Medical Statistics

Belgrade, Serbia

Medical Statistics

Belgrade, Serbia

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Iversen L.,Primary Care | Hannaford P.C.,Primary Care | Lee A.J.,Medical Statistics | Fielding S.,University of Aberdeen
British Journal of General Practice | Year: 2010

Background Although many individuals have multiple lifestyle risk factors, tew studies have investigated the impact of lifestyle risk factor combinations among women. Aim To investigate the relationship between individual and combinations of lifestyle risk factors in middle-aged women with subsequent mortality, and to estimate the associated population attributable risks. Design of study Prospective cohort study. Setting Royal College of General Practitioners' (RCGP) Oral Contraception Study, UK. Method In 1994-1995, women remaining under follow-up in the RCGP Oral Contraception Study were sent a lifestyle survey, from which modifiable risk factors were identified: pack-years smoked, physical inactivity, never drinking versus consuming at least 7 units of alcohol weekly, and being underweight, overweight, or obese. The cohort was followed to December 2006 or death. Population attributable risks were calculated. Results Of 10 059 women studied, 896 died. Pack-years smoked (11-20 years: adjusted hazard ratio [HR] = 1.82, 95% confidence interval [Cl] = 1.46 to 2.27; >20 years: adjusted HR = 2.34, 95% Cl = 2.00 to 2.74); never drinking alcohol (adjusted HR = 1.66, 95% Cl = 1.34 to 2.05); being underweight (adjusted = HR 1.66, 95% Cl = 1.03 to 2.68); and physical inactivity (<15 hours/week: adjusted HR = 1.73, 95% Cl = 1.46 to 2.04) were significantly associated with mortality compared with their respective reference group. Women with multiple lifestyle risk factors had higher mortality risks than those reporting one factor. The population attributable risk of the combination of smoking, physical inactivity, body mass index outside normal range, and alcohol (never drinking or excess intake) was 59% (95% Cl = 31 % to 78%). Conclusion Assuming a causal relationship between lifestyle and mortality, avoidance of four lifestyle risk factors would have prevented 60% of the deaths. The importance of avoiding smoking and undertaking physical inactivity during midlife should continue to be emphasised. © British Journal of General Practice 2010.


Mitrakas L.,University of Thessaly | Gravas S.,University of Thessaly | Karasavvidou F.,University of Thessaly | Dimakopoulos G.,Medical Statistics | And 5 more authors.
Tumor Biology | Year: 2015

Endothelin-1 (ET-1) is a multifunctional peptide exerting its effects via receptors A and B. ET-1 and its receptors, endothelin axis (ET axis), play a promoting role in cancer biology. Alterations of proteins of ET axis have been detected in non-metastatic muscle-invasive bladder cancer (NMMIBC). The objective of this study is to investigate the potential role of ET-1 tumor expression as a biomarker of prognosis, compared to other prognostic parameters (epidemiologic and pathologic), in NMMIBC. We prospectively included 40 consecutive, primary, high-grade NMMIBC patients. Tumor specimens after initial transurethral resection were stained immunohistochemically for ET-1. The ET-1 evaluation of expression was based on staining intensity (SI) of ET-1. SI was classified according to an arbitrary four-tiered scale (negative = 0, mild = 1, moderate = 2, strong = 3). Epidemiologic and pathologic parameters were analyzed, using univariate and multivariate statistics, for disease progression, progression-free survival (PFS), and overall survival (OS). ET-1 overexpression (SI = 3) was the unique parameter which associated significantly, both in univariate (log-rank test, p = 0.033) and multivariate (Cox regression analysis, p = 0.045, HR = 4.849, 95 % CI: 1.039–22.624) analysis, with an increased hazard ratio of progression. ET-1 overexpression (SI = 3) was also the unique parameter which associated, marginally significantly in univariate analysis (log-rank test, p = 0.056) and highly significantly in multivariate analysis (Cox regression analysis, p = 0.005, HR = 7.001, 95 % CI: 1.782–27.501), with an increased hazard ratio of death. Overexpression of ET-1 may be a potential biomarker of unfavorable prognosis in NMMIBC patients. © 2015, International Society of Oncology and BioMarkers (ISOBM).


Wiskin C.,University of Birmingham | Duffy J.,Medical Statistics | Weetman K.,University of Warwick | Skelton J.,University of Birmingham | Swindells C.,Salford Royal NHS Foundation Trust
British Journal of Health Care Management | Year: 2016

This article reports changes in mindset and attitudes of a cohort of 798 NHS managers in relation to the implementation of a new NHS trust-wide performance appraisal system. This was measured through two methods: the statistical analysis of data collected before and after an intensive training/orientation intervention by means of χ2 tests; and a corpus linguistic analysis of word associations and text comments that is novel to the literature. © 2016 MA Healthcare Ltd.


Kachewar S.G.,RMC | Gandage S.G.,RMC | Pawar H.J.,Medical Statistics
Journal of Clinical and Diagnostic Research | Year: 2012

Purpose: The assessment of foetal Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) is useful in non-invasively diagnosing foetal anaemias, irrespective of their cause. A study was therefore undertaken to find out its effectiveness in the local obstetric population. Materials and methods: Doppler ultrasound measurements of foetal MCA-PSV were done in 1200 pregnant women who were referred for antenatal ultrasound between 12-40 weeks of gestation. The statistical analysis was done by using Microsoft Excel 2007 and SPSS software, version 12. Results: A statistically significant (p < 0.05) positive correlation was found to exist between the gestational age and MCA-PSV. 14 foetuses had their MCA-PSV elevated enough to label them as being anaemic. Iso-immunization was seen in 4 foetuses, severe maternal hypertension in 4, foetal parvo virus B19 infection in 3 and thalassemia in 3. Also, a disturbed MCA waveform pattern (The K-G waveform) was transiently seen in few cases with normal MCA-PSV values (The Pravara Effect). Conclusion: Foetal MCA-PSV can objectively demonstrate foetal anaemia in pregnant patients, irrespective of the underlying cause. Every effort must therefore be made to use this non-invasive test to look for foetal anaemia in the obstetric population.


Eckstein C.,Hospital Barmherzige Bruder Regensburg | Kottmann T.,Medical Statistics | Fuchtmeier B.,Hospital Barmherzige Bruder Regensburg | Muller F.,Hospital Barmherzige Bruder Regensburg
International Orthopaedics | Year: 2016

Purpose: Long-term results after treatment of calcaneal fractures are rare. For this reason, we conducted a retrospective follow-up after a minimum of 20 years post surgery. Methods: Between 1990 and 1994, a total of 66 patients received surgical treatment for displaced calcaneal fractures. At that time, osteosynthesis was performed using small, one-third tubular plates. After collecting empirical data, we conducted a follow-up at least 20 years post surgery using X-ray imaging and clinical questionnaires (AOFAS and SF-36 questionnaire). Results: It was possible to recruit a total of 22/66 patients (33 %) after a mean of 22 years (range, 20–24) post surgery. With regard to the AOFAS scores (mean value, 74 points), 12 showed very good or good results, four showed average and six poor results. Patients with orthopaedic shoes also had low AOFAS scores. The Boehler’s angle had been increased from +2° prior to surgery to +21° post-operatively. At the time of follow-up, the mean value was +17°. The angle correlated with the AOFAS score. Also, the SF-36 physical score was clearly reduced when compared to a general population, and correlated significantly with the AOFAS score. Conclusion: There is still no evidence that open reduction and internal fixation of calcaneal fractures results in better outcomes than conservative therapy. This has been confirmed by our long-term results that provided disillusioning results: in a small population, only 55 % of the patients showed very good or good clinical overall results. Furthermore, SF-36 showed impaired physical subscores, which correlated significantly with the AOFAS. © 2015, SICOT aisbl.


PubMed | Hospital Barmherzige Bruder Regensburg and Medical Statistics
Type: Journal Article | Journal: International orthopaedics | Year: 2016

Long-term results after treatment of calcaneal fractures are rare. For this reason, we conducted a retrospective follow-up after a minimum of 20years post surgery.Between 1990 and 1994, a total of 66 patients received surgical treatment for displaced calcaneal fractures. At that time, osteosynthesis was performed using small, one-third tubular plates. After collecting empirical data, we conducted a follow-up at least 20years post surgery using X-ray imaging and clinical questionnaires (AOFAS and SF-36 questionnaire).It was possible to recruit a total of 22/66 patients (33%) after a mean of 22years (range, 20-24) post surgery. With regard to the AOFAS scores (mean value, 74 points), 12 showed very good or good results, four showed average and six poor results. Patients with orthopaedic shoes also had low AOFAS scores. The Boehlers angle had been increased from +2 prior to surgery to +21 post-operatively. At the time of follow-up, the mean value was +17. The angle correlated with the AOFAS score. Also, the SF-36 physical score was clearly reduced when compared to a general population, and correlated significantly with the AOFAS score.There is still no evidence that open reduction and internal fixation of calcaneal fractures results in better outcomes than conservative therapy. This has been confirmed by our long-term results that provided disillusioning results: in a small population, only 55% of the patients showed very good or good clinical overall results. Furthermore, SF-36 showed impaired physical subscores, which correlated significantly with the AOFAS.


Kennedy M.B.,Brighton and Sussex Medical School | Malik M.,Medical Statistics | Haq I.,University of Sydney | Williams S.E.,University of Brighton | Okorie M.,Medicine and Medical Education
BMC Medical Education | Year: 2016

Background: The aim of this study was to determine the training provisions in practical safe prescribing for foundation doctors in NHS hospitals located in the South Thames region. Methods: A web-based questionnaire was distributed by e-mail to all 1762 foundation doctors in the South Thames Foundation School (STFS) region. In addition, a separate questionnaire was distributed to prescribing training Leads at 15 NHS Hospital Trusts. Quantitative data were analysed using descriptive statistics and thematic analysis was performed on qualitative data. Results: Trainers: 10 Prescribing Leads (67 %) responded. Of the 9 NHS Trusts that offered safe prescribing training in their induction programme, 5 included a practical prescribing session. By the end of the foundation year, 6 NHS Trusts had provided at least one dedicated practical prescribing session for F1s compared with 2 NHS Trusts for F2s. Trainees: A total of 124 foundation trainees (7.2 %) responded (69 F1s and 55 F2s). 87 % of F1s received dedicated training in safe prescribing at their Trust induction (n = 60) in comparison to 49 % of F2s (n = 27). 80 % of F1s (n = 55) had a practical prescribing session during induction versus 27 % of F2s (n = 15). The difference was significant, X 2 (1, N = 124) = 34.23, p <0.0001. Emerging themes from qualitative data included, recognition of medical education as a continuum, importance of working relationships with pharmacists and neglect of F2s. Conclusions: There appears to be a lack of emphasis on the training of F2 doctors in practical safe prescribing compared with F1 doctors. There should be standardisation of safe prescribing training provisions, particularly in the induction period and for F2 doctors. © 2016 The Author(s).


PubMed | University of Brighton, University of Sydney, Brighton and Sussex Medical School, Medical Statistics and Medicine and Medical Education
Type: Journal Article | Journal: BMC medical education | Year: 2016

The aim of this study was to determine the training provisions in practical safe prescribing for foundation doctors in NHS hospitals located in the South Thames region.A web-based questionnaire was distributed by e-mail to all 1762 foundation doctors in the South Thames Foundation School (STFS) region. In addition, a separate questionnaire was distributed to prescribing training Leads at 15 NHS Hospital Trusts. Quantitative data were analysed using descriptive statistics and thematic analysis was performed on qualitative data.Trainers: 10 Prescribing Leads (67%) responded. Of the 9 NHS Trusts that offered safe prescribing training in their induction programme, 5 included a practical prescribing session. By the end of the foundation year, 6 NHS Trusts had provided at least one dedicated practical prescribing session for F1s compared with 2 NHS Trusts for F2s. Trainees: A total of 124 foundation trainees (7.2%) responded (69 F1s and 55 F2s). 87% of F1s received dedicated training in safe prescribing at their Trust induction (n=60) in comparison to 49% of F2s (n=27). 80% of F1s (n=55) had a practical prescribing session during induction versus 27% of F2s (n=15). The difference was significant, X (2) (1, N=124)=34.23, p <0.0001. Emerging themes from qualitative data included, recognition of medical education as a continuum, importance of working relationships with pharmacists and neglect of F2s.There appears to be a lack of emphasis on the training of F2 doctors in practical safe prescribing compared with F1 doctors. There should be standardisation of safe prescribing training provisions, particularly in the induction period and for F2 doctors.


Mattei A.,Medical Statistics | Sbarbati M.,Local Health Unit of Rieti | Fiasca F.,Clinical Medicine and Public Health | Angelone A.M.,Health Science University | And 2 more authors.
Human Vaccines and Immunotherapeutics | Year: 2016

AGE severity is linked to etiology, and Rotavirus (RV) accounts for most of severe cases. In 2009 the World Health Organization recommended RV vaccination for all children. Worldwide a number of Countries implemented RV vaccination in their pediatric immunisation programmes, but only a limited number in Europe. This study was designed to estimate the proportion of RVGE among children aged <6 y who were diagnosed with AGE and admitted to hospitals in Italy during the years 2005–2012. A total of 334,982 hospital discharge forms were collected, being 79,344 hospitalizations associated with RV. The average hospitalization rate (HR) was 146/100,000 children for RVGE in primary diagnosis (PD) and 150/100,000 children for RVGE in secondary diagnosis (SD). Since 2008 the RVGE hospitalization figures and rates (HRs) in SD exceed those in PD. The majority of RVGE hospitalizations (33.67%) were reported among children aged ≤ 2 years. Despite some limitations due to the hospital discharge database (HDD) synthetic contents and low potential for clinical interpretation, the analysis of national HDD, including PD and SD, documents that RV still represents a consistent cause of pediatric hospitalizations in Italy. © 2016, © Antonella Mattei, Margherita Sbarbati, Fabiana Fiasca, Anna Maria Angelone, Maria Chiara Mazzei, and Ferdinando di Orio.


Blach O.,Royal Sussex County Hospital | Ali A.,Royal Sussex County Hospital | Goubet S.,Medical Statistics | Nawrocki J.,Royal Sussex County Hospital | And 2 more authors.
Journal of Clinical Urology | Year: 2015

Objective: This study represents the first direct comparison of management of epididymo-orchitis (EO) by Accident and Emergency (A&E), Urology and Genito-Urinary Medicine (GUM) departments in a large tertiary care centre, and their compliance with international guidelines. Methods: Case notes of patients with EO who attended A&E, Urology and GUM between January and June 2014 were analysed retrospectively. Results: A total of 127 men were seen (median age: 33, range: 15–79). Forty-four attended A&E (median age: 35), 30 Urology (median age: 37), and 53 GUM (median age: 31). MSU was sent in 17/44 (38.6%) of A&E, 11/30(36.7%) of Urology, and 35/53(66%) of GUM patients. Fifty-three of 53 (100%) of GUM, 14/44 (31.8%) of A&E and four of 30 (13.3%) of Urology patients had chlamydia and gonorrhoea NAAT testing. Of these, 90.9% of A&E, 93.3% of Urology and 100% of GUM patients were prescribed antibiotics. Twelve A&E and one Urology patient were referred to GUM. Conversely, only three of 11 A&E and zero of five GUM patients aged over 50 were referred for urological follow-up. Conclusion: The management of EO, especially in younger men at risk of STIs by A&E and Urology, and older men at risk of urological problems by GUM, is an area for significant improvement. Closer co-operation between departments, unifying local management protocols, abandoning the traditional demographic divide, and ensuring effective referral pathways are essential to improving care. © 2015, © British Association of Urological Surgeons 2015.

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