Category: Statistics

Nurs Health Sci. 2025 Mar;27(1):e70023. doi: 10.1111/nhs.70023.

ABSTRACT

The aim of this study is to determine the mediating role of moral sensitivity in the effect of nurses’ professional values on missed nursing care. A descriptive and correlational study was conducted with 640 nurses working in the inpatient units of a public and a private hospital with the MISSCARE Survey-Turkish, the Moral Sensitivity Questionnaire, and the Revised Nursing Professional Values Scale. Data analyses were performed using the Statistical Package for Social Sciences 26.0, Hayes’ PROCESS macro for SPSS v4.0, and the Analysis of Moment Structures 24.0. It was determined that nurses’ professional values had a significant and positive effect on moral sensitivity, and nurses’ moral sensitivity had a significant and negative effect on missed nursing care. In addition, the direct and indirect effects of nurses’ professional values on missed nursing care were statistically significant. The research model showed that increasing nurses’ professional values and moral sensitivity decreased missed nursing care, and moral sensitivity significantly mediated the interaction between nurses’ professional values and missed nursing care.

PMID:39799606 | DOI:10.1111/nhs.70023

J Eval Clin Pract. 2025 Feb;31(1):e14225. doi: 10.1111/jep.14225.

ABSTRACT

OBJECTIVE: To examine the medical students’ awareness of laparoscopic surgery as well as assess the perceived importance of laparoscopic simulation training, and its impact on students’ confidence, career aspirations, proficiency, spatial skills, and physical tolerance.

DESIGN: Descriptive and comparative study using pre- and post-training assessments.

SETTING: Simulation training sessions centred on laparoscopic surgery techniques.

PARTICIPANTS: Medical students in year three (n = 49) participated in laparoscopic simulation training sessions.

RESULTS: Before the simulation training, 85.7% of students were unaware of laparoscopy, with females being less familiar than males (96.3% vs. 72.8%). 85.7% believed mastering laparoscopy was crucial before training, and 81.6% believed simulation training could enhance surgical skills. A disparity existed in this belief between the sexes, with 91% of males and 74.1% of females seeing the value in such training for skill improvement. Pretraining, males (54.5%) were more confident than females (26%) in mastering laparoscopy. Post-training, confidence increased for both groups, and the percentage of students wishing to pursue a surgical career also rose from 50% to 72.7%. Despite initial disparities in the time spent on training modules between males and females, both groups achieved similar proficiency levels by the end of the training. Although females initially lagged in spatial awareness and skills, post-training results showed significant improvement, matching their male counterparts. 26.5% of students experienced physical fatigue post-training, with a higher percentage of females (33.3%) reporting fatigue than males (18.2%). Regarding concentration during simulations, 81.8% of males could maintain focus compared to 48.2% of females.

CONCLUSIONS: Laparoscopic simulation training effectively improved the understanding, confidence, and surgical skills of medical students, with evident benefits in shaping their career aspirations. While both genders exhibited significant gains, female students faced challenges in terms of physical tolerance and initial spatial awareness. However, their post-training achievements mirrored those of their male peers, highlighting the effectiveness and importance of such simulation training programmes.

PMID:39799586 | DOI:10.1111/jep.14225

Eur J Trauma Emerg Surg. 2025 Jan 12;51(1):8. doi: 10.1007/s00068-024-02671-z.

ABSTRACT

BACKGROUND AND IMPORTANCE: Traumatic intracranial hemorrhage (tICH) after mild traumatic brain injury (mTBI) is not uncommon in the elderly. Often, these patients are admitted to the hospital for observation. The necessity of admission in the absence of clinically important intracranial injuries is however unclear.

OBJECTIVES: The objective of this study is to identify which factors additional to tICH affect the risk of this outcome and to evaluate the differences in the risk of adverse outcome in younger and older mTBI patients with tICH.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective study assessed adult (≥ 16 years) mTBI patients with tICH admitted to a Level 1 trauma center between January 2017 and October 2020.

OUTCOME MEASURES AND ANALYSIS: Patients were stratified into two groups, age < 65 years and age ≥ 65 years. Adverse outcome due to tICH was assessed using a composite adverse outcome which comprised either, a drop in GCS by more than 1 point, progression of or new neurological deficits, seizure activity, progression of tICH on repeated neuroimaging after clinical deterioration, a neurosurgical intervention, a readmission within three months of injury related to TBI, or death. Logistic regression analysis was used to identify independent predictors of the composite adverse outcome.

MAIN RESULTS: In total, 332 mTBI patients with tICH were enrolled in our study. Older mTBI patients with tICH met the criteria for the composite adverse outcome significantly more often than younger patients (12.6% 95% CI 8.0-17.0% vs. 4.9%, 95% CI 1.0-9.0%, p = 0.033). The univariate analysis showed that a neurological deficit (OR 6.55, 95% CI 2.37-18.08) or a SDH on admission (OR 3.13, 95% CI 1.40-6.99) was positively associated with the composite adverse outcome in older patients. The presence of isolated traumatic SAH (tSAH) was associated with a decreased risk of the composite adverse outcome (OR 0.10, 95% CI 0.01-0.71). Multivariate analysis was not possible.

CONCLUSION: Serious adverse outcomes are frequently observed in older mTBI patients with tICH. Nonetheless, our findings suggest that older patients with an isolated tSAH are at low-risk for deterioration and may be directly discharged from the ED after a short period of observation.

PMID:39799536 | DOI:10.1007/s00068-024-02671-z

Eat Weight Disord. 2025 Jan 12;30(1):3. doi: 10.1007/s40519-025-01714-7.

ABSTRACT

OBJECTIVE: This systematic review explores the intricate relationship between body composition, with a specific focus on skeletal muscle mass, and vascular health indices, including measures of arterial stiffness-pulse wave velocity (PWV) and cardio-ankle vascular index (CAVI)-as well as arterial structure, specifically carotid artery intima-media thickness (cIMT).

METHODS: An extensive literature search, encompassing PubMed, Scopus, EMBASE, Web of Science, and Google Scholar, was conducted until January 2024. Inclusion criteria involved original observational studies, with cross-sectional or longitudinal designs, reporting body composition parameters and vascular health measures. The Newcastle-Ottawa Scale (NOS) assessed study quality. Statistical analyses utilized Stata 17.0, employing random-effects meta-analysis, sensitivity analysis, and evaluation of publication bias.

RESULTS: Fifteen observational studies (n = 21,215) met the inclusion criteria. Pooled analyses revealed a positive association between fat-free mass (FFM) and carotid intima-media thickness (IMT) (effect size [ES]: 1.79, 95% CI 1.68-1.91), highlighting a relationship with arterial structure. Similarly, body fat percentage (BFP) was positively associated with PWV (ES: 1.45, 95% CI 1.15-1.82), and FFM showed a positive association with CAVI (ES: 1.46, 95% CI 0.78-2.71), both measures of arterial stiffness. Subgroup analyses revealed a non-significant association between appendicular skeletal muscle (ASM) and IMT (ES: 1.01, 95% CI 0.76-1.35).

CONCLUSION: This meta-analysis highlights the complex relationship between body composition and vascular health. Subgroup analyses suggest the need for further research into specific body composition indices and their clinical implications.

LEVEL OF EVIDENCE: III evidence obtained from well-designed cohort and cross-sectional studies.

PMID:39799535 | DOI:10.1007/s40519-025-01714-7

Updates Surg. 2025 Jan 12. doi: 10.1007/s13304-025-02092-6. Online ahead of print.

ABSTRACT

Stoma reversal surgery is known for relatively high complication rates. While Enhanced Recovery After Surgery (ERAS) protocols are extensively validated for colorectal surgery, their use in stoma reversal remains underexplored. This systematic review and meta-analysis evaluates clinical outcomes of stoma reversal surgery under ERAS protocols compared to standard care (SC) practices. Medline, EMBASE, and Cochrane Central databases were searched for studies that compared clinical outcomes of stoma reversal surgery under ERAS protocols versus SC practices. The endpoints of interest were length of stay (LOS), ileus, wound infection, anastomotic leak, time to first stool, overall, minor, and major postoperative complications, readmission rates, and reoperation rates. Mean difference (MD) was calculated for continuous variables and Odds Ratio (OR) for dichotomous variables. Statistical analysis was performed with R version 4.4.0. We included eight studies comprising 1322 patients. Among these, 603 (45.6%) followed an ERAS protocol, while 719 (54.4%) received SC practices. ERAS was associated with a significant decrease in LOS (MD -1.83; 95% CI -2.55 to -1.12; p < 0.01), wound infection (OR 0.47; 95% CI 0.23 to 0.97; p = 0.041), and time to first stool (MD -1.02; 95% CI -1.22 to -0.81; p < 0.01). No statistically significant difference was observed regarding ileus, anastomotic leak, overall, minor, and major postoperative complications, readmission rates, or reoperation rates. The implementation of ERAS protocols in stoma reversal procedures should be considered, as it was associated with a shorter length of hospital stay without increasing morbidity, and may even reduce complications such as wound infections.

PMID:39799533 | DOI:10.1007/s13304-025-02092-6

Arch Toxicol. 2025 Jan 12. doi: 10.1007/s00204-024-03914-z. Online ahead of print.

ABSTRACT

The kinetically-derived maximal dose (KMD) is defined as the maximum external dose at which kinetics are unchanged relative to lower doses, e.g., doses at which kinetic processes are not saturated. Toxicity produced at doses above the KMD can be qualitatively different from toxicity produced at lower doses. Here, we test the hypothesis that high-dose-dependent toxicological effects of octamethylcyclotetrasiloxane (D4) occur secondary to kinetic overload. Octamethylcyclotetrasiloxane (D4) is a volatile, highly lipophilic monomer used to produce silicone polymers, which are ingredients in many consumer products and used widely in industrial applications and processes. Chronic inhalation at D4 concentrations 10⁴ times greater than human exposures produces mild effects in rat respiratory tract, liver weight increase and pigment accumulation, nephropathy, uterine endometrial epithelial hyperplasia, non-significant increased uterine endometrial adenomas, and reduced fertility secondary to inhibition of rat-specific luteinizing hormone (LH) surge. Mechanistic studies indicate a lack of human relevance for most of these effects. Respiratory tract effects arise in rats due to direct epithelial contact with mixed vapor/aerosols and increased liver weight is a rodent-specific adaptative induction of drug-metabolizing hepatic enzymes. D4 is not mutagenic or genotoxic, does not interact with dopamine receptors, and interacts at ERα with potency insufficient to cause uterine effects or to alter the LH surge in rats. These mechanistic findings suggest high-dose-dependence of the toxicological effects secondary to kinetic overload, a hypothesis that can be tested when appropriate kinetic data are available that can be probed for the existence of a KMD. We applied Bayesian analysis with differential equations to information from kinetic studies on D4 to build statistical distributions of plausible values of the K_m and V_max for D4 elimination. From those distributions of likely K_m and V_max values, a set of Michaelis-Menten equations were generated that are likely to represent the slope function for the relationship between D4 exposure and blood concentration. The resulting Michaelis-Menten functions were then investigated using a change-point methodology known as the “kneedle” algorithm to identify the probable KMD range. We validated our K_m and V_max using out of sample data. Analysis of the Michaelis-Menten elimination curve generated from those V_max and K_m values indicates a KMD with an interquartile range of 230.0-488.0 ppm [2790-5920 mg/m³; 9.41-19.96 µM]. The KMD determined here for D4 is consistent with prior work indicating saturation of D4 metabolism at approximately 300 ppm [3640 mg/m³; 12.27 µM] and supports the hypothesis that many adverse effects of D4 arise secondary to high-dose-dependent events, likely due to mechanisms of action that cannot occur at concentrations below the KMD. Regulatory methods to evaluate D4 for human health protection should avoid endpoint data from rodents exposed to D4 above the KMD range and future toxicological testing should focus on doses below the KMD range.

PMID:39799522 | DOI:10.1007/s00204-024-03914-z

Eur Arch Otorhinolaryngol. 2025 Jan 12. doi: 10.1007/s00405-024-09194-8. Online ahead of print.

ABSTRACT

OBJECTIVE: In this study, we aimed to evaluate the localization and configuration of vibration and obstruction in drug-induced sleep endoscopy(DISE) in obstructive sleep apnea patients and to investigate the optimal sedation depth.

MATERIALS AND METHODS: The study was conducted prospectively with 42 patients. After achieving sedation with intravenous anesthetic agents, simultaneous monitoring of the patient’s bispectrometry (BIS), DISE and sleep testing with a type 2 polysomnography device were performed. DISE was performed using fentanyl and midazolam, followed by propofol administered with manually controlled infusion method. The recorded data were evaluated and subjected to statistical comparisons.

RESULTS: It was observed that as BIS values decreased, the frequency of decreased respiratory effort and desaturation increased. Central apneas were observed with BIS values below 65 and were found to increase with deeper sedation, while with BIS values above 70, all respiratory events were obstructive apneas, with retro-palatal obstruction being the most common. It was noted that vibration occurred in over 90% of patients within the BIS range of 60-70. It was decided that the optimal sedation depth for evaluating vibration and obstruction in sleep endoscopy was within the BIS range of 60-75.

CONCLUSION: According to the results of our study, as sedation depth increases, the frequency of central apnea and desaturation increases. In our study, the sedation depth within the BIS 60-75 range was found to be the most suitable range for evaluating obstructive apnea and snoring.

PMID:39799520 | DOI:10.1007/s00405-024-09194-8

Bioinformatics. 2025 Jan 12:btaf017. doi: 10.1093/bioinformatics/btaf017. Online ahead of print.

ABSTRACT

MOTIVATION: Fine-mapping aims to prioritize causal variants underlying complex traits by accounting for the linkage disequilibrium of GWAS risk locus. The expanding resources of functional annotations serve as auxiliary evidence to improve the power of fine-mapping. However, existing fine-mapping methods tend to generate many false positive results when integrating a large number of annotations.

RESULTS: In this study, we propose a unified method to integrate high-dimensional functional annotations with fine-mapping (Funmap). Funmap can effectively improve the power of fine-mapping by borrowing information from hundreds of functional annotations. Meanwhile, it relates the annotation to the causal probability with a random effects model that avoids the over-fitting issue, thereby producing a well-controlled false positive rate. Paired with a fast algorithm, Funmap enables scalable integration of a large number of annotations to facilitate prioritizing multiple causal SNPs. Our comprehensive simulations across a wide range of annotation relevance settings demonstrate that Funmap is the only method that produces well-calibrated FDR under the setting of high-dimensional annotations while achieving better or comparable power gains as compared to existing methods. By integrating GWASs of 4 lipid traits with 187 functional annotations, Funmap consistently identified more variants that can be replicated in an independent cohort, achieving 15.5%-26.2% improvement over the runner-up in terms of replication rate.

AVAILABILITY: The Funmap software and all analysis code are available at https://github.com/LeeHITsz/Funmap.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:39799513 | DOI:10.1093/bioinformatics/btaf017

Rheumatology (Oxford). 2025 Jan 12:keaf014. doi: 10.1093/rheumatology/keaf014. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe the clinical profile and compare the long-term outcomes of patients with S-PAN treated with various treatment regimens at our centre in the last 2 decades.

METHODS: Data regarding clinical presentation, treatment allocation, relapses and outcomes of patients fulfilling American College of Rheumatology (ACR) 1990 criteria for PAN in the last 2 decades were recorded from electronic medical records. Relapse-free survival and predictors were analysed using KM survival statistics and regression analysis.

RESULTS: Altogether, 53 patients including 2 with hepatitis B infection were included. Cutaneous lesions and peripheral neuropathy were the commonest manifestations. Most patients (64.2%) presented with a five-factor score (FFS) of 0. Disease-attributable hypertension and peripheral gangrene were the most common manifestations of severe disease. During a median follow-up period of 53.5 months in 49 patients, 43 (87.8%) attained complete response while 3(6.1%) had a partial response. Nineteen (40.4%) patients relapsed at a median duration of 82 (IQR 36.3-127.7) months. The relapse-free survival in patients who received induction with mycophenolate (n = 26), was comparable to that with cyclophosphamide (n = 21) [adjusted HR : 0.68]. Smoking history was an independent predictor of relapse (HR = 6.28, p= 0.013) while age was protective (HR = 0.94, p= 0.015). FFS and BVAS at 3 months were among the predictors of mortality (total deaths = 5).

CONCLUSION: In our cohort of S-PAN, relapses were observed in 40.4% of patients. Mycophenolate was similar to cyclophosphamide in maintaining relapse-free survival. Only 10% fatality was recorded. FFS and BVAS at 3 months were predictors of mortality.

PMID:39799509 | DOI:10.1093/rheumatology/keaf014

QJM. 2025 Jan 12:hcaf008. doi: 10.1093/qjmed/hcaf008. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are frequently reported within the HSE. The Irish Longitudinal Study on Ageing(TILDA) found that 40% of over 50 s experience a fall in a two year period, with 20% requiring hospital attendance (1). It has been estimated that the cost of injuries related to falls in older people will increase exponentially over the coming years (2). There is no national database in Ireland with statistics for nursing home(NH) residents presenting with falls to our Emergency Departments(ED).

AIM: To review the prevalence and risk factors for nursing home patients presenting to the Emergency Department with falls.

DESIGN: Retrospective chart review.

METHOD: Retrospective review of all NH presentations to the ED of a university hospital over one year.

RESULTS: There were 519 ED presentations by NH residents over one year. 48.17% (n = 250), presented with a fall. One third of ED visits presented during conventional working hours. Falls patients were more likely to be admitted when not reviewed by a G.P. prior to presentation. The average length of stay for falls admissions was 10.77 days(n = 132), vs 9.56(n = 153) for admissions with no documented fall. There was no statistical difference in the falls risk medications between groups. Patients presenting with falls were more likely to have bone protection reviewed during their stay(P=.011). Patients with falls were also more likely to use mobility aids(P < 0.001).

CONCLUSION: Rapid referral to falls prevention programmes and the use of standardised care pathways for high falls risk patients are essential for future prevention and management.

PMID:39799508 | DOI:10.1093/qjmed/hcaf008