scholarly journals P-BN61 Optimal timing of laparoscopic cholecystectomy for admitted acute cholecystitis patients

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
James Lucocq ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Logistic Regression ◽  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Acute Cholecystitis ◽  
Regression Models ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Total Length ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background The Tokyo 2018 guidelines support emergency laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) over delayed laparoscopic cholecystectomy (DLC) for mild cholecystitis, substantiated by a lower total length of stay. The supporting studies are limited by small sample sizes, and clinically relevant findings may have been missed. The aims of the present paper were firstly, to compare the peri- and post-operative course following emergency and delayed LC for AC. Methods All patients who underwent ELC and DLC for AC following hospital admission between January 2015 and December 2019 were included in the study. Pre-operative, operative and post-operative data over a 100-day follow-up period were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were splint into groups based on previous admissions and outcomes were compared between ELC and DLC. Multivariate logistic regression models were then used on the entire cohort to adjust for other variables and to determine the impact of ELC versus DLC. Complications of the category Clavien-Dindo ≥2 were considered. Results In the group with no previous admissions (n = 630), DCL patients had lower rates of intra-/post-operative complications (8.0%vs.17.9%;p<0.001), lower rates of re-admission (6.6%vs.12.2%;p=0.04) and longer total length of stay (6dvs.5d;p=0.03). In patients with previous admissions (n = 181), DCL had lower rates of intra-/post-operative complications (14.1%vs.25.5%;p=0.06) but there was no significant difference in length of stay (13dvs.12d;p=0.81). The ELC group had a significantly lower admission CRP, ASA and age (p < 0.001). In the multivariate logistic regression models, ELC was positively associated with subtotal/conversion to open (OR,1.94;p=0.01), drain insertion (OR,2.54;p<0.001), bile leak (OR,2.38;p<0.001), post-operative imaging (OR,1.83;p=0.01), longer post-operative stay (OR,7.26,p<0.001) and readmission (OR-1.9;p=0.01).  Conclusions DLC, once the period of active inflammation has settled, offers superior post-operative outcomes, including lower rates of complication, re-admission and post-operative length of stay; however is associated with longer total length of stay. DLC is only advised where the risk of re-admission is minimised (i.e surgery six weeks following the episode) and relies on the management of surgical waiting lists.

45 Application of Machine Learning Models to Thermal Burn Patient Outcome Predictions in the Aftermath of a Nuclear Event

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S33-S34
Author(s):  
Morgan A Taylor ◽  
Randy D Kearns ◽  
Jeffrey E Carter ◽  
Mark H Ebell ◽  
Curt A Harris
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Regression Models ◽  
Large Scale ◽  
Prediction Models ◽  
Burn Patients ◽  
Thermal Burn ◽  
Logistic Regression Models ◽  
Burn Patient

Abstract Introduction A nuclear disaster would generate an unprecedented volume of thermal burn patients from the explosion and subsequent mass fires (Figure 1). Prediction models characterizing outcomes for these patients may better equip healthcare providers and other responders to manage large scale nuclear events. Logistic regression models have traditionally been employed to develop prediction scores for mortality of all burn patients. However, other healthcare disciplines have increasingly transitioned to machine learning (ML) models, which are automatically generated and continually improved, potentially increasing predictive accuracy. Preliminary research suggests ML models can predict burn patient mortality more accurately than commonly used prediction scores. The purpose of this study is to examine the efficacy of various ML methods in assessing thermal burn patient mortality and length of stay in burn centers. Methods This retrospective study identified patients with fire/flame burn etiologies in the National Burn Repository between the years 2009 – 2018. Patients were randomly partitioned into a 67%/33% split for training and validation. A random forest model (RF) and an artificial neural network (ANN) were then constructed for each outcome, mortality and length of stay. These models were then compared to logistic regression models and previously developed prediction tools with similar outcomes using a combination of classification and regression metrics. Results During the study period, 82,404 burn patients with a thermal etiology were identified in the analysis. The ANN models will likely tend to overfit the data, which can be resolved by ending the model training early or adding additional regularization parameters. Further exploration of the advantages and limitations of these models is forthcoming as metric analyses become available. Conclusions In this proof-of-concept study, we anticipate that at least one ML model will predict the targeted outcomes of thermal burn patient mortality and length of stay as judged by the fidelity with which it matches the logistic regression analysis. These advancements can then help disaster preparedness programs consider resource limitations during catastrophic incidents resulting in burn injuries.

Child awareness of and access to cigarettes: impacts of the point-of-sale display ban in England

2018 ◽  
Vol 28 (5) ◽  
pp. 526-531 ◽  
Author(s):  
Anthony A Laverty ◽  
Eszter Panna Vamos ◽  
Christopher Millett ◽  
Kiara C-M Chang ◽  
Filippos T Filippidis ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Drug Use ◽  
Regression Models ◽  
Multivariate Logistic Regression ◽  
Tobacco Advertising ◽  
Point Of Sale ◽  
Logistic Regression Models ◽  
Annual Survey ◽  
Perceived Difficulty ◽  
Ease Of Access

IntroductionEngland introduced a tobacco display ban for shops with >280 m2 floor area (‘partial ban’) in 2012, then a total ban in 2015. This study assessed whether these were linked to child awareness of and access to cigarettes.MethodsData come from the Smoking, Drinking and Drug Use survey, an annual survey of children aged 11–15 years for 2010–2014 and 2016. Multivariate logistic regression models assessed changes in having seen cigarettes on display, usual sources and ease of access to cigarettes in shopsResultsDuring the partial display ban in 2012, 89.9% of children reported seeing cigarettes on display in the last year, which was reduced to 86.0% in 2016 after the total ban (adjusted OR 0.58, 95% CI 0.50 to 0.66). Reductions were similar in small shops (84.1% to 79.3%)%) and supermarkets (62.6% to 57.3%)%). Although the ban was associated with a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (57.0% in 2010 to 39.8% in 2016), we did not find evidence of changes in perceived difficulty or being refused sale among those who still did.DiscussionTobacco point-of-sale display bans in England reduced the exposure of children to cigarettes in shops and coincided with a decrease in buying cigarettes in shops. However, children do not report increased difficulty in obtaining cigarettes from shops, highlighting the need for additional measures to tackle tobacco advertising, stronger enforcement of existing laws and measures such as licencing for tobacco retailers.

Abstract TP321: Is Weekend Admission Associated With Increased 30-day Stroke Mortality? The Effect of Adjustment Using a Claims-Based Stroke Severity Index

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Cheng-Yang Hsieh ◽  
Sheng-Feng Sung
Keyword(s):  
Logistic Regression ◽  
Regression Models ◽  
Severity Index ◽  
Case Mix ◽  
Stroke Severity ◽  
Stroke Mortality ◽  
Multivariate Logistic Regression ◽  
Stroke Patients ◽  
Logistic Regression Models ◽  
Case Mix Adjustment

Introduction: Whether weekend admission is associated with increased stroke mortality in Taiwan remains uncertain, partly because of an inadequate case-mix adjustment in other studies using an insurance claims databases. Hypothesis: Adding the 7-item claims-based stroke severity index (SSI) to a multivariate logistic regression model might alter the analysis of the effect of weekend admission on 30-day stroke mortality. Methods: We identified, in the Taiwan Longitudinal Health Insurance Database, which is linked with the National Death Registry, patients hospitalized for acute ischemic stroke between 2001 and 2013. The primary outcome was mortality 30 days post-admission. In base logistic regression models with and without the SSI, we tested the odds ratio (OR) of 30-day mortality in patient admitted on weekends using the covariates of age, sex, year of admission, Charlson’s comorbidity index, brain surgery, physician specialty and surgical volume, hospital ownership, accreditation, and patient volume. Results: We analyzed 46,007 consecutive hospitalized stroke patients (mean age: 68.8 ± 12.0 years; male: 59%), with an SSI of 7.5 ± 5.3 (range: 4.1-27.1), 23.0% were admitted on the weekend, and 4.2% died within 30 days. Patients who died within 30 days were more likely to have been admitted on a weekend (4.9% vs. 4.0%, p < 0.001). Nevertheless, patients admitted on a weekend had a higher SSI than those admitted on a weekday (7.8 vs. 7.4, p < 0.001). In multivariate logistic regression models, weekend admission was associated with 30-day mortality (OR: 1.22, 95% CI: 1.10-1.35) in the base model but not in the base model plus SSI (OR: 1.07, 95% CI: 0.95-1.20). Conclusions: We confirmed that, after stroke severity had been adjust by adding the SSI, weekend admission did not increase the 30-day mortality of stroke patients in Taiwan. A case-mix adjustment in comparative outcome studies of stroke patients is important when using an insurance claims database.

Forced Sexual Victimization Among Youth in Custody: Do Risk Factors Vary by Gender and Perpetrator?

2019 ◽  
Vol 100 (2) ◽  
pp. 151-172
Author(s):  
Eileen M. Ahlin
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Logistic Regression ◽  
National Survey ◽  
Regression Models ◽  
Sexual Victimization ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Using Data

There is relatively little literature examining risk factors associated with sexual victimization among youth in custody. The current study explored whether risk of forced sexual victimization among youth in custody differs by gender or perpetrator. Using data from a sample of 8,659 youth who participated in the National Survey of Youth in Custody, multivariate logistic regression models were employed to investigate gender differences in risk factors associated with overall forced sexual victimization and staff-on-inmate and inmate-on-inmate forced sexual victimization. Findings suggest that gender differences are more pronounced when perpetrator type is considered.

scholarly journals Youth Working in Tobacco Farming: Effects on Smoking Behavior and Association with Health Status

2019 ◽  
Author(s):  
Ethel Alderete ◽  
Jennifer Livaudais-Toman ◽  
Celia Kaplan ◽  
Steven E. Gregorich ◽  
Raúl Mejía ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Health Status ◽  
Regression Models ◽  
Smoking Behavior ◽  
Economic Benefits ◽  
Social Consequences ◽  
Multivariate Logistic Regression ◽  
Accidental Injury ◽  
Logistic Regression Models ◽  
Serious Injury

Abstract Background Cultivation of tobacco raises concerns about detrimental health and social consequences for youth, but tobacco producing countries only highlight economic benefits. We compared sociodemographic and health-related characteristics of school-age youth who worked and did not work in tobacco farming and assessed the effects on smoking behavior and health at one year.Methods We used existing data collected in the province of Jujuy, Argentina where 3188 youth 13 to 17 years of age from a random middle school sample responded to longitudinal questionnaires in 2005 and 2006. Multivariate logistic regression models predicted association of tobacco farming work with health status and smoking behavior at one year.Results 22.8% of youth in the tobacco growing areas of the province were involved in tobacco farming. The mean age of initiation to tobacco farming was 12.6 years. Youth working in farming had higher rates of fair or poor versus good or excellent self-perceived health (30.3% vs. 19.0%), having a serious injury (48.5% vs. 38.5%), being injured accidentally by someone else (7.5% vs. 4.6%), being assaulted (5.5% vs. 2.6%), and being poisoned by exposure to chemicals (2.5% vs. 0.7%). Youth working in tobacco farming also had higher prevalence of ever (67.9% vs. 55.2%), current (48.0% vs. 32.6%) and established smoking (17.8% vs. 9.9%). In multivariate logistic regression models tobacco farming in 2005 was associated with significant increased reporting of serious injury (OR=1.4; 95%CI 1.1-2.0), accidental injury by someone else (OR=1.5; 95% 1.0-2.1), assault (OR=2.2; 95% CI 1.3-3.8), and poisoning by exposure to chemicals (OR=2.5; 95% CI 1.2-5.4). Tobacco farming in 2005 predicted established smoking one year later (OR=1.5; 95% CI 1.1-2.0).Conclusion Youth who work in tobacco faming face a challenging burden of adversities that increase their vulnerability. Risk assessments should guide public policies to protect underage youth working in tobacco farming. (298 words)

scholarly journals Risk factors associated with stillbirth of piglets born from oxytocin-assisted parturitions

2020 ◽  
Vol 13 (10) ◽  
pp. 2172-2177
Author(s):  
Nguyen Hoai Nam ◽  
Peerapol Sukon
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Models ◽  
Significant Risk ◽  
Gestation Length ◽  
Stillbirth Rate ◽  
Multivariate Logistic Regression ◽  
Crown Rump Length ◽  
Logistic Regression Models ◽  
Factors Associated

Aim: The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions. Materials and Methods: Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing. Results: The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets. Conclusion: Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.

What Do Québec Children Eat During Their First Six Months?

2004 ◽  
Vol 65 (3) ◽  
pp. 106-113 ◽  
Author(s):  
Marie-Claire Lepage ◽  
Jocelyne Moisan ◽  
Michel Gaudet
Keyword(s):  
Logistic Regression ◽  
Regression Models ◽  
Family Income ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Mineral Supplements ◽  
Factors Associated ◽  
Birth Factors ◽  
Primiparous Women ◽  
Breast Fed

Study objectives were to describe the introduction of foods and beverages and the use of vitamin and/or mineral supplements among infants aged six months, and to identify factors associated with following Québec recommendations on introducing foods and beverages. Study subjects were primiparous women interviewed by phone when their infants were approximately six months old. Data were gathered on foods and beverages offered to infants, the age at which these were introduced, and supplements. The use of each food, beverage, and supplement was evaluated according to recommendations. Mean age at which foods were introduced and proportions of women who followed recommendations were calculated. Multivariate logistic regression models were used to identify the factors associated with following recommendations. Results indicated that among the 1,937 interviewed mothers, 212 (10.9%) exclusively breast-fed their infants before age four months, 1,073 (55.4%) breast-fed their infants at birth but gave them formula or foods before age four months, and 652 (33.7%) formula-fed their infants at birth. Factors associated with adherence to recommendations were breast-feeding exclusively, being older than 30 years, an annual family income of at least $60,000, and being a non-smoker. Few mothers followed all the recommendations.

scholarly journals Early life serum neurofilament dynamics predict neurodevelopmental outcome of preterm infants

2021 ◽  
Author(s):  
Katharina Goeral ◽  
Annalisa Hauck ◽  
Andrew Atkinson ◽  
Michael B. Wagner ◽  
Birgit Pimpel ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Preterm Infants ◽  
Regression Models ◽  
Neurodevelopmental Outcome ◽  
Multivariate Logistic Regression ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Logistic Regression Models ◽  
Equivalent Age ◽  
Motor Outcome

Abstract Background and purpose To determine whether neurofilament light chain (NfL), a promising serum and cerebrospinal fluid (CSF) biomarker of neuroaxonal damage, predicts functional outcome in preterm infants with neonatal brain injury. Methods Our prospective observational study used a sensitive single-molecule array assay to measure serum and CSF NfL concentrations in preterm infants with moderate to severe peri/intraventricular hemorrhage (PIVH). We determined temporal serum and CSF NfL profiles from the initial diagnosis of PIVH until term-equivalent age and their association with clinical and neurodevelopmental outcome until 2 years of age assessed by Bayley Scales of Infant Development (3rd edition). We fitted univariate and multivariate logistic regression models to determine risk factors for poor motor and cognitive development. Results The study included 48 infants born at < 32 weeks of gestation. Median serum NfL (sNfL) at PIVH diagnosis was 251 pg/mL [interquartile range (IQR) 139–379], decreasing markedly until term-equivalent age to 15.7 pg/mL (IQR 11.1–33.5). CSF NfL was on average 113-fold higher (IQR 40–211) than corresponding sNfL values. Additional cerebral infarction (n = 25)-but not post-hemorrhagic hydrocephalus requiring external ventricular drainage (n = 29) nor any other impairment-was independently associated with sNfL. Multivariate logistic regression models identified sNfL as an independent predictor of poor motor outcome or death at 1 and 2 years. Conclusions Serum neurofilament light chain dynamics in the first weeks of life predict motor outcome in preterm infants with PIVH.

In-Hospital Mortality and Trends Associated with Splenectomy in Patients with Immune-Mediated Thrombocytopenia (ITP).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1398-1398
Author(s):  
Samantha M. Jaglowski ◽  
John C. Byrd ◽  
Jeffrey A. Jones
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Medical Management ◽  
Regression Models ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Teaching Status ◽  
Observation Period

Abstract Abstract 1398 Poster Board I-420 Background: Splenectomy remains a standard treatment for ITP patients not responding to medical management, but anecdotal reports suggest that use of the procedure is in decline. We studied patterns of use and outcome of splenectomy performed for ITP at the population level. Methods: Using data from the Nationwide Inpatient Sample and ICD-9 diagnosis and procedure codes, we identified 39,543 splenectomies among hospital admissions including a diagnosis of ITP (ICD-9 287.3) from 1993-2005. Admissions were characterized by patient and hospital facility characteristics. Laparascopic procedures were identified by published procedure coding algorithms. Factors influencing in-hospital mortality for 2005 were further evaluated using multivariate logistic regression models. Results: Annual estimates for incidence of splenectomy are displayed in Figure 1. Between 1993 and 2005, there was a decrease in the total number of splenectomies performed for ITP, with the most significant drop occurring from 1997 to 2000, concurrent with the FDA approval of rituximab. Over the same period, there has been an increase in the proportion of splenectomies performed laparoscopically from 3.4% to 18.6%. Patient gender, age, presence of comorbid malignancy, and Charlson score were not significantly associated with type of splenectomy procedure. Among facility factors, only hospital teaching status was a statistically significant predictor of laparoscopic splenectomy use, early but not later in the observation period. On an annual basis, in-hospital mortality did not vary significantly over the observation period, with risks ranging from 1.5% (95% CI 0.83-2.86%) in 1993 to 4% (95% CI 2.8%-5.7%) in 1997. Annual mortality risk between open and laparoscopic procedures likewise did not significantly differ. However, over the total 13-year observation period there was a >60% increased risk of death with an open versus laparoscopic procedure (OR 1.669, p<0.0001). In 2005, 2869 splenectomy procedures were performed. Multivariate logistic regression models for in-hospital mortality that year found that presence of a malignancy (OR 9.65, p=0.003) significantly increased mortality risk. Charlson comorbidity approached statistical significance (0 v. ≥1, OR 6.83, p=0.087). Hospital bed-size (OR 0.87, p=0.73), location (rural v. urban, OR 3.80, p=0.127), and teaching status (OR 0.39, p=0.203) were not significantly associated with outcome. Conclusions: While the overall mortality risk from splenectomy in ITP is low, it is influenced by the presence of malignancy and other comorbid conditions. Further studies designed to evaluate newer medical management strategies (e.g. rituximab, thrombopoeitin mimetics, etc.) versus surgical intervention in these higher-risk populations are warranted. Disclosures: No relevant conflicts of interest to declare.

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