Tag: statistics

J Obes Metab Syndr. 2025 Apr 8. doi: 10.7570/jomes24029. Online ahead of print.

ABSTRACT

BACKGROUND: Grip strength and muscle-strengthening activity (MSA) have been independently associated with type 2 diabetes mellitus (T2DM). However, analyses that consider grip strength in conjunction with MSA, while factoring in age and sex as well, are limited. Therefore, we aimed to investigate the association of relative grip strength (RGS) and MSA, separately and in combination, with T2DM, considering differences in age and sex.

METHODS: A total of 27,702 participants aged 19 years and older were included from 2014 to 2021 from the Korea National Health and Nutrition Examination Survey. The association between RGS, MSA, and T2DM was assessed using logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the independent and joint associations of RGS and MSA on T2DM prevalence.

RESULTS: Highest (Q4) RGS levels were independently associated with lower odds of T2DM (OR, 0.39; 95% CI, 0.32 to 0.46; P for trend <0.001). Similarly, engaging in MSA 2 o 3 days per week was associated with lower odds of T2DM (OR, 0.80; 95% CI, 0.66 to 0.96), although the trend was not statistically significant (P for trend=0.775). In the joint analysis, participants with normal RGS and engaging in MSA ≥2 days per week had the lowest odds of T2DM (OR, 0.60; 95% CI, 0.51 to 0.70).

CONCLUSION: Higher RGS and engaging in MSA 2 to 3 days per week are independently associated with lower likelihood of T2DM. The combined association of normal RGS and MSA 2 days or more per week shows the greatest benefit for T2DM prevention.

PMID:40194887 | DOI:10.7570/jomes24029

BMJ Open Qual. 2025 Apr 7;14(2):e003179. doi: 10.1136/bmjoq-2024-003179.

ABSTRACT

Telemedicine can improve care delivery through reducing clinic wait-time, improving accessibility to specialist care, minimising cross-infection risk at patient’s convenience. Despite these benefits, telemedicine uptake remained low within our gastroenterology department, with only four teleconsultations conducted in 6 months prior to this project’s conceptualisation. This quality improvement (QI) project aimed to improve telemedicine utilisation within our department by 20% over a 3-month period. Surveys conducted during the planning phase identified key barriers to telemedicine adoption, including high clinic load, concerns over medicolegal issues and unfamiliarity with data security protocols. To address these issues, a multistakeholder QI team introduced several key measures, including streamlining telemedicine workflow, providing clinician training and implementing patient educational posters. These interventions successfully increased the adoption of telemedicine (median 8 (IQR 2.5) vs 31 (IQR 13) teleconsultations per month, p<0.01) over the intervention period, with 84% of patients reporting positive experiences. Additionally, this project reduced carbon emissions, saving approximately 3446 kg of CO2, equivalent to 388 gallons of gasoline. This QI project highlights the potential for telemedicine to enhance healthcare delivery while promoting environmental sustainability. Key lessons include the importance of structured workflows and stakeholder engagement to overcome barriers. Future interventions should aim to refine telemedicine pricing models and expand the initiative to other departments within the hospital to ensure long-term sustainability.

PMID:40194883 | DOI:10.1136/bmjoq-2024-003179

BMJ Open Qual. 2025 Apr 7;14(2):e003175. doi: 10.1136/bmjoq-2024-003175.

ABSTRACT

INTRODUCTION: It is widely acknowledged that health disparities exist in minority populations, with ethnicity, gender, language, ability and culture emerging as critical determinants of health outcomes. At present, research is available demonstrating that patients with protected characteristics experience less favourable patient safety outcomes. However, there has been limited focus on reviewing how processes within the healthcare system contribute to this inequity of care received by minority populations. This study reviews the prevalence of incident reporting of medication errors for people with selected protected patient characteristics within an acute NHS Trust. The aim is to determine if there are unexplained variations.

METHOD: This cross-sectional study was conducted across an NHS Trust group of five hospitals, serving a diverse local population. Incidents reporting errors in medication use were obtained for the 7-month period between 1 January 2021 and 31 July 2021. The χ² test was used to assess if protected patient characteristics impacted the rate of medicine-related error reporting.

RESULT: Medication error reporting is not equitable between different gender, ethnic or age groups. The results of this study show that these characteristics were negatively related to the number of medication incidents reported.

CONCLUSION: This study demonstrates that further systematic support is required to reduce the variations in medicine error reporting for patients with key protected characteristics. Infrastructure to overcome known barriers to safe care in the mainstream such as language, culture, beliefs and lower levels of understanding needs further development.

PMID:40194882 | DOI:10.1136/bmjoq-2024-003175

BMJ Open. 2025 Apr 7;15(4):e094667. doi: 10.1136/bmjopen-2024-094667.

ABSTRACT

OBJECTIVE: The study was conducted to determine the immunisation status of children under 2 years of age, assess the determinants of non-immunisation and evaluate the association between immunisation status and various sociodemographic factors.

METHODS: A cross-sectional questionnaire-based study was conducted at the outpatient department of Khyber Teaching Hospital, Peshawar, over a period of 4 months. A convenience sampling technique was used and the sample size was calculated using the WHO sample size formula, resulting in n=363. A semistructured questionnaire was used to measure the primary outcome, which was the immunisation status of children under 2 years of age. Immunisation data were verified through vaccination cards to ensure accuracy and minimise recall bias. The questionnaire also collected information on sociodemographic factors, including maternal education, place of residence and household income. Statistical analysis was done at the end of the study using SPSS (V.25).

RESULTS: According to the vaccination card, it was found that 43.3% of the children were fully immunised, 32.5% of the children were partially immunised and the percentage of unimmunised children was 24.2.

CONCLUSION: We found that the immunisation status of children was not satisfactory. Sustained efforts are required to achieve universal coverage of immunisation. Significant interventions are required, especially in areas that are more rural and less educated.

PMID:40194881 | DOI:10.1136/bmjopen-2024-094667

BMJ Open. 2025 Apr 7;15(4):e098838. doi: 10.1136/bmjopen-2025-098838.

ABSTRACT

OBJECTIVE: To evaluate the association between the use of medical information applications and urgent emergency room consultation behaviour among parents who visited the emergency department (ED) of their children.

DESIGN: Cross-sectional survey.

SETTING: A primary-level paediatric emergency medical facility in Nagano Prefecture.

PARTICIPANTS: Parents of children aged 8 years or younger who had visited the medical facility between December 2023 and March 2024.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was defined as an association between the urgency of ED visits and parental use of mobile applications. The secondary outcome was the association between the urgency of ED visits and app evaluations among parents using the app. The urgency of the ED visits was classified according to the Japan Triage and Acuity Scale.

RESULTS: In total, 386 parents participated in this study (response rate: 91%). Among these, 77% were mothers and the median age was 36.3 years. Of the ED visits by app users, 63.7% were classified as urgent, compared with 41.7% of visits by non-users (adjusted OR: 2.8, 95% CI: 1.7 to 4.7, p<0.001). Among the participants who used the app, 94.4% answered that they would recommend the app and 87.0% answered that the app made it easier to decide whether to visit the hospital. In addition, the proportion of children who revisited the ED within 6 months was higher for children with a medical history than for those without such a history. There were no significant associations between the urgency of ED visits and parental education, self-reported financial status, or whether the parent was a healthcare professional.

CONCLUSIONS: The use of the medical information app was significantly associated with parental ED urgency. These findings suggest that such apps may support informed decision-making in paediatric emergency care. Future research should investigate the effect of this app on a broader population, including cases involving ambulance transport.

PMID:40194878 | DOI:10.1136/bmjopen-2025-098838

BMJ Open. 2025 Apr 7;15(4):e095173. doi: 10.1136/bmjopen-2024-095173.

ABSTRACT

OBJECTIVE: Healthcare professionals must possess statistical literacy to provide evidence-based care and engage patients in decision-making. However, there have been concerns about healthcare professionals’ inadequate understanding of health statistics. As an initial step in addressing the issue, we assessed the statistical literacy of medical students and doctors in South Korea by evaluating their comprehension of four statistical concepts: (a) single-event probability, (b) relative risk reduction, (c) positive predictive value and (d) 5-year survival rate.

DESIGN: Cross-sectional survey study.

SETTING: The survey was conducted from October 2018 to January 2019 in one medical school and its affiliated teaching hospital in Seoul, South Korea.

PARTICIPANTS: 303 medical students from all six grades and 291 doctors from various specialties.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the correct answer rate for each question. The secondary outcome measure was the mean number of correct answers across the four statistical literacy questions, calculated for each individual.

RESULTS: The correct answer rates for basic numeracy questions were close to 100%. Regarding statistical literacy, 95.5% and 83.2% of the participants accurately understood single-event probability and relative risk reduction, respectively. However, only 49.3% and 49.2% of the participants accurately understood the positive predictive value and 5-year survival rate, respectively. The correct answer rates for the question about the 5-year survival rate differed significantly between students (40.9%) and doctors (57.7%) (p<0.001). There were no statistically significant differences in the correct answer rates for other questions, regardless of the student’s grade level or the doctor’s specialty.

CONCLUSIONS: Medical students and doctors have weaker statistical literacy than their basic numeracy. Therefore, it is essential to implement medical education and professional development programmes that focus on improving their statistical literacy. These programmes should specifically address measures of medical test accuracy and the distinction between a 5-year survival rate and mortality.

PMID:40194877 | DOI:10.1136/bmjopen-2024-095173

BMJ Open. 2025 Apr 7;15(4):e094799. doi: 10.1136/bmjopen-2024-094799.

ABSTRACT

Lung ultrasound (LUS) has proven high diagnostic accuracy for community-acquired pneumonia (CAP) in developed countries. However, its diagnostic performance in resource-limited settings with high pulmonary tuberculosis (TB) incidence is less established. Additionally, the role of LUS in monitoring CAP progression remains underexplored.

OBJECTIVES: To validate the diagnostic performance, monitoring and prognostic utility of LUS for CAP in a high pulmonary TB incidence setting.

DESIGN: Prospective single-centre cohort study.

SETTING: Pulmonary department of a tertiary hospital in Vietnam.

PARTICIPANTS: A total of 158 patients suspected of having CAP were enrolled, with 136 (mean age 62 years, 72.8% male) included in the final analysis.

INTERVENTIONS: Patients underwent LUS and chest X-ray (CXR) within 24 hours of admission, with a follow-up LUS on days 5-8.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the diagnostic accuracy of LUS and CXR compared with discharge diagnosis. Secondary outcomes included the accuracy compared with CT scan results, changes in LUS parameters-consolidation size, number and Lung Ultrasound Score (LUSS)-and their association with in-hospital mortality.

RESULTS: LUS demonstrated higher sensitivity than CXR (96.0% (95% CI 90.0% to 99.0%) vs 82.8% (95% CI 73.9% to 89.7%)). LUS specificity was 64.9% (95% CI 47.5% to 80.0%), compared with 54.1% (95% CI 36.9% to 70.5%) for CXR. The moderate specificity for LUS was due to sonographic-similar conditions, notably TB in 5.1% of patients. Consolidation size and numbers showed marginal resolution, while LUSS showed more pronounced decreases over time. The baseline LUSS showed limited discriminative ability for predicting mortality (area under the curve, AUC 0.65, 95% CI 0.55 to 0.75), while follow-up LUSS and changes in LUSS (ΔLUSS) demonstrated higher levels of discrimination (AUC 0.81 (95% CI 0.71 to 0.89) and 0.89 (95% CI 0.80 to 0.95), respectively). For each one-point increase in ΔLUSS, the odds of in-hospital mortality went up by 70% (p=0.002). An improved LUSS effectively ruled out mortality (negative predictive value 97.4%).

CONCLUSION: Although LUS is highly sensitive for diagnosing CAP, its specificity in TB-endemic regions warrants further caution. Serial LUS assessments, particularly monitoring LUSS changes, are valuable for tracking disease progression and prognostication, with increasing LUSS indicating potential clinical deterioration.

PMID:40194875 | DOI:10.1136/bmjopen-2024-094799

BMJ Open. 2025 Apr 7;15(4):e091656. doi: 10.1136/bmjopen-2024-091656.

ABSTRACT

OBJECTIVE: Observational studies have found that cigarette smoking increased the prevalence and incidence of sarcopenia, whereas alcohol consumption appeared to decrease the risk. These findings, however, may be susceptible to either confounding bias or reverse causation. We conducted a Mendelian randomisation (MR) study to appraise the causal relation of cigarette smoking and alcohol consumption to the risk of sarcopenia.

METHODS: Genetic instruments associated with cigarette smoking (cigarettes per day) and alcohol consumption (drinks per week) were retrieved from the publicly available genome-wide association data. Individual-level, electronic medical record-linked data on sarcopenia, grip strength and appendicular lean mass were obtained from the UK Biobank. We performed two-sample univariable and multivariable MR analyses to examine the relation of genetically determined cigarette smoking and alcohol consumption to the risk of sarcopenia and its indices.

RESULTS: One SD increase of genetically determined cigarette smoking was associated with an increased risk of sarcopenia (OR=2.51, 95% CI: 1.26 to 5.01, p=0.001), decreased grip strength (β=-0.63 kg, 95% CI: -1.13 to -0.13, p=0.01) and less appendicular lean mass (β=-0.22 kg, 95% CI: -0.44 to -0.01, p=0.04). Although one SD increase of genetically determined alcohol consumption was associated with decreased grip strength (β=-1.15 kg, 95% CI: -2.09 to -0.10, p=0.02), no statistically significant causal association was observed between genetically determined alcohol consumption and either sarcopenia (OR=0.96, 95% CI: 0.35 to 2.62, p=0.94) or appendicular lean mass (β=-0.23 kg, 95% CI: -0.91 to 0.45, p=0.51).

CONCLUSIONS: Our findings showed that genetically determined cigarette smoking, but not alcohol consumption, was causally associated with the risk of sarcopenia.

PMID:40194871 | DOI:10.1136/bmjopen-2024-091656

BMJ Open. 2025 Apr 7;15(4):e090746. doi: 10.1136/bmjopen-2024-090746.

ABSTRACT

Between 2020 and 2050, the world’s population aged 80 years and over will triple, drastically increasing the prevalence of frailty and associated healthcare costs. Multimodal exercise programmes have proven to be an ideal countermeasure for frailty, but the current Flemish standard of care does not include them. The purpose of this study is to investigate the effect of the home-based exercise programme for frail community-dwelling older adults (>70 years), ACTIVE-AGE@home, on frailty-associated outcomes, when delivered by professionals or volunteers, as well as its cost-effectiveness. A pragmatic randomised controlled trial will be conducted. Participants will be randomised into three parallel groups using permuted block randomisation. There will be two intervention groups: in one group, the intervention is delivered by professionals with a bachelor or masters’ degree in physiotherapy, occupational therapy and/or physical education, and in the other by trained volunteers. Both groups will be compared with a control group receiving usual care. Participants (n=195) are community-dwelling physically frail older adults (>70 years), as defined by Fried et al. (2001). The intervention is a 24 week programme that consists of three 1 hour visits per week and contains aerobic, strength, balance, flexibility, coordination and dual tasking exercises, accompanied by goal-setting and motivational interviewing. The Timed Chair Stand (TCS) test is the primary outcome. Functional ability, cognition, loneliness, self-management, health-related quality of life, healthcare utilisation and meaningful activities will be measured in all groups at 0, 24 and 48 weeks. Time and expenses invested by professionals or volunteers will be kept in diaries for trial and model-based cost-effectiveness analyses, expressed in incremental cost per QALY (quality-adjusted life year). The model will be designed to associate the frailty at the end of follow-up with further expected healthcare expenses beyond the duration of the trial. Statistical analysis will be blinded to group allocation, and outcome assessors will be blinded to the maximal extent possible. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Medical Ethics Committee of UZ Brussel (O.G. 016), Peer reflection group Biomedical Ethics, Laarbeeklaan 101, 1090 Brussels. Results will be disseminated in publications and other relevant platforms. This study was registered at Clinicaltrials.gov on 6 July 2023 and posted on 14 July 2023 after National Library of Medicine quality control review. Registration details: NCT05946109 TRIAL REGISTRATION NUMBER: NCT05946109.

PMID:40194869 | DOI:10.1136/bmjopen-2024-090746

BMJ Open Ophthalmol. 2025 Apr 7;10(1):e002144. doi: 10.1136/bmjophth-2025-002144.

ABSTRACT

BACKGROUND/AIMS: To determine the accuracy of an innovative paper-based, low-cost, easily accessed, portable method of evaluating the visual field (VF).

METHODS: Two groups of consecutive patients with glaucoma and controls were enrolled. Both eyes were assessed, and the Humphrey field analyser (HFA) (24-2) was used to identify patients with and without VF defects. The TsiogkaSpaeth grid (TS) grid test was performed in each eye of all participants. The Humphrey VF examination and the TS grid examination were conducted consecutively on the same day by two different examiners, prior to any other eye examinations. Sensitivity, specificity, and positive and negative predictive values of the TS grid scotoma area were assessed, using the results found with the HFA as the reference standard. A mixed-effects logistic regression model with a random intercept per participant was used to account for the correlation between eyes.

RESULTS: This prospective, cross-sectional study recruited 51 participants in a tertiary care hospital-based glaucoma department. Of them, 19 had glaucomatous defects in both eyes, 12 had defects in 1 eye only and 21 had no defects in either eye. The sensitivity and specificity of the TS grid test were 81.63% (95% CI 68% to 91.2%) and 84.91% (95% CI 72.4% to 93.3%), respectively, positive predicted value was 83.33% (95% CI 69.8% to 92.5%) and negative predictive value was 83.33% (95% CI 70.7% to 92.1%). The area under the curve was 0.83 (95% CI 0.76 to 0.91). There was a significant correlation between the TS grid test score and the VF Index of the HFA 24-2 (r=0.87, p<0.0001) and the mean deviation of the HFA 24-2 (r=0.85, p<0.0001).

CONCLUSIONS: The TS grid test offers a reliable, low-cost alternative for VF examination in glaucoma patients. This method could be advantageous in clinical settings with limited access to traditional testing equipment. The TS grid has limitations, including difficulty of fixation loss testing and ensuring the correct fixation distance. The test’s self-administration reliability is uncertain, and some patients were unable to perform it. Other limitations concern the grid’s design and the small sample size of the study.

PMID:40194868 | DOI:10.1136/bmjophth-2025-002144