Tag: statistics

Wounds. 2025 Oct;37(10):409-416.

ABSTRACT

BACKGROUND: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) provides repeated wound cleansing plus the therapeutic benefits of traditional NPWT and has been elevated to a first-line therapy in some regions given evidence of its effectiveness.

OBJECTIVE: To examine the effect of NPWTi-d on health care utilization and costs in South Africa, where NPWTi-d may still be used as a therapy of last resort.

METHODS: This retrospective study was conducted utilizing a large, South African, private health insurance claims database. A matched cohort of 836 inpatients receiving NPWTi-d or NPWT for various wound types from 2018 through 2022 was created using propensity scoring. Differences in outcomes were compared between groups using t tests.

RESULTS: Despite matching, patients who received NPWTi-d were likely more complex than those who received NPWT, as indicated by a longer length of stay (18.5 days and 13.2 days, respectively; P < .001) and higher overall care costs during the index hospital admission. Readmission rates were similar between groups; however, patients who received NPWTi-d were less likely to have visits for wound-related subacute care or rehabilitation (20.1% vs 53.6%). The average cost of this care (in South African rand) was significantly lower for patients receiving NPWTi-d than for those receiving NPWT (R3 231 and R12 317, respectively; P < .001).

CONCLUSION: Although this study had limitations, including a potential selection bias, study data suggest that NPWTi-d may reduce wound-related health care utilization and costs for some patients through decreases in visits for subacute care. More studies are needed to fully assess how NPWTi-d affects wound care pathways, patient outcomes, and costs in South Africa.

PMID:41270202

PLoS Comput Biol. 2025 Nov 21;21(11):e1013678. doi: 10.1371/journal.pcbi.1013678. Online ahead of print.

ABSTRACT

We investigate proteins within heterogeneous cell membranes where non-equilibrium phenomena arises from spatial variations in concentration and temperature. We develop simulation methods building on non-equilibrium statistical mechanics to obtain stochastic hybrid continuum-discrete descriptions which track individual protein dynamics, spatially varying concentration fluctuations, and thermal exchanges. We investigate biological mechanisms for protein positioning and patterning within membranes and factors in thermal gradient sensing. We also study the kinetics of Brownian motion of particles with temperature variations within energy landscapes arising from heterogeneous microstructures within membranes. The introduced approaches provide self-consistent models for studying biophysical mechanisms involving the drift-diffusion dynamics of individual proteins and energy exchanges and fluctuations between the thermal and mechanical parts of the system. The methods also can be used for studying related non-equilibrium effects in other biological systems and soft materials.

PMID:41270151 | DOI:10.1371/journal.pcbi.1013678

Acta Ortop Mex. 2025 Sep-Oct;39(5):292-298.

ABSTRACT

INTRODUCTION: the decision to amputate a severely injured limb is a dilemma for any orthopedic surgeon. There are multiple factors for this decision, being controversial for decision making.

OBJECTIVE: to know the type of prescription pattern for decision-making in early amputation of a severely injured limb in a reference trauma hospital.

MATERIAL AND METHODS: analytical, cross-sectional and prospective observational study. Orthopedic surgeons and resident physicians in the orthopedic specialty were evaluated, who evaluated five clinical cases of severely injured limbs, and through MESS, decided whether to amputate the limb. The statistic used was 2 to assess the coincidence of the decisions with the experts’ responses, and Odds Ratio to estimate risks. The value that was taken as statistically significant was p < 0.005.

RESULTS: sample 81 participants, 64.2% OB and 35.8% MR. The agreement of responses with the group of experts, OB was 85.4% and MR was 70%. In the OB, work experience had a higher percentage of coincidences, but they were not statistically significant (> 20 years, p = 0.034; 10-19 years, p = 0.011; < 9 years, p = 0.011) on the other hand, presenting a current certification (p = 0.002) and have a postgraduate degree after the specialty (p = 0.006) if they had one when compared with the responses of the group of experts.

CONCLUSIONS: in all the physician surveyed, the correct application of MESS, they had a great agreement in the correct decision to save or amputate a severely damaged limb.

PMID:41270137

Acta Ortop Mex. 2025 Sep-Oct;39(5):287-291.

ABSTRACT

INTRODUCTION: the objective of our work is to assess the timeline of return to work (RTW) and sports, following arthroscopic partial meniscectomy. We hypothesized that patients in greater-intensity occupations would demonstrate greater duration of absence from work and sports, and also that most patients return to unrestricted activity within 7 weeks after knee arthroscopy.

MATERIAL AND METHODS: we obtained from 100 cases preop Tegner, Lysholm, VAS and type of work based on physical demand (REFA classification). We reevaluate all cases at three months and at two years postop.

RESULTS: all the patients returned to work, and 90% returned to sports. The median RTW time was 4.8 months. 79% RTW by six months. Of the 21 patients with no subjective improvement by six months, seven required revision knee arthroscopy, 14 had biomechanical examinations that showed submaximal effort and they returned to work. We evaluated type of meniscal tear, gender, age, Lysholm score, Tegner, VAS, satisfaction with knee results postop and rehabilitation sessions, and we did not find any statistically significant correlation with RTW time.

CONCLUSION: we thought RTW after meniscal surgery strongly depends on the physical work strain, but we didn’t find that in our study. So, we taught much more variables influences on work return, and worker compensation has an important value.

PMID:41270136

Acta Ortop Mex. 2025 Sep-Oct;39(5):273-279.

ABSTRACT

INTRODUCTION: degenerative shoulder diseases have an estimated prevalence between 16 and 25% in the population over 65 years of age. Mexico lacks a system to document and analyze shoulder arthroplasty procedures. This study aimed to identify the clinical profile of patients undergoing shoulder arthroplasty in Mexico.

MATERIAL AND METHODS: observational, descriptive, and multicenter study conducted between 2014 and 2024. Clinical and demographic characteristics were collected, including comorbidities, surgical indication, Constant functional score, type of arthroplasty performed, type of prosthesis used, and average cost.

RESULTS: a total of 516 patients were included; 353 (68.41%) were female. The mean age was 70.09 ± 9.5 years. The right shoulder was affected in 321 (62.2%) cases, and right-hand dominance was present in 485 (93.9%) patients. The most common comorbidity was arterial hypertension (266 patients, 39.45%). The most frequent indication was rotator cuff tear arthropathy (208 patients, 40.31%). The Constant score improved by 46.54 points. The most commonly used arthroplasty was reverse in-lay (339 cases, 65.69%). The average cost per prosthesis was $170,000.00 MXN.

CONCLUSION: in our country, the typical candidate for shoulder arthroplasty is a female patient between 60 and 80 years of age, with a diagnosis of rotator cuff tear arthropathy or osteoarthritis causing significant functional limitation of the affected limb.

PMID:41270134

PLoS One. 2025 Nov 21;20(11):e0337590. doi: 10.1371/journal.pone.0337590. eCollection 2025.

ABSTRACT

Conventional lecture-based instruction in music theory often falls short in fostering deep engagement, critical thinking, and applied musicianship-particularly in educational contexts shaped by teacher-centered traditions. This study presents the design, implementation, and empirical evaluation of a Flipped Classroom Module (FCM) tailored to undergraduate music theory instruction in Chinese higher education. Grounded in a tripartite theoretical framework integrating Self-Directed Learning, Course Development Theory, and Collaborative Learning Theory. The module employs a three-phase instructional sequence-pre-class preparation, in-class collaboration, and post-class reflection-delivered through a customized learning management system. A quasi-experimental design (N = 60) compared the FCM group with a traditional instruction control group across both cognitive and practical learning domains. Validated pre- and post-tests assessed music-theoretical knowledge and applied skills, and statistical analyses (independent and paired-sample t-tests) revealed significant learning gains in the FCM group (p < .05). Beyond confirming the pedagogical efficacy of the flipped approach, the study demonstrates how culturally responsive instructional design can enhance accessibility, learner autonomy, and instructional coherence within constrained curricular environments. The findings contribute to ongoing international discourse on digital transformation in higher music education and offer a replicable framework for theory-informed, discipline-specific flipped pedagogy.

PMID:41270124 | DOI:10.1371/journal.pone.0337590

JMIR Public Health Surveill. 2025 Nov 21;11:e62693. doi: 10.2196/62693.

ABSTRACT

BACKGROUND: Despite the wide variety of studies that have focused on the recent COVID-19 infodemic, defining health mis- or disinformation remains a challenge due to the dynamic nature of the social media ecosystem and, in particular, the different terminologies from different fields of knowledge.

OBJECTIVE: In this work, we aim to develop a conceptual framework of health misinformation during pandemic contexts that will enable the establishment of an interoperable definition of this concept and consequently a better management of these problems in the future.

METHODS: We conducted a systematic review of reviews to develop a conceptual framework for health misinformation during the pandemic context as a case study.

RESULTS: This review comprises 51 reviews from which we developed a conceptual framework that integrates 6 key domains-sources, drivers, content, dissemination channels, target audiences, and health-related effects of mis- or disinformation-offering a structured approach to analyze and categorize health misinformation. These 6 domains collectively form the basis of our proposed conceptual framework.

CONCLUSIONS: Our results highlight the complexity and multifaceted nature of health disinformation and underscore the need for a common language across disciplines addressing this global problem in order to use interoperable definitions and advance this evolving field of study. By offering a structured conceptual framework, we also provide a valuable foundation for interventions aimed at surveillance, public communication, and digital content moderation in future health emergencies.

PMID:41269748 | DOI:10.2196/62693

JAMA Health Forum. 2025 Nov 7;6(11):e254241. doi: 10.1001/jamahealthforum.2025.4241.

ABSTRACT

IMPORTANCE: With hospital-based obstetric care declining in rural areas, risk-appropriate care, which aligns patient clinical conditions with hospital capabilities using level of care, may be limited for pregnant rural residents, especially those with higher-risk conditions that necessitate specialty or subspecialty obstetric care.

OBJECTIVE: To assess the proportion of higher-risk pregnant rural residents who receive risk-appropriate care during childbirth and identify factors associated with not receiving risk-appropriate care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used linked vital statistics and hospital discharge data for pregnant rural residents with higher-risk clinical conditions who had hospital-based births in Michigan (2010-2020), Oregon (2010-2020), Pennsylvania (2010-2018), and South Carolina (2010-2020). Data analyses were performed between December 2023 and July 2025.

EXPOSURE: Birth hospital maternal level of care (I, basic; II, specialty; III, subspeciality; IV, regional perinatal).

MAIN OUTCOMES AND MEASURES: The main outcome was birth in a hospital with risk-appropriate care, defined as having the necessary level of care for the patient’s clinical condition. Covariates included age, race and ethnicity, insurance, education, prenatal care utilization, medical and obstetric comorbidities, distance to the closest risk-appropriate hospital (quartile 1: 0.50-5.57 miles, quartile 2: 5.58-18.90 miles, quartile 3: 18.91-33.93 miles, quartile 4: 33.94-209.80 miles), year, and state.

RESULTS: A total of 199 225 higher-risk pregnant rural residents (mean [SD] maternal age, 27.9 [5.6] years) were included, of whom 11 651 (5.9%) identified as Hispanic, 3054 (1.5%) as non-Hispanic American Indian or Alaska Native, 1370 (0.7%) as non-Hispanic Asian or Pacific Islander, 18 296 (9.2%) as non-Hispanic Black, 5320 (2.7%) as non-Hispanic other race, and 159 253 (79.9%) as non-Hispanic White. Birth at a risk-appropriate hospital occurred for 38 441 of 70 647 individuals (54.4%) with conditions requiring level II care, 4611 of 9270 (49.7%) with conditions requiring level III care, and 1793 of 6527 (27.5%) with conditions requiring level IV care. Those with significantly higher rates of not receiving risk-appropriate care included American Indian or Alaska Native (adjusted incidence rate ratio [aIRR], 1.13; 95% CI, 1.10-1.17), or Hispanic (aIRR, 1.06; 95% CI, 1.03-1.08) individuals (compared with White individuals), those without private insurance (public: aIRR, 1.03; 95% CI, 1.01-1.04; uninsured: aIRR, 1.07; 95% CI, 1.01-1.14), those who were younger and had less education (age <20 years: aIRR, 1.05; 95% CI, 1.03-1.08, compared with 30-34 years; some high school: aIRR, 1.04; 95% CI, 1.03-1.06, compared with high school degree), and those who lived further from a risk-appropriate hospital (furthest quartile: aIRR, 23.86; 95% CI, 20.48-27.79, compared with closest quartile).

CONCLUSIONS AND RELEVANCE: In this study, lack of risk-appropriate care was common for pregnant rural residents with clinical complexity. Associated factors, including race, ethnicity, insurance, age, education, and distance, highlight the barriers and need for increasing access to subspecialty care for pregnant rural residents.

PMID:41269701 | DOI:10.1001/jamahealthforum.2025.4241

JAMA Health Forum. 2025 Nov 7;6(11):e254403. doi: 10.1001/jamahealthforum.2025.4403.

ABSTRACT

IMPORTANCE: Dentists’ limited participation in Medicaid is a substantial barrier to addressing the persistent unmet need for dental care among adult Medicaid beneficiaries.

OBJECTIVE: To assess dentists’ experiences and perceptions regarding Medicaid and to identify barriers and facilitators to participation as well as strategies to improve dentists’ participation and service delivery.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study involved semistructured individual interviews of dentists from 8 states (Maryland, Massachusetts, Michigan, New York, North Carolina, South Dakota, Wisconsin, Wyoming) about their experiences with and perceptions of Medicaid. The study was conducted between August 2022 and July 2023. Data were analyzed from September 2023 to September 2024.

MAIN OUTCOMES AND MEASURES: Themes related to Medicaid participation were identified through thematic analysis, and descriptive statistics were used to characterize the sample.

RESULTS: Of the 67 dentists interviewed, 46 (68.6%) accepted Medicaid, and 21 (31.3%) did not accept Medicaid. The sample consisted of 36 females (53.7%) and 31 males (46.3%), with a mean (SD) age of 45.1 (14.4) years and a mean (SD) of 16.4 (13.8) years of work experience. Three key domains affecting dentists’ participation in Medicaid were identified: system-level, dentist-level, and patient-level factors. At the system-level domain, barriers to Medicaid acceptance, including low reimbursement rates, administrative burdens, restrictive benefit designs, and poor communication about benefits, played a role in perceived inefficiencies and limited dentists’ engagement. Challenges at the dentist-level domain included language barriers, capacity constraints, stigma surrounding Medicaid, and concerns about financial sustainability. Factors at the patient level, including appointment adherence, unfavorable perceptions of preventive care, logistical barriers, and limited oral health literacy, had a potential role in limiting effective care delivery. Dentists who accepted Medicaid reported frustration with administrative inefficiencies and reimbursement rates, whereas those who did not participate in Medicaid emphasized financial stability concerns.

CONCLUSIONS AND RELEVANCE: This study highlights the complex interplay of barriers and facilitators at system, dentist, and patient levels that impact oral health care delivery to adult Medicaid beneficiaries. Increasing reimbursement rates is important but should be complemented by efforts to streamline administrative processes, improve patient engagement, and support dentists through targeted incentive programs.

PMID:41269700 | DOI:10.1001/jamahealthforum.2025.4403

JAMA Netw Open. 2025 Nov 3;8(11):e2541409. doi: 10.1001/jamanetworkopen.2025.41409.

ABSTRACT

IMPORTANCE: Infants in neonatal intensive care units (NICUs) are at risk of acquiring organisms with multidrug resistance or high epidemic potential (MDRO+), which may precede invasive infections. High-resolution analysis of transmission cultures of MDRO+ may help mitigate these risks through targeted infection prevention measures.

OBJECTIVES: To assess the potential of whole-genome sequencing in resolving suspected transmission chains of MDRO+ and to identify associated risk factors for cluster involvement.

DESIGN, SETTING, AND PARTICIPANTS: This prospective monocentric cohort study was conducted at a level III NICU at the Medical Center-University of Freiburg, Freiburg, Germany. Of 551 admitted infants, 434 were included because they remained on the ward for 48 hours or more and received 1 or more screenings between February 15, 2019, and November 16, 2020. Statistical analysis was conducted from December 1, 2021, to November 10, 2024.

EXPOSURES: Time-dependent patient- and ward-level factors, medical device use, nursing effort score, invasive procedures, antibiotic use, prevalence of MDRO+, and staffing metrics were analyzed for association with transmission chains.

MAIN OUTCOMES AND MEASURES: The primary outcome was transmission of MDRO+, defined as colonization or invasion with genetically indistinguishable bacteria, defined by amplified fragment length polymorphism or whole-genome sequencing. Secondary outcomes included colonization rates, bloodstream infections, and risk factors associated with transmission.

RESULTS: The study included 434 infants (median gestational age, 34.6 weeks [IQR, 31.4-38.3 weeks]; 242 boys [55.8%]; median birth weight, 2165 g [IQR, 1410-2965 g]). Overall, 225 patients (51.8% [95% CI, 47.1%-56.5%]) were colonized with at least 1 MDRO+. Of 418 unique colonizations, 142 (34.0% [95% CI, 29.6%-38.6%]) were linked with transmission by whole-genome sequencing. Thirty-seven unique transmission clusters were identified, most frequently involving Escherichia coli (n = 11). Four of 10 bloodstream infections with MDRO+ (40.0%) were linked with transmission events. Increased full-time nurse staffing (odds ratio [OR], 0.28 [95% CI, 0.21-0.38]; P < .001) and prior antibiotic use (OR, 0.41 [95% CI, 0.26-0.63]; P < .001) were associated with decreased transmission risk, while vascular catheter use was associated with increased transmission risk (OR, 1.65 [95% CI, 1.26-2.17]; P < .001).

CONCLUSIONS AND RELEVANCE: This cohort study involving infants in the NICU suggests that bacterial sequencing can accurately detect bacterial transmission events. Multivariate analysis suggests that the bacterial transmission risk on a NICU can be modified.

PMID:41269695 | DOI:10.1001/jamanetworkopen.2025.41409