Category: Statistics

J Neurosurg Spine. 2025 Mar 28:1-7. doi: 10.3171/2024.11.SPINE23706. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to determine efficiencies associated with dual-position versus single-position lateral lumbar interbody fusion (LLIF).

METHODS: Billing databases were queried for LLIF procedures performed by a single surgeon at a high-volume tertiary care center. Case-specific costs for each procedure were collected. Cases were matched by the number of levels treated. One-level and 2-level LLIFs with percutaneous pedicle screw (PPS) fixation (LLIF+PPS) using a single vendor system were included. Length of stay, operative time, and operative costs were compared for dual-position and single-position LLIF cases using continuous and categorical variable comparisons.

RESULTS: Among 9 patients with 1-level LLIF+PPS, dual-position LLIF+PPS (n = 3) compared with single-position LLIF+PPS (n = 6) was associated with similar mean lengths of stay (2.0 vs 2.2 days), longer operating room time (160.1 vs 149.7 minutes), and greater mean costs for operating room staff and supplies ($1347 vs $1263); however, the differences were not statistically significant. Time-based anesthesiology costs were higher for dual-position LLIF+PPS than for single-position LLIF+PPS ($741 vs $521, p = 0.03). Among 8 patients with 2-level LLIF+PPS, patients undergoing dual-position (n = 5) and single-position (n = 3) LLIF+PPS had similar mean lengths of stay (1.2 vs 1.5 days). However, dual-position surgery was associated with a longer mean operating room time (257.8 vs 182.3 minutes, p = 0.03), greater mean operating room cost ($2275 vs $1352, p = 0.02), and greater time-based cost of anesthesiology coverage ($864 vs $644, p = 0.01).

CONCLUSIONS: In this cohort of patients undergoing 1- and 2-level LLIF+PPS, single-position surgery was associated with shorter operating room time, lower operating room costs, and similar postoperative hospital length of stay when compared with dual-position surgery for a similar pathology.

PMID:40153840 | DOI:10.3171/2024.11.SPINE23706

J Gastrointestin Liver Dis. 2025 Mar 28;34(1):81-89. doi: 10.15403/jgld-5873.

ABSTRACT

BACKGROUND AND AIMS: Tumor recurrence poses a significant challenge post-liver transplantation (LT) for hepatocellular carcinoma (HCC), necessitating the development of more precise predictive tools. In this study we aimed to investigate nucleolin as a biomarker for predicting HCC recurrence after LT.

METHODS: A cohort of 241 HCC patients undergoing LT was enrolled from three medical facilities spanning January 1, 2015, to December 31, 2017. Utilizing tissue microarrays, we assessed the predictive potential of nucleolin. Survival analyses, including Kaplan-Meier and log-rank tests, were employed to scrutinize overall survival and recurrence-free survival. Based on univariate and multivariate Cox regression analyses of preoperative parameters, nomogram and risk score were designed to predict HCC recurrence and determine the effectiveness of the model.

RESULTS: The expression of nucleolin in HCC nucleus was increased. High nucleolin expression in tumor tissues correlated with poor overall survival and recurrence-free survival (5-year overall survival ratios: 34% vs. 64.8%, 5-year recurrence-free survival ratios: 36.1% vs.67.9%, all p<0.001). Multivariate Cox regression analysis identified nucleolin expression score, Hangzhou criteria, HBsAg, tumor differentiation and alpha-fetoprotein level as independent risk factors for tumor recurrence in HCC patients post- LT. A new nomogram is established based on the above risk factors with effective prediction efficiency (area under time-dependent receiver operating characteristic =0.742, concordance-index =0.7742).

CONCLUSIONS: Nucleolin can be combined with a nomogram as an effective tool to predict recurrence in HCC patients following LT.

PMID:40153827 | DOI:10.15403/jgld-5873

J Gastrointestin Liver Dis. 2025 Mar 27;34(1):64-70. doi: 10.15403/jgld-5926.

ABSTRACT

BACKGROUND AND AIMS: Late-evening snacks bring multiple benefits to liver cirrhosis patients. However, a consensus on the nutrient composition of the snack is still not clear. This study showed a direct comparison between a protein snack and a a branched-chained amino acid (BCAA) snack.

METHODS: A randomized clinical trial with 32 Vietnamese liver cirrhosis outpatients (61.0, 57-63 years), allocated into two groups: Protein group (n=16) and BCAA group (n=16) took place. Both groups received a snack providing 270-300 kcal, 50g carbohydrates, <5g lipid, and 13g of protein with 8g being protein powder in Protein group and 4g protein powder and 4g BCAA powder in BCAA group. Serum biochemical parameters, anthropometric data, and Chronic Liver Disease Questionnaire scores were examined in both groups before and after the 3-week intervention.

RESULTS: After receiving the snacks for 3 weeks, albumin was significantly increased in the Protein group (p<0.01) while it was not in the BCAA group. Only the ALT liver enzyme was statistically decreased in the Protein group (p<0.01). After the intervention, the handgrip strength of the Protein group increased from 24.3kg (±9.1 SD) to 25.7kg (±9.2 SD) (p=0.012); while, in BCAA group, the mean also changed from 24.7kg (±6.6 SD) to 25.6kg (±7.4 SD) (p=0.237). The overall Chronic Liver Disease Questionnaire score was significantly increased from 6.0 to 6.7 and 6.6 in the Protein group and the BCAA group, respectively.

CONCLUSIONS: A protein snack is an effective dietary intervention in improving albumin, biochemical parameters, and nutritional status for compensated liver cirrhosis outpatients. Considering cost, availability, and taste, a BCAA snack might be unnecessary for liver cirrhosis outpatients.

PMID:40153825 | DOI:10.15403/jgld-5926

J Gastrointestin Liver Dis. 2025 Mar 27;34(1):40-46. doi: 10.15403/jgld-6082.

ABSTRACT

BACKGROUND AND AIMS: Religious fasting observed in diverse populations may influence the reporting of digestive symptoms. Greek-Orthodox (Byzantine style) religious fasting is prolonged and similar to a vegan diet. We aimed to evaluate the association between functional gastrointestinal symptoms and disorders of gut-brain interaction (DGBI) with this religious fasting.

METHODS: We investigated Romanian participants in the Rome Foundation Global Epidemiology Study who observe Greek-Orthodox religious fasting, by adding specific questions on religious fasting to the study questionnaire. Data were analyzed in connection with the reported gastrointestinal symptoms.

RESULTS: 2015 Romanians were included in the analyses. Overall, 716 (35.5%) of the respondents practiced some fasting, of which 446 (62.3%) fasted on Easter and Christmas, 90 (12.6%) observed all fasts, and 625 (87.3%) practiced weekly fasting. Of the latter, 167 (23.3%) fasted every week and 90 (12.6%) reported symptoms during fasting. There were no statistically significant associations between Greek-Orthodox fasting, to any degree, with upper or lower DGBI or gastrointestinal symptoms.

CONCLUSIONS: The results from this representative sample show that a substantial proportion of the Romanian population adheres to Greek-Orthodox fasting. However, in contrast to the a priori hypothesis, we did not have sufficient evidence that religious fasting is associated with the prevalence of DGBI, or with functional gastrointestinal symptoms.

PMID:40153820 | DOI:10.15403/jgld-6082

J Gastrointestin Liver Dis. 2025 Mar 28;34(1):108-114. doi: 10.15403/jgld-5852.

ABSTRACT

BACKGROUND AND AIMS: Constipation is commonly seen among patients with cardiovascular diseases and is linked to adverse outcomes. However, the association between constipation and the risk of acute myocardial infarction (AMI) remains conflicting. Therefore, we aimed to conduct a systematic review and meta-analysis to summarize the available data on this topic.

METHOD: We identified potentially eligible studies from the MEDLINE and EMBASE databases, searching from inception to May 2024, to investigate the association between constipation and the risk of developing AMI. To be included, studies needed to compare incidence of AMI between cohorts with and without constipation. Effect size and 95% confidence intervals (CIs) were combined using the generic inverse variance method. All statistical analyses were performed by Review Manager 5.4.

RESULTS: Our meta-analysis included seven studies that met the eligibility criteria. There were 5,351,976 participants, with a mean age of 57.8 years and 74% were males. We found that patients with constipation had a 14% increased risk of AMI with a pooled risk ratio (RR) of 1.14 (95%CI: 1.08-1.14; I²=85%; p<0.001) compared to those without constipation.

CONCLUSIONS: Our study revealed that constipation is associated with a higher risk of AMI. Emphasizing and addressing gastrointestinal health, including constipation, as an important issue is essential for comprehensive cardiovascular care.

PMID:40153815 | DOI:10.15403/jgld-5852

J Med Internet Res. 2025 Mar 28;27:e65269. doi: 10.2196/65269.

ABSTRACT

BACKGROUND: The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior.

OBJECTIVE: We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations.

METHODS: A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34% (14/41) of studies rated as good quality and 66% (27/41) as satisfactory.

RESULTS: Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I²=95.9%, 93.6%, and 95.3% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects.

CONCLUSIONS: The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations.

PMID:40153796 | DOI:10.2196/65269

J Med Internet Res. 2025 Mar 28;27:e63278. doi: 10.2196/63278.

ABSTRACT

BACKGROUND: Carbohydrate counting (CC) can be burdensome and difficulty with adherence has been reported. Automated CC through mobile apps offers innovative solutions to ease this burden.

OBJECTIVE: This cross-sectional web-based survey aims to identify (1) perceived barriers to CC by Canadians living with type 1 diabetes (T1D) and (2) app features that would help reduce these barriers. The secondary objective aims to compare apps used by participants with the suggested app features.

METHODS: People with T1D aged 14 years and older, living in Canada, were recruited through the BETTER Canadian registry, diabetes organizations, and social media. Participants completed a 39-question web-based survey (closed- and open-ended) to identify barriers in CC, preferred CC app features, and current app use. Respondents rated barriers and app features using a 5-point Likert scale. The features were cross-referenced in each app reported being used by participants. Descriptive statistics summarized barriers and app feature preferences, and statistical analyses identified differences by age, app use, and insulin modality. Mean scores (out of 5) were compared using 2-tailed t tests or nonparametric tests. Open-ended questions were analyzed using inductive thematic analysis.

RESULTS: Participants (N=196; woman: n=145, 74%; mean age 40 [SD 17] years; mean diabetes duration 22 (14) years; relied on CC to determine insulin doses at mealtimes: n=178, 90.8%) reported barriers related to carbohydrate identification, nutrient interaction, and insulin dose calculation, as well as psychosocial factors. Preferred app features included nutrient analysis (165/196, 84.2%), personalization (151/196, 77.1%), insulin bolus calculation (145/196, 74%), and health care professional support (135/196, 68.8%). Among the 16 apps used by participants, most (12/16, 75%) supported nutrient analysis but only one offered bolus calculations or health care professional support, and none offered personalization. Users on injections reported greater barriers to blood glucose monitoring for insulin adjustments compared to exclusive pump users (mean score of 3.87, SD 1.22 vs mean 3.30, SD 1.28; P=.001). They also expressed higher needs for meal logs in an electronic food journal (mean 4.06, SD 1.18 vs mean 3.69, SD 1.17; P=.01), bolus dose suggestions (mean 4.37, SD 0.98 vs mean 3.84, SD 1.26; P=.001), and app personalization (mean 4.47, SD 0.86 vs mean 3.93, SD 1.21; P<.001). No significant differences were observed based on age or app use. The thematic analysis revealed participants’ perceptions of suggested barriers and features, as well as new barriers such as calculation errors from unreliable food data and nutrition labels, fear of eating disorders, limited app reliability, and insufficient health care support, with suggestions for technology-based solutions.

CONCLUSIONS: CC mobile apps currently used do not meet the needs of people with T1D. A novel CC app with app features such as photo recognition, reliable nutrient values, and personalized bolus calculations could reduce the CC burden.

PMID:40153793 | DOI:10.2196/63278

J Med Internet Res. 2025 Mar 28;27:e62957. doi: 10.2196/62957.

ABSTRACT

BACKGROUND: Interest in integrating robotics within intensive care units (ICUs) has been propelled by technological advancements, workforce challenges, and heightened clinical demands, including during the COVID-19 pandemic. The integration of robotics in ICUs could potentially enhance patient care and operational efficiency amid existing challenges faced by health care professionals, including high workload and decision-making complexities.

OBJECTIVE: This qualitative study aimed to explore ICU clinicians’ perceptions of robotic technology and to identify the types of tasks that might benefit from robotic assistance. We focused on the degree of acceptance, perceived challenges, and potential applications for improving patient care in 5 Southeastern US hospitals between January and August 2023.

METHODS: A qualitative study through semistructured interviews and questionnaires was conducted with 15 ICU clinicians (7 nurses, 6 physicians, and 2 advanced practice providers) from 5 hospitals in the Southeast United States. Directed content analysis was used to categorize and interpret participants’ statements, with statistical tests used to examine any role-based differences in how they viewed robotic integration.

RESULTS: Among the 15 participants, 73% (11/15) were female, with an average of 6.4 (SD 6.3) years of ICU experience. We identified 78 distinct tasks potentially suitable for robotic assistance, of which 50 (64%) involved direct patient care (eg, repositioning patients and assisting with simple procedures), 19 (24%) concerned indirect patient care (eg, delivering supplies and cleaning), 6 (8%) addressed administrative tasks (eg, answering call lights), and 3 (4%) were classified as mixed direct and indirect (eg, sitting with a patient to keep them calm). Most participants supported the automation of routine, noncritical tasks (eg, responding to nurse calls and measuring glucose levels), viewing this strategy as a way to alleviate workload and enhance efficiency. Conversely, high-complexity tasks requiring nuanced clinical judgment (eg, ventilator settings) were deemed unsuitable for full automation. Statistical analysis revealed no significant difference in how nurses, physicians, and advanced practice providers perceived these tasks (P=.22).

CONCLUSIONS: Our findings indicate a significant opportunity to use robotic systems to perform noncomplex tasks in ICUs, thereby potentially improving efficiency and reducing staff burden. Clinicians largely view robots as supportive tools rather than substitutes for human expertise. However, concerns persist regarding privacy, patient safety, and the loss of human touch, particularly for tasks requiring high-level clinical decision-making. Future research should involve broader, more diverse clinician samples and investigate the long-term impact of robotic assistance on patient outcomes while also incorporating patient perspectives to ensure ethical, patient-centered adoption of robotic technology.

PMID:40153785 | DOI:10.2196/62957

JMIR Form Res. 2025 Mar 28;9:e69001. doi: 10.2196/69001.

ABSTRACT

BACKGROUND: Subsequent to the COVID-19 pandemic in 2020, a different approach to health care utilization was required to improve safety and efficiency. In the postpandemic era, virtual care and remote assessment of musculoskeletal conditions has become more common, and examining the accuracy of these remote encounters remains vital. In 2023, an innovative, video-based tool-the Virtual Performance Measure (VPM)-was introduced to assess the functional difficulties of patients with osteoarthritis of the knee joint. Further validation of this tool is warranted to expand its application longitudinally and in more diverse populations.

OBJECTIVE: This study examined the longitudinal validity of the VPM, a digitally based outcome tool, in patients with osteoarthritis of the hip and knee joints who had undergone arthroplasty.

METHODS: Patients completed a web-based survey after watching 40 videos that demonstrated 10 functional tasks with increasing difficulty, prior to and at approximately 3-5 months following surgery. The Lower Extremity Functional Scale (LEFS) was used as the reference measure. Longitudinal convergent and known-groups validity as well as sensitivity to change were assessed.

RESULTS: The data of 120 patients (n=80, 67% female; mean age 67, SD 9 years; n=58, 48% with hip osteoarthritis and n=62, 52% with knee osteoarthritis) were examined. There was a statistically significant improvement in both LEFS (t₁₁₉=16.04, P<.001) and VPM total scores (t₁₁₉=13.92, P<.001) over time. The correlation between the postoperative LEFS and VPM scores was higher (r=0.66; P<.001) than the correlation between the change scores of these measures (r=0.51; P<.001). The area under the curve value for the VPM’s ability to differentiate between urgent and nonurgent candidates for surgery was 0.71 (95% CI 0.57-0.84). Sensitivity to change as measured by the standardized response mean was 1.27 (95% CI 1.09-1.45), indicating good ability to detect change over time.

CONCLUSIONS: The VPM demonstrated sufficient longitudinal convergent and known-groups validity as well as sensitivity to change in patients with hip and knee osteoarthritis following arthroplasty. This tool has a potential to improve the delivery of care by increasing access, reducing the frequency of in-person visits, and improving the overall efficiency of the health care system following a major surgery.

PMID:40153784 | DOI:10.2196/69001

J Med Internet Res. 2025 Mar 28;27:e55072. doi: 10.2196/55072.

ABSTRACT

BACKGROUND: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health.

OBJECTIVE: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health.

METHODS: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis.

RESULTS: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use.

CONCLUSIONS: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology.

PMID:40153777 | DOI:10.2196/55072