Category: Statistics

South Med J. 2025 Sep;118(9):585-588. doi: 10.14423/SMJ.0000000000001867.

ABSTRACT

OBJECTIVES: There has been growing evidence that insurance status is a major indicator of postoperative outcomes, which has been extensively reported in orthopedic procedures such as shoulder and knee arthroplasty. Patients with Medicaid public insurance had increased complications, longer lengths of stay, and increased costs compared with patients who had private insurance when controlling for demographic characteristics. Our study compared the outcomes of patients with Medicaid insurance with those patients with private commercial insurance who have undergone anterior cruciate ligament (ACL) reconstruction. We hypothesized that patients with Medicaid insurance coverage would have worse patient-reported outcomes and complication rates in comparison with a matched cohort of patients with private insurance.

METHODS: Our departmental registry was queried for all patients who underwent primary arthroscopically assisted ACL reconstruction by 10 surgeons in the practice between January 2018 and June 2022 and were at least 2 years out from their surgery. Eligible patients in the matched cohort model were contacted via telephone for consent to participate in this study and questioned about their pain level, return to sport, physical therapy compliance, and any incidence of retear rates or additional procedures in their ipsilateral or contralateral knee. Patients were then compared across insurance types based on Lysholm knee score, as well as the other patient-reported outcomes.

RESULTS: A total of 189 ACL reconstructions were screened during the study period. Fifteen private insurance and 15 Medicaid patients responded to the telephone call and consented to the study. Comparison of the clinical outcomes within the insurance cohorts revealed that there were no significant differences in Lysholm knee scores, pain scores, revision rate, and return to sport. The only significant difference observed was that Medicaid patients had a greater physical therapy compliance rate. Multivariate linear regression analysis revealed that males had the highest odds ratio associated with higher Lysholm scores, but there was no significance observed with any factor.

CONCLUSIONS: Although Medicaid patients did have greater physical therapy attendance, this did not improve their postoperative outcomes, which may suggest that Medicaid status may affect physical therapy effectiveness and can be a confounding variable related to other health disparities. Because the multivariate linear regression analysis did not show any associated factors with poorer postoperative outcomes, this may imply that some demographic factors or insurance status may not be contraindications to ACL reconstruction. Despite the lack of significance, males had a greater likelihood of achieving acceptable Lysholm knee scores based on the multivariate analysis.

PMID:41032267 | DOI:10.14423/SMJ.0000000000001867

South Med J. 2025 Sep;118(9):579-584. doi: 10.14423/SMJ.0000000000001875.

ABSTRACT

OBJECTIVES: An opioid-sparing, multimodal pain (MMP) protocol was initiated at our institution in August 2016 in the Division of Trauma and Acute Care Surgery (TACS). During the next year, the practice was codified into a protocol. This study aims to evaluate the dissemination and impact of MMP.

METHODS: We conducted a single-center retrospective cohort study of all patients admitted to a surgical service from May 2015 to July 2020 to evaluate opioid and nonopioid prescribing for analgesia. The analysis consisted of three populations: patients admitted to the TACS service, the General Surgery subspecialty (GSS) services (excluding TACS), and other surgical department (OSD) services.

RESULTS: Of the 12,010 patients who met the inclusion criteria, 1979 (16.5%) were admitted to the TACS service, 1106 (9.2%) to GSS services, and 8925 (74.3%) to OSD services. Opioid morphine milligram equivalents averaged 38.6 ± 33.3 daily but decreased in all groups over time. Nonopioid adjunctive medications were used in 5932 (49.4%) and increased in all groups after implementation of the protocol (all P < 0.001). After MMP introduction, nonopioid analgesic use increased most rapidly in TACS and the slowest in OSD. Conversely, the average daily morphine milligram equivalents decreased most quickly in TACS (24.4%, P < 0.001), while GSS and OSD services saw a subsequent decrease in opioid use (P = 0.004 and P < 0.001, respectively) as MMP increased.

CONCLUSIONS: Implementation of an MMP protocol by a single division can facilitate the spread of nonopioid adjunctive pain medication use and decrease opioid utilization throughout surgical specialties in a hospital.

PMID:41032266 | DOI:10.14423/SMJ.0000000000001875

ATS Sch. 2025 Oct 1. doi: 10.34197/ats-scholar.2025-0008OC. Online ahead of print.

ABSTRACT

Background: Burnout, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, negatively affects resident physicians and patients. Although burnout is common among intensive care unit (ICU) healthcare workers, data on its impact on resident physicians during their medical ICU (MICU) rotations are limited. Objective: This study aimed to determine the prevalence, key drivers, and mitigating factors for burnout among resident physicians rotating through the MICU. Methods: We conducted a single-center, mixed-methods prospective cohort study in the MICU of an academic quaternary care hospital. Over the course of a 9-month period, we surveyed residents at the end of their MICU rotation and assessed the prevalence of burnout using the Maslach Burnout Inventory, as well as perceived drivers and mitigators of burnout. Focus groups were conducted to further explore internal medicine (IM) residents’ perceptions of drivers and mitigators of MICU-related burnout. Results: Forty-nine residents completed the survey (80% response rate), and 25 IM residents participated in focus groups. The overall burnout prevalence was 88%. Although not statistically significant, higher burnout rates were observed among first-year residents (94% vs. 78%; P = 0.12) and non-IM residents (100% vs. 81%; P = 0.07). Fifty-three percent of residents believed that there was more burnout in the MICU than other ICU rotations. Three themes emerged as drivers of burnout: patient factors (high acuity, adverse outcomes, ethical dilemmas), team and unit dynamics (interdisciplinary tensions, MICU insider-outsider bias), and the clinical learning environment (limited work-life balance, steep learning curve, normalization of burnout). The primary mitigating factors were meaningful patient interactions, supportive team dynamics, structured debriefing, protected time, and focused skill development. Conclusion: Burnout in residents rotating through the MICU is extremely high, higher than the previously reported baseline resident burnout rate of 50-75%. First-year and non-IM residents may be especially vulnerable because of unfamiliarity with the unique team and unit dynamics and clinical learning environment of the MICU (high acuity, high intensity, frequent exposure to dying patients, and unit insider-outsider bias). This study highlights unique factors, which contribute to burnout among MICU residents, that differ from those affecting other critical care staff and could be addressed through targeted interventions.

PMID:41032260 | DOI:10.34197/ats-scholar.2025-0008OC

J Anim Sci. 2025 Oct 1:skaf340. doi: 10.1093/jas/skaf340. Online ahead of print.

ABSTRACT

BACKGROUND: Feed efficiency, nutrient utilization, and methane emission are highly dependent on the gastrointestinal microbiota, implying an influence of these microorganisms on economically important traits (e.g., carcass traits and meat quality). The interaction between microbial composition, diet, and host performance suggests that microbiota-targeted strategies may increase production in livestock animals. However, little is known about this interaction in beef cattle. We aimed to characterize the gastrointestinal microbiota and identify taxa associated with performance phenotypes in Nellore bulls.

RESULTS: We identified 1,268 bacterial and 75 archaeal amplicon sequence variants (ASVs). For both bacteria and archaea, alpha diversity showed significant within-year variation. No statistical differences were found for the Shannon index for bacteria in 2019 versus 2021 or archaea in 2019-2020 and 2021-2022. Except for 2022 (bacteria), no clusters were observed for bacteria or archaea beta diversity across years. Ten different bacteria ASVs were found to affect ribeye area (RA), whereas only five did so for metabolic weight (MW). For archaea, eight ASVs had a significant effect on RA, whereas 15 were found to affect MW. Coefficients of the regression of phenotype on ASV ranged from (± SE, in SD units) -0.40 ± 0.08 (ASV 892, Bacteroidales RF16 spp.) to 0.36 ± 0.11 (ASV 605, Marvinbryantia spp.) for MW, and from -0.72 ± 0.20 (ASV 188, Faecalibacterium spp.) to 0.65 ± 65 (ASV 457, Christensenellaceae R-7 spp.) for RA.

CONCLUSION: Our study revealed significant associations between ASV and traits of economic importance in beef cattle, including carcass, feed efficiency, and morphology, indicating that the microbiome influences animal performance. Further research is needed to elucidate the biological mechanisms behind these associations.

PMID:41032256 | DOI:10.1093/jas/skaf340

Neurol Sci. 2025 Oct 1. doi: 10.1007/s10072-025-08525-9. Online ahead of print.

ABSTRACT

BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder potentially influenced by immune system dysregulation, with the human leukocyte antigen (HLA) system implicated in its pathogenesis. This study aims to evaluate HLA variants’ association with PD risk and clinical attributes.

METHODS: A systematic review and meta-analysis, registered with PROSPERO (CRD420250650550) and adhering to PRISMA Guidelines, was conducted. PubMed, Web of Science, and Scopus were searched from February 2005 to February 2025 for determined keywords. Eligible studies included human-based primary research reporting HLA associations with PD risk or clinical features. Data was extracted on study characteristics, HLA alleles/genotypes, and clinical outcomes. Meta-analysis used fixed-effect models to pool odds ratios (ORs) with 95% confidence intervals (CIs), assessing heterogeneity via I² and Cochran’s Q statistics. Publication bias was evaluated using the trim-and-fill method.

RESULTS: Sixteen studies analyzing 42 HLA markers were included. Pooled ORs indicated increased PD risk with insignificant heterogeneity for HLA-B*07, HLA-C*07:02, HLA-DQA1*01:02, HLA-DQA1*05:05, HLA-DRB1*03:01, and HLA-DRB1*15:01, with protective effects for HLA-DQB1*03:02 and HLA-DQB1*04:01. The analysis for HLA genotypes showed substantial heterogeneity across the studies. The publication bias effect was limited using trim-and-fill method, affecting all the homogenous analyses. HLA-DR expression correlated with motor-cognitive function, and HLA-DQB1*06:02 was linked to daytime sleepiness.

CONCLUSION: Specific HLA alleles influence PD susceptibility and clinical presentation, highlighting the immune system’s role in PD pathogenesis. Future research may explore the influence of HLA haplotypes on PD to ascertain whether there is a direct impact or if the associations are merely a consequence of linkage disequilibrium.

PMID:41032234 | DOI:10.1007/s10072-025-08525-9

Eur Arch Paediatr Dent. 2025 Oct 1. doi: 10.1007/s40368-025-01115-5. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effectiveness of the “Marzhan Tis” mobile application in improving oral hygiene practices among children with autism spectrum disorder (ASD) and to examine its usability and correlation with learning success.

METHODS: A prospective, non-randomized cohort study was conducted with 90 children aged 3-18 years diagnosed with Level 1 ASD from rehabilitation centers in Almaty, Kazakhstan. Participants were divided into an intervention group (IG), which used the app for 1 month, and a control group (CG), which received standard oral hygiene instructions. Oral hygiene was assessed using the Simplified Oral Hygiene Index (OHI-S), approximal plaque index (API), and papillary-marginal-alveolar index (PMA). Adherence was measured using the modified Oral Hygiene Assessment Scale (OHAS-10), and a structured 15-item caregiver questionnaire evaluated behavioral changes and app usability. Statistical analysis included the Shapiro-Wilk test for normality, Mann-Whitney U and Wilcoxon signed-rank tests for between and within-group comparisons, Chi-square tests for categorical variables, and Pearson correlation for usability-learning associations.

RESULTS: Significant improvements were observed in the IG for all oral hygiene indices (OHI-S reduction: 28-52%; API and PMA improvement > 50%, p < 0.05). Oral hygiene adherence increased by 18.8% (p = 0.001). Independence in brushing improved in 85% of IG children (χ² = 28.7, p = 0.001). A strong correlation was found between app usability and learning outcomes (r = 0.65, p = 0.01).

CONCLUSION: The “Marzhan Tis” mobile app effectively improved oral hygiene skills and independence in children with ASD Level 1. Its usability and gamified features support its integration into pediatric oral health interventions.

PMID:41032232 | DOI:10.1007/s40368-025-01115-5

Radiol Med. 2025 Oct 1. doi: 10.1007/s11547-025-02111-x. Online ahead of print.

ABSTRACT

Thymomas are the most common primary tumors of the anterior mediastinum, frequently associated with paraneoplastic syndromes like myasthenia gravis. This preliminary study investigated the correlation between radiomic features extracted from venous-phase CT images, histological grading (WHO), and disease staging (Masaoka-Koga and TNM) in patients with thymomas. A total of 37 patients were analyzed, with 107 radiomic features extracted using PyRadiomics module. Statistical analysis revealed 11 significant radiomic features distinguishing early and advanced thymomas according to Masaoka-Koga/TNM staging (p < 0.05), with shape_Sphericity, shape_Maximum3DDiameter, and firstorder_Skewness being the most predictive. For WHO classification, 7 significant features differentiated low-risk and high-risk thymomas (p < 0.05), with shape_Sphericity, firstorder-Range, and firstorder_RootMeanSquared showing the highest performance. LASSO models demonstrated high accuracy, with an AUC of 0.9 for Masaoka-Koga/TNM staging and 0.82 for WHO classification. These findings suggest that radiomic features can effectively distinguish thymoma stages and risk levels, potentially aiding in treatment planning and prognosis. By enabling noninvasive tumor characterization, radiomic features could support more personalized treatment strategies and improve decision-making in clinical practice.

PMID:41032229 | DOI:10.1007/s11547-025-02111-x

Anat Rec (Hoboken). 2025 Oct 1. doi: 10.1002/ar.70062. Online ahead of print.

ABSTRACT

The human inner ear (IE) is a complex structure whose morphological variability underpins both normal function and the manifestation of otologic pathologies. Previous studies aiming to describe the structural variability of the IE have been limited by low-resolution imaging and small sample numbers. This study utilized the largest number of cadaveric high-resolution micro-computed tomography (CT) images to date to characterize the bony morphology of the healthy human IE. Fifty-four cadaveric temporal bone specimens underwent micro-CT imaging. Images were semi-automatically segmented and converted to three-dimensional surface mesh models for morphological measurement and analysis. Statistical shape models (SSMs) were created for the IE, cochlea, and vestibular system, as well as for sex- and side-based subgroups. Normative ranges for linear and volumetric dimensions of the IE were determined, and mean values were consistent with those previously reported. Significant sex-based differences and strong univariate linear relationships were identified for many dimensions and volumes. SSMs highlighted the semicircular canals, cochlear basal turn, and hook regions as key contributors to morphological variability across the total sample set. Sex-specific SSMs revealed distinct variation patterns: females exhibited greater vestibular variability, while males showed cochlear basal turn/hook region variability. Multivariate models were developed for the prediction of IE volumes from dimensions obtainable from clinical quality scans, with high accuracy. The morphological variability of the healthy IE was described in extensive detail and depicted in three dimensions. These findings may be used to inform the assessment of IE malformations, analysis of drug delivery strategies to the IE, and otologic implant design optimization.

PMID:41031437 | DOI:10.1002/ar.70062

Palliat Support Care. 2025 Oct 1;23:e178. doi: 10.1017/S1478951525100801.

ABSTRACT

OBJECTIVES: In the cultural context of China, it holds profound significance for nursing students to engage in discussions about hospice and palliative care with their families. This study aimed to explore nursing students’ willingness to discuss hospice and palliative care with their families and the factors associated with it.

METHODS: Nursing students from three schools in three Chinese provinces (n = 1,234) completed questionnaires on general information, hospice and palliative care awareness, attitude toward death, and willingness to discuss hospice and palliative care with their families. This cross-sectional analysis utilized logistic regression to investigate the predictors of participants’ willingness to discuss hospice and palliative care with their families.

RESULTS: The mean hospice and palliative care knowledge score was 6.68, and 19.1% were willing to discuss the topic with their families. Factors associated with nursing students’ willingness to discuss hospice and palliative care with their families included region, whether their family members considered talking about death a taboo, whether a family member was severely ill and at risk of death, their knowledge of World Hospice and Palliative Care Day, hospice and palliative care knowledge score, and death avoidance attitude. Participants with higher hospice and palliative care knowledge scores were more willing to discuss the topic with their families, while a higher death avoidance score was associated with unwillingness.

SIGNIFICANCE OF RESULTS: Nursing students significantly lack hospice and palliative care awareness, and their willingness to discuss the topic with their families needs improvement. Nursing schools should provide systematic and standardized hospice and palliative care education and communication skills training.

PMID:41031435 | DOI:10.1017/S1478951525100801

JMIR Med Educ. 2025 Sep 9. doi: 10.2196/71339. Online ahead of print.

ABSTRACT

BACKGROUND: Early exposure to research methodology is essential in medical education, yet many students show limited motivation to engage with non-clinical content. Gamified strategies such as educational escape rooms (EERs) may help improve engagement, but few studies have explored their feasibility at scale or evaluated their impact beyond student satisfaction.

OBJECTIVE: To assess the feasibility, engagement, and perceived educational value of a large-scale escape room specifically designed to introduce third-year medical students to the principles of diagnostic test evaluation.

METHODS: We developed a low-cost immersive escape room based on a fictional diagnostic accuracy study, with six puzzles mapped to five predefined learning objectives: (1) identifying key components of a diagnostic study protocol, (2) selecting an appropriate gold-standard test, (3) defining a relevant study population, (4) building and interpreting a contingency table, and (5) critically appraising diagnostic metrics in context. The intervention was deployed to an entire class of third-year medical students across 12 sessions between March and April 2023. Each session included 60 minutes of gameplay and a 45-minute debriefing. Students completed pre-/post-intervention questionnaires assessing their knowledge of diagnostic test evaluation and perceptions of research training. Descriptive statistics and paired t-tests were used to evaluate score changes; univariate linear regressions assessed associations with demographics. Free-text comments were analyzed using Reinert’s hierarchical classification.

RESULTS: Among 530 participants, 490 completed the full evaluation. Many participants had limited prior exposure to escape rooms (206/490, 42% had never participated), and most reported low initial confidence with critical appraisal of scientific articles. All student teams completed the scenario, with a mean completion time of 53 (±4) minutes. Mean overall knowledge scores increased from 62/100 (±1) before to 82/100 (±2) after the activity (+32%, p<0.001). Gains were observed across all learning objectives and were not influenced by age, sex, or prior experience. Students rated the EER as highly entertaining (9.1±1.1/10) and educational (8.2±1.5/10). Following the intervention, 87% (393/452) felt more comfortable with critical appraisal of diagnostic test studies, and 79% (357/452) considered the escape room format highly appropriate for an introductory session. Thematic analysis of open-ended feedback identified six clusters, including engagement, teamwork, and perceived usefulness of the pedagogical approach. Word clouds showed a marked shift from negative to positive attitudes toward research training.

CONCLUSIONS: This study demonstrates the feasibility and enthusiastic reception of a large-scale, reusable escape room aimed at teaching the fundamental principles of diagnostic test evaluation to undergraduate medical students. While not designed to cover the broader spectrum of research designs or methods, the intervention successfully addressed targeted objectives within a specific area of research appraisal. This approach may serve as a valuable entry point to engage students with evidence-based reasoning and pave the way for deeper exploration of medical research methodology.

PMID:41031434 | DOI:10.2196/71339