Category: Statistics

Risk Manag Healthc Policy. 2025 May 27;18:1761-1771. doi: 10.2147/RMHP.S517386. eCollection 2025.

ABSTRACT

BACKGROUND: Sepsis, a severe medical condition caused by a dysregulated host response to infection, accounts for 20% of global fatalities. While simplifying early sepsis treatment with the Sepsis Six care bundle has been shown to reduce mortality by 46.6%, multiple barriers often prevent clinical nurses from adhering to sepsis care recommendations. Identifying these barriers is essential to eliminating them, and thus the Sepsis Six Care bundle (BLISS-1) questionnaire was developed to identify the barriers to and facilitators of nurses’ implementation of the Sepsis Six care bundle while caring for sepsis patients. The current study assessed the psychometric properties of the BLISS-1 questionnaire to evaluate its validity and reliability.

PURPOSE: This study assessed the psychometric properties of the BLISS-1 questionnaire.

METHODS: A total of 180 clinical nurses working in different critical care units at a selected University Hospital participated in a cross-sectional, descriptive study. Data were collected using the BLISS-1 Questionnaire, used to assess the perceived barriers to and facilitators of Sepsis Six performance. Descriptive statistics, Cronbach’s alpha reliability analysis, and Promax rotation EFA were performed to assess the validity and reliability of the questionnaire.

RESULTS: The BLISS-1 questionnaire has strong internal consistency, with Cronbach’s alpha values of 0.978 for perceived barriers and 0.976 for perceived importance. Factor analysis revealed that key barriers included skepticism about the protocol’s clinical efficacy and operational challenges such as limited training and insufficient resources.

CONCLUSION: This study revealed the BLISS-1 questionnaire to be highly reliable. Focused education, appropriate resource allocation, and supporting policies are needed to increase nurses’ adherence to the Sepsis Six protocol and, hence, improve patient outcomes.

PMID:40454349 | PMC:PMC12126116 | DOI:10.2147/RMHP.S517386

ACS Cent Sci. 2025 Feb 17;11(5):665-671. doi: 10.1021/acscentsci.4c01878. eCollection 2025 May 28.

ABSTRACT

Covalent organic frameworks (COFs) have emerged as promising atmospheric water harvesters, offering a potential solution to the pressing global issue of water scarcity, which threatens millions of lives worldwide. This study presents a series of 2D COFs, including HCOF-3, HCOF-2, and a newly developed structure named COF-309, designed for optimized water harvesting performance with a high working capacity at low relative humidity. To elucidate their water sorption behavior, we introduce a hydrophilicity index directly linked to intrinsic properties, such as the strength and spatial density of adsorptive sites. This index is mathematically correlated to the step of water adsorption isotherms. Our correlation provides a predictive tool that extends to other microporous COFs and metal-organic frameworks, significantly enhancing the ability to predict their onset positions of water adsorption isotherms based on structural characteristics. This advancement holds the potential to guide the development of more efficient materials for atmospheric water harvesting.

PMID:40454336 | PMC:PMC12123544 | DOI:10.1021/acscentsci.4c01878

Clin Interv Aging. 2025 May 27;20:717-726. doi: 10.2147/CIA.S523457. eCollection 2025.

ABSTRACT

BACKGROUND: The healthy nucleus pulposus (NP) of the intervertebral disc is normally replete with proteoglycans and highly hydrated. With degeneration, the disc loses its capacity to bind water, substantially reducing its ability to cushion physiologic loads. Supplementation of degenerated NP with a commercially available NP allograft represents a promising approach to ameliorating lumbar discogenic pain.

METHODS: This was a prospective, single arm clinical study involving 21 patients at 5 US sites. The magnitude of improvement in back pain severity, back disability and quality of life was evaluated in Medicare-age (≥65 years) patients with chronic axial low back pain treated with intradiscally delivered NP allograft at up to three lumbar vertebral levels (L1-S1). Followup was at 1, 3 and 6 months. Back pain was determined using an 11-point numeric rating scale (NRS), back function by Oswestry disability index (ODI) and quality of life using the PROMIS-29 questionnaire.

RESULTS: There was a 60% reduction in average back pain scores between baseline and 6 months; the difference (4.0, 95% CI [2.9, 5.2]) was statistically significant (p < 0.001). 82% and 71% of participants achieved ≥30% and ≥50% NRS improvement, respectively, at 6 months, and 65% of participants reported a final NRS score ≤3. The 6-month improvement in mean ODI scores was 50% with an average difference of 22.8 (95% CI [14, 31]) (p < 0.001). 68% and 51% realized ≥30% and ≥50% ODI improvements, respectively, at 6 months. All PROMIS-29 domains showed improvements toward the normative mean value of 50 by 6 months. No adverse events related to the NP allograft were reported.

CONCLUSION: These findings show clinically significant pain palliation, functional improvement and quality of life enhancement in older adults following supplementation of the degenerated disc with NP allograft.

PMID:40454303 | PMC:PMC12126140 | DOI:10.2147/CIA.S523457

J Pain Res. 2025 May 27;18:2739-2750. doi: 10.2147/JPR.S512263. eCollection 2025.

ABSTRACT

INTRODUCTION: Recently, increasing research has shown inferior outcomes in patients with respect to specific social determinants of health. Therefore, optimizing diversity training given to pain management providers is imperative for physicians to provide culturally competent healthcare and to improve patient outcomes. In this paper, we attempt to describe trends in the Pacific Spine and Pain Society (PSPS) membership to help discover optimal diversity education paradigms for pain management providers by performing a survey on behalf PSPS.

METHODS: A survey was disseminated to all members of the PSPS at the 2022 annual meeting. Opinions were solicited with respect to respondents’ demographics, diversity training type, diversity training timing, and how this correlates with a respondent’s self-reported confidence in navigating diversity issues in the workplace. Cronbach’s alpha test was used to rate internal consistency while logistic regression models were used for statistical analysis.

RESULTS: Cronbach’s alpha produced a rating of 0.91. A total of 164 individuals responded to the survey, with 115 (70%) being male and 98 (60%) did not consider themselves to be under-represented in medicine. Survey respondents who obtained diversity training post-fellowship (p = 0.004) and with interactive training type (p = 0.010) self-reported to be more confident in handling matters of diversity in the workplace. Respondents who were underrepresented (p = 0.018), females (p = 0.033), practice in the west coast (p = 0.036), academic practice (p=0.031), and non-rural areas (p = 0.033) were also found to be more confident in handling matters of diversity.

CONCLUSION: Practitioners who received diversity training post-fellowship and with interactive and role model formats felt most confident to handle matters of diversity. Underrepresented groups, females, individuals from non-rural practices and individuals from academic practices appear to feel more confident in handling these issues.

PMID:40454301 | PMC:PMC12126138 | DOI:10.2147/JPR.S512263

J Pain Res. 2025 May 26;18:2689-2698. doi: 10.2147/JPR.S520944. eCollection 2025.

ABSTRACT

OBJECTIVE: Transversus abdominis plane block (TAPB) has been widely used for lower-segment cesarean sections (CS). However, traditional single-level TAPB may not provide sufficient analgesia for parturients. This study aimed to validate whether dual-level TAPB could offer more extensive blocking and better clinical outcomes.

METHODS: A total of 114 full-term parturients undergoing lower-segment CS were included in this prospective, randomized, controlled study. Subjects were randomly assigned to receive either single-level (group SL) or dual-level (group DL) TAPB. Dual-level TAPB was performed at the umbilical level and the level above the anterior superior iliac spine, while single-level was performed only at the umbilical level. The primary outcome was the proportion of the abdomen successfully blocked 20 minutes after TAPB.

RESULTS: Twenty minutes after TAPB, dual-level TAPB resulted in a more extensive cutaneous sensory block compared to single-level TAPB. The difference in the proportion of successfully blocked zones was statistically significant, with 46.9% (43.8%, 53.1%) in group SL versus 71.9% (62.5%, 75.0%) in group DL, p < 0.001. Notably, the proportion of parturients with the “surgical area” completely blocked was significantly higher in group DL (94.7%) than in group SL (82.5%) (p = 0.039). Compared to Group SL, the first request for postoperative analgesia was delayed in Group DL by 2.5 hours.

CONCLUSION: Compared to traditional single-level TAPB, dual-level TAPB produced more extensive cutaneous sensory block and better postoperative analgesia effects.

PMID:40454299 | PMC:PMC12125607 | DOI:10.2147/JPR.S520944

J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(5):102611. doi: 10.1016/j.jscai.2025.102611. eCollection 2025 May.

ABSTRACT

BACKGROUND: Pulmonary embolism (PE) is a leading cause of cardiovascular death; little data exist on whether mechanical thrombectomy confers a mortality benefit. Using a retrospective review, 311 consecutive patients with PE who underwent aspiration thrombectomy were compared to 309 propensity score-matched patients with PE treated with anticoagulation alone.

METHODS: Using a retrospective review, we identified 311 consecutive patients with PE who underwent mechanical thrombectomy along with standard of care; we then identified 1841 patients admitted with a primary diagnosis of PE and used propensity score matching to identify 309 patients with similar pulmonary embolism severity index (PESI) scores and variables. We then evaluated 2-year outcomes between the 2 groups.

RESULTS: Of the 311 patients treated with thrombectomy, 262 were at elevated risk by the European Society of Cardiology (ESC) stratification, 261 had a positive simplified pulmonary embolism severity index (sPESI) and 208 were of PESI class III or higher. Of the 309 patients treated with anticoagulation alone, 261 had elevated risk by ESC stratification, 257 had a positive sPESI, and 201 were PESI class III or higher. When all patients were evaluated, there was a mortality benefit starting at 30 days in patients undergoing thrombectomy; when patients with metastatic cancer were excluded, the mortality benefit was only seen in higher-risk patients. Low-risk patients with or without right ventricular strain had similar mortality whether managed with thrombectomy or anticoagulation alone, with numerically more significant bleeding, stroke, and recurrent pulmonary emboli.

CONCLUSIONS: In this single-center, retrospective review, patients with PE who were of ESC high risk and who underwent aspiration thrombectomy with a FlowTriever System (Inari Medical) had a statistically significant reduction in mortality compared to a propensity score-matched group treated with anticoagulation alone; separation in mortality curves continued at 2 years. Our findings also suggest that low-risk patients perform equally well with or without thrombectomy but incur numerically more bleeding events, stroke, and recurrent pulmonary emboli.

PMID:40454282 | PMC:PMC12126064 | DOI:10.1016/j.jscai.2025.102611

Anesth Pain Med. 2025 Apr 30;15(2):e161467. doi: 10.5812/aapm-161467. eCollection 2025 Apr 30.

ABSTRACT

BACKGROUND: This is a prospective observational study. Dexamethasone is commonly associated with postoperative hyperglycemia. There is limited data on the glycemic effect of dexamethasone among the diabetic population.

OBJECTIVES: In the current investigation, postoperative glucose levels were measured in both diabetic and non-diabetic individuals, and then a single dose of intraoperative dexamethasone was administered.

METHODS: A total of 86 participants, with ASA I/II, were categorized into two groups: Diabetic and non-diabetic. Each group consisted of 43 individuals. The participants’ ages ranged from 18 to 70 years. During the operation, a single dosage of dexamethasone, with a maximum of 8 milligrams, was provided intraoperatively. “Postoperative nausea and vomiting” (PONV), random blood glucose (RBG), and pain ratings were recorded before surgery, immediately after surgery, after 12 hours, and 24 hours following surgery. Preoperative blood glucose levels were also recorded. The “Chi-square test and the unpaired t-test” were used for comparison and to analyze the data. A significance level of P < 0.05 was deemed significant.

RESULTS: There was a statistically significant variance in RBG levels between diabetics and non-diabetics (P = 0.001). At various time periods, there was no correlation between the severity of PONV and diabetes among the participants. At various time intervals, the length of the procedure and the pain levels were equivalent to one another. In each group, there was a significant rise in RBG up to 12 hours, followed by a decline after 24 hours to a level similar to preoperative values.

CONCLUSIONS: A single dose of intraoperative “dexamethasone” was associated with transient hyperglycemia postoperatively up to 12 hours, which was more pronounced among the diabetic population and without major adverse effects like PONV in either group.

PMID:40454258 | PMC:PMC12125660 | DOI:10.5812/aapm-161467

Anesth Pain Med. 2025 Mar 11;15(2):e156544. doi: 10.5812/aapm-156544. eCollection 2025 Apr 30.

ABSTRACT

BACKGROUND: Postoperative delirium is a significant problem that deteriorates the cognitive state of patients after cardiac surgery, which can be a short- or long-term complication.

OBJECTIVES: This study was conducted to evaluate the efficacy of dexmedetomidine, commenced simultaneously with anesthesia induction and continued throughout the surgical operation, on postoperative delirium after cardiac surgery with cardiopulmonary bypass.

METHODS: This randomized, double-blind, case-control trial was conducted on sixty-one patients undergoing cardiac surgery. The patients were randomly divided into dexmedetomidine (case) and normal saline (control) groups. The primary outcome was the incidence of delirium, as screened by the Confusion Assessment Method for the ICU (CAM-ICU).

RESULTS: There was no distinction in CAM-ICU outcomes between the two groups at 6 and 24 hours postoperatively. However, the difference in non-positive CAM-ICU results was statistically significant at 24 hours for +1 and -1 Richmond Agitation-Sedation Scale scores.

CONCLUSIONS: Starting dexmedetomidine before cardiopulmonary bypass did not significantly affect the delirium rate based on CAM-ICU assessments. Further research examining larger groups is necessary to clarify the efficacy of perioperative dexmedetomidine on postoperative delirium.

PMID:40454256 | PMC:PMC12125664 | DOI:10.5812/aapm-156544

Oncol Lett. 2025 May 21;30(1):356. doi: 10.3892/ol.2025.15102. eCollection 2025 Jul.

ABSTRACT

The present study explored the impact of dual-source dual-energy CT (DECT) quantitative parameters combined with ultrasonography (US) imaging features on the diagnostic value of extrathyroidal extension in papillary thyroid carcinoma (PTC). Analysis was conducted on 136 nodules pathologically confirmed as PTCs in 102 patients who presented to the Affiliated People’s Hospital of Jiangsu University (Zhenjiang, China) between January 2018 and August 2023. All patients underwent DECT and US examinations, and the parameters for nodule examination using DECT included iodine concentration, normalized iodine concentration and energy spectrum curve slope. Gemstone spectral imaging (GSI) and US imaging features of extrathyroidal extension (ETE) and non-ETE groups were statistically examined for diagnostic usefulness. A logistic regression model was then constructed and diagnostic performance was assessed using receiver operating characteristics curves. The area under the curve (AUC) for iodine concentration in identifying ETE was 0.722, with the highest accuracy when 2.88 mg/ml was used as the diagnostic threshold. The corresponding sensitivity and specificity were 58.3 and 85.6%, respectively, with a Youden index of 0.44. The AUC for normalized iodine concentration in identifying ETE was 0.713, with the highest accuracy when 0.285 was used as the diagnostic threshold. The corresponding sensitivity and specificity were 65.7 and 78.6%, respectively, with a Youden index of 0.443. The AUC for slope of Hounsfield unit curve in identifying ETE was 0.738, with the highest accuracy when 3.4 was used as the diagnostic threshold. The corresponding sensitivity and specificity were 68.5 and 78.6%, respectively, with a Youden index of 0.471. The AUC of US (maximum longitudinal diameter >5 mm) was 0.712, with the highest accuracy when 3.845 cm was used as the diagnostic threshold. The corresponding sensitivity and specificity were 46.3 and 89.3%, respectively, with a Youden index of 0.356. The AUC for ETE identification using GSI and US morphological parameters was 0.782, with the highest accuracy when 0.762 was used as the diagnostic threshold. The corresponding sensitivity and specificity were 80.6 and 85.7%, respectively, with a Youden index of 0.663. In conclusion, the accuracy of ultrasound combined with GSI parameters in diagnosing ETE of PTC was improved when compared with that of single DECT and ultrasound morphological examinations.

PMID:40454243 | PMC:PMC12123170 | DOI:10.3892/ol.2025.15102

Front Cardiovasc Med. 2025 May 16;12:1549736. doi: 10.3389/fcvm.2025.1549736. eCollection 2025.

ABSTRACT

BACKGROUND: The optimal cannulation strategy for acute type A aortic dissection (ATAAD) surgery via a minimally invasive approach remains a topic of debate. This study aimed to compare the feasibility and safety of different aortic arch branch cannulation techniques using a single upper hemisternotomy.

METHODS: A retrospective analysis was performed on 207 patients with ATAAD who underwent total arch replacement combined with frozen elephant trunk techniques between December 2019 and July 2023. Patients were categorized into four groups based on the cannulation site: IA group (innominate artery, n = 174), LCA group (left carotid artery, n = 21), RSA group (right subclavian artery, n = 5), and RCA group (right carotid artery, n = 7). Perioperative outcomes, including mortality, complications, and operative times, were compared using appropriate statistical methods.

RESULTS: A total of 207 patients were included and categorized into four groups based on the site of arterial cannulation: IA (n = 174), LCA (n = 21), RSA (n = 5), and RCA (n = 7). Baseline characteristics, including age and preoperative comorbidities, were comparable across the groups. Intraoperative metrics, such as cross-clamp time, circulatory arrest time, selective cerebral perfusion time, and cardiopulmonary bypass (CPB) time, showed no statistically significant differences. Although the CPB time was numerically shorter in the IA group, this difference was not significant (p > 0.05). Perioperative mortality occurred in 25 patients (12.1%), with no statistically significant differences among the groups (IA: 12.6%, LCA: 0%, RSA: 20.0%, RCA: 28.6%; p > 0.05). Postoperative clinical outcomes, including ventilator support duration, ICU stay, and hospital length of stay, were also similar across all groups.

CONCLUSION: Aortic arch branch cannulation is a feasible and safe arterial perfusion strategy for ATAAD surgery via a minimally invasive single upper hemisternotomy. Among the options, the innominate artery demonstrated favorable outcomes and was not inferior to other arch vessels, and may be considered a suitable first choice when feasible.

PMID:40454235 | PMC:PMC12122429 | DOI:10.3389/fcvm.2025.1549736