Category: Statistics

FP Essent. 2025 Jul;554:19-24.

ABSTRACT

Personality disorders describe enduring, pervasive, pathologic patterns of behavior and inner experiences that deviate from a patient’s culture. Personality disorders are divided into three clusters depending on core features. Diagnosis of a personality disorder is generally made based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, although other diagnostic modalities exist. The most common disorders in primary care settings include obsessive-compulsive personality, narcissistic personality, and borderline personality disorders. Obsessive-compulsive personality disorder is associated with pathologic perfectionism and intense rigidity. Treatment is primarily psychotherapy, although there is some evidence for using selective serotonin reuptake inhibitors. Narcissistic personality disorder is marked by grandiosity, need for admiration, and a lack of empathy. Psychotherapy is the primary treatment. Borderline personality disorder is associated with instability and intense reactivity, and the primary treatment is typically psychotherapy. Dialectical behavior therapy was developed specifically for borderline personality disorder, although evidence suggests other behavior therapies may be as beneficial.

PMID:40674742

FP Essent. 2025 Jul;554:7-12.

ABSTRACT

Attention-deficit/hyperactivity disorder (ADHD) is characterized by the inability to regulate attention and/or symptoms of hyperactivity that interfere with some level of daily functioning. Although this disorder is well-recognized in children, it is less frequently diagnosed and treated in adults. The pathogenesis of ADHD is not well understood, but norepinephrine and dopamine appear to play roles in the disorder because they modulate the area of the brain involved in attention and behavior regulation. ADHD has a high comorbidity rate, particularly with substance use disorder. Screening for ADHD can be performed in the primary care setting with tools such as the Adult ADHD Self-Report Scale. Diagnosis should be made based on the Diagnostic and Statistical Manual of Mental Disorders criteria, which lists symptoms of inattention and hyperactivity-impulsivity separately. For adults, diagnosis requires patients to have at least five of the symptoms in either category for more than 6 months. Symptoms must have been present before age 12 and must have occurred in at least two independent settings. Treatment is generally a combination of cognitive behavior therapy and stimulant medications, usually amphetamines, although exceptions exist based on comorbid conditions.

PMID:40674740

Obstet Gynecol. 2025 Jul 17. doi: 10.1097/AOG.0000000000006013. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the efficacy of intramuscular (IM) methotrexate in patients with recurrent compared with primary ectopic pregnancy.

DATA SOURCES: Systematic searches of the MEDLINE, EMBASE, and Scopus databases were conducted in February 2025.

METHODS OF STUDY SELECTION: This meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All English-language, full-text studies in which adult patients (18 years of age or older) were treated with IM methotrexate and stratified by their history of a previous ectopic pregnancy were included. Patients with at least one prior ectopic pregnancy, regardless of which fallopian tube was affected and how it was managed, were defined as having recurrent ectopic pregnancy. We excluded studies that did not report patients requiring further treatment, those in which medical management through alternative routes (other than IM) or therapies were studied, and those investigating nontubal ectopic pregnancy or heterotopic pregnancies.

TABULATION, INTEGRATION, AND RESULTS: Two investigators independently identified studies using the eligibility criteria. The primary outcome was treatment success, characterized by the complete resolution of ectopic pregnancy without the need for further treatment. The efficacy of single-dose and multidose (comprising both two doses and fixed multidose, ie, two or more doses) IM methotrexate regimens was evaluated. Outcomes were reported as relative risk (RR) and 95% CI. From 6,349 search results, 15 observational studies comprising 3,944 patients (502 recurrent, 3,442 primary ectopic pregnancy) were included. Administration of a single dose of IM methotrexate was significantly less successful in patients with recurrent compared with those with primary ectopic pregnancy (RR 0.79, 95% CI, 0.63-1.00, P=.050). However, there was no statistical difference in success for patients receiving multidose treatment (RR 1.14, 95% CI, 0.71-1.84, P=.590).

CONCLUSION: Current observational data suggest that patients with recurrent ectopic pregnancy should be considered for multidose IM methotrexate to achieve similar rates of success compared with primary ectopic pregnancy.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42025642895.

PMID:40674737 | DOI:10.1097/AOG.0000000000006013

JMIR Form Res. 2025 Jul 17;9:e65320. doi: 10.2196/65320.

ABSTRACT

BACKGROUND: Advancements in science and technology can exacerbate health disparities, particularly when there is a lack of diversity in clinical research, which limits the benefits of innovations for underrepresented communities. Programs like the All of Us Research Program (AoURP) are actively working to address this issue by ensuring that underrepresented populations are represented in biomedical research, promoting equitable participation, and advancing health outcomes for all. African American communities have been particularly underrepresented in clinical research, often due to historical instances of research misconduct, such as the Tuskegee Syphilis Study, which have deeply impacted trust and willingness to participate in research studies. With the US population becoming increasingly diverse, it is crucial that clinical research studies reflect this diversity to improve health outcomes. However, limited data and small sample sizes in qualitative studies on the inclusion of underrepresented groups hinder progress in this area.

OBJECTIVE: The goal of this paper is to analyze recruitment conversations between research assistants (RAs) and potential participants in the AoURP to identify key topics that influence enrollment. By examining these interactions, we aim to provide insights that can improve engagement strategies and recruitment practices for underrepresented groups in biomedical research.

METHODS: Our study design was an observational, retrospective approach using machine learning for content analysis. Specifically, we used structural topic modeling to identify and compare latent topics of conversation in recruitment calls by Morehouse School of Medicine RAs between February 2021 and April 2022 by estimating expected topic proportions in the corpus as a function of enrollment and participation in AoURP.

RESULTS: In total, our model estimated 45 topics of which 12 coherent topics were identified. Notable topics, that were more likely to occur in conversations between RAs and participants that enrolled and participated, include closing or following up to schedule an appointment, COVID-19 protocols for in-person visits, explaining precision medicine and the need for representation, and working through objections, including concerns about costs, insurance, care changes, and health fears. Topics among potential participants who did not enroll include technical challenges and describing physical measurement visits (eg, collection of basic physical data, such as height, weight, and blood pressure).

CONCLUSIONS: Using an approach that leverages machine learning to identify topical structure and themes with limited human subjectivity is a promising strategy to identify gaps in, and opportunities to improve, the recruitment of underserved communities into clinical trials.

PMID:40674722 | DOI:10.2196/65320

JMIR Med Inform. 2025 Jul 17;13:e68409. doi: 10.2196/68409.

ABSTRACT

BACKGROUND: Emergency medicine can benefit from artificial intelligence (AI) due to its unique challenges, such as high patient volume and the need for urgent interventions. However, it remains difficult to assess the applicability of AI systems to real-world emergency medicine practice, which requires not only medical knowledge but also adaptable problem-solving and effective communication skills.

OBJECTIVE: We aimed to evaluate ChatGPT’s (OpenAI) performance in comparison to human doctors in simulated emergency medicine settings, using the framework of clinical performance examination and written examinations.

METHODS: In total, 12 human doctors were recruited to represent the medical professionals. Both ChatGPT and the human doctors were instructed to manage each case like real clinical settings with 12 simulated patients. After the clinical performance examination sessions, the conversation records were evaluated by an emergency medicine professor on history taking, clinical accuracy, and empathy on a 5-point Likert scale. Simulated patients completed a 5-point scale survey including overall comprehensibility, credibility, and concern reduction for each case. In addition, they evaluated whether the doctor they interacted with was similar to a human doctor. An additional evaluation was performed using vignette-based written examinations to assess diagnosis, investigation, and treatment planning. The mean scores from ChatGPT were then compared with those of the human doctors.

RESULTS: ChatGPT scored significantly higher than the physicians in both history-taking (mean score 3.91, SD 0.67 vs mean score 2.67, SD 0.78, P<.001) and empathy (mean score 4.50, SD 0.67 vs mean score 1.75, SD 0.62, P<.001). However, there was no significant difference in clinical accuracy. In the survey conducted with simulated patients, ChatGPT scored higher for concern reduction (mean score 4.33, SD 0.78 vs mean score 3.58, SD 0.90, P=.04). For comprehensibility and credibility, ChatGPT showed better performance, but the difference was not significant. In the similarity assessment score, no significant difference was observed (mean score 3.50, SD 1.78 vs mean score 3.25, SD 1.86, P=.71).

CONCLUSIONS: ChatGPT’s performance highlights its potential as a valuable adjunct in emergency medicine, demonstrating comparable proficiency in knowledge application, efficiency, and empathetic patient interaction. These results suggest that a collaborative health care model, integrating AI with human expertise, could enhance patient care and outcomes.

PMID:40674718 | DOI:10.2196/68409

Singapore Med J. 2025 Jul 17. doi: 10.4103/singaporemedj.SMJ-2024-155. Online ahead of print.

ABSTRACT

INTRODUCTION: Inhaler therapy is paramount in asthma management, yet non-adherence poses a significant challenge. This study investigates inhaler adherence patterns among adult asthma patients, employing the Test of Adherence to Inhalers (TAIs) questionnaire.

METHODS: This cross-sectional study recruited 99 eligible patients from a specialist outpatient clinic over six months. The TAI questionnaire was administered to the patients. Data on asthma control test scores, medication possession ratio, and healthcare utilisation were collected. Statistical analyses were performed to examine the associations between adherence, patient characteristics, and clinical outcomes.

RESULTS: More than half of the patients (68.7%) exhibited intermediate (n = 23) or poor (n = 45) adherence, with younger age associated with poorer adherence. Different patterns of non-compliance were identified; 38.8% (n = 19) of patients with poor adherence showed deliberate non-compliance, whereas only 7.3% (n = 3) with good adherence showed unconscious non-compliance. Surprisingly, patients with intermediate and poor adherence often achieved good asthma control, revealing potential challenges in outcome-based adherence assessments. A relatively higher but statistically non-significant proportion of patients with poor adherence had at least one hospitalisation or emergency department attendance due to asthma (42.2% with poor adherence vs. 35.5% with good adherence) or at least one asthma exacerbation requiring oral corticosteroid (64.4% with poor adherence vs. 48.4% with good adherence) in the past 12 months.

CONCLUSION: This study provides insights into inhaler adherence among local adult asthma patients, identifying distinct adherence patterns and recognising potential complacency issues associated with traditional adherence assessments. Despite these limitations, our findings contribute to the optimisation of asthma care through a nuanced understanding of inhaler adherence.

PMID:40674702 | DOI:10.4103/singaporemedj.SMJ-2024-155

Singapore Med J. 2025 Jul 17. doi: 10.4103/singaporemedj.SMJ-2024-156. Online ahead of print.

ABSTRACT

INTRODUCTION: Procedures are frequently performed under regional or local anaesthesia, where patients maintain a level of consciousness. This has been associated with heightened pre- and intraprocedural anxiety levels, which may increase the risk of emotional distress and worsen patient outcomes. Music therapy has been proposed as an effective non-pharmacological intervention to reduce anxiety levels. This is a pilot study aimed at evaluating the effect of music therapy on anxiety and perceived pain during intravitreal injections (IVI) in the Singaporean context.

METHODS: Study participants were randomised into groups with and without music therapy. Anxiety levels were assessed using the Spielberger State-Trait Anxiety Inventory (state subscale) before and after IVI. The patients’ perceptions of pain and discomfort were rated on a visual analogue scale.

RESULTS: Fifty and 51 patients were assigned to the music therapy and control groups, respectively. After IVI, anxiety levels were lower in the music therapy group than the control group (-5.94 ± 10.81 vs. -5.02 ± 7.59; P = 0.62), although the difference was not statistically significant. The levels of pain and discomfort reported by patients in both groups were comparable.

CONCLUSION: In the setting of IVIs, anxiety levels among patients receiving music therapy were reduced compared to those who had no music therapy, although the difference in anxiety levels was not statistically significant. Future studies should evaluate the impact of patient autonomy over the choice of music on the effectiveness of music therapy.

PMID:40674695 | DOI:10.4103/singaporemedj.SMJ-2024-156

Neurology. 2025 Aug 12;105(3):e213905. doi: 10.1212/WNL.0000000000213905. Epub 2025 Jul 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: Higher dietary intake of alpha-linolenic acid (ALA), a plant-derived omega-3 polyunsaturated fatty acid (PUFA), was associated with a lower risk of multiple sclerosis (MS) in a prospective cohort study and lower risk of new lesions, relapses, and disability progression in a patient cohort. We examined whether serum levels of ALA and other PUFAs predicted MS outcomes up to 11 years after clinical onset.

METHODS: This prospective study was conducted among participants in the BENEFIT clinical trial, who had serum samples collected starting at randomization. Serum fatty acids were measured using gas chromatography. We evaluated the association of individual fatty acids with time to clinically definite MS (CDMS) and other measures of disease activity and progression using Cox, negative binomial, and linear regression.

RESULTS: We followed 468 participants for 5 years, including 278 followed to year 11. At baseline, the median age was 30 years and 71% were women. Higher baseline serum ALA levels were associated with a lower risk of CDMS and relapses during follow-up. The multivariable-adjusted hazard ratios for CDMS comparing top to bottom quartile were 0.60 (95% CI 0.39-0.95) and 0.60 (95% CI 0.37-0.98) after 5 and 11 years, respectively. The multivariable adjusted risk ratios for relapses comparing top to bottom quartile were 0.60 (95% CI 0.38-0.94) and 0.65 (95% CI 0.43-0.99) after 5 and 11 years, respectively. None of the other 35 fatty acids were associated with CDMS risk. Three fatty acids were associated with relapse rate after 5 years, but not 11 years. Higher ALA levels were associated with a slower decline in MS Functional Composite, an assessment of disability, at 5 years. The association was similar at 11 years, but the results did not retain statistical significance. Baseline ALA levels were not associated with subsequent changes in cognitive function, time to confirmed Expanded Disability Status Scale progression, new active lesions, or brain volume loss.

DISCUSSSION: Higher serum ALA levels were associated with a lower risk of CDMS, relapses, and disability progression in a large prospective cohort. The results were null or inconsistent for other fatty acids.

PMID:40674673 | DOI:10.1212/WNL.0000000000213905

JAMA Oncol. 2025 Jul 17. doi: 10.1001/jamaoncol.2025.2120. Online ahead of print.

NO ABSTRACT

PMID:40674084 | DOI:10.1001/jamaoncol.2025.2120

JAMA Oncol. 2025 Jul 17. doi: 10.1001/jamaoncol.2025.2010. Online ahead of print.

ABSTRACT

IMPORTANCE: Retrospective case series have identified having cancer and receiving treatment for cancer as risk factors for inferior COVID-19 outcomes.

OBJECTIVE: To determine risk factors for hospitalization and death in patients with cancer with COVID-19 infection.

DESIGN, SETTING, AND PARTICIPANTS: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) is a prospective longitudinal natural history cohort study examining the impact of COVID-19 on patients with cancer. Adults were eligible within 14 days of an initial positive SARS-CoV-2 test result if they were receiving active treatment for cancer or had prior stem cell/bone marrow transplant or CAR T-cell treatment. The statistical analysis took place between September 2024 and April 2025.

MAIN OUTCOMES AND MEASURES: The primary objective of the study was to determine patient factors, therapy types, and cancer types associated with COVID-19 severity, defined as hospitalization for or death from COVID-19 within 30 and 90 days after the first positive SARS-CoV-2 test result. Multivariable regressions were performed for COVID-19-specific hospitalization and mortality (proportional hazard and cause-specific hazard models).

RESULTS: Of 1572 eligible adult patients (median [range] age, 60 [18-93] years; 840 female [53.4%]), 1066 (67.8%) had a solid tumor, with 683 (64.0%) having metastatic disease; breast (252 [23.6%]) and lung cancer (148 [13.9%]) were most common. At enrollment, 1013 patients (64.4%) were unvaccinated for SARS-CoV-2. COVID-19-related mortality at 90 days was 3.0% and did not increase at subsequent time points. The cumulative incidence of COVID-19-specific death in the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors and other hematologic cancers. In multivariable analysis, receipt of chemotherapy (hazard ratio [HR], 1.97; 95% CI, 1.52-2.54) and baseline history of stroke, atrial fibrillation, or pulmonary embolism (HR, 1.78; 95% CI, 1.33-2.38) were associated with a higher risk of hospitalization. Vaccination prior to SARS-CoV-2 infection was associated with a lower risk of hospitalization (HR, 0.52; 95% CI, 0.38-0.70). Over 2 years of follow-up, there were 1739 cancer treatment disruptions, of which 881 (50.7%) were attributed to COVID-19, with most disruptions occurring within the first 30 days.

CONCLUSIONS AND RELEVANCE: The results of this prospective cohort study showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.

PMID:40674082 | DOI:10.1001/jamaoncol.2025.2010