Category: Statistics

Am J Health Syst Pharm. 2024 Nov 21:zxae346. doi: 10.1093/ajhp/zxae346. Online ahead of print.

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE: A previous study at Ascension Seton Hospital Network (ASHN) found a 1:1 dose conversion to insulin detemir 100 units/mL (iDet100) from insulin glargine 300 units/mL (iGlar300) increased the incidence of hypoglycemia as compared to a 1:1 conversion from insulin glargine 100 units/mL. No studies have evaluated an automatic 20% dose reduction for this specific therapeutic interchange. The purpose of this study was to compare hypoglycemia rates following implementation of a protocol specifying a minimum 20% dose reduction when converting from iGlar300 to inpatient iDet100.

METHODS: This multicenter, retrospective chart review-based study was a before/after study evaluating the impact of an ASHN protocol implemented in April 2021 requiring a minimum 20% reduction when converting from home iGlar300 to inpatient iDet100. Previously, a 1:1 interchange was standard. Patients admitted between May 2019 and December 2022 were included if at least 1 dose of iDet100 was received following interchange from iGlar300. The primary endpoint was hypoglycemia incidence before and after protocol implementation. Secondary endpoints included time to first hypoglycemia and number of doses given before hypoglycemia. Logistic regression was performed to analyze the relationship between percent interchange from home dose and hypoglycemia rate.

RESULTS: A total of 284 patients were included: 128 in the preprotocol arm and 156 in the postprotocol arm. The incidence of hypoglycemia was significantly lower in the postprotocol arm than in the preprotocol arm (11.9% vs 24.7%; P = 0.018). The median time to first hypoglycemia was longer in the postprotocol versus the preprotocol arm, though the difference was not statistically significant (13 vs 18.5 hours, P = 0.082). For each percent reduction from iGlar300 to iDet100, the likelihood of hypoglycemia was reduced by 5.3%.

CONCLUSION: A protocol requiring a minimum 20% dose reduction from iGlar300 to inpatient iDet100 reduced the incidence of hypoglycemia. Health systems should consider adopting a similar approach to reduce the occurrence of hypoglycemia upon interchange.

PMID:39569508 | DOI:10.1093/ajhp/zxae346

Int Health. 2024 Nov 21:ihae083. doi: 10.1093/inthealth/ihae083. Online ahead of print.

ABSTRACT

BACKGROUND: We explored the relationship between adolescent physical activity levels, socio-economic conditions and body mass index (BMI) in order to gain a deeper understanding of the relevant factors affecting adolescent obesity.

METHODS: A stratified random sampling method was used to conduct a questionnaire survey of middle school students in the Chengdu-Chongqing Economic Zone. Multiple linear and logistic regression analysis methods were used to statistically analyse the data obtained.

RESULTS: The level of moderate to vigorous physical activity (MVPA) not only significantly reduces the incidence of obesity in adolescents, it also has a positive effect on avoiding underweight in adolescents. The impact of a father’s BMI on a son’s weight is higher than that of a daughter, while the impact of a mother’s BMI on a child’s weight is the opposite. High monthly income has a positive effect on reducing the BMI of male and female adolescents, but full-time working mothers actually increase the risk of obesity in their children. Teenagers who have exercise habits or view exercise as a form of enjoyment have a significantly reduced risk of obesity.

CONCLUSIONS: The level of MVPA and exercise habits are important factors in inhibiting the development of obesity in adolescent students.

PMID:39569471 | DOI:10.1093/inthealth/ihae083

Clin Exp Dermatol. 2024 Nov 21:llae515. doi: 10.1093/ced/llae515. Online ahead of print.

ABSTRACT

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients’ quality of life and mental health. Effective management often involves both medical and surgical interventions. The aim of the study was to assess the effectiveness of wide local excision and secondary intention healing in improving quality of life and mental health in patients with moderate to severe HS.

METHODS: A single-center prospective study was conducted with 40 patients suffering from moderate to severe HS, refractory to prior treatments. Pre-surgical ultrasound mapping of lesions was performed using Ultra High-Frequency Ultrasound (UHFUS). Patients underwent wide surgical excision followed by secondary intention healing based on HS-TIME principles. Quality of life was measured using Skindex-16, and mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with subscales for anxiety (HADS-A) and depression (HADS-D). Assessments were conducted at baseline, 4 weeks post-surgery, and after complete wound healing. Statistical analyses included paired t-tests and multiple linear regression to determine factors influencing outcomes.

RESULTS: The study included 14 males and 26 females with a mean age of 39 years. Significant improvements were observed in Skindex-16 scores (pre: 57.92, post: 16.03) and HADS scores (HADS-A: pre: 6.13, post: 2.63; HADS-D: pre: 5.50, post: 3.21), indicating reduced pain, discomfort, and psychological distress. Multivariate analysis revealed that improvements were associated with male sex, HS stage II, longer disease duration, and lower BMI.

CONCLUSION: Wide local excision combined with secondary intention healing significantly improves quality of life and mental health in HS patients. The findings suggest that a comprehensive approach addressing both surgical and psychological aspects can enhance patient outcomes. Future research should focus on long-term benefits and the development of standardized postoperative care protocols.

PMID:39569455 | DOI:10.1093/ced/llae515

Nutr Health. 2024 Nov 21:2601060241300236. doi: 10.1177/02601060241300236. Online ahead of print.

ABSTRACT

Background: Preliminary studies suggest that creatine and guanidinoacetic acid (GAA) may function as moderate vasodilators, enhancing tissue oxygen saturation. However, the potential effects of this combination on brain oxygenation in humans remain unknown. Aim: The primary objective of this randomized controlled pilot trial was to assess cerebral blood oxygenation indices following a 7-day administration of a mixture containing creatine and GAA in healthy adults. Methods: Nineteen apparently healthy young adults (mean age 21.2 ± 0.4 years; 9 females) were randomly assigned to receive either a mixture (consisting of 2 g of creatine and 2 g of GAA) or a placebo in a crossover design. Oxygen saturation (SpO₂) and hemoglobin index (tHb) in the prefrontal cortex were assessed at rest (REST), during meditation that focused on mindful breathing (MED), during a three-component cognitive task (TASK), and during a post-task recovery (REC) before and after 7 days of supplementation. Results: Two-way ANOVA with repeated measures revealed statistically significant differences (treatment vs. time interaction) between interventions for SpO₂ during the REST (F = 5.733, P = 0.028), MED (F = 5.897, P = 0.026), and REC phases (F = 6.715, P = 0.018), indicating that the creatine-GAA mixture was more effective than placebo in enhancing oxygen saturation in the prefrontal brain both before, during, and after a cognitive task. Conclusion: These promising findings are of considerable interest for nutritional neuroscience but require validation through well-designed longitudinal trials with larger sample sizes. The study is registered at ClinicalTrials.gov (NCT06371651).

PMID:39569437 | DOI:10.1177/02601060241300236

J Am Med Inform Assoc. 2024 Nov 21:ocae271. doi: 10.1093/jamia/ocae271. Online ahead of print.

ABSTRACT

OBJECTIVE: Machine learning applications for longitudinal electronic health records often forecast the risk of events at fixed time points, whereas survival analysis achieves dynamic risk prediction by estimating time-to-event distributions. Here, we propose a novel conditional variational autoencoder-based method, DySurv, which uses a combination of static and longitudinal measurements from electronic health records to estimate the individual risk of death dynamically.

MATERIALS AND METHODS: DySurv directly estimates the cumulative risk incidence function without making any parametric assumptions on the underlying stochastic process of the time-to-event. We evaluate DySurv on 6 time-to-event benchmark datasets in healthcare, as well as 2 real-world intensive care unit (ICU) electronic health records (EHR) datasets extracted from the eICU Collaborative Research (eICU) and the Medical Information Mart for Intensive Care database (MIMIC-IV).

RESULTS: DySurv outperforms other existing statistical and deep learning approaches to time-to-event analysis across concordance and other metrics. It achieves time-dependent concordance of over 60% in the eICU case. It is also over 12% more accurate and 22% more sensitive than in-use ICU scores like Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores. The predictive capacity of DySurv is consistent and the survival estimates remain disentangled across different datasets.

DISCUSSION: Our interdisciplinary framework successfully incorporates deep learning, survival analysis, and intensive care to create a novel method for time-to-event prediction from longitudinal health records. We test our method on several held-out test sets from a variety of healthcare datasets and compare it to existing in-use clinical risk scoring benchmarks.

CONCLUSION: While our method leverages non-parametric extensions to deep learning-guided estimations of the survival distribution, further deep learning paradigms could be explored.

PMID:39569428 | DOI:10.1093/jamia/ocae271

J Rehabil Med. 2024 Nov 21;56:jrm40897. doi: 10.2340/jrm.v56.40897.

ABSTRACT

OBJECTIVE: To estimate the effectiveness and costs of Rehabilitation for Life (RFL) compared with usual rehabilitation and care after hip fracture to determine which course offered the most value for money.

DESIGN: Cost-utility analysis.

PATIENT: Community-dwelling patients aged 65+ after hip fracture.

METHOD: 123 intervention and 122 control patients were included. Data was collected at 5 points from discharge to 1-year follow-up. Cost analysis included expenses to hospital, general practice, specialist services, medications, rehabilitation, home and informal care, transport, and waiting times. The primary outcome was the incremental cost per quality-adjusted life year (QALY).

RESULTS: The intervention group experienced a statistically significant mean QALY gain of 0.02 -compared with the control group. The intervention was more costly by €4,224, resulting in an incremental cost of €159,990 per QALY gained. Two municipalities had several patients in respite care, yielding an imbalance. A subanalysis excluding these patients demonstrated QALY gain at 0.03 and the cost difference of €2,586 was not statistically significant.

CONCLUSION: The intervention demonstrated a slight improvement in effectiveness over the control but was costly. For patients not requiring respite care, the intervention effect was slightly higher, and the cost differences statistically insignificant. In total 91% received informal care and the economic contribution of informal care exceeded the municipal home care services.

PMID:39569421 | DOI:10.2340/jrm.v56.40897

Orthop J Sports Med. 2024 Nov 19;12(11):23259671241289096. doi: 10.1177/23259671241289096. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: A retear after anterior cruciate ligament (ACL) reconstruction remains a common and devastating complication. Knee bone morphology is associated with the risk of ACL injuries, ACL retears, and osteoarthritis, and a combination of tools that derive bone shape from clinical imaging, such as magnetic resonance imaging (MRI) and statistical shape modeling, could identify patients at risk of developing these joint conditions.

PURPOSE: To identify bone shape features before primary ACL reconstruction in patients with an eventual retear compared to those with a known intact ACL graft.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: Bone was automatically segmented on 2-dimensional proton density-weighted MRI of the knee in patients at the time of the initial ACL injury using deep convolutional neural networks. Patients with a subsequent retear after reconstruction within 3 years (22 femurs, 19 tibias) were compared with those with an intact ACL graft at 3 years (20 femurs, 22 tibias) using statistical shape modeling to identify preoperative bone shape features predictive of a retear after ACL reconstruction.

RESULTS: Statistical shape modeling revealed 2 specific bone shape features (modes) in the femur and 1 mode in the tibia that demonstrated significant differences at the time of the initial injury in patients with subsequent retears. In the femur, a narrower intercondylar notch width, a widened medial condylar width, an increased femoral condylar offset ratio, increased surface area along the lateral femoral condyle relative to the medial condyle, and a more prominent trochlear sulcus at the time of the initial injury were associated with retears after ACL reconstruction. In the tibia, a diminished ACL facet prominence, a squared lateral and medial tibial plateaus, and a broader and flattened tibial spine at the time of the initial injury were associated with retears after ACL reconstruction.

CONCLUSION: Using the automatic bone segmentation pipeline on preoperative MRI, the authors identified bone shape features associated with a retear after ACL reconstruction. The use of this pipeline enables large-scale studies of bone shape on MRI and could predict patients at risk of ACL retears to alter treatment decisions.

PMID:39569414 | PMC:PMC11577471 | DOI:10.1177/23259671241289096

Orthop J Sports Med. 2024 Nov 20;12(11):23259671241292641. doi: 10.1177/23259671241292641. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: Patellofemoral osteochondral fractures (OCFs) have the potential to hinder patients’ function and quality of life. Several fragment fixation techniques have been described, with both metallic screw and bioabsorbable fixation showing favorable functional outcomes. Despite the promising results associated with both fixation methods, no study has directly compared their functional outcomes.

PURPOSE: To compare the functional and radiographic outcomes between bioabsorbable and metallic screw patellofemoral OCF fixation in an adolescent cohort.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: A retrospective review was conducted identifying surgically treated pediatric patients (<18 years of age) with OCFs of the patellofemoral joint. Inclusion criteria were treatment with metallic screw or bioabsorbable fixation (bioabsorbable compression screw, suture bridge, or chondral darts), with preoperative radiographs and operative notes available for review. Patient information, injury characteristics, treatments, and outcomes were collected with a specific focus on return-to-activity time and postoperative complications. Univariate analyses were conducted to compare radiographic and functional outcomes between groups.

RESULTS: According to the study criteria, 37 knees in 37 patients (84% male), with a mean age of 14.2 ± 1.8 years, were identified. A total of 24 patients were injured during sports participation, with basketball and football being the most common sports. OCF fixation cohorts consisted of 12 patients treated with metallic screw fixation and 25 with bioabsorbable fixation. No statistically significant differences were appreciated when comparing median time to full activity between the fixation groups (P = .427). However, time to full activity was unequally distributed, with 66.7% of the metallic screw fixation group returning to activity later than the total cohort’s median, compared with 42.9% of the bioabsorbable fixation group (P = .04). Two-thirds (8/12) of patients treated with metallic screws required return to the operating room for hardware removal compared with no patient treated with bioabsorbable fixation (P < .001). Two complications occurred with no significant differences appreciated between groups (P = .202). However, both postoperative complications were recorded in the metallic screw fixation group: 1 patient with osteochondral malunion and another with arthrofibrosis.

CONCLUSION: This study demonstrated that pediatric patellofemoral OCFs had good outcomes with high healing and low complication rates regardless of fixation type. Because of the high rate of secondary hardware removal procedures, metallic screw constructs delayed the return to sports and activity time. Patients treated with bioabsorbable fixation did not require a secondary operation for hardware removal and thus were more likely to recover sooner. Future studies are necessary to assess the potential outcome differences between different types of bioabsorbable fixation methods. Based on these findings, surgeons can consider bioabsorbable fixation as an option for the management of OCF lesions.

PMID:39569413 | PMC:PMC11577468 | DOI:10.1177/23259671241292641

Epilepsy Behav Rep. 2024 Oct 29;28:100724. doi: 10.1016/j.ebr.2024.100724. eCollection 2024.

ABSTRACT

Benefits of exercise on general health and wellbeing are undeniable. The International League Against Epilepsy has provided some guidance into exercise and sports for epilepsy. However, people with epilepsy are typically misinformed and restricted by fear and lack of evidence about exercise benefits in epilepsy. Our study seeks to investigate engagement in exercise in epilepsy at our center and identify potential barriers to physical activity. We conducted an anonymous survey at the Epilepsy Clinic using a clinically validated measure of exercise (IPAQ) at various levels: vigorous, moderate, and walking, and a questionnaire of 21 potential reasons for inactivity. Data were collected in REDCap. Statistical analysis was performed on SAS. We collected responses from 72 epilepsy participants between January and April 2024. Participants with controlled seizures were more likely to engage in moderate exercise compared to respondents with uncontrolled seizures. The top two general perceived barriers were having no one to exercise with and not liking exercise. Epilepsy-specific barriers were higher in respondents with uncontrolled seizures compared to those with controlled seizures, with the top two reasons being fear of “exercise-induced” seizures and lack of guidance on appropriate exercises. Our findings showed that there were more participants with controlled seizures who perform moderate exercise compared to those with uncontrolled seizures. Future studies are needed to evaluate whether exercise can have an impact on improving seizure control. Our study also highlights opportunities to educate health care providers, patients, and community members about exercise to facilitate engagement in exercise and improve epilepsy outcomes.

PMID:39569405 | PMC:PMC11576386 | DOI:10.1016/j.ebr.2024.100724

Neurol Clin Pract. 2025 Feb;15(1):e200400. doi: 10.1212/CPJ.0000000000200400. Epub 2024 Nov 15.

ABSTRACT

BACKGROUND AND OBJECTIVES: Recent studies have suggested that antibiotics could be a contributing factor to Parkinson disease (PD), but validation in other population cohorts, such as Asians, is needed. This study examined the association between exposure to antibiotics and PD risk in the Korean population.

METHODS: Using the National Health Insurance Service (NHIS) database, this population-level cohort research study from Korea included 298,379 people aged 40 years and older who underwent a national health examination in 2004-2005. Cumulative antibiotic exposure days were investigated over 4 years (2002-2005), and new cases of PD were followed for 14 years (2006-2019). Various covariates, such as infectious diseases, were considered in the analysis. Multivariable Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHRs) and CIs for the PD risk from antibiotic exposure.

RESULTS: PD risk was statistically significantly higher in those exposed to antibiotics for ≥121 days than in those not exposed to antibiotics (aHR, 1.29; 95% CI 1.07-1.55). In addition, compared with those exposed to antibiotics for 1-14 days, those exposed to antibiotics for ≥121 days had a higher risk of PD (aHR, 1.37; 95% CI 1.17-1.61). The results of sensitivity analyses that applied washout periods or extended antibiotic exposure periods were consistent with those of the main analyses.

DISCUSSION: Extended usage of antibiotics was linked to a higher incidence of PD, even after controlling for several risk variables. Further research is needed to warrant the causation and mechanisms of antibiotic exposure and PD.

PMID:39569393 | PMC:PMC11575412 | DOI:10.1212/CPJ.0000000000200400