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Journal of General Internal Medicine May 2024Novel statistical methods have emerged in recent medical literature, which clinicians must understand to properly appraise and integrate evidence into their practice.... (Review)
Review
Novel statistical methods have emerged in recent medical literature, which clinicians must understand to properly appraise and integrate evidence into their practice. Some of these key concepts include win ratios, restricted mean survival time, responder analyses, and standardized mean difference. This article offers guidance to busy clinicians on the comprehension and practical applicability of the results to patients. Win ratios provide an alternative method to analyze composite outcomes by prioritizing individual components of the composite; prioritization of the outcomes should be evidence-based, pre-specified, and patient-centered. Restricted mean survival time presents a method to analyze Kaplan-Meier curves when assumptions required for Cox proportional hazards analysis are not met. As it only considers outcomes that occur within a specific timeframe, the duration of follow-up must be appropriately defined and based on prior epidemiologic and mechanistic evidence. Researchers can analyze continuous outcomes with responder analyses, in which participants are dichotomized into "responders" or "non-responders." While clinicians and patients may more easily grasp outcomes analyzed in this way, they should be aware of the loss of information and resulting imprecision, as well as potential to manipulate data presentation. When meta-analyzing continuous outcomes, point estimates can be converted to standardized mean differences to facilitate the combination of data utilizing various outcome measures. However, clinicians may find it challenging to grasp the clinical meaningfulness of a standardized mean difference, and may benefit from converting it to well-known outcomes. By providing the background knowledge of these statistical methods, along with practical applicability, benefits, and inevitable limitations, this article aims to provide clinicians with an approach to appraise the literature and apply the results in clinical practice.
Topics: Humans; Data Interpretation, Statistical; Outcome Assessment, Health Care
PubMed: 38172409
DOI: 10.1007/s11606-023-08582-w -
Journal of Interprofessional Care Sep 2023Health professionals are actively contributing to interprofessional collaboration, yet implementation and assessment of interprofessional education (IPE) within Family...
Implementation and impact of an interprofessional education curriculum on medical, pharmacy, and social work students' attitudes, perceptions, and self-assessed teamwork skills.
Health professionals are actively contributing to interprofessional collaboration, yet implementation and assessment of interprofessional education (IPE) within Family Medicine is not well documented. From October 2014 to December 2018, social work, pharmacy, and medical students worked as an IP team involving inpatient, outpatient, and home visit experiences. Students completed two validated surveys pre- and post- their interprofessional education rotation: the Interdisciplinary Education Perception Scale (IEPS) and the Teams Skills Scale (TSS). Paired t-test analyses were conducted on individual pre- and post-survey scores. Twenty-seven (77%) of the 35 participating students completed pre- and post-surveys. Significant differences were found in mean change in pre-IEPS mean scores (4.95) and post-IEPS mean scores (5.29), with a mean difference in matched pairs of 0.31 ( < .001, = 27). A significant difference was found in student pre-TSS mean scores (3.52) and post-TSS mean scores (4.31), with a mean difference in matched pairs of 0.79 ( < .0001, = 27). Our findings demonstrate that the IPE curriculum had a positive impact on students' attitudes and self-assessed teamwork skills, with greater learning outcomes identified amongst pharmacy and social work students than medical students. Implementing IP curriculum into Family Medicine experiences is both feasible and worthy of further investigation.
Topics: Humans; Interprofessional Relations; Interprofessional Education; Curriculum; Pharmacy; Students, Medical; Students, Pharmacy; Attitude of Health Personnel; Social Work; Education, Pharmacy
PubMed: 36747337
DOI: 10.1080/13561820.2023.2169260 -
Cornea Oct 2023The aim of this study was to evaluate a new femtosecond laser application for refractive corneal lenticule extraction with suction control and computerized regulation of...
PURPOSE
The aim of this study was to evaluate a new femtosecond laser application for refractive corneal lenticule extraction with suction control and computerized regulation of centration and alignment (Ziemer CLEAR).
METHODS
This was a retrospective, consecutive, noncomparative case series study. Patients undergoing CLEAR for spherical equivalent (SE) between -3 and -10 D, evaluating SE, defocus equivalent, refractive astigmatism, visual acuity, and centration at 10 months were evaluated in the study.
RESULTS
Fifty-three eyes of 42 patients (mean age 40.4 ± 8.6 years) were included, with preoperative SE -5.99 ± 1.49 D and mean corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR. With no suction losses, an intact lenticule was extracted in all eyes. In 6 eyes, peripheral adhesion was resolved by lenticulerrhexis, and in 1 eye, the incision was opened by a crescent blade. Moderate interface inflammation occurred in 3 eyes. At day 1, in the 42 eyes with uneventful surgery, the mean CDVA was 20/27, whereas in the 11 eyes with extra surgical manipulations, it was 20/36 ( P = 0.04). At 10 months, for the 53 eyes, the mean uncorrected distance visual acuity was 0.05 ± 0.09 logMAR; in 37 eyes (70%), it was 20/25 or better; and the mean CDVA was 0.04 ± 0.06 logMAR. Eight eyes (15%) lost 1 logMAR line. The mean SE was -0.13 ± 0.15 D. The mean defocus equivalent was 0.33 ± 0.32 D, with 46 eyes (87%) ≤0.50 D and 52 eyes (98%) ≤1 D. Refractive astigmatism was ≤0.50 D in 48 eyes (90%). The efficacy index was 1.00, and the safety index was 0.98. The mean decentration from the corneal vertex was 0.28 ± 0.07 mm.
CONCLUSIONS
The application yielded good predictability, efficacy, and safety. Slower visual recovery was observed after extra surgical manipulations.
Topics: Humans; Adult; Middle Aged; Astigmatism; Retrospective Studies; Myopia; Treatment Outcome; Lasers, Excimer; Refraction, Ocular; Corneal Stroma; Corneal Surgery, Laser
PubMed: 36156507
DOI: 10.1097/ICO.0000000000003123 -
Endocrine Oct 2023Subclinical hyperthyroidism (SCH) is found to be associated with renal dysfunction. Hyperthyroidism is a well-known cause of secondary systolic hypertension. However,...
BACKGROUND
Subclinical hyperthyroidism (SCH) is found to be associated with renal dysfunction. Hyperthyroidism is a well-known cause of secondary systolic hypertension. However, the effect of SCH on the kidney and its vasculature is still unknown.
AIM
To assess the presence of renal function changes and renal vasodysfunction in SCH patients and their relation to hypertension.
METHODS
The study included 321 patients with SCH and 80 healthy matched controls. Laboratory investigations included thyroid function tests, anti-TSH receptor antibody (TRAb), creatinine, estimated glomerular filtration rate (eGFR), serum osmolarity (S. Osmol), urine osmolarity (U. Osmol), Fractional Excretion of Sodium (FeNa), Fractional Excretion of Potassium (FeK), copeptin (CPP), and aldosterone/renin ratio (ARR). Ultrasound for the thyroid gland, echocardiography, total peripheral resistance (TPR), flow-mediated dilatation (FMD), and Renal Arterial distensibility (RAD) was also done.
RESULTS
Serum creatinine was significantly lower while eGFR was significantly higher in SCH patients compared to euthyroid subjects (mean 0.59 ± 0.11 mg/dl Vs mean 0.8 ± 0.1 mg/dl, p = 0.001 and mean 128.28 ± 14.69 ml/min/1.73m2 Vs mean 100.49 ± 14.9 ml/min/1.73m2, p = 0.013, respectively). The TPR and FMD showed a significant decrease in SCH group compared to controls (mean 975.85 ± 159.33 mmHg.min/L Vs mean 1120.24 ± 135.15 mmHg.min/L, p = 0.045 and mean 7.03 ± 4.02% Vs mean 13.48 ± 4.57%, p = 0.003, respectively). RAD was significantly higher in hypertensive SCH patients compared to normotensive SCH patients (mean 17.82 ± 2.46 mmHg Vs mean 11.98 ± 3.21 mmHg, p = 0.001).
CONCLUSION
SCH patients showed vascular resistance reduction. Alterations in thyroid hormones and blood pressure could be the driving mechanisms for the change in renal functions in patients with SCH.
Topics: Humans; Hyperthyroidism; Thyroid Hormones; Kidney; Thyroid Function Tests; Hypertension
PubMed: 37490265
DOI: 10.1007/s12020-023-03361-3 -
Military Medicine Nov 2023Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood...
INTRODUCTION
Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood adversity (CA) within the veteran, adult, and pediatric populations. Given the need to maximize soldier resiliency, an examination of the link between CA and chronic pain in an active duty population for a better understanding that informs treatment options is warranted.
MATERIALS AND METHODS
The analytic sample comprised 32 men and 8 women drawn from a retrospective review of 203 intake assessments at an interdisciplinary pain management center. We identified a group (CA) of 20 patients who reported a history of pre-adolescent sexual abuse or living in an "abusive" childhood home and compared it with a control group (no-CA) of 20 patients, matched for age, gender, pain history duration, and pain problem. Validated measures were used to assess pain intensity, interference in functioning and well-being, emotional sequelae of pain as reflected in symptoms of depression and anxiety, and pain-related catastrophic thinking. Data were analyzed using descriptive statistics and independent samples t-test analyses.
RESULTS
Differences in current, worst, and average pain ratings were non-significant between groups. The CA group reported significantly greater effect of pain on mood (mean: 6.20 versus 4.25, P < .02) and showed a trend toward higher pain interference in functioning (mean: 17.70 versus 15.05, P = .053). The CA patients had significantly more serious depression (mean: 12.65 versus 4.50, P < .001) and anxiety symptoms (mean: 10.60 versus 2.35, P < .001) and significantly higher pain catastrophizing tendency (mean: 30.05 versus 20.50, P < .03).
CONCLUSIONS
Overall, the findings suggest that childhood trauma should be considered by providers when treating depression and anxiety in soldiers with chronic pain. Being mindful of trauma-informed care may have implications, perhaps, for cases perceived as treatment resistant.
Topics: Adult; Male; Child; Adolescent; Humans; Female; Chronic Pain; Military Personnel; Adverse Childhood Experiences; Emotions; Anxiety
PubMed: 37948239
DOI: 10.1093/milmed/usad244 -
Equine Veterinary Journal Sep 2023Acute phase protein (APP) measurement is used to detect inflammation. Intramuscular (IM) injections could cause tissue injury and induce an acute phase response (APR).
BACKGROUND
Acute phase protein (APP) measurement is used to detect inflammation. Intramuscular (IM) injections could cause tissue injury and induce an acute phase response (APR).
OBJECTIVES
To evaluate the effects of IM procaine penicillin G (PPG) injections on APP concentrations in horses.
STUDY DESIGN
Prospective longitudinal design.
METHODS
PPG was administered intramuscularly to six horses, twice daily, for 5 days. Plasma fibrinogen (FIB), serum amyloid A (SAA), haptoglobin (HAP), creatine kinase (CK), and aspartate aminotransferase (AST) were quantified daily for 5 days before the first injection, during the course of administration, and for 4 days after the final dose. Analytes were quantified every other day for the remaining 16 days. Data were compared using a parametric or non-parametric repeated measures ANOVA and a Tukey's or Mann-Whitney rank sum test, respectively. Significance was set at p < 0.05.
RESULTS
CK was increased over baseline (mean ± SD: 200 ± 74 IU/L) on Days 1-6 (p < 0.001 to p = 0.02, mean ± SD: 723-1177 ± 355-544 IU/L) and AST was increased above baseline (mean ± SD: 233 ± 58 IU/L) on Days 2-7 and 10 (p < 0.001 to p = 0.05, mean ± SD: 307-437 ± 79-146 IU/L). Increased FIB was noted over baseline (mean ± SD: 177 ± 30 mg/dl) on Days 6-8 and 10 (p = 0.02 to p = 0.03, mean ± SD: 234-252 ± 33-49 mg/dl). SAA was increased above baseline (mean ± SD: 4.7 ± 2.9) on Day 6 (p = 0.02, mean ± SD: 113 ± 186 μg/ml). There was no change in HAP.
MAIN LIMITATIONS
Healthy horses were used, small sample size, and a lack of a negative control group.
CONCLUSIONS
Serial intramuscular procaine penicillin G (IM PPG) injections may result in increased positive APP concentrations in horses and this must be considered when these test results are interpreted.
Topics: Horses; Animals; Penicillin G Procaine; Acute-Phase Proteins; Prospective Studies; Injections, Intramuscular; Serum Amyloid A Protein
PubMed: 36200352
DOI: 10.1111/evj.13886 -
Frontiers in Psychology 2023Oblique Target-rotation in the context of exploratory factor analysis is a relevant method for the investigation of the oblique simple structure. It was argued that...
INTRODUCTION
Oblique Target-rotation in the context of exploratory factor analysis is a relevant method for the investigation of the oblique simple structure. It was argued that minimizing single cross-loadings by means of target rotation may lead to large effects of sampling error on the target rotated factor solutions.
METHOD
In order to minimize effects of sampling error on results of Target-rotation we propose to compute the mean cross-loadings for each block of salient loadings of the independent clusters model and to perform Target-rotation for the block-wise mean cross-loadings. The resulting transformation-matrix is than applied to the complete unrotated loading matrix in order to produce mean Target-rotated factors.
RESULTS
A simulation study based on correlated independent clusters model and zero-mean cross-loading models revealed that mean oblique Target-rotation resulted in smaller bias of factor inter-correlations than conventional Target-rotation based on single loadings, especially when sample size was small and when the number of factors was large. An empirical example revealed that the similarity of Target-rotated factors computed for small subsamples with Target-rotated factors of the total sample was more pronounced for mean Target-rotation than for conventional Target-rotation.
DISCUSSION
Mean Target-rotation can be recommended in the context of oblique factor models based on simple structure, especially for small samples. An R-script and an SPSS-script for this form of Target-rotation are provided in the Supplementary Material.
PubMed: 38090166
DOI: 10.3389/fpsyg.2023.1285212 -
Naunyn-Schmiedeberg's Archives of... Sep 2023Treatment with mirtazapine, a widely prescribed antidepressant, has been linked to weight gain and dyslipidemia. Whether dyslipidemia occurs secondary to increased...
Treatment with mirtazapine, a widely prescribed antidepressant, has been linked to weight gain and dyslipidemia. Whether dyslipidemia occurs secondary to increased appetite due to antidepressant treatment, or due to direct pharmacological effects of mirtazapine is unknown. The aim of this analysis is to complement our previously published results of the effect of mirtazapine on metabolism and energy substrate partitioning from a proof-of-concept, open-label clinical study (ClinicalTrials.gov NCT00878540) in 12 healthy males (20-25 years). We report the effect of a seven-day administration of mirtazapine 30 mg per day on weight and lipid metabolism in healthy men under highly standardized conditions with respect to diet, physical activity and day-night-rhythm and under continuous clinical observation. After a 7-day administration of mirtazapine 30 mg, we observed a statistically significant increase in triglyceride levels (mean change + 4.4 mg/dl; 95% CI [- 11.4; 2.6]; p = 0.044) as well as TG/HDL-C ratio (mean change + 0.2; 95% CI [- 0.4; 0.1]; p = 0.019) and a decrease in HDL-cholesterol (mean change - 4.3 mg/dl; 95% CI [2.1; 6.5]; p = 0.004), LDL-cholesterol (mean change - 8.7 mg/dl; 95% CI [3.8; 13.5]; p = 0.008), total cholesterol (mean change - 12.3 mg/dl; 95% CI [5.4; 19.1]; p = 0.005), and non-HDL-C (mean change - 8.0 mg/dl; 95% CI [1.9; 14.0]; p = 0.023). Notably, weight (mean change - 0.6 kg; 95% CI [0.4; 0.8]; p = 0.002) and BMI (mean change - 0.2; 95% CI [0.1; 0.2]; p = 0.002) significantly decreased. No change in waist circumference (mean change - 0.4 cm; 95% CI [- 2.1; 2.9]; p = 0.838) or waist-to-hip-ratio (mean change 0.0; 95% CI [- 0.0; 0.0]; p = 0.814) was observed. This is the first study showing unfavorable changes in lipid metabolism under mirtazapine in healthy individuals despite highly standardized conditions including dietary restriction, and despite the observation of a decrease of weight. Our findings support the hypothesis that mirtazapine has direct pharmacological effects on lipid metabolism. ClinicalTrials.gov: NCT00878540.
Topics: Humans; Male; Antidepressive Agents; Cholesterol, HDL; Dyslipidemias; Fasting; Mirtazapine; Triglycerides; Weight Gain
PubMed: 36890393
DOI: 10.1007/s00210-023-02448-y -
Radiation Oncology (London, England) Aug 2023Children with brain tumors are at high risk of neurocognitive decline after radiotherapy (RT). However, there is a lack of studies on how RT doses to organs at risk...
BACKGROUND
Children with brain tumors are at high risk of neurocognitive decline after radiotherapy (RT). However, there is a lack of studies on how RT doses to organs at risk (OARs) impacts neurocognition. The aim of this study was to examine dose-risk relationships for mean RT dose to different brain structures important for neurocognitive networks. We explored previously established OARs and potentially new OARs.
METHODS
A sample of 44 pediatric brain tumor survivors who had received proton and/or photon RT were included. Correlations between mean RT doses to OARs and IQ were analyzed. Previously established OARs were cochleae, optic chiasm, optic nerve, pituitary gland, hypothalamus, hippocampus and pons. Potential new OARs for RT-induced neurocognitive decline were cerebellum, vermis and thalamus.
RESULTS
Mean RT dose to different OARs correlated with several IQ subtests. Higher mean RT dose to cochleae, optic nerve, cerebellum, vermis and pons was correlated with lower performance on particularly full-scale IQ (FIQ), Perceptual Reasoning (PRI), Working Memory (WMI) and Processing Speed Index (PSI). Higher mean RT dose to hippocampus correlated with lower performance on processing speed and working memory. For those receiving whole brain RT (WBRT), higher mean RT dose to the pituitary gland correlated with lower performance on working memory.
CONCLUSION
A high dose-risk correlation was found between IQ subtests and mean RT dose in established and potential new OARs. Thus, in the lack of validated dose constraints for vulnerable brain structures, a parsimonious approach in RT planning should be considered to preserve neurocognitive networks.
Topics: Child; Humans; Organs at Risk; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Brain; Brain Neoplasms; Radiotherapy, Intensity-Modulated
PubMed: 37568180
DOI: 10.1186/s13014-023-02324-2 -
L'Encephale Dec 2023Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients.
OBJECTIVE
Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients.
METHODS
A descriptive and analytical cross-sectional study was carried out at the psychiatry department of Hassan II University Hospital in Fez over 12 months to compare three groups of patients: "schizo-obsessive" (n=32), "schizophrenia" (n=34), and "OCD" (n=46). All participants (n=112) were assessed using the mini-international neuropsychiatric interview (MINI), the Yale-Brown obsessive-compulsive scale (Y-BOCS), the Brown assessment of beliefs scale (BABS), the Hamilton anxiety rating scale (HAM-A), the Beck's depression inventory (BDI-II), the positive and negative syndrome scale (PANSS), and the clinical global impressions-severity scale (CGI-S).
RESULTS
The "schizo-obsessive" group differed from the "schizophrenia" group in: more severe psychotic symptoms (mean=64.16±17.049, P<0.001), higher anxiety (mean=8.87±5,655, P<0.001) and depression (mean=7.50±5.989, P<0.001) scores, more prevalent suicide attempts (46.9%), higher illness severity score (mean=5.13±1.157, P=0.02), and more professional disinsertion (78.1%). The "schizo-obsessive" group (mean= 14.47±3.388) had significantly poor insight (P<0.001) compared to the "OCD" group (mean= 8.35±4.542). There were similarities in the obsessive and compulsive themes between the "schizo-obsessive" and the "OCD" groups, with no significant difference of severity (P=0.26).
CONCLUSION
A careful assessment of obsessive symptomatology is essential in schizophrenia for better patient management and prognosis.
Topics: Humans; Schizophrenia; Cross-Sectional Studies; Obsessive-Compulsive Disorder; Psychotic Disorders; Comorbidity
PubMed: 36244835
DOI: 10.1016/j.encep.2022.07.002