Tag: statistics

Cureus. 2025 Apr 26;17(4):e83042. doi: 10.7759/cureus.83042. eCollection 2025 Apr.

ABSTRACT

Objectives The prevalence of pediatric pain, either related to the child’s hospital visit or because of diagnostic and/or therapeutical interventions, is of primordial importance in pediatric emergency departments (PEDs). In this study, we evaluate the evolution of pain assessment and management in Portuguese PEDs over 11 years. Methods We prepared a questionnaire addressed to head physicians of 45 Portuguese PEDs in 2007 and statistically compared the responses to those provided in 2018, where we also posed these questions to nurse managers. Results Pain assessment in our cohort of Portuguese PEDs has significantly improved, namely, with the establishment of local protocols and widespread use of pain scales (from 52% to 93%, p = 0.03). However, effective adoption of pain management remains insufficient, as mild to moderate pain is still far from being universally treated (only 22% always use analgesia). Nonetheless, there seems to be adequate treatment of severe pain and respective common use of opioids, but correct practices were not generally adopted when specific types of pain were analyzed. Procedural sedation and analgesia have significantly increased but are not yet universally practiced. In the year 2018, about 88% of these inadequacies are reflected by the staff’s perception that pain management remains suboptimal, and more training is needed. Conclusion The development of collective awareness and the institution of national guidelines for pediatric pain have helped to improve the conjuncture in Portuguese PEDs. However, a coordinated nationwide plan to promote local training and optimize knowledge translation is still lacking.

PMID:40438844 | PMC:PMC12116828 | DOI:10.7759/cureus.83042

Cureus. 2025 Apr 27;17(4):e83093. doi: 10.7759/cureus.83093. eCollection 2025 Apr.

ABSTRACT

OBJECTIVE: Concerning endovascular treatment for acute ischemic stroke with intracranial vessel occlusion, shortening the door-to-puncture time (DTP) improves the patient’s outcome. To determine endovascular treatment, magnetic resonance angiography or computed tomography angiography is performed for occluded vessel detection. Another detection method of internal carotid artery (ICA) occlusion or middle cerebral artery first segment (M1) occlusion is ultrasound (US). Bilateral flow pattern analysis of common carotid arteries by US leads to the diagnosis of ICA or M1 occlusion within a few minutes. Moreover, it can be conducted in the emergency department. The addition of the US for the initial evaluation of vessel occlusion can shorten the DTP. In this study, we evaluated the effectiveness of carotid artery US imaging in detecting large vessel occlusion (LVO) and shortening the DTP.

MATERIALS AND METHODS: This is a retrospective case-control study. Our analysis was based on the data from 150 patients with LVO or medium vessel occlusion who underwent endovascular revascularization treatment at our hospital between January 2015 and December 2022. Among them, 104 patients who had an anterior circulation vessel occlusion were included. They were divided into the US evaluation group and the non-US evaluation group, and their characteristics, treatment time course, and outcomes were compared.

RESULTS: This study included 104 patients with a median age of 81 years (interquartile range: 73-89 years), 57.7% were females, and the pre-stroke modified Rankin Scale (mRS) median was 0.5 (interquartile range: 0-3). Our cohort included advanced aged patients; therefore, this study included 56.7% of patients over 80 years old and 35.6% of pre-stroke mRS over 3. The US (US group) and non-US (non-US group) evaluation groups included 54 and 50 patients, respectively. As magnetic resonance imaging evaluation in the non-US group was performed over the 4.5 hours delayed arrival of patients from the last known well (LKW) to consider the evaluation of tPA administration, selection bias occurred. The US group included high National Institutes of Health Stroke Scale (NIHSS) patients (P = 0.0152) and more ICA occlusions (P = 0.0146). Onset (LKW) to door time was shorter in the US group (median, 75 min (35-146.5 minutes)) than the non-US group (median, 179 minutes (47.3-432.8 minutes); P = 0.0426), and the DTP was shorter for the US group (median, 75.5 minutes (63.8-87.3 minutes)) than for the non-US group (median, 85 minutes (67-129 minutes); P = 0.0102). Statistical difference was not seen in puncture to reperfusion time among the US group (median, 71.5 minutes (51-114 minutes)) and non-US group (median, 67 minutes (42.3-98.5 minutes); P = 0.5581). The onset (LKW) to reperfusion was shorter for the US group (median, 251 minutes (201-327.3 minutes)) than for the non-US group (median, 319 minutes (200-633.5 minutes); P = 0.0348). No statistical differences were seen for thrombolysis in cerebral infarction grade 2b-3 after treatment, improvement of NIHSS, and mRS at 90 days.

CONCLUSION: US is a useful imaging method to identify an anterior circulation LVO. It can distinguish patients with severe internal carotid or middle cerebral artery occlusion from medium vessel occlusion or other peripheral vessel occlusions. US helps to shorten the DTP time of LVO.

PMID:40438838 | PMC:PMC12116222 | DOI:10.7759/cureus.83093

Cureus. 2025 Apr 28;17(4):e83141. doi: 10.7759/cureus.83141. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: Patients with heart failure (HF) and chronic kidney disease (CKD) often face therapeutic challenges, necessitating optimized treatment strategies to improve clinical outcomes. This study aims to evaluate the effectiveness of sacubitril/valsartan (Entresto) in improving clinical outcomes, reducing hospitalizations, and preserving renal function in HF patients with CKD, with a primary focus on changes in renal function (estimated glomerular filtration rate (eGFR)), and secondary outcomes, including heart performance (left ventricular ejection fraction (LVEF)) and hospitalization rates.

METHODOLOGY: This prospective observational study was conducted from January 2023 to December 2023. A total of 196 consecutively enrolled HF patients with CKD stages 2-4 were included and administered sacubitril/valsartan at FDA-recommended doses. Assessments of eGFR, hospitalization rates, LVEF, and adverse events were performed at three, six, and 12 months. Statistical analysis was conducted using SPSS version 25 (IBM Corp., Armonk, NY), and a p-value < 0.05 was considered significant.

RESULTS: The mean eGFR improved significantly from 45.8 ± 12.4 mL/min/1.73 m² to 48.5 ± 11.5 mL/min/1.73 m² after 12 months (p = 0.032), representing a 5.90% increase. Hospitalizations decreased markedly from 210 to 48 events, with hospitalization rates dropping from 65.31% to 17.35%. LVEF improved significantly from 32.5 ± 6.7% to 41.5 ± 6.1% (27.69% increase). The New York Heart Association (NYHA) functional class also improved: class II patients increased from 43.88% to 63.27%, while class IV patients declined from 16.33% to 9.18%. Adverse events included hyperkalemia in 11.22%, symptomatic hypotension in 8.16%, and worsening renal function in 5.10% of patients; 7.14% of patients discontinued therapy due to side effects.

CONCLUSION: Sacubitril/valsartan demonstrated significant improvement in cardiac function, reduction in hospitalization rates, and preservation of renal function in HF patients with CKD, supporting its clinical utility in this population.

PMID:40438836 | PMC:PMC12119063 | DOI:10.7759/cureus.83141

Cureus. 2025 Apr 28;17(4):e83118. doi: 10.7759/cureus.83118. eCollection 2025 Apr.

ABSTRACT

Cancer care faces challenges with chemotherapy-induced nausea and vomiting (CINV). Olanzapine and aprepitant, alone or with traditional antiemetics, promise CINV prevention. Their mechanisms target neurotransmitters, providing better control with manageable side effects. This study aims to rigorously review the efficacy and safety of olanzapine versus aprepitant in preventing CINV. Randomized clinical trials comparing olanzapine versus aprepitant in preventing CINV were selected following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. A comprehensive literature search was conducted in various databases and registries through March 21, 2024. Quality assessment utilized Cochrane’s ‘Risk of Bias tool (RoB2)’, and Review Manager 5.4.1 synthesized results using a random effect model. The main outcomes focused on odds ratios (ORs) for complete response (CR) in acute, delayed, and overall phases. Safety was assessed from trial descriptions. The certainty of evidence was assessed using GRADE Pro. Two hundred and eighty-two records were identified initially, yielding eight eligible RCTs with a total of 1056 participants after screening. All studies targeted CINV in adults undergoing highly emetogenic chemotherapy. In the acute phase, both drugs demonstrated similar efficacy in nausea and vomiting control (OR = 1.01, 95% CI = 0.63,1.62). During the delayed phase, no significant difference was observed (OR = 0.81, 95% CI = 0.62,1.04). In the overall phase, olanzapine exhibited slightly better nausea control than aprepitant, with statistical significance (OR = 0.76, 95% CI = 0.59,0.99). Emetic control was comparable across treatment arms (OR 0.93, 95 % CI 0.70-1.24). Olanzapine provided a clinically meaningful reduction in nausea. However, the sedation caused by olanzapine, which is significantly higher than that caused by aprepitant, can impair daily functioning, diminish treatment adherence, and increase fall risk.

PMID:40438835 | PMC:PMC12117596 | DOI:10.7759/cureus.83118

Cureus. 2025 Apr 28;17(4):e83111. doi: 10.7759/cureus.83111. eCollection 2025 Apr.

ABSTRACT

Background Smoking is a major global health concern, linked to numerous medical conditions, including hearing loss and psychological distress. Research suggests that smokers have a significantly higher risk of hearing impairment than non-smokers, possibly due to oxidative stress and vascular damage. Smoking is also associated with psychological effects such as depression, anxiety, and stress, though the relationship is complex. This study aims to compare the prevalence and degree of hearing loss between smokers and non-smokers using pure tone audiometry, and to evaluate the levels of psychological distress (depression, anxiety, and stress) in both groups using the Depression, Anxiety, and Stress Scale-21 (DASS-21) score. It also aims to assess the relationship between smoking frequency and duration with hearing loss and psychological distress. Materials and methods A prospective cross-sectional study was conducted at the ENT Outpatient Department of AIIMS Bhopal over three months. A total of 100 male participants aged 18-55 years were divided into two groups: 50 smokers (current or past) and 50 age- and gender-matched non-smokers. Hearing was evaluated through pure tone audiometry, tuning fork tests, and otoscopy. Psychological distress was assessed using the DASS-21, while nicotine dependence was measured using the Fagerström Test for Nicotine Dependence. Data were analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, NY, USA), applying the Chi-square test, with a significance level of p < 0.05. Results Hearing loss was significantly more prevalent in smokers (18, or 36%) than in non-smokers (7, or 14%) (p = 0.017). However, no statistically significant correlation was found between the severity of hearing loss and the frequency or duration of smoking. Psychological distress was observed in both groups, with depression (10 (20%) vs. 6 (12%)), anxiety (18 (36%) vs. 23 (46%)), and stress (2 (4%) vs. 0%) being more common in smokers, though these differences were not statistically significant. Nicotine dependence varied, with 22 (44%) of smokers having very low dependence, while two (4%) had very high dependence. Higher cigarette consumption was significantly associated with greater nicotine dependence (p < 0.001). Conclusion Smoking is associated with a significantly higher risk of hearing loss, reinforcing the need for awareness and early screening among smokers. However, no strong link was found between smoking and psychological distress in this study. Given the limitations of sample size and study duration, further research is needed to explore the long-term effects of smoking on both hearing and mental health. Smoking cessation programs should incorporate regular hearing assessments and psychological support for better overall well-being.

PMID:40438834 | PMC:PMC12117464 | DOI:10.7759/cureus.83111

Cureus. 2025 Apr 27;17(4):e83103. doi: 10.7759/cureus.83103. eCollection 2025 Apr.

ABSTRACT

INTRODUCTION: The rising prevalence of dementia has increased the demand for long-term care, with family members often assuming caregiving responsibilities. While this form of care reduces healthcare costs and improves patients’ quality of life, it also exposes caregivers to physical and mental health challenges, often rendering them “invisible patients.” Well-being remains a key focus in both medical and psychosocial research and can be assessed through Ryff’s eudaimonic framework. This study aims to identify distinct latent profiles of family caregivers based on well-being patterns, highlighting, through a person-centered approach, the vulnerabilities and resources associated with each profile.

METHODS: The study included 73 family caregivers from Romania, aged between 30 and 87 years (M = 57.12, SD = 10.36), the majority being women (75.3%). Latent profile analysis (LPA) was used to identify well-being patterns based on scores obtained on the six dimensions of Ryff’s scale (54 items, adapted for Romania). The selection of models and distinctiveness of profiles were statistically established through various criteria (Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and entropy), together with a meaningful interpretation, emphasizing the role of meaning in life, autonomy, and self-acceptance in maintaining caregivers’ health, well-being, and resilience.

RESULTS: The LPA analysis identified a four-profile model of well-being, i.e., high (11%), moderate (38%), low (41.1%), and very low (10%), highlighting both the heterogeneity of perceptions and the caregivers’ vulnerabilities and strengths within each profile. Major differences between profiles are primarily driven by the purpose in life and autonomy dimensions, with values progressively decreasing from one profile to the next. The high profile exhibits the highest scores on these dimensions, while the very low profile records the lowest. The most pronounced deficits appear in the very low profile, particularly in self-acceptance and environmental mastery. The high entropy value of the model (0.93) indicates a well-defined solution with significant differences between profiles.

CONCLUSION: The study highlights variations in well-being among family caregivers of individuals with dementia, making a significant contribution to the identification of distinct latent profiles. A person-centered approach facilitates tailored interventions by clinicians, while the findings provide valuable support both for clinical practitioners and for the development of public health policies.

PMID:40438829 | PMC:PMC12117279 | DOI:10.7759/cureus.83103

Cureus. 2025 Apr 28;17(4):e83139. doi: 10.7759/cureus.83139. eCollection 2025 Apr.

ABSTRACT

Acute appendicitis is a common surgical emergency caused by inflammation and infection of the appendix, yet there is limited consensus on its management despite its widespread prevalence. While surgery remains the standard, the role of antibiotics, particularly in nonoperative management, is increasingly recognized. This study aims to identify the antibiotic regimens for appendicitis in three governmental and military hospitals in Taif City, assess their consistency with international guidelines, review effectiveness, and determine the length of hospital stay for patients following different treatment methods. Method: A retrospective chart review design was used to analyze the antibiotics regimen used for managing appendicitis and perforated appendicitis among patients of various age groups in Taif City. Data was collected from the medical records of patients admitted to pediatric and adult surgery units from January 2020 to December 2022. SPSS software, version 26.0, was used for descriptive analysis, while inferential statistical tests were used to compare hospital stays. Results: The study analyzed 646 hospital records for patients with appendicitis. Surgical interventions were common, with open appendectomy being the most common procedure, 522 (80.8%). Only 25 (3.9%) patients received preoperative antibiotics, while 481 (74.5%) patients received postoperative antibiotics, mostly Augmentin, with oral administration being preferred in 450 (69.7%) cases. Postoperative outcomes showed low complication rates, with only 54 (8.4%) experiencing surgical-site infections, hernia, and minimal abdominal pain. The mean hospital stay was 2.2 days. Conclusion: The study suggests that compliance with preoperative antibiotic guidelines should be improved, and nonoperative management options should be discussed in certain patient populations. The focus should be on rational antibiotic usage and patient-oriented treatment methods to maximize appendicitis treatment compared to existing literature.

PMID:40438815 | PMC:PMC12119032 | DOI:10.7759/cureus.83139

Cureus. 2025 Apr 26;17(4):e83044. doi: 10.7759/cureus.83044. eCollection 2025 Apr.

ABSTRACT

INTRODUCTION: Gestational diabetes is a common complication of pregnancy and is linked to adverse health outcomes for both mothers and their children. Lower maternal educational levels and poor health literacy have also been associated with poor health outcomes. However, few studies have analyzed the magnitude of the association between maternal education and poor outcomes for both mother and child in the context of gestational diabetes. This study aimed to explore the potential relationship between maternal and paternal education levels and the risk of negative health outcomes in both mother and child in pregnant women with gestational diabetes in the United States.

METHODS: This project is a retrospective cohort study. National Vital Statistics System-Natality (NVSS-N) data from 2019 to 2020 was used, sampling women aged 18-34 with gestational diabetes who gave birth to a singleton. Outcomes were the presence of at least one congenital anomaly and maternal intensive care unit (ICU) admission. Multivariable logistic regression analysis via Stata V. 16 (StataCorp LLC, College Station, TX, US) estimated adjusted odds ratio (OR) and 95% confidence interval (CI).

RESULTS: Among 541,117 women, 38% had a high school diploma or less, 52% completed some college, and 11% held a master’s degree or higher. The maternal ICU admission rate was 0.17%, and at least one congenital anomaly occurred in 0.21% of births. In adjusted models, compared to mothers with a high school diploma or less, those with a master’s degree or some college had adjusted ORs of 1.14 (95% CI = 0.80, 1.61) and 1.11 (95% CI = 0.90, 1.36) for congenital anomalies, respectively. Paternal education was associated with reduced odds for both outcomes.

CONCLUSIONS: Maternal education was not associated with adverse outcomes in gestational diabetes. Findings suggest paternal education may impact patient outcomes and should be further explored. Potential alternative targets to improve the health of women with gestational diabetes and their offspring are warranted.

PMID:40438814 | PMC:PMC12116785 | DOI:10.7759/cureus.83044

Cureus. 2025 Apr 28;17(4):e83113. doi: 10.7759/cureus.83113. eCollection 2025 Apr.

ABSTRACT

Background Continuous ambulatory peritoneal dialysis (CAPD) is a feasible and practical option for renal replacement therapy (RRT) in patients with end-stage renal disease (ESRD). However, the superiority of the surgical method versus the percutaneous method for peritoneal dialysis catheter (PDC) placement is not well established. Methods We retrospectively analyzed 91 peritoneal dialysis (PD) catheters inserted using two methods: the minilaparotomy technique performed by a surgeon (Group S, n=57) and the percutaneous technique performed by a nephrologist (Group N, n=34) over a 36-month study period. Results The primary PDC nonfunction rate was comparable between the two groups (3.5% vs. 3.3%). Catheter survival at one year (78.9% vs. 80%, p=0.761) and at the end of the study (61.4% vs. 66.6%, p=0.947) was higher in Group N but not statistically significant. The mean duration of catheter survival (in months) was identical in both groups (19.62±10.42 vs. 19.62±10.42), and patient survival at the end of the study was also comparable (78.9% vs. 80%, p=0.852). Peritonitis rates (per patient-year) did not differ significantly between the groups (0.15 vs. 0.10, p=0.693). Mechanical complication rates and refractory peritonitis rates were also comparable between the two groups. Conclusion The outcomes of percutaneously placed PDCs performed by a well-trained nephrologist were comparable to those placed by surgeons using the minilaparotomy technique. Training more nephrologists in percutaneous PDC insertion could enhance patient access and convenience in care.

PMID:40438804 | PMC:PMC12117519 | DOI:10.7759/cureus.83113

Cureus. 2025 Apr 28;17(4):e83130. doi: 10.7759/cureus.83130. eCollection 2025 Apr.

ABSTRACT

Background and objective Over the past few years, the complexity of brachytherapy (BT) has increased, and the practice patterns have shifted to distinguish high-volume centers as primary sites for these procedures. As a result, women with locally advanced cervical cancer (LACC) who are treated with external-beam radiotherapy (EBRT) at local centers are now more likely to be referred to higher-volume centers for their final BT boost. The impact of splitting radiotherapy sites on treatment adherence and outcomes is unclear. The purpose of this study was to compare the duration of treatment, recurrence, and survival between patients who received all radiotherapy at one center compared to those with split treatment. Methods A retrospective chart review was completed to identify women with stage IB-IVA cervical cancer treated with definitive radiation therapy (RT), including EBRT and BT between 2018 and 2023. Patients were grouped by location of EBRT, either at the primary institution (PI) or at an outside center. Patients were excluded if they had incomplete radiation therapy data, a missing address/zip code, metastatic disease, or a prior hysterectomy. Variables collected included demographics (age, race, ethnicity, insurance status, or geographic setting), disease and treatment characteristics, comorbidities, distance traveled to the RT sites, treatment duration, and survival status. Recurrence and survival analyses are limited to patients with at least one year of follow-up. Results Of the 66 women included in this study, 24 (36.3%) underwent EBRT at an outside location and were included in the split RT group. There was no significant difference between the two groups regarding age, disease characteristics, or comorbidities. The mean distance traveled to the PI was compared between the two groups and found to be statistically significant (p=0.001, t-test), with patients in the split group traveling a mean of 66.7 miles compared to 39.1 in the PI-only group. Likewise, the distance traveled to the EBRT site was significant, with women in the split group traveling a mean of only 13.6 miles compared to 39.1 (p<0.001, t-test). Of the 42 patients treated exclusively at the PI, 95.2% completed treatment within the recommended 56 days as opposed to 54.2% of the split RT patients (p<0.001, chi-squared test). Additionally, overall survival data were not significant; 80.8% of women in the PI-only group are reported to be alive without disease compared to 90.0% in the split group (p=1.000, chi-squared test). Conclusions In this study, we observed similar outcomes between LACC patients who had split their RT and those who received both EBRT and BT at the same high-volume PI. Yet, women who received RT at the PI exclusively had a shorter median duration of treatment and were more likely to complete treatment within the recommended timeline. Given the known relationship between treatment duration and patient outcomes in LACC, this study highlights the need to address factors that protract treatment duration to reduce potential disparities in care.

PMID:40438795 | PMC:PMC12118517 | DOI:10.7759/cureus.83130