Category: Statistics

Int J Cancer. 2024 Nov 29. doi: 10.1002/ijc.35267. Online ahead of print.

ABSTRACT

Pancreatic adenocarcinoma (PAC) is notorious for its poor survival. The provision of survival scenarios-that is, best-case, typical and worst-case scenarios-could prove valuable to patients and clinicians. This study investigated survival scenarios and how these have changed over a period of 16 years for patients with PAC. Data from the Netherlands Cancer Registry were used to identify patients with localized and metastatic PAC (2005-2021). Survival scenarios, including best-case, upper-typical, typical (median), lower-typical, and worst-case, were estimated based on survival curve percentiles (p10, p25, p50, p75, and p90). Annual differences were assessed for significance using weighted linear regression analyses. Factors associated with these scenarios were identified through univariable tests. Overall, 14,622 patients with localized and 20,199 with metastatic PAC were included. For patients with localized PAC, the best, upper-typical and typical survival scenarios improved statistically significant with average annual improvement of 1.54 (95%CI: 1.2-1.88), 0.67 (0.56-0.78), and 0.24 (0.19-0.29) months, respectively. For patients with metastatic PAC the best and upper-typical survival scenarios increased statically significantly with annual improvement of 0.28 (0.21-0.34) and 0.06 (0.02-0.09) months, respectively. The best-case and upper-typical scenarios were associated with younger patients, more aggressive disease-focused treatments, fewer comorbidities, and better overall performance status. Over the past 16 years, survival improvements in patients with PAC have been most notable in these scenarios. Although the absolute gains were modest, these results offer encouraging potential for advancements in life-prolonging care for this type of cancer.

PMID:39614657 | DOI:10.1002/ijc.35267

Womens Health (Lond). 2024 Jan-Dec;20:17455057241299213. doi: 10.1177/17455057241299213.

ABSTRACT

BACKGROUND: Researchers and participants who are members of minoritized populations experience negative psychosocial and wellness outcomes like burnout. Burnout may manifest uniquely for Black women in academia conducting research with Black women participants navigating similar sociocultural contexts.

OBJECTIVES: This article qualitatively interprets our experiences as 15 Black women scholar-practitioners at a midwestern university conducting community-engaged research. We discuss our experiences of care and burnout while working to reduce opioid use disparities among Black women community members as we simultaneously navigate multilevel challenges in academia.

DESIGN: We employ collaborative autoethnography, an autobiographical writing method, using a Black feminist framework and intersectionality methodology.

METHODS: We are 15 Black women researcher-subjects on the REFOCUS study-a mixed-methods National Institute on Health-funded project examining nonmedical prescription opioid misuse among Black Kentuckians. We examined a series of multigenerational sista circles and individual journal entries we completed to understand the multilevel power dynamics impacting our individual and collective work, burnout, and care.

RESULTS: Themes were: (1) “I see me in you”: Research with Black Women, (2) “Pervasive, cellular, and epigenetic”: Burnout Experiences; (3) “Taxing but rewarding”: The Price We Pay to See an Outcome, and (4) “Thank God for the collective”: Complexities of Caring Through the Process.

CONCLUSION: We highlight the importance of continued efforts to address workload inequities among Black women in academia, particularly for those working to combat health disparities among Black women or within Black communities. We make recommendations for structural, institutional, and interpersonal steps to improve the support of Black women across career stages.

PMID:39614651 | DOI:10.1177/17455057241299213

Aging Cell. 2024 Nov 29:e14436. doi: 10.1111/acel.14436. Online ahead of print.

ABSTRACT

Recent studies indicated that the dysregulation of mitochondria-associated endoplasmic reticulum membrane (MAM) could be a significant hub in the pathogenesis of Parkinson’s disease (PD). However, little has been known about how MAM altered in PD. This study was aimed to observe morphological changes and analyze proteomic profiles of MAM in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD mouse models. In MPTP-treated mice, transmission electron microscopy was applied for MAM ultrastructural visualization. Nano ultra-high performance liquid chromatography-tandem mass spectrum and bioinformatic analysis were adopted to obtain underlying molecular data of MAM fractions. The loosened, shortened and reduced MAM tethering was found in substantia nigral neurons from MPTP-treated mice. In midbrain MAM proteomics, 158 differentially expressed proteins (DEPs) were identified between two groups. Specific DEPs were validated by western blot and exhibited significantly statistical changes, aligning with proteomic results. Bioinformatic analysis indicated that membrane, cytoplasm and cell projection were three major localizations for DEPs. Biological processes including metabolism, lipid transport, and immunological and apoptotic signaling pathways were greatly affected. For consensus MAM proteins, the enriched pathway analysis revealed the potential relationship between neurodegenerative diseases and MAM. Several biological processes such as peroxisome function and clathrin-mediated endocytosis, were clustered, which provided additional insights into the fundamental molecular pathways associated with MAM. In our study, we demonstrated disrupted ER-mitochondria contacts in an MPTP-induced PD mouse model. The underlying signatures of MAM were revealed by proteomics and bioinformatic analysis, providing valuable insights into its potential role in PD pathogenesis.

PMID:39614648 | DOI:10.1111/acel.14436

Acupunct Med. 2024 Nov 29:9645284241298011. doi: 10.1177/09645284241298011. Online ahead of print.

ABSTRACT

BACKGROUND: Considering the importance of cardiac rehabilitation after coronary artery bypass grafting (CABG) and the development of acupuncture over the past few decades, the aim of this study was to evaluate the effects of acupuncture on patients’ exercise tolerance, heart rate and blood pressure after CABG.

METHODS: Thirty-four patients with a history of recent CABG were recruited between 2019 and 2020 for this clinical trial and randomly divided into two groups receiving acupuncture plus cardiac rehabilitation (group A) and cardiac rehabilitation alone (group B). In both groups, exercise-based rehabilitation exercise was performed. Group A additionally received acupuncture at PC6, PC4, HT7 and GB20 bilaterally. Changes in blood pressure, heart rate and Borg scale score were evaluated before, during and after the course of the treatment.

RESULTS: Heart rate was significantly lower in group A compared to group B after completion of the course of the treatment (P = 0.022). However, there were no statistically significant differences between the two groups in systolic or diastolic blood pressure or Borg scale scores (P > 0.05). Nevertheless, the Borg scale scores showed a significant decrease within each group over time (P < 0.001), reflecting an improvement in the patients’ ability to tolerate activity after cardiac rehabilitation with or without acupuncture.

CONCLUSION: Acupuncture in combination with exercise-based cardiac rehabilitation was more effective at decreasing heart rate than cardiac rehabilitation alone after CABG. Both approaches appeared to be similarly effective at improving exercise tolerance. In this study, the addition of acupuncture at the aforementioned traditional acupuncture point locations to exercise-based cardiac rehabilitation did not affect blood pressure.

TRIAL REGISTRATION NUMBER: IRCT20171208037793N1 (Iranian Registry of Clinical Trials).

PMID:39614639 | DOI:10.1177/09645284241298011

J Prim Care Community Health. 2024 Jan-Dec;15:21501319241304143. doi: 10.1177/21501319241304143.

ABSTRACT

INTRODUCTION/OBJECTIVES: The cost of medical services is a major barrier to healthcare accessibility for underserved populations in the United States. Community charity medical clinics help address this disparity by providing free or reduced-cost care for the medically underinsured; however, their economic and public health contributions are unknown. The objective of this study was to evaluate the scope of services and monetary impact of 4 community charity medical clinics in North Texas, with one of the largest medically underinsured populations in the United States.

METHODS: A cross-sectional study was conducted using electronic health records from 4 clinics serving adults and children in North Texas. Encounters from June 1 to December 31, 2018 completed by with sufficient documentation to assign a level of service were reviewed. There were 3942 encounters identified and 2148 (54.5%) audited. Centers for Medicare and Medicaid Services Evaluation and Management Standards were used to identify level of service provided for each encounter, and their subsequent value was determined based on CMS fee-for-service schedules at the time service was provided. Common conditions managed during these encounters were identified using ICD-10 codes documented with each encounter.

RESULTS: The most prevalent diagnoses encountered were hypertension, diabetes, hyperlipidemia, and major depressive disorder. We estimate the total value of services and medications provided for 1 year is between $840 278.30 to $845 737.41.

CONCLUSIONS: The charity clinics in North Texas provide a significant economic impact through a high level of charity care and a broad scope of services for a vulnerable patient population. The results may be used in the development and implementation of future services to meet the needs of the medically underinsured.

PMID:39614637 | DOI:10.1177/21501319241304143

Ann Otol Rhinol Laryngol. 2024 Nov 29:34894241303021. doi: 10.1177/00034894241303021. Online ahead of print.

ABSTRACT

BACKGROUND: Branchial cleft cysts are pediatric congenital anomalies that can present as sinus tracts to the neck. Intraoperative methylene blue dye with fibrin glue has been suggested as an effective tool for tracking the tract’s depth to help definitively excise. In this large retrospective study of 118 patients spanning a decade, we aim to elucidate outcomes of branchial cleft anomaly excision without methylene blue dye.

METHODS: A retrospective review was conducted with patients who received branchial cleft anomaly (BCA) with sinus tract excision at Monroe Carrell Jr. Children’s Hospital from June 2012 to June 2022. We collected demographic variables, BCA characteristics, perioperative care variables (ie, prior drainage, imaging, and concurrent procedure), and perioperative outcomes (ie, intra- and post-operative complications). Median and interquartile range (IQR) were calculated for continuous demographic variables, and average and standard deviation (SD) were calculated for sinus tract length. Two-tailed Chi-square or Fisher’s exact tests were performed to compare categorical samples where applicable with a statistical significance threshold set a priori at P < .05, and multivariable logistic regression assessed significant associations.

RESULTS: The sample included 118 patients with an average tract length of 3.3 cm (SD = 1.7 cm). Incision/drainage was performed before definitive excision in 16 (13.6%) patients and was associated with age above the median (aOR = 5.29, 95% CI = 1.39-20.09, P = .015) and female sex (aOR = 3.81, 95% CI = 1.12-13.01, P = .032). Most patients (N = 85, 72.0%) did not receive imaging. Among 118 cases, 2 (1.7%) required return to the operating room for surgical site complications. No patients experienced intra-operative complications or tract recurrence necessitating revision surgery.

CONCLUSION: Patients with branchial cleft sinus tracts that were surgically excised without intraoperative dye achieved definitive resection with no recurrence and limited post-operative complications. While not a direct comparison, these results suggest that using intraoperative dye may be associated with unnecessary costs without benefit in outcomes.

PMID:39614624 | DOI:10.1177/00034894241303021

J Intellect Disabil Res. 2024 Nov 29. doi: 10.1111/jir.13200. Online ahead of print.

ABSTRACT

BACKGROUND: The 22q11.2 deletion syndrome (22q11.2DS) entails intellectual disabilities and higher risk of psychotic disorders. Neurocognitive deficits predict real-life functioning of schizophrenic patients. We investigated real-life functioning in 22q11.2DS, aiming at defining how neurocognitive profile and psychopathological variables impact on psychotic patients’ social functioning.

METHODS: We recruited 63 patients with schizophrenia (SCZ, N = 63), 44 with 22q11.2DS (DEL, N = 44) and 19 with 22q11.2DS and psychosis (DEL-SCZ, N = 19), all matched for age, sex and neurocognitive profile; we administered the Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS), the Specific Levels of Functioning (SLoF) scale and the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). We implemented descriptive analyses, MANCOVA and linear regression statistics.

RESULTS: The DEL-SCZ and the SCZ groups showed similar levels in Interpersonal Relationships (p = 0.093) and Social Acceptability subscales (p = 0.283). The DEL group scored higher on the Interpersonal Relationships subscale compared with the SCZ group (p = 0.001). The groups scored similarly on the other SLoF subscales. Both BNSS total score (beta = -0.343; p = 0.004) and BNSS asociality (beta = -0.487; p = 0.038) significantly predicted the Interpersonal Relationships variable in the groups with psychosis (SCZ and DEL-SCZ).

DISCUSSION AND CONCLUSIONS: Individuals with 22q11.2DS display a similar real-life functioning to patients with chronic schizophrenia. Social functioning impairments are typical of psychosis regardless of the genetic condition and highly predicted by negative symptoms like asociality. The 22q11.2DS represents a reliable biological model to study vulnerability to psychosis and its consequences on patients’ real-life and social functioning.

PMID:39614621 | DOI:10.1111/jir.13200

Hand (N Y). 2024 Nov 29:15589447241300713. doi: 10.1177/15589447241300713. Online ahead of print.

ABSTRACT

BACKGROUND: The recent trend in administering postoperative oral corticosteroids has proven effective in alleviating pain and improving surgical outcomes for hand and upper extremity procedures. However, concerns persist regarding potential infection risks despite a lack of supporting evidence in the current literature. We propose that a 6-day regimen of low-dose postoperative oral corticosteroids is safe and does not increase the likelihood of surgical site infections (SSIs) in adult upper extremity surgeries.

METHODS: A retrospective study of all adult patients who underwent clean, upper extremity surgery, including both soft tissue and hardware implantation cases, between November 2021 and November 2023, performed at a single institution were included in the study. Primary outcome measures were diagnosis of SSI by 14 days and 30 days. Categorical variables were compared using χ² tests, and continuous variables were compared using Wilcoxon rank-sum tests. A P value less than .05 was considered statistically significant.

RESULTS: A total of 813 cases were included for analysis-196 received a 6-day course of postoperative oral steroids (methylprednisolone) and 617 did not. Both groups had similar SSI rates of 4.1% and 3.1%, respectively, with no statistical differences between the groups at any postoperative time. Subgroup analysis of patients diagnosed with an SSI identified no statistically different demographic factors or medical comorbidities when comparing patients who received postoperative oral corticosteroids versus those who did not.

CONCLUSIONS: Low-dose, postoperative oral steroid use following adult upper extremity surgery is safe and does not increase the risk of SSI. Further investigations with prospective studies on postoperative oral corticosteroids would prove advantageous.

PMID:39614609 | DOI:10.1177/15589447241300713

Mov Disord Clin Pract. 2024 Nov 29. doi: 10.1002/mdc3.14285. Online ahead of print.

ABSTRACT

BACKGROUND: Transcranial direct current stimulation (tDCS) over the supplementary motor area (SMA) has shown promise in Tourette syndrome (TS), but previous studies were limited in size and stimulation duration.

OBJECTIVE: The aim was to explore the efficacy and safety of multiple sessions of cathodal tDCS over the bilateral SMA on tic severity in TS.

METHODS: A double-blind, randomized, sham-controlled trial 1 mA cathodal tDCS over bilateral SMA was performed in participants with TS older than 16 years. The intervention involved two 20-min periods of stimulation with either sham or active tDCS per day, over 5 consecutive days, during which participants actively suppressed tics. Tic severity was measured using the Yale Global Tic Severity Scale Total Tic Severity (YGTSS-TTS, primary outcome) score at baseline, day 5 (visit 5), and 1 week later (visit 6). Questionnaires focusing on comorbidities were performed at baseline and visit 6.

RESULTS: Twenty-four participants were randomly assigned (12 active, 12 sham; 8 women; median age: 26). We observed a significant effect of visit on YGTSS-TSS, but no significant effect of treatment or treatment × visit interaction emerged. In contrast, a statistically significant effect of the treatment × visit interaction was observed for the motor tic subscore, with significantly larger improvement in the active arm. Furthermore, we detected a significantly larger decrease in premonitory urge intensity at visit 6 after active stimulation. No effect was detected on severity of comorbidities.

CONCLUSIONS: This preliminary study suggests that bilateral tDCS over the SMA provides small, but significant benefits in reducing motor tic severity in TS.

PMID:39614604 | DOI:10.1002/mdc3.14285

Nurs Open. 2024 Dec;11(12):e70082. doi: 10.1002/nop2.70082.

ABSTRACT

BACKGROUND: Sound mathematical skills are paramount for effective nursing practice and patient safety.

OBJECTIVES: To explore the factors that influence nursing student anxiety when engaging with mathematics-related activities in nursing education.

DESIGN: A concurrent mixed methods employing cross-sectional online survey and focus group interviews.

SETTING: One undergraduate nursing course at an Australian university.

PARTICIPANTS: Bachelor of Nursing students from across academic years.

METHODS: An online survey comprising closed- and open-ended questions to assess mathematics anxiety and self-efficacy and associated factors affecting its application to practice. Focus group interviews to explore anxieties related to mathematics and students’ approaches to nursing mathematics. Quantitative data were analysed using descriptive statistics and qualitative data using inductive content analysis.

RESULTS: A total of 202 nursing students commenced the survey, of which 135 were fully completed, while 17 students participated in focus groups. Less than half were school leavers. Around three-quarters reported some level of fear of mathematics, while many lacked confidence, fear of making errors and/or harming patients and negative childhood experiences of mathematics. Survey items demonstrated extensive variation in perceptions.

CONCLUSIONS: The complexity and diversity of anxieties presents key challenges for nurse academics seeking to educate competent, safe students. Teaching approaches should be varied and consideration of having specialist mathematics teachers and learning psychologists on teaching teams to ensure student success.

REPORTING METHOD: This study is reported using Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS).

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:39614599 | DOI:10.1002/nop2.70082