scholarly journals LO057: Association between metoclopramide treatment in the ED for concussion and persistent post-concussion headaches: a propensity score matching analysis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S50-S50
Author(s):  
N. Bresee ◽  
M. Aglipay ◽  
N. Barrowman ◽  
F. Momoli ◽  
A. Dubrovsky ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Scores ◽  
Secondary Analysis ◽  
Self Report ◽  
Multivariate Logistic Regression Model ◽  
Control Groups ◽  
Post Injury ◽  
Significant Difference ◽  
Persistent Headache

Introduction: There is a paucity of pediatric literature regarding effective treatment for post-concussion headache. The objective of this study was to assess whether metoclopramide treatment in the Emergency Department (ED) within 48 hours of injury was associated with reduced persistent headache symptoms post-concussion at 1-week and 1-month post-injury. Methods: Children aged 8-18 years with acute concussion were enrolled across 9 EDs of the Pediatric Emergency Research Canada network in a prospective cohort study [Predicting and Preventing Post-concussive Problems in Paediatrics (5P)] from August 2013 to June 2015. Treatments administered in ED (including metoclopramide) were collected using standardized forms. Self-report symptom questionnaires were rated at baseline, at 7 and 28 days follow-up using the validated Post-Concussion Symptom Inventory (PCSI). Propensity scores for treatment with metoclopramide were calculated using a multivariate logistic regression model including confounders. Intervention and control groups were matched 1:4 on the logit of the propensity scores using a greedy algorithm and nearest-neighbour approach. The primary outcome was headache persistence at one-month. Results: 2095 patients met inclusion criteria and completed baseline assessment. At 1 and 4 weeks respectively, 54% (963/1808) and 26% (456/1780) of participants completing follow-up had persistent headache symptoms. 50 metoclopramide treated participants were propensity score matched to 234 controls (1:4 matching). At 4 weeks, no statistically significant difference in persistent headache symptoms was observed between the treatment and propensity score matched control groups (OR: 0.67; 95% CI: 0.33-1.36, p=0.26). There was also no statistically significant difference between the groups at 1-week post-concussion (OR 0.58; 95% CI: 0.32-1.05, p=0.07). Conclusion: This secondary analysis was unable to detect a statistically significant association between acute ED treatment with metoclopramide and reduced medium and long-term headache symptoms post-concussion. Nevertheless, the 1-week results hold promise, but require a well-powered RCT to fully address confounding issues to determine the benefit of metoclopramide post-concussion.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

A randomized trial of levamisole versus placebo as adjuvant therapy in malignant melanoma.

1991 ◽  
Vol 9 (5) ◽  
pp. 736-740 ◽  
Author(s):  
L E Spitler
Keyword(s):  
Malignant Melanoma ◽  
Adjuvant Therapy ◽  
Randomized Trial ◽  
Control Groups ◽  
Disease Free Interval ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
And Control

We conducted a long-term follow-up (median, 10.5 years) of patients included in a randomized trial of levamisole versus placebo as surgical adjuvant therapy in 203 patients with malignant melanoma. Of the patients randomized, 104 received levamisole, and 99 received placebo. The results show that there is no difference between the treatment and control groups with regard to any of the three end points analyzed. These included disease-free interval, time to appearance of visceral metastasis, and survival. Moreover, there was no significant difference between the treatment and control groups after adjusting for age, sex, or stage of disease.

scholarly journals Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5777
Author(s):  
Gaon-Sorae Wang ◽  
Kyoung-Min You ◽  
You-Hwan Jo ◽  
Hui-Jai Lee ◽  
Jong-Hwan Shin ◽  
...  
Keyword(s):  
Health Insurance ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Cohort Analysis ◽  
Adult Patients ◽  
Multivariate Logistic Regression Model ◽  
Insurance Status ◽  
Matched Cohort ◽  
Health Insurance Status ◽  
Significant Difference

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusion: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

scholarly journals Evaluating the effectiveness of a group-based resilience intervention versus psychoeducation for emergency responders in England: A randomised controlled trial

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241704
Author(s):  
Jennifer Wild ◽  
Shama El-Salahi ◽  
Michelle Degli Esposti ◽  
Graham R. Thew
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Self Report ◽  
Post Traumatic Stress ◽  
Emergency Responders ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Resilience Intervention

Background Emergency responders are routinely exposed to traumatic critical incidents and other occupational stressors that place them at higher risk of mental ill health compared to the general population. There is some evidence to suggest that resilience training may improve emergency responders’ wellbeing and related health outcomes. The aim of this study was to evaluate the effectiveness of a tertiary service resilience intervention compared to psychoeducation for improving psychological outcomes among emergency workers. Methods We conducted a multicentre, parallel-group, randomised controlled trial. Minim software was used to randomly allocate police, ambulance, fire, and search and rescue services personnel, who were not suffering from depression or post-traumatic stress disorder, to Mind’s group intervention or to online psychoeducation on a 3:1 basis. The resilience intervention was group-based and included stress management and mindfulness tools for reducing stress. It was delivered by trained staff at nine centres across England in six sessions, one per week for six weeks. The comparison intervention was psychoeducation about stress and mental health delivered online, one module per week for six weeks. Primary outcomes were assessed by self-report and included wellbeing, resilience, self-efficacy, problem-solving, social capital, confidence in managing mental health, and number of days off work due to illness. Follow-up was conducted at three months. Blinding of participants, researchers and outcome assessment was not possible due to the type of interventions. Results A total of 430 participants (resilience intervention N = 317; psychoeducation N = 113) were randomised and included in intent-to-treat analyses. Linear Mixed-Effects Models did not show a significant difference between the interventions, at either the post-intervention or follow-up time points, on any outcome measure. Conclusions The limited success of this intervention is consistent with the wider literature. Future refinements to the intervention may benefit from targeting predictors of resilience and mental ill health. Trial registration ISRCTN registry, ISRCTN79407277.

scholarly journals Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis

2017 ◽  
Vol 05 (07) ◽  
pp. E587-E594 ◽  
Author(s):  
Takeshi Yamashina ◽  
Manabu Fukuhara ◽  
Takanori Maruo ◽  
Gensho Tanke ◽  
Saiko Marui ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Secondary Analysis ◽  
Colorectal Polyps ◽  
Propensity Score Model ◽  
Propensity Score Matching Analysis ◽  
Significant Difference ◽  
Cold Snare Polypectomy ◽  
Few Data ◽  
Snare Polypectomy

Abstract Background and study aims Cold snare polypectomy (CSP) for small colorectal polyps has lower incidence of adverse events, especially delayed postpolypectomy bleeding (DPPB). However, few data are available on comparisons of the incidence of DPPB of CSP and hot polypectomy (HP). The aim of this study was to evaluate the incidence of DPPB after CSP and compare it with that of HP. A propensity score model was used as a secondary analysis. Patients and methods This was a retrospective cohort study conducted in a single municipal hospital. We identified 539 patients with colorectal polyps from 2 mm to 11 mm in size who underwent CSP (804 polyps in 330 patients) or HP (530 polyps in 209 patients) between July 2013 and June 2015. Results There were no cases of DPPB in the CSP group. Conversely, DPPB occurred in 4 patients (1.9 %) after HP, resulting in a significant difference between the CSP and HP groups (0.008 % vs 0 %, P = 0.02). Propensity score-matching analysis created 402 matched pairs, yielding a significantly higher DPPB rate in the HP group than CSP group (0.02 % vs 0 %, P = 0.04). However, significantly more patients in the CSP group had unclear horizontal margins that precluded assessment (83 vs 38 cases, P < 0.001). The retrieval failure rate was significantly higher in the CSP group than in the HP group (3 % vs 0.7 %, P = 0.01). Conclusions DPPB was less frequent with CSP than HP, as selected by the propensity score-matching model. Our findings indicate that CSP is recommended polypectomy in daily clinical setting. However, special care should be taken during polyp retrieval and horizontal margin assessment, and these issues could be taken into account in follow-up after CSP.

Abstract 14598: Multiple Arterial Coronary Bypass Grafting is Associated With Improved Survival in Females

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Derrick Tam ◽  
Rodolfo Rocha ◽  
Jiming Fang ◽  
Maral Ouzounian ◽  
Joanna Chikwe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Administrative Databases ◽  
Rank Test ◽  
Bypass Grafting ◽  
Female Patients ◽  
Significant Difference ◽  
Arterial Grafting

Introduction: Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) is associated with improved survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) in observational studies of mostly males. It is not known whether the MAG is beneficial in females. Herein, we compared the late clinical outcomes of MAG versus single arterial grafting (SAG) in females undergoing CABG for multivessel coronary artery disease (CAD) Methods: Clinical and administrative databases for Ontario, Canada, were linked to obtain all female patients with angiographic evidence of left main, triple, or double vessel disease undergoing isolated non-emergent primary CABG from 2008-2019. Baseline characteristics were compared and 1:1 propensity score matching was performed to account for differences. 30-day mortality was compared in the matched groups. Late mortality and MACCE ( composite of stroke, myocardial infarction, repeat revascularization, and death) was compared between the matched groups with a stratified log rank test and Cox-proportional hazard model. Results: In total 2,961 and 7,954 females underwent CABG with MAG and SAG respectively for multivessel CAD. Prior to propensity-score matching, compared to SAG, those that underwent MAG were younger (66.0 vs. 68.9 years) and had less comorbidities. After propensity-score matching, 2,446 well-matched pairs were formed. In matched patients, there was no significant difference in 30-day mortality (1.6% vs 1.8%, P=0.43) between MAG and SAG. The median and maximum follow-up was 5.0 and 11.0 years respectively. Over the entire follow-up, MAG was associated with improved survival (Figure, hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.75-0.98) and freedom from MACCE (HR: 0.85, 95%CI: 0.76-0.95). Conclusions: MAG was associated with improved survival and freedom from MACCE and should be considered for female patients with good life expectancy requiring CABG.

scholarly journals How Accurate are Concussed College Athlete’s Self-reported Balance Problems?

2019 ◽  
Vol 34 (5) ◽  
pp. 793-793
Author(s):  
A DaCosta ◽  
M Fasciana ◽  
A Crane ◽  
A LoGalbo
Keyword(s):  
Assessment Tool ◽  
Collegiate Athletes ◽  
Self Report ◽  
Balance Performance ◽  
Post Injury ◽  
Sports Concussion ◽  
Baseline Testing ◽  
Balance Problems ◽  
Balance Error

Abstract Purpose The Balance Error Scoring System (BESS) has been determined to be a reliable and valid measure of balance performance (Bell et al., 2011). Previous research indicates self-reported balance difficulties and postural stability are positively correlated (Broglio et al., 2009). Furthermore, athletes exhibit an increase in errors on the BESS following a concussion (McCrea et al., 2004). Methods 68 collegiate athletes (age 18-23; M=19.62, SD=1.44) received baseline, post-concussion, and follow-up evaluations. Balance performance was measured via the BESS on the Sports Concussion Assessment Tool-5th edition (SCAT5), while symptom reporting was measured by the SCAT5 and ImPACT neurocognitive testing. Results Multiple simple linear regressions were conducted, suggesting that changes in BESS performance from baseline to post-trauma significantly predicted self-report of “balance problems” at post-trauma on ImPACT (F(1, 66)=11.94, p=.001; R2=.15) and SCAT5 (F(1, 66)=5.73, p=.02; R2=.08). While baseline BESS errors were significantly correlated with post-trauma BESS errors (r=.29, p=.02), BESS errors at post-trauma did not significantly predict self-reporting of balance problems on either assessment. Conclusion Results suggest that self-reported balance difficulties following a concussion are an indicator of change in intraindividual balance performance, but not post-trauma balance performance alone. Furthermore, it provides clinical context as the individuals’ perception of change may be greater, impacting the likelihood of self-reporting of balance problems at post-trauma. These results support the clinical utility of examining pre- and post-injury changes in balance by including balance measurements in pre-participation baseline testing.

Piano-accompanied solfège reading experiences of preservice music teachers

2020 ◽  
pp. 1321103X1987107
Author(s):  
Elif Guven
Keyword(s):  
Music Teachers ◽  
Control Group ◽  
Reading Practices ◽  
Control Groups ◽  
Plot Analysis ◽  
Experimental Implementation ◽  
Significant Difference ◽  
And Control ◽  
Experimental Group

This study examines how piano-accompanied solfège reading practices of preservice music teachers ( N = 28) affect their performance on their musical hearing, reading, and writing (MHRW) classes. A pretest–posttest design with control groups was employed. The data were analyzed by 2 × 2 split-plot analysis of variance (ANOVA) and one-way ANOVA. Consequently, a significant difference was not found between the MHRW performance scores of the experimental and control groups. An analysis of mean performance scores revealed that the scores received by the control group were higher than those of the experimental group after the practice. Follow-up interviews that were held with 14 students after the experimental implementation revealed that students believed piano-accompanied courses were more useful, and they felt more comfortable with piano accompaniment. Although MHRW performance scores indicated that piano-accompanied solfège reading practices did not have a significant effect on preservice music teachers’ MHRW performances, it helped them participate in courses more enthusiastically.

scholarly journals Prophylactic Effect of Memantine in Docetaxel Induced Neuropathy in Patients With Breast Cancer

2021 ◽  
Author(s):  
Pegah Mohammadzadeh ◽  
Elnaz Shaseb ◽  
Zohreh Sanaat ◽  
Parvin Sarbakhsh ◽  
Nasrin Gholami ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Peripheral Neuropathy ◽  
Intervention Group ◽  
Metastatic Breast ◽  
Control Group ◽  
P Value ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Abstract Purpose Peripheral neuropathy is a complication of taxane that in severe cases can limit the optimal treatment. The aim of this study was to evaluate the efficacy of memantine in prevention of docetaxel induced peripheral neuropathy in patients with breast cancer. Methods In this randomized clinical trial, 40 women between the ages of 18 and 64 years with non-metastatic breast cancer (stages I to III) were included (registry number: IRCT20160310026998N9 and registry date: 26 March 2019). All patients were treated with the AC-T regimen (with docetaxel). Patients in intervention group received memantine at a dose of 20 mg for 8 weeks at the beginning of the first cycle of docetaxel. Patients in control group did not take any medication for neuropathy prevention. To assess the neuropathy, DN4 and CTCAE questionnaires were used at baseline, one months, three months and six months after the intervention. Results The DN4 questionnaire score was remarkably less in memantine group in follow up one (p-value: 0.033) and three (p < 00.1). The CTCAE follow up score did not change during study. The Neuropathy duration and Neuropathy onset, were shown significant difference between the intervention and control groups, p = 0.050 and p = 0.001, respectively. From 40 patients, 8 (40%) in memantine group and 2 (10%) in control group, did not experience any kind of neuropathy. Conclusion Data showed that prophylactic administration of memantine 20 mg/day has been effective in prevention of severity and incidence of docetaxel induced neuropathy in patients with breast cancer.

scholarly journals Effectiveness of Physical Therapy for the Management of Chronic Spine Disorders: A Propensity Score Approach

2006 ◽  
Vol 86 (3) ◽  
pp. 381-394 ◽  
Author(s):  
Janet K Freburger ◽  
Timothy S Carey ◽  
George M Holmes
Keyword(s):  
Physical Therapy ◽  
Propensity Score ◽  
Short Form ◽  
Intervention Group ◽  
Control Group ◽  
Control Groups ◽  
Sf 36 ◽  
Spine Disorders ◽  
And Control

Abstract Background and Purpose. Evidence on the effectiveness of physical therapy for the management of chronic spine disorders is limited. The purpose of this study was to use a large current database, the National Spine Network database, to assess the effectiveness of physical therapy in the management of chronic spine disorders. Subjects. The participants were people who had spine problems lasting 3 months or longer and who were seen for an initial visit and a follow-up visit (N=4,479) at 1 of 17 US spine centers. Methods. A propensity score approach was used to create a matched sample of participants who received physical therapy (intervention group) and participants who did not receive physical therapy (control group). The 2 groups were similar with regard to more than 50 baseline characteristics. Outcomes were assessed with the Oswestry Disability Index (ODI) and the 36-Item Short-Form Health Survey (SF-36). Results. Both the intervention and control groups improved between the initial and the follow-up visits on ODI scores and on SF-36 physical function, role physical, and bodily pain scores. Although the amount of improvement in the outcome measures was significantly greater for the intervention group than for the control group, the differences were small (3–5 points). When the subgroup of participants who had the greatest propensity for receiving physical therapy was examined, differences in the amount of improvement between the intervention and control groups were larger (5–13 points). Discussion and Conclusion. Physical therapy was effective in the management of chronic spine disorders in participants with the greatest propensity for receiving physical therapy. When the entire sample was considered, differences in the amount of improvement between the intervention and control groups were not clinically relevant. [Freburger JK, Carey TS, Holmes GM. Effectiveness of physical therapy for the management of chronic spine disorders: a propensity score approach.

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