Yates Continuity Correction Research Articles

Quality of life and abdominal wall functionality after abdominal wall reconstruction: A prospective single center follow-up study

BackgroundFascial breakdown with the occurrence of an incisional hernia (IH) is an important and challenging complication of any laparotomy. For a long time, the success of the abdominal wall reconstruction (AWR) was measured only from the surgeon’s perspective by defining outcome measures such as wound morbidity and recurrence. The understanding that complete recovery is difficult to assess without considering patients has shifted the paradigm of optimal outcomes to Patient Reported Outcome Measures (PROMS) and Quality of Life (QoL), which are pivotal to evaluate the success and efficacy of AWR.MethodsWe conducted a prospective follow-up study of 91 patients undergoing mesh-augmented abdominal wall reconstruction for primary or recurrent incisional hernia between January 2021 and December 2023. Demographic data, comorbidities, and hernia characteristics were recorded. All patients were evaluated preoperatively by a native abdomino-pelvic CT scan to assess the characteristics of hernia (length, width, surface, and volume of the incisional hernia sac and of peritoneal cavity), the presence of mesh (if previously inserted), and abdominal wall muscles status. All intervention were performed by the same surgical team according to the techniques described by Rives – Stoppa (RS), Ramirez (ACS), and Novitsky (PCS). Abdominal wall function was assessed using trunk raising (TR) and double leg lowering (DLL) measurements performed preoperatively, 1 month, 6 months, and 1 year postoperatively. At the same time, pre- and post-operative quality of life was analysed using the EQ-5D score.ResultsMean age of 59.42 ± 12.28 years and a male/female ratio of 35/56 were recorded, most of them being obese. There were 36 (42%) patients with defects larger than 10 cm. The distribution of the type of surgical intervention was: RS 35 patients, ACS 13 patients, and PCS 43 patients. The mean value of combined score for the preoperative abdominal wall functionality was 4.41 ± 1.67 (2–8) while the mean value of preoperative EQ-5D index was 0.652 ± 0.026 (-0.32–1.00). QoL was poor and very poor for 48% (44) of the patients who recorded index values less than 0.56 (50% percentile). Preoperative EQ-5D index was highly correlated with Combined AWF score (r = 0.620; p < 0.0001) and the correlation was specific (AUC = 0.799; p < 0.0001; asymptotic 95%CI = 0.711–0.923). At 12 months, the AWF score increased to 8.13 ± 2.58 (1–10) and the QoL total score to 0.979 ± 0.007 (0.71–1). Good and very good total scores for QoL were recorded for 47 patients (84%) compared to 33 (36%) in the preoperative evaluation (χ2 with Yates continuity correction for two degrees of liberty = 46.04; p < 0.00001).ConclusionOur results suggest that patients can expect to see a significant overall improvement in all five components of QoL measured with the help of Eq. 5D questionnaire. This improvement is dependent by hernia size, and some individual patient’s factors (diabetes, cardiovascular diseases, and age over 60 years).

Does Urinary Catheter Replacement Prior To Obtaining Urine for Culture Make a Difference?

Background: Indwelling urinary catheters (UCs) generate biofilm that grows over time, raising concern that after several days any culture from a UC may generate a false positive result. Whether and when to replace a UC prior to culture is controversial, with prior studies recommending anywhere from 3 to 14 days as appropriate, but with no conclusive data. We evaluated urine culture results across a large healthcare system where, beginning in 2019, some facilities adopted the practice of changing UC before collection if indwelling for 3 days or more. Method: Analysis was from nursing electronic health record documentation of UC changes and urine cultures collected on patients with indwelling UC in 2022. UC changes were defined as a stop followed by a start within 12 hours. Patient exclusion criteria included a UC other than “temporary/indwelling” and surgical procedure during the admission. Statistics applied Pearson’s Chi-squared test with Yates continuity correction using R Core Team (2023) R: A Language and Environment for Statistical Computing. Result: Total UC episodes meeting criteria was 88,347 across 152 acute care hospitals. Episodes in days was 0-3 for 65%, 4-9 for 29% and &gt;9 for 6%. Most urine cultures were taken at 3 days (p UC Changed? Culture Negative Culture Positive No 4916 (98.8%) 61 (1.2%) Yes 588 (98.7%) 8 (1.3%) Cultures were positive at the same rate whether a UC change occurred or not at &gt;3 days (p=0.96). No difference was found in NHSN reported CAUTI prevalence among the UC change vs. no change in the &gt;3 day groups. Conclusion: Urine culture results do not appear to be impacted by UC change as early as 3 days. UC change without benefit may generate unnecessary costs and complications.

Poster 397: Orthopaedic Injury Analysis Among Male and Female High School and Collegiate Aged Soccer Players Presenting to United States Emergency Departments

Objectives: Soccer is the second most played sport in America by participation, with upwards of 12 million players nationally in 2018. A majority of those athletes are adolescents and young adults, with 71% of players falling between the ages of 6 and 24. This study aimed to determine if any injury profile differences exist in the intra- and post-COVID eras between male and female soccer players in both high school and college. Methods: Deidentified Emergency Department data for the years 2020-2022 were queried using the Consumer Product Safety Commission's National Electronic Injury Surveillance System (CPSC NEISS). The raw data was further stratified for a high school age range of 13-17 and a college age range of 18-24. Each of these age ranges were filtered for diagnosis codes 52, 55, 57, and 64 correlating with concussions, dislocations, fractures, and sprains/strains, respectively. The location filter was set to code 9 for a location of sports and recreation. Using the narrative filter, the resultant cases were limited to those that mentioned “soccer”. The identified patient data for each year was collated for total case counts. A Test of Equal Proportions with a Yates Continuity Correction was performed to compare the rate of individual and categorized injuries by sex within each age range and within the same sex between age groups. Results: There were 693, 1371, and 1524 injuries in 2020, 2021, and 2022 respectively, for a total of 3588 injuries. Using statistical weights, this translated to a national estimate of 88,576 soccer-related injuries over that timeframe. Categorically, in each of the three years, males had a higher proportion of fractures when compared to females in the 13-17 age range (p&lt;0.001), while the high school aged females sustained a significantly higher proportion of concussions and sprains/strains (p&lt;0.001). Per specific injury, males experienced a greater rate of clavicular, isolated radial, wrist, nonspecific forearm, finger, and nonspecific lower leg fractures than females aged 13-17 (p&lt;0.001, p&lt;0.027, p&lt;0.001, p&lt;0.001, p&lt;0.025, p&lt;0.029). Conversely, high school aged females were diagnosed with knee and ankle sprains/strains at a higher rate than their male counterparts (p&lt;0.012, p&lt;0.001). There were no significant injury profile differences between college aged male and female soccer athletes. When comparing high school versus college aged males, those in the 13-17 group experienced a larger rate of fractures and concussions, while those in the 18-24 group experienced a greater proportion of dislocations and sprains/strains (p&lt;0.001, p&lt;0.037, p&lt;0.004, p&lt;0.001). College aged males were diagnosed with higher rates of shoulder dislocations, skull fractures, finger fractures, knee sprains/strains, and ankle sprains/strains when compared to their younger counterparts (p&lt;0.001, p&lt;0.007, p&lt;0.001, p&lt;0.001, p&lt;0.05). On the other hand, high school aged male soccer players proportionally sustained more isolated radial, nonspecific forearm, wrist, and pelvic fractures (p&lt;0.001, p&lt;0.001, p&lt;0.002, p&lt;0.002). The only significant difference between high school and college aged females were higher rates of concussions in the 13-17 age group, whereas 18-24 year olds experienced a larger proportion of skull fractures (p&lt;0.01, p&lt;0.01). Conclusions: Since 2020, high school aged males experienced a significantly higher rate of fractures, whereas their female counterparts sustained a larger proportion of concussions and sprains/strains. Within males across all age ranges, higher rates of concussions and fractures were found in adolescents, whereas college males were more often diagnosed with dislocations and sprains/strains. Within females across all ages, high school soccer players experienced a larger proportion of concussions, while college players were diagnosed with a higher rate of skull fractures. Injury profiles between males and females soccer players in college showed no significant differences. Current literature surrounding age and skill-level based soccer injury profiling is limited, with most data reflective of the previous two decades. Our findings allow for insight on the intra- and post-COVID athlete, highlighting potential areas for injury prevention based on sex and age, while underscoring injuries of high clinical suspicion commonly seen in soccer players presenting to US emergency departments.

Emphasizing the Importance of Naproxen Prophylaxis May Decrease the Rate of Heterotopic Ossification After Hip Arthroscopy

To investigate the incidence of heterotopic ossification (HO) in patients prescribed prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs), both before and after the introduction of a standardized education protocol. A retrospective review was conducted using a database of hip arthroscopy patients treated by a single surgeon at an academic hospital from 2015 to 2023. The inclusion criteria were (1) primary hip arthroscopy for the treatment of femoroacetabular impingement, (2) completion of a 2-week course of prophylactic postoperative NSAIDs (500 mg of naproxen twice daily), and (3) availability of follow-up radiographs at the 6-month postoperative visit. The control cohort was merely prescribed the postoperative prophylactic NSAIDs, whereas the intervention cohort also received dedicated in-person education, emphasizing the importance of NSAID adherence. The presence of HO was determined through review of follow-up radiographs. Standard descriptive statistics were used to describe the findings. Both the control and intervention groups consisted of 200 continuous hip arthroscopy patients, with the control group treated from 2015 to 2017 and the intervention group treated from 2020 to 2023. Within the control group, 10 cases of HO (5%) were detected. Within the intervention group, 2 cases of HO (1%) were found. The Pearson χ2 test with Yates continuity correction produced a value of 4.21, with a P value of .04. In this study, we found a significantly lower incidence rate of HO in patients who received standardized education on the importance of NSAID compliance versus those who did not. This finding suggests that patient education may play a contributory role in reducing the incidence of HO after hip arthroscopy. Level III, comparative cohort study.

Sex differences in surgical site infections following coronary artery bypass grafting: a retrospective observational study

Surgical site infection (SSI) following cardiac surgery poses a significant challenge for healthcare providers. Despite advances in surgical techniques and infection control measures, SSI remains a leading cause of morbidity and mortality, in addition to being a significant economic burden on healthcare services. Current literature suggests there is a reproducible difference in the incidence of SSI following cardiac surgery between sexes. We aim to assess the sex-specific predictive risk factors for sternal SSI following coronary artery bypass grafting (CABG) in addition to identifying any differences in the causative organisms between groups. Adult patients undergoing isolated CABG between January 2012 and December 2022 in one UK hospital organization were included. In this 10-year, retrospective observational study, a total of 10,208 patients met the inclusion criteria. Pre-operative risk factors were identified using univariate analysis. To assess dependence between sex and organism or Gram stain, a Pearson Chi-squared test with Yates correction for continuity was performed. In total there were 8457 males of which 181 developed a sternal SSI (2.14%) and 1751 females, 128 of whom had a sternal SSI (7.31%). Male patients were found to be significantly more likely to develop an SSI secondary to a Gram-positive organism, whereas female patients were more likely to have a Gram-negative causative organism (P<0.00001). Staphylococcus was statistically more likely to be the causative organism genus in male patients. Pseudomonas aeruginosa was found to be twice as common in the female cohort compared with the male group. In our study, we found a statistically significant difference in the causative organisms and Gram stain for post-CABG sternal SSIs between males and females. Male patients predominately have Gram-positive associated SSIs, whereas female SSI pathogens are more likely to be Gram negative. The preoperative risk profiles of both cohorts are similar, including being an insulin-dependent diabetic and triple vessel coronary artery disease. Given these findings, it prompts the question, should we be tailoring our SSI treatment strategies according to sex and associated risk profiles?

Efficacy of oral levonorgestrel emergency contraception with same day etonogestrel contraceptive implant: A prospective observational study

ObjectiveTo determine a 1-month pregnancy rate point estimate and 95% confidence interval for guideline-supported, same-day initiation of an etonogestrel implant plus oral levonorgestrel emergency contraception. Study designIn this single-arm, prospective observational study, all emergency contraception clients who presented to four Planned Parenthood Association of Utah clinics from February 2021 to March 2023 received information about oral levonorgestrel with same-day etonogestrel implant insertion. Participants were ≤35 years and reported unprotected intercourse within 5 days with negative pregnancy testing. The primary outcome measure was a 1-month home pregnancy test. We calculated the efficacy using a test of proportions with Yates continuity correction. ResultsA total of 160 emergency contraception clients (7.6% of 2106 approached) enrolled and 153 had 1-month pregnancy outcomes. A positive pregnancy test occurred in 2 participants resulting in an overall pregnancy rate of 1.32% (95% confidence interval 0.23%−5.19%). Ultrasound gestational dating assigned conception of the first pregnancy to 8 days before enrollment. For the second pregnancy, ultrasound dating designated conception at 5 days prior to enrollment. Limiting the efficacy rate to the single pregnancy that occurred within 5 days of unprotected intercourse, we report a pregnancy rate of 0.66% (95% confidence interval 0.03%−4.19%). ConclusionsIn this observational study of emergency contraception clients selecting oral levonorgestrel with same-day etonogestrel implant, we identified a pregnancy rate within the established range of oral emergency contraception methods alone. ImplicationsClients presenting for emergency contraception may also desire ongoing highly-effective contraception, yet current clinical guidelines serve as a barrier to same-day method initiation for the etonogestrel implant and other hormonal methods. Improving access to contraceptive method initiation will reduce the ongoing risk of unwanted pregnancy for this population. Clinical Trial RegistrationClinicaltrials.gov NCT04678817; registered 12/16/20

The Yates, Conover, and Mantel statistics in 2 × 2 tables revisited (and extended)

AbstractAsymptotic inferences about the difference, ratio or odds‐ratio of two independent proportions are very common in diverse fields. This article defines for each parameter eight conditional inference methods. These methods depend on: (1) using a chi‐squared type statistic or a z type one; (2) using the classic Yates continuity correction or the less well‐known Conover one; and (3) whether the p‐value of the test is determined by doubling the one‐tailed p‐value or by the Mantel method (asymmetrical approach). In all cases, the conclusions are: (i) the methods based on the chi‐squared statistic should not be used, as they are too liberal; (ii) for those in favor of using the criterion of doubling the p‐value, the best method is using the z statistic with Conover continuity correction; and (iii) for those in favor of the asymmetrical approach, the best method is based on the z statistic with Conover continuity correction and the Mantel p‐value.

Has the COVID-19 Pandemic Affected Homeless Patients Visiting the Emergency Department?

Objective: Our aim was to compare emergency department visits among homeless patients before and during the COVID-19 pandemic. Material and Methods: We retrospectively examined data from homeless patients who visited a city hospital's emergency department in Istanbul between March 11, 2018, and March 10, 2022. The study included patients over 18 years old who were registered in the hospital's automation system as "homeless" or "living on the street," and who had sought social service support. Descriptive statistics, Student's t-test, Mann-Whitney U test, chi-squared test, Fisher's exact chi-squared test, Fisher-Freeman-Halton exact chi-squared test, and Yates continuity correction test were utilized for data analysis. Results: The study encompassed a total of 105 homeless patients, with 85 (81%) being male and aged between 18 and 88 years. The mean age was 44.54±16.25 years. Of the patients, 21.9% visited the emergency department before the pandemic, and 78.1% visited during the pandemic. Among homeless patients suspected of COVID-19, 20% who visited the emergency department tested positive for the polymerase chain reaction (PCR) test. Conclusion: Our findings indicate an increase in the number of homeless patients seeking care in the emergency department during the COVID-19 pandemic

Exact correction factor for estimating the OR in the presence of sparse data with a zero cell in 2 × 2 tables.

In case-control studies, odds ratios (OR) are calculated from 2 × 2 tables and in some instances, we observe small cell counts or zero counts in one of the cells. The corrections to calculate the ORs in the presence of empty cells are available in literature. Some of these include Yates continuity correction and Agresti and Coull correction. However, the available methods provided different corrections and the situations where each could be applied are not very apparent. Therefore, the current research proposes an iterative algorithm of estimating an exact (optimum) correction factor for the respective sample size. This was evaluated by simulating data with varying proportions and sample sizes. The estimated correction factor was considered after obtaining the bias, standard error of odds ratio, root mean square error and the coverage probability. Also, we have presented a linear function to identify the exact correction factor using sample size and proportion.

PD06-07 HOW DURABLE IS THE CHILDHOOD HYPOSPADIAS REPAIR? A DATA-LINKAGE STUDY OF PENILE REOPERATIONS OVER 30 YEARS

You have accessJournal of UrologyCME1 Apr 2023PD06-07 HOW DURABLE IS THE CHILDHOOD HYPOSPADIAS REPAIR? A DATA-LINKAGE STUDY OF PENILE REOPERATIONS OVER 30 YEARS Sergey Vavilov, Erin Nolan, Grahame H. Smith, Peter Pockney, Malcolm Starkey, and Aniruddh V. Deshpande Sergey VavilovSergey Vavilov More articles by this author , Erin NolanErin Nolan More articles by this author , Grahame H. SmithGrahame H. Smith More articles by this author , Peter PockneyPeter Pockney More articles by this author , Malcolm StarkeyMalcolm Starkey More articles by this author , and Aniruddh V. DeshpandeAniruddh V. Deshpande More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to estimate the overall risk of penile reoperations after a childhood hypospadias repair, especially in the second and third decades of life, and explore the risk factors of reoperations. METHODS: All children operated on for hypospadias in three children’s hospitals in NSW Australia between April 1991 and December 2006 were identified and their health records linked (July 2001 to December 2020) using the Centre of Health Record Linkage NSW. The details regarding penile reoperations (procedure codes and dates) were captured. Patients were then grouped in three age categories for the analysis: 1 - 0-10, 2 - 10-20, and 3 - 20-30 years old. Primary reconstructive operations performed over 15 years (between 1991 and 2006) were classified into six categories: Distal – Hemicircumcision, Distal – MAGPI, Distal – TIP, Distal – Other, Proximal, Multi-Stage Repair. The reoperations were collapsed into four patient relevant categories: 1) Urethroplasty related, 2) Chordee related 3) Cystoscopies, and 4) Others. The cumulative incidence rate was measured by calculating the sum of reoperations divided by 100 person years at risk. The differences in the incidence of reoperations by hypospadias severity, urethral plate division and persistent chordee after degloving were calculated using chi-square tests with the Yates continuity correction to account for smaller cell sizes. RESULTS: 1105 patients (group 1=617, group 2=1099, group 3=473) were identified with a median follow-up of 18.4 years. The cumulative incidence rate of a penile reoperation in group 1 was 7.3, in group 2 was 1.7, and in group 3 was 0.6 per 100-patient years at risk. The cumulative incidence (risk) of a penile reoperation over 20 years was 37%. Over the entire follow-up period, the highest incidence rate of penile reoperations was after multi-stage (9.9) and single-stage proximal hypospadias repair (5.7) and TIP repair (3.6). There was a higher penile reoperation risk after proximal hypospadias repair, if at primary repair the native urethral plate was divided (p<0.0001), and if there was a persistent chordee after degloving (p=0.04). No reoperations for chordee were identified. CONCLUSIONS: This study is the first of its kind that identifies the quantum and the risk factors for reoperations over 30 years of follow-up and will inform not only better counselling but also further research into technical and non-technical aspects of hypospadias care. Source of Funding: 1. School of Medicine and Public Health, University of Newcastle, Small Project Grant. 2. Hunter New England Research and Translation Centre Research Grant 3. Priority Research Centre GrowUpWell Seed Funding 2020 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e158 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Vavilov More articles by this author Erin Nolan More articles by this author Grahame H. Smith More articles by this author Peter Pockney More articles by this author Malcolm Starkey More articles by this author Aniruddh V. Deshpande More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessment of the content and quality of YouTube videos related zygomatic implants: A content-quality analysis.

This study aimed to evaluate the content and quality of YouTube videos of zygomatic implants. According to Google Trends (2021), "zygomatic implant" was the most preferred keyword related to the topic. Therefore, in this study "zygomatic implant" was used as a keyword for the video search. Demographic characteristics such as the number of views, likes/dislikes, comments, video duration, number of days after upload, uploaders, and target audiences of the videos were evaluated. To evaluate the accuracy and content quality of videos (available from YouTube), the video information and quality index (VIQI) and global quality scale (GQS) were used. Statistical analyses were performed using the Kruskal-Wallis test, Mann-Whitney U test, chi-square test, Fisher's exact chi-square test, Yates continuity correction, and Spearman correlation analysis (p < 0.05). A total of 151 videos were searched; 90 met all inclusion criteria. According to the video content score, 78.9% of the videos were identified as low content, 20% as moderate, and 1.1% as high content. There was no statistical difference between the groups in video demographic characteristics (p> 0.001). Conversely, information flow, accuracy of information, video quality and precision, and total VIQI scores were statistically different between the groups. The moderate-content group had a higher GQS score than the low-content group (p < 0.001). The videos were mainly uploaded (40%) from hospitals and universities. Most videos were targeted toward professionals (46.75%). Low-content videos had higher ratings than the moderate- and high-content videos. Most YouTube videos on zygomatic implants showed low-content quality. This implies that YouTube is not a reliable source of information on zygomatic implants. Dentists, prosthodontists, and oral and maxillofacial surgeons should be aware of the content of video-sharing platforms and take responsibility for enriching video content.

Intravenous Low Dose (4 mg) Dexamethasone as an Adjunct to Epidural Labour Analgesia with 0.125% Ropivacaine in Parturients: A Randomised Controlled Study

Introduction: Labour pain is one of the most severe pains, and the mother’s demand is reason enough for the induction of labour analgesia, provided that no contraindications exist. Labour analgesia must be safe for both the mother and the child. Aim: To assess the impact of a low dose (4 mg) of intravenous (IV) dexamethasone used in conjunction with neuraxial labour analgesia with 0.125% Ropivacaine. Materials and Methods: The present study was a doubleblinded randomised controlled study conducted at tertiary care hospital on 80 parturients classified as American Society of Anaesthesiologists (ASA) II. The parturients were over 18 years old, in their third trimester, carrying a single live foetus that was cephalic at 36 weeks of gestation, and whose cervical dilation was greater than 3 cm and who requested epidural analgesia. All parturients were randomly divided into two equal groups. Before receiving epidural analgesia, the dexamethasone group received 4 mg of IV dexamethasone in 50 mL of normal saline. Patients in the control group received only 50 mL of normal saline. After an initial bolus of 0.125% ropivacaine (8 mL given gradually over 5 minutes), all expectant mothers received a continuous background infusion of 0.125% ropivacaine at a rate of 5 mL/h, along with patient-controlled boluses of 5 mL of the same medication given with a lockout interval of 12 minutes using a Patient Controlled Epidural labour Analgesia (PCEA) pump through the epidural route. Yates continuity correction test (Chi-square test), Fisher’s exact test, and Fisher Freeman Halton were used to compare qualitative data. For categorical data, numbers and percentages were used to summarise all continuous variables as mean±SD. Results: Demographics such as age, height, weight, and preprocedure obstetric-related details were comparable in both groups. There was no statistically significant difference in the average hourly medication intake between the dexamethasone group and the control group (Group D-7.64±0.88 mL/hr and Group C-8.04±1.24 mL/hr, p-value=0.09). Other factors, including pain scores, haemodynamics, administration method, and side effects, did not differ significantly between the two groups. Conclusion: Despite having modest analgesic properties, IV dexamethasone could not significantly reduce the hourly average medication consumption of ropivacaine during epidural labour analgesia.

EFFECTIVENESS OF NURSING EDUCATION IN TIMELY ORGAN REFERRAL: A SMALL INTERVENTION, AN IMPRESSIVE OUTCOME

EFFECTIVENESS OF NURSING EDUCATION IN TIMELY ORGAN REFERRAL: A SMALL INTERVENTION, AN IMPRESSIVE OUTCOME

PATENCY RATE OF BRACHIOCEPHALIC VS RADIOCEPHALIC AVF IN CHRONIC KIDNEY DISEASE PATIENTS IN POPULATION OF D.I.KHAN DIVISION, PAKISTAN

Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it can be retained for only 02-03weeks due to infection. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs Brachiocephalic AVFs in population of D.I.Khan division, Pakistan. Materials &amp; Methods: This randomized controlled trail was conducted in the surgical unit at District Headquarter Teaching Hospital D.I.Khan, Pakistan from January 2017 to January 2020. Two hundred and sixty six patients were randomly allocated by toss method into two groups, one for Brachiocephalic AVF (BCAVF) and second for Radiocephalic AVF (RCAVF). Sex &amp; patency rates were our nominal while age grouping was our ordinal variable. The data for the sample was described by count &amp; percentages &amp; was analyzed for the population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare the patency rate of Brachiocephalic AVF vs. Radiocephalic AVF at alpha 0.05 with Yates continuity correction using online statistical calculator. Results: The patency was present in 129 (97%, 80% CI 94.45-98.39%) cases &amp; absent in 4 (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic AVF group while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases &amp; absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p-value of &lt;.0001 (less than alpha). So, the null hypothesis was rejected, showing significant difference between two groups. Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint.

ASSESSMENT OF THE RELATIONSHIP BETWEEN TEMPOROMANDIBULAR JOINT SOUNDS AND BRUXISM

Aim of the study: The study aims to assess the possible relationship between bruxism and TMJ sounds. Material and methods: The relationship between temporomandibular joint (TMJ) sounds and bruxism was evaluated in a sample composed of 62 females and 39 males varied in age from 21 to 56 years with a mean age of 40.0±1.07. The participants were informed about the purpose of this study, and they gave their consent. The main methods we used in registering TMJ sound were palpation and auscultation. A self-administered Bruxism Assessment Questionnaire assessed bruxism. Results: The prevalence of bruxism in study group was 60.39% (n = 61) – sleep bruxism (SB) and awake bruxism (AB) were 38.2% and 23.4%, respectively. A total of 53.47% (n = 54) of the sample exhibited some type of clicking joint sound. Chi-square test for independence (with Yates Continuity Correction) indicated significant association between bruxism and TMJ sounds, χ2 (1, n = 101) = 4.183, p = .046, phi = .28. Conclusions: Biomechanical factors seem to play a significant role in TMJ disk displacement development. Based on the research, it should be concluded that bruxism may be associated with joint pathologies, such as disc displacement and joint noises.

MP44-13 A SECOND-LOOK AT REPORTED STATISTICS: CHALLENGES IN REPLICATING REPORTED P-VALUES IN PEDIATRIC UROLOGY LITERATURE

You have accessJournal of UrologyPediatric Urology II (MP44)1 Sep 2021MP44-13 A SECOND-LOOK AT REPORTED STATISTICS: CHALLENGES IN REPLICATING REPORTED P-VALUES IN PEDIATRIC UROLOGY LITERATURE Erik Drysdale, Lauren Erdman, Mandy Rickard, Marta Skreta, Jin Kyu Kim, Daniel T. Keefe, Joana Dos Santos, Michael Chua, and Armando J. Lorenzo Erik DrysdaleErik Drysdale More articles by this author , Lauren ErdmanLauren Erdman More articles by this author , Mandy RickardMandy Rickard More articles by this author , Marta SkretaMarta Skreta More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Daniel T. KeefeDaniel T. Keefe More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Michael ChuaMichael Chua More articles by this author , and Armando J. LorenzoArmando J. Lorenzo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002065.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: p-values are the accepted metric for reporting statistically significant findings in science. Ensuring that p-values are robust, reproducible, and generated from the proper tests is essential for ensuring accurate scientific inference. We explored this issue by attempting to verify reported p-values from binary outcome tests and explore the reproducibility of p-value reporting in the hydronephrosis (HN) and bowel and bladder dysfunction (BBD) literature. METHODS: We analyzed 254 papers that were included in previously reported projects conducted regarding HN (n=129) and BBD (n=125). All studies reviewed had at least 2 groups being compared and reported a significant difference. We extracted group counts for the two primary groups from the sampled papers and calculated the Fisher’s exact test p-value. RESULTS: We found that 38 of the 254 (BBD=15, HN=23, 15%) papers sampled had insignificant p-values using our approach, but were reported as significant at <5%. Of these 38 papers, 16 had results that had results that could not be found significant through any attempted approach, 12 could achieve significance through a chi-square test without a Yates continuity correction, and the remaining 10 could be accounted for by differing methodologies (e.g. more than two groups or different test procedures). CONCLUSIONS: A meaningful number studies from pediatric urology appear to report p-values that are difficult to reproduce. A combination of reproducible code, sensitivity analyses, as well as arms-length reproduction attempts can help to reduce non-robust results. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e797-e798 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erik Drysdale More articles by this author Lauren Erdman More articles by this author Mandy Rickard More articles by this author Marta Skreta More articles by this author Jin Kyu Kim More articles by this author Daniel T. Keefe More articles by this author Joana Dos Santos More articles by this author Michael Chua More articles by this author Armando J. Lorenzo More articles by this author Expand All Advertisement Loading ...

Breast MRI during Neoadjuvant Chemotherapy: Lack of Background Parenchymal Enhancement Suppression and Inferior Treatment Response.

Background Suppression of background parenchymal enhancement (BPE) is commonly observed after neoadjuvant chemotherapy (NAC) at contrast-enhanced breast MRI. It was hypothesized that nonsuppressed BPE may be associated with inferior response to NAC. Purpose To investigate the relationship between lack of BPE suppression and pathologic response. Materials and Methods A retrospective review was performed for women with menopausal status data who were treated for breast cancer by one of 10 drug arms (standard NAC with or without experimental agents) between May 2010 and November 2016 in the Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and Molecular Analysis 2, or I-SPY 2 TRIAL (NCT01042379). Patients underwent MRI at four points: before treatment (T0), early treatment (T1), interregimen (T2), and before surgery (T3). BPE was quantitatively measured by using automated fibroglandular tissue segmentation. To test the hypothesis effectively, a subset of examinations with BPE with high-quality segmentation was selected. BPE change from T0 was defined as suppressed or nonsuppressed for each point. The Fisher exact test and the Z tests of proportions with Yates continuity correction were used to examine the relationship between BPE suppression and pathologic complete response (pCR) in hormone receptor (HR)-positive and HR-negative cohorts. Results A total of 3528 MRI scans from 882 patients (mean age, 48 years ± 10 [standard deviation]) were reviewed and the subset of patients with high-quality BPE segmentation was determined (T1, 433 patients; T2, 396 patients; T3, 380 patients). In the HR-positive cohort, an association between lack of BPE suppression and lower pCR rate was detected at T2 (nonsuppressed vs suppressed, 11.8% [six of 51] vs 28.9% [50 of 173]; difference, 17.1% [95% CI: 4.7, 29.5]; P = .02) and T3 (nonsuppressed vs suppressed, 5.3% [two of 38] vs 27.4% [48 of 175]; difference, 22.2% [95% CI: 10.9, 33.5]; P = .003). In the HR-negative cohort, patients with nonsuppressed BPE had lower estimated pCR rate at all points, but the P values for the association were all greater than .05. Conclusions In hormone receptor-positive breast cancer, lack of background parenchymal enhancement suppression may indicate inferior treatment response. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Philpotts in this issue.

Identifying factors that affected student enrolment in Additional Mathematics for urban areas of Kuantan district

The skilful and qualified Science, Technology, Engineering and Mathematics (STEM) workforces are expected to be in high demand in the 21st digital economy. In Malaysia public education system, the principal key to STEM education is Additional Mathematics. However, the statistics depicted that the number of upper secondary students enrolled in Additional Mathematics have been severely delineated. Furthermore, the prerequisite to enrol in STEM and Technical and Vocational Education and Training (TVET) courses in tertiary education is achieving a minimum grade C for Additional Mathematics. Therefore, the principal objective of this article is to identify the significant factors that affected the upper secondary students enrolled in Additional Mathematics using Pearson’s chi-square test without Yates continuity correction and unadjusted odds ratio (OR). A validated questionnaire comprised nine potential factors that affected enrolment in additional mathematics was distributed to 389 Form Four students’ cohort 2020 from four selected urban government schools to pursue this objective. Based on the finding of this article, several initiatives might be taken by the policymakers, such as the teachers may enhancing and throughout the broad of STEM and TVET careers in the 21st digital economy era, while the students’ parents can participate in schools in building the communicating and coordinating mechanism. Consequently, the number of upper secondary enrolled in STEM education might be increased to pipeline the future STEM and TVET human capitals in sustaining and stabilising the national economy in the digital era.

Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population.

This was a large database study. The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion). CSM is a major contributor to disability and reduced quality of life worldwide. Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used. Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086). The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.

ADAM10 plasma levels predict worsening in cognition of older adults: a 3-year follow-up study

BackgroundBlood-based biomarkers for Alzheimer’s disease (AD) are highly needed in clinic practice. So far, the gold standards for AD diagnosis are brain neuroimaging and beta-amyloid peptide, total tau, and phosphorylated tau in cerebrospinal fluid (CSF); however, they are not attractive for large-scale screening. Blood-based biomarkers allow an initial large-scale screening of patients under suspicion that could later be tested for the already established CSF biomarkers. To this regard, in this study, we evaluated whether plasma ADAM10 levels would be predictors of declines in cognition in community-dwelling older adults after a 3-year period follow-up.MethodsThis was a 3-year longitudinal cohort study that included 219 community-dwelling older adults. Sociodemographic, clinical, lifestyle, depressive symptoms (GDS), and cognitive data (Mini-Mental State Examination, MMSE; Clock Drawing test, CDT) were gathered. The measurement of ADAM10 plasma levels was performed using a sandwich ELISA kit. Bivariate comparisons between groups were performed using Wilcoxon-Mann-Whitney for continuous data and Pearson’s chi-square tests with Yates continuity correction for categorical data. Longitudinal analyzes of changes in the MMSE scores were performed using linear mixed-effects modeling.ResultsBaseline MMSE scores and ADAM10 levels were significantly associated with MMSE scores on the follow-up assessment. When analyzing the interaction with time, normal MMSE scores and the ADAM10 plasma levels at baseline presented a significant and independent negative association with MMSE score values on the follow-up assessment. The analyses also showed that the predictive effect of ADAM10 plasma levels on decreasing MMSE scores on follow-up seems to be more pronounced in participants with normal MMSE, when compared with those with altered MMSE scores at baseline.ConclusionsConsidering that ADAM10 increase in plasma is detected as soon as in mild cognitive impairment (MCI) patients, the results presented here may support the complementary clinical use of this biomarker, in addition to the classical AD biomarkers. Taken together, these results provide the first direct evidence that changes in ADAM10 plasma levels are predictors of cognitive worsening in older adults. Moreover, this work can shed light on the study of blood biomarkers for AD and contribute to the advancement of the area.