Category: Statistics

Health Serv Res. 2024 Aug 5. doi: 10.1111/1475-6773.14365. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess factors impacting obstetric transport and referral processes for pregnant patients experiencing an emergency in a rural state without a perinatal regionalized system of care.

DATA SOURCES AND STUDY SETTING: Data is from Critical Access Hospitals (CAHs) without obstetric units and healthcare providers involved in obstetric care and transport at hospitals with varying levels of obstetric capacity in Montana.

STUDY DESIGN: This mixed-methods study involved surveying CAHs without obstetric units about the hospitals’ capacity for obstetric emergencies and transport policies. Survey data were collected from 32 of 34 CAHs without obstetric units (94% response rate) in the fall of 2021. Subsequent interviews were conducted in the fall and winter of 2022-2023 with 20 hospital and emergency medical services (EMS) personnel to provide further insights into the referral and transport process during obstetric emergencies.

DATA COLLECTION/EXTRACTION METHODS: Survey data were collected using REDCap; interviews were conducted via videoconference. We performed descriptive statistics and Fisher’s exact tests for quantitative data. We analyzed qualitative data using a three-phase pragmatic analytic approach.

PRINCIPAL FINDINGS: The survey of CAHs found 12 of 32 facilities faced difficulties coordinating transport for pregnant patients. Qualitative data indicated this was often due to the state’s decentralized transport system. Challenges identified through both quantitative and qualitative data included weather, securing a receiving facility/provider, and coordinating medical transport. Only 10 CAHs reported having written protocols for transporting pregnant patients; of those, four facilities had formal transfer agreements. Qualitative data emphasized variations in awareness and the utility of obstetric transport policies.

CONCLUSIONS: A decentralized transport system in a rural state can exacerbate existing challenges faced by providers arranging transport for pregnant patients during an obstetric emergency. State and interfacility policies could enhance the transport process for increased regionalization as well as increased support for and coordination of existing EMS.

PMID:39103196 | DOI:10.1111/1475-6773.14365

J Dr Nurs Pract. 2024 Aug 5;17(2):110-116. doi: 10.1891/JDNP-2023-0018.

ABSTRACT

Background: Transgender (TG) clients experience provider bias, erasure, refusal to treat, and violence. Objective: The purpose of this article is to identify barriers to healthcare for TG individuals and discuss recommendations for providers treating this population. Methods: Literature review of prime research was conducted using the Whittemore and Knafl methodology (2005). Results: Evidence suggests that barriers to TG healthcare include lack of provider TG knowledge and trans sensitivity, lack of provider communication, and lack of emotional and physical safe healthcare environments. Conclusions: TG clients face barriers to accessing healthcare, and specific recommendations to improve provider practice will decrease these barriers. Implications for Practice: Lack of provider education affects TG individuals accessing quality healthcare. Recommendations to improve provider practice are essential to improve care.

PMID:39103193 | DOI:10.1891/JDNP-2023-0018

J Dr Nurs Pract. 2024 Aug 5;17(2):100-109. doi: 10.1891/JDNP-2021-0010.

ABSTRACT

Background: Adolescents affected by childhood cancer experience various degrees of psychosocial distress, social isolation, and social support throughout the treatment process. Objective: To create and implement an evidence-based practice project consisting of a pilot half-day camp program to improve social support and connectedness for adolescents affected by childhood cancer. Methods: A pilot half-day camp program was implemented. Twenty adolescent patients, survivors, and siblings (ages 13-18 years) participated in the program. Participants provided basic demographic information and completed pretest, immediate posttest, and 4-week posttest surveys to assess their levels of social support and camp connectedness. Data were analyzed using descriptive statistics and two-tailed Wilcoxon signed-rank test. Results: All measures of social support in adolescent participants affected by childhood cancer trended upward following the conclusion of the program, then trended downward over time, with overall social support and family social support significantly decreasing over time postintervention. Camp connectedness was not significantly impacted by the program. Conclusions: Social support decreases as participants are further out from attending a half-day camp program. This pilot program demonstrated the feasibility of a short-term, local, cost-effective camp program that is scalable to larger groups. Implications for Nursing: Providers should refer adolescents affected by childhood cancer to camp programs for social support. More research is needed to determine if more frequent camp programs sustain a high level of social support in participants.

PMID:39103192 | DOI:10.1891/JDNP-2021-0010

J Dr Nurs Pract. 2024 Aug 5;17(2):86-99. doi: 10.1891/JDNP-2023-0060.

ABSTRACT

Background: Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. Objective: This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. Methods: A 6-week telemedicine program was developed and implemented using the CGM’s time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. Results: A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, F(2, 14) = 18.203, p < .001. Paired-samples t tests indicate that APRN-led education improved body mass index, t(8) = 4.232, p = .002; decreased systolic blood pressure, t(8) = 2.90, p = .010, and diastolic blood pressure, t(8) = 3.21, p = .007; and increased self-management skills as evidenced by DSMQ-R, t(8) = -5.498, p < .001. Conclusions: This QI project highlights multiple interventions for improving diabetes management in a primary care facility. Implications for Nursing: An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.

PMID:39103191 | DOI:10.1891/JDNP-2023-0060

Biostatistics. 2024 Aug 5:kxae030. doi: 10.1093/biostatistics/kxae030. Online ahead of print.

ABSTRACT

The under-5 mortality rate (U5MR), a critical health indicator, is typically estimated from household surveys in lower and middle income countries. Spatio-temporal disaggregation of household survey data can lead to highly variable estimates of U5MR, necessitating the usage of smoothing models which borrow information across space and time. The assumptions of common smoothing models may be unrealistic when certain time periods or regions are expected to have shocks in mortality relative to their neighbors, which can lead to oversmoothing of U5MR estimates. In this paper, we develop a spatial and temporal smoothing approach based on Gaussian Markov random field models which incorporate knowledge of these expected shocks in mortality. We demonstrate the potential for these models to improve upon alternatives not incorporating knowledge of expected shocks in a simulation study. We apply these models to estimate U5MR in Rwanda at the national level from 1985 to 2019, a time period which includes the Rwandan civil war and genocide.

PMID:39103178 | DOI:10.1093/biostatistics/kxae030

BMJ Ment Health. 2024 Aug 4;27(1):e300971. doi: 10.1136/bmjment-2023-300971.

ABSTRACT

QUESTION: For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents’ well-being and psychological need?

STUDY SELECTION AND ANALYSIS: Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023.

INCLUSION CRITERIA: parents of CYP aged 5-18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study.

FINDINGS: 32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender.

CONCLUSIONS: The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required.

PROSPERO REGISTRATION NUMBER: CRD42022344453.

PMID:39103177 | DOI:10.1136/bmjment-2023-300971

BMJ. 2024 Aug 5;386:q1732. doi: 10.1136/bmj.q1732.

NO ABSTRACT

PMID:39103172 | DOI:10.1136/bmj.q1732

BMJ. 2024 Aug 5;386:e073515. doi: 10.1136/bmj-2022-073515.

NO ABSTRACT

PMID:39103171 | DOI:10.1136/bmj-2022-073515

BMJ. 2024 Jul 30;386:q1694. doi: 10.1136/bmj.q1694.

NO ABSTRACT

PMID:39103166 | DOI:10.1136/bmj.q1694

J Dermatolog Treat. 2024 Dec;35(1):2386973. doi: 10.1080/09546634.2024.2386973. Epub 2024 Aug 5.

ABSTRACT

BACKGROUND: Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.

OBJECTIVES: To identify physicians’ prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.

METHODS: We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.

RESULTS: A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.

CONCLUSION: This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.

PMID:39103160 | DOI:10.1080/09546634.2024.2386973