Category: Statistics

Worldviews Evid Based Nurs. 2025 Dec;22(6):e70077. doi: 10.1111/wvn.70077.

ABSTRACT

BACKGROUND: Sleep disturbances and delirium are prevalent problems in the intensive care unit. Evidence suggests that these conditions negatively impact patient outcomes by increasing the length of hospital stays, delaying recovery, and raising healthcare costs.

AIM: This study aimed to investigate the effect of implementing a sleep care bundle on sleep quality and delirium among critically ill patients.

METHODS: A quasi-experimental research design was used. A purposive sample of 66 patients was divided equally into two groups: a bundle group that received a sleep care bundle and a control group that received routine unit care in the chest intensive care units at Mansoura University in Egypt. Data were collected using the critically ill patients’ outcome evaluation tool based on the Richards-Campbell Sleep Questionnaire Scale and the Intensive Care Delirium Screening Checklist.

RESULTS: Compared to the control group, the bundle group demonstrated statistically significant improvements across all sleep quality domains measured by the Richards-Campbell Sleep Questionnaire by Day 3. Specifically, sleep depth improved from 1.24 ± 0.44 to 1.82 ± 0.39 (effect size = 0.600), ability to fall asleep from 1.21 ± 0.42 to 1.91 ± 0.29 (effect size = 0.703), number of awakenings from 1.27 ± 0.45 to 1.79 ± 0.42 (effect size = 0.483), sleep efficiency from 1.24 ± 0.44 to 1.76 ± 0.44 (effect size = 0.600), and overall sleep quality from 1.24 ± 0.44 to 1.85 ± 0.36 (effect size = 0.600). In addition, the occurrence of delirium on Day 3 was significantly lower in the bundle group (0.0%) compared with the control group (15.2%) (χ² = 7.471, p = 0.023). Subsyndromal delirium was observed in 6.1% of the bundle group and 15.2% of the control group. The overall percentage of patients without delirium was significantly higher in the bundle group (93.9%) compared to the control group (69.7%).

LINKING EVIDENCE TO ACTION: Implementing a sleep care bundle enhances sleep quality and reduces the occurrence of delirium in critically ill patients. Therefore, it can be integrated as an adjunctive intervention alongside routine care for these patients. To strengthen future applications, incorporating fidelity monitoring is recommended to ensure consistent implementation of the sleep care bundle and to optimize its effectiveness in clinical practice.

PMID:41174866 | DOI:10.1111/wvn.70077

Worldviews Evid Based Nurs. 2025 Dec;22(6):e70074. doi: 10.1111/wvn.70074.

ABSTRACT

BACKGROUND: Hemodialysis can lead to complications that negatively impact patients’ quality of life. Managing hemodialysis effectively requires patient adherence to complex regimens.

AIM: This randomized controlled experimental study aimed to assess the impact of nurse-led telephone-based patient education and counseling on disease management, quality of life, and self-care behaviors in hemodialysis patients.

METHODS: Conducted between September 2022 and June 2023 at State Hospital’s Hemodialysis Unit, the study included an intervention and a control group. Data were collected using tools such as the Scale for Dietary Knowledge in Hemodialysis Patients (SDKHP), Attitude Scale for the Dietary Therapy of Hemodialysis Patients (ASDTHP), Dialysis Symptom Index (DSI), Fluid Control in Hemodialysis Patients Scale (FCHPS), the Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula (AVF), and the Kidney Disease Quality of Life-36 (KDQOL-36).

RESULTS: Pre- and posttest comparisons showed significant improvements in the intervention group’s mean scores for SDKHP, ASDTHP, and FCHPS, with the control group experiencing declines. DSI scores indicated reduced symptoms in the intervention group and an increase in the control group. The AVF Self-Care Scale results demonstrated increased self-care behaviors in the intervention group, while a decrease was observed in the control group. KDQOL-36 subscales, including physical and mental functioning, disease burden, and symptom management, also improved in the intervention group, while scores declined in the control group. These findings confirm the effectiveness of telephone-based patient education and counseling on multiple outcome measures.

LINKING EVIDENCE TO ACTION: Nurse-led, telephone-based patient education and counseling improved dietary adherence and disease management. Telephone-based patient interventions enhanced patients’ self-care skills regarding AVF maintenance. Quality of life improved across multiple dimensions in the intervention group. Telephone counseling ensured continued monitoring and individual support, even after discharge. Nurses should integrate telephone-based counseling into routine care, especially for chronic disease management.

PMID:41174863 | DOI:10.1111/wvn.70074

Worldviews Evid Based Nurs. 2025 Dec;22(6):e70079. doi: 10.1111/wvn.70079.

ABSTRACT

BACKGROUND: Nurse-led telephone-based follow-up interventions play a role in patient follow-up, but at present, no meta-analysis has been found to assess the effectiveness of nurse-led, telephone follow-up interventions for patients with acute coronary syndrome.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effectiveness of nurse-led telephone-based follow-up interventions on health outcomes in people with acute coronary syndromes.

DESIGN: Systematic review and meta-analysis of randomized controlled trials.

METHODS: A comprehensive search of six databases: PubMed, Web of Science, Embase, Cochrane Library, CINAHL and Scopus was conducted from the inception of the databases to 30 September 2023. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the included randomized controlled studies. Review Manager 5.4 and Stata 16.0 were used to conduct statistical analysis.

RESULTS: A total of 12 studies were included. Nurse-led telephone-based follow-up interventions may reduce systolic and diastolic blood pressure (MD = -2.55, 95% CI [-4.16, -0.94]) (MD = -2.15, 95% CI [-3.18, -1.12]) and low-density lipoprotein (MD = -9.06, 95% CI [-14.33, -3.79]) in patients with acute coronary syndrome. However, its effectiveness in controlling high-density lipoprotein (MD = 1.65, 95% CI [-4.30, 7.61]) and reducing total cholesterol (MD = -2.72, 95% CI [-7.57, 2.13]) was uncertain. In addition, the results showed that the nurse-led follow-up intervention did not play a role in improving anxiety (SMD = -0.20, 95% CI [-0.44, 0.04]) and depression (SMD = -0.07, 95% CI [-0.21, 0.06]) in patients with acute coronary syndrome, but it probably improved drug adherence (RR = 1.30, 95% CI [1.05, 1.60]) and smoking cessation (RR = 1.31, 95% CI [1.08, 1.60]).

LINKING EVIDENCE TO ACTION: The findings of this review suggest that nurse-led telephone-based follow-up interventions had a potentially positive effect on controlling blood pressure and low-density lipoprotein levels, as well as improving medication adherence and smoking cessation among patients with acute coronary syndrome, compared to usual care. However, the intervention did not appear to significantly impact high-density lipoprotein, total cholesterol, anxiety, and depression, indicating that further research in these areas will be necessary in the future.

TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews): CRD42023465894.

PMID:41174862 | DOI:10.1111/wvn.70079

Stomatologiia (Mosk). 2025;104(5):53-56. doi: 10.17116/stomat202510405153.

ABSTRACT

THE AIM OF THE STUDY: High precise evaluation of the premaxilla morphology is essential to perform detailed diagnosis and treatment plans in implantology and the orthodontic field. We aimed to study morphometric analysis measurements of the premaxilla.

MATERIALS AND METHODS: In this cross-sectional study, maxillary CBCT images from 208 patients were evaluated in the Maxillofacial Radiology department between 2014-2024. Sagittal views were assessed to determine thickness of the anterior part in three levels. The difference in canal diameter and length between genders was evaluated using an One Way ANOVA test.

RESULTS: When determining the thickness of the alveolar ridge of the anterior part of the maxillary bone in the sagittal plane at the upper level, it was 11.00±1.65 mm in men and 10/70±1.78 mm in women (f=0.32), (p=0.811), at the lower level 5.62±0.97 mm in men and 5.35±0.78 mm in women (f=0.54), (p=0.66) and an average level of 6.05±141 mm in men and 5.70±1.18 mm in women (f=0.29), (p=0.83), respectively, statistically significant no gender difference was observed.

CONCLUSION: The average superior thickness of the maxillary anterior bone was 10.85±1.71 mm, the medium thickness was 5.87±1.29 mm, the inferior thickness was 5.48±0.87 mm, among Mongolian adults. We observed that the maxillary anterior bone thickness is increased from tip to base of the them.

PMID:41174850 | DOI:10.17116/stomat202510405153

J Neurosurg. 2025 Oct 31:1-10. doi: 10.3171/2025.7.JNS242730. Online ahead of print.

ABSTRACT

OBJECTIVE: Resection is the foundation of spheno-orbital meningioma (SOM) treatment, but the confluence of critical neurovascular structures traversing the cranium and orbit and the unforgiving nature of orbital injury make resection of the tumor’s orbital components challenging. Large series detailing surgical outcomes are rarely reported, and a surgical framework is needed. This study examined the feasibility of resection of SOMs with an involved orbit. The authors classified SOMs based on the relative orbital involvement to determine tumor resectability, with the goals of improving proptosis and functional visual outcome and avoiding new deficit.

METHODS: A retrospective chart review identified patients with surgically treated SOMs with a minimum 1-year follow-up at an academic center from 2002 to 2023. Imaging and clinical presentations and outcomes are reported, and a clinically relevant grading system is proposed based on imaging findings of orbital hyperostosis (grade 1), periorbital involvement (grade 2), intraorbital involvement without (grade 3a) or with (grade 3b) rectus muscle invasion, or involvement of the orbital apex or optic nerve (grade 4).

RESULTS: Among 93 included patients (71% female), the mean age at surgery was 54.8 years. The most common presentations were proptosis (74.2%), visual decline (57.0%), and cranial neuropathies (30.1%). Gross-total resection of the orbital contents was achieved in 88.5%, 50.0%, 16.7%, and 24.1% of grade 1-4 tumors, respectively; it was less likely in grade 3 or 4 tumors (OR 0.06, 95% CI 0.019-0.190; p < 0.001), unless it was for oncological removal in a patient with no functional vision. Resection led to stable or improved vision in most patients across all grades (96.2%, 100%, 83.3%, and 93.1% in grade 1-4 tumors, respectively). Proptosis was less pronounced in grade 1 tumors, and the degree of proptosis was statistically more likely to improve with pronounced proptosis in higher-grade tumors (Δexophthalmos index 0.04, 0.14, 0.11, and 0.15 in grade 1-4 tumors, respectively). Overall surgical, visual, and ophthalmological morbidities were similar across all grades, and there were no deaths.

CONCLUSIONS: This study introduces a grading system for SOMs and validates its utility through the assessment of surgical outcomes of a large patient cohort. This grading system allows for a better understanding of visual risks associated with surgery and facilitates comparisons across clinical studies. This may guide clinical management discussions and future research of this complex pathology.

PMID:41172370 | DOI:10.3171/2025.7.JNS242730

J Neurosurg. 2025 Oct 31:1-10. doi: 10.3171/2025.7.JNS251312. Online ahead of print.

ABSTRACT

OBJECTIVE: The authors of this study aimed to identify predictors of in-hospital mortality in patients with primary supratentorial intracerebral hemorrhage (ICH) at emergency department admission and 6 hours thereafter. Additionally, they evaluated the predictive accuracy of a modified ICH (mICH) Score incorporating midline shift (MLS), compared to that of the original ICH Score.

METHODS: This retrospective analysis included adult patients with primary supratentorial ICH who had been admitted to a Comprehensive Stroke Center between July 2017 and December 2023. Data extracted from the electronic medical records included demographics, clinical history, blood pressure, ICH characteristics on CT scans (i.e., location, hematoma volume, intraventricular hemorrhage, MLS), Glasgow Coma Scale (GCS) score, ICH Score, laboratory tests (i.e., white blood cell [WBC] count and hemoglobin, hematocrit, platelet, and glucose levels), antithrombotic use, neurological interventions, and discharge status. The primary outcome was in-hospital mortality. The mICH Score was calculated by substituting ICH volume in the original risk stratification scale with MLS (≥ 5 mm = 1 point). Statistical analyses included descriptive statistics, chi-square test, t-test, logistic regression, and receiver operating characteristic curve analysis.

RESULTS: The in-hospital mortality rate among 518 patients with primary supratentorial ICH was 23%. Compared with survivors, deceased patients were older, had lower BMIs, more frequently presented with loss of consciousness, and had lower GCS scores and higher ICH Scores at admission and 6 hours thereafter. Independent predictors of death included older age, lower BMI, cortical ICH location, hematoma volume ≥ 30 cm3, intraventricular hemorrhage, MLS ≥ 5 mm, lower GCS score, higher ICH Score, elevated systolic blood pressure, higher WBC count and glucose level, and lower hemoglobin and hematocrit levels. On admission, the ICH Score (area under the curve [AUC] 0.890) and GCS score (AUC 0.879) showed a strong predictive performance for mortality, which improved at 6 hours after admission (AUC 0.914 for both). The mICH Score (AUC 0.897) demonstrated predictive accuracy comparable to that of the ICH Score. Twenty-one percent of the patients experienced ICH Score progression at 6 hours, which was associated with a 2.4-fold increase in mortality risk.

CONCLUSIONS: Findings in this study confirm established predictors of mortality in supratentorial ICH and highlight the prognostic value of neurological assessment 6 hours after admission. The mICH Score offers a practical and similarly accurate alternative to the original ICH Score for predicting in-hospital mortality. These findings underscore the importance of early and serial assessments to guide risk stratification in patients with ICH.

PMID:41172364 | DOI:10.3171/2025.7.JNS251312

J Neurosurg Spine. 2025 Oct 31:1-11. doi: 10.3171/2025.7.SPINE25357. Online ahead of print.

ABSTRACT

OBJECTIVE: Enhanced recovery after surgery (ERAS) has demonstrated benefits across various surgical specialties. However, a significant research-practice gap remains, with fewer than half of spine surgeons incorporating ERAS principles into daily practice. A key barrier to ERAS implementation in spine surgery is postoperative compliance, as patients often express concerns about worsening pain. To address these challenges, the authors developed a standardized, delivery-focused ERAS clinical pathway (CP) for oblique lumbar interbody fusion (OLIF). This study prospectively evaluated whether ERAS-CP can improve postoperative compliance without compromising pain control compared with conventional ERAS.

METHODS: This prospective, randomized noninferiority trial involved 41 patients undergoing OLIF from July 2023 to February 2024. Patients were randomized to either the ERAS-CP group (n = 21) or the control (conventional ERAS) group (n = 20). The ERAS-CP comprised a CP system integrated into the electronic health record system, patient education manual, and dedicated medical personnel support. The control group (conventional ERAS) followed standard ERAS principles but lacked these structured compliance-enhancing interventions. The primary outcome was back pain at discharge measured by the numeric rating scale. Secondary outcomes included ERAS compliance, pain management, and patient satisfaction.

RESULTS: Demographics were similar between the groups. The ERAS-CP group demonstrated noninferiority in back pain at discharge compared with the control group in the intent-to-treat analysis (difference -0.1, 95% CI -1.4 to 1.1) and the per-protocol analysis (difference -0.3, 95% CI -1.6 to 1.0). The ERAS-CP group achieved earlier ambulation (median 2 [range 1-9] vs 3.5 [range 2-18] hours, p = 0.011) and longer daily ambulation times (mean 91.7 vs 68.2 minutes/day, p = 0.047). Nonopioid analgesic use was higher in the ERAS-CP group on postoperative days 1 and 2 (p < 0.05), with no difference in opioid use. Both groups reported high satisfaction with pain management (78%). No significant differences were found in complication rates, length of stay, or 3-month clinical outcomes.

CONCLUSIONS: The ERAS-CP for OLIF demonstrated noninferiority in pain management while improving adherence to key ERAS components. By reinforcing postoperative compliance through structured interventions, ERAS-CP may enhance recovery in lumbar spinal fusion surgery.

PMID:41172361 | DOI:10.3171/2025.7.SPINE25357

JMIR Res Protoc. 2025 Oct 31;14:e73201. doi: 10.2196/73201.

ABSTRACT

BACKGROUND: Heavy metals present in the environment, including lead, cadmium, and mercury, pose significant health risks to pregnant women and fetal development through food, water, and air contamination. Exposure to these metals has been linked to miscarriage, low birth weight (LBW), preterm birth, and developmental issues in children. The mechanism of oxidative stress, characterized by increased 8-hydroxy-2′-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels, contributes to DNA damage, genomic instability, and adverse pregnancy outcomes. Additionally, DNA methylation changes induced by metal exposure may further exacerbate these risks. Certain micronutrients play a crucial role in heavy metal detoxification, and Moringa oleifera, a locally available plant rich in antioxidants and chelating compounds, has demonstrated protective effects against mercury (Hg), lead (Pb), and cadmium (Cd) toxicity in experimental studies. However, intervention studies on pregnant women remain scarce.

OBJECTIVE: The objective of this study was to evaluate the effect of M. oleifera supplementation in reducing heavy metal toxicity and oxidative stress biomarkers, 8-OHdG and MDA, in pregnant women exposed to high levels of heavy metals.

METHODS: A quasi-experimental, nonrandomized pre-post test design is used. Pregnant women with elevated heavy metal levels, identified through initial screening, will be included in the intervention group, receiving M. oleifera supplementation for 2 months. The control group will consist of women from similar geographical regions who will not receive the intervention. Primary outcomes will include changes in heavy metal concentrations, measured using inductively coupled plasma mass spectrometry (ICP-MS). Secondary outcomes will focus on reductions in oxidative stress biomarkers, measured via enzyme-linked immunosorbent assay (ELISA). Statistical analyses, including analysis of covariance (ANCOVA), will be used to adjust for baseline differences between the groups.

RESULTS: A total of 26 mothers for each group have participated. As of February 2025, the laboratory analyses have been ongoing, and the result is expected to be published at the end of 2025. The protocol anticipates that the intervention group will show a significant reduction in both heavy metal levels and oxidative stress biomarkers compared to the control group, suggesting the potential efficacy of M. oleifera in detoxifying heavy metals and reducing oxidative stress.

CONCLUSIONS: This study is expected to provide preliminary evidence on the potential effectiveness and safety of M. oleifera supplementation for reducing heavy metal toxicity and oxidative stress in pregnant women.

PMID:41172352 | DOI:10.2196/73201

JMIR Form Res. 2025 Oct 31;9:e78907. doi: 10.2196/78907.

ABSTRACT

Findings from a pilot randomized trial of 916 households indicated that outreach text messages were not an effective strategy to increase enrollment in the United States Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among eligible households in Arizona.

PMID:41172350 | DOI:10.2196/78907

Plast Reconstr Surg. 2025 Oct 30. doi: 10.1097/PRS.0000000000012567. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is one of the most common cancers diagnosed worldwide, with an estimated 2.3 million new cases in 2020. Breast reconstruction following mastectomy is crucial for the physical and mental well-being of patients. Therefore, the nipple-skin-sparing mastectomy (NSSM) technique has become a highly preferred surgical treatment option for breast cancer in recent years. Breast implants are placed above or below the pectoralis major muscle in single-stage procedures. This study aimed to elaborate on the inferior pedicled dermal flap technique, present the results of single-stage breast reconstruction following NSSM, and compare postoperative outcomes with those previously reported.

METHODS: Between 2014 and 2023, 420 patients who underwent nipple-sparing mastectomy and prosthesis repair in our clinic were retrospectively evaluated. Among these patients, 129 patients who underwent one-stage repair using an inferior pedicled adipodermal flap were included in our study. Patients were analyzed in terms of topographic features, breast size, amount of breast tissue removed, history of chemotherapy and radiotherapy, magnitude and types of postoperative complications.

RESULTS: A total of 129 patients with a mean age of 47.07 years (SD:8,02) were included in the study. Following the exclusion of breasts in which the NSSM technique was not utilized, 215 breasts were analyzed for outcomes. Postoperative complications were observed in 58 breasts (26.9%). These were categorized as major (n = 17; 7.9%) or minor (n = 41; 19.1%). Significant complications included total NAC necrosis, pillar necrosis, and prosthesis exposure. Minor complications included partial NAC necrosis, distal necrosis of medial and lateral pillars, loss of NAC grafts, local infections, and early postoperative seroma formation. Specifically, complications were distributed as follows: 30 breasts with partial NAC necrosis, 26 with pillar necrosis, 14 with complete NAC necrosis, 5 with graft loss, 15 with localized infections, and 26 with early seromas. Statistical analysis demonstrated a significant association between increased sternal notch-to-nipple distance and overall complication rates (p = 0.0027). Similarly, a significant correlation was found between higher breast volume (as indicated by resected tissue weight) and both total (p = 0.0035) and major (p = 0.0092) complication rates.

CONCLUSIONS: A common complication of single-session NSSM and implant reconstruction is areolar skin necrosis; therefore, double-layer repair is recommended to protect the circulation of thin skin flaps post-mastectomy. Autologous muscle and an inferior pedicled adipodermal flap as the second layer under the skin flap can be considered a more reliable technique for ptotic breasts.

PMID:41172344 | DOI:10.1097/PRS.0000000000012567