Category: Statistics

Curr Eye Res. 2024 Dec 5:1-5. doi: 10.1080/02713683.2024.2435357. Online ahead of print.

ABSTRACT

PURPOSE: to evaluate changes in retinal microvasculature and sensitivity (RS) preceding the appearance of diabetic retinopathy (DR) among patients with type 1 diabetes (T1D).

METHODS: in this observational cross-sectional cohort study, vascular parameters measured by OCTA and RS evaluated by microperimetry were assessed in patients with T1D without DR (no-DR), T1D with mild DR (m-DR), and healthy controls.

RESULTS: Sixty-two eyes of 31 patients with T1D and 40 eyes of 20 healthy patients were included. OCTA examinations did not yield any significant differences in terms of perfusion density (PD), vascular density (VD), foveal avascular zone (FAZ) area, FAZ perimeter or FAZ circularity between patients with diabetes (no-DR vs. m-DR). However, comparisons between healthy controls and patients with diabetes (both no-DR and m-DR groups) revealed statistically significant differences in PD, VD, and FAZ area. Similarly, no significant differences were observed between no-DR and m-DR groups regarding RS, gaze fixation stability (GFS), or macular integrity (MI). Nevertheless, mean RS and MI were significantly impaired in patients with T1D, both in no-DR and m-DR groups, compared to healthy controls. A statistically significant positive correlation was observed between RS and PD and between FAZ area and RS.

CONCLUSION: although no differences were found between patients with diabetes without DR and those with mild DR, these patients already demonstrated some degree of retinal impairment, both structural and functional, when compared to healthy controls. Our data support the hypothesis that neurodegeneration occurs together with microvascular damage at early stages of diabetes.

PMID:39637437 | DOI:10.1080/02713683.2024.2435357

Global Spine J. 2024 Dec 5:21925682241307634. doi: 10.1177/21925682241307634. Online ahead of print.

ABSTRACT

STUDY DESIGN: Systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aimed to evaluate the learning curve in endoscopic spinal surgery, including the time to mastery and challenges faced by novice surgeons, to improve learning and surgical outcomes.

METHODS: Data extraction included the learning curve period and a comparison of surgeons with more experience or late period of the learning curve (late) and surgeons with less experience and in the early period of the learning curve (early) with respect to demographic, surgical, hospitalization, functional, and complication variables. Statistical analysis was performed using Review Manager 5.4.1 software.

RESULTS: This meta-analysis included 16 studies (n = 1902). The average number of cases required to reach the learning curve was 32.5 ± 10.5. The uniportal technique required fewer cases (30.1 ± 10.2) than biportal technique (38.7 ± 10.3). There were no significant differences in demographic variables, operation level, or duration of symptoms between the advanced and novice surgeons. Advanced surgeons showed better outcomes in VAS leg pain at less than 6 months (SMD 0.18, 95% CI 0.01-0.34) and >6 months (SMD 0.14, 95% CI 0.02-0.27), as well as VAS back pain at > 6 months (SMD 0.16, 95% CI 0.04-0.29). The incidence of total complications was significantly higher in the novice surgeon group. The specific complications did not differ significantly between the 2 groups.

CONCLUSIONS: The average number of cases required to reach the learning curve was 32.5 ± 10.5. Experienced surgeons had shorter surgery and fluoroscopy times, better outcomes in leg and back pain, and a lower incidence of complications than novice surgeons.

PMID:39637434 | DOI:10.1177/21925682241307634

Psychiatriki. 2024 Dec 3. doi: 10.22365/jpsych.2024.020. Online ahead of print.

ABSTRACT

Anaesthesiologists actively involved with COVID-19 are at increased risk for post-traumatic stress syndrome (PTSS). We assessed the PTSD and possible determinants of anaesthesiologists in COVID-19 referral hospitals in the post-COVID-19 era with the validated PTSD Checklist for DSM-5 (PCL-5) and the Eysenck Personality Questionnaire (EPQ). A multicenter cross-sectional survey was conducted among anaesthesiologists working in the 7 COVID-19 referral university/tertiary hospitals during November 2022 (post-COVID-19 era) in Greece. PCL-5 is a 20-item, 5-point Likert scale self-report measure, scored in two different ways to ensure a provisional diagnosis of PTSS. Eysenck Personality Questionnaire (EPQ) explores 3 main dimensions of personality, whereas the Lie (L) scale serves as a measure of “dishonesty”. Multivariate logistic regression analysis was performed to identify predicting factors of PTSS using the stepwise forward method. One hundred doctors (response rate 85%) from 7 hospitals (72% females, median age 46 [33-51.5] years) participated. The overall Cronbach’s alpha for PCL-5 was 0.946. According to each scoring, 18% and 23% of responders were diagnosed with PTSS, respectively, while 7% were classified as suffering from probable PTSD. Interestingly, children (OR=0.17, p=0.048) and the satisfaction with job position (OR=0.211, p=0.024) exhibited a protective effect against PTSS. On the other hand, family obligations were identified as an aggravating factor (OR=4.274, p=0.026). Concerning personality traits, only neuroticism was identified as a statistically significant independent factor predicting PTSS (OR=1.524, p=0.001). Finally, job ranking was also a statistically significant independent factor predicting PTSS, with a 3 times risk augmentation for each level in the job hierarchy (from Residents towards Academics) (OR=3.034, p=0.022). In the post-COVID-19 era, up to 23% of Greek anaesthesiologists working in referral hospitals suffered from PTSS. Children and job satisfaction exhibited a protective role in contrast to higher ranks of the job hierarchy.

PMID:39637422 | DOI:10.22365/jpsych.2024.020

Psychiatriki. 2024 Dec 3. doi: 10.22365/jpsych.2024.018. Online ahead of print.

ABSTRACT

The negative consequences of the COVID-19 pandemic and the subsequent restrictive measures on the mental health and well-being of the population and psychiatric patients have been widely recognized. Patients’ treatment attendance and engagement with mental health services had been negatively affected by the pandemic, whereas patients were less likely to receive timely outpatient care. The pandemic also impacted the use of inpatient services. The aim of the present study was to explore the variability of attendance and admissions to a general hospital psychiatric ward over a 12-month interval after the onset of the pandemic (March 2020), compared to the respective 12-month pre-pandemic interval. A retrospective, observational pre/post study was performed, involving a general hospital psychiatric ward in Corfu, Northwest Greece, which serves an insular catchment area of approximately 100,000 inhabitants. For data analysis, c- and u-charts of statistical process control charts were employed, using monthly data (March 2019 to February 2021). Overall, a significant decline in attendance rates was observed, mostly accounted for by a 26.5% reduction in voluntary attendance rates (1516 patients prior vs. 1114 patients after the onset of the pandemic). The involuntary commitment of patients did not differ between the two periods (106 prior vs. 100 after the onset of the pandemic). Admission rates did not change significantly between the two periods. Diagnoses that exhibited significant variance in examinations between the two study periods were mood disorders and personality disorders, whereas there was no significant variation in the number of admissions across different diagnoses. Length of hospital stay increased significantly by 13.2% over the first year of the pandemic, from 25.57 days (Md= 13, IQR= 22) during the pre-COVID-19 period to 28.95 days (Md= 22, IQR= 28) during the COVID-19 period. Patients with schizophrenia and related disorders (Mean= 34.25 days, SD= 43.19) and mood disorders (Mean= 26.26, SD= 33.48) had prolonged hospital stays compared to other diagnoses. These findings highlight significant shifts in psychiatric care delivery during the pandemic and underscore the need for targeted interventions to address the evolving demands on mental health services during public health crises.

PMID:39637420 | DOI:10.22365/jpsych.2024.018

J Am Acad Orthop Surg. 2024 Dec 3. doi: 10.5435/JAAOS-D-24-00325. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the clinical outcomes in patients who underwent bilateral total shoulder arthroplasty (TSA) at a single institution. Secondarily, we evaluated the influence of the time interval between successive TSAs on clinical outcomes of the second TSA.

METHODS: A single-institution shoulder arthroplasty database was reviewed for patients undergoing bilateral primary anatomic TSA (aTSA) or reverse TSA (rTSA) between 2000 and 2022. Clinical outcomes, including outcome scores, range of motion, and shoulder strength, were assessed in patients with minimum 2-year follow-up. Postoperative complications and achievement of the minimal clinical important difference, substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were evaluated. Statistical comparisons were made between first and second TSAs, between TSA variations, and based on time between TSAs (<1, 1 to 5, >5 years).

RESULTS: We identified 180 bilateral TSA patients (68 aTSA/aTSA, 29 aTSA/rTSA, three rTSA/aTSA, 80 rTSA/rTSA). When evaluating side-to-side differences, the second rTSA in the aTSA/rTSA group had more favorable postoperative Shoulder Pain and Disability Index (P = 0.032) and forward elevation strength (P = 0.028) compared with the first aTSA. No other side-to-side comparisons were statistically significant or exceeded the minimal clinical important difference, SCB, or PASS. Patients undergoing second aTSA after first aTSA or undergoing first rTSA had superior SCB and PASS for active external rotation (P = 0.009 and P = 0.005, respectively). Complications were similar between strata, but revision rates were lowest after first rTSA in rTSA/rTSA patients. The time interval between successive TSAs did not influence the clinical outcome.

CONCLUSION: All bilateral TSA combinations demonstrated excellent outcomes with most patients achieving clinically relevant benchmarks, with no influence of timing between arthroplasties.

LEVEL OF EVIDENCE: III, retrospective comparative cohort study.

PMID:39637405 | DOI:10.5435/JAAOS-D-24-00325

Kardiologiia. 2024 Nov 30;64(11):106-116. doi: 10.18087/cardio.2024.11.n2794.

ABSTRACT

Aim To identify metabolomic and structure and function markers of remote left ventricular (LV) remodeling in patients with chronic heart failure (CHF) of ischemic etiology and LV ejection fraction (EF) &lt;50%.Material and methods This prospective study included 56 patients with 3-4 NYHA functional class CHF of ischemic etiology (mean age, 66±7 years) and 50 patients with ischemic heart disease (IHD) without signs of CHF (69 [64; 73.7] years). Concentration of 19 amino acids, 11 products of kynurenine catabolism of tryptophan, 30 acylcarnitines with different chain lengths were measured in all participants. The metabolites that showed statistical differences between the comparison groups were then used for the analysis. Echocardiography was used to assess LV cavity remodeling at the time of the CHF patient inclusion in the study and after 6 months of follow-up. Predictors of long-term LV cavity remodeling were assessed for this cohort taking into account statistically significant echocardiographic parameters and metabolites.Results Patients with CHF of ischemic etiology, predominantly (81%) had pathological calculated types of LV remodeling (concentric and eccentric hypertrophy, 46 and 35%, respectively). However, this classification had limitations in describing this cohort. In addition, in this group, the concentrations of alanine, proline, asparagine, glycine, arginine, histidine, lysine, valine, indolyl-3-acetic acid, indolyl-3-propionic acid, C16-1-OH, and C16-OH were significantly (p&lt;0.05) lower, and the concentrations of most medium- and long-chain acylcarnitines were higher than in patients with IHD without signs of CHF. The long-term (6 months) reverse remodeling of the LV cavity in CHF of ischemic etiology was influenced by changes in the interventricular septum thickness (hazard ratio, HR, 19.07; 95% confidence interval, CI, 1.76-206.8; p=0.006) and concentrations of anthranilic acid (HR 19.8; 95% CI 1.01-387.8; p=0.019) and asparagine (HR 8.76; 95% CI 1.07-71.4; p=0.031).Conclusion The presence of an interventricular septum thickness of more than 13.5 mm, anthranilic acid concentrations of higher than 0.235 μM/l, or an asparagine concentration of less than 135.2 μM/l in patients with CHF of ischemic etiology after 6 months of follow-up affects their achievement of LV cavity reverse remodeling.

PMID:39637396 | DOI:10.18087/cardio.2024.11.n2794

Kardiologiia. 2024 Nov 30;64(11):96-105. doi: 10.18087/cardio.2024.11.n2781.

ABSTRACT

Aim To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P&lt;0.001 was considered significant.Results The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p&lt;0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.

PMID:39637395 | DOI:10.18087/cardio.2024.11.n2781

Kardiologiia. 2024 Nov 30;64(11):84-95. doi: 10.18087/cardio.2024.11.n2783.

ABSTRACT

Aim To evaluate the risks of all-cause death (ACD), cardiovascular death (CVD), death from recurrent acute decompensated heart failure (ADHF), and a composite index of CVD and death from recurrent ADHF in patients with chronic heart failure (CHF) after the first hospitalization for ADHF during a long-term, five-year follow-up in the conditions of specialized medical care and in real clinical practice.Material and methods This prospective cohort observational study included 942 patients after ADHF. Group 1 consisted of 510 patients who continued the outpatient follow-up at a specialized center for the treatment of CHF (cCHF); group 2 consisted of 432 patients followed up at outpatient and polyclinic institutions (OPI) at the place of residence. During the five-year follow-up, the causes of death were determined based on the medical records of inpatients, postmortem examinations, or the conclusion in the medical records of outpatients. Rates of ACD, CVD, death from recurrent ADHF, and the composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with a R statistical package.Results ACD was 32.3% and 53.5% in groups 1 and 2, respectively (p&lt;0.001). Based on the results of Cox proportional hazards models, it was shown that the follow-up in group 1, regardless of other factors, was associated with a decrease in the ACD risk (HR 2.07; 95% CI 1.68-2.54; p&lt;0.001), CVD (HR 1.94; 95% CI 1.26-2.97; p=0.002), death from recurrent ADHF (HR 2.4; 95% CI 1.66-3.42; p&lt;0.001) and the composite mortality index (HR 2.2; 95% CI 1.65-2.85; p&lt;0.001) compared to group 2. The risks of death in CHF patients with moderately reduced left ventricular ejection fraction (LVEF) (HFmrEF) were consistent with the death rates in CHF patients with low LVEF (HFrEF) and were significantly higher than in CHF patients with preserved LVEF (HFpEF). The prognosis of life worsened with an increase in the Clinical Condition Assessment Scale score and age. The prognosis of life was better in women, as well as with higher values of systolic blood pressure (BP) and 6-minute walk test. In the structure of death in both groups, death from ADHF and sudden cardiac death (SCD) prevailed.Conclusion The absence of specialized follow-up at an outpatient CHF center increases the risks of ACD, CVD, death from recurrent ADHF, and the composite endpoint at a depth of five-year observation. The leading causes of death were recurrent ADHF and SCD.

PMID:39637394 | DOI:10.18087/cardio.2024.11.n2783

Kardiologiia. 2024 Nov 30;64(11):76-83. doi: 10.18087/cardio.2024.11.n2733.

ABSTRACT

Aim To analyze the results of myocardial revascularization in the Russian Federation (RF) for ACS in 2023 compared to previous years.Material and methods The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), myocardial revascularization in the above-listed ACS forms, the number of fatal outcomes depending on the ACS form and the revascularization method used. The data for this analysis were obtained from the 2023 Ministry of Health of Russia monitoring in the section of revascularization in ACS and were compared with the data for the past 8 years.Results, conclusion In 2023, 438,315 patients were hospitalized for ACS in the Russian Federation: 309,158 with NSTE-ACS and 148,729 with STEMI. The total number of hospitalizations for ACS per 1 million of the Russian population was 2,982: 1,011 with STEMI and 2,103 with NSTE-ACS. The availability of primary PCI in 2023 reached its maximum of 55.3% compared to previous years; the total number of PCI for STEMI was 75.7%, and the mortality rate in the whole STEMI group was a minimum of 10.7% for the past 8 years. In 2023, the maximum number of PCIs for NSTE-ACS for the past 8 years was recorded, both in absolute values (120,990) and in relative values (39.1%). In the whole NSTE-ACS group, mortality was 2.5%, which was also the lowest for the past 8 years.

PMID:39637393 | DOI:10.18087/cardio.2024.11.n2733

J Med Internet Res. 2024 Dec 5;26:e49927. doi: 10.2196/49927.

ABSTRACT

BACKGROUND: Previous efforts to apply machine learning-based natural language processing to longitudinally collected social media data have shown promise in predicting suicide risk.

OBJECTIVE: Our primary objective was to externally validate our previous machine learning algorithm, the Suicide Artificial Intelligence Prediction Heuristic (SAIPH), against external survey data in 2 independent cohorts. A second objective was to evaluate the efficacy of SAIPH as an indicator of changing suicidal ideation (SI) over time. The tertiary objective was to use SAIPH to evaluate factors important for improving or worsening suicidal trajectory on social media following suicidal mention.

METHODS: Twitter (subsequently rebranded as X) timeline data from a student survey cohort and COVID-19 survey cohort were scored using SAIPH and compared to SI questions on the Beck Depression Inventory and the Self-Report version of the Quick Inventory of Depressive Symptomatology in 159 and 307 individuals, respectively. SAIPH was used to evaluate changing SI trajectory following suicidal mentions in 2 cohorts collected using the Twitter application programming interface.

RESULTS: An interaction of the mean SAIPH score derived from 12 days of Twitter data before survey completion and the average number of posts per day was associated with quantitative SI metrics in each cohort (student survey cohort interaction β=.038, SD 0.014; F_4,94=3.3, P=.01; and COVID-19 survey cohort interaction β=.0035, SD 0.0016; F_4,493=2.9, P=.03). The slope of average daily SAIPH scores was associated with the change in SI scores within longitudinally followed individuals when evaluating periods of 2 weeks or less (ρ=0.27, P=.04). Using SAIPH as an indicator of changing SI, we evaluated SI trajectory in 2 cohorts with suicidal mentions, which identified that those with responses within 72 hours exhibit a significant negative association of the SAIPH score with time in the 3 weeks following suicidal mention (ρ=-0.52, P=.02).

CONCLUSIONS: Taken together, our results not only validate the association of SAIPH with perceived stress, SI, and changing SI over time but also generate novel methods to evaluate the effects of social media interactions on changing suicidal trajectory.

PMID:39637380 | DOI:10.2196/49927