Category: Statistics

Acta Chir Orthop Traumatol Cech. 2024;91(5):276-281. doi: 10.55095/ACHOT2024/052.

ABSTRACT

INTRODUCTION: During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy.

MATERIAL AND METHODS: The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced.

RESULTS: The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80-84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85-89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average – in the 80-84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85-89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery.

CONCLUSIONS: Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure.

KEY WORDS: total hip arthroplasty, total knee arthroplasty, osteoarthritis, hip fracture, life expectancy.

PMID:39496193 | DOI:10.55095/ACHOT2024/052

Ann Intern Med. 2024 Nov 5. doi: 10.7326/ANNALS-24-00829. Online ahead of print.

ABSTRACT

BACKGROUND: Late career physicians (LCPs; physicians working beyond age 65 to 75 years) may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations (HCOs) have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. Despite recent controversies, little is known about the content and implementation of such policies.

OBJECTIVE: To characterize key features of LCP policies and the perspectives of medical leaders responsible for policy development and implementation.

DESIGN: Mixed-methods study using content analysis and key informant interviews.

SETTING: 29 U.S. HCOs with LCP policies active in 2020.

PARTICIPANTS: 21 purposively sampled interviewees in physician leadership roles at 18 HCOs.

MEASUREMENTS: Descriptive statistics of policy features and content analysis of interviews.

RESULTS: Although policies had many commonalities-mandatory universal screening at a trigger age around 70 years, a strategy of screening followed by in-depth assessment of positive results, and commitment to patient safety as the key motive-they varied substantially in the testing required, funding, processes after a positive screening result, and decision making around concerning results. Policies prioritized institutional discretion in interpreting and responding to test results; many lacked clear language about appeals or other procedural protections for physicians. Leaders were generally satisfied with policies but reported preemptive retirements as physicians approached the screening age and cautioned that substantial investment in cultivating physicians’ buy-in was required for successful rollout.

LIMITATIONS: Sampled policies and interviews may not be representative of all HCOs. The analysis excluded the experiences of HCOs that tried and failed to implement LCP screening.

CONCLUSION: Policies about LCPs are considered successful by institutional leaders. Policy variations and early adopters’ implementation experiences highlight opportunities to improve physician acceptance and program rigor.

PRIMARY FUNDING SOURCE: The Greenwall Foundation.

PMID:39496180 | DOI:10.7326/ANNALS-24-00829

Ann Intern Med. 2024 Nov 5. doi: 10.7326/M23-3179. Online ahead of print.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) is common in women of reproductive age and is associated with obesity. Clinical guidelines recommend weight loss, but the impact on the clinical manifestations of PCOS is unclear.

PURPOSE: To quantify the effect of weight loss interventions on clinical features of PCOS, compared with usual care.

DATA SOURCES: MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, and trial registries were searched from inception through June 2024.

STUDY SELECTION: Randomized controlled trials comparing interventions aiming to reduce weight against usual care, including lower-intensity weight loss interventions in people with PCOS. Conversations with people with PCOS informed the outcomes.

DATA EXTRACTION: Pairs of independent reviewers screened studies, extracted data, and assessed risk of bias (RoB). Outcomes included glycemic control (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR], fasting insulin and glucose), hormonal markers (free androgen index [FAI] and other sex hormones), menstrual frequency, hirsutism, and PCOS-related quality of life (QoL). Pooled mean differences were obtained from random-effects meta-analysis with Knapp-Hartung adjustment.

DATA SYNTHESIS: Primary analyses included 29 comparisons with 1529 participants: 13, 12, and 4 comparisons were judged as high, some, or low RoB, respectively. Twelve used behavioral interventions, 9 used glucagon-like peptide-1 (GLP1) agonists, and 8 used other weight loss medications. Weight loss interventions were associated with significantly greater improvements in HOMA-IR (mean difference, -0.45 [-0.75 to -0.15]; I ² = 24%), FAI (mean difference, -2.03 [-3.0 to -1.07]; I ² = 48%), and menstrual frequency (mean difference, 2.64 [0.65 to 4.63]; I² = 43%). There was no evidence that weight loss interventions were associated with clinically or statistically significant improvements in hirsutism, QoL, or other sex hormones, which may be due to the limited power of the available data.

LIMITATION: There was high statistical heterogeneity in the interventions, comparators, and outcomes, largely unexplained by sensitivity and subgroup analyses.

CONCLUSION: Weight loss interventions were associated with improvements in some important features of PCOS and should be considered as a routine treatment option for people with PCOS.

PRIMARY FUNDING SOURCE: National Institute for Health and Care Research School for Primary Care Research. (PROSPERO: CRD42022367488).

PMID:39496172 | DOI:10.7326/M23-3179

J Med Internet Res. 2024 Nov 4;26:e56386. doi: 10.2196/56386.

ABSTRACT

BACKGROUND: eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one’s understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL.

OBJECTIVE: This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables.

METHODS: In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables.

RESULTS: The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t₆₃₆=4.94; P<.001) and PL (t₆₃₆=3.18; P<.001), but no significant differences were found in eHealth literacy (t₆₃₆=1.23; P=.22).

CONCLUSIONS: The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities.

PMID:39496161 | DOI:10.2196/56386

JMIR Mhealth Uhealth. 2024 Nov 4;12:e56475. doi: 10.2196/56475.

ABSTRACT

BACKGROUND: As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted.

OBJECTIVE: This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC.

METHODS: Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects.

RESULTS: A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02).

CONCLUSIONS: This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy.

PMID:39496160 | DOI:10.2196/56475

JMIR Public Health Surveill. 2024 Nov 4;10:e58711. doi: 10.2196/58711.

ABSTRACT

BACKGROUND: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients’ issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear.

OBJECTIVE: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints.

METHODS: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites).

RESULTS: Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=-0.25, 95% CI -0.49 to -0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=-0.39, 95% CI -0.54 to -0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden.

CONCLUSIONS: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163.

PMID:39496153 | DOI:10.2196/58711

J Med Internet Res. 2024 Nov 4;26:e60291. doi: 10.2196/60291.

ABSTRACT

BACKGROUND: Recent surveys indicate that 48% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice.

OBJECTIVE: We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions.

METHODS: We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability, source reliability, and source relevancy. We determined the correct, complete response to the 10 questions from reputable and scholarly emergency medical references. These were compiled by an EM resident physician. For the readability of the chatbot responses, we used the Flesch-Kincaid Grade Level of each response from readability statistics embedded in Microsoft Word. Differences between chatbots were determined by the chi-square test.

RESULTS: Each of the 4 chatbots’ responses to the 10 clinical questions were scored across 8 domains by 5 EM faculty, for 400 assessments for each chatbot. Together, the 4 chatbots had the best performance in clarity and understandability (both 85%), intermediate performance in accuracy and completeness (both 50%), and poor performance (10%) for source relevance and reliability (mostly unreported). Chatbots contained dangerous information in 5% to 35% of responses, with no statistical difference between chatbots on this metric (P=.24). ChatGPT, Google Bard, and Claud AI had similar performances across 6 out of 8 domains. Only Bing AI performed better with more identified or relevant sources (40%; the others had 0%-10%). Flesch-Kincaid Reading level was 7.7-8.9 grade for all chatbots, except ChatGPT at 10.8, which were all too advanced for average emergency patients. Responses included both dangerous (eg, starting cardiopulmonary resuscitation with no pulse check) and generally inappropriate advice (eg, loosening the collar to improve breathing without evidence of airway compromise).

CONCLUSIONS: AI chatbots, though ubiquitous, have significant deficiencies in EM patient advice, despite relatively consistent performance. Information for when to seek urgent or emergent care is frequently incomplete and inaccurate, and patients may be unaware of misinformation. Sources are not generally provided. Patients who use AI to guide health care decisions assume potential risks. AI chatbots for health should be subject to further research, refinement, and regulation. We strongly recommend proper medical consultation to prevent potential adverse outcomes.

PMID:39496149 | DOI:10.2196/60291

J Drugs Dermatol. 2024 Nov 1;23(11):965-971. doi: 10.36849/JDD.8159.

ABSTRACT

BACKGROUND: Iron oxides, antioxidants, and pigmentary titanium dioxide are sunscreen additive ingredients that enhance visible light protection, reduce associated hyperpigmentation, and protect against certain photosensitive dermatoses There are currently no standardized recommendations for visible light protection with these additive ingredients, leading to varied clinical recommendations.

OBJECTIVES: This study aimed to evaluate dermatology practitioners’ counseling practices for visible light protection.

METHODS: An electronic survey was distributed to dermatology practitioners. Survey responses were compiled for analysis, and statistical significance was calculated using a standard 95% confidence interval.

RESULTS: 91.68% of 974 respondents actively counsel patients about visible light protection, primarily emphasizing its role in exacerbating pigmentation in patients with melanin-rich skin (70.92%). Of these, 10.34% recommended sunscreens with visible light protective additive ingredients specifically for patients with melanin-rich skin, and 48.89% recommended them for managing melasma or post-inflammatory hyperpigmentation. Iron oxide additive ingredients were most frequently recommended (90.92%), followed by antioxidants (69.08%) and pigmentary TiO2, (58.85%). 8.32% of respondents reported not counseling patients about visible light protection, with major reasons encompassing the lack of standardized guidelines (50.62%), challenges in recommending suitably tinted sunscreens (27.16%), limited availability of sunscreen options (23.46%), and insufficient supportive data (18.52%).

CONCLUSION: There is a need for increased education and awareness regarding visible light protection strategies and the identification of patients who may benefit the most from a targeted photoprotective strategy. Establishing standardized guidelines and broadening the availability of sunscreen options conferring visible light protection may help address these gaps. J Drugs Dermatol. 2024;23(11):965-971. doi:10.36849/JDD.8159.

PMID:39496128 | DOI:10.36849/JDD.8159

J Drugs Dermatol. 2024 Nov 1;23(11):986-991. doi: 10.36849/JDD.7985.

ABSTRACT

BACKGROUND: Tyrosinase is the rate-limiting enzyme of melanogenesis and thus an ideal inhibitory target for treating hyperpigmentation. There are many commercially available tyrosinase inhibitors with limited clinical efficacy. A recent screen of 50,000 compounds found isobutylamido thiazolyl resorcinol (ITR) to be the most potent inhibitor of human tyrosinase.

OBJECTIVE: To summarize the current evidence on the efficacy and adverse effects of ITR in treating hyperpigmentation.

METHODS: A literature search was conducted using PubMed and Google Scholar databases in June 2022. Fourteen clinical studies investigating the use of topical ITR in hyperpigmentation treatment or prevention were identified.

RESULTS: Most studies (n=13) investigated topical ITR as a treatment, while only one investigated ITR as a preventative measure against hyperpigmentation. All studies (n=14) found ITR to provide statistically significant improvements to hyperpigmentation conditions, including facial hyperpigmentation (n=3), melasma (n=5), post-inflammatory hyperpigmentation (PIH) (n=3), and UV-induced hyperpigmentation (n=3). Evidence suggests that the effective dosage and duration of topical ITR appears to be 0.1% to 0.2% ITR 2 to 4 times daily for 12 to 24 weeks. Successful prevention of UVB-induced hyperpigmentation has been seen following twice-daily topical ITR application for 3 weeks (P&lt;0.001).

CONCLUSION: Topical ITR can significantly reduce hyperpigmentation, however, the evidence for its use is limited. Further investigation is warranted to identify the optimal dosage and application schedule of ITR, as well as compare the efficacy of ITR vs hydroquinone to determine if ITR is superior to the current standard of care. J Drugs Dermatol. 2024;23(11):986-991.&nbsp; doi:10.36849/JDD.7985.

PMID:39496126 | DOI:10.36849/JDD.7985

J Drugs Dermatol. 2024 Nov 1;23(11):972-978. doi: 10.36849/JDD.8239.

ABSTRACT

BACKGROUND: Artificial intelligence chatbots (AIC) have sharply risen in popularity. Dermatology, heavily involving visual, clinical, and pathological pattern-recognition techniques, will be impacted by AIC. Thus, this study aims to categorize the attitudes and beliefs of American dermatologists towards AIC and their potential uses, benefits, and risks.

METHODS: An online cross-sectional survey was distributed to dermatologists across the United States. Questions explored opinions on AIC along with perceived benefits, risks, and important considerations for the incorporation of AIC into the practice of dermatology. Demographic data and self-reported understanding of AIC were also collected.

RESULTS: 192 complete responses were received. 53.6% of respondents were female. 44.3% were between ages 30 to 39. 41.1% had 0 to 10 years of experience as attending physicians. 76.5% of participants believed it is somewhat or very likely that AIC will be formally incorporated into dermatology. Higher self-reported understanding of AIC was associated with an increased perceived likelihood of AIC implementation as well as decreased perceived risk associated with AIC. Notably, 86% of respondents believed AIC would impact “patient education,” while concerns regarding “misinformation” and “incorrect diagnoses” were prevalent (89% and 78.5%, respectively). Participants anticipated AIC’s role primarily in administrative tasks, with 75.7% citing “reduced work burden on physicians” as a potential benefit.

CONCLUSION: Dermatologists in the United States foresee the integration of AIC into their practice, emphasizing its potential in administrative roles. Concerns revolve around the complexity of medical understanding and effective patient communication. As AIC continues to evolve, ongoing studies are crucial to evaluate their safety and efficacy in dermatological practice. J Drugs Dermatol. 2024;23(11):972-978. doi:10.36849/JDD.8239.

PMID:39496117 | DOI:10.36849/JDD.8239