Category: Statistics

J Am Acad Orthop Surg. 2025 Aug 4. doi: 10.5435/JAAOS-D-24-01502. Online ahead of print.

ABSTRACT

INTRODUCTION: Dislocation is a known risk after total hip arthroplasty (THA), occurring in approximately 2% of cases. Although the posterolateral approach is the most commonly used approach to the hip, the disruption of posterior soft tissue is a concern for implant stability. The introduction of robotic assistance in arthroplasty has demonstrated improved implant positioning, although the effect on outcomes is still being assessed. The purpose of our study was to assess the 90-day dislocation rate between robotic-assisted and manual primary THA through the PL approach.

METHODS: Data were collected from two board-certified adult reconstruction surgeons who performed THA through a PL approach from 2014 to 2023. These two surgeons had high-volume arthroplasty practices and transitioned from manual to robotic-assisted surgery within this period. Variables including patient demographic information, use of robotic assistance, total 90-day complications, and Hip Disability and Osteoarthritis Outcome Score were collected and analyzed. Statistical analysis for numerical values was conducted using Student t-test and categorical variables with chi-square analysis, with alpha set at 0.05.

RESULTS: Two thousand five hundred forty-eight patients underwent a THA through the PL approach at our institution from 2014 to 2023. One thousand seven hundred twenty-seven patients had a manual THA, and 821 patients had a robotic-assisted THA. No significant difference was noted in total complication rates (n = 59, 3.4% vs. n = 18, 2.2%, P = 0.092) or dislocation rates (n = 7, 0.4% vs. n = 3, 0.4%, P = 0.88) between the manual and robotic-assisted groups, respectively. No statistical difference was found in the Hip Disability and Osteoarthritis Outcome Score at any of the postoperative time points. Total surgical time was markedly longer for the robotic-assisted group (88 minutes) compared with the manual group (74 minutes).

CONCLUSION: This study demonstrated no notable difference in 90-day dislocation rates for high-volume arthroplasty-trained surgeons when comparing manual versus robotic-assisted THA when using the PL approach.

PMID:40758989 | DOI:10.5435/JAAOS-D-24-01502

Sex Transm Dis. 2025 Aug 4. doi: 10.1097/OLQ.0000000000002227. Online ahead of print.

ABSTRACT

AIM: Human Papillomavirus (HPV) is a common sexually transmitted infection that often affects the reproductive system. HPV infection can cause various cancers and clinical symptoms in women, impacting their sexual activity and quality of life. Hence, this study aimed to assess the impact of motivational interviewing on the sexual function of women with HPV.

METHODS: This randomized controlled study utilized a pretest-posttest research design with a control group and involved 62 HPV patients from healthcare centers affiliated with Babol University of Medical Sciences, Iran. The study was registered on the Iranian Registry of Clinical Trials (IRCT20230531058348N1) in 2023.06.11 after we received ethics code. The patients were divided into two groups: an experimental and a control group. The allocation to these groups was determined using the blocked randomized allocation technique based on pretest scores. The experimental group received the motivational intervention over five sessions, while the control group received routine intervention. All participants completed the Female Sexual Function Index (FSFI) questionnaire before and immediately after the interventions. Data were entered into SPSS 24 and analyzed. Descriptive statistics included means and standard deviations for quantitative data and frequency percentages for qualitative variables. Chi-square tests and independent t-tests were used to examine relationships and compare initial variables. ANCOVA was used to compare questionnaire scores between the two groups. The significance level was set at 0.05.

RESULTS: The intervention (N = 31) and control (N = 31) groups had similar ages (33.58 ± 6.14 vs 34.96 ± 7.04 years, P = 0.412). Sexual dysfunction occurred in 74.2% of HPV-positive women. Covariance analysis showed that motivational interviewing had a significant positive effect on overall sexual function in women with HPV (η2 = 0.717, P < 0.001). Motivational interviewing with a large effect size also led to improved sexual desire (η2 = 0.566), increased arousal (η2 = 0.728), increased wetness (η2 = 0.531), increased orgasm (η2 = 0.525), increased sexual satisfaction (η2 = 0.563), and reduced sexual pain (η2 = 0.680) (P = 0.001).

CONCLUSION: The results of the study suggested that offering counseling to women with HPV could improve their sexual functioning, leading to a better overall sexual experience, mental and emotional well-being, and ultimately strengthening their quality of life and marital connections. Moreover, this could influence how healthcare providers support and aid people with HPV.

PMID:40758983 | DOI:10.1097/OLQ.0000000000002227

Acad Med. 2025 Jul 31. doi: 10.1097/ACM.0000000000006180. Online ahead of print.

ABSTRACT

PURPOSE: An increasing body of evidence reports on the training, development, implementation, operationalization, and outputs of clinical competency committees (CCCs). However, there is a paucity of syntheses on this existing evidence, contributing to a limited understanding of the factors that influence optimal CCC functioning. This scoping review maps studies that investigated and reported on CCC faculty development, structures and processes, and barriers, facilitators, and recommendations to optimize CCC functioning.

METHOD: The authors searched MEDLINE, Embase, Education Source, and Web of Science on January 31, 2023, and April 1, 2024, using subject headings and search terms such as clinical competency committee, resident, and faculty development. The searches were restricted to articles published between July 30, 2013, and April 1, 2024. The authors used a quasi-statistical content analysis to quantify and draw meaning from the evidence on CCC faculty development, structures, processes, and factors that influence optimal CCC functioning.

RESULTS: Data were extracted from 39 full-text articles. Four key thematic categories describe the focus of the findings: (1) faculty development, including the topics and delivery of the training for individuals involved in CCCs; (2) CCC structures, including the various sizes and compositions and meeting frequencies and durations; (3) CCC processes, including procedures before, during, and after the meetings; and (4) barriers, facilitators, and recommendations for optimal CCC functions.

CONCLUSIONS: This review demonstrates extensive variability in the ways in which CCCs are structured and run across programs. The findings reveal multiple key barriers and facilitators related to the sufficiency of collected assessment data, CCC composition, pre-CCC meeting work, understanding and interpretation of performance data, and presence of biases during decision-making. Postgraduate programs, CCC leaders, and accrediting bodies can use the findings and implications in this review to inform strategic thinking and future research agendas for local CCC development, implementation, operationalization, and optimization efforts.

PMID:40758982 | DOI:10.1097/ACM.0000000000006180

J Craniofac Surg. 2025 Aug 4. doi: 10.1097/SCS.0000000000011789. Online ahead of print.

ABSTRACT

To quantitatively evaluate the effect of corrective surgery for involutional entropion on tear film parameters-specifically lipid layer thickness (LLT), meibomian gland dysfunction (MGD), and incomplete blinking (IB)-using interferometry and meibography. A retrospective analysis was performed on 24 patients (48 eyes) diagnosed with involutional entropion who underwent corrective surgery. Tear film LLT, blinking patterns, MGD grade, Schirmer test, tear break-up time (BUT), and best-corrected visual acuity (BCVA) were measured pre- and postoperatively using the LipiView II Ocular Surface Interferometer. Comparisons before and after surgery were conducted, and statistical analyses were performed. Of the 24 patients, 11 had bilateral and 13 had unilateral entropion, with a mean age of 64.67±16.98 years. In entropionic eyes, BCVA improved from 0.17±0.22 to 0.11±0.13 (P=0.047), and LLT significantly increased from 66.74±26.94 nm to 81.37±21.42 nm (P<0.001). Meibomian gland dysfunction grade improved from 1.60±1.06 to 1.29±0.96 (P<0.001). No significant changes were observed in blinking rate, Schirmer score, or BUT. No statistically significant correlation was found among BCVA, LLT, and MGD grade. In conclusion, involutional entropion is associated with reduced tear film LLT and MGD. Surgical correction leads to significant improvements in LLT, MGD grade, and visual acuity. These findings highlight the role of entropion repair in restoring ocular surface health and suggest potential benefits in managing meibomian gland-related tear film dysfunction.

PMID:40758961 | DOI:10.1097/SCS.0000000000011789

Anesthesiology. 2025 Aug 4. doi: 10.1097/ALN.0000000000005694. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic pain is a leading cause of disability globally, with limited treatment options and frequent adverse effects. The IMI-PainCare-BioPain project aimed to enhance analgesic drug development by standardizing biomarkers. This study, IMI2-PainCare-BioPain-RCT1, evaluated the effects of lacosamide, pregabalin, and tapentadol on peripheral nerve excitability in healthy subjects through a randomized, double-blind, placebo-controlled crossover trial.

METHODS: The study included 43 healthy participants aged 18-45 years. Participants underwent four treatment periods where they received single doses of lacosamide (200 mg), pregabalin (150 mg), tapentadol (100 mg), or placebo. High-frequency stimulation was applied to induce hyperalgesia. The two primary endpoints were changes in Strength Duration Time Constant (SDTC) in large sensory and motor fibers between lacosamide and placebo periods at the first post-dose timepoint compared to baseline (60 min). Other predefined endpoints included recovery cycle, threshold electrotonus (TEd), and S2 accommodation as well as effects of pregabalin and tapentadol.

RESULTS: Lacosamide statistically significantly reduced SDTC in large sensory fibers (mean reduction 0.04 (95% CI 0.01-0.08), p = 0.012) and in motor fibers (mean reduction 0.04 (95% CI 0.00-0.07), p = 0.039) but had no effect on small sensory fibers at the first timepoint compared to placebo. There were no effects of pregabalin and tapentadol on SDTC. Of other predefined endpoints, lacosamide produced statistically significant changes in subexcitability, S2 accommodation TEd(peak), and TEd40(Accom) in large sensory fibers. No statistically significant changes were observed in refractoriness, relative refractory period, or accommodation half-time at the first timepoint compared to placebo.

CONCLUSIONS: This study demonstrates that nerve excitability testing can detect pharmacodynamic effects on large myelinated fibers in healthy subjects. Lacosamide statistically significantly reduced peripheral nerve excitability, particularly in large sensory fibers.

PMID:40758952 | DOI:10.1097/ALN.0000000000005694

Blood Adv. 2025 Aug 4:bloodadvances.2024015787. doi: 10.1182/bloodadvances.2024015787. Online ahead of print.

ABSTRACT

We aim to evaluate the efficacy of brentuximab vedotin (BV) combined with gemcitabine followed by BV maintenance in relapsed or refractory (R/R) peripheral T-cell lymphoma (PTCL). Patients (pts) with at least 5% CD30-positive cells by immunohistochemistry received 4 GBV induction (28d) cycles of gemcitabine 1000 mg/m2 (d1;d15) plus BV 1.8 mg/kg (d8) followed in responding pts by up to 12 BV maintenance (21d) cycles. Primary end point was overall response rate (ORR) after 4 induction cycles by CT-scan-based Lugano criteria. Of the 71 enrolled pts (median age of 66 years), 80.3% had received 1 prior line, 60.6% were refractory. The diagnoses per pathology central review were TFHL (47.9%), ALCL, [ALK- (19.7%) and ALK+ (7%)], PTCL-NOS (12.7%) and other entities (12.7%). In the intention-to-treat analysis, ORR was 46.5% with 19.7% complete response. Twenty-eight pts received maintenance. Grade 3-4 adverse events reported in ≥10% of pts during induction comprised: of neutropenia (55%), thrombocytopenia (14%), anemia (21%), infection (14%); during maintenance comprised of neutropenia (39%), thrombocytopenia (21%) and peripheral neuropathy (14%). With a median follow-up of 32.6 months, the median duration of response (DOR), progression-free (PFS) and overall survival were 15.8, 4.5 and 12.9 months, respectively. Efficacy, higher in ALCL, was present in the TFHL and PTCL-NOS group with and ORR, CR, PFS and DOR of 37.2%, 18.6%, 4 and 12.5 months, respectively. A negative association of high baseline soluble CD30 on both response and survival was found, which in ad hoc analysis appeared highly relevant in TFHL and PTCL-NOS patients. EudraCT 2017-000409-1 and NCT03496779.

PMID:40758949 | DOI:10.1182/bloodadvances.2024015787

Health Aff (Millwood). 2025 Aug;44(8):970-976. doi: 10.1377/hlthaff.2024.01661.

ABSTRACT

Black and Latino patients are disproportionately affected by end-stage renal disease and face significant disparities in treatment, with underuse of peritoneal dialysis and higher conversion rates from home peritoneal dialysis to in-center hemodialysis. With concerted efforts from policy makers to increase the uptake of home dialysis modalities such as peritoneal dialysis, policies to better support Black and Latino patients who receive peritoneal dialysis are greatly needed. Through in-depth, semistructured interviews conducted during the period July 2022-June 2023 in Seattle, Washington, this qualitative study explored the experiences of twelve Black and eight Latino/a participants from a local community-based dialysis organization who were either receiving home peritoneal dialysis or had transferred from home peritoneal dialysis to in-center hemodialysis. Factors that influenced participants’ experiences with peritoneal dialysis included poor mental health, the medicalization of the home, and language and cultural barriers. Our findings suggest that policies to improve access to mental health services, promote the use of community spaces for storage of dialysis supplies, and address language and cultural barriers in health care could improve the experiences of Black and Latino patients receiving peritoneal dialysis.

PMID:40758932 | DOI:10.1377/hlthaff.2024.01661

Health Aff (Millwood). 2025 Aug;44(8):933-942. doi: 10.1377/hlthaff.2024.01495.

ABSTRACT

Persistent shortages of workers providing long-term services and supports (LTSS) for more than a dozen years have led to increased reliance on foreign-born workers to meet the growing demand. However, there is a dearth of empirical data on long-term changes in the composition of the direct care workforce by nativity status and care setting. Using data from the American Community Survey (2012-22), we examined the extent to which foreign-born workers contributed to LTSS workforce growth and how their participation was distributed across care settings. We found that foreign-born direct care workers have increasingly filled workforce gaps, particularly in the home and community-based services (HCBS) sector. The HCBS workforce grew by more than 24 percent during the period 2012-22, while the institutional workforce declined by 23 percent; this decline was primarily due to the exodus of native-born workers. Foreign-born workers accounted for approximately half of the increase in the direct care workforce in HCBS settings during this period. To address continued workforce shortages in LTSS and meet the demand for HCBS, policy makers should consider immigration reforms to support a sustainable supply of foreign-born workers, investments in training and career pathways, and improvements in job quality through higher wages and opportunities for career advancement.

PMID:40758931 | DOI:10.1377/hlthaff.2024.01495

Health Aff (Millwood). 2025 Aug;44(8):953-962. doi: 10.1377/hlthaff.2024.01494.

ABSTRACT

Nonprofit hospital workers represent a significant portion of the US health care workforce. Previous research indicates that wage inequalities exist within nonprofit hospitals, varying by hospital characteristics. To explore whether these inequalities have grown over time, particularly during the COVID-19 pandemic, we used Internal Revenue Service Form 990 and Medicare cost reports from the period 2009-23 to examine trends in wages and wage inequalities within nonprofit hospitals and assess differences by hospital characteristics. Persistent and widening wage inequalities in most years were observed, except during some years of the pandemic. Because hospitals are often large employers, wage inequality within them may reflect and reinforce broader patterns of local economic inequality, making this a relevant metric for evaluating the social benefit of nonprofit hospitals.

PMID:40758930 | DOI:10.1377/hlthaff.2024.01494

Health Aff (Millwood). 2025 Aug;44(8):1005-1010. doi: 10.1377/hlthaff.2024.01394.

ABSTRACT

Between 2018 and 2022, remote physiologic monitoring (RPM) claims increased, especially for Black (25,253 percent) and Hispanic (5,051 percent) Medicare patients. After adjustment for age, sex, and clinical factors, in 2022, Black and Hispanic Medicare patients had 88 percent and 84 percent higher RPM use rates, respectively, compared with White patients.

PMID:40758929 | DOI:10.1377/hlthaff.2024.01394