Category: Statistics

Cureus. 2025 Mar 10;17(3):e80373. doi: 10.7759/cureus.80373. eCollection 2025 Mar.

ABSTRACT

Background Digital mental health interventions, including chatbot systems, are increasingly recognized for their potential to address mental health challenges among healthcare professionals. In particular, reflective practices facilitated by chatbots may support identity development and alleviate stress. However, the long-term effects of such interventions remain underexplored. Objective This study investigated the effects of a chatbot system using the line chart method over approximately nine months on the professional identity development and stress levels of healthcare professionals in Japan. Methods Professional identity formation specifically refers to how healthcare professionals perceive, develop, and integrate their professional roles and responsibilities into their self-concept. To evaluate this construct and associated stress levels, a parallel-group design was employed, in which eight participants (nurses and physical therapists) were randomly allocated to either a system-use group (Group A) or a non-use group (Group B). Both groups were followed for nine months, with periodic assessments conducted before and after the intervention, as well as after a washout period. The Japanese version of the Dimensions of Identity Development Scale (DIDS-J), assessing Commitment Formation, Identification with Commitment, Broad Exploration, Deep Exploration, and Ruminative Exploration, and the Public Health Research Foundation Stress Checklist Short Form (PHRF-SCL), evaluating Anxiety/Uncertainty, Fatigue/Physical Responses, Autonomic Symptoms, and Depressive Mood/Inadequacy, were administered. Results In the between-group comparisons, Group A demonstrated statistically significant improvements compared to Group B in the DIDS-J subscales, including Commitment Formation (16.5±0.6 vs. 14.0±0.8), Identification with Commitment (16.5±0.6 vs. 14.3±1.0), Broad Exploration (18.0±0.8 vs. 15.0±0.8), and Deep Exploration (18.0±1.1 vs. 14.5±1.3). Additionally, significant improvements were observed in the PHRF-SCL subscales, specifically Anxiety/Uncertainty (5.5±1.3 vs. 7.5±0.6), Fatigue/Physical Responses (4.5±0.6 vs. 7.8±1.3), and Depressive Mood/Inadequacy (4.5±1.3 vs. 9.3±0.6). Conclusion The results suggest that long-term use of a chatbot system employing reflective methods may promote professional identity development and reduce certain stress responses in healthcare professionals. Nonetheless, sample size limitations, pre-existing group differences, and environmental variables constrain the interpretation of findings. Future research with larger and more diverse populations, extended follow-up periods, and additional physiological or life-event measures is warranted to validate and refine these preliminary outcomes.

PMID:40213764 | PMC:PMC11984021 | DOI:10.7759/cureus.80373

Cureus. 2025 Mar 11;17(3):e80385. doi: 10.7759/cureus.80385. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: Although a right bundle branch block (RBBB) complicates anterior wall ST-segment elevation myocardial infarction (AW-STEMI), its independent prognostic significance remains understudied.

MATERIAL AND METHOD: This cross-sectional observational study was conducted at the Punjab Institute of Cardiology, Lahore, over a period of 18 months from January 2022 to June 2023. A total of 349 patients presenting with acute AW-STEMI were enrolled. They were stratified into RBBB and non-RBBB groups. Outcomes included mortality, cardiogenic shock, cardiac arrest, arrhythmias, complete heart block (CHB), post-myocardial infarction (MI) angina, and hospital stay duration. The effect of confounding variables on in-hospital mortality was evaluated through stratification among the two groups.

RESULTS: AW-STEMI with RBBB was reported in 50 (14.3%) out of 349 patients. Both groups had a similar mean age (p = 0.276), and comorbidities, including hypertension (p = 0.363), diabetes mellitus (p = 0.872), chronic kidney disease (CKD) (p = 0.299), dyslipidemia (p = 0.486), smoking status, and prior myocardial infarction (p > 0.05), were comparable. Left ventricular ejection fraction (LVEF) was significantly lower in RBBB patients (p < 0.001). Peak troponin-I levels were significantly higher in the RBBB group (p < 0.001, 95% confidence interval (CI): 6.581-11.803). In-hospital mortality was significantly higher in RBBB patients (16% vs. 5.7%, p = 0.009, odds ratio (OR) = 3.160, 95% CI: 1.284-7.777). Cardiogenic shock occurred more frequently in RBBB patients (36% vs. 16.4%, p = 0.003, OR = 2.672, 95% CI: 1.394-5.120). Arrhythmias were significantly higher in the RBBB group (42% vs. 19.7%, p = 0.001, OR = 2.946, 95% CI: 1.569-5.529). Cardiac arrest (16% vs. 11.4%, p = 0.354) and post-MI angina (24% vs. 15.4%, p = 0.170) were more common in RBBB patients but were not statistically significant. CHB was observed in 12% of RBBB patients vs. 8% in non-RBBB (p = 0.345). CKD was strongly associated with increased mortality, with all affected STEMI patients with RBBB experiencing fatal outcomes, whereas those without RBBB had significantly lower mortality. The choice of reperfusion strategy played a crucial role, with primary PCI demonstrating a survival benefit in RBBB patients, while thrombolysis and medical management were linked to markedly higher mortality rates in this group.

CONCLUSION: Patients with AW-STEMI and RBBB had significantly worse in-hospital outcomes, including higher mortality, increased risk of cardiogenic shock, and a greater prevalence of arrhythmias. Although cardiac arrest, post-MI angina, and CHB were more frequent in RBBB patients, these differences were not statistically significant. Primary PCI was associated with a lower mortality risk in RBBB patients.

PMID:40213750 | PMC:PMC11983667 | DOI:10.7759/cureus.80385

Cureus. 2025 Mar 11;17(3):e80426. doi: 10.7759/cureus.80426. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: Despite the major prevalence of concussion, it is the most misdiagnosed and undertreated form of traumatic brain injury.

METHODS: This multi-institutional questionnaire-based cross-sectional study aimed to assess concussion knowledge, exposure, and learning among neurosurgery, neurology, and emergency medicine residents in the western region of Saudi Arabia. The data collection of the responses was conducted between January and March 2024. The questionnaire contained 30 structured questions in three sections: Demographic data, knowledge of concussion definitions and management, and learning experiences on the topic.

RESULTS: A total of 105 residents participated, with a mean age of 28.32±2.62 years. Fifty-two (49.52%) were males. Neurosurgery residents scored significantly higher, 4±0.85 out of 9, in concussion knowledge in comparison to residents in neurology, 3 ± 1.32 out of 9, and emergency medicine, 3.32±1.06 out of 9 residents. These differences were statistically significant (p=<0.005). Linear regression analysis indicated that residents who received lower scores on the concussion knowledge tended to rate themselves lower than those who received higher scores (B=0.461, p=0.0107). Fifty-six (53.33%) residents have not been clinically exposed to patients with concussions. The residents scored a median of 8 (2-10) out of 10 regarding their desire to involve concussion-related knowledge in their curricula. Fifty-seven (54.29%) residents chose textbooks as their most preferred source of learning about concussion, and 37 (35.24%) chose textbooks as their most preferred format.

CONCLUSION: Residents of three specialties exhibited notable gaps in their knowledge of concussion; however, neurosurgery residents demonstrated better knowledge than their counterparts. These findings necessitate further education and training according to residents’ preferred sources and formats to improve medical care and reduce unfavorable outcomes.

PMID:40213744 | PMC:PMC11983672 | DOI:10.7759/cureus.80426

Cureus. 2025 Mar 11;17(3):e80391. doi: 10.7759/cureus.80391. eCollection 2025 Mar.

ABSTRACT

PURPOSE: This study aims to present the long-term functional and anatomical outcomes of intravitreal dexamethasone (DEX) implant in patients with central retinal vein occlusion (CRVO) in real-world daily practice.

METHODS: Retrospective study of consecutive patients with macular edema due to CRVO, treated with 0.7 mg DEX implant and had 48-month follow-up. Data on best-corrected visual acuity (BCVA) and central subfield thickness (CST) at months 12, 24, 36, and 48 after initiation of DEX implant treatment were collected from patients’ charts. Patient demographics and co-morbidities were also recorded, while potential factors affecting the final anatomical and functional outcomes were assessed.

RESULTS: Thirty-one patients (31 eyes) received a mean number of 4.1±1.1 DEX implants and demonstrated significantly improved BCVA at all time-points of follow-up (p<0.001 for all comparisons). Accordingly, CST decreased significantly at all time-points of follow-up (p<0.001 for all comparisons). Treatment naïve patients were found to have lower BCVA at month 48 compared to those who had previously received intravitreal aflibercept, although there was no difference regarding CST between the two groups at month 48. When assessing factors that may predict the outcome, only naïve administration of treatment was found to have a negative correlation with BCVA at 48 months.

CONCLUSIONS: In this series of patients with macular edema secondary to CRVO, a demonstrable improvement in BCVA was recorded along with CST decrease at a long-term follow-up of four years. Only naïve treatment with DEX implant negatively correlated with visual acuity outcomes, but it was not confirmed at the multivariate analysis. Therefore, there was no evidence to support a predictive relationship between demographic and baseline anatomical factors and final BCVA and CST.

PMID:40213734 | PMC:PMC11984006 | DOI:10.7759/cureus.80391

Cureus. 2025 Mar 11;17(3):e80414. doi: 10.7759/cureus.80414. eCollection 2025 Mar.

ABSTRACT

Background Clinical audits serve as a critical tool for quality improvement, evaluating current practices to enhance patient care. Radiology request forms (RRFs) are essential for accurate diagnosis and treatment but often face challenges like incomplete or inaccurate information, illegibility, and non-compliance with established guidelines. This audit aimed to assess the adequacy of RRF completion at Othman Digna Teaching Hospital, Sudan, and implement interventions to improve compliance with guidelines. Materials and methods A prospective audit was conducted between November and December 2024. The first cycle involved assessing 50 randomly selected RRFs for adherence to the Royal College of Radiologists (RCR) guidelines. Interventions included introducing standardized forms and providing physician training. A second cycle of 50 RRFs was evaluated post-intervention. Data were analyzed using descriptive statistics and graphical representations. Results Compliance with eight key standards improved significantly post-intervention. Patient name compliance increased from 98% to 100%, while patient age rose from 12% to 98%. The inclusion of clinical background details and the question to be answered both reached 100% from initial rates of 16% and 4%, respectively. Overall mean compliance improved from 26% to 95.5%. Conclusions The study demonstrated significant improvements in the completion of RRFs following targeted interventions. Regular audits, standardized procedures, and continuous training are essential to sustaining compliance and improving communication between clinicians and radiologists, ultimately enhancing patient care.

PMID:40213733 | PMC:PMC11983657 | DOI:10.7759/cureus.80414

Cureus. 2025 Mar 11;17(3):e80410. doi: 10.7759/cureus.80410. eCollection 2025 Mar.

ABSTRACT

Background Organ transplantation is a successful medical intervention available for end-stage organ failure. There is a wide gap between the need and the availability of organs.The government has begun specific, long-term initiatives to encourage organ donation, although it has not been able to come to a stage of full realisation. Objective The objective of this study is to assess the knowledge, attitude, and practice (KAP) regarding organ donation among the general population in Perambalur, India. Methodology This cross-sectional study was performed among the general population in Perambalur, Tamil Nadu, India, from December 2022 to February 2023. About 470 individuals were selected using the convenience sampling method. A semi-structured pro forma was used to collect the socio-demographic profile, and a questionnaire was used to assess the KAP of organ donation. The minimum and maximum scores for knowledge of organ donation were 0-13 and for attitude and practice as 0-8. The data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY), and the categorical data were represented as frequency and percentage, whereas mean and standard deviation represent quantitative data. The chi-square test was used to investigate the relationship between sociodemographic characteristics and KAP regarding organ donation. Results A total of 470 responses were analyzed, with 57.7% males and 65.3% from rural areas. Most (84.7%) had heard of organ donation, mainly through television (78.6%). Awareness was highest for eye (89.4%), kidney (76%), and heart (71%) donation. While 83.6% supported organ donation, only 16.8% pledged, and 5% registered as donors. Adequate KAPs were seen in 34.1%, 29.1%, and 27.1% of participants, respectively. Younger age, urban residence, higher education, and upper socioeconomic class were significantly associated with better KAP scores (p=0.001). Conclusion Despite high awareness and a positive attitude toward organ donation, actual donor registration remains low. More than one-fourth of the participants had adequate KAP, influenced by factors such as younger age, urban residence, higher education, and upper socioeconomic status. Misconceptions, cultural beliefs, and religious concerns were key barriers to participation. Targeted awareness campaigns involving media, healthcare professionals, and religious scholars are crucial to increasing acceptability. Strengthening donor registration systems and policy-driven incentives can help bridge the gap between awareness and actual organ donation.

PMID:40213729 | PMC:PMC11984589 | DOI:10.7759/cureus.80410

Cureus. 2025 Mar 11;17(3):e80428. doi: 10.7759/cureus.80428. eCollection 2025 Mar.

ABSTRACT

Both microscopic and endoscopic transsphenoidal approaches can be utilized to treat pituitary adenomas or pituitary neuroendocrine tumors (PitNETs). While both techniques have shown comparable beneficial outcomes, challenges remain, and definitive long-term data are lacking. A comprehensive study could help optimize surgical strategies for pituitary tumor management, ultimately improving patient outcomes. This retrospective study compares the outcomes of microscopic and endoscopic transsphenoidal surgeries for treating pituitary tumors. Fifty-two patients (23 men and 29 women) who underwent surgery between January 2012 and December 2018 were included. Patients were classified into two groups based on the surgical approach: 26 underwent microscopic surgery and 26 underwent endoscopic surgery. Preoperative and postoperative MRI scans, tumor size, and hormone levels were analyzed. The primary outcomes evaluated included the extent of tumor resection, complication rates, hormonal remission, and improvements in visual symptoms. The results showed no statistically significant difference in tumor resection between the two groups, with total radiological remission achieved in 65.4% of patients in both the microscopic and endoscopic groups. The hormonal remission rate was 81.3% in the microscopic group and 86.6% in the endoscopic group. Complications included transient diabetes insipidus in 25% of patients and rhinorrhea in 9.6%, and no surgical mortality was observed. The endoscopic approach offered advantages such as reduced mucosal trauma and improved visualization, while challenges included the need for a bloodless surgical field. Despite these differences, both techniques demonstrated comparable outcomes regarding tumor resection, complication rates, and hormonal remission.

PMID:40213724 | PMC:PMC11985159 | DOI:10.7759/cureus.80428

Cureus. 2025 Mar 11;17(3):e80408. doi: 10.7759/cureus.80408. eCollection 2025 Mar.

ABSTRACT

Background Coronary artery disease (CAD) is the leading cause of death and premature disability worldwide. Secreted frizzled-related protein 5 (SFRP5), a recently identified adipokine, acts as an antagonist of Wingless-type family member 5A (WNT5A) signaling. Since WNT5A triggers inflammation in endothelial cells, the anti-inflammatory properties of SFRP5 play a crucial role in counteracting this effect. Lower SFRP5 levels contribute to the chronic inflammatory conditions associated with CAD by promoting WNT5A signaling. Aim This study aimed to assess serum SFRP5 levels in CAD patients and compare them with those in non-CAD patients at a tertiary care hospital. Materials and methods The study sample included 40 angiographically confirmed CAD patients as cases and 40 non-CAD patients as controls. Serum SFRP5 levels and lipid profiles were measured and compared between the two groups. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA), employing descriptive statistics, normality tests, t-tests, chi-square tests, and correlation analyses. A p-value of <0.05 was considered statistically significant. Results Serum SFRP5 levels were significantly lower in CAD patients (1.25 ± 0.35) compared to controls (2.46 ± 0.96) (p < 0.01). Additionally, SFRP5 showed a significant negative correlation with triglycerides and low-density lipoprotein cholesterol (p < 0.05). Conclusions This study demonstrated that serum SFRP5 levels were significantly lower in CAD patients compared to controls. Therefore, serum SFRP5 may serve as a novel biomarker for the early prediction of CAD.

PMID:40213711 | PMC:PMC11984588 | DOI:10.7759/cureus.80408

Cureus. 2025 Mar 11;17(3):e80393. doi: 10.7759/cureus.80393. eCollection 2025 Mar.

ABSTRACT

Introduction Transplant renal artery stenosis (TRAS) is a potentially treatable posttransplant complication, primarily presenting with arterial hypertension and allograft dysfunction. Its prevalence in children with posttransplant hypertension ranges from 5% to 15%. Diagnosis is typically made through invasive angiography following suspicion raised by echo Doppler findings. Treatment options include medical therapy, percutaneous transluminal angioplasty (PTA)/stenting, and surgical revascularization. This study aimed to assess the efficacy, complications, and outcomes of PTA/stenting procedures in children with TRAS. Methods We reviewed all pediatric patients who underwent renal transplantation in Serbia between June 2001 and February 2023 to identify cases of TRAS treated with PTA. Statistical analysis was performed to compare pre- and post-intervention arterial vessel diameters, serum creatinine levels, estimated glomerular filtration rate (eGFR), mean blood pressure, systolic and diastolic blood pressure indices, and the number of antihypertensive medications used. Results Seven patients underwent PTA with or without stent placement for TRAS. None were treated solely with medical therapy or surgical intervention. The overall prevalence of TRAS was 6.32%, higher in cadaveric transplants (11.11%) compared to living-related transplants (3.39%). Of the seven patients, five underwent PTA alone, while two required stent placement. Two of the five PTA patients required re-interventions, resulting in a total of seven angioplasty procedures. No complications occurred following the procedures. After a mean follow-up of 56.86 ± 45.76 months, patients demonstrated improved blood pressure control and reduced use of antihypertensive medications. While the mean eGFR showed a nonsignificant improvement, one patient with severe concomitant cytomegalovirus disease progressed to grade IV chronic kidney disease. Conclusions PTA, with or without stenting, appears to be an effective and safe treatment for TRAS in children, with immediate and intermediate-term results comparable to those reported in the literature. Stent placement may be particularly suitable for adolescents who have completed their growth phase.

PMID:40213709 | PMC:PMC11984333 | DOI:10.7759/cureus.80393

Cureus. 2025 Mar 10;17(3):e80353. doi: 10.7759/cureus.80353. eCollection 2025 Mar.

ABSTRACT

Background Patients undergoing dialysis require intensive treatment and supportive care, which affects their caregivers physically, socially, economically, and psychologically. However, this topic has been largely underexplored. Objectives This study aimed to examine the socio-economic and psychological burdens experienced by primary caregivers of patients undergoing dialysis. Method This cross-sectional study was conducted over 12 weeks using purposive sampling of primary caregivers of patients undergoing dialysis at two public and two private dialysis centers in Trinidad and Tobago. The questionnaire collected data on socio-demographics, economics, and selected psychological issues. Selected global health status questions adapted from the World Health Organization Quality of Life Brief Version were included. Participants were assured of confidentiality and anonymity. Verbal consent was obtained by completing an online questionnaire. The collected data were entered into a Statistical Package for the Social Sciences spreadsheet. Data analysis included hypothesis testing at a 5% level of significance using chi-square tests of association and analysis of variance. Results The final sample comprised 150 participants (response rate: 100%). The majority of caregivers were aged 46-55 (n = 44, 29.3%), women (n =82, 54.7%), and had attained tertiary-level education (n = 82, 54.7%). Most caregivers were the patient’s son or daughter (n = 53, 35.3%), lived with the patient (n = 83, 55.3%), and were employed full time (n = 104, 69.3%). More than half (n = 79, 52.7%) reported having at least one health condition, with 40% (n = 61) reporting “getting sick easily” after becoming a caregiver. The majority experienced psychological symptoms of feeling nervous, anxious, or on edge (n = 115, 76.7%). Caregivers reported feeling depressed (n = 49, 32.7%), experiencing burnout (n = 101, 67.8%), and having suicidal thoughts (n = 10, 6.7%). Caregivers spent between one (n = 4, 2.7%) and four (n = 30, 20.0%) days a week taking patients for dialysis treatments, with the majority (n = 80, 53.3%) spending three days weekly. Travel time to dialysis centers ranged from 45 minutes (n = 46, 30.7%) to three hours (n = 5, 3.0%). Most caregivers also reported difficulty having a good work-life balance (n = 106, 70.7%), inability to attend social events (n = 93, 62.0%), reduced personal time (n = 86, 57.3%), and the need to adjust their work hours (n = 99, 66.0%). The majority also experienced economic hardships such as worrying about finances (n = 102, 68.0%). Caregivers also wished other family members contributed financially to patient care (n = 107, 71.3%), especially because the majority (n = 99, 66.0%) were unable to afford to send the patient to a nursing home. Nearly half (n = 66, 44%) of caregivers rated their quality of life (QoL) as “less than good”and more than half (n = 99, 66%) felt that their life lacked meaning. Conclusion Caregivers spend a considerable amount of time with patients, which affects them biologically, socially, economically, and psychologically. More than half of caregivers had challenges in maintaining a work-life balance. The majority were worried about finances (n = 102, 68.0%). Participants experienced anxiety (n = 116, 76.7%), burnout (n = 102, 68.0%), depression (n = 49, 32.7%), and suicidal thoughts (n = 10, 6.7%). These findings underscore the need for targeted intervention to support caregivers and improve their overall QoL.

PMID:40213708 | PMC:PMC11984004 | DOI:10.7759/cureus.80353