Category: Statistics

Transfusion. 2024 Nov 4. doi: 10.1111/trf.18049. Online ahead of print.

ABSTRACT

BACKGROUND: Previous reports suggest that blood donors have a lower mortality risk, which may partially reflect the “healthy donor effect” (HDE). HDE arises in donors due to selection bias and confounding if not appropriately addressed.

STUDY DESIGN AND METHODS: Using the Sax Institute’s 45 and Up Study data linked with blood donation history, we used a “5-year exposure window” method to select donors into regular high-frequency whole blood (WB)donors (at least two donations per exposure year) and low-frequency donors (remaining donors) with an active donation career of 5 years. To further reduce the confounding, we used statistical approaches like the inverse probability weighted (IPW) marginal structural model and the doubly robust targeted minimum loss-based estimator (TMLE), which incorporated machine learning algorithms and time-varying analyses.

RESULTS: We selected 4750 (64.7%) low-frequency and 2588 (35.3%) high-frequency donors in the analyses. A total of 69 (1.5%) from the low-frequency and 45 (1.7%) donors from the regular high-frequency group died during the 7-year follow-up period. We did not find any statistically significant association between regular high-frequency blood donation and mortality (IPW RR = 0.98 95% CI 0.68, 1.28). TMLE model also showed similar results to IPW (RR = 0.97 95% CI 0.80, 1.16). Time-varying TMLE did not find any significant association between high-frequency donation and all-cause mortality either (RR = 0.98 95% 0.74, 1.29).

CONCLUSIONS: We did not find a significant association between regular high-frequency WB donation and all-cause mortality when appropriate methods were employed to minimize the HDE.

PMID:39494482 | DOI:10.1111/trf.18049

HSS J. 2024 Nov;20(4):539-543. doi: 10.1177/15563316231207632. Epub 2023 Oct 28.

ABSTRACT

BACKGROUND: The use of telemedicine increased greatly following the onset of the COVID-19 pandemic. It is unclear whether and how sociodemographic factors have affected orthopedics patients’ use of this technology in the pandemic.

PURPOSE: The aim of this study was to determine how patient demographic variability in telemedicine use is influenced by the Area Deprivation Index (ADI) and distance to clinical site among patients seeking care for hip and knee arthritis from orthopedic surgeons.

METHODS: Demographic data and visit type were collected from the electronic medical record for patients seen in our academic medical center either before or during the COVID-19 pandemic by orthopedic surgeons who specialize in hip and knee arthroplasty. Univariate and multivariate analyses were performed regarding age, race, insurance status, ADI, and distance to a clinical site.

RESULTS: In the COVID era, among 4901 visits with 3124 unique patients, those using telemedicine were younger and more likely to be White compared to those who did not use telemedicine. There was no significant difference in telemedicine use based on ADI, distance to a clinical site, or insurance status.

CONCLUSIONS: This retrospective analysis suggests that orthopedic patients who were White and of younger age were more likely to use telemedicine in the first year of the COVID-19 pandemic. There was no statistically significant relationship between distance from a clinical site or ADI and telemedicine use, suggesting that factors other than these are greater contributors to telemedicine utilization in our cohort. Further information is needed to determine how telemedicine may disproportionately limit access to orthopedic care according to these and other patient factors.

PMID:39494430 | PMC:PMC11528590 | DOI:10.1177/15563316231207632

HSS J. 2024 Nov;20(4):490-497. doi: 10.1177/15563316231194614. Epub 2023 Sep 12.

ABSTRACT

BACKGROUND: Adductor canal block (ACB) is commonly included in multimodal analgesia regimens for knee surgery. Nonetheless, the incidence, etiology, and procedure-specific risk of saphenous nerve injury after knee surgery with ACB have not been established.

PURPOSE: We sought to identify the risk of saphenous nerve injury during knee surgery with ACB.

METHODS: We conducted a retrospective cohort study of patients at a single institution who underwent elective knee surgery with ultrasound-guided ACB between January 1, 2014, and December 31, 2018, and had subsequent saphenous nerve injury. The primary outcome was the incidence of saphenous nerve injury within 3 months of surgery, by surgical type and approach. Secondary outcomes included attribution of the most likely etiology and clinical outcome of the injury.

RESULTS: In 28,196 cases of knee surgery with ACB, we identified 18 cases (0.06%) of saphenous nerve injury. The most common surgery associated with saphenous nerve injury was anterior cruciate ligament (ACL) reconstruction with autograft (8/18 cases); 3 cases of injury were seen after TKA, 2 after medial patellofemoral ligament reconstruction, 2 after arthroscopy/meniscal surgery, and 1 after patellar fixation. The most likely etiology of nerve injury was attributed to ACB in 5 of 18 cases (28%) and to non-ACB cause in 13 of 18 (72%). Prognosis was rated as unknown in 11 of 18, poor in 2 of 18, favorable in 3 of 18, and full recovery in 2 of 18.

CONCLUSIONS: This 5-year retrospective, single-institution cohort study found a low overall incidence of saphenous nerve injury after knee surgery with ACB, but the injury likelihood varied based on surgery and approach. Although not statistically significant, ACL reconstruction with hamstring autograft and ACB performed for postoperative rescue analgesia were most frequently associated with nerve injury.

PMID:39494428 | PMC:PMC11528913 | DOI:10.1177/15563316231194614

HSS J. 2024 Nov;20(4):515-521. doi: 10.1177/15563316231183379. Epub 2023 Jul 6.

ABSTRACT

BACKGROUND: Performing lateral lumbar interbody fusion (LLIF) in a single prone position may pose many advantages over the traditional lateral decubitus position, but there are questions concerning its safety profile and outcomes.

PURPOSE: We sought to study the safety and efficacy of LLIF performed with the patient in the prone position.

METHODS: We conducted a retrospective cohort study including patients who underwent primary LLIF in the prone position for degenerative lumbar conditions. Complications and patient-reported outcome measures (PROMs) (Oswestry Disability Index [ODI], and visual analogue scale [VAS] scores for leg and back pain) were collected. Patients who underwent single-position prone LLIF were then propensity score matched for age, race, comorbidity index, number of levels, body mass index, and smoking status with patients who underwent single-position lateral LLIF. Patient-reported outcome measures and complications were compared between the 2 groups. Two postoperative timepoints were defined: early (<6 months) and late (≥6 months).

RESULTS: Twenty single-position prone LLIF patients were included (35% 1-level, 35% 2-level, 15% 3-level, and 15% 4-level). No intraoperative complications were reported. Eleven (55%) patients experienced transient postoperative anterior thigh weakness. Five (25%) patients experienced postoperative complications such as anemia, urinary retention, ileus, and new-onset sensory symptoms. Oswestry Disability Index, VAS leg, and VAS back scores all improved at the >6-month time point compared with preoperative states. There were no significant differences at any postoperative time point for PROMs between prone and lateral LLIF groups. Among the matched cohort, complications were observed in 3 (21%) of patients compared with only 1 (7%) in the lateral group although this difference was not statistically significant.

CONCLUSION: This retrospective study suggests that prone LLIF procedures may be safe and effective. Ergonomic and logistic benefits from the approach may make it a beneficial approach for surgeons to begin implementing.

PMID:39494427 | PMC:PMC11528793 | DOI:10.1177/15563316231183379

HSS J. 2024 Nov;20(4):498-501. doi: 10.1177/15563316231192952. Epub 2023 Aug 17.

ABSTRACT

INTRODUCTION: The acromiohumeral center-edge angle (ACEA) is a parameter that can be measured on plain shoulder radiographs and has been found to be associated with increased risk of sustaining a rotator cuff tear.

PURPOSE: The aim of this study was to investigate this association using plain radiographs and to explore its applicability on shoulder magnetic resonance imaging (MRI) in the same patients.

METHODS: This retrospective study compared 45 patients who underwent rotator cuff repair between September 2021 and April 2022 and 41 patients with normal shoulders. The ACEA was measured by 2 independent observers on anteroposterior radiographs and shoulder MRI. The collected data were analyzed and P values of <.05 were considered statistically significant.

RESULTS: The ACEA was found to be higher in patients with rotator cuff tears (23.48° ± 7.11°) when compared with the control group (15.54° ± 4.4°). On shoulder MRI assessment, a higher ACEA was also seen in the rotator cuff tear group (18.93° ± 6.7°) than in the control group (13.79° ± 4.9°). The ACEA measurement on MRI showed strong intrarater reliability (0.965), but weak interrater reliability (0.251).

CONCLUSION: This retrospective study found an association between increased ACEA and risk of rotator cuff tear when measured on plain radiographs. In addition, we found an association between increased ACEA measurement on shoulder MRI and rotator cuff tears, thus suggesting the applicability of ACEA measurement on shoulder MRI.

PMID:39494426 | PMC:PMC11528716 | DOI:10.1177/15563316231192952

JRSM Open. 2024 Oct 30;15(9):20542704241290721. doi: 10.1177/20542704241290721. eCollection 2024 Sep.

ABSTRACT

OBJECTIVES: To assess how ethnicity, migration status and occupation are associated with healthcare workers (HCW) redeployment experiences during COVID-19 in a nationwide ethnically diverse sample.

DESIGN: A cross-sectional analysis using data from the nationwide United Kingdom Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study.

SETTING: Healthcare settings.

PARTICIPANTS: Healthcare workers (HCW).

MAIN OUTCOME MEASURES: Outcome measures included redeployment, provision of training and supervision during redeployment, change in patient contact and interaction with COVID-19 patients.

METHODS: We used logistic regression to examine associations of ethnicity, migration status, and occupation with redeployment experiences of HCWs.

RESULTS: Of the 10,889 HCWs included, 20.4% reported being redeployed during the first UK national lockdown in March 2020. Those in nursing roles (Odds Ratio (OR) 1.22, 95% Confidence Interval (CI) 1.04-1.42, p = 0.009) (compared to medical roles) had higher likelihood of being redeployed as did migrants compared to those born in the UK (OR 1.26, 95% CI 1.06-1.49, p = 0.01) (in a subcohort of HCWs on the agenda for change (AfC) pay scales). Asian HCWs were less likely to report receiving training (OR 0.66, 95% CI 0.50-0.88, p = 0.005) and Black HCWs (OR 2.02, 95% CI 1.14-3.57, p = 0.02) were more likely to report receiving supervision, compared to White colleagues. Finally, redeployed Black (OR 1.33, 95% CI 1.07-1.66, p = 0.009) and Asian HCWs (OR 1.30, 95% CI 1.14-1.48, p < 0.001) were more likely to report face-to-face interaction with COVID-19 patients than White HCWs.

CONCLUSIONS: Our findings highlight disparities in HCWs’ redeployment experiences by ethnicity, migration, and job role which are potentially related to structural inequalities in healthcare.

PMID:39494380 | PMC:PMC11528580 | DOI:10.1177/20542704241290721

Clin Interv Aging. 2024 Oct 30;19:1765-1772. doi: 10.2147/CIA.S480480. eCollection 2024.

ABSTRACT

PURPOSE: Chronic diseases in older age are major sources of burden for healthcare systems. Compliance with medications is the key to treatment success for these patients, especially for frail individuals living in community settings. However, adherence to long-term medications in this population is not optimal, which leads to the need for frequent screening of compliance within large-scale public health surveys. In this context, a brief, simple and valid measure capturing medication adherence is not yet available. This study aims to develop and psychometrically test the Therapeutic Adherence Scale, a brief four-item tool that measures medication adherence in community-dwelling older adults affected by chronic diseases.

METHODS: We conducted a three-phase process of instrument development, content validity assessment and psychometric testing.

RESULTS: Of the candidate nine items derived from a review of the literature, only four were deemed essential to capture intentional and nonintentional nonadherence. These items underwent structural validity, convergent and known-groups validity, and internal consistency on a sample of 269 participants (mean age = 7.91 years, SD = 7.26). Confirmatory factor analysis confirmed satisfactory fit indices (RMSEA = 0.000, CFI = 1.00, TLI = 1.00). Scores of the TAS were higher for those perceiving loneliness (ρ = 0.33, p < 0.001), those declaring memory loss in the last year (ρ = 0.29, p < 0.001), and those exhibiting worse mental quality of life (ρ = -0.15, p = 0.03) compared with the other groups. Cronbach’s alpha and split-half reliability coefficients were acceptable, with values of 0.68 and 0.77, respectively.

CONCLUSION: The Therapeutic Adherence Scale is a brief, valid and reliable self-report measure of medication adherence that can be used in practice and research to screen patients living in community settings. This tool is also free to use, which contributes to advancing knowledge on the field of medication adherence of older adults affected by chronic diseases.

PMID:39494367 | PMC:PMC11531711 | DOI:10.2147/CIA.S480480

Acta Biochim Pol. 2024 Oct 18;71:13581. doi: 10.3389/abp.2024.13581. eCollection 2024.

ABSTRACT

CONTEXT: Oxidative stress is an important factor for vitreomacular interface disease development in a theoretical model.

PURPOSE: The aim of the study was to evaluate the correlation between oxidative stress in the human epiretinal membrane (ERM) and retinal morphological changes.

MATERIAL AND METHODS: The study included patients scheduled for vitrectomy with epiretinal membrane removal. LogMAR best corrected visual acuity was assessed and optical coherence tomography was performed. Patients were divided into three groups: Type 1 – epiretinal membrane with premacular fibrosis; type 2 – epiretinal membrane with co-existing layer hole; and type 3 – ERM with co-existing full-thickness macular hole. During vitrectomy, epiretinal membranes were collected. Total oxidant status was determined by an automated colorimetric method in homogenates of epiretinal membrane.

STATISTICAL ANALYSIS: The Mann-Whitney U test, Kruskal-Wallis test and Spearman linear correlation analysis were used. Statistical significance was set with a level of α = 0.05.

RESULTS: Twenty-one Caucasian women (60%) and 14 men (40%) were included in the study. The average age of participants was 74.7 years (95% CI: 71.13-75.45). The mean best corrected visual acuity LogMAR value in the group was 0.8 (95% CI: 0.9-0.7). The mean ratio of total oxidant status to protein level in the collected samples was 0.161 (95% CI: 0.08-0.23) µmol/mg of protein. No correlation was found between total oxidant status and the degree of morphological retinal changes.

CONCLUSION: The study found no significant correlation between the level of oxidative stress in epiretinal membrane and retinal morphological changes.

PMID:39494364 | PMC:PMC11528693 | DOI:10.3389/abp.2024.13581

Brain Commun. 2024 Oct 12;6(6):fcae355. doi: 10.1093/braincomms/fcae355. eCollection 2024.

ABSTRACT

Despite grey matter atrophy in cortical and subcortical regions has been related to cognitive impairment in multiple sclerosis, only a few studies evaluated its predictive value for alterations in the long-term. We aimed to determine early predictors of cognitive status after 20 years of multiple sclerosis. In this longitudinal retrospective study, participants underwent a 1.5 T MRI scanning at diagnosis (T0) and after two years (T2), which included the evaluation of regional grey matter volume loss patterns. All individuals with multiple sclerosis underwent a comprehensive neuropsychological assessment at the end of the study and were classified considering their global and specific cognitive domains status (memory, attention/information processing speed, executive functioning). Clinical and MRI characteristics were assessed as predictors of long-term cognitive impairment. Analysis of covariance, t-test, unadjusted and adjusted (for age, sex, disease duration, volume of white matter lesions, volume of cortical lesions) logistic regression were conducted. One hundred seventy-five people with multiple sclerosis (118 females; mean ± SD age at the end of study = 47.7 ± 9.4 years) clinically followed for 20 years from onset (mean ± SD = 19.9 ± 5.1) were evaluated. At the end of the study, 81 (47%) were classified as cognitively impaired: 38 as mildly impaired (22%), and 43 as severely impaired (25%). In particular, 46 were impaired in memory (27%), 66 were impaired in attention/information processing speed (38%), and 71 were impaired in executive functioning (41%). Regression models identified precuneus (adjusted odds ratio = 3.37; P < 0.001), insula (adjusted odds ratio = 2.33; P = 0.036), parahippocampal gyrus (adjusted odds ratio = 2.07; P < 0.001) and cingulate (adjusted odds ratio = 1.81; P = 0.009) as the most associated regions with global cognitive impairment and domains-specific cognitive alterations after a mean of 20 years of multiple sclerosis, after adjusting for demographic and clinical variables as well as for focal white matter and grey matter damage. Early grey matter volume loss of specific cortical and deep grey matter regions predicts global and domain cognitive alterations after 20 years from multiple sclerosis diagnosis.

PMID:39494361 | PMC:PMC11528517 | DOI:10.1093/braincomms/fcae355

Int J Gen Med. 2024 Oct 29;17:4985-4990. doi: 10.2147/IJGM.S487553. eCollection 2024.

ABSTRACT

PURPOSE: To explore the relationship between hyperlipidemia and full-frequency idiopathic sudden sensorineural hearing loss (FFHL).

PATIENTS AND METHODS: A total of 145 FFHL patients admitted from September 2021 to May 2024 were analyzed. Eighty-five patients with hyperlipidemia and 60 patients with normal serum lipids statistically analyze the patient’s gender, age, onset time, accompanying symptoms, and serum lipids. Measure the pure tone hearing threshold before and after treatment, and calculate the average increase in hearing threshold. Compare the correlation between various factors and prognosis.

RESULTS: The hyperlipidemia group had a higher proportion of males (P=0.043) and vertigo (P=0.044) compared to the control group, while other information between the two groups lacked statistical significance. Effective patients (n=44) in the hyperlipidemia group showed significant differences in vertigo (P=0.020), age (P=0.032), and onset (P=0.030) compared to ineffective patients (n=41). Analysis showed that these were independent correlated factors affecting prognosis. Other indicators, including serum lipids, have no significance in predicting the prognosis of patients with hyperlipidemia and complete frequency decline in hearing loss.

CONCLUSION: Patients with hyperlipidemia have higher rates of males and vertigo. The age, onset, and vertigo of patients with hyperlipidemia are related to prognosis, while various lipid indicators are not related to the prognosis of sudden hearing loss.

PMID:39494360 | PMC:PMC11531281 | DOI:10.2147/IJGM.S487553