Category: Statistics

J Glaucoma. 2024 Mar 19. doi: 10.1097/IJG.0000000000002372. Online ahead of print.

ABSTRACT

PRCIS: Elevated corneal hysteresis (CH) and resistance factor (CRF) in obese and over-weight children imply weight’s effect on corneal biomechanics. Increased Goldmann-correlated intraocular pressure (IOPg) in obese indicates glaucoma risk, emphasizing screening for IOP, retinal changes.

PURPOSE: To evaluate the effect of obesity on corneal biomechanics, retinal nerve fibre layer (RNFL) and central macular thicness (CMT) in children.

PATIENTS AND METHODS: In this prospective, cross-sectional, comparative study, 146 eyes of normal-weight, over-weight, and obese children aged between 6 to 17 years were evaluated. The IOPg, corneal compensated IOP (IOPcc), CH, CRF and the average retinal nerve fiber layer (RNFL), average cup-to-disk ratio (c/d), central macular thickness (CMT) were measured by Ocular Response Analyser and Spectral-Domain Optical Coherence Tomography (SD-OCT), respectively.

RESULTS: There was no statistically significant difference regarding age, sex, IOPcc, average RNFL thickness, c/d ratio, and CMT among the groups (P≥0.05). The IOPg was significantly higher in obese children compared to normal-weight children, while CH and CRF values were significantly higher in both obese and over-weight children compared to healthy ones (P<0.05). There was a positive correlation between BMI percentile and IOPg, CH, and CRF values.

CONCLUSION: In our study, higher IOPg, corneal hysteresis, and corneal resistance factor values suggest that obese children could be potential candidates for glaucoma. Therefore, it would be appropriate to screen them for IOP and retinal alterations. On the other hand, further investigations with larger sample sizes and longer follow-up periods are needed to eliminate the risk of glaucoma in obese children.

PMID:38506830 | DOI:10.1097/IJG.0000000000002372

JAMA Psychiatry. 2024 Mar 20. doi: 10.1001/jamapsychiatry.2024.0171. Online ahead of print.

ABSTRACT

IMPORTANCE: Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies.

OBJECTIVE: To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023.

EXPOSURES: Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods.

MAIN OUTCOMES AND MEASURES: Disclosure of recent intent, suicide note presence, and known psychotropic usage.

RESULTS: Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]).

CONCLUSIONS AND RELEVANCE: This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

PMID:38506817 | DOI:10.1001/jamapsychiatry.2024.0171

JAMA Netw Open. 2024 Mar 4;7(3):e243109. doi: 10.1001/jamanetworkopen.2024.3109.

ABSTRACT

IMPORTANCE: Platform trials have become increasingly common, and evidence is needed to determine how this trial design is actually applied in current research practice.

OBJECTIVE: To determine the characteristics, progression, and output of randomized platform trials.

EVIDENCE REVIEW: In this systematic review of randomized platform trials, Medline, Embase, Scopus, trial registries, gray literature, and preprint servers were searched, and citation tracking was performed in July 2022. Investigators were contacted in February 2023 to confirm data accuracy and to provide updated information on the status of platform trial arms. Randomized platform trials were eligible if they explicitly planned to add or drop arms. Data were extracted in duplicate from protocols, publications, websites, and registry entries. For each platform trial, design features such as the use of a common control arm, use of nonconcurrent control data, statistical framework, adjustment for multiplicity, and use of additional adaptive design features were collected. Progression and output of each platform trial were determined by the recruitment status of individual arms, the number of arms added or dropped, and the availability of results for each intervention arm.

FINDINGS: The search identified 127 randomized platform trials with a total of 823 arms; most trials were conducted in the field of oncology (57 [44.9%]) and COVID-19 (45 [35.4%]). After a more than twofold increase in the initiation of new platform trials at the beginning of the COVID-19 pandemic, the number of platform trials has since declined. Platform trial features were often not reported (not reported: nonconcurrent control, 61 of 127 [48.0%]; multiplicity adjustment for arms, 98 of 127 [77.2%]; statistical framework, 37 of 127 [29.1%]). Adaptive design features were only used by half the studies (63 of 127 [49.6%]). Results were available for 65.2% of closed arms (230 of 353). Premature closure of platform trial arms due to recruitment problems was infrequent (5 of 353 [1.4%]).

CONCLUSIONS AND RELEVANCE: This systematic review found that platform trials were initiated most frequently during the COVID-19 pandemic and declined thereafter. The reporting of platform features and the availability of results were insufficient. Premature arm closure for poor recruitment was rare.

PMID:38506807 | DOI:10.1001/jamanetworkopen.2024.3109

JAMA Netw Open. 2024 Mar 4;7(3):e243201. doi: 10.1001/jamanetworkopen.2024.3201.

ABSTRACT

IMPORTANCE: The emergence and promise of generative artificial intelligence (AI) represent a turning point for health care. Rigorous evaluation of generative AI deployment in clinical practice is needed to inform strategic decision-making.

OBJECTIVE: To evaluate the implementation of a large language model used to draft responses to patient messages in the electronic inbox.

DESIGN, SETTING, AND PARTICIPANTS: A 5-week, prospective, single-group quality improvement study was conducted from July 10 through August 13, 2023, at a single academic medical center (Stanford Health Care). All attending physicians, advanced practice practitioners, clinic nurses, and clinical pharmacists from the Divisions of Primary Care and Gastroenterology and Hepatology were enrolled in the pilot.

INTERVENTION: Draft replies to patient portal messages generated by a Health Insurance Portability and Accountability Act-compliant electronic health record-integrated large language model.

MAIN OUTCOMES AND MEASURES: The primary outcome was AI-generated draft reply utilization as a percentage of total patient message replies. Secondary outcomes included changes in time measures and clinician experience as assessed by survey.

RESULTS: A total of 197 clinicians were enrolled in the pilot; 35 clinicians who were prepilot beta users, out of office, or not tied to a specific ambulatory clinic were excluded, leaving 162 clinicians included in the analysis. The survey analysis cohort consisted of 73 participants (45.1%) who completed both the presurvey and postsurvey. In gastroenterology and hepatology, there were 58 physicians and APPs and 10 nurses. In primary care, there were 83 physicians and APPs, 4 nurses, and 8 clinical pharmacists. The mean AI-generated draft response utilization rate across clinicians was 20%. There was no change in reply action time, write time, or read time between the prepilot and pilot periods. There were statistically significant reductions in the 4-item physician task load score derivative (mean [SD], 61.31 [17.23] presurvey vs 47.26 [17.11] postsurvey; paired difference, -13.87; 95% CI, -17.38 to -9.50; P < .001) and work exhaustion scores (mean [SD], 1.95 [0.79] presurvey vs 1.62 [0.68] postsurvey; paired difference, -0.33; 95% CI, -0.50 to -0.17; P < .001).

CONCLUSIONS AND RELEVANCE: In this quality improvement study of an early implementation of generative AI, there was notable adoption, usability, and improvement in assessments of burden and burnout. There was no improvement in time. Further code-to-bedside testing is needed to guide future development and organizational strategy.

PMID:38506805 | DOI:10.1001/jamanetworkopen.2024.3201

J Glaucoma. 2024 Mar 11. doi: 10.1097/IJG.0000000000002375. Online ahead of print.

ABSTRACT

PRECIS: Our study highlights the long-term success of trabeculectomy or AGV surgery in subjects with glaucoma secondary to ICE syndrome. However, many of ICE syndrome cases may need multiple glaucoma surgeries to achieve controlled IOP, with/without concomitant corneal graft surgery.

PURPOSE: To evaluate the long-term outcome of trabeculectomy and Ahmed glaucoma valve (AGV) implantation in iridocorneal endothelial syndrome (ICE).

METHODS: Patients with glaucoma secondary to ICE syndrome who underwent either trabeculectomy or AGV surgery with intraoperative adjunctive MMC from 2009 to 2020 were included in this study. All patients were followed for at least 6 months after initial surgery. The main outcome measures were intraocular pressure (IOP), number of IOP lowering medications and surgical success. Surgical success was defined as complete according to the levels of IOP (<18) and at least 20% reduction from preoperative IOP without medications and qualified as complete success but with medications, where the number of medications was less than preoperative numbers. Cumulative success was the sum of the qualified and complete success.

RESULTS: Twenty-nine eyes of 29 patients were included. Trabeculectomy was done in 13 patients (group A, 44.8%) and 16 patients underwent AGV surgery (group B, 55.2%). The median age was 50(42-56.50) and 47(36.75-52.75) years in groups A and B, respectively (P value=0.10). All patients completed at least 2 years of follow up. Mean IOP was not significantly different between groups preoperatively (P=0.70) and the effect of the type of surgery on IOP was not statistically significant at multiple follow-up time points (repeated measures ANOVA, P=0.44). The mean IOP decreased from 35.76±6.36 mmHg preoperatively to 16.00+3.10 in group A and from 36.12+8.11 mmHg to 17.00+3.75 in group B (P=0.449) at year 2 of follow-up. The effect of the type of surgery was not significant on the total number of IOP lowering medications used throughout the study (repeated measures ANOVA, P=0.81). Kaplan-Meier analysis show complete success in 14 patients (48.3%), 11 patients (37.9%) and 7 patients (24.1%) at 6-month, 1 year and 2 years follow-up, respectively. Cumulative success rate was 95% at two years follow-up for all patients.

CONCLUSIONS: In 2 year follow up, trabeculectomy or AGV could significantly reduce the IOP in glaucoma patients secondary to ICE syndrome.

PMID:38506803 | DOI:10.1097/IJG.0000000000002375

Mayo Clin Proc. 2024 Mar 12:S0025-6196(23)00572-4. doi: 10.1016/j.mayocp.2023.11.022. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine differences in the incidence and prevalence of diagnosed diabetes by county rurality.

PATIENTS AND METHODS: This observational, cross-sectional study used US Centers for Disease Control and Prevention data from 2004 through 2019 for county estimates of incidence and prevalence of diagnosed diabetes. County rurality was based on 6 levels (large central metro counties [most urban] to noncore counties [most rural]). Weighted least squares regression was used to relate rurality with diabetes incidence rates (IRs; per 1000 adults) and prevalence (percentage) in adults aged 20 years or older after adjusting for county-level sociodemographic factors (eg, food environment, health care professionals, inactivity, obesity).

RESULTS: Overall, in 3148 counties and county equivalents, the crude IR and prevalence of diabetes were highest in noncore counties. In age and sex ratio-adjusted models, the IR of diabetes increased monotonically with increasing rurality (P<.001), whereas prevalence had a weak, nonmonotonic but statistically significant increase (P=.002). Further adjustment for sociodemographic factors including food environment, health care professionals, inactivity, and obesity attenuated differences in incidence across rurality levels, and reversed the pattern for prevalence (prevalence ratios [vs large central metro] ranged from 0.98 [95% CI, 0.97 to 0.99] for large fringe metro to 0.94 [95% CI, 0.93 to 0.96] for noncore). In region-stratified analyses adjusted for sociodemographic factors including inactivity and obesity, increasing rurality was inversely associated with incidence in the Midwest and West only and inversely associated with prevalence in all regions.

CONCLUSION: The crude incidence and prevalence of diagnosed diabetes increased with increasing county rurality. After accounting for sociodemographic factors including food environment, health care professionals, inactivity, and obesity, county rurality showed no association with incidence and an inverse association with prevalence. Therefore, interventions targeting modifiable sociodemographic factors may reduce diabetes disparities by region and rurality.

PMID:38506780 | DOI:10.1016/j.mayocp.2023.11.022

J Adolesc Health. 2024 Mar 11:S1054-139X(24)00070-3. doi: 10.1016/j.jadohealth.2024.01.034. Online ahead of print.

ABSTRACT

PURPOSE: To identify intimate partner violence (IPV)-related injury patterns of U.S. patients of three age groups: <18 years (adolescents), 18-25 years (emerging adults), and >25 years (adults).

METHODS: We performed a nationally representative retrospective review of all patients presenting to U.S. Emergency Department for IPV-related injuries from 2005 through 2020. Demographics and injury patterns were calculated using statistical methods accounting for the weighted stratified data. Main outcomes were injury morphology, mechanism, severity, location, and temporal associations of IPV-related injuries among the three age groups.

RESULTS: There was a higher proportion of female victims, sexual assault cases, and lower trunk injuries among adolescents compared to emerging adults and adults. There was increasing injury severity, fractures, and hospital admissions with increasing age. Adolescents experienced a greater prevalence of fractures of the head, neck, hands, fingers, and distal lower extremity, while trunk fractures increased with age. The peak prevalence of violence-related Emergency Department visits among adolescents was in June and September, with the peak day as Tuesday.

DISCUSSION: Injurious forms of IPV are prevalent across all age groups, with sexual assault cases demonstrably higher among adolescents and increasing severity of injuries as victims age. Identification of age-specific injury patterns will aid health-care professionals and policymakers in developing targeted interventions for adolescents who experience IPV.

PMID:38506777 | DOI:10.1016/j.jadohealth.2024.01.034

Am J Orthod Dentofacial Orthop. 2024 Mar 19:S0889-5406(24)00061-1. doi: 10.1016/j.ajodo.2024.01.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Clear aligner technology based on a machine learning algorithm is currently available for orthodontic treatment. Treatment planning on the basis of 3-dimensional crown, root, and bone imaging is claimed to provide accurate diagnosis and better treatment outcomes for adult patients with complex needs. This study aimed to answer the following questions: (1) would practitioners modify their original treatment plan once provided with the crown, root, and bone view? and (2) does practitioner satisfaction regarding treatment outcomes change once the crown, root, and bone view is provided?

METHODS: An online questionnaire was emailed to members of the American Association of Orthodontists (n = 2300) and the Virginia Orthodontic Education and Research Foundation (n = 211). The survey consisted of videos of 4 patients shown in 2 presentations: crown-only and crown, root, and bone views, generated by artificial intelligence-driven treatment planning software (3D Predict aligner system; 3D Predict, New York, NY). Respondents were asked to answer treatment-related questions and rate the treatment outcomes using a visual analog scale. Statistical analyses were completed to determine the significance of crown, root, and bone view on treatment planning with clear aligners.

RESULTS: A total of 70 orthodontists participated in the survey. There were significant differences in responses when viewing patients in crown-only and crown, root, and bone presentations. Across the 4 patients, 33%-43% of practitioners changed their sentiment toward the treatment plan (P <0.001). When rating satisfaction on the 100-point scale, average ratings changed by 10.6 to 21.0 points; both increases and decreases in satisfaction were seen across the patients (P <0.001).

CONCLUSIONS: When given 3-dimensional information on the position of a patient’s crowns, root, and bone coverage, orthodontists are likely to change their clear aligner treatment plan. This study showed that a confirmation of dehiscence and fenestrations using the root and bone view resulted in practitioner dissatisfaction despite an initial satisfaction with the crown-only view.

PMID:38506775 | DOI:10.1016/j.ajodo.2024.01.014

Fam Med. 2024 Mar 18. doi: 10.22454/FamMed.2024.956897. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Despite the increasing number of sexual and gender minority (SGM) patients in the United States and designation by the National Institutes of Health as a population with health disparities, available tools are lacking to train medical students on appropriate care for this population. Therefore, we developed and implemented a novel, self-directed, 2-week online elective for undergraduate medical students. The objective of our study was to evaluate the effectiveness of this course in increasing medical students’ competency and confidence in caring for SGM patients.

METHODS: We developed the curriculum using Kern’s six-step model for curriculum development. We created anonymous pre- and postcourse surveys using the standardized Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Survey (LGBT-DOCSS) questionnaire to assess cultural competence, as well as a 5-point Likert-scored survey to assess self-perceived confidence in the care of SGM patients. We tested the statistical significance in pre- and postsurvey scores via paired sample t tests in R (R Project for Statistical Computing).

RESULTS: We found statistically significant increases in the LGBT-DOCSS categories of clinical preparedness (P&lt;.001), basic knowledge (P&lt;.001), overall competency (P&lt;.001), and self-perceived confidence in caring for SGM patients (P&lt;.001, N=33).

CONCLUSIONS: The course represents an effective solution for increasing medical students’ self-perceived competence and confidence in caring for SGM patients. The flexibility and ease of the online format may be appealing to both students and institutions, and ultimately can serve to increase access to crucial content that is largely absent from current undergraduate medical education. Future evaluation efforts will be required to determine whether the course impacts long-term behavioral changes and outcomes.

PMID:38506704 | DOI:10.22454/FamMed.2024.956897

Fam Med. 2024 Mar 19. doi: 10.22454/FamMed.2024.269942. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: We submitted research questions to the Council of Academic Family Medicine Educational Research Alliance (CERA) to assess the format of family medicine resident education about health disparities associated with incarceration and the perceived efficacy of efforts to prepare graduates for competent care of formerly incarcerated patients in practice. We think this is a universal problem, and current efforts are insufficient.

METHODS: We evaluated data as part of the fall 2022 CERA survey of program directors (PDs). We reviewed descriptive statistics, generated comparative analysis, and reported relational analysis. We analyzed internal structure with principal component analysis and inter-item reliability.

RESULTS: A total of 286 out of 678 (42%) eligible PDs completed the survey. Most respondents felt that educating residents about health disparities associated with incarceration was important and that residents would welcome that education. However, PDs lacked existing curricula. PDs did not think that medical school graduates were well-prepared in this area, and ambivalence existed about whether residency graduates were well-prepared to treat formerly incarcerated patients upon graduation. Comparative analysis revealed differences in responses based on the type of program, the program and community size, and the PD demographics.

CONCLUSIONS: PDs acknowledged the importance of training residents about health disparities associated with incarceration and about care for formerly incarcerated patients in practice. However, they identified a gap between what was currently offered and what is needed to impact perception of resident readiness upon graduation. This training was felt to be most important in university-based programs with 31+ residents in US communities of greater than 150,000 people. We found no difference based on geographic location.

PMID:38506703 | DOI:10.22454/FamMed.2024.269942