Category: Statistics

J Am Board Fam Med. 2024 Nov-Dec;37(6):1047-1054. doi: 10.3122/jabfm.2024.240059R1.

ABSTRACT

BACKGROUND: With the goals of improving health care delivery, patient outcomes, and creating a more engaged workforce, there have been consistent calls over the past 2 decades for increasing research capacity within the field of family medicine. Since 2014, the University of Minnesota Department of Family Medicine and Community Health (UMN DFMCH) has implemented strategies to enhance clinical faculty research capabilities while maintaining high-quality clinical care and medical education. This study reports changes in clinical faculty publications.

METHODS: Peer-reviewed publication data from 2013, 2016, 2019, and 2022 were analyzed for clinical faculty employed by the UMN DFMCH during those years. An annual research culture survey was administered via e-mail to clinical faculty in 2021, 2022, and 2023. The survey asked questions regarding Research Leadership, Culture, Training, Infrastructure, and Capacity.

RESULTS: While 2019 had the highest total number of publications with 99, 2022 had the highest proportion of faculty with at least 1 publication (50%). In 2023, 63.6% of survey respondents thought there were opportunities for them to participate in research, up from 41.0% in 2021. When asked about their research capacity and goals, 43.5% in 2023 responded positively, compared with 19.4% in 2021.

CONCLUSIONS: The efforts in our department to increase research capacity through investing in research infrastructure, faculty training and mentoring, and funding have led to notable increases in clinical faculty publications and positive perceptions of our research culture. These results provide additional evidence of the value of a model that harmonizes clinical care, education and research missions.

PMID:40118553 | DOI:10.3122/jabfm.2024.240059R1

J Neurosurg Pediatr. 2025 Mar 21:1-8. doi: 10.3171/2024.12.PEDS24542. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with advanced moyamoya disease have chronic cerebrovascular insufficiency with superimposed acute ischemic insults, leading to brain atrophy and cognitive decline. The outcomes of revascularization procedures in moyamoya patients with marked brain atrophy are not yet clearly known.

METHODS: This retrospective study used an approach based on the global cerebral atrophy scale to identify patients with severe brain atrophy from a single-surgeon series of patients with moyamoya disease undergoing revascularization from January 2015 to January 2024. Clinical outcomes (modified Rankin Scale [mRS] score, improvement in symptoms and cognitive function) and radiological outcomes (arterial spin labeling [ASL] perfusion) were studied and compared between direct and indirect revascularization groups.

RESULTS: Of 153 patients in the series, 16 (mean age 8.9 years) had severe brain atrophy (cortical atrophy score ≥ 8). The presenting symptoms were recurrent transient ischemic attack in 6 patients (37.5%), major stroke in 7 patients (43.75%), and seizure in 3 patients (18.75%). Fourteen patients underwent surgeries for both hemispheres and 2 patients underwent surgery for 1 hemisphere. Of the 30 hemispheres, 17 (56.7%) were treated with direct revascularization and 13 (43.3%) with indirect revascularization. The mean follow-up duration was 38.8 months. The median mRS score improved from 3 (preoperative) to 1.5 (last follow-up), with 11 patients (68.75%) showing improvement in mRS score. Thirteen patients (81.25%) showed improvement in presenting symptoms. Overall, 12 of 16 patients (75%) showed improvement in cognitive function at the last follow-up. The mean preoperative and follow-up ASL scores improved for the lower-perfusion hemispheres from 7.9 to 8.9 and for the higher-perfusion hemispheres from 9.6 to 10.45, respectively. Differences between preoperative and postoperative ASL scores for both groups were statistically significant. There was no significant difference in clinical and radiological outcomes between the direct and indirect revascularization groups. Clinical outcomes were comparable across patient groups based on the distribution of brain atrophy (unilateral/bilateral, predominant left/right side, predominant vascular territory involved).

CONCLUSIONS: Moyamoya patients with severe brain atrophy showed improvement in paroxysmal symptoms, cognitive function, and overall clinical functioning status, as well as radiological perfusion, after undergoing either direct or indirect revascularization. Comparative efficacy of direct and indirect revascularization in these patients needs further investigation.

PMID:40117668 | DOI:10.3171/2024.12.PEDS24542

J Neurosurg Pediatr. 2025 Mar 21:1-6. doi: 10.3171/2024.12.PEDS24418. Online ahead of print.

ABSTRACT

OBJECTIVE: Intrathecal baclofen (ITB) is commonly used to treat secondary generalized dystonia. Intraventricular baclofen (IVB) has been shown to be a safe alternative treatment with low complications. The objective of this study was to report the long-term effects of IVB.

METHODS: This retrospective analysis included patients who underwent IVB therapy from April 2005 to June 2024. The decision to use IVB and the surgical technique have been previously described. Data collection included sex, race, etiology of dystonia, Gross Motor Functional Classification System scores, Barry-Albright Dystonia Scale (BADS) scores, Ashworth Scale scores, medical and surgical management of dystonia, follow-up duration, and complications. Patients whose IVB pump was removed within 1 year and those with less than 1 year of follow-up were excluded.

RESULTS: Thirty-six patients with IVB were identified, and 27 patients (median age 12.9 years) were ultimately included. The most common cause of secondary dystonia was cerebral palsy in 21 patients (78%), followed by metabolic and neurodegenerative disorders in 4 (14%), infection in 1 (4%), and severe traumatic brain injury (TBI) in 1 (4%). The follow-up duration ranged from 1.2 to 16.7 years, with a median of 7.7 years and mean of 8.4 years. The baclofen dosage was twice as high in patients with metabolic and neurodegenerative disorders compared with those with cerebral palsy, TBI, and infection, with median dosages of 1455 μg/day and 725 μg/day, respectively. Both posttreatment BADS and Ashworth Scale scores showed statistically significant improvement. Complications included infection that necessitated pump removal in 1 patient (4%), wound dehiscence that was treated with wound revision and antibiotics in 1 patient (4%), and hydrocephalus that required CSF diversion in 4 patients (15%). In 2 patients, IVB therapy was ineffective at controlling dystonia and, thus, was discontinued after 1.3 and 2.7 years. One patient asked for the pump to be removed after 1.2 years due to “does not like the physical pump itself.” Four patients (15%) developed hydrocephalus, which required CSF diversion via a ventriculoperitoneal shunt in 3 patients and a lumboperitoneal shunt in 1 patient, with no further shunt or IVB complications.

CONCLUSIONS: IVB is well tolerated in patients with generalized secondary dystonia refractory to conventional medical therapy, ITB, and deep brain stimulation. Positive long-term outcomes were reported in this cohort, with significant improvement in dystonia and overall complication rates similar to those reported with ITB.

PMID:40117664 | DOI:10.3171/2024.12.PEDS24418

J Neurosurg Spine. 2025 Mar 21:1-11. doi: 10.3171/2024.11.SPINE24609. Online ahead of print.

ABSTRACT

OBJECTIVE: Previous research suggests elective surgical procedures performed later in the week have worse outcomes. This study investigated whether the day of the week on which elective anterior cervical discectomy and fusion (ACDF) surgery was performed impacts clinical outcomes.

METHODS: Using data from the Quality Outcomes Database, a nationwide, multicenter prospective registry, this study included patients undergoing elective ACDF for cervical spondylosis. Patients were categorized into groups based on the surgery day (early week, Monday and Tuesday; late week, Thursday and Friday). Analyzed outcomes included postoperative complications, readmissions, reoperations, and patient-reported outcomes. Statistical methods included the independent t-test, Pearson’s chi-square test, and multivariable logistic regression.

RESULTS: The study analyzed 19,818 patients, with 41.7% undergoing surgery early in the week and 36.9% later. There were no significant differences in 30-day mortality, readmissions, or reoperations between the two groups. Early-week surgical procedures were associated with a higher incidence of postoperative dysphagia requiring nasogastric tubes (0.6% vs 0.3%, p = 0.02) and a higher incidence of vocal cord paralysis (0.5% vs 0.3%, p = 0.01). The data indicate a surgical selection bias with more complex surgical procedures and higher risk patients typically scheduled earlier in the week, which likely contributed to the increased rates of dysphagia. Conversely, patients who underwent operations on Fridays were more likely to be discharged on the same day compared to those earlier in the week (p = 0.02), without a significant difference in length of stay overall. Surgical procedures performed later in the week were more likely to be performed at ambulatory surgical centers rather than inpatient facilities (p < 0.01), indicating a strategic selection of healthier patients for end-of-week procedures.

CONCLUSIONS: The day of elective ACDF surgery does not affect mortality, readmissions, or reoperation rates. However, early-week surgical procedures may see slightly higher rates of postoperative dysphagia and vocal cord paralysis, likely due to the scheduling of more complex cases or higher risk patients during these days. Overall, the authors’ data confirm that day of surgery does not influence overall patient recovery significantly. This information is useful for surgical planning and for providing patient reassurance that the day of the week does not significantly impact surgical outcomes.

PMID:40117661 | DOI:10.3171/2024.11.SPINE24609

J Neurosurg Pediatr. 2025 Mar 21:1-13. doi: 10.3171/2024.11.PEDS24322. Online ahead of print.

ABSTRACT

OBJECTIVE: The goal in this study was to retrospectively evaluate the safety and feasibility of purely neuroendoscopic removal of choroid plexus tumors (CPTs) in children using a monoportal or biportal technique.

METHODS: The clinical, radiological, and surgical data of all children with CPTs removed via purely endoscopic or microsurgical approaches in the last 12 years at two centers were retrospectively reviewed. Both centers were fully equipped with advanced neuroendoscopic technology, and surgical teams were fully trained in complex neuroendoscopic intraventricular surgical procedures.

RESULTS: The study involved 32 patients, divided into two groups: 13 undergoing endoscopic procedures and 19 undergoing microsurgical procedures. In the endoscopic group, the mean age was 2.11 years. Eight tumors were located in the lateral ventricles, and 5 in the third ventricle. The mean tumor volume was 6.59 cm3 (range 0.25-15.4 cm3); 9 patients had hydrocephalus at presentation. The monoportal technique was used in 9 patients, and the biportal technique was used in 4 patients. Gross-total removal was achieved in all patients-within a single procedure in 11 patients, and in a two-stage procedure in 2 patients. In the microsurgical group the mean age was 3.75 years. Seventeen tumors were located in the lateral ventricles, and 2 in the third ventricle. The mean tumor volume was 15.07 cm3 (range 1.2-84.35 cm3). The following microsurgical approaches were used: transcortical (n = 11), transcallosal (n = 5), and interhemispheric transprecuneal (n = 3). There was no statistically significant difference between the cases treated via microsurgical and endoscopic approaches with regard to CPT volume (p = 0.06), presence of hydrocephalus (p = 0.22), need for shunt surgery (p = 0.78), or complications (p = 0.06). Furthermore, a statistically significant difference was found in surgery time and blood loss: in endoscopic procedures there was significantly lower blood loss and a shorter surgery time (p < 0.005).

CONCLUSIONS: The present study conducted at two hospitals has demonstrated that neuroendoscopic removal of the CPT is a safe and feasible alternative to the conventional microsurgical procedure. The lower blood loss, lower rates of serious complications, and full resolution of hydrocephalus are the main points in favor of neuroendoscopic surgery to obtain gross-total removal of intraventricular CPT in infants and children.

PMID:40117660 | DOI:10.3171/2024.11.PEDS24322

J Neurosurg. 2025 Mar 21:1-9. doi: 10.3171/2024.11.JNS241896. Online ahead of print.

ABSTRACT

OBJECTIVE: Atypical intracranial meningiomas are characterized by brain invasion and faster growth than lower-grade counterparts. Surgery improves survival for patients with atypical meningiomas, and this study assesses the association between the timing of surgery and survival.

METHODS: Patients > 18 years of age with intracranial atypical meningiomas resected (2004-2019) and cataloged in the National Cancer Database were included. Descriptive statistics of sociodemographic and clinical characteristics were generated. Kaplan-Meier survival curves for each variable were generated. Cox proportional hazards models were developed to assess the association of time between diagnosis and surgery with overall survival, while controlling for age, sex, race, ethnicity, facility type, tumor size, comorbidity, resection type, adjuvant radiotherapy, and systemic therapy.

RESULTS: A total of 5452 patients were included; 17.81% of the patients were between 18 and 50 years, 66.89% were between 51 and 75 years, and 15.30% were > 75 years. Among the cohort, 55.98% of patients were female. The average time between diagnosis and surgery was 0.8 months; 63.33% of the patients underwent gross-total resection, 28.28% received adjuvant radiotherapy, and 0.92% received systemic therapy. Overall, 21.39% of the patients died during the study period, and the average follow-up time after surgery was 50.9 months. Bivariate analysis showed that the risk of patient mortality over the entire study period increased significantly for every additional month between diagnosis and surgery (hazard ratio [HR] 1.03, 95% CI 1.01-1.06; p = 0.01). On multivariable analysis, a longer time between diagnosis and surgery (HR 1.03, 95% CI 1.00-1.05; p = 0.02) remained a significant predictor of mortality after adjusting for age, sex, race, ethnicity, treatment facility type, tumor size, frailty, resection type, adjuvant radiotherapy, and systemic therapy. On subgroup analysis, delayed time to surgery was associated with increased mortality for those who received subtotal resection (HR 1.04, 95% CI 1.01-1.07; p = 0.01), but not for those who received gross-total resection (HR 1.02, 95% CI 0.97-1.06; p = 0.43). Patients who were female, Asian, treated at an academic program, and received radiotherapy were associated with significantly decreased mortality, whereas patients who were male, African American, had a tumor size > 60 mm, had more comorbidities, and underwent subtotal resection experienced increased mortality.

CONCLUSIONS: Additional time between diagnosis and surgery is associated with an increased risk of mortality after adjusting for confounders. The authors recommend surgery as soon as safely possible after diagnosis for patients with intracranial meningiomas with signs of atypia.

PMID:40117658 | DOI:10.3171/2024.11.JNS241896

Surg Technol Int. 2025 Mar 21;45:sti45/1860. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a wide range of nonoperative options to manage symptomatic knee osteoarthritis (OA). This paper aimed to 1) define the treatment sequence for patients undergoing up to four subsequent rounds (i.e., cryoneurolysis) of superficial (Cryo-Superficial) and/or deep genicular nerves (Cryo-Deep/Both), intra-articular corticosteroid injections (IA-CS), triamcinolone extended-release (IA-TA-ER), hyaluronic acid (IA-HA), or non-steroidal anti-inflammatory drugs (IA-NSAIDs); 2) compare usage of extended-release versus standard corticosteroid injections; and 3) quantify distribution of repeated treatments.

MATERIALS AND METHODS: We identified 502 patients with symptomatic knee OA and received nonoperative intervention within the Innovations in Genicular Outcomes (IGOR) registry from 2021 to 2024. Treatment journey during follow up was presented aggregating baseline patient demographics, along with sequence of nonoperative treatments per patient, duration, and frequency of repeated use. Repeated use of Round 1 treatment for subsequent treatment rounds was estimated with descriptive statistics.

RESULTS: Fifty-three percent of patients received only the original Round 1 treatment option, either single/repeated dose and did not receive any alternative treatment. Seventy-three percent of patients treated with intra-articular extended-release triamcinolone (IA-TAER) repeated the treatment at least once, whereas 60% of those treated with other treatments did so. No adverse events were reported in patients during repeated treatments.

CONCLUSION: Patients who received IA-TAER were more likely to repeat the same injection, with 73% repeating at least once and no adverse events were attributed to repeated injections. Approximately half of the patients have switched from the initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment. Significance and Innovation 1. Our study used a newly developed real-world registry IGOR to characterize treatment progression for patients with symptomatic knee OA undergoing up to five rounds of nonoperative treatment. 2. Non-surgical interventions included cryoneurolysis, intra-articular injections of NSAIDs, hyaluronic acid injections, corticosteroid, or extended release steroid (triamcinolone) injections. 3. We found 73% of patients treated with intra-articular extended-release steroid injections repeated treatment at least once, relative to 60% by other treatments. 4. We found approximately half of patients switched from initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment.

PMID:40117656

Hepatology. 2025 Mar 21. doi: 10.1097/HEP.0000000000001312. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: This large-scale, population-based cohort study examined the associations between metabolic syndrome and cholangiocarcinoma risk, including its intra- and extra-hepatic forms.

APPROACH AND RESULTS: A total of 4,932,211 adults aged ≥40 years participated in a government-initiated health checkup program (2012-2017), which collected lifestyle data, anthropometric measurements, and biochemical tests. Follow-up continued until 2021, with data linkage to National Cancer and Death Registries to ascertain the occurrence of cholangiocarcinoma and obtain vital status information. Fine and Gray models accounted for competing risks. During 35,879,371 person-years of follow-up, 6,117 cholangiocarcinoma cases were identified, with an incidence rate of 17.05 (95% CI: 15.90-18.20) per 100,000 person-years. Individuals with metabolic syndrome had significantly higher incidences of both intra- and extra-hepatic cholangiocarcinoma (p<0.0001). The multivariate-adjusted hazard ratio (HR) for cholangiocarcinoma among those with metabolic syndrome was 1.20 (1.14-1.27). Stratification analyses by age, sex, liver enzyme levels, and comorbidities consistently demonstrated an increased cholangiocarcinoma risk among individuals with metabolic syndrome. A dose-response relationship was observed, with a higher number of metabolic components correlating with an elevated cholangiocarcinoma risk, even after accounting for all-cause mortality as a competing risk. The adjusted subdistribution HRs ranged from 1.16 (95% CI: 1.02-1.32) for individuals with one metabolic component to 1.67 (95% CI: 1.45-1.94) for those with five (p for trend <0.0001).

CONCLUSIONS: The positive association between metabolic syndrome and cholangiocarcinoma risk suggests that managing metabolic risk factors might reduce the occurrence of both intra- and extra-hepatic cholangiocarcinoma.

PMID:40117647 | DOI:10.1097/HEP.0000000000001312

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1404a4566.

ABSTRACT

INTRODUCTION: Hidradenitis suppurativa is a disease with a decisive burden on sufferers, both physical and psychological. It was expected that the more intense the severity of symptoms the patients experienced, the greater the correlation with the psychosomatic manifestations would be.

OBJECTIVES: The present study aimed to explore the correlation between hidradenitis suppurativa and the psychosomatic burden, the personality, and the demographic characteristics of the participants.

METHODS: The participants were 90 outpatients of the hospital, aged 18 to 65, who had been diagnosed with hidradenitis and were sufficiently proficient in Greek. The psychometric instruments administered were the Symptom Checklist-90 (SCL90), the Beck Depression Inventory (BDI), the Eysenck Personality Questionnaire (EPQ), the short-form McGill Pain Questionnaire (SF-MPQ), the Hurley and refined Hurley classifications, the International Hidradenitis Suppurativa Severity Scoring System (IHS4), and a short demographic questionnaire. All statistical analyses were performed using the SPSS-28 statistical package.

RESULTS: According to statistical analyses, there was no statistically significant relationship between disease severity, psychosomatic burden, and personality. However, there were statistically significant associations with demographic factors, such as being female or not being in a relationship, the patient’s body mass index, the locus of the skin lesion, a history of hospitalization, comorbidities, psychiatric history, and pain with psychopathological manifestations and personality.

CONCLUSIONS: It is important that further research be conducted that will include more mental disorders besides anxiety and depression while at the same time excluding confounding factors for safer interpretation of the results.

PMID:40117646 | DOI:10.5826/dpc.1404a4566

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4871.

ABSTRACT

INTRODUCTION: Pustular psoriasis (PP) is a rare life-threatening skin disease with negatively impact on quality of life (QoL). Clinically, it may be systemic (generalized pustular psoriasis [GPP]) or localized on palms and soles (palmoplantar pustulosis [PPP]). It is not rare to observe plaque psoriasis associated with GPP.

OBJECTIVES: We explored the therapies used for PP and their correlation with patient QoL scores, through a cross-sectional study using retrospective data from a monocentric database in the period 2017-2021.

METHODS: Patient characteristics were summarized using descriptive statistics and treatment predictors of QoL were identified by multiple regression analysis. Among 108 patients with PP, 57.4% had GPP + PSO whereas 42.6% had PPP. The therapeutic management is based on systemic conventional treatments and biological therapies in both GPP and PPP.

RESULTS: GPP + PSO patients with an impaired QoL (DLQI≥10) were associated with biological therapy including certolizumab (odds ratio [OR]=2.38), etanercept (OR=2.25), secukinumab (OR=2.03) or ustekinumab (OR=2.79) whereas, PPP patients were positively associated with secukinumab (OR=2.85) or apremilast (OR 4.28, 95%-CI 0.56-9.62).

CONCLUSIONS: Currently, systemic conventional therapy remains the therapeutic fulcrum of PP management. A great effect on QoL, especially for GPP+PSO, was assessed regardless the ongoing treatment and only newer biologic options were able to somehow positively impact.

PMID:40117644 | DOI:10.5826/dpc.1501a4871