Category: Statistics

J Adv Nurs. 2025 Feb 25. doi: 10.1111/jan.16839. Online ahead of print.

ABSTRACT

BACKGROUND: In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.

AIM: To explore patient perceptions of their involvement in nursing bedside handovers.

METHODS: A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and Likert scale questions. Open-ended questions further explored participation in bedside handovers. Descriptive statistics and comparative analyses were performed and responses to open-ended questions underwent summative deductive content analysis.

RESULTS: Of the 390 participants, over half reported five or more bedside handovers (n = 197, 50.7%). Most perceived the importance of (n = 334, 79.0%), and expressed their satisfaction with (n = 327, 89.6%), involvement in bedside handover. Perceptions of handover were mostly positive. There were a few significant differences throughout based on type of hospital, gender and age-group. Open ended responses shared perceptions on the perceived benefits, challenges and barriers and ways to enhance involvement in bedside handover. Patients expressed several challenges, including lack of awareness of their right to participate, the approach of nurses and the timing of handovers as hindering their participation in bedside handovers.

CONCLUSION: Patients perceived the importance of, were mostly satisfied with, and had positive perceptions of bedside handover. However, several challenges hindered effective patient participation. Further research is needed into bedside handover as it is essential to enhance patient-centred quality care that aligns with national safety and quality healthcare standards.

IMPACTS: Understanding the significance of patient involvement in bedside handovers motivates patients to actively share information about their care, leading to increased patient satisfaction and the promotion of patient-centred care. Addressing challenges through targeted strategies can enhance patient participation, communication, increased patient satisfaction and foster a more patient-centred approach to care.

PATIENT OR PUBLIC CONTRIBUTION: The conduct of this study was supported by the consumer advisory group in the participating hospitals who also reviewed the survey questionnaires and conducted face validity of the survey.

PMID:39996386 | DOI:10.1111/jan.16839

Int J Low Extrem Wounds. 2025 Mar;24(1):192-197. doi: 10.1177/15347346231158858. Epub 2023 Feb 21.

ABSTRACT

INTRODUCTION: Because of its rarity compared to dry and wet gangrene of the lower limb, the gaseous form has often been considered as the most severe form of gangrenous disease. We aimed to report clinical, paraclinical, and therapeutic features, and to identify mortality risk factors of gas gangrene of the lower limb.

PATIENTS AND METHODS: We conducted a one-center case series retrospective study over a period of 13 years from January 2006 to December 2018.

RESULTS: A total of 19 patients were included: 12 men, 7 women. Mean age was 59.3 ± 11.3 years. There were 17 diabetic patients and one patient was on radio-chemotherapy for lower rectal cancer. Septic shock was initially present in 4 cases. Hyperleukocytosis was noted in 17 patients. C-reactive protein was elevated in 11 patients. All patients were put on antibiotics then operated on. A total of 8 patients died postoperatively (42%) in an average time of 9.6 days after surgery. On univariate analysis, factors associated with mortality were: Septic shock on admission (p = 0.02); local signs limited to foot (p = 0.05) or extended above the knee (p = 0.02); leukocytosis (p = 0.005); glycemia level (p = 0.02); antibiotic therapy duration (p = 0.04); antibiotic association of Penicillin G, metronidazole, and gentamicin (p = 0.02); amputation procedure solely (p = 0.04) or debridement procedure without amputation (p = 0.05); intraoperative transfusion (p = 0.006); and hospital stay (p = 0.01).

CONCLUSION: Identifying gas gangrene mortality factors is fundamental to standardize management. Our study was able to build on the small size of our series, but further prospective and large-scale studies are required.

PMID:39996358 | DOI:10.1177/15347346231158858

J Res Health Sci. 2025 Jan 1;25(1):e00640. doi: 10.34172/jrhs.2025.175. Epub 2024 Dec 25.

ABSTRACT

BACKGROUND: Integrated trauma systems (ITS) have shown potential in reducing traffic crash-related injuries and mortality, although their structure and impact can vary. This study assessed the effectiveness of ITS in Guilan, Iran. Study Design: A retrospective observational study.

METHODS: Utilizing a cross-sectional analysis, this descriptive-analytical study was conducted in Northern Iran from 2015 to 2019 to compare road traffic crash (RTC) data in Guilan (with ITS) against Mazandaran (without ITS), considering weather as a confounder. The study involved pre- and post-ITS intervention analyses to evaluate changes in RTC, injury, and mortality rates.

RESULTS: Before ITS implementation, Guilan’s daily RTC mean was 38.4 (SD=16.7), which significantly decreased to 30.8 (SD=13.7) after the intervention. Conversely, in the control province of Mazandaran, the daily average number of RTCs increased from 37.29 (SD=14.1) to 42.55 (SD=16.4) post-ITS implementation in Guilan. Furthermore, the mortality rate in Guilan showed a marginal decline from 27.74 (SD=12.6) pre-ITS to 26.60 (SD=11.9) post-ITS, indicating the positive impact of the ITS. In contrast, Mazandaran demonstrated a significant increase in mortality from 32.16 (SD=14.5) to 51.75 (SD=15.7). The statistical analysis confirmed a significant reduction in mortality and injury incidence in Guilan at the time of the intervention, with a marked decrease observed post-intervention (P<0.001).

CONCLUSION: The findings revealed that RTC prevention is feasible in Iran, with ITS in Guilan significantly reducing RTCs, injuries, and mortalities, underscoring the importance of ongoing efforts to expand ITS components nationally.

PMID:39996349 | DOI:10.34172/jrhs.2025.175

J Res Health Sci. 2025 Jan 1;25(1):e00639. doi: 10.34172/jrhs.2025.174. Epub 2024 Dec 25.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disorder diagnosed by elevated blood sugar. Key risk factors for T2DM include obesity, a sedentary lifestyle, and poor dietary habits. The proportion of macronutrients and the dietary inflammatory index (DII) seem to be associated with the risk of T2DM. This study aimed to assess and compare the macronutrient intake, DII, and BMI of newly diagnosed T2DM patients with healthy individuals in Kermanshah, Iran. Study design: This study employed a case-control design.

METHODS: A total of 105 newly diagnosed T2DM patients were selected as the case group, while an equal number of control participants were selected from their non-diabetic friends or neighbors. Dietary intake was assessed using a validated food frequency questionnaire. Energy, macronutrients, fatty acids intake, and DII were estimated using ShaFA software. Statistical significance was set at P values below 0.05.

RESULTS: The study included 105 newly diagnosed T2DM and 105 healthy individuals. Diabetic patients had significantly lower intake of protein, total fat, polyunsaturated fatty acids (PUFA), and monounsaturated fatty acids (MUFA), while their body mass index (BMI) and DII were higher. Multiple logistic regression indicated that protein, PUFA, and MUFA are protective factors for T2DM, while BMI, carbohydrates, and saturated fat intake are risk factors. A higher DII was correlated with an increased risk of T2DM risk, even after adjusting for BMI.

CONCLUSION: Lower BMI and DII, balanced macronutrient intake, and consumption of MUFA and omega-3 fatty acids may be beneficial in preventing or delaying the onset of T2DM. Further research is needed to explore these associations in greater depth.

PMID:39996348 | DOI:10.34172/jrhs.2025.174

J Res Health Sci. 2025 Jan 1;25(1):e00637. doi: 10.34172/jrhs.2025.172. Epub 2024 Dec 25.

ABSTRACT

BACKGROUND: Hypertension (HTN) elevates blood pressure (BP) in the arteries. It is defined as systolic BP (SBP)>140 mm Hg and/or diastolic BP (DBP)>90 mm Hg. This study aimed to identify determinant risk factors of longitudinal change of SBP and DBP with time to first remission of hypertensive patients. Study Design: A retrospective cohort study.

METHODS: A descriptive and inferential analysis was employed to explore the determinant risk factors, and a multivariate joint model was applied to test the significant association of the possible risk factors.

RESULTS: Of all 369 patients, 235 (63.7%) had first remission with a median survival time of five months. The patients demonstrated shorter first remission time when they had no history of comorbidity, resided in urban areas, took a combination of drugs, and were younger. Similarly, residence, age, treatment, history of diabetes mellitus (DM), history of stroke, and observation time were determinant risk factors of SBP. On the other hand, age, treatment, history of DM, chronic kidney diseases, and observation time were identified as determinant risk factors of DBP. The result revealed a strong positive association between changes in SBP and DBP (P=0.9923). In addition, a significant association was observed between the value of SBP and time to first remission (γ_1=-0.0693, HR=0.993).

CONCLUSION: Having good follow-ups, receiving control of comorbidity, and taking a combination of drugs show several opportunities for decreasing BP. Consequently, this compels patients to experience the first remission early.

PMID:39996346 | DOI:10.34172/jrhs.2025.172

Nurs Crit Care. 2025 Mar;30(2):e13289. doi: 10.1111/nicc.13289.

ABSTRACT

BACKGROUND: Oral care is critical for preventing ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. ICU nurses play a key role in delivering this care but often encounter challenges stemming from knowledge gaps and inconsistent practices.

AIM: To assess ICU nurses’ knowledge, attitudes and practices (KAP) in oral care for VAP prevention and identify demographic factors influencing these variations using random forest analysis.

STUDY DESIGN: A multi-centre cross-sectional study was conducted. Between April and June 2023, 291 ICU nurses from five ICUs across three public tertiary hospitals in Ganzhou City were surveyed using proportionate stratified sampling. Likert-scale questionnaires evaluated KAP, and statistical analyses, including t-tests, analysis of variance and random forest models, were used to determine demographic predictors of KAP scores.

RESULTS: The average KAP scores were as follows: knowledge 27.34 (±4.53), attitudes 31.89 (±4.24), and practices 43.13 (±9.0). Significant predictors of KAP included academic titles, professional positions, gender, ICU tenure and department. Common barriers to effective oral care included lack of formal training, time constraints and limited resources.

CONCLUSIONS: ICU nurses demonstrate positive attitudes towards VAP prevention, but significant gaps in knowledge and practice remain. Targeted education, especially for less-experienced and lower qualified nurses, and standardized protocols are essential to improve adherence to oral care practices and reduce VAP incidence.

RELEVANCE TO CLINICAL PRACTICE: The findings highlight the need for tailored educational interventions to address knowledge gaps, particularly among male, less-experienced and lower qualified nurses. Implementing standardized training protocols can enhance oral care practices, improve patient outcomes and reduce VAP incidence.

PMID:39996334 | DOI:10.1111/nicc.13289

Ann Surg. 2025 Feb 25. doi: 10.1097/SLA.0000000000006679. Online ahead of print.

ABSTRACT

OBJECTIVE: To design and validate a questionnaire-based scoring system that measures distress and quality of life implications related to specific bowel function symptoms and consequences.

SUMMARY OF BACKGROUND DATA: The Patient Reported Outcomes after Pouch Surgery Delphi consensus study identified symptoms and consequences that were utilized to previously create a pouch severity score. The existing score does not specifically evaluate patients’ accommodations to pouch function or their perceived distress related to bowel-related quality of life over time.

METHODS: Pouch patients were recruited at inflammatory bowel disease centers and via patient advocacy websites. They were administered a questionnaire-based survey eliciting responses regarding the frequency of a variety of bowel symptoms identified in the prior Delphi consensus study. For each item, participants also responded to the question “How much does having this symptom (or consequence) bother you?”. Participants also reported on their quality of life. The responses were used to generate the Ileoanal Pouch Syndrome Distress index. Test-retest validity, convergent validity, and clinical validity were evaluated.

RESULTS: The distress index was calculated by adding the patient’s scores for all 16 items. The possible scores range from 0 to 64, ranked from least to most bothersome symptoms. With increasing distress index scores, a higher proportion of patients reported poor quality of life. The receiver operating characteristic area under the curve for the distress score prediction of poor quality of life was calculated at 0.871. The distress index showed excellent correlation with bowel function scores and measures of clinical validity.

CONCLUSIONS: The distress index represents a step forward in the patient-centered management of ileoanal pouch function. When used in combination with the severity score and longitudinally over time, it will allow surgeons and gastroenterologists to take a nuanced approach to optimizing bowel function for a population of highly complex gastrointestinal patients, while accounting for symptom accommodation over time.

PMID:39996315 | DOI:10.1097/SLA.0000000000006679

Mol Ecol. 2025 Feb 25:e17702. doi: 10.1111/mec.17702. Online ahead of print.

ABSTRACT

Polyploidisation is a significant reproductive barrier, yet genetic evidence indicates that interploidy admixture is more common than previously thought. Theoretical models and controlled crosses support the ‘triploid bridge’ hypothesis, proposing that hybrids of intermediate ploidy facilitate gene flow. However, comprehensive evidence combining experimental and genetic data from natural mixed-ploidy species is missing. Here, we investigated the rates and directionality of gene flow within a diploid-autotetraploid contact zone of Cardamine amara, a species with abundant natural triploids. We cytotyped over 400 individuals in the field, conducted reciprocal interploidy crosses, and inferred gene flow based on genome-wide sequencing of 84 individuals. Triploids represent a conspicuous entity in mixed-ploidy populations (5%), yet only part of them arose through interploidy hybridisation. Despite being rarely formed, triploid hybrids can backcross with their parental cytotypes, producing viable offspring that are often euploid (in 42% of cases). In correspondence, D-statistics and coalescent simulations documented a significant genome-wide signal of bidirectional gene flow in sympatric but not allopatric populations. Triploids, though rare, thus seem to play a key role in overcoming polyploidy-related reproductive barriers in C. amara. In sum, we present integrative evidence for interploidy gene flow mediated by a triploid bridge in natural populations.

PMID:39996298 | DOI:10.1111/mec.17702

Cureus. 2025 Jan 24;17(1):e77935. doi: 10.7759/cureus.77935. eCollection 2025 Jan.

ABSTRACT

Introduction Many medical students do not have access to hands-on surgical experience throughout the pre-clinical curriculum. To address this issue, we developed a low-cost abdominal surgery simulator for use during instructive years and tested its efficacy through a proof-of-concept, randomized controlled trial. Our goal is to help medical students integrate foundational anatomy with surgical pathology, enhancing their understanding and translating to academic success on board-relevant topics. Methods Second-year students at Edward Via College of Osteopathic Medicine-Carolinas Campus (VCOM-CC) were split into two groups. The control group utilized the traditional curriculum, while the experimental group used the curriculum along with the simulator in instructive and integrative sessions. We created pre- and post-assessments comprised of gastrointestinal anatomy relevant to United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 medical licensing examinations and compared the groups’ outcomes using statistical analysis. Results Statistical analysis was performed on the average change between the pre-assessment and post-assessment scores. This trial revealed an average change of -0.267, a standard deviation of 3.90 for the experimental group (n = 15), and an average change of -1.375, a standard deviation of 2.93 for the control group (n = 16). A two-sample t-test at 95% confidence interval yielded a p-value of 0.3246. Conclusion Although this trial did not demonstrate a statistically significant difference in the average score change, the increased exposure to both surgical and anatomical concepts provides a relevant learning experience for students before their clinical curriculum. In the future, we aim to integrate our simulator into pre-clinical medical education. Furthermore, we plan to evaluate the impact of our simulator on the performance of the two groups during surgical rotations as part of our ongoing research.

PMID:39996231 | PMC:PMC11848221 | DOI:10.7759/cureus.77935

Cureus. 2025 Jan 25;17(1):e77949. doi: 10.7759/cureus.77949. eCollection 2025 Jan.

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the world’s most serious healthcare issues, causing morbidity, mortality, and high healthcare costs, making effective treatment strategies essential. This meta-analysis assessed the comparative effectiveness and safety of ceftaroline, linezolid, and vancomycin in treating MRSA infections. Searches were undertaken across major electronic databases, including PubMed, Cochrane CENTRAL, Embase, and Web of Science, from 2000 to 2024. A total of 24 studies (17 randomized controlled trials (RCTs) and seven observational studies) involving 11,332 patients met the inclusion criteria. Patients on vancomycin treatment were more likely to have lower odds of being cured than controls (OR 0.68; 95% CI (0.58, 0.81), p < 0.0001), especially when compared to linezolid (OR 0.61; 95% CI (0.49, 0.74), p < 0.00001). Furthermore, mortality rates were significantly higher in vancomycin-treated patients than in controls (OR 1.25; 95% CI (1.00, 1.56), p = 0.05) and more precisely than in linezolid (OR 1.29; 95% CI (1.03, 1.62), p = 0.03). Microbiological eradication rates were not statistically different between vancomycin and the comparators (OR, 0.82; 95% CI (0.63, 1.07), p = 0.14). Safety analysis demonstrated comparable adverse event profiles between vancomycin and linezolid for thrombocytopenia, anemia, and hepatotoxicity. Although vancomycin remains a viable option owing to its accessibility and cost-effectiveness, our findings suggest that newer alternatives, particularly linezolid, may offer superior clinical outcomes in specific MRSA infections, especially in cases of pneumonia or high-risk patients. These results have important implications for clinical practice and antimicrobial stewardship programs and support a more nuanced approach to MRSA treatment based on patient-specific factors, infection characteristics, and local resources.

PMID:39996230 | PMC:PMC11848488 | DOI:10.7759/cureus.77949