Category: Statistics

West Afr J Med. 2024 Oct 30;41(10):1028-1033.

ABSTRACT

BACKGROUND: Colonoscopy remains the gold standard for examining and detecting lesions of the colon and can be used as a therapeutic procedure.

AIM: To report our colonoscopy experience in a private hospital in Nigeria.

PATIENTS AND METHODS: This was a retrospective review of all consecutive patients who underwent colonoscopy from September 2020 to January 2022 (17 months) at Saint Nicholas hospital, a private hospital in Lagos, Nigeria. Informed consents for colonoscopy were obtained from all the patients recruited. Ethical approval for the publication of this manuscript was obtained from the Hospital authority. Each patient had a 3-day bowel preparation before the procedure. Statistical analysis was carried out using IBM SPSS version 26.

RESULTS: A total of one hundred and one patients were recruited into the study with no exclusion. There were 68 males and 33 females with a male to female ratio of 2:1. The mean age of the patients was 52.2± 1.4 years with age range of 23-93 years. The most common indication for colonoscopy was bleeding per rectum. Caecal intubation was achieved in 97% of the patients. Normal findings were recorded in 71% of the patients.

CONCLUSION: The most common indication for colonoscopy was bleeding per rectum. Caecal intubation was achieved in the majority of the patients with the colon noted to be normal in over two-thirds of the patients.

PMID:40009832

West Afr J Med. 2024 Oct 30;41(10):1023-1027.

ABSTRACT

AIM: To report the relationship between average keratometric (AK) readings and axial length (AL) measurements in left eyes of patients attending a cataract surgery camp in sub-Saharan Africa.

METHODS: A prospective evaluation of 648 left eyes of consecutive patients who presented for a cataract surgery camp. The KOWA Autorefractor and Alcon ocuscan were used for measurements. Left eyes alone were evaluated to reduce duplication of data. The data obtained were statistically analyzed using Statistical Package for Social Sciences, version 20.0 (SPSS v20).

RESULTS: A total of 648 eyes of 648 patients were analyzed. There were 306 (47.2%) males and 342 (52.8%) females with age range from 11 to 95 years, mean ± SD age of 65.70 ± 14.28 years. AL range was from 18.00 mm to 30.39 mm, mean ± SD of 23.21± 1.19. AK ranged from 38.50 D to 48.50 D with mean ± SD of 43.41±1.68. AK reading of patients’ left eye increased as the patients age increased (p=0.007). AK readings also increased with a reduction in AL (p=<0.001). Hence smaller eyes had steeper corneas. AL of left eye and AK readings were linearly related by: AL = 33.29 – 0.232AK.

CONCLUSION: Average keratometric readings in left eyes of our cohort of patients increased with age (p=0.007) and reducing axial length (p=<0.001). Axial length of left eye and Average-K readings are linearly related by: AL = 33.29 – 0.232AK. This formula can be utilized during cataract camps to estimate either value, used in intraocular lens calculations.

PMID:40009825

West Afr J Med. 2024 Oct 30;41(10):1015-1022.

ABSTRACT

BACKGROUND: Magnesium has been shown to attenuate succinylcholine-induced fasciculation (SIF) and postoperative muscle pain (POMP); however, the optimal dose remains undetermined. This study explores the effects of varying low doses in a Nigerian population.

METHODS: Ninety patients, aged 18 and 65 years, ASA I and II, who had succinylcholine-assisted airway management, under general anaesthesia, (with propofol-midazolam co-induction, isoflurane and pancuronium maintenance), were randomised into three groups. All patients received magnesium pretreatment before induction; group A received 7.5mg/kg, group B received 10 mg/kg, while group C received 20 mg/kg.

RESULTS: Socio-demographic characteristics were comparable in all groups, p-value > 0.05. The overall incidence of SIF was similar between groups A (24, 80.0%) and B (22, 73.3%), and significantly higher than group C (12, 40.0%) (p = 0.001). Incidence of mild SIF were similar between groups A, (13, 43.3%) and B, (16, 53.3%), and statistically lesser than C, (12, 40.0%), p-value 0.001. The overall POMP incidence was similar between group A, (15, 50.0%) and B, (14, 46.7%), and statistically higher than C, (6, 20.0%), p-value 0.021.

CONCLUSION: This study demonstrates that a 20 mg/kg magnesium pretreatment attenuates SIF and POMP more effectively than 7.5 mg/kg and 10 mg/kg doses in patients undergoing succinylcholine-assisted airway management for general anesthesia.

PMID:40009802

JCO Clin Cancer Inform. 2025 Feb;9:e2400156. doi: 10.1200/CCI-24-00156. Epub 2025 Feb 26.

ABSTRACT

PURPOSE: Complex cancers require discussion at multidisciplinary cancer conferences (MCCs) to determine the best management. This study assessed the impact of a tumor board (TB)-specific information technology platform on the quality of information presented, case discussions, and care plans at thoracic MCCs.

METHODS: Between September 2020 and February 2022, using a before-after study design, we prospectively collected data through direct observation of thoracic MCCs at an academic cancer center. In addition, we reviewed medical records to assess the rate of change in care plans, compliance of all care plans with national guidelines, concordance of treatment received with MCC recommendations, and time from MCC presentation to treatment. Observational data were collected using a validated tool, Metric for the Observation of Decision-Making. We used SAS version 9.4 (SAS Institute Inc, Cary, NC) for statistical analyses.

RESULTS: We identified 151 and 166 thoracic cancer cases before and after implementation of the information technology platform, respectively. The overall quality of case presentation and discussion, represented by a mean composite score (summation of individual variables scored on a 1-5 scale, poor to excellent), increased from 56.8 to 82.0 (P < .001). This improvement was also observed across multiple subcomponents of the composite score all with P < .001. There was no statistically significant difference between the two cohorts in rate of change in care plans by the MCC, care plan compliance with national guidelines, and concordance of treatment received with MCC recommendations.

CONCLUSION: Technology improves the quality of information and discussion at TBs. However, this study did not demonstrate an impact on compliance with practice guidelines. Practitioners should explore the available TB technology platforms to optimize the conduct of MCCs in their respective institutions.

PMID:40009786 | DOI:10.1200/CCI-24-00156

West Afr J Med. 2024 Oct 30;41(10):1007-1014.

ABSTRACT

BACKGROUND: Access to affordable and quality care is critical to reducing suffering and mortality from diabetes given the huge economic challenge it poses. Health insurance aims to, among other things, improve the quality of health care services provided to patients.

OBJECTIVES: To assess and compare client satisfaction with quality of care among health-insured and non-insured diabetic patients in Kaduna State.

METHODS: A comparative cross-sectional study was conducted using a two-stage sampling technique and 500 respondents, comprising 250 (50%) insured and 250 (50%) uninsured patients. Data was collected with a pretested, semi-structured, interviewer-administered questionnaire. Data was analysed using IBM SPSS version 25. A p-value < 0.05 was considered statistically significant, and results were presented using tables.

RESULTS: The mean satisfaction scores of the health-insured and noninsured patients were found to be 106.6 and 109.5 respectively. The noninsured patients were more satisfied with the Health workers’ interpersonal approach (p = 0.022) and communication (p = 0.026), while the health-insured patients were more satisfied with the financial aspect of care (p = 0.040). However, there is no statistically significant difference in the composite satisfaction between the health-insured and non-insured patients. Religion, duration of diabetes and educational status were found to be predictors of client satisfaction.

CONCLUSIONS: The study found that although there was no significant difference in total satisfaction with the quality of care, the noninsured patients were more satisfied with the Health workers’ interpersonal approach and communication. It was recommended that the NHIA through accredited health facilities should improve interpersonal relationships and communication with health-insured diabetic patients.

PMID:40009780

Cogn Emot. 2025 Feb 26:1-12. doi: 10.1080/02699931.2025.2468281. Online ahead of print.

ABSTRACT

The relationships between perceived fatigue and changes in sustained attention performance during early stages of working on cognitively demanding tasks remain poorly understood. In addition, concerns have been raised that self-ratings of fatigue may be biased by socially desirable response tendencies, potentially confounding the relationship between perceived fatigue and attention performance. In this study, we assessed perceived fatigue briefly before tracking changes in concentration performance, processing speed, and error rates among N = 110 tenth graders, while they completed the d2-R test of sustained attention. By statistically controlling for social desirability, we examined relationships between perceived fatigue and the initial levels and slopes of three latent growth-curves capturing changes in the d2-R test’s performance measures. Individuals with higher fatigue exhibited lower concentration performance, a weaker decline in processing speed, and a higher error rate over the course of testing. Post hoc power analyses supported the robustness of our results. Implications for mental fatigue research are discussed.

PMID:40009770 | DOI:10.1080/02699931.2025.2468281

JMIR Aging. 2025 Feb 26;8:e65292. doi: 10.2196/65292.

ABSTRACT

BACKGROUND: Dementia is characterized by impairments in an individual’s cognitive and functional abilities. Digital cognitive assessments have been shown to be effective in detecting mild cognitive impairment and dementia, but whether they can stage the disease remains to be studied.

OBJECTIVE: In this study, we examined (1) the correlation between scores obtained from BrainCheck standard battery of cognitive assessments (BC-Assess), a digital cognitive assessment, and scores obtained from the Dementia Severity Rating Scale (DSRS), and (2) the accuracy of using the BC-Assess score to predict dementia stage delineated by the DSRS score. We also explored whether BC-Assess can be combined with information from the Katz Index of Independence in activities of daily living (ADL) to obtain enhanced accuracy.

METHODS: Retrospective analysis was performed on a BrainCheck dataset containing 1751 patients with dementia with different cognitive and functional assessments completed for cognitive care planning, including the DSRS, the ADL, and the BC-Assess. The patients were staged according to their DSRS total score (DSRS-TS): 982 mild (DSRS-TS 10-18), 656 moderate (DSRS-TS 19-26), and 113 severe (DSRS-TS 37-54) patients. Pearson correlation was used to assess the associations between BC-Assess overall score (BC-OS), ADL total score (ADL-TS), and DSRS-TS. Logistic regression was used to evaluate the possibility of using patients’ BC-OS and ADL-TS to predict their stage.

RESULTS: We found moderate Pearson correlations between DSRS-TS and BC-OS (r=-0.53), between DSRS-TS and ADL-TS (r=-0.55), and a weak correlation between BC-OS and ADL-TS (r=0.37). Both BC-OS and ADL-TS significantly decreased with increasing severity. BC-OS demonstrated to be a good predictor of dementia stages, with an area under the receiver operating characteristic curve (ROC-AUC) of classification using logistic regression ranging from .733 to .917. When BC-Assess was combined with ADL, higher prediction accuracies were achieved, with an ROC-AUC ranging from 0.786 to 0.961.

CONCLUSIONS: Our results suggest that BC-Assess could serve as an effective alternative tool to DSRS for grading dementia severity, particularly in cases where DSRS, or other global assessments, may be challenging to obtain due to logistical and time constraints.

PMID:40009769 | DOI:10.2196/65292

JAMA Netw Open. 2025 Feb 3;8(2):e2454506. doi: 10.1001/jamanetworkopen.2024.54506.

ABSTRACT

IMPORTANCE: Inflammatory breast cancer (IBC) is an aggressive variant for which trimodality treatment (ie, neoadjuvant systemic therapy [NST] followed by modified radical mastectomy without immediate reconstruction and postmastectomy radiotherapy [PMRT]) represents guideline-concordant care (GCC) and is associated with improved overall survival (OS). However, it is unclear whether there are disparities in trimodality treatment receipt among patients with IBC and how such disparities might affect OS.

OBJECTIVE: To assess trends in IBC trimodality treatment receipt in a contemporary cohort.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using data from the National Cancer Database. Women with nonmetastatic IBC treated from calendar years 2010 to 2018 were included. Data analysis was performed from April 1, 2023, to March 1, 2024.

EXPOSURES: Guideline-concordant care (ie, trimodality treatment administered in the correct sequence with time to NST initiation <60 days post diagnosis).

MAIN OUTCOMES AND MEASURES: The main outcomes were associations between patient-, disease-, treatment-, and facility-level factors and receipt of overall and modality-specific GCC and associations between these factors and adjusted OS.

RESULTS: Of 6945 patients identified (median age, 57 [IQR, 47-66] years; 2.4% Asian or Pacific Islander, 7.8% Hispanic, 17.1% non-Hispanic Black, and 71.5% non-Hispanic White), only 1740 (25.1%) received all forms of GCC: 91.3% (n = 5662) received NST initiation less than 60 days post diagnosis, 63.3% (n = 4395) received PMRT, and 51.3% (n = 3564) underwent guideline-concordant surgery (ie, modified radical mastectomy without immediate reconstruction with >6 lymph nodes removed). Receipt of GCC did not differ significantly by race and ethnicity, insurance status, or location. Asian (odds ratio [OR], 0.48; 95% CI, 0.27-0.84), Black (OR, 0.53; 95% CI, 0.41-0.68), and Hispanic (OR, 0.40; 95% CI, 0.29-0.55) patients were less likely to have NST initiation less than 60 days post diagnosis vs White patients (all P ≤ .001). Recipients of GCC had improved adjusted OS vs nonrecipients (hazard ratio [HR], 0.75; 95% CI, 0.68-0.84; P < .001). Black patients had significantly lower adjusted OS ,compared with White recipients (HR, 1.41; 95% CI, 1.26-1.58; P < .001). When GCC was received for triple-negative IBC, there was no racial and ethnic disparity in OS.

CONCLUSIONS AND RELEVANCE: In this cohort study of women with nonmetastatic IBC, there were no disparities observed in GCC receipt, but only 25.1% of patients with IBC received all forms of GCC for which they were eligible. Among those who received GCC, there was no racial disparity in survival for triple-negative IBC, suggesting opportunities to improve equity through standardization of care.

PMID:40009385 | DOI:10.1001/jamanetworkopen.2024.54506

JAMA Netw Open. 2025 Feb 3;8(2):e2459170. doi: 10.1001/jamanetworkopen.2024.59170.

ABSTRACT

IMPORTANCE: Given the increasing prevalence of dementia and the limited treatment options available, ultrasound neuromodulation could serve as a novel add-on therapy to standard treatments for Alzheimer disease (AD). As ultrasound neuromodulation is still in its early stages, further research is essential to fully explore its potential in treating brain disorders.

OBJECTIVE: To evaluate clinical and functional imaging effects of transcranial pulse stimulation (TPS) in patients with AD.

DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, sham-controlled, crossover clinical trial was conducted at the Medical University of Vienna between January 1, 2017, and July 27, 2022. Sixty patients with clinically diagnosed AD receiving state-of-the-art treatment were randomly allocated to treatment sequence groups verum-sham (first cycle verum, second cycle sham, n = 30) and sham-verum (n = 30). Data analysis was performed from July 28, 2022, to September 5, 2024.

INTERVENTION: Each participant received 6 verum and 6 sham TPS sessions (6000 pulses, 0.20 mJ/mm2, 5 Hz) to frontoparietal brain areas.

MAIN OUTCOMES AND MEASURES: Neuropsychological tests, including the primary outcome Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) corrected total score (CTS), were performed at baseline and 1 week, 1 month, and 3 months following the stimulations in each cycle. Primary and secondary outcomes, including functional magnetic resonance imaging and Beck Depression Inventory-II, were analyzed by intention-to-treat analysis and, for sensitivity, by per protocol analysis.

RESULTS: For the intention-to-treat analysis, 60 patients between ages 51 and 82 years (mean [SD], 70.65 [8.16] years; 30 females; 30 males) were included. The CERAD CTS increased by a mean (SD) of 2.22 (6.87) points in the verum condition from 70.93 (14.27) points at baseline to 73.15 (14.90) 3 months after stimulation, while the mean (SD) score in the sham condition increased by 1.00 (6.82) point vs baseline from 71.68 (13.62] at baseline to 72.68 (14.48) 3 months after stimulation. Primary data analysis of the condition × session interaction was not significant (P = .68; partial η2 [ηp2] = 0.01), but its interaction with age was P = .003; ηp2 = 0.08, followed by post hoc analyses of age subsamples. Although several patients older than 70 years benefited from verum TPS, only the younger subgroup (≤70 years) showed significantly higher CTS increases for verum in all poststimulation sessions (condition × session: P = .005; ηp2 = 0.16). At 3 months after stimulation, for example, a mean (SD) 3.91 (7.86)-point increase was found for verum TPS in the younger patients, but a mean (SD) CTS decrease of 1.83 (5.80) was observed for sham. Memory-associated brain activation was significantly higher after verum TPS in the precuneus, visual, and frontal areas, while resting state functional connectivity was significantly upregulated in the dorsal attention network. In the per protocol sample, a significant reduction of the Beck Depression Inventory-II scores 3 months following verum TPS was found (verum baseline: 7.27 [5.87]; verum 3 months after stimulation: 5.27 [5.27]; sham baseline: 6.70 [5.65]; sham 3 months after stimulation: 6.22 [4.40]; P = .008; ηp2 = 0.23). During both verum and sham conditions, the most common observed adverse symptom was depression; no major neuropathologic change was detected in the patients by detailed neuroradiologic assessments.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of TPS in patients with AD, a 2-week verum treatment improved cognitive scores in the younger subgroup, ameliorated depressive symptoms, and induced upregulation of functional brain activation and connectivity. These findings suggest TPS may be a safe and promising add-on therapy for patients with AD receiving state-of-the-art treatment.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03770182.

PMID:40009384 | DOI:10.1001/jamanetworkopen.2024.59170

JAMA Netw Open. 2025 Feb 3;8(2):e2459548. doi: 10.1001/jamanetworkopen.2024.59548.

ABSTRACT

IMPORTANCE: Neonatal short bowel syndrome with intestinal failure is rare, and observational studies are limited to small cohorts. Health disparities exist in long-term management with little known about the initial hospitalization.

OBJECTIVE: To identify children with neonatal short bowel syndrome with intestinal failure and to determine whether race, ethnicity, and neighborhood opportunity are associated with length of stay during their initial hospitalizations.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of children with neonatal short bowel syndrome and intestinal failure was conducted between 2004 and 2020, with validation and analysis performed from July 2022 to April 2024. Children were identified from the Pediatric Health Information System database, which included administrative data from 50 freestanding US children’s hospitals. Children were included on the basis of a diagnosis code of postsurgical malabsorption and billed charges for a neonatal intensive care unit stay and sustained parenteral nutrition use.

EXPOSURES: Race and ethnicity were included as a single variable with categories of Hispanic, non-Hispanic Black, non-Hispanic White, other (Asian and multiracial, combined because of low numbers), and unknown according to hospital report. Child Opportunity Index quintile ranged from very low (lowest quintile) to very high (highest quintile).

MAIN OUTCOMES AND MEASURES: The primary outcome was length of stay measured in number of days from admission to discharge. The χ2 analysis was used to examine unadjusted associations between categorical variables, and Wilcoxon rank-sum test was used for continuous variables.

RESULTS: A total of 2267 children with neonatal short bowel syndrome with intestinal failure were identified (997 female [44%]; 410 Hispanic [18%]; 481 non-Hispanic Black [21%]; 690 non-Hispanic White [30%]; 231 other [10%]; 455 unknown [20%]), with 629 (28%) living in areas with very low Child Opportunity Index. The median (IQR) length of stay for the initial admission was 150 (112-200) days, with a median (IQR) cost of $528 628 ($374 040-$766 446). In multivariable analysis, non-Hispanic Black children remained in the hospital for 16 days longer than their non-Hispanic White counterparts (95% CI, 7-25 days; P < .001). Child Opportunity Index was not significantly associated with length of stay when controlling for race and ethnicity.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, children with neonatal short bowel syndrome with intestinal failure experienced long initial hospital stays, incurring high costs, with non-Hispanic Black children disproportionately affected. Interventions targeting safe and efficient transition to home are needed to address both efficacy and equity for these children.

PMID:40009383 | DOI:10.1001/jamanetworkopen.2024.59548