Tag: pubmed

Neurology. 2025 Jul 22;105(2):e213832. doi: 10.1212/WNL.0000000000213832. Epub 2025 Jun 27.

ABSTRACT

BACKGROUND AND OBJECTIVES: Stroke is known for its poor prognosis. Although genetic instruments have shown promise in stratifying first stroke risk in the general population, it is unknown whether they are associated with stroke prognosis. Our study aims to explore the role of genetic risk of stroke in the progression from stroke-free to first stroke and then to recurrent stroke, subsequent coronary heart disease (CHD), and death in China and the United Kingdom.

METHODS: We used data from 2 prospective population-based cohorts, China Kadoorie Biobank (CKB) and UK Biobank (UKB). Participants who were unrelated and free of stroke and CHD at baseline were included. Genetic risks of stroke were quantified using integrative polygenic risk scores (iPRSs), which incorporated summary statistics from multiple genome-wide association studies for stroke outcomes and its subtypes, and vascular-risk traits. We used a multistate model to analyze the roles of genetic risk in the transitions from baseline to first incident stroke and then to recurrent stroke, subsequent CHD, and death.

RESULTS: Our study included 80,908 CKB participants and 380,348 UKB participants, with mean ages (% female) of 54.0 years (58.6%) and 56.1 years (55.4%). During median follow-ups of 11.9 years and 13.4 years in the CKB and UKB, respectively, 13,481 and 5,772 participants had their first stroke, neither experienced a CHD, or died within 28 days. These survivors had 5,707 and 943 recurrent strokes, as well as 1,196 and 418 CHD events, respectively. iPRSs were associated with recurrent stroke and CHD among stroke survivors in both populations. The corresponding hazard ratios (HRs) and 95% CIs per SD of iPRSs were 1.08 (1.05-1.11) and 1.08 (1.02-1.15) in CKB and 1.11 (1.03-1.19) and 1.23 (1.10-1.37) in UKB, respectively. There was no association between iPRSs and mortality risk. When we further divided the first stroke into 4 pathologic subtypes, both populations revealed statistically significant associations between iPRSs and the transitions from first ischemic stroke to recurrent stroke and CHD.

DISCUSSION: Our study shows that the genetic risk of first stroke also influences the prognosis of stroke survivors, indicating that PRS has the potential to improve stroke prognosis.

PMID:40577674 | DOI:10.1212/WNL.0000000000213832

JMIR Cancer. 2025 Jun 27;11:e70275. doi: 10.2196/70275.

ABSTRACT

BACKGROUND: Blood tests used to identify patients at increased risk of undiagnosed cancer are commonly used in isolation, primarily by monitoring whether results fall outside the normal range. Some prediction models incorporate changes over repeated blood tests (or trends) to improve individualized cancer risk identification, as relevant trends may be confined within the normal range.

OBJECTIVE: Our aim was to critically appraise existing diagnostic prediction models incorporating blood test trends for the risk of cancer.

METHODS: MEDLINE and EMBASE were searched until April 3, 2025 for diagnostic prediction model studies using blood test trends for cancer risk. Screening was performed by 4 reviewers. Data extraction for each article was performed by 2 reviewers independently. To critically appraise models, we narratively synthesized studies, including model building and validation strategies, model reporting, and the added value of blood test trends. We also reviewed the performance measures of each model, including discrimination and calibration. We performed a random-effects meta-analysis of the c-statistic for a trends-based prediction model if there were at least 3 studies validating the model. The risk of bias was assessed using the PROBAST (prediction model risk of bias assessment tool).

RESULTS: We included 16 articles, with a total of 7 models developed and 14 external validation studies. In the 7 models derived, full blood count (FBC) trends were most commonly used (86%, n=7 models). Cancers modeled were colorectal (43%, n=3), gastro-intestinal (29%, n=2), nonsmall cell lung (14%, n=1), and pancreatic (14%, n=1). In total, 2 models used statistical logistic regression, 2 used joint modeling, and 1 each used XGBoost, decision trees, and random forests. The number of blood test trends included in the models ranged from 1 to 26. A total of 2 of 4 models were reported with the full set of coefficients needed to predict risk, with the remaining excluding at least one coefficient from their article or were not publicly accessible. The c-statistic ranged 0.69-0.87 among validation studies. The ColonFlag model using trends in the FBC was commonly externally validated, with a pooled c-statistic=0.81 (95% CI 0.77-0.85; n=4 studies) for 6-month colorectal cancer risk. Models were often inadequately tested, with only one external validation study assessing model calibration. All 16 studies scored a low risk of bias regarding predictor and outcome details. All but one study scored a high risk of bias in the analysis domain, with most studies often removing patients with missing data from analysis or not adjusting the derived model for overfitting.

CONCLUSIONS: Our review highlights that blood test trends may inform further investigation for cancer. However, models were not available for most cancer sites, were rarely externally validated, and rarely assessed calibration when they were externally validated.

PMID:40577667 | DOI:10.2196/70275

JMIR Public Health Surveill. 2025 Jun 27;11:e67005. doi: 10.2196/67005.

ABSTRACT

BACKGROUND: Approximately 30% of people living with HIV in Brazil have suboptimal adherence to antiretroviral therapy (ART). Theoretical models of health behaviors and objective evidence support the role of perceived barriers in hindering health behaviors.

OBJECTIVE: We aimed to evaluate the psychometric properties of the perceived barriers to ART adherence (PEDIA) scale among gay, bisexual, and other men who have sex with men (MSM) and transgender and nonbinary (TGNB) persons in Brazil.

METHODS: Using a cross-sectional study design, we evaluated the factor structure, construct validity, convergent and discriminant factorial validity, and internal reliability of the PEDIA scale using 2 convenience samples of participants aged 18 years or older living in Brazil. Sample 2020 was recruited through an internet-based survey between February and March 2020 and Sample 2021 between May 2021 and January 2022. The study instrument included sociodemographic information, ART use, and the 3 measures of ART adherence. Using Sample 2020, we performed exploratory factor analysis (EFA) with parallel analysis to evaluate PEDIA’s factor structure. Based on the goodness of fit measures and theoretical relevance, we developed a reduced version of PEDIA (PEDIAr). Using Sample 2021, we performed a psychometric evaluation of PEDIAr, which included confirmatory factor analysis (CFA), examination of modification indexes and item-item and item-total correlations, and an assessment of its correlation with different measures of adherence to ART. Goodness of fit was evaluated based on multiple indices.

RESULTS: EFA conducted on Sample 2020 (n=1692) revealed a 2-factor structure with 3 factor loadings <0.4 (excluded). Using Sample 2021 (n=4893), modification indices from the CFA and item-item and item-total correlations along with item relevance analysis suggested the exclusion of 5 additional items. CFA fit indices for PEDIAr were adequate (root mean square error of approximation=0.07, comparative fit index=0.95, Tucker-Lewis Index=0.94, standardized root mean square residual=0.05). Construct validity was supported by factor loadings above 0.6 and negative correlations between PEDIAr scores and 3 measures of adherence to ART. McDonald omega was 0.795 and 0.859 for factors 1 and 2, respectively. The square root of the average variance extracted (AVE) was 0.704 and 0.711 for factors 1 and 2, respectively, and the difference between AVE and the square of the factor correlations with other items was small (0.001 and 0.009, respectively) and not statistically significant for both factors (P=.94 and P=.55, respectively).

CONCLUSIONS: PEDIAr, the 10-item reduced version of PEDIA, proved to be valid among gay, bisexual, and other MSM and TGNB persons in Brazil. This shorter instrument was able to capture 2 distinguished dimensions of the perceived barriers to adherence to ART (practical aspects and psychological aspects). By proactively identifying individuals struggling with adherence to ART, PEDIAr can facilitate timely interventions and improve personalized care.

PMID:40577646 | DOI:10.2196/67005

J Manag Care Spec Pharm. 2025 Jul;31(7):723-728. doi: 10.18553/jmcp.2025.31.7.723.

ABSTRACT

BACKGROUND: Health plans have acknowledged there is a significant unmet need to improve prior authorization (PA) processes to increase patient access to life saving nonstatin therapies. Outcomes from a series of regional working groups in the United States provided recommendations for developing standardized patient eligibility criteria and a checklist for streamlining the PA process.

OBJECTIVE: To (1) develop a standardized PA checklist to streamline collection of adequate PA documentation by prescribers, regardless of health insurance plan type, and (2) measure the impact of the PA checklist in clinical practice in a controlled observational study.

METHODS: A working group of thought leaders representing payers and providers was assembled by PRIME Education, in collaboration with the Academy of Managed Care Pharmacy, the American Society for Preventive Cardiology, and the Preventive Cardiovascular Nurses Association. The working group developed and finalized a PA checklist for PCSK9 inhibitors that was integrated into the electronic medical record for 2 large community health care systems with geographic representation of patients with cardiovascular disease: Random chart audits were conducted prior to (historical controls) and 6 months after (post-intervention) implementation of the checklist (n = 100 each set). Primary study endpoints were rates of approvals and time to approval/receipt of prescribed drug. Statistical analyses measured changes in PA documentation outcomes, including treatment history and authorization approvals/denials. Survey questions provided to health care provider teams before and after integration of the PA checklist measured changes in prescriber attitudes on effectiveness and efficiency of the PA checklist.

RESULTS: Following implementation of the PA checklist, a 19% absolute increase in initial PA approvals and a 2-day overall reduction in time-to-treatment with prescribed PCSK9 inhibitor therapy were observed. Documentation of side effects (54%; P < 0.0001), statin contraindications (31%; P < 0.0001), and prior lipid therapies failed (20%; P < 0.0001) also increased postimplementation. In surveys, prescribers reported greater efficiency and effectiveness of the PA process when using the standardized PA checklist.

CONCLUSIONS: Time-to-treatment for nonstatin therapies for eligible patients with hypercholesterolemia was decreased in 2 community health systems following integration of a standardized PA checklist developed through a collaboration between patients and providers.

PMID:40577037 | DOI:10.18553/jmcp.2025.31.7.723

J Manag Care Spec Pharm. 2025 Jul;31(7):627-640. doi: 10.18553/jmcp.2025.31.7.627.

ABSTRACT

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as first-line therapy for glycemic management for adults with type 2 diabetes and specific comorbidities. It is unknown whether there are meaningful differences in how GLP-1 RA vs SGLT2i therapy may affect health care resource utilization and medical costs.

OBJECTIVE: To compare health care resource utilization and costs in adults with type 2 diabetes newly initiating GLP-1 RA vs SGLT2i therapy.

METHODS: We used the Humana Healthcare Research database and a retrospective cohort study design to identify patients with type 2 diabetes, enrolled in a Medicare Advantage Prescription Drug plan from January 1, 2018, to June 30, 2022. Eligible patients had at least 2 pharmacy claims for a GLP-1 RA or SGLT2i drug and had at least 12 months of continuous enrollment prior to and after the first prescription claim. Propensity score matching adjusted for population differences between GLP-1 RA and SGLT2i groups. Subgroup analyses included patients with baseline atherosclerotic cardiovascular disease and obesity. Main outcomes included inpatient stays, emergency department visits, and all-cause health care costs in the 12-month follow-up period.

RESULTS: The 1:1 matched cohort consisted of 22,167 individuals each treated with SGLT2i or GLP-1 RA, had a mean age of 68.2 years, and was 52.2% female, 73.4% White, and 18.6% Black. There were no significant differences in all-cause or diabetes-related inpatient stays or emergency department visits between GLP-1 RA and SGLT2i users for overall and subgroup analyses. Compared with SGLT2i patients, those on GLP-1 RA had 3.1% (95% CI = 0.9%-5.3%) higher medical costs in the overall cohort but 2.9% (95% CI = -5.5% to -0.2%) lower medical costs in the obesity subgroup. Pharmacy costs for patients on GLP-1 RA were 6% to 9% higher for overall and subgroup analyses, resulting in 4% to 6% higher total health care costs for GLP-1 RA users relative to SGLT2i users.

CONCLUSIONS: There were no significant differences in health care resource utilization in the overall cohort between patients taking GLP-1 RA vs those taking SGLT2i, and pharmacy and total health care costs were higher in the GLP-1 RA group. In the obesity subgroup, GLP-1 RA initiators had lower medical costs.

PMID:40577036 | DOI:10.18553/jmcp.2025.31.7.627

Acta Cardiol. 2025 Jun 27:1-9. doi: 10.1080/00015385.2025.2524239. Online ahead of print.

ABSTRACT

AIMS: To document the cross-prevalence of overall macro- and microangiopathy in T2DM and identify common and vessel-size-specific variables associated with comorbidities.

METHODS: Cross-sectional study of 876 T2DM patients to assess frequency of macrovascular and microvascular target organ damage (TOD). Logistic regressions were performed to identify common and specific variables linked to TODs.

RESULTS: Overall prevalence of Mic and Mac were 41% and 33%, respectively; 45.5% had no comorbidities (Mic[-]Mac[-]); 21% had microangiopathy only (Mic[+]Mac[-]), 13.5% had macroangiopathy only (Mic[-]Mac[+]); 20% both (Mic[+]Mac[+]). Compared to Mic[-]Mac[-], the 3 TOD groups had more (micro)albuminuria. Mic[-]Mac[+] and Mic[+]Mac[+] had more diabetic foot (DF) and heart failure (HF) than Mic[-]Mac[-]. Mic[+]Mac[+] suffered more often from atrial fibrillation than Mic[-]Mac[-]. Mic[+]Mac[+] suffered twice more from peripheral artery disease and thrice higher DF, and 1.5 times more HF vs. Mic[-]Mac[+]. Non-HDL-C, remnant cholesterol, sleep apnoea and non-O blood group were associated with Mic/Mac.

CONCLUSIONS: This transversal analysis provides quantitative data on cross-prevalence of micro- and macroangiopathies in a 3rd line hospital. Small and large-vessel diseases are highly intertwined with atherosclerotic, cardiometabolic and cardiorenal co-morbidities.

PMID:40577026 | DOI:10.1080/00015385.2025.2524239

JAMA Netw Open. 2025 Jun 2;8(6):e2517095. doi: 10.1001/jamanetworkopen.2025.17095.

ABSTRACT

IMPORTANCE: Many US communities face a crisis of people experiencing unsheltered homelessness often intertwined with opioid use. Jurisdictions seek policy options for managing unsanctioned encampments of this population, but their various outcomes are unclear.

OBJECTIVE: To evaluate policy options and their health and economic outcomes for an encampment of people experiencing homelessness and opioid use disorder (OUD).

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study conducted a closed-cohort state-transition simulation using the Researching Effective Strategies to Prevent Opioid Death (RESPOND) model from October 2021 to October 2022. The study was based primarily on data from Massachusetts and simulated an urban encampment with a population experiencing homelessness and high-risk opioid use. Data analysis was performed from December 2022 to October 2024.

EXPOSURE: The following encampment management strategies were modeled: (1) status quo (no sweep); (2) sweep, a sudden disruption of all residents, followed by no additional resources; (3) housing with medication for opioid use disorder (MOUD) requirement; or (4) housing without MOUD requirement.

MAIN OUTCOMES AND MEASURES: The primary outcomes were overdose and all-cause mortality per 1000 person-years, weeks spent in housing and taking MOUD, and economic cost from a modified government payer perspective. Sensitivity analyses were conducted by varying uncertain parameters.

RESULTS: The simulated cohort included 400 adults (mean [SD] age, 48 [17] years; 232 males [58.0%]). Under the status quo strategy, there were 50.4 (95% uncertainty interval [UI], 48.9-52.2) deaths per 1000 person-years, 15.5 (95% UI, 14.0-17.2) deaths from overdose per 1000 person-years, and 2990 (95% UI, 2897-3081) person-weeks spent taking MOUD for a total cost of $6 583 000 (95% UI, $6 502 000-$6 660 000). A sweep strategy resulted in 53.1 (95% UI, 51.3-55.2) deaths per 1000 person-years, 16.4 (95% UI, 18.2-20.2) deaths from overdose per 1000 person-years, and 1694 (95% UI, 1625-1764) person-weeks spent taking MOUD at a total cost of $6 820 000 (95% UI, $6 736 000-$6 899 000). The housing with medication requirement strategy resulted in 51.2 (95% UI, 49.4-53.0) deaths per 1000 person-years, 16.3 (95% UI, 14.6-18.1) deaths from overdose per 1000 person-years, and 3050 (95% UI, 3025-3075) person-weeks spent taking MOUD and in housing, for a total cost of $7 264 000 (95% UI, $7 188 000-$7 336 000). A housing without MOUD requirement strategy resulted in 49.2 (95% UI, 47.6-51.1) deaths per 1000 person-years, 14.3 (95% UI, 12.7-16.2) deaths from overdose per 1000 person-years, and 5014 (95% UI, 4942-5085) person-weeks spent taking MOUD and 14 511 (95% UI, 14 461-14 562) person-weeks spent in housing, for a total cost of $8 822 000 (95% UI, $8 774 000-$8 868 000).

CONCLUSIONS AND RELEVANCE: In this decision analytical model study of approaches to homeless encampments involving individuals with OUD, sweeps increased mortality and spending. Housing without MOUD requirement was the most costly strategy but saved more lives.

PMID:40577017 | DOI:10.1001/jamanetworkopen.2025.17095

JAMA Netw Open. 2025 Jun 2;8(6):e2517103. doi: 10.1001/jamanetworkopen.2025.17103.

ABSTRACT

IMPORTANCE: The number of people experiencing homelessness (PEH) in the US has increased substantially in recent years. The leading cause of death among PEH is drug overdose, with opioids accounting for the majority of such deaths.

OBJECTIVE: To assess the costs and health outcomes of providing stable housing to PEH who have opioid use disorder (OUD).

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation conducted a model-based cost-effectiveness analysis of PEH with OUD in the US.

EXPOSURE: Provision of stable housing, with no requirement to enter OUD treatment.

MAIN OUTCOMES AND MEASURES: Primary outcomes were overdoses and deaths over 5 years, lifetime per-person discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios (ICERs) compared with the status quo (no housing provision).

RESULTS: In a model of 1000 PEH (700 male; mean [SD] age, 46.4 [14.0]; 300 female; mean [SD] age, 46.5 [14.3]), under the status quo, 191 (95% CI, 152-237) deaths occurred over 5 years (58 [95% CI, 44-78] from overdose and 133 [95% CI, 101-167] from other causes). With the housing intervention, 140 (95% CI, 114-185) deaths occurred (53 [95% CI, 39-76] from overdose and 87 [95% CI, 73-110] from other causes). The housing intervention was associated with a gain of 3.59 (95% CI, 3.13-3.98) lifetime QALYs per person at an incremental cost of $26 800 (95% CI, $21 200-$32 300) per QALY gained compared with the status quo. Over extensive sensitivity analyses, the ICER remained less than $90 000 per QALY gained.

CONCLUSIONS AND RELEVANCE: This economic evaluation found that investing in stable housing for this marginalized population, even with no requirement to enter OUD treatment, was associated with cost-effectiveness, fewer deaths, and improved health outcomes. Efforts are urgently needed to improve the health of PEH with OUD; it is essential to understand the outcomes and cost-effectiveness of housing provision for this marginalized population because housing status is a key social determinant of health.

PMID:40577016 | DOI:10.1001/jamanetworkopen.2025.17103

JAMA Netw Open. 2025 Jun 2;8(6):e2517760. doi: 10.1001/jamanetworkopen.2025.17760.

ABSTRACT

IMPORTANCE: Accurate estimation of surgical transfusion risk is important for perioperative planning and effective resource allocation. Most machine learning models in health care are not validated or perform poorly in external settings.

OBJECTIVE: To externally validate a publicly available machine learning algorithm (Surgical Personalized Anticipation of Transfusion Hazard [S-PATH]) to estimate red cell transfusion during surgery within a national sample of hospitals.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated all surgical cases performed in 2020 or 2021 at 45 US hospitals participating in the Multicenter Perioperative Outcomes Group. Obstetric and nonoperative cases were excluded. Data analysis was performed from February 2023 to March 2025.

EXPOSURES: At each hospital, S-PATH was used to estimate surgical transfusion risk using patient- and procedure-specific characteristics without local retraining. A baseline model representing the standard-of-care maximum surgical blood ordering schedule (MSBOS) approach, which omits patient factors, was used for comparison. Risk thresholds above which a type and screen would be recommended were set for 96% sensitivity. Performance was evaluated at each hospital separately.

MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in the percentage of patients with type and screen order recommendations between S-PATH and MSBOS at each hospital. The secondary outcome was area under the receiver operating characteristic curve (AUROC).

RESULTS: In this cohort study of 3 275 956 surgical cases (median [IQR] age, 57 [40-69] years; 53.1% female) performed at 45 hospitals (28 of 45 academic [62.2%]), S-PATH recommended type and screen orders for a median (IQR) of 32.5% (25.8%-42.0%) of cases, whereas the MSBOS approach recommended type and screens for a median (IQR) of 51.6% (46.9%-61.1%) of cases for the same sensitivity (median [IQR] difference, 17.9 [14.8-24.9] absolute percentage points). The median (IQR) S-PATH AUROC was 0.929 (0.915-0.946), whereas the median (IQR) MSBOS AUROC was 0.857 (0.822-0.884).

CONCLUSIONS AND RELEVANCE: In this cohort study of 45 hospitals, a personalized surgical transfusion risk prediction algorithm demonstrated external validity and discrimination. S-PATH was consistently more effective than standard care, suggesting its potential for use as a perioperative clinical decision support tool.

PMID:40577014 | DOI:10.1001/jamanetworkopen.2025.17760

JAMA Netw Open. 2025 Jun 2;8(6):e2517825. doi: 10.1001/jamanetworkopen.2025.17825.

ABSTRACT

IMPORTANCE: Surgeon training with a specific implant is often not considered in implant registry-based studies, which may lead to unobserved confounding bias. Discrepancies between registry and clinical trial outcomes for patellofemoral arthroplasty (PFA) may originate from differences in surgeon training levels.

OBJECTIVE: To compare revision rates for knees operated on by knee surgeons specifically trained for PFA and knee surgeons who were not.

DESIGN, SETTING, AND PARTICIPANTS: In this population-based cohort study, the framework of a target trial was used to compare outcomes for 2 patient groups: patients who underwent PFA performed by knee surgeons who had (trial surgeons) vs who had not (nontrial surgeons) received focused PFA training as part of a randomized clinical trial. All primary PFA procedures from January 1, 2008, through December 31, 2015, were identified using Danish registries and individual hospital notes with 6 years’ follow-up. Data were analyzed from January 24 to March 1, 2024.

EXPOSURE: Focused PFA training.

MAIN OUTCOMES AND MEASURES: The primary outcome was 6-year risk of revision. Analyses were conducted according to a prespecified statistical analysis plan, using multiple logistic regression to estimate marginal risk ratios for 6-year risks of revision, reoperation, and mortality, adjusting for potential confounders.

RESULTS: Of 482 eligible knees of patients who had undergone PFA, 274 (57%; 206 female [75%]; mean [SD] age, 61 [13] years) were operated on by trial surgeons, and 208 (43%; 142 female [68%]; mean [SD] age, 57 [12] years) by nontrial surgeons. Trial surgeons operated on knees with higher patellofemoral Kellgren-Lawrence osteoarthritis grade (range 0-4, with 0 indicating no osteoarthritis and 4 indicating severe osteoarthritis) than nontrial surgeons (79% vs 53% with grade 3 to 4) and higher tibiofemoral Kellgren-Lawrence osteoarthritis grades (37% vs 17% with grade 2 to 4). The 6-year revision rate for trial surgeons was 8% (22 of 274 knees) vs 26% (54 of 208 knees) for nontrial surgeons, corresponding to an adjusted relative risk (RR) of 0.35 (95% CI, 0.22-0.56; P < .001). The reoperation rate was 12% (33 of 274 knees) for trial surgeons vs 19% (40 of 208 knees) for nontrial surgeons, with an adjusted RR of 0.71 (95% CI, 0.42-1.18; P = .19). There was no difference in mortality for trial vs nontribal surgeon groups (18 of 274 knees [7%] vs 12 of 208 knees [6%]; adjusted RR, 1.11 [95% CI, 0.53-2.33; P = .79).

CONCLUSIONS AND RELEVANCE: In this cohort study using a target trial emulation approach to assess the association of surgeon training with PFA outcomes, the cumulative 6-year revision rate for PFA was lower for knees operated on by PFA-trained knee surgeons, suggesting that such surgeon training was associated with a better outcome. This suggests that the level of training may be an important confounder for registry-based comparisons of implant outcome, and that this confounder may even obscure inherent implant outcomes.

PMID:40577013 | DOI:10.1001/jamanetworkopen.2025.17825