10 weeks. In general, we observed that the values of fasting plasma glucose (FPG) (p = .006) and fasting capillary blood glucose (FCBG) (p < .001) had lower values with a tendency to decrease in FCG (p = .003) and FBG (p < .005) in both formulas. We observed statistically significant reductions in waist circumference (WC) (p = .012), arm circumference (AC) (p = .015), and percentage of fat (<0.0001) for all participants. However, we noticed a greater reduction in the caffeinated formula group (-2.92%, p = .005) compared to the decaffeinated formula (-1.62%, p = .008). Consumers of both cocoa and FOS-enriched coffee formulas benefited from reduced FBG, FCG, WC, and body fat percentage. The consumption of caffeinated formula was more effective in reducing the percentage of fat, while the decaffeinated formula was more effective in reducing diastolic blood pressure. PRACTICAL APPLICATIONS: This study provides robust evidence that effects of fortified coffee on non-diabetic people is positive for reduction in blood glucose, body fat and diastolic blood pressure. This study proposes a practical and safe coffee formulation for the consumption of caffeinated and decaffeinated coffee for non-diabetic people.

PMID:35064574 | DOI:10.1111/jfbc.14081

Stat Med. 2022 Jan 21. doi: 10.1002/sim.9315. Online ahead of print.

ABSTRACT

Multiple imputation is a promising approach to handle missing data and is widely used in analysis of longitudinal clinical studies. A key consideration in the implementation of multiple imputation is to obtain accurate imputed values by specifying an imputation model that incorporates auxiliary variables potentially associated with missing variables. The use of informative auxiliary variables is known to be beneficial to make the missing at random assumption more plausible and help to reduce uncertainty of the imputations; however, it is not straightforward to pre-specify them in many cases. We propose a data-driven specification of the imputation model using Bayesian lasso in the context of longitudinal clinical study, and develop a built-in function of the Bayesian lasso imputation model which is performed within the framework of multiple imputation using chained equations. A simulation study suggested that the Bayesian lasso imputation model worked well in a variety of longitudinal study settings, providing unbiased treatment effect estimates with well-controlled type I error rates and coverage probabilities of the confidence interval; in contrast, ignorance of the informative auxiliary variables led to serious bias and inflation of type I error rate. Moreover, the Bayesian lasso imputation model offered higher statistical powers compared with conventional imputation methods. In our simulation study, the gains in statistical power were remarkable when the sample size was small relative to the number of auxiliary variables. An illustration through a real example also suggested that the Bayesian lasso imputation model could give smaller standard errors of the treatment effect estimate.

PMID:35064581 | DOI:10.1002/sim.9315

Eur Geriatr Med. 2022 Jan 22. doi: 10.1007/s41999-021-00600-6. Online ahead of print.

ABSTRACT

PURPOSE: To describe the impact of COVID-19 on hip fracture care during the first 6 months of the pandemic.

METHODS: A secondary analysis of 4385 cases in the Irish Hip Fracture Database from 1st June 2019 to 31st August 2020 was conducted.

RESULTS: Hip fracture admissions decreased by 15% during the study period (p < 0.001). Patient characteristics were largely unchanged as the majority of cases occurred in females over 80 years admitted from home. Adherence to many of the Irish Hip Fracture Standards (IHFS) changed following the COVID-19 pandemic. There was an increase in patients admitted to an orthopaedic ward from Emergency Department (ED) within 4 h from 27 to 36% (p < 0.001). However, the proportion of patients reviewed by a geriatrician reduced from 85% pre-COVID to 80% (p < 0.001). Fewer patients received a bone health assessment [90% from 95% (p < 0.001)] and specialist falls assessment [(82% from 88% (p < 0.001)]. No change was seen in time to surgery or incidence of pressure injuries. There was a significant decrease in length of stay from 18 to 14 days (p < 0.001). There was an increase in patients discharged home during the COVID-19 period and a decrease in patients discharged to rehabilitation, convalescence or nursing home care. There was no statistically significant change in mortality.

CONCLUSION: Healthcare services were widely restructured during the pandemic, which had implications for hip fracture patients. There was a notable change in compliance with the IHFS. Multidisciplinary teams involved in hip fracture care should be preserved throughout any subsequent waves of the pandemic.

PMID:35064562 | DOI:10.1007/s41999-021-00600-6

J Am Geriatr Soc. 2022 Jan 22. doi: 10.1111/jgs.17667. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying patients at high risk of drug-related hospital admission (DRA) may help to efficiently target preventive interventions. We developed a score to predict DRAs in older patients with multimorbidity and polypharmacy.

METHODS: We used participants from the multicenter European OPERAM trial (“Optimising PharmacothERapy in the Mutlimorbid Elderly”). We assessed the association between easily identifiable predictors and 1-year DRAs by univariable logistic regression. Variables with p-value< 0.20 were taken forward to backward regression. We retained all variables with p < 0.05 in the model. We assessed the C-statistic, calibration (observed/predicted proportions), and overall accuracy (scaled Brier score, <0.25 indicating a useful model) of the score, and internally validated it by tenfold cross-validation.

RESULTS: Within 1 year, 435/1879 (23.2%) patients (mean age 79.4 years) had a DRA. The score included seven variables: previous hospitalizations, non-elective admission, hypertension, cirrhosis with portal hypertension, chronic kidney disease, diuretic, oral corticosteroid. The C-statistic was 0.64 (95% CI 0.61-0.67). Patients with <1 point had a 12.4% predicted and observed risk of DRA, while those with >3 points had a 40.4% predicted and 38.9% observed risk of DRA. The scaled Brier score was 0.05. Calibration showed an adequate match between predicted and observed proportions.

CONCLUSION: Comorbidities related to drug metabolism, specific medications, non-elective admission, and a history of hospitalization, were associated with a higher risk of DRA. Awareness of these associations and the score we developed may help identify patients most likely to benefit from preventive interventions.

PMID:35064571 | DOI:10.1111/jgs.17667

Acad Psychiatry. 2022 Jan 22. doi: 10.1007/s40596-021-01574-0. Online ahead of print.

ABSTRACT

OBJECTIVE: The relationship between a resident physician and his/her supervising attending is foundational to graduate medical education and may impact the clinical learning environment and resident well-being. This paper focuses on how to measure connection between a resident and their clinical supervisor. Connection includes the subdomains of psychological safety, empathy, educational alliance, and feedback.

METHODS: After reviewing the literature, the authors designed the 12-item, 7-point Connection Index (CI₁₂) to quantitatively measure connections between a resident and his/her supervisor during a 6-month period (supervision dyad), and based on educational alliance, empathy, psychological safety, and effective feedback. A 9-criteria evaluation framework was applied to assess its reliability and validity on a sample of psychiatry residents at a residency program, July 2016 through June 2018.

RESULTS: Out of a total possible number of 50 residents, 100% participated to rate 41 supervisors over 201 supervision dyads; the CI₁₂ satisfied all eight of the eight testable criteria, including high scalability (H = 0.78), consistency (alpha = 0.98), test-retest validity (ICC = 0.95), and construct validity where CI₁₂ was found to have statistically significant correlations with outcomes measures (greater connection was associated with less negative emotional experiences, less mistreatment or bias, less burnout, and higher attendance to supervision sessions).

CONCLUSION: The authors showed the CI₁₂ can be a valid and reliable instrument to quantify whether a resident and his/her supervisor connects during a 6-month supervision with respect to empathy, psychological safety, educational alliance, and feedback. We recommend assessing connections as part of the overall evaluation of a resident’s experience with the clinical learning environment.

PMID:35064549 | DOI:10.1007/s40596-021-01574-0