Category: Statistics

J Med Internet Res. 2024 Nov 29;26:e53157. doi: 10.2196/53157.

ABSTRACT

BACKGROUND: Smart glasses have emerged as a promising solution for enhancing communication and care coordination among distributed medical teams. While prior research has explored the feasibility of using smart glasses to improve prehospital communication between emergency medical service (EMS) providers and remote physicians, a research gap remains in understanding the specific requirements and needs of EMS providers for smart glass implementation.

OBJECTIVE: This study aims to iteratively design and evaluate a smart glass application tailored for prehospital communication by actively involving prospective users in the system design process.

METHODS: Grounded in participatory design, the study consisted of 2 phases of design requirement gathering, rapid prototyping, usability testing, and prototype refinement. In total, 43 distinct EMS providers with diverse backgrounds participated in this 2-year long iterative design process. All qualitative data (eg, transcribed interviews and discussions) were iteratively coded and analyzed by at least 2 researchers using thematic analysis. Quantitative data, such as System Usability Scale (SUS) scores and feature ratings, were analyzed using statistical methods.

RESULTS: Our research identified challenges in 2 essential prehospital communication activities: contacting online medical control (OLMC) physicians for medical guidance and notifying receiving hospital teams of incoming patients. The iterative design process led to the identification of 5 key features that could potentially address the identified challenges: video call functionality with OLMC physicians, call priority indication for expedited OLMC contact, direct communication with receiving hospitals, multimedia patient information sharing, and touchless interaction methods for operating the smart glasses. The SUS score for our system design improved from a mean of 74.3 (SD 11.3) in the first phase (classified as good usability) to 80.3 (SD 13.1) in the second phase (classified as excellent usability). This improvement, along with consistently high ratings for other aspects (eg, willingness to use and feature design), demonstrated continuous enhancement of the system’s design across the 2 phases. Additionally, significant differences in SUS scores were observed between EMS providers in urban areas (median 85, IQR 76-94) and rural areas (median 72.5, IQR 66-83; Mann-Whitney U=43; P=.17), as well as between paramedics (median 72.5, IQR 70-80) and emergency medical technicians (median 85, IQR: 74-98; Mann-Whitney U=44.5; P=.13), suggesting that EMS providers in urban settings and those with less training in treating patients in critical conditions perceived the smart glass application as more useful and user-friendly. Finally, the study also identified several concerns regarding the adoption of the smart glass application, including technical limitations, environmental constraints, and potential barriers to workflow integration.

CONCLUSIONS: Using a participatory design approach, this study provided insights into designing user-friendly smart glasses that address the current challenges EMS providers face in dynamic prehospital settings.

PMID:39612486 | DOI:10.2196/53157

Medicine (Baltimore). 2024 Nov 29;103(48):e40192. doi: 10.1097/MD.0000000000040192.

ABSTRACT

BACKGROUND: Rhinosinusitis (RS), a common inflammatory disorder, adversely affects quality of life and can progress to serious complications without intervention. Conventional therapies, including antibiotics and corticosteroids, exhibit inherent limitations and risks. Traditional Chinese medicine (TCM), with its extensive historical use in RS management, remains understudied in contemporary evaluations. This systematic review evaluates the efficacy and safety of TCM in RS treatment, aiming to guide clinical decision-making.

METHODS: A systematic search was undertaken in Chinese and English databases, such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Web of Science, and other relevant databases, to gather randomized controlled trials of TCM for patients with RS from January 2014 to February 2024. Two researchers independently curated and synthesized data from eligible literature, conducted meta-analyses with ReviewManager 5.4.1, and assessed evidence quality via GRADEPro GDT.

RESULTS: A total of 48 articles included 4490 patients, of which 2249 were control group and 2241 were in the experimental group. Meta-analytic outcomes revealed that the integration of TCM with western medicine conventional treatment significantly enhanced the total effective rate [risk ratio=1.20, 95% confidence interval (CI) (1.17, 1.23), P < 0.05] and yielded a notable reduction in Lund-Kennedy score [mean difference (MD)=-1.32, 95% CI (-1.72, -0.93), P < 0.05], Lund-Mackay score [MD=-1.13, 95% CI (-1.27, -1.00), P < 0.05], SNOT-20 score [MD=-3.02, 95% CI (-4.34, -1.69), P < 0.05], nasal congestion Visual Analogue Scale (VAS) score [MD=-1.05, 95% CI (-1.65, -0.45), P < 0.05], runny nose VAS score [MD=-0.84, 95% CI (-1.13, -0.54), P < 0.05], headache VAS score [MD=-0.90, 95% CI (-1.45, -0.35), P < 0.05], olfactory impairment VAS score [MD=-1.43, 95% CI (-1.75, -1.11), P < 0.05], and total TCM syndrome score [standardized mean difference (SMD)=-1.78, 95% CI (-2.58, -0.97), P < 0.05]. Additionally, significant decreases were observed in levels of tumor necrosis factor-α [SMD=-2.14, 95% CI (-3.42, -0.87), P < 0.05] and interleukin-6 [SMD=-1.64, 95% CI (-2.08, -1.21), P < 0.05], with statistical significance achieved for all measured outcomes. Regarding safety considerations, an insignificant variance was observed between the 2 therapeutic approaches, with no statistically discernible difference (P > 0.05).

CONCLUSION: Combining TCM with western medicine in RS treatment yields superior outcomes over western medicine alone, with enhanced efficacy, reduced nasal symptoms, and lower inflammation. Rigorous multicenter RCTs are warranted to affirm these advantages and bolster the evidence for TCM in RS management.

PMID:39612467 | DOI:10.1097/MD.0000000000040192

Medicine (Baltimore). 2024 Nov 29;103(48):e40645. doi: 10.1097/MD.0000000000040645.

ABSTRACT

A typical surgical technique for pregnant women with potentially fatal problems affecting the mother or fetus is an emergency cesarean section (ECS). The decision-to-delivery interval (DDI) for ECS should be within 30 minutes. The objective of this study was to investigate crash ECS indications and effects on maternal and neonatal outcomes. In this retrospective study, all women undergoing crash cesarean section (CS) at Obstetrics and Gynecology department at King Abdulaziz University hospital, Jeddah, Saudi Arabia during 2022 and 2023 were evaluated. Data about demographic and obstetric characteristics of mother, ECS indications, DDI, and outcomes for mothers and newborns was gathered from the patient’s sheet. One hundred 3 crash CS were performed during study period. Crash CS indications were fetal bradycardia (64.1%), prolapsed cord (24.3%), uterine rupture (6.8%), and severe antepartum hemorrhage (4.9%). D-D time range from 2 to 30 minutes. DDI was ≤15 minutes in 90 patients (87.4%) and >15 minutes in 13 patients (12.6%). Gestational age was <32 weeks (16.7%), between 32 and <37 weeks (15.5%), and ≥37 weeks (68.0%). Good maternal outcome was reported in 89 (86.4%), while 24 (13.6%) had complications. Intensive care unit maternal admission was significantly higher in gestational age 32 to <37 weeks versus <32 weeks and ≥37 weeks of gestation (18.8% vs 5.9% and 2.9%, P = .050). Fetal outcome was good in 69 (67.0%), while 34 (33.0%) had complications. Neonatal body weights, Apgar score at 1, 5, 10 minutes, and umbilical cord arterial pH were significantly decreased in preterm versus termed neonates (P < .0001, P < .0001, P < .0001, P = .014, and P = .003). Moreover, respiratory distress syndrome, jaundice, intubation, neonatal deaths, and sepsis were significantly higher in preterm versus term deliveries (P < .0001, P = .029, P < .0001, P = .010, and P = .031). Good neonatal outcome was significantly higher (P < .0001); while respiratory distress syndrome was significantly lower (P = .007) in deliveries with DDI ≤ 15 minutes versus > 15 minutes. The 30-minute standard for DDI time interval may be a feasible guideline at least for level-3 hospitals. Crash CS indication was mostly due to fetal bradycardia. The maternal and neonatal outcomes were better in term than preterm deliveries. The positive effect of very short intervals on neonatal outcome still needs to be proven.

PMID:39612466 | DOI:10.1097/MD.0000000000040645

Medicine (Baltimore). 2024 Nov 29;103(48):e40685. doi: 10.1097/MD.0000000000040685.

ABSTRACT

Evidence suggests a strong association between prostate diseases, lower urinary tract symptoms (LUTS), and pro-inflammatory diets. Our study was conducted to assess the relationship between the Dietary Inflammatory Index (DII) and prostate diseases, LUTS using the 2003 to 2008 U.S. National Health and Nutrition Examination Survey (NHANES) database. After the chi-square test to investigate whether demographic data and prostate diseases, LUTS were correlated, for positive results, we performed weighted multivariable logistic regression models analysis. In addition, we performed nonlinear tests using restricted cubic spline (RCS) and assessed the stability between different subgroups by subgroup and interaction analyses. The study included 30,619 subjects. After adjusting the regression model for fully confounding variables, DII was only correlated with benign prostatic hyperplasia (BPH) (OR = 1.074, 95% CI = 1.016-1.136; P = .012). And, the RCS relationship between DII and BPH was positively correlated (nonlinear: P = .830). We did not find statistically significant interactions in all subgroups. At the same time, we did not find any correlation between DII and other prostate diseases and LUTS. Pro-inflammatory diets are associated with an increased risk of BPH. Dietary modifications to reduce the intake of pro-inflammatory nutrients can be helpful in mitigating the development of BPH.

PMID:39612464 | DOI:10.1097/MD.0000000000040685

Medicine (Baltimore). 2024 Nov 29;103(48):e40635. doi: 10.1097/MD.0000000000040635.

ABSTRACT

BACKGROUND: This study aimed to assess the impact of the timing of low-dose hydrocortisone adjuvant therapy initiation on clinical outcomes in patients with septic shock by a systematic review and meta-analysis.

METHODS: We conducted a comprehensive search of all randomized controlled trials (RCTs) and cohort studies available in the PubMed, Web of Science, and Embase databases. The search included articles published from the founding of these databases until August 1, 2024. The purpose of the search was to compare the results of initiating low-dose hydrocortisone (HC) adjuvant therapy at different time periods. The main reported results included short-term mortality (ICU mortality and hospital mortality) as key outcomes, and secondary outcomes such as the rate of renal replacement treatment continuous renal replacement therapy (CRRT), length of stay in the intensive care unit (ICU), and rate of shock reversal.

RESULTS: Seven trials, with a total of 3063 patients, were included. The main finding of this meta-analysis indicates that the early treatment group, which received low-dose hydrocortisone, had a lower ICU mortality rate compared to the late treatment group. Additionally, the hospital mortality rate in the early treatment group was lower than that in the late treatment group. There was a correlation between the timing of beginning of HC and the short-term mortality of patients with septic shock. The secondary findings indicated that there were no notable disparities in the rates of CRRT, the rate of reversing shock, and the duration of stay in the ICU.

CONCLUSION: Administering low doses of HC early on can decrease the risk of death in septic shock patients in the short-term mortality. There were no substantial disparities observed in the rate of CRRT, the rate of reversal of shock, and the duration of stay in the ICU. Additional extensive RCTs are required to validate this conclusion.

PMID:39612454 | DOI:10.1097/MD.0000000000040635

Medicine (Baltimore). 2024 Nov 29;103(48):e40427. doi: 10.1097/MD.0000000000040427.

ABSTRACT

BACKGROUND: The association between polymorphisms in the ATP-binding cassette transporter A1 (ABCA1) gene and the risk of developing glaucoma has yielded conflicting results across various studies. This meta-analysis aims to comprehensively assess whether genetic variations in ABCA1 significantly contribute to the susceptibility to glaucoma.

METHODS: An extensive search was conducted across major databases, including PubMed, EMBASE, and the China National Knowledge Infrastructure (CNKI), covering all publications from the inception of each database through December 2023. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to quantify the strength of the association between ABCA1 polymorphisms and glaucoma risk.

RESULTS: A significant association was observed between ABCA1 gene polymorphisms and glaucoma risk in the overall analysis, as demonstrated by allele contrast (P < .001), homozygote comparison (P < .001), heterozygote comparison (P < .001), recessive genetic model (P = .017), and dominant genetic model (P < .001). Notably, these associations were particularly pronounced in the Asian population, with all models showing statistical significance (P < .05). However, no significant association was detected in Caucasian or mixed populations, suggesting a potential ethnic specificity in the genetic susceptibility to glaucoma conferred by ABCA1 polymorphisms.

CONCLUSIONS: Our findings indicate that ABCA1 polymorphisms may play a role in increasing the risk of glaucoma, specifically within Asian populations. This contrast highlights the importance of considering ethnic background in genetic association studies.

PMID:39612451 | DOI:10.1097/MD.0000000000040427

Medicine (Baltimore). 2024 Nov 29;103(48):e40664. doi: 10.1097/MD.0000000000040664.

ABSTRACT

Chronic opioid use (COU) after traumatic injuries is a global health concern. COU after trauma delays recovery and increases the risk of long-term drug dependence. However, the population-prevalence and factors associated with COU after traumatic injury in South Korea remain unclear. We aimed to estimate the prevalence of COU and associated risk factors in patients after trauma in South Korea. A historical cohort study using the population-representative database including 1,103,405 South Korean subjects, patients admitted due to a newly diagnosed trauma (n = 65,444) or nontraumatic etiologies (n = 338,321) from January 1, 2003, to June 30, 2015, were analyzed. COU was defined as the prescription of opioid in the first 3 to 6 months from the index date. Prevalence of COU was summarized. A multivariable logistic regression analysis was conducted to investigate association of COU with traumatic injuries, accounting for a priori sociodemographic and clinical risk factors. A total of 13.5% and 12.6% of patients were found to be chronic opioid users in the trauma and the control group, respectively. The adjusted odds ratio (aOR) (95% CI) of COU in the injured compared to the noninjured was 1.13 (1.01 to 1.16), when controlling for age group, sex, calendar year, area of residence, previous opioid use, comorbidity, surgery during the index admission and intensive care unit care. Risk factors included being aged 65 to 74 years (aOR = 2.87; 95% CI = 2.73 to 3.01), aged ≥ 75 years (aOR = 2.48; 95% CI = 2.35 to 2.62), and history of previous opioid use (aOR = 3.27; 95% CI = 3.21 to 3.34) were the most significant risk factors of COU, independent of injury. COU was prevalent both in the injured and noninjured patients, with slightly increased risk of COU in those sustaining traumatic injury compared to those who were noninjured. Further stud y to address prevalent COU in South Korea is required to avoid opioid-related harms.

PMID:39612447 | DOI:10.1097/MD.0000000000040664

Medicine (Baltimore). 2024 Nov 29;103(48):e40474. doi: 10.1097/MD.0000000000040474.

ABSTRACT

BACKGROUND: To systematically evaluate the efficacy and safety of acupuncture in the treatment of atrial fibrillation (AF).

METHODS: Eight databases were searched. The search time limit is from January 2000 to November 2023. All randomized controlled trials on acupuncture treatment of AF were included. After the literature screening, data extraction and quality evaluation were carried out independently according to the inclusion and exclusion criteria, and the included literature was analyzed by Meta using RevMan 5.4 software.

RESULTS: A total of 15 research studies on randomized controlled trials were included, involving 1960 patients. The results of the meta-analysis showed that acupuncture therapy could increase the sinus cardioversion rate of patients with AF, and the difference was statistically significant (relative risk = 1.21, 25% confidence interval (CI) [1.11, 1.31], P < .001). The clinically effective rate of the acupuncture plus drug treatment group was higher than that of the drug treatment group (relative risk = 1.32, 95% CI [1.19, 1.46], P < .01). Acupuncture plus other conventional therapies treatment was more helpful in reducing the ventricular rate of patients with AF (mean difference = -7.89, 95% CI [-14.52, -1.26], P = .006). The cardioversion time of patients with AF treated with acupuncture plus conventional therapies was shorter than those treated with traditional therapies alone (standardized mean difference = -1.82, 95% CI [-3.28, -0.35], P = .01). No severe adverse reactions such as hemorrhage, hematoma, or local infection caused by acupuncture were reported in the study.

CONCLUSION: The available evidence shows that acupuncture can effectively improve the total clinical effective rate and sinus rhythm recovery rate, shorten the recovery time of sinus rhythm, and reduce the ventricular rate, and there are no apparent adverse reactions. However, a limited number of studies may affect the generalizability of the findings. Future studies should include more extensive and diverse studies to enhance the power and generalizability of the findings.

PMID:39612438 | DOI:10.1097/MD.0000000000040474

Medicine (Baltimore). 2024 Nov 29;103(48):e40612. doi: 10.1097/MD.0000000000040612.

ABSTRACT

While observational studies have illustrated correlations between plasma metabolites and gastric cancer (GC), the causal association between the 2 is still unclear. Our study aims to delineate the bidirectional relationship between plasma metabolites and GC and find potential metabolic pathways. We undertook a bidirectional 2-sample Mendelian randomization (MR) analysis to investigate the causal relationship, specificity, and direction of association between 1400 plasma metabolites and GC. The GWAS data for metabolites was obtained from a cohort of 8299 European individuals. And the GC’s GWAS data was from FinnGen Consortium with 2384 European individuals, and the GWAS catalog with 1029 European ancestry cases for validation. Causal estimates were primarily calculated by the inverse-variance weighted (IVW) method. To ensure robustness, we performed comprehensive sensitivity analyses to assess heterogeneity and address concerns regarding horizontal pleiotropy. We validated the forward relationship between metabolites and GC from another database and implemented meta-analysis. Furthermore, we conducted metabolic enrichment and pathway analysis of these causal metabolites using MetaboAnalyst5.0/6.0 with the database of Kyoto Encyclopedia of Genes and Genomes. All statistical analysis was carried out using R software. Metabolites like 2s, 3R-dihydroxybutyrate, 4-acetamidobutanoate, ferulic acid 4-sulfate and methyl indole-3-acetate was proven positively linked with the development of GC. Asparagine, glucose to maltose ratio, glycohyocholate, Gulonate levels, linoleoyl ethanolamide and Spermidine to (N(1) + N(8))-acetylspermidine ratio was proven to be negatively associated with GC. Moreover, linoleic acid, histidine, glutamine, bilirubin, Succinate to proline ratio were found to be potentially linked to the development of GC. Furthermore, our analysis identified 18 significant metabolic pathways, including Arginine and proline metabolism (P < .009) and Valine, leucine, and isoleucine biosynthesis (P < .031). Our findings offer evidence supporting potential casual relations between multiple plasma metabolites and GC. These findings may offer great potential for future application of these biomarkers in GC screening and clinical prevention strategies.

PMID:39612432 | DOI:10.1097/MD.0000000000040612

Medicine (Baltimore). 2024 Nov 29;103(48):e40483. doi: 10.1097/MD.0000000000040483.

ABSTRACT

Chronic obstructive pulmonary disease (COPD) frequently results in hospital readmission and contributes to increased morbidity and mortality. This multicenter prospective study aimed to identify factors that increase the risk of readmission within 30 to 90 days of severe COPD exacerbation. A total of 415 patients admitted to the emergency department (ED) or general pulmonology ward after discharge due to severe exacerbations from 13 tertiary centers in Turkey were included. Of the participants, 346 (83.4%) were male and 69 (16.6%) were female, with an average age of 69.0 ± 9.1 years. Readmissions within 30 and 90 days after the initial hospitalization occurred in 176 (42.4%) and 191 (46%) patients, respectively. Prospective data collection focused on exacerbation severity, disease severity, and the utility of initial admissions. Factors for 30 to 90 day readmission were analyzed using univariate and multivariate regression models. A 30-day readmission correlated significantly with Hospital Anxiety Depression Scale scores above 16 [odds ratio [OR] 95% confidence intervals [CI]: 1.9 (1.1-3.6); P = .042], severe exacerbation history in the previous year [OR 95% CI: 1.7 (1.1-2.9); P = .038], hospital-acquired pneumonia [OR 95% CI: 1.9 (1-4.1); P = .049)], and frequent antibiotic use in the previous year [OR 95% CI: 1.8 (1.2-2.7); P = .007]. Risk factors for 90-day readmissions included: Grades 3 to 4 tricuspid regurgitation [OR 95% CI: 2.2 (1.1-4.4); P = .024], 2 or more moderate COPD exacerbations [OR 95% CI: 1.9 (1.2-3.1); P = .010], severe exacerbation history in the previous year [OR 95% CI: 2.5 (1.5-4.2); P = .001], immunosuppression [OR 95% CI: 2.7 (1.2-5.7); P = .013], frequent antibiotic use the previous year [OR 95% CI: 1.5 (1-2.4); P = .048], hospitalization via the ED [OR 95% CI: 1.6 (1.1-2.6); P = .028]. To mitigate complications and readmissions, patients with a history of frequent severe COPD exacerbations, high anxiety and depression scores, frequent antibiotic requirements, immunosuppression, tricuspid regurgitation, hospital-acquired pneumonia, and those admitted to the ED should be prioritized for remote monitoring after initial discharge.

PMID:39612431 | DOI:10.1097/MD.0000000000040483