Category: Statistics

J Am Acad Orthop Surg. 2025 Jul 3. doi: 10.5435/JAAOS-D-24-00604. Online ahead of print.

ABSTRACT

BACKGROUND: Dorsal wrist spanning plate (DWSP) fixation is a technique used to treat distal radius fractures with severe metaphyseal comminution, diaphyseal extension, and other complex fracture patterns. One concern of this technique is the potential risk of stiffness due to prolonged immobilization. The purpose of our study was to examine the association of DWSP duration on range of motion (ROM) outcomes after plate removal.

METHODS: Patients who underwent DWSP fixation for distal radius fracture with greater than 6 months of follow-up after DWSP removal at a single institution were retrospectively identified. Patients with a concomitant upper extremity injury were excluded. The primary outcome of interest was ROM. Secondary outcomes included visual analog scale pain scores and radiographic measurements. A piecewise regression analysis was run to evaluate for a nonlinear relationship between DWSP duration and ROM.

RESULTS: Fifty-one patients were included for analysis. DWSP removal occurred at a mean of 110 days (range, 59-182 days). Median duration of follow-up after DWSP removal was 11.7 months (interquartile range = 8.2 months to 1.8 years). No significant association was observed between DWSP duration and visual analog scale (P = 0.11), complication rate (P = 0.45), radial inclination (P = 0.57), radial height (P = 0.74), or volar tilt (P = 0.13). Piecewise regression demonstrated a statistically significant reduction in supination (P = 0.001), pronation (P = < 0.001), and wrist flexion (P = 0.014) for DWSP >120 days when controlling for age, sex, polytrauma, duration of follow-up, and additional fixation.

DISCUSSION: There is a nonlinear association between DWSP duration and wrist ROM (flexion, supination, and pronation). When DWSP duration is longer than 120 days, there is a negative correlation with ROM when controlling for covariates. When DWSP duration is less than or equal to 120 days, there is no correlation with ROM. Our findings suggest that patients with longer duration of DWSP duration (>120 days) are more likely to have range-of-motion limitations; additional research is necessary to determine whether implant retention longer than 120 days by itself or fracture or patient-specific factors which require longer implant retention are the causative agents for this motion limitation.

LEVEL OF EVIDENCE: Retrospective cohort, Level IV.

PMID:40627859 | DOI:10.5435/JAAOS-D-24-00604

JMIR Res Protoc. 2025 Jul 8;14:e74018. doi: 10.2196/74018.

ABSTRACT

BACKGROUND: The incidence of postoperative pancreatic fistula following distal pancreatectomy is as high as 30%-50%. Postoperative pancreatic fistula can be a major cause of perioperative morbidity, resulting in prolonged hospital stays and increased health care costs. The management of the pancreatic stump is one of the key factors influencing the occurrence of postoperative pancreatic fistula after distal pancreatectomy, but the optimal management approach remains debatable. The main methods for pancreatic stump closure include manual suturing and stapler closure. However, both methods are associated with a high risk of postoperative pancreatic fistula, which may be related to the balance between providing sufficient pancreatic duct burst pressure and ensuring blood supply to the stump. Ligation of the pancreatic stump has been attempted to reduce the risk of postoperative pancreatic fistula following distal pancreatectomy, but its efficacy remains limited by the challenge of achieving the optimal ligation force.

OBJECTIVE: This study aims to investigate whether ligation of the pancreatic stump with a quantified force can decrease the risk of postoperative pancreatic fistula following distal pancreatectomy.

METHODS: In this nonrandomized controlled clinical study at a tertiary center in China, the major eligibility criterion is the presence of lesions planned for distal pancreatectomy. Sixty patients will be allocated to the experimental or control group according to their choice. Recruitment for either group will be discontinued upon reaching the predefined sample size of 30 participants. In the experimental group, the pancreas will be ligated 5 mm from the pancreatic stump with a quantified force to provide a pancreatic duct burst pressure of approximately 40-70 mm Hg. The ligation force will be provided by a 3.2-mm-diameter silicone ring. During pancreatic stump ligation, this silicone ring will be stretched to 15 mm, generating an applied force of 1.3 N. The pancreas will be severed using energy-based devices before or after the ligation. In the control group, the pancreatic stump will be managed by manual suturing or stapling closure according to the surgeon’s clinical judgment and preference. Postoperative regular follow-up examinations will be conducted. The primary outcomes include postoperative pancreatic fistula and postoperative hospital stay, and the secondary outcomes include intra-abdominal infection, incision infection, and postoperative treatment costs. The primary and secondary outcomes of patients in this cohort will be statistically compared using appropriate tests.

RESULTS: This study started in February 2025, and the recruitment period is from February to September 2025.

CONCLUSIONS: This protocol proposes a novel approach for pancreatic stump management aimed at preventing postoperative pancreatic fistula following distal pancreatectomy. The research team established the optimal ligation force for the pancreatic stump to ensure adequate burst pressure for the pancreatic duct while preventing acute stump necrosis, thereby theoretically reducing the risk of postoperative pancreatic fistula.

TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2500097781; https://www.chictr.org.cn/showproj.html?proj=247008.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/74018.

PMID:40627856 | DOI:10.2196/74018

J Am Acad Orthop Surg. 2025 Jul 3. doi: 10.5435/JAAOS-D-24-01334. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between testosterone replacement therapy (TRT) and hip fractures remains underexplored. This study aims to investigate this relationship. We hypothesize that patients prescribed TRT experience a lower rate of hip fractures compared with a control group.

METHODS: The PearlDiver Mariner165 data set was used to obtain two random cohorts of 500,000 patients. The experimental group received TRT for at least 3 months and the control group did not. We used one-to-one matching to evaluate the effects of TRT in 301,724 patients. The incidence of hip fractures was assessed over a 2-year follow-up using the International Classifications of Disease codes. Multivariable logistic regression identified the association between TRT and hip fractures. Statistical significance was set at P < 0.05.

RESULTS: The patients in the TRT group were associated with a lower incidence of hip fractures compared with the control group (0.13% vs. 0.25%, P < 0.001). The multivariable analysis showed that TRT use was associated with a decreased incidence of hip fractures with an adjusted odds ratio (aOR) of 0.58 (95% confidence interval [CI], 0.51 to 0.66, P < 0.001). After stratifying by sex, the multivariable analysis showed that TRT use in male patients was associated with a decreased incidence of hip fractures with an aOR of 0.61 (95% CI, 0.53 to 0.72, P < 0.001); in female patients, it was associated with a decreased incidence of hip fractures with an aOR of 0.49 (95% CI, 0.38 to 0.63, P < 0.001).

CONCLUSION: Patients prescribed TRT had a 1.9 times lower likelihood of sustaining hip fractures. Further investigation into the association of TRT and fragility fractures garners continued interest. In addition, this can provide insight into the potential benefits of TRT use and maintaining bone health to improve bone mass and improve results of orthopaedic interventions.

LEVEL OF EVIDENCE: III.

PMID:40627853 | DOI:10.5435/JAAOS-D-24-01334

JMIR Res Protoc. 2025 Jul 8;14:e66396. doi: 10.2196/66396.

ABSTRACT

BACKGROUND: Women who experience intimate partner violence (IPV) are more likely to develop disabling chronic pain (CP). However, there is little information on what it means to live with CP while being exposed to IPV. In addition, despite well-established risk and protective factors for CP and its health outcomes, there are no data on whether these factors differ in women who have experienced IPV compared to those who have not.

OBJECTIVE: Our aims are to understand the meaning and implications of living with CP for women who have experienced IPV compared to women with CP alone and to identify possible differences in risk and protective factors as well as health outcomes.

METHODS: We have designed 2 studies to be conducted in 2 phases. The first phase will involve a qualitative study with a descriptive and exploratory design. Individual semistructured interviews will be conducted with at least 10 women with CP alone and with 10 women with CP who have experienced IPV. Reflexive thematic analysis will be used to examine participants’ experiences, meanings, and realities. In the second phase, a cross-sectional study will be conducted with women with CP affected by IPV, including those currently experiencing IPV and those with past exposure to IPV, as well as women with CP who have never experienced IPV. A total of 359 women will complete various scales assessing risk and protective factors (eg, pain-related worrying and activity patterns) and health outcomes (eg, legal and illegal drug use and health care use). Data analysis will involve inferential statistics and machine learning.

RESULTS: As of May 2025, we had contacted relevant associations to present the project and begin recruiting voluntary participants. We have conducted the pilot study to assure the adequacy of the questionnaire and usability or technical functionality of the web-based platform. The results are expected to be published starting in January 2026.

CONCLUSIONS: This research addresses two urgent needs in pain research identified by the European Pain Federation: (1) expanding knowledge on CP management in relation to contextual factors; and (2) identifying specific psychosocial, self-management, and health profiles among women with CP who have experienced IPV and those who have not. This could provide valuable insights for personalizing pain management treatments. In addition, the findings may help identify women experiencing IPV who present to health care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/66396.

PMID:40627849 | DOI:10.2196/66396

Folia Biol (Praha). 2025;71(2):73-78. doi: 10.14712/fb2025071020073.

ABSTRACT

Medulloblastoma (MB) in children is associated with distinct molecular subgroups, reflecting substantial biological heterogeneity. The presence of isocitrate dehydrogenase 1 (IDH1) and IDH2 mutations in paediatric MB has been rarely reported and not routinely investigated. Our study included 23 samples from paediatric patients diagnosed with MB. Hotspot alterations at codons IDH1 R132 and IDH2 R172 were examined using Sanger sequencing following polymerase chain reaction (PCR). The mean age of the patients was 10 years (SD: 4.25), comprising 17 males and 6 females. All cases exhibited classical histological features of MB. β-Catenin expression was observed in four cases (17.4 %), while 19 cases (82.6 %) showed no expression. No statistically significant differences in progression-free survival (PFS) were found between MBs with positive or negative β-catenin expression (P = 0.6). Radiotherapy alone was administered to four patients (17.4 %), while 19 patients (82.6 %) received combined radiotherapy and chemotherapy. The median PFS was 383 days (1 year and 18 days). IDH1 R132 or IDH2 R172 hotspot mutations were not detected in any of the samples. The absence of IDH1 or IDH2 mutations in paediatric MB may be attributed to differences in mutational profiles and cellular origins in childhood MB, despite its histomolecular similarities with adult MB.

PMID:40627836 | DOI:10.14712/fb2025071020073

JMIR Cardio. 2025 Jul 8;9:e68817. doi: 10.2196/68817.

ABSTRACT

BACKGROUND: Heart failure management involves comprehensive lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring, placing additional responsibility on patients and caregivers, with successful adherence often requiring extensive counseling and understandable patient education materials (PEMs). Prior research has shown PEMs related to cardiovascular disease often exceed the American Medical Association’s fifth- to sixth-grade recommended reading level. The large language model (LLM) ChatGPT may be a useful tool for improving PEM readability.

OBJECTIVE: We aim to assess the readability of heart failure-related PEMs from prominent cardiology institutions and evaluate GPT-4’s ability to improve these metrics while maintaining accuracy and comprehensiveness.

METHODS: A total of 143 heart failure-related PEMs were collected from the websites of the top 10 institutions listed on the 2022-2023 US News & World Report for “Best Hospitals for Cardiology, Heart & Vascular Surgery.” PEMs were individually entered into GPT-4 (version updated July 20, 2023), preceded by the prompt, “Please explain the following in simpler terms.” Readability was assessed using the Flesch Reading Ease score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. The accuracy and comprehensiveness of revised GPT-4 PEMs were assessed by a board-certified cardiologist.

RESULTS: For 143 institutional heart failure-related PEMs analyzed, the median FKGL was 10.3 (IQR 7.9-13.1; high school sophomore) compared to 7.3 (IQR 6.1-8.5; seventh grade) for GPT-4’s revised PEMs (P<.001). Of the 143 institutional PEMs, there were 13 (9.1%) below the sixth-grade reading level, which improved to 33 (23.1%) after revision by GPT-4 (P<.001). No revised GPT-4 PEMs were graded as less accurate or less comprehensive compared to institutional PEMs. A total of 33 (23.1%) GPT-4 PEMs were graded as more comprehensive.

CONCLUSIONS: GPT-4 significantly improved the readability of institutional heart failure-related PEMs. The model may be a promising adjunct resource in addition to care provided by a licensed health care professional for patients living with heart failure. Further rigorous testing and validation is needed to investigate its safety, efficacy, and impact on patient health literacy.

PMID:40627825 | DOI:10.2196/68817

JCO Clin Cancer Inform. 2025 Jul;9:e2500078. doi: 10.1200/CCI-25-00078. Epub 2025 Jul 8.

ABSTRACT

PURPOSE: Cancer is a leading cause of morbidity and mortality in the United States. Mapping electronic health record (EHR) data to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) may standardize data structure and allow for multiple database oncology studies. However, the number of oncology studies produced with the OMOP CDM has been low. To investigate the discrepancy between the public health impact of cancer and the output of OMOP CDM clinical cancer studies, we evaluated (EHR) data quality of five surgical oncology cohorts in the All of Us Research Program: mastectomy, prostatectomy, colectomy, melanoma excision, and lung cancer resection.

METHODS: We selected procedure codes that were the basis of each phenotype. We used a data quality checklist to evaluate five domains systematically: conformance, completeness, concordance, plausibility, and temporality.

RESULTS: Most phenotype-defining source codes were mapped to Current Procedural Terminology 4, which is an EHR standard. All cohorts had low concept prevalence. Most bivariate correlations between concepts were weak (⍴ ≤ 0.5). The small number of biomarkers available for use limited our plausibility analysis. The median time between biopsy and surgery varied across cohorts.

CONCLUSION: We identified multiple data completeness issues, which limited the fitness for use evaluation. Also, using the OMOP CDM procedure concepts and mappings presented challenges for our study. Variable amounts of missingness in OMOP CDM surgical oncology data may affect the fitness for use of cancer data. Further research is warranted to improve the quality of that data.

PMID:40627823 | DOI:10.1200/CCI-25-00078

JMIR Mhealth Uhealth. 2025 Jul 8;13:e60173. doi: 10.2196/60173.

ABSTRACT

BACKGROUND: Timely and appropriate care is critical for patients with ST-elevation myocardial infarction (STEMI). Effective communication and prompt sharing of test results, particularly electrocardiograms (ECGs), between the referring emergency medicine (EM) physician or emergency medical service (EMS) paramedic and the interventional cardiologist (IC) are essential. This exchange relies on fax or SMS text messages. The SmartAMI-ACS (Strategic Management of Acute Reperfusion and Therapies in Acute Myocardial Infarction) App was developed to streamline communication. It is user friendly and privacy compliant, and enables rapid, secure ECG sharing to support faster, informed clinical decision-making.

OBJECTIVE: This paper details the results of targeted preimplementation surveys to establish barriers and enablers of using a smartphone app to transmit ECG images among ICs, EM physicians, and EMS paramedics to help tailor implementation interventions.

METHODS: To assess the proposed acceptability and uptake of the app, preimplementation surveys were disseminated to ICs, EM physicians, and EMS paramedics in one region of Ontario, Canada. Questions were generated based on selected components of the Consolidated Framework for Implementation Research, results from a pilot study carried out at a regional hospital where the SmartAMI-ACS app was previously implemented, and predicted barriers based on expert guidance. The preimplementation surveys consisted of 7-point Likert scale questions (1=strongly disagree and 7=strongly agree) and open-ended questions. Open-ended data were extracted verbatim and analyzed using an inductive qualitative approach, with transcripts coded into descriptive qualitative codes and then collapsed into themes.

RESULTS: Survey uptake was acceptable, with 9 of the invited 10 ICs, 51 of the invited 223 EM physicians, and 93 of the invited 1138 EMS paramedics responding. All groups recognized that current practices for sharing ECGs allowed room for improvement, accepting that fax can be inconvenient and SMS text messages may not be secure. When asked whether there was a need for a smartphone app to transmit ECGs, ICs (mean 6.67, SD 0.5), EM physicians (mean 5.57, SD 1.3), and EMS paramedics (mean 5.79, SD 1.45) consistently agreed. Commonly reported barriers were concerns over technological challenges, privacy issues, and cell phone reception strength. Through the identification of the barriers in each stakeholder group, implementation strategies were developed that facilitated the scale-up of this system-change intervention.

CONCLUSIONS: Results from the 3 web-based preimplementation surveys to identify key barriers and enablers to the implementation of the app helped inform the selection of tailored implementation strategies to support the rollout of the app across the health region. The surveys identified key barriers around technology, privacy, and access to required Wi-Fi that needed to be addressed during app implementation to facilitate uptake and use. Results from the surveys, and ongoing evaluation of effectiveness, are informing the expansion of the app intervention to local ambulance services and other health regions.

PMID:40627818 | DOI:10.2196/60173

Neurology. 2025 Aug 12;105(3):e213854. doi: 10.1212/WNL.0000000000213854. Epub 2025 Jul 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: Recent literature suggests no elevated risk of cardiovascular disease in patients having nonfocal transient neurologic attacks (TNAs), yet the origin of these attacks remains unclear. Therefore, we investigated their incidence and potential risk factors in a prospective cohort study, hypothesizing associations with cardiovascular risk factors.

METHODS: Within the Dutch population-based Rotterdam Study, community-living individuals aged 45 years or older underwent assessment for demographic and cardiovascular risk factors in study cohorts initiated in 1990, 2000, and 2006. Participants were subsequently followed until January 1, 2021, for disease incidence through automated linkage of the study database with medical records from participants’ general practitioners. For this study, participants free from TNA at baseline were selected and followed up for the outcome of a nonfocal TNA. The risk of nonfocal TNA was determined through age-specific incidence rates (IRs). Potential risk factors of nonfocal TNA were identified using cause-specific, multivariable, Cox proportional hazard modeling accounting for age, sex, education (university or higher vocational vs lower education level), cardiovascular risk factors, ultrasound markers of carotid atherosclerosis, antithrombotic medication use, and a history of vascular diseases. Sensitivity analyses consisted of conducting this regression among participants without any history of vascular disease at study entrance.

RESULTS: After 204,474 person-years of follow-up in 14,096 participants (mean [SD] age 65.5 [10.3] years, 59.0% female), 518 index nonfocal TNAs (3.7%) occurred. The incidence of nonfocal TNA increased with age, with an IR in those aged between 55 and 59 years of 65.5 (95% CI 33.6-116.2) per 100,000 person-years of follow-up to 424.0 (95% CI 348.0-512.0) in those aged 85 years or older. Older age (hazard ratio [HR] 1.08, 95% CI 1.07-1.09), a lower education level (HR 1.62, 95% CI 1.15-2.29), plaque presence on carotid ultrasound (HR 0.80, 95% CI 0.65-1.00), and the use of antithrombotics (HR 0.59, 95% CI 0.39-0.90) were all independently associated with the risk of nonfocal TNA. After restricting analyses to the 12,499 individuals without history of vascular disease, only the associations of age and a higher maximum attained education level with the risk of nonfocal TNA remained statistically significant.

DISCUSSION: Nonfocal TNAs predominantly affect older adults and those with lower educational attainment, suggesting that these attacks originate from socioeconomic determinants rather than from established cardiovascular risk factors.

PMID:40627815 | DOI:10.1212/WNL.0000000000213854

JMIR Ment Health. 2025 Jul 8;12:e70458. doi: 10.2196/70458.

ABSTRACT

BACKGROUND: The dual nature of suicide-related internet use (SRIU) as preventative or harmful is well-documented, but its characteristics in the mental health patient population remain underresearched. Some evidence suggests mental health patients engage in SRIU differently from the general population.

OBJECTIVE: This study aims to explore the types, motivations, frequency, and perceived impacts of SRIU in suicidal mental health patients, as well as their engagement with web-based prevention resources.

METHODS: A cross-sectional study was conducted using an anonymous web-based survey distributed between June and December 2023. Participants (n=696) were UK adults with secondary mental health service contact and recent suicidal thoughts or behaviors. Of these, 523 (75%) participants engaged in SRIU. Collected data included sociodemographic details, clinical history, types and motivations for SRIU, and interactions with suicide prevention resources. Analysis used descriptive statistics, chi-square, and Wilcoxon tests, with multiple testing corrections applied.

RESULTS: The most common SRIU type was searching for suicide-related content (456/523, 87.4%), followed by connecting with others (271/523, 51.8%). Motivations included seeking information on suicide methods (313/523, 60.8%) and support for suicidality (271/523, 57.2%), with significant overlap. Participants perceived SRIU as neither harmful nor helpful overall, with those seeking suicide methods rating it as more harmful. Most participants encountered suicide prevention messaging, but less than half engaged with it. Only 27.5% (n=144) participants disclosed their SRIU to clinicians, with only 1 in 10 being asked about it by their clinician.

CONCLUSIONS: This study underscores the dual role of SRIU as both a source of support and a potential risk for mental health patients. Despite high exposure to suicide prevention messaging, engagement was limited, suggesting inefficiencies in current intervention designs. Clinicians rarely inquired about SRIU, and voluntary disclosure by patients was low, representing missed opportunities for intervention. Proactive discussions about SRIU in clinical settings could improve risk identification and support planning. Addressing its harmful aspects while leveraging its potential for support requires integrated online and offline strategies.

PMID:40627808 | DOI:10.2196/70458