Category: Statistics

J Adv Nurs. 2024 Oct 19. doi: 10.1111/jan.16532. Online ahead of print.

ABSTRACT

AIM: To evaluate the impact of nurse-led one-on-one psychoeducation sessions on gender diverse individuals seeking gender-affirming genital surgery.

DESIGN: A quasi-experimental, pre- and post-test research design was employed to examine the impact of a nurse-led initiative on improving patients self-perceived knowledge and confidence pertaining to gender affirming genital surgery. The study followed the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines and the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

METHODS: The curriculum for the initiative was crafted through literature reviews, expert panel engagements, multidisciplinary team input and was delivered by two specialist gender nurses.

RESULTS: The results indicated a statistically significant increase in all participants’ self-perceived knowledge and confidence scores. Furthermore, the study increased confidence in the ability to ask questions and plan for the logistical and financial aspects of surgery.

CONCLUSION: Participants reported that the sessions were very useful, and for most, the information did not change their desire to seek surgery but did help them make more informed choices about the procedure, timing and preferred surgeon.

IMPLICATIONS FOR PATIENT CARE: The study underscores the imperative role of support networks and recommends interventions to facilitate open communication within families. The study emphasises the importance of customising healthcare approaches to align with the preferences of patients.

IMPACT: The study addressed the need for psychoeducation sessions for individuals considering gender-affirming genital surgery. The main findings revealed a significant increase in participants’ self-perceived knowledge and confidence, following a nurse-led intervention. The research’s impact extends to gender-diverse individuals seeking surgery globally.

PATIENT OR PUBLIC CONTRIBUTION: Four individuals who had undergone gender-affirming surgeries contributed their perspectives to the study design, ensuring that the educational content addressed specific information needs and concerns.

PMID:39425745 | DOI:10.1111/jan.16532

Cytotherapy. 2024 Oct 5:S1465-3249(24)00885-5. doi: 10.1016/j.jcyt.2024.09.004. Online ahead of print.

ABSTRACT

OBJECTIVE: This intermediate-size expanded access program aimed to evaluate safety and clinical efficacy of multiple intravenous infusions of autologous, Hope Biosciences adipose-derived mesenchymal stem cell (HB-adMSC) therapy in elderly patients with Parkinson’s disease (PD).

METHODS: Ten eligible participants (aged 76-95 years) received six intravenous infusions each with 200MM autologous HB-adMSCs over 18 weeks, with the end of study (EOS) at week 26. Safety was assessed through adverse events (AEs) and serious adverse events (SAEs). Efficacy was measured through improvements in both motor and non-motor symptoms, utilizing scales including Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts I-IV, Parkinson’s Disease Questionnaire-39 (PDQ-39), Parkinson’s disease Fatigue Scale (PFS-16), Patient Health Questionnaire-9 (PHQ-9), and Visual Analog Scale (VAS). Analysis employed paired t-tests and Minimal Clinically Important Difference (MCID) thresholds for the patient-reported outcomes.

RESULTS: Most AEs (37 out of 46) were mild in severity, with 5 SAEs reported, none attributed to the drug. No deaths occurred. Despite lack of statistical significance across the efficacy endpoints, modest yet clinically meaningful improvements with effect size > 0.3 were observed in several secondary efficacy endpoints (MDS-UPDRS part I & III, PDQ-39, and PHQ-9) at the EOS, nearing or surpassing the established MCID values.

CONCLUSIONS: The administration of autologous 200MM HB-adMSCs was found to be safe and well-tolerated in the elderly PD population. Although not achieving statistical significance, modest clinical improvements were noted across multiple secondary endpoints. These findings underscore the safety profile of the treatment in elderly patients and highlight the importance of evaluating clinical relevance alongside statistical measures for meaningful patient outcomes. Further investigation with a larger, randomized, placebo-controlled design is warranted to validate these observations.

PMID:39425736 | DOI:10.1016/j.jcyt.2024.09.004

Neuromodulation. 2024 Oct 18:S1094-7159(24)00673-1. doi: 10.1016/j.neurom.2024.08.008. Online ahead of print.

ABSTRACT

OBJECTIVES: The neuromodulatory effects of transcranial alternating current stimulation (tACS) on electroencephalogram (EEG) dynamics are quite heterogenous. The primary objective of the study is to comprehensively characterize the effects of two tACS protocols on resting-state EEG.

MATERIALS AND METHODS: A total of 36 healthy participants were recruited and were randomized into three groups. Two groups received either personalized theta (4-8 Hz) or gamma (40 Hz) stimulation bilaterally in the frontal regions for 20 minutes (4 minutes ON, 1 minute OFF, four cycles). The third group performed relaxed breath watching for 20 minutes. Artifact-free, 1-minute EEG segments from the baseline, during tACS, and after stimulation resting EEG were characterized to see the effects of tACS. Threshold-free cluster enhanced permutation tests (for spectral measures) and two-way mixed analysis of variance (for aperiodic slope) were used for statistical inferences.

RESULTS: Current modeling simulation using ROAST with preset parameters (800 μA, AF3 AF4 locations) showed that induced electric fields can activate frontal cortical regions. During the stimulation period, personalized theta tACS entrained theta band power in the centro-parietal areas. There was a compensatory power decrease in the beta and gamma bands after theta tACS. No entrainment effects were observed for gamma tACS during stimulation, but a significant entrainment was observed in the theta and beta bands in the parieto-occipital regions after stimulation. The delta band power decreased in the central regions. No spectral modulations were seen after breath watching. The spectral slope, which measures aperiodic activity, was not affected by either breath watching or tACS.

CONCLUSIONS: Characterizing the effects of multiple tACS protocols is critical to effectively target specific neural oscillatory patterns and to personalize the protocols. The study can be extended to target specific oscillatory patterns associated with cognitive deficits in neuro-psychiatric conditions.

PMID:39425734 | DOI:10.1016/j.neurom.2024.08.008

J Hand Surg Am. 2024 Oct 17:S0363-5023(24)00433-7. doi: 10.1016/j.jhsa.2024.09.009. Online ahead of print.

ABSTRACT

Single center studies are limited by bias, lack of generalizability and variability, and inability to study rare conditions. Multicenter observational research could address many of those concerns, especially in hand surgery where multicenter research is currently quite limited; however, there are numerous barriers including regulatory issues, lack of common terminology, and variable data set structures. The Observational Health Data Sciences and Informatics (OHDSI) program aims to surmount these limitations by enabling large-scale, collaborative research across multiple institutions. The OHDSI uses the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to standardize health care data into a common language, enabling consistent and reliable analysis. The OMOP CDM has been transformative in converting multiple databases into a standardized code with a single vocabulary, allowing for coherent analysis across multiple data sets. Building upon the OMOP CDM, OHDSI provides an extensive suite of open-source tools for all research stages, from data extraction to statistical modeling. By keeping sensitive data local and only sharing summary statistics, OHDSI ensures compliance with privacy regulations while allowing for large-scale analyses. For hand surgery, OHDSI can enhance research depth, understanding of outcomes, risk factors, complications, and device performance, ultimately leading to better patient care.

PMID:39425718 | DOI:10.1016/j.jhsa.2024.09.009

J Manipulative Physiol Ther. 2024 Oct 19:S0161-4754(24)00065-4. doi: 10.1016/j.jmpt.2024.09.007. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to compare the effects of foot positioning on muscle activities of the peroneus longus (PL), medial gastrocnemius (MG), and tibialis anterior (TA)/PL ratio in individuals with chronic ankle instabilities (CAI) during wobble board training.

METHODS: Thirty individuals with CAI were included, and statistical significance of PL and MG muscle activities was determined using 1-way repeated measures analysis of variance alongside TA/PL activity ratio at the university research laboratory. The participants performed the wobble board training in 3 different foot positions: medial from the centerline of the wobble board (WBT-M), middle from the centerline of the wobble board, and lateral from the centerline of the wobble board (WBT-L). Peroneus longus, MG, and TA muscle activities were measured using surface electromyography.

RESULTS: Peroneus longus activity was significantly higher in the WBT-L position than in the other 2 positions, and it was significantly higher in the middle from the centerline of the wobble board than in the WBT-M position. Medial gastrocnemius activity was significantly greater in the WBT-L position than in the other 2 positions. Tibialis anterior/PL ratio was higher in the WBT-M position than in the other 2 positions.

CONCLUSION: The findings of this study showed that WBT-L increased PL muscle activity by >70% of the maximal voluntary isometric contraction without increasing TA/PL ratio in individuals with CAI.

PMID:39425704 | DOI:10.1016/j.jmpt.2024.09.007

J Manipulative Physiol Ther. 2024 Oct 16:S0161-4754(24)00061-7. doi: 10.1016/j.jmpt.2024.09.004. Online ahead of print.

ABSTRACT

OBJECTIVE: The objectives of the study were to (1) determine the association between kinesiophobia and lumbar joint position sense (JPS) in individuals with chronic low back pain (CLBP); (2) examine the relationship between kinesiophobia and postural stability in individuals with CLBP; and (3) investigate whether pain intensity mediates the relationship between kinesiophobia, lumbar JPS, and postural stability in individuals with CLBP.

METHODS: In this cross-sectional study, a total of 83 individuals diagnosed with CLBP were included. The level of fear of movement was assessed using the Tampa Scale for Kinesiophobia (TSK). Lumbar JPS was measured using the active target repositioning technique, which involved evaluating JPS in 3 directions: lumbar flexion, side-bending to the left, and side-bending to the right. The repositioning accuracy of the lumbar joint was quantified in degrees using a dual digital inclinometer. Postural stability was assessed using a stabilometric force platform, which measured anterior to posterior (A-P) sway, medial to lateral (M-L) sway, and the ellipse area in mm².

RESULTS: The findings of this study revealed a statistically significant and moderate positive correlation between kinesiophobia and lumbar JPS in various directions, including flexion (r = 0.51, P < .001), side-bending to the left (r = 0.37, P = .001), and side-bending to the right (r = 0.34, P = .002). Similarly, a significant positive association was observed between kinesiophobia and postural stability, as indicated by the correlation coefficients: A-P sway (r = .47, P < .001), M-L sway (r = 0.58, P < .001), and ellipse area (r = 0.51, P < .001). Furthermore, the analysis revealed that pain significantly mediated the relationship between kinesiophobia and both lumbar JPS (P < .05) and postural stability (P < .05). These findings were demonstrated through mediation analysis.

CONCLUSIONS: This study identified a significant association between kinesiophobia, lumbar JPS, and postural stability. Additionally, we observed the presence of pain as a potential mediator in this relationship. However, it is important to note that our cross-sectional study design precludes establishing causality or determining the direct mediation effect of pain on adverse outcomes.

PMID:39425703 | DOI:10.1016/j.jmpt.2024.09.004

Int J Geriatr Psychiatry. 2024 Oct;39(10):e70001. doi: 10.1002/gps.70001.

ABSTRACT

OBJECTIVES: To investigate the intermediary role of physical performance in the association between physical activity and mild cognitive impairment (MCI) in older adults with type 2 diabetes mellitus (T2DM), residing in rural areas.

METHODS: This study employed a random sampling method to select 316 patients aged 65 years and older, all diagnosed with T2DM, from 24 different rural areas in China. The relationships between physical activity, physical performance, and MCI were analyzed using a logistic regression model, and the proposed mediation model was validated through bootstrap test.

RESULTS: In this study, the prevalence of MCI in the rural-based older adults with T2DM was 53.48%. A significant correlation was observed between the levels of physical activity and physical performance. Moreover, diminished physical performance was positively correlated with an increased propensity for MCI, even after adjusting for relevant covariates. Physical performance was discerned to exert a partial mediating influence on the relationship between physical activity and MCI.

CONCLUSIONS: The empirical evidence generated by this study posits that the impact of physical activity on MCI is partially mediated through physical performance in an aging population with T2DM residing in rural environments. Consequently, interventional strategies aimed at ameliorating physical performance may serve as a viable approach to mitigate the progression of cognitive decline.

PMID:39425696 | DOI:10.1002/gps.70001

ACS Nano. 2024 Oct 19. doi: 10.1021/acsnano.4c09312. Online ahead of print.

ABSTRACT

Precise size and shape control in nanocrystal synthesis is essential for utilizing nanocrystals in various industrial applications, such as catalysis, sensing, and energy conversion. However, traditional ensemble measurements often overlook the subtle size and shape distributions of individual nanocrystals, hindering the establishment of robust structure-property relationships. In this study, we uncover intricate shape evolutions and growth mechanisms in Co₃O₄ nanocrystal synthesis at a subnanometer scale, enabled by deep-learning-assisted statistical characterization. By first controlling synthetic parameters such as cobalt precursor concentration and water amount then using high resolution electron microscopy imaging to identify the geometric features of individual nanocrystals, this study provides insights into the interplay between synthesis conditions and the size-dependent shape evolution in colloidal nanocrystals. Utilizing population-wide imaging data encompassing over 441,067 nanocrystals, we analyze their characteristics and elucidate previously unobserved size-resolved shape evolution. This high-throughput statistical analysis is essential for representing the entire population accurately and enables the study of the size dependency of growth regimes in shaping nanocrystals. Our findings provide experimental quantification of the growth regime transition based on the size of the crystals, specifically (i) for faceting and (ii) from thermodynamic to kinetic, as evidenced by transitions from convex to concave polyhedral crystals. Additionally, we introduce the concept of an “onset radius,” which describes the critical size thresholds at which these transitions occur. This discovery has implications beyond achieving nanocrystals with desired morphology; it enables finely tuned correlation between geometry and material properties, advancing the field of colloidal nanocrystal synthesis and its applications.

PMID:39425689 | DOI:10.1021/acsnano.4c09312

Intern Med J. 2024 Oct 19. doi: 10.1111/imj.16538. Online ahead of print.

ABSTRACT

BACKGROUND: Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator.

AIMS: To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes.

METHODS: This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis.

RESULTS: Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re-admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01-9.13, P < 0.001), in-hospital mortality (OR 3.62, 95% CI 2.19-5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25-4.97, P = 0.01). Length of stay was longer in patients requiring early post-ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001).

CONCLUSIONS: One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.

PMID:39425571 | DOI:10.1111/imj.16538

J Prim Care Community Health. 2024 Jan-Dec;15:21501319241284971. doi: 10.1177/21501319241284971.

ABSTRACT

INTRODUCTION: Individuals with participation and activity limitations face important healthcare challenges.

OBJECTIVES: We investigated healthcare utilization and characteristics of Canadians living with participation and activity limitations between 2001 and 2010.

METHODS: We pooled data from 5 cycles of the Canadian Community Health Survey (2001-2010 CCHS). The multistage stratified cluster-sampling method used covered approximately 98% of Canadians, aged 12 years and older residing in private dwellings. We described sociodemographic, behavioral, and health-related characteristics of participants with participation and activity limitations and reported their annual utilization (prevalence; 95% CI) of 7 healthcare providers. Multivariable modified Poisson regression identified individual characteristics associated with healthcare utilization and examined the trends over time.

RESULTS: Annually, 8.1 million Canadians aged 12 years and older (29.8%) reported participation and activity limitations. Most common health conditions were back problems (37%) and arthritis (34%). Predominant healthcare providers were medical doctors (88.8%; 95% CI = 88.6-89.0), nurses (16.3%; 95% CI = 16.1-16.6), physiotherapists (15.0%; 95% CI = 14.7-15.2), and chiropractors (14.4%; 95% CI = 14.2-14.7). Overall, males, older adults, immigrants, those with lower education, lower income, recent employment, and better general health were less likely to consult providers. Over time, utilization of most non-medical providers increased.

CONCLUSION: Participation and activity limitations are prevalent in Canada, and most consulted medical doctors. Disadvantaged groups reported lower utilization of most providers, emphasizing access challenges and the need for equitable and integrated healthcare policies. Improving access to rehabilitation services and their inclusion within universal healthcare coverage should be a priority.

PMID:39425559 | DOI:10.1177/21501319241284971