Tag: statistics

Br J Dermatol. 2021 Sep 3. doi: 10.1111/bjd.20689. Online ahead of print.

ABSTRACT

BACKGROUND: In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared to adults.

OBJECTIVES: To test the diagnostic accuracy of previously agreed consensus criteria and develop a shortlist of best predictive diagnostic criteria for childhood psoriasis.

METHODS: A case-control diagnostic accuracy study in 12 UK dermatology departments (2017-2019) assessed 18 clinical criteria using blinded trained investigators. Children (<18 years) with dermatologist diagnosed psoriasis (cases n=160) or a different scaly inflammatory rash (controls n=170) were recruited. The best predictive criteria were identified using backward logistic regression and internal validation was conducted using bootstrapping.

RESULTS: The sensitivity of the consensus agreed criteria and consensus scoring algorithm was 84.4%, specificity was 65.1% and area under the curve (AUC) 0.75. Seven diagnostic criteria which performed best were: i) scale and erythema in the scalp involving the hairline; ii) scaly erythema inside the external auditory meatus; iii) persistent well-demarcated erythematous rash anywhere on the body; iv) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees; v) persistent erythema in the umbilicus; vi) well demarcated erythematous rash in the napkin area involving the crural folds; vii) family history of psoriasis. Sensitivity of the best predictive model was 76.8%, specificity 72.7% and AUC 0.84. The c-statistic optimism adjusted shrinkage factor was 0.012.

CONCLUSIONS: This study provides examination and history-based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary care patients. External validation is now needed.

PMID:34477218 | DOI:10.1111/bjd.20689

Rev Esp Salud Publica. 2021 Sep 3;95:e202109123.

ABSTRACT

OBJECTIVE: Research has uncovered a global pandemic of physical inactivity and schools have been signaled as possible “agents” to modify these negative scores, since all children spend many hours a day there. The aim was to evaluate if it is possible to increase the physical activity levels of a whole school using a multifactorial, self-regulated intervention program during recess.

METHODS: A cross-sectional study was conducted involving all the students (N=50) of a rural public school located in northern Spain (grades 1-6). The study followed an ABA case study research design (changes in the experimentation conditions and data collection after each one: week 1 no intervention, weeks 2-3 intervention, week 4 no intervention) and mixed quantitative-qualitative methodology which included the use of accelerometers (each participant wore one during the whole school day and the school week), field notes (researcher) and focus groups (teachers). Normality tests, descriptive and inferential statistics (ANOVAs) were conducted in the quantitative data obtained, while thematic content and constant comparison analyses in the qualitative data.

RESULTS: Quantitative results showed that there was a significant increase to 67.15 ± 13.95 minutes/day of moderate-to-vigorous physical activity (MVPA) in week 2. Boys reached significantly higher scores than girls: 72.1 ± 12.12. Unfortunately, these scores went back to almost normal in the second week of implementation of the program (58.21 ± 12.88; boys= 62.75 ± 10.86). From the joined analysis of the researcher field notes and the teachers’ focus groups 4 themes emerged: intensity change, dominance change, interactions change and self-regulation.

CONCLUSIONS: It is possible to increase the physical activity levels of a whole school with a multifactorial, self-regulated program, but it is necessary to acknowledge that novelty “wears out” to avoid losing efficacy with time.

PMID:34477180

Rev Esc Enferm USP. 2021 Sep 1;55:e20200428. doi: 10.1590/1980-220X-REEUSP-2020-0428. eCollection 2021.

ABSTRACT

OBJECTIVE: To identify knowledge, skills, and attitudes on Evidence-Based Practice of nursing students in the School of Nursing of Universidade de São Paulo and to explore the relationship between knowledge, skills, and attitudes and associated variables.

METHOD: This is an exploratory, descriptive, analytical study conducted with 125 nursing undergraduate students. The data were obtained through application of the Evidence-Based Practice Questionnaire.

RESULTS: The mean score for the questionnaire was 4.73 (SD = 0.79), with a higher score in the Attitudes domain. There was a significant statistical correlation between questionnaire score and course year (p < 0.001).

CONCLUSION: There is a gap in the knowledge and skills associated to Evidence-Based Practice among nursing students. Effective strategies for teaching this subject in the nursing undergraduate course must be developed.

PMID:34477197 | DOI:10.1590/1980-220X-REEUSP-2020-0428

Medicine (Baltimore). 2021 Sep 3;100(35):e27165. doi: 10.1097/MD.0000000000027165.

ABSTRACT

BACKGROUND: The mechanism of cryptogenic stroke (CS) in patients with atrial septal abnormalities remains unclear, and the increased incidence of atrial vulnerability may be one of the reasons. We performed this meta-analysis to clarify the association between atrial septal abnormalities and atrial vulnerability, and to provide evidence-based basis for the prevention and mechanism of CS.

METHODS: We systematically searched for studies on the association between atrial septal abnormalities and atrial vulnerability, and pooled available data on types of atrial septal abnormalities, types of atrial vulnerability, and methods of atrial vulnerability detection. The primary endpoints were the occurrence of atrial arrhythmias or P wave abnormalities. Random-effects models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: Twelve case-control studies were eligible. Compared with the control group, patients with atrial septal abnormalities had a higher risk of atrial vulnerability (OR: 1.93; 95% CI: 1.13-3.30, P = .02). Data based on stroke patients showed that the group with atrial septal abnormalities had a higher risk of atrial vulnerability than the control group (OR: 2.00; 95% CI: 1.13-3.53, P = .02). However, there was no significant difference in the incidence of atrial vulnerability between the 2 groups of nonstroke patients. Subgroup analysis showed that although atrial septal abnormality increased the risk of atrial vulnerability in the subgroup of atrial septal aneurysm (OR: 1.68; 95% CI: 0.47-5.95, P = .42), the subgroup of atrial fibrillation (AF)/atrial fluster (OR: 1.81; 95% CI: 0.94-3.46, P = .07) and the subgroup of subcutaneous recording system (OR: 1.33; 95% CI: 0.68-2.61, P = .41), the difference was not statistically significant.

CONCLUSIONS: Atrial septal abnormalities can increase the risk of atrial vulnerability, and atrial arrhythmia caused by atrial septal abnormalities may be one of the mechanisms of CS.

PMID:34477173 | DOI:10.1097/MD.0000000000027165

Medicine (Baltimore). 2021 Sep 3;100(35):e27182. doi: 10.1097/MD.0000000000027182.

ABSTRACT

In this single-center retrospective study, we intended to evaluate the frequencies and characteristics of computed tomography findings of pancreatobiliary inflammation (PBI) in patients treated with lenvatinib and the relationship of these findings with treatment-planning changes.We included 78 patients (mean ± standard deviation, 69.8 ± 9.4 years, range: 39-84 years, 62 men) with hepatocellular carcinoma (n = 62) or thyroid carcinoma (n = 16) who received lenvatinib (June 2016-September 2020). Two radiologists interpreted the posttreatment computed tomography images and assessed the radiological findings of PBI (symptomatic pancreatitis, cholecystitis, or cholangitis). The PBI effect on treatment was statistically evaluated.PBI (pancreatitis, n = 1; cholecystitis, n = 7; and cholangitis, n = 2) was diagnosed in 11.5% (9/78) of the patients at a median of 35 days after treatment initiation; 6 of 9 patients discontinued treatment because of PBI. Three cases of cholecystitis and 1 of cholangitis were accompanied by gallstones, while the other 5 were acalculous. The treatment duration was significantly shorter in patients with PBI than in those without (median: 44 days vs. 201 days, P = .02). Overall, 9 of 69 patients without PBI showed asymptomatic gallbladder subserosal edema.Lenvatinib-induced PBI developed in 11.5% of patients, leading to a significantly shorter treatment duration. Approximately 55.6% of the PBI cases were acalculous. The recognition of this phenomenon would aid physicians during treatment planning in the future.

PMID:34477177 | DOI:10.1097/MD.0000000000027182

Medicine (Baltimore). 2021 Sep 3;100(35):e27144. doi: 10.1097/MD.0000000000027144.

ABSTRACT

This study aimed to evaluate the diagnostic performance of diffusion kurtosis imaging (DKI) and prostate-specific antigen (PSA) biomarkers in differentiating prostate cancer (PCa) and benign prostatic hyperplasia (BPH).A total of 43 cases of prostate diseases verified by pathology were enrolled in the present study. These cases were assigned to the BPH group (n = 20, 68.85±10.81 years old) and PCa group (n = 23, 74.13 ± 7.37 years old). All patients underwent routine prostate magnetic resonance imaging and DKI examinations, and the mean diffusivity (MD), mean kurtosis (MK), and fractional anisotropy (FA) values were calculated. Three serum indicators (PSA, free PSA [fPSA], and f/t PSA) were collected. We used univariate logistic regression to analyze the above quantitative parameters between the 2 groups, and the independent factors were further incorporated into the multivariate logistic regression model. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic efficacy of the single indicator and combined model.The difference in PSA, f/t PSA, MK, and FA between PCa and BPH was statistically significant (P < .05). The AUC for the combined model (f/t PSA, MK, and FA) of 0.972 (95% confidence interval [CI]: 0.928, 1.000) was higher than the AUC of 0.902 (95% CI: 0.801, 1.000) for f/t PSA, 0.833 (95% CI: 0.707, 0.958) for MK, and 0.807 (95% CI: 0.679, 0.934) for FA.The MK and FA values for DKI and f/t PSA effectively identify PCa and BPH, compared to the PSA indicators. Combining DKI and PSA derivatives can further improve the diagnosis efficiency and might help in the clinical setting.

PMID:34477170 | DOI:10.1097/MD.0000000000027144

Medicine (Baltimore). 2021 Sep 3;100(35):e27131. doi: 10.1097/MD.0000000000027131.

ABSTRACT

The evaluation of bone disease in multiple myeloma (MM) is an important topic in imaging. This study retrospectively investigated whole-body diffusion-weighted imaging (WB-DWI) in the evaluation of bone marrow infiltration and treatment response in MM.A total of 126 patients with MM who underwent WB-DWI between January 2016 and December 2020 were enrolled. All the patients received 4-course induction chemotherapy. WB-DWI was performed before and after chemotherapy to measure the apparent diffusion coefficient (ADC) values. According to gender and Revised International Staging System (RISS) staging groups, the relationship between ADC value and bone marrow plasma cell infiltration ratio before treatment were explored using Spearman and Pearson correlation coefficients. Comparison of ADC values before and after treatment according to different chemotherapy regimens and treatment response was performed by 2-independent samples non-parametric tests and t test.There was a negative correlation between the ADC value and the degree of bone marrow infiltration and this was statistically significant (r = -0.843, P < .001). In different gender and RISS groups, ADC value before treatment was negatively correlated with the proportion of plasma cell infiltration (male, r = -0.849; female, r = -0.836; Stage I, r = -0.659; Stage II, r = -0.870; Stage III, r = -0.745; all P < .001). The ADC values of all subjects increased to varying degrees after 4-course induction chemotherapy, including different chemotherapy regimens and treatment responses (all P < .05 except for progressive disease group).The ADC value was negatively correlated with the degree of bone marrow infiltration in different gender and RISS stages. The ADC value increased after treatment, but it was not consistent with progressive disease group. The increase of ADC value may indicate the disease burden and outcome of MM induced chemotherapy.

PMID:34477159 | DOI:10.1097/MD.0000000000027131

J Neurointerv Surg. 2021 Sep 2:neurintsurg-2021-017765. doi: 10.1136/neurintsurg-2021-017765. Online ahead of print.

ABSTRACT

BACKGROUND: Futile recanalization-when patients have a successful recanalization but fail to achieve a satisfactory functional outcome- is a common phenomenon of endovascular treatment of acute ischemic stroke (AIS). The present study aimed to identify the predictors of futile recanalization in AIS patients who received endovascular treatment.

METHODS: This is a post-hoc analysis of the DIRECT-MT trial. Demographics, clinical characteristics, acute stroke workflow interval times, biochemical parameters, and imaging characteristics were compared between futile and meaningful recanalization groups. Multivariate analysis was performed to identify the predictors of futile recanalization.

RESULTS: Futile recanalization was observed in 277 patients. In multivariable logistic regression analysis, older age (p<0.001), higher baseline systolic blood pressure (SBP) (p=0.032), incomplete reperfusion defined by extended Thrombolysis In Cerebral Infarction (eTICI) grades (p=0.020), and larger final infarct volume (FIV) (p<0.001) were independent predictors of futile recanalization.

CONCLUSIONS: Old age, high baseline SBP, incomplete reperfusion defined by eTICI, and large FIV were independent predictors of futile recanalization after endovascular therapy for AIS.

PMID:34475255 | DOI:10.1136/neurintsurg-2021-017765

J Nucl Med. 2021 Sep 2:jnumed.121.262905. doi: 10.2967/jnumed.121.262905. Online ahead of print.

NO ABSTRACT

PMID:34475238 | DOI:10.2967/jnumed.121.262905

Proc Natl Acad Sci U S A. 2021 Sep 7;118(36):e2025061118. doi: 10.1073/pnas.2025061118.

ABSTRACT

A prevailing view is that Weber’s law constitutes a fundamental principle of perception. This widely accepted psychophysical law states that the minimal change in a given stimulus that can be perceived increases proportionally with amplitude and has been observed across systems and species in hundreds of studies. Importantly, however, Weber’s law is actually an oversimplification. Notably, there exist violations of Weber’s law that have been consistently observed across sensory modalities. Specifically, perceptual performance is better than that predicted from Weber’s law for the higher stimulus amplitudes commonly found in natural sensory stimuli. To date, the neural mechanisms mediating such violations of Weber’s law in the form of improved perceptual performance remain unknown. Here, we recorded from vestibular thalamocortical neurons in rhesus monkeys during self-motion stimulation. Strikingly, we found that neural discrimination thresholds initially increased but saturated for higher stimulus amplitudes, thereby causing the improved neural discrimination performance required to explain perception. Theory predicts that stimulus-dependent neural variability and/or response nonlinearities will determine discrimination threshold values. Using computational methods, we thus investigated the mechanisms mediating this improved performance. We found that the structure of neural variability, which initially increased but saturated for higher amplitudes, caused improved discrimination performance rather than response nonlinearities. Taken together, our results reveal the neural basis for violations of Weber’s law and further provide insight as to how variability contributes to the adaptive encoding of natural stimuli with continually varying statistics.

PMID:34475203 | DOI:10.1073/pnas.2025061118