Tag: pubmed

Retina. 2025 Jan 29. doi: 10.1097/IAE.0000000000004418. Online ahead of print.

ABSTRACT

PURPOSE: To determine the pathoanatomical alteration of ectopic inner foveal layers (EIFL) and its relationship to visual recovery after epiretinal membrane (ERM) peeling surgery.

METHODS: Clinical charts and tracked spectral-domain optical coherence tomography images of patients diagnosed with stage 3 and 4 ERM were reviewed and analyzed preoperatively and at 3 and 6 months postoperatively. Central macular thickness (CMT) and EIFL thickness were measured at these time points. Wilcoxon signed-rank test was used for analysis and P < 0.05 was considered statistically significant.

RESULTS: The study cohort consisted of 54 eyes of 54 patients, 27 of whom were female. The mean age was 69.2 years. The mean Snellen VA improved from 20/50 preoperatively to 20/35 at 3 months (P<0.001) and remained 20/35 at 6 months, significantly better than preoperative levels (P=0.002). The mean preoperative EIFL thickness was 169.15 µm and decreased to 95.70 µm at 3 months (P = 0.001) and 90.95 µm at 6 months (P = 0.02). Similarly, CMT reduced from 510.00 µm preoperatively to 444.56 µm at 3 months (P < 0.001) and 415.50 µm at 6 months (P < 0.001). Reduction in EIFL thickness was significantly correlated with improvement in log-MAR VA (P =0.02) 6 months after surgery.

CONCLUSION: ERM peeling results in reduced EIFL thickness, restoration of the normal foveal pit structure, and a corresponding improvement in visual acuity. Reduction in EIFL thickness is correlated with visual improvement.

PMID:39899800 | DOI:10.1097/IAE.0000000000004418

Neurology. 2025 Feb 25;104(4):e210229. doi: 10.1212/WNL.0000000000210229. Epub 2025 Feb 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Ordinal scales are widely adopted as outcome measures in neurologic randomized controlled trials (RCTs). We aimed to evaluate which statistical methods have been used to test and estimate treatment effects from ordinal outcomes in recent RCTs across a range of acute neurologic diseases.

METHODS: We searched PubMed for RCTs in 5 acute monophasic neurologic diseases (stroke, traumatic brain injury [TBI], subarachnoid hemorrhage [SAH], meningitis, and Guillain-Barré syndrome [GBS]) published in high-impact journals between January 1, 2015, and November 1, 2023. Trials had to report on an ordinal scale as the primary or secondary efficacy outcome. Two independent reviewers performed study screening and data extraction. We evaluated the results to determine how investigators (1) addressed the ordinal nature of outcomes, (2) assessed and reported key assumptions, (3) used longitudinal measurements, and (4) adjusted for prognostic covariates.

RESULTS: We reviewed 70 RCTs for treatment evaluations in stroke (n = 36), TBI (n = 13), SAH (n = 10), meningitis (n = 7), and GBS (n = 4). In 46 of 70 trials (66%), investigators retained the full ordering information, commonly analyzed using a proportional odds model (33/46 trials, 72%). The proportional odds assumption was not addressed in 23 of 33 trials (62%). In 22 of 70 trials (31%), the ordinal outcome was dichotomized, with notable variation in the cut-point for each ordinal scale. In 41 of 70 trials (59%), the ordinal outcome was assessed at multiple time points while some form of longitudinal data analysis was performed in only 3 of these 41 studies (7%). The time point chosen for analysis varied within neurologic conditions. Covariate adjustment was reported in 48 of 70 studies (69%).

DISCUSSION: There is a large variation in the current practice of analyzing ordinal outcomes in neurologic trials. Dichotomization and focus on a single time point are common; therefore, information contained in the rank ordering of the outcome and repeated measurements is not fully used. Further research needs to clarify the balance between maximizing the statistical power, making assumptions, and allowing for straightforward interpretations in approaches that make more effective use of the outcome data.

PMID:39899785 | DOI:10.1212/WNL.0000000000210229

Health Aff (Millwood). 2025 Feb;44(2):215-223. doi: 10.1377/hlthaff.2024.00190.

ABSTRACT

Consolidation of physician practices, largely driven by health systems, has motivated policy efforts to move care toward lower-price, non-health system settings. At the same time, however, private equity (PE) firms are increasingly acquiring those non-health system practices, potentially negating the prior price advantages of those practices. We used novel ownership data on gastroenterology practices linked to commercial claims for the period 2015-20 to study how PE acquisitions affect the prices and volume of care relative to both health system-affiliated practices and independent practices. We examined both professional fees and facility fees. After PE acquisition, prices increased by $92 per claim, or 28.4 percent, driven by a 78.1 percent increase in professional fees. Facility fees did not exhibit a statistically significant change. Meanwhile, utilization also increased. These findings suggest that PE firms have multiple avenues for raising prices-in this case, primarily via professional fees. For policy makers, although moving care out of higher-price health system settings remains a key strategy to lower spending, unchecked growth in professional fees in PE-acquired outpatient settings may nullify some of the intended effects.

PMID:39899779 | DOI:10.1377/hlthaff.2024.00190

Health Aff (Millwood). 2025 Feb;44(2):224-233. doi: 10.1377/hlthaff.2024.00145.

ABSTRACT

The Hyde Amendment prohibits US federal spending on abortion, including federal Medicaid dollars. Seventeen states cover abortion care in their Medicaid programs, using state funds, but causal evidence on how Medicaid coverage for abortion affects pregnancy outcomes is limited. Using a difference-in-differences design and 2014-21 birth and abortion data from the Centers for Disease Control and Prevention that predate the US Supreme Court’s Dobbs decision in 2022, we evaluated a 2018 policy introducing Medicaid coverage for abortion in Illinois. This change increased the number of abortions in the state by 2.43 per 1,000 reproductive-age females, an 18.2 percent increase, and reduced births by 1.66 per 1,000 reproductive-age females, a 2.8 percent decrease, relative to twenty-nine comparison states that did not cover abortion during the study period. Subgroup analyses of birth rates suggested that decreases in birth rates were more pronounced among Black and Hispanic residents, residents in counties with higher poverty rates, and residents closer to an abortion facility. Our finding suggests that Medicaid can play an important role in abortion access.

PMID:39899778 | DOI:10.1377/hlthaff.2024.00145

Health Aff (Millwood). 2025 Feb;44(2):187-195. doi: 10.1377/hlthaff.2024.00978.

ABSTRACT

The evolving composition and experiences of the family caregiver workforce have profound ramifications for public policy but are not well understood. Drawing on the linked National Health and Aging Trends Study and National Study of Caregiving, we found that the numbers of family caregivers providing help to older adults increased by nearly six million between 2011 and 2022, rising from 18.2 million to 24.1 million. Among older adults receiving care, network size was stable, at about two caregivers per older adult at both points in time. However, in 2022, family caregivers were assisting older adults who were younger, more likely to be male and better educated, and less likely to have dementia. We found few changes in competing work and child care responsibilities, weekly care hours, and caregiving-related difficulty. A smaller number of family caregivers were assisting fewer older adults with dementia, but in this group, co-residence increased by 25 percent, average care hours increased by 50 percent, and employment decreased. For family caregivers as a whole, challenges persist, and for those assisting people with dementia, tailored surveillance and effective support programs are needed.

PMID:39899774 | DOI:10.1377/hlthaff.2024.00978

Health Aff (Millwood). 2025 Feb;44(2):206-214. doi: 10.1377/hlthaff.2024.00687.

ABSTRACT

Private equity (PE) acquisitions of health care providers are often framed as a monolithic intervention, but firms’ strategies for generating returns for investors may vary. In a difference-in-differences analysis using data from the 2005-19 Medicare hospital cost reports, we compared 242 US hospitals acquired by PE firms with 870 matched control hospitals not acquired by such firms. By firm, we examined changes in salary expenditures (reflecting staffing costs of delivering care) and cumulative charges (reflecting service utilization) associated with acquisition. On average, hospitals acquired by PE firms reduced salary expenditures, whereas control hospitals increased salary expenditures. At the firm level, salary expenditures declined between 12.9 percent and 27.3 percent of preacquisition levels. These reductions occurred across most clinical departments, although the specific departments and sizes of salary cuts varied across firms. Consistent with reduced staffing and capacity, most hospitals demonstrated a simultaneous decline in cumulative charges after acquisition-despite often raising their chargemaster rates (charges per service)-implying a reduced volume of services delivered. Some hospitals exhibited an alternative strategy of increasing cumulative charges without cutting salary expenditures. PE firms varied in management strategies, with most demonstrating cost cutting through salary expenditures.

PMID:39899773 | DOI:10.1377/hlthaff.2024.00687

J Am Acad Orthop Surg Glob Res Rev. 2025 Feb 3;9(2). doi: 10.5435/JAAOSGlobal-D-24-00152. eCollection 2025 Feb 1.

ABSTRACT

INTRODUCTION: Healthcare institutions have sought to standardize opioid prescribing after elective total joint arthroplasty. The purpose of this study was (1) to compare opioid prescriptions at discharge with perceived opioid prescribing patterns and (2) to determine the relationship between preoperative adjunctive treatments and opioids prescribed at discharge.

METHODS: All surgeons who performed total joint arthroplasty of the shoulder, hip, or knee from January 1, 2021, to October 4, 2023, at a single academic institution were included. Surgeons completed a survey assessing perceived opioid prescriptions at discharge and perioperative pain protocols. Actual prescriptions were captured using our institutional opioid database. All opioid prescriptions were converted to morphine milligram equivalents (MMEs).

RESULTS: Orthopaedic surgeons prescribed on average 594.2 MMEs more than they perceived as their postoperative protocol. They prescribed an additional 60.9 MMEs for every 10 MMEs that they perceived they were prescribing. Patients receiving liposomal bupivacaine were prescribed on average 597 fewer MMEs and had fewer opioid prescriptions (P < 0.001). Genicular nerve blocks and cryoneurolysis were associated with fewer prescribed MMEs (P < 0.001).

CONCLUSION: Orthopaedic surgeons prescribe substantially more opioids than intended. This study underscores the need for standardized opioid prescribing practices and the potential of adjunctive treatments in reducing opioid prescribing.

PMID:39899747 | DOI:10.5435/JAAOSGlobal-D-24-00152

J Chem Inf Model. 2025 Feb 3. doi: 10.1021/acs.jcim.4c02013. Online ahead of print.

ABSTRACT

Quantitative structure-property relationship (QSPR) analysis plays a crucial role in predicting physicochemical properties and biological activities of pharmaceutical compounds, aiding in drug design and optimization. This study focuses on leveraging QSPR within the framework of vertex and edge-weighted (VEW) molecular graphs, exploring their significance in drug research. By examining 48 drugs used in the treatment of various cancers and their physicochemical properties, previous studies serve as a foundation for our research. Introducing a novel methodology for computing vertex and edge weights, we highlight the importance of considering atomic properties and interbond dynamics. Statistical analysis, employing linear regression models, reveals enhanced correlations between topological indices and the physicochemical properties of drugs. Comparison with previous studies on unweighted molecular graphs highlights the enhancements achieved with our approach.

PMID:39899740 | DOI:10.1021/acs.jcim.4c02013

J Am Acad Orthop Surg Glob Res Rev. 2025 Jan 29;9(2). doi: 10.5435/JAAOSGlobal-D-24-00151. eCollection 2025 Feb 1.

ABSTRACT

BACKGROUND: Preoperative optimization of modifiable risk factors (MRFs) for arthroplasty patients is a critical aspect of predicting and improving postoperative outcomes. This study evaluates the correlation between seven MRFs and postoperative adverse outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

METHODS: A retrospective review of primary TKA and THA were identified from a large medical claims database. Patients were categorized based on the number of MRF diagnoses present before surgery (anemia, malnutrition, obesity, opioid abuse/dependence, mental illness, type 2 diabetes mellitus, and tobacco use), from zero to seven. Adverse outcomes evaluated were surgical site infections (SSIs), venous thromboembolic events (VTEs), and readmissions.

RESULTS: Of the patient records queried (THA = 303,857; TKA = 692,157), two or more MRFs were identified in 41% of THA patients and 47% of TKA patients. Patients with two or more MRFs were at an increased odds of developing an SSI, and patients with three or more MRFs had increase odds of having a 30-day hospital readmission.

CONCLUSIONS: This study adds to the compendium of literature, which promotes preoperative optimization of MRFs in arthroplasty patients to decrease the risks of 90-day postoperative complications.

PMID:39899738 | DOI:10.5435/JAAOSGlobal-D-24-00151

Proc Natl Acad Sci U S A. 2025 Feb 11;122(6):e2417812122. doi: 10.1073/pnas.2417812122. Epub 2025 Feb 3.

ABSTRACT

Researchers in the social sciences are interested in the consequences of institutions, increasingly on a global scale. Institutions that may be negotiated between states can have consequences at a microlevel, as local populations adjust their expectations and ultimately even their behavior to take institutional rules into account. However, large-scale fine-grained analyses that test for the complex evidence of such institutions locally are rare. This article focuses on a key institution: International borders. Using computer vision techniques, we show that it is possible to produce a geographically specific, validated, and replicable way to characterize border legibility, by which we mean the ability to visually detect the presence of an international border in physical space. We develop and compare computer vision techniques to automatically estimate legibility scores for 627,656 imagery tiles from virtually every border in the world. We evaluate statistical and data-driven computer vision methods, finding that fine-tuning pretrained visual recognition models on a small set of human judgments allows us to produce local legibility scores globally that align well with human notions of legibility. Finally, we interpret these scores as useful approximations of states’ border orientations, a concept that prior literature has used to capture the visible investments states make in border areas to maintain jurisdictional authority territorially. We validate our measurement strategy using both human judgments and five nomological validation indicators.

PMID:39899723 | DOI:10.1073/pnas.2417812122