Tag: statistics

Adv Gerontol. 2021;34(3):461-465.

ABSTRACT

The work is based on the results of a retrospective analysis of the medical records of 56 patients with traumatic brain injury complicated by acute subdural hematoma with a volume of 60-100 cm3. The patients were divided into 2 groups according to their age: the 1st group included 29 patients aged 22-29 years, the 2nd group consisted of 27 patients aged 61-69 years. The degree of impaired consciousness in the victims at admission to the clinic was evaluated on the Glasgow scale, the effectiveness of the treatment at discharge from the hospital was performed on the Rankin scale, assessing the degree of independence and disability. Elderly patients were found to have a more severe condition upon admission to the clinic. Upon discharge from the hospital, the assessment of the degree of independence and disability on the Rankin scale revealed a statistically significant predominance of scores in the group of elderly patients (p<0,01), which indicates less effective treatment in comparison with young patients. The results of this study can serve as a basis for the development of additional recommendations in outpatient practice for the care and care of patients in the older age group and a personalized approach to neurosurgical patients taking into account their age.

PMID:34409827

Nat Commun. 2021 Aug 18;12(1):5026. doi: 10.1038/s41467-021-25120-6.

ABSTRACT

Nationwide prospective surveillance of all-age patients with acute respiratory infections was conducted in China between 2009‒2019. Here we report the etiological and epidemiological features of the 231,107 eligible patients enrolled in this analysis. Children <5 years old and school-age children have the highest viral positivity rate (46.9%) and bacterial positivity rate (30.9%). Influenza virus, respiratory syncytial virus and human rhinovirus are the three leading viral pathogens with proportions of 28.5%, 16.8% and 16.7%, and Streptococcus pneumoniae, Mycoplasma pneumoniae and Klebsiella pneumoniae are the three leading bacterial pathogens (29.9%, 18.6% and 15.8%). Negative interactions between viruses and positive interactions between viral and bacterial pathogens are common. A Join-Point analysis reveals the age-specific positivity rate and how this varied for individual pathogens. These data indicate that differential priorities for diagnosis, prevention and control should be highlighted in terms of acute respiratory tract infection patients’ demography, geographic locations and season of illness in China.

PMID:34408158 | DOI:10.1038/s41467-021-25120-6

Rev Esp Salud Publica. 2021 Aug 19;95:e202108105.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic caused that the Health Department of the Autonomous Region of Madrid redirected the Obstetrics, Gynecology and Neonatology emergency care. On March 24^th 2020, the HULP launched a program of postpartum early discharge and home visit. The objective of this work was to detect if the care strategy “Voluntary early discharge and home visit by the midwife (2^nd year EIR)” applied by the HULP during the COVID-19 pandemic had any adverse effect on the woman and/or the newborn.

METHODS: Cross-sectional observational descriptive study using convenience sampling among women included in the early discharge-home visit program from March 24^th to May 5^th 2020. 222 medical records and telephone surveys to postpartum women who complied with the inclusion criteria were analyzed. The statistical analysis was performed using SAS 9.4.

RESULTS: The average of inpatient time was 25 hours and 15 minutes. 8.6% of newborns were sent back to the HULP, and 2.2% were readmitted for hyperbilirubinemia. 2.3% of parents took their infants to the Emergency Care Unit, but only 0.46% needed readmission. 0.4% of postpartum women were readmitted. At the discharge, 84.2% of newborns exclusively breastfed. After one week of the birth, 73.4% of infants were exclusively breastfeeding, 18% were mixed breastfeeding, and 8.6% were bottle feeding. 89.6% of women believed early discharge was appropriate. Home visit was described as “very satisfactory” in 83.3% of cases, and the care provided, in 88.7% of cases.

CONCLUSIONS: With the early discharge-home visit program, continuity of care is provided, health problems were detected and resolved and high maternal satisfaction levels were obtained.

PMID:34408124

J Oral Sci. 2021 Aug 17. doi: 10.2334/josnusd.21-0196. Online ahead of print.

ABSTRACT

PURPOSE: This study compared the removability of AH Plus and EndoSequence BC sealers using in vitro micro-computed tomography.

METHODS: Ten single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size X5 (50/0.06) (Dentsply-Sirona). Canals were obturated with a single cone gutta-percha and either AH Plus (Dentsply-Sirona) (Group A) or EndoSequence BC (Brasseler) (Group B). ProTaper Universal Retreatment files (Dentsply-Sirona) were used to remove obturation materials after 90 days at 37^oC/100% humidity. Each tooth was scanned using micro-computed tomography (SkyScan 1272; Bruker) at an isotropic resolution of 6 μm from which the percent of material removed was calculated. Two-sample t-tests and one-way ANOVA were used for analysis.

RESULTS: The percent removal of materials in the coronal third was 92.9% ± 7.3% (Group A) and 93.2% ± 6.1% (Group B). Removal in the middle third was 94.9% ± 8.5% (Group A) and 96.5% ± 6.1% (Group B). Apical third removal was 76.2% ± 27.9% (Group A) and 70.1% ± 30.8% (Group B). No statistically significant differences were determined between the two sealers or among the sectional thirds within each group (P > 0.05).

CONCLUSION: AH Plus and EndoSequence BC sealers exhibit the same removability at all canal levels of 70% to 96%, with better removal coronally.

PMID:34408113 | DOI:10.2334/josnusd.21-0196

BMJ Open. 2021 Aug 18;11(8):e054055. doi: 10.1136/bmjopen-2021-054055.

ABSTRACT

INTRODUCTION: Breast reconstruction (BR) is offered to improve quality of life for women with breast cancer undergoing mastectomy. As most women will be long-term breast cancer survivors, high-quality information regarding the long-term outcomes of different BR procedures is essential to support informed decision-making. As different techniques vary considerably in cost, policymakers also require high-quality cost-effectiveness evidence to inform care. The Brighter study aims to explore the long-term clinical and patient-reported outcomes (PROs) of implant-based and autologous BR and use health economic modelling to compare the long-term cost-effectiveness of different reconstructive techniques.

METHODS AND ANALYSIS: Women undergoing mastectomy and/or BR following a diagnosis of breast cancer between 1 January 2008 and 31 March 2009 will be identified from hospital episode statistics (HES). Surviving women will be contacted and invited to complete validated PRO measures including the BREAST-Q, EQ-5D-5L and ICECAP-A, or opt out of having their data included in the HES analysis. Long-term clinical outcomes will be explored using HES data. The primary outcome will be rates of revisional surgery between implant-based and autologous procedures. Secondary outcomes will include rates of secondary reconstruction and reconstruction failure. The long-term PROs of implant-based and autologous reconstruction will be compared using BREAST-Q, EQ-5D-5L and ICECAP-A scores. Multivariable regression will be used to examine the relationship between long-term outcomes, patient comorbidities, sociodemographic and treatment factors. A Markov model will be developed using HES and PRO data and published literature to compare the relative long-term cost-effectiveness of implant-based and autologous BR.

ETHICS AND DISSEMINATION: The Brighter study has been approved by the South-West -Central Bristol Research Ethics Committee (20/SW/0020), and the Confidentiality Advisory Group (20/CAG/0021). Results will be published in peer-reviewed journals and presented at national meetings. We will work with the professional associations, charities and patient groups to disseminate the results.

PMID:34408062 | DOI:10.1136/bmjopen-2021-054055

Reg Anesth Pain Med. 2021 Aug 18:rapm-2021-102583. doi: 10.1136/rapm-2021-102583. Online ahead of print.

ABSTRACT

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.

METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.

RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.

CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.

TRIAL REGISTRATION NUMBER: RoPR ID 43191.

PMID:34408068 | DOI:10.1136/rapm-2021-102583

BMJ Open. 2021 Aug 18;11(8):e052212. doi: 10.1136/bmjopen-2021-052212.

ABSTRACT

INTRODUCTION: Tuberculosis (TB) continues to be a significant health burden, most commonly affecting the lungs and referred to as pulmonary TB (PTB). Diagnostic techniques of PTB primarily rely on expectorated sputum samples. However, the diagnostic yields are often hindered due to insufficient volume and quality of the sputum specimens. Moreover, some individuals are unable to provide sputum samples due to scanty sputum production or difficulty in coughing up and require an invasive procedure to obtain a respiratory sample, such as bronchoscopic or gastric aspiration. Thus, challenges in the acquisition of respiratory specimens warrant an alternate specimen. Therefore, this systematic review aims to evaluate the diagnostic accuracy of a stool specimen for the diagnosis of PTB in adults.

METHODS AND ANALYSIS: We will search MEDLINE (Ovid), Embase (Ovid), Web of Science and Cochrane database from inception to April 2021 using a comprehensive search strategy. Two reviewers will independently perform screening, data extraction and quality assessment. The risk of bias assessment and applicability of results of eligible studies will be performed using the Quality of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects models will be performed to calculate pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio and diagnostic odds ratio along with 95% CI of stool specimen for each reported diagnostic method against any of the reference standard test (ie, mycobacterial culture or smear microscopy or Xpert assay using respiratory specimens). Heterogeneity between studies will be assessed by I² statistics and Q statistic of the χ² test.

ETHICS AND DISSEMINATION: The results will be disseminated through publishing in a peer-reviewed medical journal and public presentations in relevant national and international conferences. As this is a systematic review of publicly available data, ethics approval is not required.

PROSPERO REGISTRATION NUMBER: CRD42021245203.

PMID:34408058 | DOI:10.1136/bmjopen-2021-052212

BMJ Open. 2021 Aug 18;11(8):e048451. doi: 10.1136/bmjopen-2020-048451.

ABSTRACT

INTRODUCTION: The thyroid cancer incidence has been increasing all over the world. However, the aetiology of thyroid cancer remains unclear. A growing body of evidence suggested exposure to persistent organic pollutants (POPs) may play a role in the initiation of thyroid cancer, but the results are generally inconsistent across studies. This review aims to synthesise the evidence for the health effects of POPs on the risk of thyroid cancer.

METHODS AND ANALYSIS: This protocol was reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) statements. A comprehensive search, including electronic database search (eg, PubMed, Embase, ProQuest and CNKI), website search and manual search, will be performed to identify all eligible studies. The Population, Exposure, Comparator and Outcome framework was used to clarify the inclusion and exclusion criteria. The Newcastle-Ottawa Scale will be used to assess the quality of included studies. Maximally adjusted effect estimates from individual studies will be summarised with random-effect models in a conservative manner. I ² statistics and Q-tests will be used to test the heterogeneity across studies. We will perform extensive sensitivity analyses, such as confounding risk ratio (confounding), E-value, fixed-effect models, excluding the most relatively weighted study, including only the high-quality studies and many predesigned subgroup analyses, etc. The findings will be reported in accordance to the PRISMA guidelines.

ETHICS AND DISSEMINATION: Ethical approval is not required in this systematic review of published literatures. The results will be published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER: CRD42020181343.

PMID:34408050 | DOI:10.1136/bmjopen-2020-048451

BMJ Open. 2021 Aug 18;11(8):e049228. doi: 10.1136/bmjopen-2021-049228.

ABSTRACT

OBJECTIVES: To explore the impact of data-sharing initiatives on the intent to share data, on actual data sharing, on the use of shared data and on research output and impact of shared data.

ELIGIBILITY CRITERIA: All studies investigating data-sharing practices for individual participant data (IPD) from clinical trials.

SOURCES OF EVIDENCE: We searched the Medline database, the Cochrane Library, the Science Citation Index Expanded and the Social Sciences Citation Index via Web of Science, and preprints and proceedings of the International Congress on Peer Review and Scientific Publication. In addition, we inspected major clinical trial data-sharing platforms, contacted major journals/publishers, editorial groups and some funders.

CHARTING METHODS: Two reviewers independently extracted information on methods and results from resources identified using a standardised questionnaire. A map of the extracted data was constructed and accompanied by a narrative summary for each outcome domain.

RESULTS: 93 studies identified in the literature search (published between 2001 and 2020, median: 2018) and 5 from additional information sources were included in the scoping review. Most studies were descriptive and focused on early phases of the data-sharing process. While the willingness to share IPD from clinical trials is extremely high, actual data-sharing rates are suboptimal. A survey of journal data suggests poor to moderate enforcement of the policies by publishers. Metrics provided by platforms suggest that a large majority of data remains unrequested. When requested, the purpose of the reuse is more often secondary analyses and meta-analyses, rarely re-analyses. Finally, studies focused on the real impact of data-sharing were rare and used surrogates such as citation metrics.

CONCLUSIONS: There is currently a gap in the evidence base for the impact of IPD sharing, which entails uncertainties in the implementation of current data-sharing policies. High level evidence is needed to assess whether the value of medical research increases with data-sharing practices.

PMID:34408052 | DOI:10.1136/bmjopen-2021-049228

BMJ. 2021 Aug 18;374:n1868. doi: 10.1136/bmj.n1868.

ABSTRACT

OBJECTIVE: To determine associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents, nursing home staff, and healthcare workers.

DESIGN: Prospective cohort study.

SETTING: Nursing homes and linked electronic medical record, test, and mortality data in Catalonia on 27 December 2020.

PARTICIPANTS: 28 456 nursing home residents, 26 170 nursing home staff, and 61 791 healthcare workers.

MAIN OUTCOME MEASURES: Participants were followed until the earliest outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Mixed effects Cox models were fitted to estimate hazard ratios with index month as a fixed effect and adjusted for confounders including sociodemographics, comorbidity, and previous medicine use.

RESULTS: Among the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period. In parallel, 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection, but fewer than five were admitted or died with covid-19. The adjusted hazard ratio for SARS-CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) for nursing home staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two doses of vaccine were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04), respectively, for nursing home residents. Nursing home staff and healthcare workers recorded insufficient events for mortality analysis.

CONCLUSIONS: Vaccination was associated with 80-91% reduction in SARS-CoV-2 infection in all three cohorts and greater reductions in hospital admissions and mortality among nursing home residents for up to five months. More data are needed on longer term effects of covid-19 vaccines.

PMID:34407952 | DOI:10.1136/bmj.n1868