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1.
Clin J Sport Med ; 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32032160

RESUMO

OBJECTIVE: To describe injury rates and injury patterns in the Canadian Football League (CFL) according to time during the season, player position, injury type, and injury location. DESIGN: Prospective, cohort study. SETTING AND PARTICIPANTS: Eight seasons from CFL injury surveillance database. INDEPENDENT VARIABLES: Depending on the analysis, time of season (preseason, regular, and playoffs), player position, injury type, and injury location. MAIN OUTCOME MEASURES: Medical attention and time-loss injury rates per 100 athletes at risk (AAR), and prevalence of time-loss injuries per week. RESULTS: The average game injury rate was 45.2/100 AAR medical attention injuries and 30.7/100 AAR time-loss injuries. Injury rates declined by 1% per week over the season for both medical attention (rate ratio = 0.99) and time-loss (rate ratio = 0.99) injuries, with a substantial decline during the playoffs compared with preseason (rate ratio = 0.70-0.77). The number of ongoing time-loss injuries increased over the course of the regular season. Quarterbacks, offensive backs, and linebackers had the highest game injury rates. Joint/ligament and muscle/tendon injuries were the most common injury types for games and practices, respectively. The lower extremity was the most commonly affected area, specifically the lower leg/ankle/foot and hip/groin/thigh. CONCLUSIONS: There was a 1% decline in injury rate per week during the season and a 30% decline during the playoffs. The number of ongoing time-loss injuries increased over the regular season. Current results can aid league officials and medical staff in making evidence-based decisions concerning player safety and health.

2.
Clin Pediatr (Phila) ; : 9922820903421, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32003235
3.
Clin Pediatr (Phila) ; : 9922820905860, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054290
4.
Biom J ; 62(1): 69-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31553488

RESUMO

We consider the problem of meta-analyzing two-group studies that report the median of the outcome. Often, these studies are excluded from meta-analysis because there are no well-established statistical methods to pool the difference of medians. To include these studies in meta-analysis, several authors have recently proposed methods to estimate the sample mean and standard deviation from the median, sample size, and several commonly reported measures of spread. Researchers frequently apply these methods to estimate the difference of means and its variance for each primary study and pool the difference of means using inverse variance weighting. In this work, we develop several methods to directly meta-analyze the difference of medians. We conduct a simulation study evaluating the performance of the proposed median-based methods and the competing transformation-based methods. The simulation results show that the median-based methods outperform the transformation-based methods when meta-analyzing studies that report the median of the outcome, especially when the outcome is skewed. Moreover, we illustrate the various methods on a real-life data set.

5.
Clin Pediatr (Phila) ; 59(2): 208-210, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31244331
6.
Clin Pediatr (Phila) ; 59(2): 205-207, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31244339
7.
Clin Pediatr (Phila) ; 59(1): 31-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31603009

RESUMO

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed "extensively resistant typhi," has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31535689

RESUMO

OBJECTIVE: Interstitial lung disease (ILD) is a leading cause of mortality in SSc. Little is known about the benefits of immunosuppressive drugs in mild ILD. Our aim was to determine whether use of CYC or MMF was associated with an improved ILD course in patients with normal or mildly impaired lung function. METHODS: A retrospective cohort of SSc subjects with ILD, disease duration below seven years and no exposure to CYC or MMF prior to the baseline visit was constructed from the Canadian Scleroderma Research Group registry. Subjects were categorized as having mild ILD if baseline forced vital capacity (FVC % predicted) was >85%. The primary exposure was any use of CYC or MMF at the baseline visit. FVC at one year was compared between exposed and unexposed subjects, using multivariate linear regression. RESULTS: Out of 294 eligible SSc-ILD subjects, 116 met criteria for mild ILD. In this subgroup, mean (s.d.) disease duration was 3.7 (2.0) years. Thirteen (11.2%) subjects were exposed to CYC or MMF at baseline. The one-year FVC was higher in exposed subjects compared with unexposed subjects, by a difference of 8.49% (95% CI: 0.01-16.98%). None of the exposed subjects experienced clinically meaningful progression over two years, whereas 24.6% of unexposed subjects did. CONCLUSION: In this real-world setting, CYC/MMF exposure at baseline was associated with higher FVC values and a lower risk of progression among subjects with mild ILD. These data suggest a window of opportunity to preserve lung function in SSc-ILD.

9.
BMJ Evid Based Med ; 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31439540

RESUMO

Properly interpreting research results is the foundation of evidence-based medicine. Most observational studies use multiple regression and report adjusted effects. In randomised trials, adjusted effects are often provided when there are chance baseline imbalances. The estimates for the exposure of interest (eg, treatment) from these adjusted analyses are usually interpreted as population average causal effects (PACEs); for example, what would be the difference in the mean outcome if everyone in the population was treated versus untreated? In this paper, we show this interpretation is incorrect when there is an interaction between treatment and other variables with respect to the outcome. We provide the appropriate methods to calculate the PACE from regression analyses and also introduce alternative methods that have gained popularity over the last 20 years. Finally, we explain why researchers should be cautious when excluding interaction terms based on p values.

12.
Stat Med ; 38(6): 969-984, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30460713

RESUMO

An aggregate data meta-analysis is a statistical method that pools the summary statistics of several selected studies to estimate the outcome of interest. When considering a continuous outcome, typically each study must report the same measure of the outcome variable and its spread (eg, the sample mean and its standard error). However, some studies may instead report the median along with various measures of spread. Recently, the task of incorporating medians in meta-analysis has been achieved by estimating the sample mean and its standard error from each study that reports a median in order to meta-analyze the means. In this paper, we propose two alternative approaches to meta-analyze data that instead rely on medians. We systematically compare these approaches via simulation study to each other and to methods that transform the study-specific medians and spread into sample means and their standard errors. We demonstrate that the proposed median-based approaches perform better than the transformation-based approaches, especially when applied to skewed data and data with high inter-study variance. Finally, we illustrate these approaches in a meta-analysis of patient delay in tuberculosis diagnosis.

13.
Patient Educ Couns ; 102(4): 735-741, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30545649

RESUMO

OBJECTIVE: Bibliotherapy refers to psychological self-help interventions that utilize treatment books to improve psychological well-being. Research supports bibliotherapy as an efficacious intervention for a variety of mental health problems. Yet, few studies have investigated bibliotherapy in psychosocial oncology. The objective of this randomized controlled trial was to examine the efficacy of the NuCare intervention, delivered as a self-directed workbook, for enhancing empowerment, coping, and quality of life and reducing distress in patients with cancer. METHODS: Eighty-nine adult patients with cancer were randomized to receive the workbook for 6 weeks or the control condition, usual care. Participants completed questionnaires at baseline, 6 weeks post-baseline, and 10 weeks post-baseline. RESULTS: The increase of empowerment (main outcome) and quality of life and the decrease of distress in the NuCare group from pre-intervention to follow-up assessment differed significantly from the respective difference scores in the control group. CONCLUSIONS: The self-administered NuCare workbook is a potentially cost-effective, minimal intervention addressing psychosocial needs of patients with cancer. PRACTICE IMPLICATIONS: Evidence-based bibliotherapy can empower patients and has the promise of reducing the burden on the healthcare system while enhancing the immediacy of psychosocial support.


Assuntos
Biblioterapia , Neoplasias/psicologia , Neoplasias/terapia , Qualidade de Vida/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado , Autoeficácia , Autogestão , Estresse Psicológico/terapia , Resultado do Tratamento , Adulto Jovem
15.
Clin Pediatr (Phila) ; : 9922818817301, 2018 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-30516058
16.
Clin Pediatr (Phila) ; : 9922818809520, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30360651
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