Tag: statistics

Cont Lens Anterior Eye. 2021 Aug 6:101498. doi: 10.1016/j.clae.2021.101498. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate comfort, visual function, and in vivo wettability after the insertion of hydrogel and silicone hydrogel contact lenses for a better understanding of how long practitioners should wait for the initial evaluation of soft contact lenses.

METHODS: A short-term prospective, contralateral, randomized, and participant-masked study was carried out. Twenty healthy participants (25.4 ± 2.6 years) were evaluated after the insertion of two different soft contact lenses at different times (1, 5, 10, 20, 30 min). Ocufilcon D (hydrogel) and Somofilcon A (silicone hydrogel) contact lenses were randomly assigned to both eyes of the same participant. Comfort, visual function under photopic conditions in terms of high-contrast visual acuity, low-contrast visual acuity, contrast sensitivity, and in vivo wettability were measured.

RESULTS: There was an increase in comfort (p < 0.001), high-contrast visual acuity (p < 0.05), and contrast sensitivity (p < 0.001, only with silicone hydrogel) directly related to time after contact lens insertion. Besides, in vivo wettability suffered a statistically significant deterioration directly related to time with both contact lenses (p < 0.05). Except for comfort and contrast sensitivity, all the parameters stabilized their values 10 min after the insertion of both soft contact lenses. Additionally, in vivo wettability and visual acuity differences were found between hydrogel and silicone hydrogel contact lenses (p < 0.05).

CONCLUSIONS: It would be possible to properly evaluate high-contrast visual acuity, low-contrast visual acuity, and in vivo wettability 10 min after the insertion of both soft contact lenses.

PMID:34373201 | DOI:10.1016/j.clae.2021.101498

Ann Emerg Med. 2021 Aug 3:S0196-0644(21)00512-6. doi: 10.1016/j.annemergmed.2021.06.012. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Heuristics, or rules of thumb, are hypothesized to influence the care physicians deliver. One such heuristic is the availability heuristic, under which assessments of an event’s likelihood are affected by how easily the event comes to mind. We examined whether the availability heuristic influences physician testing in a common, high-risk clinical scenario: assessing patients with shortness of breath for the risk of pulmonary embolism.

METHODS: We performed an event study from 2011 to 2018 of emergency physicians caring for patients presenting with shortness of breath to 104 Veterans Affairs (VA) hospitals. Our measures were physician rates of pulmonary embolism testing (D-dimer and/or computed tomography scan) for subsequent patients after having a patient visit with a pulmonary embolism discharge diagnosis, hypothesizing that physician rates of pulmonary embolism testing would increase after having a recent patient visit with a pulmonary embolism diagnosis due to the availability heuristic.

RESULTS: The sample included 7,370 emergency physicians who had 416,720 patient visits for shortness of breath. The mean rate of pulmonary embolism testing was 9.0%. For physicians who had a recent patient visit with a pulmonary embolism diagnosis, their rate of pulmonary embolism testing for subsequent patients increased by 1.4 percentage points (95% confidence interval 0.42 to 2.34) in the 10 days after, which is approximately 15% relative to the mean rate of pulmonary embolism testing. We failed to find statistically significant changes in rates of pulmonary embolism testing in the subsequent 50 days following these first 10 days.

CONCLUSION: After having a recent patient visit with a pulmonary embolism diagnosis, physicians increase their rates of pulmonary embolism testing for subsequent patients, but this increase does not persist. These results provide large-scale evidence that the availability heuristic may play a role in complex testing decisions.

PMID:34373141 | DOI:10.1016/j.annemergmed.2021.06.012

Am J Orthod Dentofacial Orthop. 2021 Aug 6:S0889-5406(21)00448-0. doi: 10.1016/j.ajodo.2021.03.014. Online ahead of print.

ABSTRACT

INTRODUCTION: This cross-sectional study sought to assess clinical features and 3-dimensional distribution of unilateral impacted maxillary central incisors and identify factors associated with the root morphology.

METHODS: Cone-beam computed tomography (CBCT) images from 94 subjects exhibiting unilateral impacted maxillary incisors were selected and evaluated. Original CBCT data were reconstructed using Mimics software (version 17.0; Materialise, Belgium). Clinical features and 3-dimensional distribution of impacted maxillary central incisors and factors associated with the root morphology were observed and analyzed by 2 orthodontists.

RESULTS: This patient cohort included 52 male patients and 42 female patients. Thirty-three incisors (35.11%) with dilacerated roots, 17 incisors (18.09%) with retained deciduous teeth, 15 incisors (15.96%) with supernumerary teeth, and 15 incisors (15.96%) with a history of trauma were identified in the study. Of the 94 impacted incisors, the most common were labially impacted (n = 65; 69.15%), followed by vertically impacted (n = 17; 18.09%) and palatally impacted (n = 12; 12.77%). Chi-square tests revealed that differences in subjects with supernumerary teeth, buccolingual position, sagittal position, and axial position in the upright and dilacerated root groups were statistically significant (P <0.05). Logistic regression analysis indicated that the incidence of dilacerations was higher in the inverted position than in the inclined position and horizontal position (P <0.05).

CONCLUSIONS: Labially impacted maxillary incisors were more common than vertically or palatally incisors. Dilaceration was most commonly observed in patients with inverted incisors. In clinical practice, CBCT is a valuable tool for diagnosing impacted maxillary central incisors and for making appropriate treatment plans for patients.

PMID:34373151 | DOI:10.1016/j.ajodo.2021.03.014

J Prosthet Dent. 2021 Aug 6:S0022-3913(21)00365-6. doi: 10.1016/j.prosdent.2021.06.047. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Studies that have analyzed the bond strength of resilient denture liners to milled denture bases are sparse, and the authors are unaware of research that has investigated the tensile bond strength of denture relining materials to 3D-printed denture bases.

PURPOSE: The purpose of this in vitro study was to evaluate the tensile bond strength of both hard and soft denture reline materials on denture bases fabricated by 3D printing and computer-aided design and computer-aided manufacture (CAD-CAM) milling technology.

MATERIAL AND METHODS: Injected, milled, and printed denture base specimens were fabricated (n=30) and bonded to 5 different denture reline materials: soft chairside reline (Coe Soft and PermaSoft), hard chairside reline (Tokuyama Rebase ii and Kooliner), and hard laboratory reline (ProBase Cold). Specimens of each reline material were divided into 5 groups (n=10) and were placed in distilled water for 24 hours before tensile testing. Maximum tensile stress values before failure were recorded, and the failure mode was also determined. The type of failure was analyzed by a scanning electron microscope. Statistics were analyzed with 2-way ANOVA and multiple comparison tests (α=.05).

RESULTS: Overall, no statistically significant difference in tensile bond strength was found in the injected, milled, and printed denture groups. However, the printed denture base group demonstrated significantly lower values of tensile bond strength (P<.05) with PermaSoft, Tokuyama Rebase ii, and ProBase Cold groups than other denture base groups (milled and injected). The milled denture bases had the highest mean value of tensile bond strength with 4 of the 5 denture relining materials tested (Coe Soft, PermaSoft, Tokuyama Rebase ii, and Kooliner). No statistically significant difference (P>.05) was found among the injected, milled, and printed denture bases when relined with Kooliner. When comparing the denture reline type, the lowest values were seen with the soft chairside relining materials, and highest values with the hard laboratory reline material. Among the modes of failure, adhesive failures were observed predominantly with the printed denture base materials relined with soft chairside relining materials, while cohesive and mixed modes of failure were found in the milled and injected denture base groups.

CONCLUSIONS: The printed denture bases had significantly lower tensile bond strength values than the injection and milled denture bases with the PermaSoft, Tokuyama Rebase ii, and ProBase Cold denture relines, while milled denture bases demonstrated the highest values of tensile bond strength for all chairside relining groups. In addition, the soft chairside relining materials showed the lowest tensile bond strength values regardless of the denture processing method with respect to the denture base type (injected, printed, and milled) compared with the hard relining materials.

PMID:34373111 | DOI:10.1016/j.prosdent.2021.06.047

Eur Urol. 2021 Aug 6:S0302-2838(21)01917-5. doi: 10.1016/j.eururo.2021.07.014. Online ahead of print.

ABSTRACT

BACKGROUND: Most available prognostic nomograms in metastatic castration-resistant prostate cancer (mCRPC) are derived from datasets not representative of the current treatment landscape. A prognostic nomogram for first-line mCRPC treatment was developed from patients treated in the PREVAIL study.

OBJECTIVE: To validate the Armstrong model in the COU-AA-302 trial.

DESIGN, SETTING, AND PARTICIPANTS: A post hoc analysis of mCRPC patients treated in the COU-AA-302 trial was carried out (NCT00887198).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The Armstrong prognostic model was applied to patients treated in COU-AA-302. A continuous risk score was derived from coefficients from the original model. Time-dependent area under the curve (tAUC) was used to evaluate the overall predictive ability of the model. Patients were categorized according to the number of risk factors present into those at a low (three or fewer risk factors), intermediate (four to six risk factors), and high (seven to ten risk factors) risk. The association with survival was assessed with Cox regression models. Interaction tests were used to assess the impact of treatment arm in each of the prognostic groups.

RESULTS AND LIMITATIONS: A total of 1088 patients were analyzed. The risk score was associated with overall survival (OS; tAUC 0.733). Most patients were at a low (49%) or intermediate (41%) risk. Risk category was significantly associated with OS (hazard ratio [HR]: 2.3; 95% confidence interval [CI]: 1.9-2.4; p < 0.001), radiographic progression-free survival (rPFS; HR: 1.7; 95% CI: 1.5-1.8; p < 0.001), and prostate-specific antigen progression-free survival (HR: 1.7; 95% CI: 1.5-1.9; p < 0.001). A significant interaction between risk group and OS (p = 0.007) and rPFS (p = 0.009) was observed. Survival was superior in low-risk patients (HR: 0.73; 95% CI: 0.59-0.89; p = 0.009), but similar in intermediate-risk (HR: 0.97; 95% CI: 0.79-1.21; p = 0.9) and high-risk (HR: 1.35; 95% CI: 0.80-2.28; p = 0.5) patients. Two-year OS rates in abiraterone versus placebo were 82% versus 74% in low-risk, 55% versus 52% in intermediate-risk, and 28% versus 31% in high-risk patients.

CONCLUSIONS: We validate the prognostic value of the Armstrong risk model in patients treated with first-line androgen receptor signaling inhibitors. Abiraterone provided a greater benefit in low-risk patients with less aggressive disease. Further research is needed to establish the role of Armstrong risk groups for treatment selection in mCRPC patients.

PATIENT SUMMARY: In this report, we validated the Armstrong nomogram in the COU-AA-302 trial population. We found a similar prognostic performance to that of the original model. Good-risk patients received the greatest benefit from abiraterone.

PMID:34373138 | DOI:10.1016/j.eururo.2021.07.014

Am J Cardiol. 2021 Aug 6:S0002-9149(21)00683-4. doi: 10.1016/j.amjcard.2021.07.024. Online ahead of print.

ABSTRACT

Gastrointestinal bleed (GIB) is an important complication in patients with hypertrophic cardiomyopathy (HC) although its prevalence, predictors and outcomes are unknown. The national inpatient sample 2011 to 2018 was analyzed to find hospitalizations with the diagnosis of HC. HC patients were divided into 2 groups: with and without GIB. Baseline characteristics between the 2 groups were compared (Table 2). Variables with p value of 0.2 or less from univariate logistic regression were included in the multivariate logistic regression to find an independent predictor of GIB in HC patients. Stata IC was used for all statistical analysis. Our study reported 242,172 HC hospitalizations between 2011 and 2018, out of which 13,231 (5.4%) also has a concurrent diagnosis of GIB. The GIB group was older (mean age ± SD: 70 ± 28 vs 65 ± 10, p <0.001), more likely to be female (62.5 vs 57%, p <0.001) and had higher burden of comorbidities . HC patients with GIB had higher in-hospital mortality rate (5.3 vs 3.1%, p <0.001), mean length of stay (7.8 vs 5.6 days, p <0.001) and mean total hospital cost ($100,294 vs 77,966, p <0.001). Age group >75, female, chronic kidney disease (CKD 3/4), end-stage renal disease, cirrhosis, coagulopathy and malnutrition were an independent predictor of GIB in HC patients. In conclusion, the prevalence of GIB during HC hospitalizations is increasing. Older, white, females with higher burden of comorbidities are at an increased risk of GIB in HC patients. Sex-based disparities in the prevalence of GIB in HC patients is an area of further research.

PMID:34373078 | DOI:10.1016/j.amjcard.2021.07.024

Health Policy. 2021 Jul 31:S0168-8510(21)00196-2. doi: 10.1016/j.healthpol.2021.07.011. Online ahead of print.

ABSTRACT

On 4 November 2020 the Italian government introduced a new policy to address the second wave of COVID-19. Based on a battery of indicators, the 21 administrative regions of Italy were assigned a risk level among yellow, orange, red, and, starting on 6 November 2020, different type of restrictions were applied accordingly. This event represents a natural experiment that allows the evaluation of the effects of non-pharmaceutical interventions, free from those nuisance factors affecting cross-national studies. In this work, we extract the daily growth rate of new cases, hospitalizations and patients in ICU from official data using an unobserved components model and assess how the different restrictions had different impacts in reducing the speed of spread of the virus. We find that all the three packages of restrictions have an effect on the speed of spread of the disease, but while the mildest (yellow) policy leads to a constant number of hospitalizations (zero growth rate), the strictest (red) policy is able to halve the number of accesses to regular wards and intensive care units in about one month. The effects of the intermediate (orange) policy are more volatile and seem to be only slightly more effective than the milder (yellow) policy.

PMID:34373109 | DOI:10.1016/j.healthpol.2021.07.011

J Clin Neurosci. 2021 Sep;91:93-98. doi: 10.1016/j.jocn.2021.06.011. Epub 2021 Jul 3.

ABSTRACT

The purpose of this study was to assess the change of dynamic alignment after the short and intensive rehabilitation (SHAiR) program in patients with dropped head syndrome (DHS). Eighteen patients with DHS patients who complained of their inability to maintain horizontal gaze and underwent the SHAiR program. Patients performed level walking at a self-selected speed. Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. Statistical analysis was performed to compare these data before and after the SHAiR program. Those who underwent the SHAiR program showed a significant increase in the head angle and stride length compared to pre-treatment measurements (p < 0.05). The SHAiR program modifies the malalignment of the head and neck and spatiotemporal parameters in DHS patients during level walking.

PMID:34373067 | DOI:10.1016/j.jocn.2021.06.011

Med Clin (Barc). 2021 Aug 6:S0025-7753(21)00393-6. doi: 10.1016/j.medcli.2021.04.032. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient’s knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients.

METHODS: Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension.

RESULTS: 980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). CONCLUSIóN: A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.

PMID:34373072 | DOI:10.1016/j.medcli.2021.04.032

J Clin Neurosci. 2021 Sep;91:391-395. doi: 10.1016/j.jocn.2021.04.006. Epub 2021 Aug 2.

ABSTRACT

BACKGROUND: Large supratentorial intraparenchymal hemorrhages are managed emergently with image-guided catheters that aim to minimize injury to surrounding parenchyma. Robotic assistance may offer advantages for stereotactic guidance and placement of such catheters. We describe our center’s experience with minimally invasive ROSA-assisted intraventricular and intraparenchymal hemorrhage catheter placement and delineate its safety and outcomes.

METHODS: A retrospective analysis was performed including all patients with intraparenchymal hematoma that underwent ROSA-assisted intraparenchymal and intraventricular catheter placement at the University of Pittsburgh Medical Center between 2017 and 2019. All patients received tissue plasminogen activator (tPA) through the intraparenchymal catheter. We performed a manual chart review of these patients. Pertinent clinical and radiological characteristics and patient outcomes were recorded and analyzed. Catheter trajectory was independently quantified and analyzed by two independent reviewers. Error between the planned trajectory and final position was calculated and analyzed.

RESULTS: Four patients (2 males and 2 females, mean age of 64 years) with deep brain large volume intraparenchymal hemorrhages were treated with catheter evacuation with robotic assistance. For 2 of the 4 patients, thin-cut CT imaging allowed for the real trajectory of the catheter to be compared to the targeted trajectory to calculate error. The mean error of catheter placement was 3.48 mm. ROSA-assisted catheter placement achieved up to 95% reduction of intraparenchymal hematoma volume with a statistically significant decrease following catheter drainage (pre- 51.8 ± 19.1 cc vs. post- 13.0 ± 14.4; p < 0.01).

CONCLUSION: Robotic stereotactic assistance offers a safe and sufficiently accurate technique for intraparenchymal hematoma and intraventricular catheter placement.

PMID:34373057 | DOI:10.1016/j.jocn.2021.04.006