Category: Statistics

Comput Inform Nurs. 2025 Mar 5. doi: 10.1097/CIN.0000000000001261. Online ahead of print.

ABSTRACT

Standardized nursing languages help nurses articulate issues with patients, forming the groundwork for the selection of nursing interventions aimed at achieving outcomes. However, the application of standardized nursing linkages on nursing processes and nursing home residents’ outcomes, as well as the identification of facility and resident factors, remains unexplored. The purpose of this study was to examine nursing home facility and resident factors on the use of NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification (NNN) and frequently occurring NNN linkages surrounding nursing home residents in Korea. Data were collected from 53 nurses of 273 residents in 19 nursing homes in Korea using a newly developed smartphone application. Descriptive statistics, analysis of variance, and analysis of covariance were used for the data analysis. Nine NNN linkages were identified in this study, mostly centered on fall prevention. We also identified that residents’ factors (including acuity, age, and admission period) and organizational factors (including year of facility establishment and facility ownership status), were related to the use of NNN. Nursing home nurses’ clinical and critical judgment and the utilization of standardized nursing languages to select proper nursing interventions and outcomes should be based on both resident and organizational factors.

PMID:40048734 | DOI:10.1097/CIN.0000000000001261

J Am Acad Orthop Surg. 2025 Feb 26. doi: 10.5435/JAAOS-D-24-01234. Online ahead of print.

ABSTRACT

INTRODUCTION: Pickleball is one of the fastest growing sports in the United States. Despite its popularity, there is limited research on pickleball-related orthopaedic injuries, particularly in the spine. This study aims to provide a deeper understanding of spinal injuries in pickleball players and offers insights into injury patterns and risk factors.

METHODS: A retrospective review from our urban tertiary medical center’s electronic medical record from 2013 to 2023 was done using OpenAI’s Generative Pretrained Transformer-4 model to identify pickleball-related orthopaedic injuries. After artificial intelligence-driven identification, a manual review of medical records identified injuries related to the spine. The resulting medical records were manually reviewed for variables such as injury year, age, sex, spinal region affected, and treatment. Artificial intelligence did not generate any data, participate in writing, or assist with statistical analysis. Statistical analyses were done using Stata software, with significance set at P < 0.05.

RESULTS: Among 1,527 pickleball-related orthopaedic injuries, 135 (8.8%) involved the spine (77% women, median age: 62 ± 12.4 years). Pickleball-related spinal injuries increased 56-fold from 2013 to 2023. Most injuries involved the lumbar spine (84%), followed by the cervical spine (15%) and thoracic spine (1%). The most common complaint was lumbar radicular symptoms (63%). Forty-six percent of patients had a body mass index over 25, and this was associated with lumbar radiculopathy and acute disk herniation (P < 0.05). Most patients sought outpatient care (98%) and 10% required surgical intervention, primarily spinal decompression.

CONCLUSION: Pickleball-related spine injuries are relatively uncommon but increasing as the sport grows in popularity, with the lumbar spine being the most frequently affected region. Elevated body mass index emerged as an important modifiable potential risk factor, and the study found a relatively high rate of surgical intervention at 10%. These findings can help guide counseling and treatment for pickleball athletes, although further research is needed to better understand risk factors, treatment options, prognosis, and return-to-play guidelines.

PMID:40048727 | DOI:10.5435/JAAOS-D-24-01234

JAMA Intern Med. 2025 Mar 6. doi: 10.1001/jamainternmed.2025.0205. Online ahead of print.

ABSTRACT

IMPORTANCE: The relationship between butter and plant-based oil intakes and mortality remains unclear, with conflicting results from previous studies. Long-term dietary assessments are needed to clarify these associations.

OBJECTIVE: To investigate associations of butter and plant-based oil intakes with risk of total and cause-specific mortality among US adults.

DESIGN, SETTING, AND PARTICIPANTS: This prospective population-based cohort study used data from 3 large cohorts: the Nurses’ Health Study (1990-2023), the Nurses’ Health Study II (1991-2023), and the Health Professionals Follow-up Study (1990-2023). Women and men who were free of cancer, cardiovascular disease (CVD), diabetes, or neurodegenerative disease at baseline were included.

EXPOSURES: Primary exposures included intakes of butter (butter added at the table and from cooking) and plant-based oil (safflower, soybean, corn, canola, and olive oil). Diet was assessed by validated semiquantitative food frequency questionnaires every 4 years.

MAIN OUTCOMES AND MEASURES: Total mortality was the primary outcome, and mortality due to cancer and CVD were secondary outcomes. Deaths were identified through the National Death Index and other sources. A physician classified the cause of death based on death certificates and medical records.

RESULTS: During up to 33 years of follow-up among 221 054 adults (mean [SD] age at baseline: 56.1 [7.1] years for Nurses’ Health Study, 36.1 [4.7] years for Nurses’ Health Study II, and 56.3 [9.3] years for Health Professionals Follow-up Study), 50 932 deaths were documented, with 12 241 due to cancer and 11 240 due to CVD. Participants were categorized into quartiles based on their butter or plant-based oil intake. After adjusting for potential confounders, the highest butter intake was associated with a 15% higher risk of total mortality compared to the lowest intake (hazard ratio [HR], 1.15; 95% CI, 1.08-1.22; P for trend < .001). In contrast, the highest intake of total plant-based oils compared to the lowest intake was associated with a 16% lower total mortality (HR, 0.84; 95% CI, 0.79-0.90; P for trend < .001). There was a statistically significant association between higher intakes of canola, soybean, and olive oils and lower total mortality, with HRs per 5-g/d increment of 0.85 (95% CI, 0.78-0.92), 0.94 (95% CI, 0.91-0.96), and 0.92 (95% CI, 0.91-0.94), respectively (all P for trend < .001). Every 10-g/d increment in plant-based oils intake was associated with an 11% lower risk of cancer mortality (HR, 0.89; 95% CI, 0.85-0.94; P for trend < .001) and a 6% lower risk of CVD mortality (HR, 0.94; 95% CI, 0.89-0.99; P for trend = .03), whereas a higher intake of butter was associated with higher cancer mortality (HR, 1.12; 95% CI, 1.04-1.20; P for trend < .001). Substituting 10-g/d intake of total butter with an equivalent amount of total plant-based oils was associated with an estimated 17% reduction in total mortality (HR, 0.83; 95% CI, 0.79-0.86; P < .001) and a 17% reduction in cancer mortality (HR, 0.83; 95% CI, 0.76-0.90; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study, higher intake of butter was associated with increased mortality, while higher plant-based oils intake was associated with lower mortality. Substituting butter with plant-based oils may confer substantial benefits for preventing premature deaths.

PMID:40048719 | DOI:10.1001/jamainternmed.2025.0205

Europace. 2025 Mar 6:euaf045. doi: 10.1093/europace/euaf045. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Current guidelines for the optimal ablation strategy for persistent atrial fibrillation(PerAF) remain unclear. While our previous RCT confirmed the favorable prognosis of aggressive ablation, real-world evidence is still lacking.

METHODS: Among 4,833 PerAF patients undergoing catheter ablation at 10 centers, two groups were defined: Regular Ablation(PVI-only or PVI plus anatomical ablation) and Aggressive Ablation(anatomical plus electrogram-guided ablation), with 1,560 patients each after propensity score(PS) matching. The primary endpoint was 12-month AF/atrial tachycardia(AT) recurrence-free survival off anti-arrhythmic drugs after a single procedure. Additional PS matching was performed within the regular group between PVI-only and anatomical ablation(n=455 each). Furthermore, anatomical ablation from the regular group was independently matched with aggressive ablation (n=1,362 each).

RESULTS: At 12 months, the Aggressive Group showed superior AF/AT-free survival(66.2% vs. 59.3%, p<0.001; HR 0.745), similar AT recurrence(12.0% vs. 11.3%, p=0.539), and significantly higher procedural AF termination(67.0% vs. 21.0%, p<0.001) than Regular Group. Moreover, patients with AF termination had improved AF/AT-free survival(72.3% vs. 55.2%, p<0.001). Safety endpoints did not differ significantly between the two groups. Both the ablation outcomes and AF termination rate showed increasing trends with the extent of ablation aggressiveness but declined with extremely aggressive ablation. After additional PS matching, within the regular group, no statistical differences were observed though AF/AT-free survival in the anatomical group was slightly higher than the PVI-only group (60.7% vs. 55.6%, p=0.122); while aggressive ablation showed improved AF/AT-free survival compared to anatomical ablation alone from regular group (67.5% vs. 59.9%, p<0.001).

CONCLUSION: Aggressive ablation achieved more favorable outcomes than regular ablation, and moderately aggressive ablation may be associated with better clinical outcomes. AF termination is a reliable ablation endpoint.

PMID:40048703 | DOI:10.1093/europace/euaf045

J Breast Imaging. 2025 Mar 6:wbaf007. doi: 10.1093/jbi/wbaf007. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze recent trends in U.S. breast cancer mortality rates by age group and race and ethnicity.

METHODS: This retrospective analysis of female breast cancer mortality rates used National Center for Health Statistics data from 1990 to 2022 for all women, by age group, and by race or ethnicity. Joinpoint analysis assessed trends in breast cancer mortality rates.

RESULTS: Breast cancer mortality rates for women 20 to 39 years old decreased 2.8% per year from 1999 to 2010 but showed no decline from 2010 to 2022 (annual percentage change [APC], -0.01; P = .98). For women of ages 40 to 74 years, breast cancer mortality rates decreased 1.7% to 3.9% per year from 1990 to 2022 (P <.001); a decline was found for all cohorts in this age group except Asian women. For women ≥75 years of age, breast cancer mortality rates declined significantly from 1993 to 2013 (APC, -1.26; P = .01) but showed no evidence of decline from 2013 to 2022 (APC, -0.2; P = .24). Across all ages, breast cancer mortality rates declined for White and Black women but not for Asian, Hispanic, and Native American women. Asian women ≥75 years of age had significantly increasing mortality rates (APC, 0.73; P <.001). For 2004 to 2022, breast cancer mortality rates were 39% higher in Black women than White women and varied strongly by age group: 104% for ages 20 to 39 years, 51% for ages 40 to 74 years, and 13% for ages ≥75 years.

CONCLUSION: Female breast cancer mortality rates have stopped declining in women <40 years of age and >74 years of age. The higher mortality rates in Black women compared with White women are age dependent and substantially higher in younger women.

PMID:40048690 | DOI:10.1093/jbi/wbaf007

Mod Rheumatol. 2025 Mar 6:roaf015. doi: 10.1093/mr/roaf015. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI), utilizing fat-saturated T2-weighted and STIR sequences, is essential for the early diagnosis and monitoring of axial spondyloarthritis (axSpA). Recently, the European Society of Musculoskeletal Radiology proposed recommendations for the standardization of MRI findings for axSpA. However, the predictive value of specific MRI findings for spinal ankylosis progression remains unclear. This study investigates whether baseline MRI findings correlate with the progression of spinal ankylosis observed on radiographs over a two-year period.

METHODS: Twenty-six axSpA patients who met ASAS criteria and underwent baseline and two-year follow-up imaging were included. MRI assessments of the lumbar spine and SIJ evaluated inflammatory and structural lesions, including Romanus and Anderson lesions. Radiographic progression was defined as a ≥2-point increase in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Statistical analyses compared clinical and imaging parameters between progression (n=9) and non-progression (n=17) groups.

RESULTS: Patients in the progression group had significantly higher baseline mSASSS (P=0.04) and mHAQ scores (P=0.04). Positive MRI findings of anterior and posterior corner inflammatory lesions and Anderson-central lesions were significantly associated with progression (P<0.05). Romanus lesions, indicative of early structural changes, were more frequent in the progression group (P=0.02). However, fat lesions and SIJ inflammation showed no significant predictive value.

CONCLUSION: Baseline MRI findings, particularly inflammatory and Romanus lesions, are strong predictors of spinal ankylosis progression in axSpA. These results highlight the importance of incorporating MRI into personalized treatment strategies to mitigate disease progression. Further studies are needed to validate these findings in larger cohorts.

PMID:40048664 | DOI:10.1093/mr/roaf015

Eur Heart J. 2025 Mar 6:ehaf080. doi: 10.1093/eurheartj/ehaf080. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: In the Surgical Treatment for Ischaemic Heart Failure Trial Extension Study (STICHES), coronary artery bypass grafting (CABG) improved outcomes of patients with ischaemic left ventricular dysfunction receiving medical therapy, whereas in the Revascularization for Ischaemia Ventricular Dysfunction trial (REVIVED-BCIS2), percutaneous coronary intervention (PCI) did not. The aim of this study was to explore differences in outcomes of participants treated with medical therapy alone in STICHES vs. REVIVED-BCIS2 and to assess the incremental benefit of CABG or PCI.

METHODS: Pooled analysis of adjusted individual participant data from two multicentre randomized trials. All patients had left ventricular ejection fraction ≤35% and coronary artery disease and received medical therapy. Participants were randomized 1:1 to CABG (STICHES) or PCI (REVIVED-BCIS2). The primary outcome was the composite of all-cause death and hospitalization for heart failure over all available follow-up.

RESULTS: A total of 1912 participants (88% male, 76% white ethnicity) were included with 98.3% completeness of follow-up for the primary outcome. The median follow-up was 118 months in STICHES and 41 months in REVIVED-BCIS2. Those receiving medical therapy alone in REVIVED-BCIS2 had fewer primary outcome events than those receiving medical therapy alone in STICHES (adjusted hazard ratio 0.60, 95% confidence interval 0.48-0.74, P < .001). Patients receiving PCI in REVIVED-BCIS2 were less likely to experience a primary outcome event than those receiving CABG in STICHES. Adjusted outcomes of patients treated with CABG in STICHES were worse than those receiving medical therapy alone in REVIVED-BCIS2.

CONCLUSIONS: Patients with ischaemic cardiomyopathy receiving medical therapy in REVIVED-BCIS2 had better outcomes than those in STICHES, with or without CABG surgery. Further trials comparing CABG, PCI, and medical therapy in this population are warranted.

PMID:40048661 | DOI:10.1093/eurheartj/ehaf080

J Antimicrob Chemother. 2025 Mar 6:dkae467. doi: 10.1093/jac/dkae467. Online ahead of print.

ABSTRACT

BACKGROUND: Helicobacter pylori eradication in penicillin-allergic patients presents challenges. Options of effective regimens are lacking in areas where tetracycline is unavailable.

OBJECTIVES: To evaluate the efficacy of replacing the proton pump inhibitor (PPI) with a potassium-competitive acid blocker (P-CAB, vonoprazan) in standard bismuth quadruple therapy containing doxycycline and metronidazole as a first-line treatment for H. pylori.

METHODS: This prospective randomized clinical trial enrolled 332 naive patients with H. pylori infection and penicillin allergy. Participants were randomly assigned in a 1:1 ratio to either the 14 day P-CAB/BDM group (vonoprazan 20 mg twice daily, colloidal bismuth 200 mg twice daily, doxycycline 100 mg twice daily and metronidazole 400 mg three times daily) or the 14 day PPI/BDM group (rabeprazole 10 mg twice daily, and the same dose of the three other drugs as in the 14 day P-CAB/BDM group).

RESULTS: Eradication rates in the P-CAB/BDM and PPI/BDM groups were 90.4% and 71.1% (P value for superiority was 0.013), respectively, by ITT analysis. The efficacy of P-CAB/BDM remained non-inferior and even superior to PPI/BDM therapy in all ITT, modified ITT and PP analyses. The overall frequency of adverse events (39.8% and 40.4%; P = 0.911) and compliance (88.0% and 91.0%; P = 0.372) were similar between P-CAB and PPI regimens. Patients with higher body surface area were significantly associated with eradication failure in both groups (P < 0.05).

CONCLUSIONS: The 14 day P-CAB/BDM therapy provided a satisfactory eradication rate of >90% (ITT analysis) and had a good safety profile as first-line H. pylori therapy, providing an alternative option for penicillin-allergic patients.

PMID:40048654 | DOI:10.1093/jac/dkae467

Psychol Health Med. 2025 Mar 6:1-19. doi: 10.1080/13548506.2025.2470878. Online ahead of print.

ABSTRACT

In contemporary society, where vegetarian diets are gaining popularity, it is imperative to develop a profound understanding of these individuals’ dietary choices and their health implications. Specifically, it is crucial to examine how the prevalence of fat phobia affects their dietary preferences, in order to promote a balanced nutritional approach. The aim of the study is to evaluate the carbohydrate quality and nutrition knowledge level of vegan and vegetarian individuals in Istanbul, Turkey, and to examine their relationship with fatphobia. A questionnaire consisting of questions about sociodemographic characteristics, eating habits, the Nutrition Knowledge Level Scale for Adults, Fat Phobia Scale, and a 24-hour Food Consumption Record Form was administered face-to-face to 500 vegetarian individuals aged 18-65 living in Istanbul. Individuals in this study are 26.4% vegan, 10.4% lacto-vegetarian, 25.4% lacto-ovo-vegetarian, 12% pollo-vegetarian, 10.4% pesco-vegetarian and 15.4% semi-vegetarian. The group that has the highest Basic Nutrition Information (47.51 ± 7.95), Food Preference Information (24.27 ± 6.04), Evaluation of Daily Food Preferences as Correct (6.89 ± 1, 33) are vegans. The group with the highest Evaluating the Importance Degree of the Relationship Between Nutrition and Health (9.27 ± 0.89) and Carbohydrate Quality Index value (11.08 ± 2.14) are pesco-vegetarians. The group with the highest Fat Phobia Scale (3.23 ± 0.28) are pollo-vegetarians. There was no statistically significant difference between the Carbohydrate Quality Index values and ‘Fat Phobia Scale Total’ scores of the different vegetarian dietary types (p > 0.05). It has been found that pesco-vegetarians have the highest carbohydrate quality index. Pollo-vegetarians, on the other hand, are noted for having the highest fat phobia.

PMID:40048647 | DOI:10.1080/13548506.2025.2470878

J Neurosci Nurs. 2025 Mar 6. doi: 10.1097/JNN.0000000000000826. Online ahead of print.

ABSTRACT

BACKGROUND: Thrombolytic therapy is an effective intervention for acute ischemic stroke. However, the timely administration of this treatment can be hindered by delayed decision-making on the part of family members. Little is known about the reasons for their delay in making decisions. METHODS: This qualitative interview study used face-to-face, individual, semistructured interviews with 16 participants from 2 tertiary hospital neurology wards in Guangdong, China. The interviews were analyzed using inductive content analysis, and descriptive statistics were used to summarize participants’ characteristics. RESULTS: Three main themes emerged: a large family communication network, struggling with bleeding risk, and seeking distance treatment advice. CONCLUSION: In China, family members make decisions on behalf of patients and are affected by various factors in the decision-making process, resulting in delayed decision-making. They may experience psychological conflicts when deciding whether to permit thrombolysis, and they tend to seek information from external sources without understanding thrombolysis. Healthcare professionals caring for stroke patients eligible for thrombolytic therapy should provide decision-making support programs tailored to the specific needs of these family members to reduce delayed decision-making.

PMID:40048642 | DOI:10.1097/JNN.0000000000000826