Category: Statistics

Clin J Sport Med. 2024 Nov 1;34(6):559-566. doi: 10.1097/JSM.0000000000001258. Epub 2024 Oct 15.

ABSTRACT

OBJECTIVE: To investigate the prevalence of asymptomatic radiologic groin region findings in adult professional soccer players using magnetic resonance imaging (MRI) and examine the influence of age and limb dominance on their occurrences.

DESIGN: Cross-sectional trial.

SETTING: Soccer club medical service, private practice.

PARTICIPANTS: Forty-seven male professional soccer players.

INTERVENTIONS: Players underwent a groin presigning MRI scan with a magnetic field induction of 1.5 Tesla. Image analysis of their pubic bones was performed according to The Copenhagen Standardized MRI protocol to assess the pubic symphysis and adductor regions of players.

MAIN OUTCOME MEASURES: The prevalence of various changes in the symphysis, pubic bone, and adjacent areas.

RESULTS: Fifty images of pubic bones and adjacent regions (53.2%) highlighted 1 to 4 changes, while another 44 images (46.8%) demonstrated 5 or more changes. The most frequent changes observed in the pubic bone were joint surface irregularities (100%), symphyseal sclerosis (93.6%), pubic bone swelling (56.3%), parasymphyseal high-intensity line (55.3%), fatty infiltration in bone marrow (38.3%), and adductor tendinopathy (34%). When comparing the prevalence of different changes in the dominant and nondominant limbs, no statistically significant differences were found.

CONCLUSIONS: In adult professional soccer players with no prior groin pain complaints in recent history (12 months), asymptomatic changes are extremely common in the pubic joint and adjacent areas, including those that are very likely to be considered the main cause of pain when investigated in soccer players with groin pain. None of these changes were associated with limb dominance.

PMID:39476373 | DOI:10.1097/JSM.0000000000001258

Clin J Sport Med. 2024 Nov 1;34(6):543-551. doi: 10.1097/JSM.0000000000001274. Epub 2024 Oct 1.

ABSTRACT

OBJECTIVE: The aim of this study was to assess whether a history of prior concussions, and especially multiple prior concussions, is associated with clinical recovery following a subsequent sport-related concussion among collegiate student athletes.

DESIGN: A naturalistic observational cohort study.

SETTING: Eleven National Collegiate Athletics Association Division III colleges.

PARTICIPANTS: Collegiate athletes sustaining concussions from September 2014 through March 2020.

INDEPENDENT VARIABLES: Participants were divided into 3 groups, athletes with: (1) no prior concussion history, (2) one prior concussion, and (3) 2 or more prior concussions.

MAIN OUTCOME MEASURES: Survival analyses were used to compare time to return to school and sports among athletes with a history of 0, 1, or ≥2 prior concussions.

RESULTS: Among the 1132 college athletes, there were no statistically significant group differences between those with 0, 1, or ≥2 prior concussions in total time to return to school or sports. There was a statistically significant difference in the proportion of athletes with ≥2 prior concussions that had not fully returned to school, without accommodations, at 28 days (6.0%) compared to athletes with no prior concussions (2.2%; odds ratio = 2.80, 95% confidence interval 1.29-6.04).

CONCLUSIONS: In summary, concussion history was not associated with time to return to sports following a subsequent sport-related concussion in these college athletes. On average, athletes with prior concussions did not take longer to return to school, although a slightly greater proportion of college athletes with ≥2 prior concussions had not fully returned to school, without accommodations, by 28 days following injury.

PMID:39476372 | DOI:10.1097/JSM.0000000000001274

J Med Internet Res. 2024 Oct 30;26:e46983. doi: 10.2196/46983.

ABSTRACT

BACKGROUND: Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete.

OBJECTIVE: This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization.

METHODS: We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission.

RESULTS: In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (P_adj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; P_adj=.06), but not with the number of admissions (Spearman ρ=-0.03; P_adj=.84).

CONCLUSIONS: Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

PMID:39476370 | DOI:10.2196/46983

Int Forum Allergy Rhinol. 2024 Oct 30. doi: 10.1002/alr.23477. Online ahead of print.

ABSTRACT

BACKGROUND: Emerging evidence has underscored the harmful effects of air pollution on the upper airway. We investigated the relationship between ambient particulate matter (PM) level and the frequency of outpatient visits for chronic rhinosinusitis (CRS).

METHODS: We conducted an ecological cohort study of US adults enrolled in The Merative MarketScan outpatient database from 2007 to 2020. For each geographical subunit (core-based statistical area [CBSA]), we calculated the annual rate of CRS-related outpatient visits per 1000 well-patient checkup visits (CRS-OV). Using data from the Environmental Protection Agency’s Air Quality System, we mapped the rolling statistical average of daily PM_2.5 and PM₁₀ over the preceding year onto each CBSA × year combination. We employed multivariable negative binomial regression modeling to estimate the association between PM levels and subsequent CRS-OV.

RESULTS: Across 3933 observations (CBSA × year combinations), encompassing ∼4 billion visits, the median CRS-OV was 164 (interquartile range 110-267). The mean PM_2.5 level was 8.9 µg/m³ (SD 2.6) and the mean PM₁₀ level was 20.2 µg/m³ (SD 7.2). Adjusting for patient demographics and respiratory comorbidities, a compounded rise in subsequent CRS-OV was observed with increasing PM levels. Each µg/m³ rise in PM_2.5 independently predicted a 10% increase in CRS-OV (adjusted incidence rate ratio [aIRR]) 1.10, 95% confidence interval [CI] 1.08-1.13) and each µg/m³ rise in PM₁₀ independently predicted a 3% increase in CRS-OV (aIRR 1.03, 95% CI 1.02-1.04).

CONCLUSION: Elevated ambient PM_2.5 and PM₁₀ levels are associated with a subsequent compounded increase in the frequency of CRS-OV, with PM_2.5 predicting a more pronounced rise compared to PM₁₀.

PMID:39476332 | DOI:10.1002/alr.23477

Nurs Open. 2024 Nov;11(11):e70072. doi: 10.1002/nop2.70072.

ABSTRACT

AIMS: This study aimed to assess nursing workload in Cardiac Intensive Care Unit (CICU) after three cardiothoracic surgery procedures during first four postoperative days using Nursing Activities Score (NAS) and Nine Equivalents of Nursing Manpower Use Score (NEMS) systems, to compare their performance for that purpose and to investigate association between nursing workload and type of surgery.

DESIGN: A comparative study.

METHODS: The research environment includes CICU of the University Hospital for Cardiovascular Diseases in Serbia. A total of 808 patients who underwent coronary, valvular, or combined surgery, resulting in 2282 filled NAS and NEMS pairs chart. Statistical analysis was performed using SPSS-19. The correlation between NAS and NEMS was tested by Spearman’s correlation coefficient. Differences were considered statistically significant at p < 0.05.

RESULTS: The lowest median of cumulative NAS 176 (175-257) and NEMS 76 (64-91) had coronary surgery patients, the highest NAS 224.5 (178-334.5) and NEMS 83 (69-121) had those with combined surgery; this difference was statistically significant (p < 0.001). The median of both scores decreased after surgery, with the following values from the first to the fourth postoperative day: NAS from 104 (102-105) to 81 (74-85) and NEMS from 46 (42-46) to 30 (30-37). The difference in mean values of both scores between the first and the fourth postoperative day was statistically significant (p < 0.001). NAS and NEMS were in a positive, strong correlation (r = 0.913; p < 0.005).

CONCLUSION: Both scores can be used to measure nursing workload, identify the required number of nurses in CICU, and support task allocation. NAS may have an advantage because it better describes extensive postoperative monitoring and care needed for cardiac surgery patients. Nursing workload is associated with type of surgery, with the highest workload measured in patients who underwent combined surgery procedure and on the first postoperative day.

PMID:39476321 | DOI:10.1002/nop2.70072

Exp Physiol. 2024 Oct 30. doi: 10.1113/EP092041. Online ahead of print.

ABSTRACT

CD34⁺ progenitor cells with angiogenic capabilities traffic into blood during exercise and extravasate afterwards but the magnitude of this response varies between people. We examined whether exercise-induced progenitor cell trafficking is influenced by cardiorespiratory fitness (maximum oxygen uptake; ${\dot{V}}_{O_2\max }$ ). Ten males (age: 23 ± 3 years; ${\dot{V}}_{O_2\max }$ : 61.88 ± 4.68 mL kg min^-1) undertook 1 h of treadmill running at 80% of ${\dot{V}}_{O_2\max }$ . Blood samples were collected before exercise (Pre), in the final minute of exercise (0 h) and afterwards at 0.25, 1 and 24 h. Pan-progenitor cells (CD34⁺, CD34⁺CD45^dim) and putative endothelial progenitor cells (CD34⁺CD133⁺, CD34⁺VEGFR2⁺, CD34⁺CD45^dimVEGFR2⁺) were quantified using flow cytometry. Progenitor subpopulations (except for CD34⁺CD45^dimVEGFR2⁺) increased at 0 h (P < 0.05) and returned to pre-exercise levels by 1 h. ${\dot{V}}_{O_2\max }$ was positively associated with the exercise-induced progenitor cell response and there were statistically significant time × ${\dot{V}}_{O_2\max }$ interactions for CD34⁺, CD34⁺CD45^dim and CD34+CD133⁺ subpopulations but not VEGFR2-expressing progenitor cells. There were statistically significant correlations between ${\dot{V}}_{O_2\max }$ and ingress (r > 0.70, P < 0.025) and egress (r > -0.77, P < 0.009) of progenitor cell subsets (CD34⁺, CD34⁺CD45^dim, CD34⁺CD133⁺), showing that cardiorespiratory fitness influences the magnitude of progenitor cell mobilisation into the blood and subsequent extravasation. These data may provide a link between high levels of cardiorespiratory fitness and vascular health.

PMID:39476319 | DOI:10.1113/EP092041

Breast Cancer Res Treat. 2024 Oct 30. doi: 10.1007/s10549-024-07538-w. Online ahead of print.

ABSTRACT

PURPOSE: The association between obesity and triple-negative breast cancer (TNBC) prognosis has been equivocal, with considerable heterogeneity between and within studies. Recent meta-analyses report adverse associations with overall survival (OS) and disease-free survival (DFS) in TNBC. We update this evidence and examine study- and disease-specific sources of heterogeneity.

METHODS: A systematic search of four databases was conducted until February 22, 2023. Random-effects meta-analyses were used to pool hazard ratios (HR) for OS, DFS, and breast cancer-specific mortality (BCSM). Subgroup analyses examined sources of study heterogeneity.

RESULTS: In meta-analyses of included studies (n = 33), significant associations were observed between excess body weight and worse OS (n = 24; HR = 1.20; 95%CI 1.20-1.34), DFS (n = 26; HR = 1.15; 1.05-1.27), and BCSM (n = 9; HR = 1.13; 1.00-1.27). In subgroup meta-analyses, significant inter-study survival differences were observed for study location (OS, DFS), time period of diagnoses (DFS), menopausal status (OS), and body mass index cut points examined (OS). Asian and European studies reported significant associations with OS (HR = 1.31; 1.11-1.54 and HR = 1.38; 1.00-1.89, respectively) and DFS (HR = 1.28; 1.07-1.54 and HR = 1.44; 1.13-1.84, respectively); however, no association was observed between obesity and TNBC prognosis in North American studies (OS: HR = 1.03; 0.89-1.19; DFS: HR = 1.05; 0.95-1.15). Location subgroup differences remained robust after excluding poor-quality studies. Post hoc analysis in the subset of studies reporting predominantly (≥ 70%) White sample showed no statistically significant associations for OS (HR = 1.13; 95%CI 0.96, 1.34), DFS (HR = 1.03; 95%CI 0.86, 1.23), or BCSM (HR = 1.08; 95%CI 0.91, 1.27).

CONCLUSION: This study further confirms that obesity is associated with poor prognosis in TNBC and identified subgroups at higher risk. Ethnic differences in the association between excess body weight and TNBC are reported. Further exploration of study and patient characteristics is needed to properly understand the populations most at risk.

PMID:39476311 | DOI:10.1007/s10549-024-07538-w

Radiol Med. 2024 Oct 30. doi: 10.1007/s11547-024-01903-x. Online ahead of print.

ABSTRACT

PURPOSE: To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM).

METHODS: We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist.

RESULTS: Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001).

CONCLUSIONS: PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.

PMID:39476275 | DOI:10.1007/s11547-024-01903-x

Naunyn Schmiedebergs Arch Pharmacol. 2024 Oct 30. doi: 10.1007/s00210-024-03549-y. Online ahead of print.

ABSTRACT

Bupropion (Bpn), an FDA-approved NDRI (norepinephrine-dopamine reuptake inhibitor), poses risks of seizures and liver failure due to its stimulant properties, necessitating the development of alternative formulations. This research aims to develop a Bpn nanoformulation within bilosomal vesicles to enhance therapeutic efficacy at lower doses, using three bile salts, span 20 surfactants, and cholesterol via thin-film hydration. Optimization of bilosomal stability is achieved by trialing various ingredient concentrations, identifying a surfactant-to-cholesterol-to-bile salt ratio of 1.5:1:0.17 µM, with sodium cholate (B.SC_F) yielding the most stable system. Bpn encapsulated in the optimized bilosomal vesicle ([email protected] _F) demonstrated high encapsulation efficiency of 78.142 ± 11.07% and drug-retaining capacity compared to the niosomal system. The in vitro and in vivo toxicity profile of the product is superior to the niosomal system and shows negligible toxicity with a viability rate of not less than 95%, with a sustained release profile in artificial cerebrospinal fluid (ACSF). In vivo, behavioral analysis on zebrafish revealed that [email protected] _F treatment more effectively improved depressive behavior compared to free Bpn and other treatments, evidenced by increased exploration rates and reduced irregular movements, as shown through statistical and trajectory data. Hence, it is concluded that the bilosomal structure, compared to the niosomal system, is a better carrier of drugs to achieve brain delivery and improve mood.

PMID:39476247 | DOI:10.1007/s00210-024-03549-y

JAMA Netw Open. 2024 Oct 1;7(10):e2440269. doi: 10.1001/jamanetworkopen.2024.40269.

ABSTRACT

IMPORTANCE: Missed test results, defined as test results not followed up within an appropriate time frame, are common and lead to delays in diagnosis and treatment.

OBJECTIVE: To evaluate the effect of a quality improvement collaborative, the Virtual Breakthrough Series (VBTS), on the follow-up rate of 2 types of test results prone to being missed: chest imaging suspicious for lung cancer and laboratory findings suggestive of colorectal cancer.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster-randomized clinical trial was conducted between February 2020 and March 2022 at 12 Department of Veterans Affairs (VA) medical centers, with a predefined 3-cohort roll-out. Each cohort was exposed to 3 phases: preintervention, action, and continuous improvement. Follow-up ranged from 0 to 12 months, depending on cohort. Teams at each site were led by a project leader and included diverse interdisciplinary representation, with a mix of clinical and technical experts, senior leaders, nursing champions, and other interdisciplinary team members. Analysis was conducted per protocol, and data were analyzed from April 2022 to March 2024.

INTERVENTION: All teams participated in a VBTS, which included instruction on reducing rates of missed test results at their site.

MAIN OUTCOMES AND MEASURES: The primary outcome was changes in the percentage of abnormal test result follow-up, comparing the preintervention phase with the action phase. Secondary outcomes were effects across cohorts and the intervention’s effect on sites with the highest and lowest preintervention follow-up rates. Previously validated electronic algorithms measured abnormal imaging and laboratory test result follow-up rates.

RESULTS: A total of 11 teams completed the VBTS and implemented 47 (mean, 4 per team; range, 3-8 per team; mode, 3 per team) unique interventions to improve missed test results. A total of 40 027 colorectal cancer-related tests were performed, with 5130 abnormal results, of which 1286 results were flagged by the electronic trigger (e-trigger) algorithm as being missed. For lung cancer-related studies, 376 765 tests were performed, with 7314 abnormal results and 2436 flagged by the e-trigger as being missed. There was no significant difference in the percentage of abnormal test results followed up by study phase, consistent across all 3 cohorts. The estimated mean difference between the preintervention and action phases was -0.78 (95% CI, -6.88 to 5.31) percentage points for the colorectal e-trigger and 0.36 (95% CI, -5.19 to 5.9) percentage points for the lung e-trigger. However, there was a significant effect of the intervention by site, with the site with the lowest follow-up rate at baseline increasing its follow-up rate from 27.8% in the preintervention phase to 55.6% in the action phase.

CONCLUSIONS AND RELEVANCE: In this cluster-randomized clinical trial of the VBTS intervention, there was no improvement in the percentage of test results receiving follow-up. However, the VBTS may offer benefits for sites with low baseline performance.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04166240.

PMID:39476237 | DOI:10.1001/jamanetworkopen.2024.40269