Category: Nevin Manimala

Int J Psychol. 2025 Apr;60(2):e70040. doi: 10.1002/ijop.70040.

ABSTRACT

Intensive longitudinal designs (ILD) are increasingly used in applied psychology to investigate research questions and deliver interventions at both within- and between-individual levels. However, while relatively complex analyses such as cross-level interaction models are trending in the field, little guidance has been provided on ILD data manipulation, including all procedures to be applied to the raw data points for getting the final dataset to be analysed. Here, we provide an introductory step-by-step tutorial and open-source R code on required and recommended data pre-processing (e.g., data reading, merging and cleaning), psychometric (e.g., level-specific reliability), and other ILD data manipulation procedures (e.g., data centering, lagging and leading). We built our tutorial on an illustrative example aimed at testing the job demand-control model at the within-individual level based on data from 211 back-office workers who received up to 18 surveys over three workdays, supporting both the strain and (partially) the buffer hypotheses. Being the common starting point of many types of analyses, data manipulation is crucial to determine the quality and validity of the resulting study outcomes. Hence, this tutorial and the attached code aim to contribute to removing methodological barriers among applied psychology researchers and practitioners in the handling of ILD data.

PMID:40122677 | DOI:10.1002/ijop.70040

Occup Environ Med. 2025 Mar 23:oemed-2024-109702. doi: 10.1136/oemed-2024-109702. Online ahead of print.

ABSTRACT

INTRODUCTION: Quantitative job-exposure matrices (JEMs) have been developed to assign exposure using International Standard Classification of Occupations (ISCO)-68 coded job information. For extended compatibility with the less detailed ISCO-88 coding, a quantitative JEM using the same underlying model was developed. We compared exposure-response relationships between cumulative respirable crystalline silica (RCS) and lung cancer risk using a quantitative JEM based on ISCO-88 (88-JEM) and ISCO-68 (68-JEM).

METHODS: Based on a common set of approximately 15 000 RCS measurements, job-specific, region-specific and time-specific exposure levels were estimated for the 88-JEM and the 68-JEM and linked to participants’ job histories. Exposure-response relationships in an international lung cancer case-control study were analysed by logistic regression and generalised additive models.

RESULTS: The 88-JEM and the 68-JEM yielded similar RCS-lung cancer associations, with elevated lung cancer risks across each cumulative exposure quartile. The 88-JEM exhibited a minor not statistically significant upward bend in the exposure-response curve at higher exposures.

CONCLUSION: To accurately detect associations between disease risk and occupational exposure, quantitative JEMs can be applied in community-based studies that provide job histories in either ISCO-88 or ISCO-68.

PMID:40122614 | DOI:10.1136/oemed-2024-109702

Heart. 2025 Mar 23:heartjnl-2024-323947. doi: 10.1136/heartjnl-2024-323947. Online ahead of print.

ABSTRACT

Cardiac telemetry has evolved into a vital tool for continuous cardiac monitoring and early detection of cardiac abnormalities. In recent years, artificial intelligence (AI) has become increasingly integrated into cardiac telemetry, making a shift from traditional statistical machine learning models to more advanced deep neural networks. These modern AI models have demonstrated superior accuracy and the ability to detect complex patterns in telemetry data, enhancing real-time monitoring, predictive analytics and personalised cardiac care. In our review, we examine the current state of AI in cardiac telemetry, focusing on deep learning techniques, their clinical applications, the challenges and limitations faced by these models, and potential future directions in this promising field.

PMID:40122590 | DOI:10.1136/heartjnl-2024-323947

Hemodial Int. 2025 Mar 23. doi: 10.1111/hdi.13231. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary hypertension affects patients with hemodialysis-dependent end-stage kidney failure; however, the estimated prevalence varies greatly due to the underutilization of right heart catheterization and the evolving diagnostic criteria of pulmonary hypertension. Pulmonary hypertension in end-stage kidney failure is often attributed to arteriovenous (AV) access; therefore, we hypothesized that patients with AV fistula/graft would have a greater prevalence of pulmonary hypertension on right heart catheterization compared to those with central venous (CV) catheter accesses.

METHODS: In this retrospective single-center cohort study, we identified and randomly sampled patients from July 2012 to August 2022 receiving hemodialysis for ≥ 3 months and who underwent right heart catheterization, using Current Procedural Terminology codes. Pulmonary hypertension was defined as mean pulmonary arterial pressure (mPAP) > 20 mmHg. Our primary outcome was the prevalence of pulmonary hypertension among patients with AV fistula/graft versus CV hemodialysis access, tested with descriptive statistics. We evaluated survival as a secondary outcome using a Cox proportional hazards model.

RESULTS: A total of 3834 patient charts were extracted. Overall, 444 charts were randomly sampled, resulting in 137 subjects meeting the inclusion criteria. The mean age was 63.8 ± 10.5 years, and 62% were male. The most common etiology of end-stage kidney failure was diabetic kidney disease (57.7%). Eighty percent of end-stage kidney failure patients had pulmonary hypertension; however, the type of hemodialysis access was not associated with pulmonary hypertension (85% CV catheter vs. 79.5% AV access, p = 0.59). Patients with pulmonary hypertension had lower hemoglobin (9.6 ± 0.8 vs. 11.2 ± 1.3 g/dL, p < 0.0001) and serum albumin (2.3 ± 0.9 vs. 3.4 ± 0.6 g/dL, p < 0.0001) than those without pulmonary hypertension. Those with pulmonary hypertension had an increased risk of mortality (hazard ratio: 2.2, 95% confidence interval: 1.04-4.61; p = 0.04).

CONCLUSION: Our findings show a high burden of pulmonary hypertension among this heterogeneous cohort of end-stage kidney failure patients, with no association between pulmonary hypertension and the type of hemodialysis access. This study highlights the need for prospective investigations incorporating current strategies for pulmonary hypertension diagnosis and treatment among the dialysis-dependent population.

PMID:40122584 | DOI:10.1111/hdi.13231

Lupus Sci Med. 2025 Mar 23;12(1):e001406. doi: 10.1136/lupus-2024-001406.

ABSTRACT

OBJECTIVE: SLE is a multisystem autoimmune disease where periods of disease activity, often difficult to predict, can cause irreversible disease damage. This study aimed to develop a patient-centric predictive model using real-world data that can identify patients with SLE at a higher risk of hospitalisation compared with the general SLE population.

METHODS: This observational, retrospective analysis used data from the Georgians Organized Against Lupus (GOAL) cohort from 2011 to 2013. The GOAL cohort is a population-based SLE cohort that collects yearly self-report surveys covering participants’ sociodemographic characteristics, clinical characteristics and perceived SLE symptoms (using the Systemic Lupus Activity Questionnaire (SLAQ)). GOAL data were linked to the Georgia Hospital Discharge Database to collect participants’ all-cause hospitalisation events in the 6 months following survey completion. A two-step approach was used to predict all-cause hospitalisations-logistic regressions selected a list of GOAL predictors that were subsequently included in the classification and regression tree (CART) models to generate patient subsets based on estimated hospitalisation rates.

RESULTS: There were 846 participants who completed 1486 surveys. Participants who were hospitalised within 6 months after survey completion were more likely to be younger, living in poverty and have more reported SLE symptoms than participants without a hospitalisation. CART modelling identified participants who reported any weight loss without trying, severe fatigue and Raynaud’s symptoms as most likely to have an all-cause hospitalisation: one in three (34%) patients in this subset were hospitalised in the 6 months following survey completion, 2.6-fold the hospitalisation rates of the overall GOAL cohort (13%) and 6.8-fold the rate in the subset with the lowest hospitalisation rate (5%).

CONCLUSIONS: This study suggests that patient-reported SLE symptoms and disease activity, specifically certain components of the SLAQ, may be of value in SLE risk management when considering hospitalisation reduction as a treatment goal.

PMID:40122582 | DOI:10.1136/lupus-2024-001406

BMJ Open Qual. 2025 Mar 23;14(1):e003198. doi: 10.1136/bmjoq-2024-003198.

ABSTRACT

BACKGROUND: Diagnostic errors (DEs) are a significant global patient safety issue, often associated with increased morbidity and mortality due to overlooked, delayed, or incorrect diagnoses. Our aim was to study the occurrence of DEs and adverse events (AEs), patient-related harm to identify vulnerable steps in the diagnostic process.

METHODS: A retrospective analysis of data from two public, national databases-National Health Care Compensation Claims Database (2009-2018) and Danish Patient Safety Database with AEs (2015-2020). Vulnerable steps in the diagnostic process were identified using a scoring tool developed by The Controlled Risk Insurance Company.

RESULTS: In the analysis of patient compensation claims, 14.5% of all settled cases (n=90 000) were classified as due to a DE, with a 59% compensation rate for DEs, twice the rate compared with other compensated cases (25%). DEs constituted 29% of all compensated cases. Death due to DEs was 8.3% (n=680 cases), 1.8 times higher compared with other cases and DEs resulted in higher degrees of disability.In the overall reported AEs, 0.3% of AEs were fatal and 1.7% AEs caused severe patient harm, per year. In a representative sample of AEs with a severe or fatal consequence (n=269), 33% were due to DEs.The initial clinical assessment was a cause or contributor to the DE in 80% of the compensation cases and in 83% of the severe or fatal AEs. The follow-up and coordination phase were a cause in 33% of compensation cases and 46% of severe or fatal AEs.

CONCLUSIONS: Errors and AEs in the diagnostic process are prevalent and a significant patient safety issue in Danish healthcare. This study identifies vulnerable steps in the diagnostic process, with patterns correlated to different degrees of severity, and highlights steps for future improvements efforts needed to mitigate the risk of DEs.

PMID:40122576 | DOI:10.1136/bmjoq-2024-003198

BMJ Open Qual. 2025 Mar 23;14(1):e003142. doi: 10.1136/bmjoq-2024-003142.

ABSTRACT

INTRODUCTION: Choosing Wisely Canada (CWC) Hepatology published recommendations in 2017 aiming to reduce low-value care and testing, including serum ammonia tests for hepatic encephalopathy (HE) and transfusion of blood products for minor invasive procedures. We explored the impact of these recommendations in reducing rates of low-value testing and care.

METHODS: We included all medicine inpatients from 23 hospitals in Ontario, Canada from the GEMINI database between April 2015 and March 2022. Weekly rates of low-value care were measured before and after the CWC Hepatology recommendations (19 July 2017). Interrupted time-series regression models were used to assess time trends for rates of low-value care. Subgroup analysis was completed on hospitalisations under hepatology or gastroenterology services.

RESULTS: Of 59 155 patients identified with liver disease, 17 906 developed HE and 11 676 cirrhosis patients underwent minor invasive procedures. In the HE cohort, there was no immediate change in the rate of ammonia tests with recommendations, but the overall rate decreased by 0.002 tests per hospitalisation per week (95% CI -0.00413 to -0.000009). With recommendations, we observed an increase in the rate of 0.242 (95% CI 0.010 to 0.474 transfusions/hospitalisation), but no significant difference in the rate change nor in the rate of platelet and vitamin K transfusions. There was no significant change in the rate of platelet and vitamin K transfusions. Hospitalisations under hepatology or gastroenterology services also did not have a change in rates of low-value care overall, except for ammonia tests where the rate decreased by 0.012 tests (95% CI -0.0177 to -0.00626 tests/hospitalisation) per week after recommendations.

CONCLUSIONS: The CWC recommendations were associated with a reduction in the rate of serum ammonia tests, but not with transfusion of blood products. Thus, there remains an opportunity to reduce low-value care and application of clinical guidelines.

PMID:40122575 | DOI:10.1136/bmjoq-2024-003142

BMJ Open Qual. 2025 Mar 23;14(1):e002959. doi: 10.1136/bmjoq-2024-002959.

ABSTRACT

Eating disorders are serious mental health conditions associated with significant morbidity and mortality. High levels of demand on services have led to increases in wait times to access support. Early intervention of eating disorders is critical to prevent entrenchment of illness and improve prognosis, with long wait times associated with higher rates of relapse.The East London Community Eating Disorder Service has seen an increase in wait time for routine referral from the 2-week local target to 17 weeks. Additionally, there have been long wait times to access treatment, including therapy and psychiatry support.A quality improvement (QI) framework was used in June 2022 to tackle the issues with capacity and flow with an aim to reduce wait times for routine referral from 17 weeks to 2 weeks in 12 months.A QI project team was formed which sought to understand the demands and capacity of the system using process mapping.From this, the team created a driver diagram and used Plan, Do, Study, Act cycles to test change iteratively. Measurements and data were displayed on control and run charts to help learn from the change ideas tested.Improvements were made and sustained, including reduction of routine referral wait time from 17 weeks to 2 weeks in 12 months. Additionally, internal wait lists reduced from 73 patients on the psychiatry list to 0 in 3 months and from 50 families waiting for therapy to 0 in 7 months.A number of inactive cases reduced from 65 to 0 during testing, thus contributing to improved flow through the service. A striking £130 233.21 annual savings in agency staff expenditure was achieved by January 2023.This has enabled a positive culture shift in the service.

PMID:40122574 | DOI:10.1136/bmjoq-2024-002959

BMJ Open Qual. 2025 Mar 23;14(1):e002277. doi: 10.1136/bmjoq-2023-002277.

ABSTRACT

BACKGROUND: The quality of care provided during the first golden hour after birth in preterm neonates significantly impacts both short- and long-term outcomes. However, implementation of these care processes varies across centres, is not standardised and affects the quality of care.

AIM: To improve the quality of care provided during the first golden hour in neonates born at <34 weeks’ gestation.

METHODS: This quality improvement initiative was conducted in a 30-bedded tertiary care teaching hospital in southern India over 28 months (April 2019-July 2021). Evidence-based interventions to improve admission temperature, respiratory care and administering parenteral nutrition and antibiotics during the golden hour were implemented through Plan-Do-Study-Act cycles in four phases for eligible neonates. The effect of these practice changes on clinical outcomes, including intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and survival ratewere studied.

RESULTS: A total of 311 eligible neonates were included in the study. Admission hypothermia significantly reduced from 79% to 22% (p=0.003), and adherence to the respiratory bundle improved from 13% to 77% (p<0.001). The time taken for administration of parenteral nutrition improved from 102±23 min to 62.5±26.7 min (mean±SD) (p<0.001). The median time for administration of antibiotics improved from 162 (135, 173) min to 74 (69, 102) min (median±IQR) (p=0.001) and improvement in mean blood glucose from 35 (12) mg/dL to 54 (14) mg/dL (mean±SD) (p<0.001) at neonatal intensive care unit (NICU) admission, and admission time to NICU from 66.4±16 min to 41±13.8 min (p<0.001).

CONCLUSION: Quality improvement project of improving care in the golden hour after birth in < 34 weeks neonates reduces admission hypothermia and hypoglycaemia and improves the time of admission to NICU, and time of administration of parenteral nutrition and antibiotics.

PMID:40122573 | DOI:10.1136/bmjoq-2023-002277

BMJ Open. 2025 Mar 22;15(3):e090614. doi: 10.1136/bmjopen-2024-090614.

ABSTRACT

OBJECTIVE: Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.

DESIGN: We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.

SETTING: This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.

PARTICIPANTS: We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.

RESULTS: The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection.

CONCLUSIONS: We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients’ lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

PMID:40122562 | DOI:10.1136/bmjopen-2024-090614