Category: Statistics

JMIR Cancer. 2025 Sep 10;11:e58657. doi: 10.2196/58657.

ABSTRACT

BACKGROUND: Electronic health records (EHRs) are a cornerstone of modern health care delivery, but their current configuration often fragments information across systems, impeding timely and effective clinical decision-making. In gynecological oncology, where care involves complex, multidisciplinary coordination, these limitations can significantly impact the quality and efficiency of patient management. Few studies have examined how EHR systems support clinical decision-making from the perspective of end users. This study aimed to explore multiprofessional experiences of EHR use in gynecological oncology and to develop a co-designed informatics platform to improve decision-making for ovarian cancer care.

OBJECTIVE: This study aims to evaluate the perspectives of health care professionals on retrieving routine clinical data from EHRs in the management of ovarian cancer and to design an integrated informatics platform that supports clinical decision-making.

METHODS: We conducted a national cross-sectional survey of 92 UK-based professionals working in gynecological oncology, including oncologists, nurses, radiologists, and other specialists in ovarian cancer. The web-based questionnaire, combining quantitative and free-text responses, assessed their experiences with EHR use, focusing on information retrieval, usability challenges, perceived risks, and benefits. In parallel, a human-centered design approach involving health care professionals, data engineers, and informatics experts codeveloped a digital informatics platform that integrates structured and unstructured data from multiple clinical systems into a unified patient summary view for clinical decision-making. Natural language processing was applied to extract genomic and surgical information from free-text records, with data pipelines validated by clinicians against original clinical system sources.

RESULTS: Among 92 respondents, 84 out of 91 (92%) routinely accessed multiple EHR systems, with 26 out of 91 (29%) using 5 or more. Notably, 16 out of 92 respondents (17%) reported spending more than 50% of their clinical time searching for patient information. Key challenges included lack of interoperability (35/141 reported challenges, 24.8%), difficulty locating critical data such as genetic results (57/85 respondents, 67%), and poor organization of information. Only 10 out of 92 professionals (11%) strongly agreed that their systems provided well-organized data for clinical use. While ease of access to patient data was a key benefit, 54 out of 90 respondents (60%) reported lacking access to comprehensive patient summaries. To address these issues, our co-designed informatics platform consolidates disparate patients’ data from different EHR systems into a single visual display to support clinical decision-making and audit.

CONCLUSIONS: Current EHR systems are suboptimal for supporting complex gynecological oncology care. Our findings highlight the urgent need for integrated, user-centered clinical decision tools. Fragmentation and lack of interoperability hinder information retrieval and may compromise patient care. Our co-designed ovarian cancer informatics platform is a potential real-world solution to improve data visibility, clinical efficiency, and ultimately the quality of ovarian cancer care.

PMID:40929723 | DOI:10.2196/58657

J Med Internet Res. 2025 Sep 10;27:e64989. doi: 10.2196/64989.

ABSTRACT

BACKGROUND: Every year in France, 40% of people aged ≥80 years are hospitalized, with an average length of hospital stay of 25 days and a readmission rate of 14% to 30% within the month following discharge. This situation is putting pressure on the health care system, encouraging the reinforcement of home care to reduce avoidable hospitalization. The EPOCA remote patient monitoring (RPM) system is a medical and social telehealth solution specialized in RPM, teleconsultation, tele-expertise, and care coordination in emergency medicine and geriatrics. The platform provides long-term medical support at home (MSAH) with 24-7 telemonitoring of older adults with polypathology. We hypothesized that receiving long-term MSAH via the EPOCA RPM system would be associated with a reduction in the rates and durations of hospitalizations or emergency department (ED) visits in older adults with polypathology.

OBJECTIVE: We aimed to compare the hospitalization and ED visit rates, as well as the cumulative hospital stay duration, before and after enrollment in the EPOCA RPM system for older adults with polypathology.

METHODS: This retrospective observational study included older adults (aged ≥70 years) with polypathology (>2 affected systems) followed throughout 2 different types of long-term MSAH between February 2022 and October 2023. We compared the number of hospital admissions, including ED visits; the cumulative duration of hospital stays during the follow-up; and the average length of hospital stays during the period corresponding to the MSAH program (Y) compared to the year before entering the program (Y – 1). Subgroup analyses were conducted according to the severity of the participants’ disability.

RESULTS: A total of 120 participants were included in the MSAH program, with a mean age of 86.8 (SD 7.9) years. Hospitalization and ED visit rates decreased (-48%) between the Y – 1 and Y periods, as did the total duration of hospital stays (-63%). A significant reduction in number of hospitalizations (median decreased from 1.0 to 0.0 per patient per year; P<.001) and ED visits (median decreased from 1.0 to 0.0 per patient per year; P<.001) was observed between the Y – 1 and Y periods. This corresponded to a significant median reduction of 14 days spent at the hospital per patient per year (P<.001). The decrease in hospitalization and ED visit rates and numbers was greater in participants with severe disabilities than in those with no or moderate disabilities.

CONCLUSIONS: Among older adults with polypathology, the EPOCA RPM system is associated with reduction in number of hospitalizations, ED visits, and duration of hospital stays. Facing the challenge of population aging, home telemonitoring embedded in the health care system offers potential benefits.

PMID:40929722 | DOI:10.2196/64989

JMIR Form Res. 2025 Sep 10;9:e75697. doi: 10.2196/75697.

ABSTRACT

BACKGROUND: Hospital falls represent a persistent and significant threat to safety within health care systems worldwide, impacting both patient well-being and the occupational health of health care staff. While patient falls are a primary concern, addressing fall risks for all individuals within the health care environment remains a key objective. Caregiver visibility and spatial monitoring are recognized as crucial considerations in mitigating fall-related incidents.

OBJECTIVE: This study aimed to investigate the association between the percentage of spatial shadow zone, defined as areas within an acute care unit unvisited by mobile workstations for prolonged periods, and the incidence of hospital falls and intensive care unit (ICU) transfers.

METHODS: This retrospective observational study was conducted in a 400-square-meter acute care unit of a tertiary hospital for over 210 days. An ultrawideband real-time location system was deployed to continuously track mobile workstations’ spatial coverage. Spatial shadow zones were defined as areas unvisited by mobile workstations for 60 continuous minutes. The primary outcome was hospital falls; the secondary outcome was ICU transfers. Multivariable logistic regression analysis, adjusted for patient-to-nurse ratio and day of week, was used to examine the association between the percentage of spatial shadow zone and these outcomes. Sensitivity analyses were performed by varying the spatial dilation distance (1-4 meters) and temporal shadow zone thresholds (15-90 minutes).

RESULTS: During this study’s period, 8 hospital falls and 89 ICU transfers occurred. Real-time location system validation indicated a mean positional error of 0.346 (SD 0.282) meters. In multivariable regression, a higher percentage of spatial shadow zone was significantly associated with an increased odds of hospital falls (odds ratio 1.02, 95% CI 1.01 to 1.03, P<.001). Conversely, a higher percentage of spatial shadow zone was associated with decreased odds of ICU transfer (odds ratio 0.99, 95% CI 0.99 to 0.99, P<.001). Sensitivity analyses demonstrated consistency of the association between spatial shadow zones and falls across varying parameter settings.

CONCLUSIONS: This study provides novel evidence for a significant positive association between the percentage of spatial shadow zones and hospital falls, underscoring the critical role of caregiver visibility in fall prevention. The findings suggest that proactively minimizing spatial shadow zones through optimized hospital design, workflow strategies, and technology-enabled monitoring may be a valuable approach to enhance patient safety and reduce hospital falls in acute care settings.

PMID:40929719 | DOI:10.2196/75697

JMIR Public Health Surveill. 2025 Sep 10;11:e73318. doi: 10.2196/73318.

ABSTRACT

BACKGROUND: In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States.

OBJECTIVE: This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua.

METHODS: Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research.

RESULTS: The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research).

CONCLUSIONS: As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

PMID:40929715 | DOI:10.2196/73318

JMIR Public Health Surveill. 2025 Sep 10;11:e68437. doi: 10.2196/68437.

ABSTRACT

BACKGROUND: Scrub typhus (ST), also known as tsutsugamushi disease, is a common febrile vector-borne illness in South Korea, transmitted by trombiculid mites infected with Orientia tsutsugamushi, with rodents serving as the main hosts. Although vector-borne diseases like ST require both a One Health approach and a spatiotemporal perspective to fully understand their complex dynamics, previous studies have often lacked integrated analyses that simultaneously address disease dynamics, vectors, and environmental shifts.

OBJECTIVE: We aimed to explore spatiotemporal trends, high-risk areas, and risk factors of ST by simultaneously incorporating host and environmental information.

METHODS: ST cases were extracted from the 2013-2019 Korea National Health Insurance Service data at 250 municipal levels and by epidemiological weeks (International Classification of Diseases, Tenth Revision, Clinical Modification code: A75.3). Data on potential risk factors, including the maximum probability of rodent presence, area of dry field farming, forest coverage, woman farmer population, and financial independence, were obtained from publicly available sources. In particular, the maximum rodent presence probability was estimated using a maximum entropy model incorporating ecological and climate variables. Spatial autocorrelation was assessed using Global Moran I statistics with 999 Monte Carlo permutations. Spatial and temporal clusters were identified using Getis-Ord Gi* and hot and cold spot trend analyses. Bayesian hurdle models with a spatiotemporal interaction term, accounting for zero-inflated Poisson distribution, were used to identify associations between ST incidence and regional factors. Stratification analyses by gender and age group (0-39, 40-59, 60-79, and ≥80 years) were performed.

RESULTS: Between 2013 and 2019, 95,601 ST patients were reported. ST incidence had positive spatial autocorrelation (I=0.600; P=.01), with spatial expansion from southwestern to northeastern regions. Spatiotemporal models demonstrated better fit compared with spatial and temporal models, as indicated by lower Watanabe-Akaike information criterion (WAIC) values. Municipalities with higher rodent suitability (β coefficient=0.618; 95% credible interval [CrI] 0.425-0.812) and lower financial independence from central government (β coefficient=-0.304; 95% CrI -0.445 to -0.163) had higher likelihoods of increased ST incidence, even after adjusting for spatiotemporal autocorrelation. However, risk factors varied by age group: among individuals aged 40 years or older, ST incidence was positively associated with rodent suitability, while patients in the 0-39 years age group showed no association with rodent suitability (β coefficient=0.028; 95% CrI -0.072 to 0.126), and ST incidence was negatively associated with the women farmer population (β coefficient=-0.115; 95% Crl=-0.223 to -0.006).

CONCLUSIONS: This is the first study to investigate ST in South Korea using a spatiotemporal framework grounded in a holistic One Health perspective. We elucidated the critical role of spatiotemporal dynamics in ST distribution, highlighting rodent suitability and economic independence as key drivers of disease distribution. Our findings lay the groundwork for evidence-based, region-specific intervention strategies and may inform targeted public health strategies in South Korea and other settings with similar ecological conditions.

PMID:40929714 | DOI:10.2196/68437

Neuro Endocrinol Lett. 2025 Sep 2;46(2):77-85. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the hotspots and frontiers in the field of subarachnoid hemorrhage using the bibliometrics method and providing references for academic research.

METHODS: All published studies related to subarachnoid hemorrhage published in the Web of Science core database from 1 January 2016 to 25 September 2021 were retrospectively identified using VOSviewer and CiteSpace software. Visualization VOSviewer and CiteSpace software were used to perform statistical and cluster analyses on authors, countries, institutions, keywords, and co-cited documents. Knowledge graphs were drawn.

RESULTS: A total of 7151 research papers related to subarachnoid hemorrhage were included for analysis. The number of papers on subarachnoid hemorrhage research showed an upward trend. The leading countries in subarachnoid hemorrhage research were the United States, China, and Japan. In addition, the Harvard Medical School, the Mayo Clinic, and the Capital Medical University were leading authorities subarachnoid hemorrhage research. The common keywords formed 7 clusters. There were 13 clusters of citations.

CONCLUSIONS: Research hotspots and directions in subarachnoid hemorrhage research were identified, such as cerebral aneurysm, early brain injury, vasospasm, and prognosis model.

PMID:40929706

J Craniofac Surg. 2025 Sep 10. doi: 10.1097/SCS.0000000000011907. Online ahead of print.

ABSTRACT

An expander capsule is a fibrous membrane that forms around an expander after tissue expansion. However, whether the capsule should be removed after the expander is removed remains controversial. The authors aimed to investigate the efficacy and safety of cervical capsulectomy for improving neck mobility and appearance after expanded flap transfer. We retrospectively analyzed patients with cervical scar contractures who underwent expanded flap transfer at our hospital between September 2018 and December 2023. Depending on whether capsulectomy was performed simultaneously with expander removal, the patients were divided into the capsule-retaining (n=50) and capsule-resecting (n=24) groups. The preoperative and postoperative cervicomental angles, neck extension range of motion, postoperative appearance satisfaction, cervical pulling sensation, cervical capsular contracture cords, and postoperative complication rates were compared between the 2 groups to evaluate the efficacy and safety of cervical capsulectomy. Complication rates were not significantly different between the groups (P>0.05). The postoperative improvements in the neck extension range of motion and cervicomental angle were significantly greater, and the appearance satisfaction score was higher in the capsule-resecting group than in the capsule-retaining group. In the capsule-retaining group, 18 (36.0%) patients experienced a significant pulling sensation during neck extension, and 10 (20.0%) patients had capsular contracture cords. The differences between the 2 groups were statistically significant (P<0.05). Cervical capsulectomy is safe and effective for improving neck mobility and appearance after expanded flap transfer.

PMID:40929700 | DOI:10.1097/SCS.0000000000011907

Ocul Immunol Inflamm. 2025 Sep 10:1-14. doi: 10.1080/09273948.2025.2552919. Online ahead of print.

ABSTRACT

PURPOSE: To describe differences in the expression of selected host biomarkers, by analysing the aqueous humour (AH), cerebrospinal fluid (CSF) and serum of patients with ocular syphilis, both with and without neurosyphilis and HIV infection, to support the diagnosis of ocular syphilis.

METHODS: A prospective observational descriptive study was conducted at Tygerberg Academic Hospital in Cape Town, South Africa, from February 1, 2018, to January 31, 2021. The study included all patients aged 18 years or older who presented to the eye clinic with ocular syphilis, provided they had a positive serum Treponema pallidum antibodies (TPA) test, an RPR titre of ≥ 8 and confirmed ocular inflammation. The HIV status of each patient was determined and the CRP, IL-2, IL-6, IL-10, IL-12 p70, MIP-1$\beta$ and IFN-$\gamma$ were measured in their AH, CSF and serum samples using a multiplex immunoassay platform. All patients received treatment.

RESULTS: The mean concentrations of biomarkers IL-2, IL-10, MIP-1$\beta$, IL-6, IL-12 p70 and IFN-$\gamma$ were consistently higher in the AH compared to the CSF and serum in patients with ocular syphilis, irrespective of their HIV status and the presence or absence of concurrent neurosyphilis.

CONCLUSION: Our findings showed significant differences in certain cytokine levels across the AH, CSF, and serum, with notably higher concentrations in the AH. This indicates that ocular syphilis triggers a unique immune response within the eye. As a result, further analysis of AH biomarkers is needed to determine if these may enhance the diagnosis of ocular and neurosyphilis.

PMID:40929698 | DOI:10.1080/09273948.2025.2552919

Ann Am Thorac Soc. 2025 Sep 10. doi: 10.1513/AnnalsATS.202501-052OC. Online ahead of print.

ABSTRACT

Background Although advances in care have improved cystic fibrosis (CF) outcomes in higher-income countries (HICs), the situation remains alarming in lower-income countries (LICs). Methods People with CF (pwCF) enrolled in the European Cystic Fibrosis Society Patient Registry (ECFSPR) and carrying at least one F508del variant allele were evaluated in 2017 and in 2022 for predicted percent forced expiratory volume (ppFEV1), underweight status, and chronic Pseudomonas aeruginosa (Pa) infection, according to the gross national income (GNI) per capita divided into three terciles (low-income countries, LICs; middle-income countries, MICs; and high-income countries, HICs). Survival was evaluated in the periods 2013-2017 and 2018-2022. Generalized linear models and Cox regression models were fitted. Findings From the 31,723 pwCF reported in ECFSPR in 2022, 13.5% lived in LICs, 19.9% in MICs, and 66.6% in HICs. PwCF living in LICs had a significantly lower median survival age, reduced ppFEV1, and higher prevalence of Pa infection and underweight status compared with pwCF from MICs and HICs. Data modeling indicated that avoiding underweight status and Pa infection would increase survival by 42 years for pwCF living in LICs. Access to CFTR modulators would further increase their survival by 15 to 29 years depending on their nutrition and infection status, resulting in a survival up to 82 years in the best-case scenario. Interpretation Access to CFTR modulators equalizes survival between LICs and higher income countries within Europe. Optimizing care practices and social determinants of health remains crucial in LICs.

PMID:40929684 | DOI:10.1513/AnnalsATS.202501-052OC

Am J Public Health. 2025 Oct;115(10):1631-1641. doi: 10.2105/AJPH.2025.308144.

ABSTRACT

Objectives. To examine how one’s community connectedness may act as a source of resilience and promote HIV prevention and care behaviors among transgender women of color. Methods. We analyzed survey data from 313 transgender women of color living in New York City collected from August 2020 to November 2022. The Community Connectedness Scale asks participants about their baseline feelings of connection, feelings of inclusion, feelings of belonging, feelings of isolation, and feelings of being unlike in relation to the transgender community. The HIV prevention and care outcomes of interest were measured at 6-month follow-up and included consistent condom usage, recent testing for sexually transmitted infections (STIs), current preexposure prophylaxis use, and HIV viral load suppression. Results. Those with a high (compared to low) community connectedness were 62% more likely to consistently use condoms and 16% more likely to test for STIs. Conclusions. Community connectedness was associated with a greater likelihood of HIV prevention behaviors. Public Health Implications. Future interventions could include strategies to strengthen community connectedness to improve HIV status neutral care continuums. (Am J Public Health. 2025;115(10):1631-1641. https://doi.org/10.2105/AJPH.2025.308144).

PMID:40929666 | DOI:10.2105/AJPH.2025.308144