Category: Statistics

Aust J Gen Pract. 2024 Nov;53(11):859-863. doi: 10.31128/AJGP-06-23-6881.

ABSTRACT

BACKGROUND AND OBJECTIVES: Management of skin cancer comprises a substantial proportion of general practitioner (GP) workload in Australia. Flap and graft procedures below the knee have an increased risk of infection. Antibiotic resistance is a threat to global health, and any decision about antibiotic prophylaxis must balance adverse outcomes of antibiotic use with patient morbidity. This study will investigate the effectiveness of two interventions to prevent surgical site infection (SSI) after below-knee surgery: (1) 450 mg of clindamycin preoperatively and postoperatively; and (2) preoperative chlorhexidine wash and nasal mupirocin.

METHOD: This prospective randomised controlled trial will be conducted across three skin cancer clinics over nine months, with 155 participants. Consecutive patients presenting for below-knee flap and graft procedures will be eligible to participate. The primary outcome is superficial SSI in the first 30 days following excision. Secondary outcomes include adverse effects (anaphylaxis, skin irritation and foreign body reaction) and patterns of antibiotic resistance.

RESULTS: As this is a study protocol paper, there are no results available to present.

DISCUSSION: As this is a study protocol paper, there are no results to be discussed.

PMID:39499845 | DOI:10.31128/AJGP-06-23-6881

Aust J Gen Pract. 2024 Nov;53(11):794-798. doi: 10.31128/AJGP-04-23-6799.

ABSTRACT

BACKGROUND AND OBJECTIVES: Little is known about the views of service providers currently working in telehealth early medical abortion (EMA) provision in Victoria, Australia. This study aims to contextualise the enablers and barriers to telehealth EMA provision, providing insight for healthcare policy and practice to improve the accessibility of this service.

METHOD: This was a qualitative descriptive study involving semi-structured interviews with 14 Victorian stakeholders with expertise and knowledge on telehealth EMA provision. Data were analysed using conventional content analysis.

RESULTS: This study presents perceived enablers and barriers across four different contexts of the Victorian abortion system: (1) perceived patient context; (2) perceived provider context; (3) health organisation-system context; and (4) sociopolitical context. The COVID-19 pandemic’s disruption of healthcare services led to greater patient and provider acceptance of telehealth EMA. However, barriers within the patient context included the inability to ensure safety and confidentiality, digital access and literacy issues, language barriers, and the importance of trusting provider-patient relationships. Providers encountered challenges in delivering holistic care via telehealth, including time and workload issues and working with interpreters. Shortcomings within the organisational context encompassed structural barriers for culturally and linguistically diverse population groups, the absence of standard telehealth guidelines and varying interpretations of telehealth. Although temporary Medicare item number changes improved access, they presented financial challenges for mixed and private billing practices.

DISCUSSION: The application of these findings by relevant health services and policymakers has the potential to improve the quality of, and increase accessibility to, telehealth EMA, better meeting the needs of individuals seeking this service.

PMID:39499832 | DOI:10.31128/AJGP-04-23-6799

J Am Assoc Nurse Pract. 2024 Nov 1;36(11):664-670. doi: 10.1097/JXX.0000000000001088.

ABSTRACT

BACKGROUND: Fragility fractures have significant sequelae, including pain, loss of mobility, and increased risk of mortality. Fracture liaison services (FLS) represent a coordinated, interdisciplinary approach to secondary prevention and reduce mortality.

PURPOSE: To investigate the effectiveness and patient outcomes regarding readmission and mortality of a newly developed, nurse practitioner (NP) coordinated FLS in Chile.

METHODOLOGY: Retrospective longitudinal analysis of 214 patients who agreed to participate in a FLS was conducted. Variables studied include patient age, gender, anatomical fracture site, dual x-ray absorptiometry scans, medication, readmission information, and mortality. Demographics and clinical data were collected and analyzed with bivariate and multivariate statistics. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who did and did not participate in the FLS.

RESULTS: The study sample was predominantly female (85%) with a mean age of 76 (SD: 12; range 41-101) years. The most frequently noted fracture sites were hip (n = 167), wrist (n = 132), and spine (n = 72). At one-year follow-up, the FLS group had a significantly lower mortality (5%, 10 patients) than those who did not participate in the program (12% [N = 50], p = .005). The Kaplan-Meier analysis indicated that patients who participated in the FLS had significantly better survival rates than those who did not participate.

CONCLUSIONS: Significantly improved survival rates were observed in FLS patients. Chile’s first FLS demonstrated improved patient outcomes, specifically a reduced mortality in patients who were enrolled in the FLS.

IMPLICATIONS: The NP role was fundamental in the screening, diagnosis, and treatment of patients with osteoporosis.

PMID:39499786 | DOI:10.1097/JXX.0000000000001088

J Am Assoc Nurse Pract. 2024 Nov 1;36(11):619-626. doi: 10.1097/JXX.0000000000001055.

ABSTRACT

BACKGROUND: Guatemala, a country with high rates of pediatric malnutrition, has significant challenges including food and potable water insecurity and a lack of health care providers.

PURPOSE: This study examined the impact of telehealth clinic attendance on pediatric malnutrition scores.

METHODOLOGY: A sample of 42 Guatemalan children aged 6-59 months with malnutrition were recruited to participate in eight clinic events, including two in-person and six telehealth clinics. Six telehealth clinics were held at 4- to 6-week intervals, bookended by an initial and concluding in-person event. Nonparametric tests were used to analyze changes between baseline and last visit z-scores for height, weight for length, mid-upper arm circumference (MUAC), and body mass index (BMI) and to examine the relationship between the number of telehealth visits and z-score measurements at baseline and last visit.

RESULTS: The number of children with severe malnutrition at baseline by weight for length, BMI, and MUAC decreased by the last visit. A decrease occurred in the number of children with stunted height. Changes in z-scores for height, weight for length, BMI, and MUAC between study onset and last visit did not reach statistical significance. Statistically significant relationships existed between clinic attendance and baseline and last visit weight for height/length z-scores and baseline MUAC z-scores.

CONCLUSIONS: Positive improvements in nutritional status occurred, especially among children with severe malnutrition. Children with severe malnutrition had significantly better telehealth attendance.

IMPLICATIONS: Studies with larger sample sizes are needed. Study results indicate that telehealth may be a tool to battle global pediatric malnutrition.

PMID:39499784 | DOI:10.1097/JXX.0000000000001055

J Am Assoc Nurse Pract. 2024 Nov 1;36(11):601-606. doi: 10.1097/JXX.0000000000001058.

ABSTRACT

The discipline of geography is an increasingly necessary lens required to understand population-level diseases. Syndemics, or co-occurring diseases or epidemics within a specific population, are contextualized by place-preexisting social, economic, and political structures. Nurse practitioners are well-positioned to critically assess the impact of geography on patient health and well-being. This perspective provides a brief summary of syndemic crises, with a case example in the West Virginia coalfields. The position of this paper is one that supports geography, in addition to social determinants of health, as a framework for syndemics. A geographic perspective provides a more comprehensive picture of marginalized populations and regions facing the phenomenon. Given the significance of holistic nursing, attention to the role of geography in syndemics provides an increased dimension of care and treatment.

PMID:39499783 | DOI:10.1097/JXX.0000000000001058

Ann Am Thorac Soc. 2024 Nov 5. doi: 10.1513/AnnalsATS.202402-171OC. Online ahead of print.

ABSTRACT

Rationale: In patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP), the apnea hypopnea index (AHI) measured off CPAP may be decreased relative to baseline AHI preceding CPAP treatment. Semi-invasive “endo-phenotyping” sleep studies attribute this fall in AHI primarily to improved ventilatory control stability. Phenotyping Using Polysomnography (PUP) attempts to reproduce these studies using routine polysomnography (PSG). Objectives: To determine whether changes in AHI following CPAP associate primarily with changes in PUP-estimated ventilatory control stability (loop gain, LG₁) or with changes in other PUP-estimated pathophysiologic mechanisms. Methods: PUP analyses were performed on existing PSGs in research participants who underwent baseline PSG, 4.4±2.2 months CPAP therapy, and CPAP withdrawal with repeat PSG on night 2 of withdrawal. Pre-CPAP PUP-estimated LG₁, arousal threshold (ArTH), and upper airway collapsibility (Vpassive) and compensation (Vcomp) were compared to corresponding values during CPAP withdrawal. Mixed effects models were constructed to determine which PUP estimate best explained changes in AHI. Results: PSG data were available for 35 participants (age 47±10.8 years; 12 female; BMI 38.5±8.6 kg/m², AHI3A 58.8±33.1 events/hr, 9 mild/moderate OSA, 26 severe OSA). Following CPAP, AHI decreased, but the change was not statistically significant. However, a significant decrease was observed in those with severe OSA (pre-CPAP 68.2 [32.6-86.3] versus CPAP withdrawal 49.0 [36.1-74.4] events/hr). Across all participants, changes in PUP estimates did not exceed test-retest agreement limits. For those with severe OSA, decrease in LG₁ (0.86 [0.61-1.13] pre-CPAP versus 0.71 [0.61-0.99] on CPAP withdrawal) and increase in Vpassive (64.8 [5.4-88.4] %Veupnea pre-CPAP versus 76.4 [20.7-92.7] %Veupnea on CPAP withdrawal) exceeded test-retest agreement limits. Increased Vpassive, decreased LG₁, and decreased ArTH were predictors of decreased AHI in mixed effects models. Vpassive had the greatest estimated effect on AHI. After accounting for Vpassive, additional estimates did not improve model performance. However, Vpassive and LG₁ were correlated, and post hoc analyses suggest these estimates may be influenced by both upper airway collapsibility and ventilatory control. Conclusions: According to PUP physiologic estimates, decreases in AHI following several months of CPAP therapy are primarily attributable to improved upper airway collapsibility.

PMID:39499779 | DOI:10.1513/AnnalsATS.202402-171OC

Ann Med. 2024 Dec;56(1):2419546. doi: 10.1080/07853890.2024.2419546. Epub 2024 Nov 5.

ABSTRACT

BACKGROUND: The prognosis of patients with coronary artery disease is adversely affected by elevated fasting plasma glucose (FPG) levels. However, the relationship between FPG levels and in-hospital cardiac arrest (IHCA) remains unclear.

OBJECTIVES: The objective of this study was to investigate the association between FPG levels and IHCA in patients diagnosed with acute coronary syndrome (ACS).

METHODS: Data from a total of 31,726 ACS patients fitted with inclusion and exclusion criteria across 241 hospitals in the Improving Care for Cardiovascular Disease in China-ACS project from November 2014 to July 2019 were collected. Different logistic regression models were utilized to examine the associations of FPG levels with IHCA. Sensitivity analyses were then conducted to assess the robustness of the findings. Marginal effect analyses were also employed to evaluate the impact of different therapies.

RESULTS: A total of 335 cases of IHCA and 293 in-hospital mortality were recorded throughout the study. A non-linear relationship between FPG levels and IHCA was identified after adjusting for the covariates. Specifically, a significant association was found between elevated FPG levels (≥6.1 mmol/L) and an increased risk of IHCA. These findings remained consistent across different subgroup analyses including both the diabetic and non-diabetic patients. Additionally, the marginal effect analyses revealed that percutaneous coronary intervention could lower the high FPG-related risk.

CONCLUSIONS: The study findings showed a positive correlation between FPG levels and a higher incidence of IHCA, irrespective of the presence of diabetes.

PMID:39499778 | DOI:10.1080/07853890.2024.2419546

J Infect Dev Ctries. 2024 Sep 30;18(9.1):S198-S205. doi: 10.3855/jidc.18846.

ABSTRACT

INTRODUCTION: The purpose of this research was to investigate the outcomes of coronavirus disease 2019 (COVID-19) infection in healthcare workers, assess the incidence of infection among them, and identify factors linked to the severity of the disease.

METHODOLOGY: This cross-sectional study was conducted retrospectively in Duhok city, Kurdistan Region of Iraq, from September 2021 to January 2023.

RESULTS: The study included 1,958 participants, of whom 1,338 (68.33%) contracted the infection. Among them, 830 (62.03%) and 372 (27.81%) patients experienced mild and moderate infections, respectively, while 136 (10.1%) had severe infections. The results indicated that several factors, including maintaining a healthy lifestyle, avoiding obesity, having a chronic condition, working consecutive hours, and being in an overwhelmed work environment were significantly associated with a higher severity of infection (p < 0.05). However, factors such as smoking habits, adherence to preventive health guidelines, direct exposure to COVID-19 patients, work days and patterns, family members with COVID-19, and hand/glove sterilization did not appear to have a significant effect on the severity of infection (p > 0.05).

CONCLUSIONS: These findings may offer valuable insights for clinicians and public health officials, and aid in the development of effective strategies to manage COVID-19 patients based on their risk factors for infection severity.

PMID:39499765 | DOI:10.3855/jidc.18846

J Infect Dev Ctries. 2024 Sep 30;18(9.1):S191-S197. doi: 10.3855/jidc.19029.

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has caused many injuries and deaths worldwide. Obesity is reported to be an important risk factor for severe COVID-19, although the underlying mechanism is not fully understood. The present study aimed to determine whether obesity or being overweight is associated with the clinical course and severity of COVID-19 in children.

METHODOLOGY: In this retrospective study, pediatric patients under the age of 18 years, who applied to our hospital between June 2021 and August 2021, and tested positive with the COVID-19 reverse transcriptase-polymerase chain reaction test were included. Age, gender, symptoms at admission, body weight, height, chest radiographs, hemograms, C-reactive protein and other laboratory findings, and days of hospitalization of the pediatric patients were obtained from the hospital automation system. All data were statistically analyzed and compared between underweight, normal, overweight, and obese groups; categorized according to body mass index (BMI).

RESULTS: The study included 116 patients. The results showed that the incidence of symptoms was higher in overweight and obese children compared to other groups (p < 0.05), while the rate of lung involvement was significantly higher in obese patients compared to other groups (p < 0.05). The optimum cut-off point for BMI percentile values in terms of lung involvement was determined to be > 91.

CONCLUSIONS: The results of this study revealed that obese children show more symptoms of COVID-19 disease than normal-weight children. In addition, these children have more frequent lung involvement and therefore have more severe disease.

PMID:39499764 | DOI:10.3855/jidc.19029

J Infect Dev Ctries. 2024 Sep 30;18(9.1):S176-S183. doi: 10.3855/jidc.19243.

ABSTRACT

INTRODUCTION: The use of telemedicine for treatment of coronavirus disease 2019 (COVID-19) infection has been effective in lowering the risk of infection and relieving strain on the healthcare system. This study aimed to describe the clinical characteristics of COVID-19 cases, their follow-up, risk factors of disease severity, and predictors of hospital admission while using telemedicine.

METHODOLOGY: The study included 611 Egyptian patients with mild and moderate COVID-19 disease. The patients were isolated at home and monitored daily.

RESULTS: Based on the World Health Organization classification, 79% of studied patients had mild illness while 20.5% had moderate illness. The initial symptoms included cough (51.7%), fever (50.8%), fatigue (45.9%), sore throat (41.1%), dyspnea (35.2%), and headache (34%); 25.2% patients had prolonged symptoms (≥ 21 days). Dyspnea was the most frequent (15.5%) long-term symptom. Age, co-existing diabetes, and COVID-19 infection with moderate severity, were associated with the need for hospitalization. We compared patients with COVID-19 infection who required hospital admission (n = 37) versus patients who continued in home isolation (n = 574). High neutrophil/lymphocyte ratio, transaminases, and ferritin significantly correlated with the need for hospitalization. 18.9% of the patients who required hospital admission had diabetes. Multivariate analysis described age and diabetes as independent predictors of disease severity. Age and high neutrophil/lymphocyte ratio were independent predictors of hospital admission.

CONCLUSIONS: Telemedicine is effective in-home management of mild/moderate COVID-19 patients, which may ease the pressure on the healthcare system, even beyond the pandemic.

PMID:39499762 | DOI:10.3855/jidc.19243