scholarly journals Physician-Related Variability in the Outcomes of an Invasive Treatment for Neck and Back Pain: A Multi-Level Analysis of Data Gathered in Routine Clinical Practice

2021 ◽  
Vol 18 (8) ◽  
pp. 3855
Author(s):  
Ana Royuela Vicente ◽  
Francisco M. Kovacs ◽  
Jesús Seco-Calvo ◽  
Borja M. Fernández-Félix ◽  
Víctor Abraira ◽  
...  
Keyword(s):  
Back Pain ◽  
Regression Models ◽  
Intraclass Correlation ◽  
Spinal Pain ◽  
Routine Clinical Practice ◽  
Invasive Treatment ◽  
Logistic Regression Models ◽  
Training Standards ◽  
Multi Level ◽  
Level Analysis

Neuro-reflexotherapy (NRT) is a proven effective, invasive treatment for neck and back pain. To assess physician-related variability in results, data from post-implementation surveillance of 9023 patients treated within the Spanish National Health Service by 12 physicians were analyzed. Separate multi-level logistic regression models were developed for spinal pain (SP), referred pain (RP), and disability. The models included all patient-related variables predicting response to NRT and physician-related variables. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were calculated. Adjusted MOR (95% CI) was 1.70 (1.47; 2.09) for SP, 1.60 (1.38; 1.99) for RP, and 1.65 (1.42; 2.03) for disability. Adjusted ICC (95%CI) values were 0.08 (0.05; 0.15) for SP, 0.07 (0.03; 0.14) for RP, and 0.08 (0.04; 0.14) for disability. In the sensitivity analysis, in which the 6920 patients treated during the physicians’ training period were excluded, adjusted MOR was 1.38 (1.17; 1.98) for SP, 1.37 (1.12; 2.31) for RP, and 1.25 (1.09; 1.79) for disability, while ICCs were 0.03 (0.01; 0.14) for SP, 0.03 (0.00; 0.19) for RP, and 0.02 (0.00; 0.10) for disability. In conclusion, the variability in results obtained by different NRT-certified specialists is reasonable. This suggests that current training standards are appropriate.

Multi-level analysis of symptoms of poison exposure reported to the Japanese Poison Information Center

2020 ◽  
Vol 35 (3) ◽  
pp. 239-243
Author(s):  
Toshiko Sawaguchi
Keyword(s):  
Odds Ratio ◽  
Regression Models ◽  
Profile Likelihood ◽  
Numerical Data ◽  
Logistic Regression Models ◽  
Information Center ◽  
Causative Agents ◽  
Optimized Model ◽  
Multi Level ◽  
Level Analysis

AbstractTwo types of analytical multi-level approach to analyse symptoms after exposure to poisons were performed using numerical data extracted from reports received by the JAPAN POISON INFORMATION CENTER on the number “Poisoning 110” during 1998–2017. In the first approach, data collected in 2017, 2012, 2007 and 2002 were used, while in the second approach, all data collected during 1999–2017 were used. In the first approach, according to the odds ratio, the order of causative agents was industrial drugs>home drugs>general drugs and in the second approach, it was industrial drugs>foods/natural poisoning>agricultural drugs. However, in the first approach, the order based on the 95% confidence interval (CI) and profile likelihood was general drugs>home drugs>industrial drugs and in the second approach, the order based on 95% CI, profile likelihood and Wald value was agricultural drugs>foods/natural poisoning>industrial drugs. These multi-prospects were developed using a multilevel approach and the most optimized model was selected from the number of numerical data and the adaptability of fit of the multi-level logistic regression models in this report.

scholarly journals Use of Electronic Health Records for Early Detection of High-Cost, Low Back Pain Patients

2015 ◽  
Vol 20 (5) ◽  
pp. 234-240 ◽  
Author(s):  
Daniel D Maeng ◽  
Walter F Stewart ◽  
Xiaowei Yan ◽  
Joseph A Boscarino ◽  
Jack Mardekian ◽  
...  
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Low Back Pain ◽  
Back Pain ◽  
Care Provider ◽  
Regression Models ◽  
Low Back ◽  
Health Records ◽  
Logistic Regression Models ◽  
Electronic Health

BACKGROUND: Low back pain (LBP) is a debilitating condition that is complex to manage. One reason is that clinicians lack means to identify early on patients who are likely to become high care utilizers.OBJECTIVE: To explore the feasibility of developing a ‘dynamic’ predictive model using electronic health record data to identify costly LBP patients within the first year after their initial LBP encounter with a primary care provider. Dynamic, in this context, indicates a process in which the decision on how to manage patients is dependent on whether they are at their first, second or third LBP visit with the provider.METHODS: A series of logistic regression models was developed to predict who will be a high-cost patient (defined as top 30% of the cost distribution) at each of the first three LBP visits.RESULTS: The c-statistics of the three logistic regression models corresponding to each of the first three visits were 0.683, 0.795 and 0.741, respectively. The overall sensitivity of the model was 42%, the specificity was 86% and the positive predictive value was 48%. Men were more likely to become expensive than women, while patients who had workers’ compensation as their primary payer type had higher use of prescription opioid drugs or were smokers before the first LBP visit were also more likely to become expensive.CONCLUSION: The results suggest that it is feasible to develop a dynamic, primary care provider visit-based predictive model for LBP care based on longitudinal data obtained via electronic health records.

scholarly journals When Europe hits the subnational authorities: the transposition of EU directives in Germany between 1990 and 2018

2020 ◽  
pp. 1-20
Author(s):  
Jana Paasch ◽  
Christian Stecker
Keyword(s):  
European Union ◽  
Policy Implementation ◽  
Regression Models ◽  
Black Box ◽  
Veto Power ◽  
Data Set ◽  
Logistic Regression Models ◽  
Eu Policies ◽  
Eu Directives ◽  
Multi Level

Abstract Federalism and the associated multi-level polity-structure have been frequently blamed for delaying the implementation of European Union (EU) directives. However, this verdict is incomplete as only a few studies open the “black box” of federalism to analyse the involvement of subnational parliaments and executives or second chambers in policy implementation. This article fills this gap and explains the transposition delay on the level of each individual implementation measure. Our novel data set covers about 850 directives and the corresponding 1,950 implementation measures between 1990 and 2018 in Germany. Using logistic regression models, we find that involving the subnational authorities substantially delays transposition. Subnational measures are three times more likely to be delayed than national ones. The effect of the veto power of a second chamber remains inconclusive. Our findings highlight the challenges federalism poses for the multi-level implementation of EU policies and have implications for the broader literature on compliance with public policies.

POST-IMPLEMENTATION SURVEILLANCE OF A NON-PHARMACOLOGICAL HEALTH TECHNOLOGY WITHIN A NATIONAL HEALTH SERVICE

2014 ◽  
Vol 30 (2) ◽  
pp. 153-164 ◽  
Author(s):  
Carlos Campillo ◽  
Montserrat Casamitjana ◽  
Fernando Carrillo-Arias ◽  
Ana Royuela ◽  
Francisco M. Kovacs ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Back Pain ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Regression Models ◽  
Health Technology ◽  
Logistic Regression Models ◽  
Post Marketing Surveillance ◽  
Discharged Patients

Objectives: The aim of this study was to describe 8-year results from post-implementation surveillance of neuroreflexotherapy (NRT), a health technology proven effective for treating neck and back pain.Methods: Post-implementation surveillance included all patients undergoing NRT across five regions within the Spanish National Health Service (SNHS). Validated methods were used to assess pain, disability, adverse events, use of health resources, and patient satisfaction. Logistic regression models were developed to identify the variables associated with the risk of a pain episode requiring more than one NRT intervention. The number of relapses among discharged patients during the 8-year period was calculated.Results: Between January 1, 2004, and June 30, 2012, 9,023 patients (median age: 53 years), presenting 11,384 subacute (25.2 percent) and chronic (74.8 percent), neck or back pain episodes, were discharged after receiving NRT. Spinal pain improved in 89 percent of cases, 83 percent abandoned drugs, and 0.02 percent required spine surgery. The only adverse event was skin discomfort (8.0 percent of patients). Number of patient complaints was 0, and answers to a standardized questionnaire reflected a high degree of satisfaction (response rate: 76.7 percent). Of the pain episodes, 18.9 percent required more than one NRT intervention; logistic regression models identified the variables associated with this. Over the 8-year period, the proportion of discharged patients referred for treatment due to relapse at the same level for neck, thoracic, and low back pain, was 16.4 percent, 6.5 percent, and 14.5 percent respectively.Conclusions: Post-marketing surveillance for a non-pharmacological technology is feasible within the SNHS. These results support generalizing NRT across the entire SNHS under the current validated application conditions.

scholarly journals Factors associated with back pain in children aged 6 to 12 years of age, an eight months prospective study

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Claire Henriot-Jéhel ◽  
Jocelyn Lemire ◽  
Caroline Teulier ◽  
André Bussières ◽  
Arnaud Lardon
Keyword(s):  
Back Pain ◽  
Aerobic Capacity ◽  
Primary Schools ◽  
Regression Models ◽  
Sport Activity ◽  
Text Messages ◽  
Muscular Endurance ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Baseline Characteristics

AbstractAssociated factors of back pain (BP) development before puberty and its persistence are poorly documented. We investigated the association and possible temporality between prior BP history (PBPH), muscular endurance (ME), aerobic capacity (AC), sport activity variables (SAV) and BP in children aged 6 to 12. We collected baseline characteristics (demographics, PBPH, ME, AC and SAV) of children from three primary schools in Canada. Parents replied to weekly text messages regarding their children BP status over an 8-month period. Logistic regression models were adjusted for potential confounders. Data from 242 children (46% female; 8.6 ± 1.7 years) were included. Over the 8-month survey BP prevalence was 48.1%, while the cumulative incidence was 31.9%. The occurrence of at least one BP event was associated with PBPH [OR (IC 95%) = 6.33 (2.35–17.04)] and high AC [2.89 (1.21–6.90)]. High AC was also associated with the development of a first BP episode [2.78 (1.09–7.07)], but ME and SAV were not. BP appears to be relatively common before puberty. BP history seems to be strongly associated with BP recurrence in children. Aerobic capacity is associated with first BP episode development.

Evaluation of speech misattribution bias in schizophrenia

2009 ◽  
Vol 40 (5) ◽  
pp. 741-748 ◽  
Author(s):  
M. Stephane ◽  
M. Kuskowski ◽  
K. McClannahan ◽  
C. Surerus ◽  
K. Nelson
Keyword(s):  
Regression Models ◽  
Group Differences ◽  
Response Accuracy ◽  
Cognitive Demands ◽  
Logistic Regression Models ◽  
Recognition Ability ◽  
Third Person ◽  
General Recognition ◽  
Multi Level ◽  
And Gender

BackgroundThe attribution of self-generated speech to others could explain the experience of verbal hallucinations. To test this hypothesis, we developed a task to simultaneously evaluate (A) operations of self-other distinction and (B) operations that have the same cognitive demands as in A apart from self-other distinction. By adjusting A to B, operations of self-other distinction were specifically evaluated.MethodThirty-nine schizophrenia patients and 26 matched healthy controls were required to distinguish between self-generated, other-generated and non-generated (self or other) sentences. The sentences were in the first, second or third person and were read in a male or female voice in equal proportions. Mixed multi-level logistic regression models were used to investigate the effect of group, sentence source, pronoun and gender of the heard sentences on response accuracy.ResultsPatients differed from controls in the recognition of self-generated and other-generated sentences but not in general recognition ability. Pronoun was a significant predictor of response accuracy but without any significant interaction with group. Differences in the gender of heard sentences were not significant. Misattribution bias differentiated groups only in the self-other direction.ConclusionsThese data support the theory that misattribution of self-generated speech to others could result in verbal hallucinations. The syntactic (pronoun) factor could impact self-other distinction in subtypes of verbal hallucinations that are phenomenologically defined whereas the acoustic factor (gender of heard speech) is unlikely to affect self-other distinction.

scholarly journals Five risk factors and their interactions of probability for a sow in breeding herds having a piglet death during days 0–1, 2–8 and 9–28 days of lactation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuzo Koketsu ◽  
Ryosuke Iida ◽  
Carlos Piñeiro
Keyword(s):  
Regression Models ◽  
Management Practices ◽  
Gestation Length ◽  
Early Lactation ◽  
Logistic Regression Models ◽  
Five Factors ◽  
More Care ◽  
Parity Number ◽  
Multi Level ◽  
Piglet Mortality

Abstract Background Increasing preweaning piglet mortality is a concern for veterinarians and producers in relation to sow performance and piglet welfare. Our objectives were (1) to characterize pre-weaning piglet mortality risk for sows (PWM) during early (0–1 days), mid- (2–8 days) and late (9–28 days) lactation and (2) to quantify the following five factors and their interactions, parity, number of piglets born alive (PBA), number of stillborn piglets (SB), gestation length (GL) and season for PWM during the three lactation phases. Methods Data obtained from 264,333 parity records of 55,635 sows farrowed in 2015 and 2016 from 74 Spanish herds. Three multi-level mixed-effects logistic regression models were separately applied for PWM during three lactation phases, which was analyzed as whether or not a sow had a piglet death (i.e. probability of a sow having a piglet death) in each phase. Results PWM during early, mid- and late lactation were 36.9, 27.0 and 15.4%, respectively. As PBA increased from 11 or less to 16 or more pigs, PWM during early and mid-lactation increased by 15.8 and 6.0%, respectively, but there was no increase during late lactation. Also, as GL decreased from 117–120 to 110–113 days, PWM during early, mid- and late lactation increased by 7.5, 6.8 and 1.5%, respectively. Additionally, PWM during the respective lactation phases increased by 8.3, 5.2 and 1.0%, as SB increased from 0 to 3 or more pigs. During early lactation, parity 1 sows had 2.1% lower PWM than parity 5 or higher sows, but during mid- and late lactation they had 4.2% higher PWM (P < 0.05). However, there was no difference between summer and winter for PWM during early lactation (P = 0.26). Conclusion Management practices to reduce PWM need to take account of these factors, and be modified for different phases. For example, during early lactation special care should be given to piglets born to parity 5 or higher sows farrowing 16 or more PBA, having 3 or more SB or GL 110–113 days, whereas during mid- and late lactation more care should be given to piglets born to parity 1 sows with the same PBA, GL and SB conditions.

Sign in / Sign up

Export Citation Format

Share Document