Tag: statistics

Hemodial Int. 2025 Mar 23. doi: 10.1111/hdi.13231. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary hypertension affects patients with hemodialysis-dependent end-stage kidney failure; however, the estimated prevalence varies greatly due to the underutilization of right heart catheterization and the evolving diagnostic criteria of pulmonary hypertension. Pulmonary hypertension in end-stage kidney failure is often attributed to arteriovenous (AV) access; therefore, we hypothesized that patients with AV fistula/graft would have a greater prevalence of pulmonary hypertension on right heart catheterization compared to those with central venous (CV) catheter accesses.

METHODS: In this retrospective single-center cohort study, we identified and randomly sampled patients from July 2012 to August 2022 receiving hemodialysis for ≥ 3 months and who underwent right heart catheterization, using Current Procedural Terminology codes. Pulmonary hypertension was defined as mean pulmonary arterial pressure (mPAP) > 20 mmHg. Our primary outcome was the prevalence of pulmonary hypertension among patients with AV fistula/graft versus CV hemodialysis access, tested with descriptive statistics. We evaluated survival as a secondary outcome using a Cox proportional hazards model.

RESULTS: A total of 3834 patient charts were extracted. Overall, 444 charts were randomly sampled, resulting in 137 subjects meeting the inclusion criteria. The mean age was 63.8 ± 10.5 years, and 62% were male. The most common etiology of end-stage kidney failure was diabetic kidney disease (57.7%). Eighty percent of end-stage kidney failure patients had pulmonary hypertension; however, the type of hemodialysis access was not associated with pulmonary hypertension (85% CV catheter vs. 79.5% AV access, p = 0.59). Patients with pulmonary hypertension had lower hemoglobin (9.6 ± 0.8 vs. 11.2 ± 1.3 g/dL, p < 0.0001) and serum albumin (2.3 ± 0.9 vs. 3.4 ± 0.6 g/dL, p < 0.0001) than those without pulmonary hypertension. Those with pulmonary hypertension had an increased risk of mortality (hazard ratio: 2.2, 95% confidence interval: 1.04-4.61; p = 0.04).

CONCLUSION: Our findings show a high burden of pulmonary hypertension among this heterogeneous cohort of end-stage kidney failure patients, with no association between pulmonary hypertension and the type of hemodialysis access. This study highlights the need for prospective investigations incorporating current strategies for pulmonary hypertension diagnosis and treatment among the dialysis-dependent population.

PMID:40122584 | DOI:10.1111/hdi.13231

Lupus Sci Med. 2025 Mar 23;12(1):e001406. doi: 10.1136/lupus-2024-001406.

ABSTRACT

OBJECTIVE: SLE is a multisystem autoimmune disease where periods of disease activity, often difficult to predict, can cause irreversible disease damage. This study aimed to develop a patient-centric predictive model using real-world data that can identify patients with SLE at a higher risk of hospitalisation compared with the general SLE population.

METHODS: This observational, retrospective analysis used data from the Georgians Organized Against Lupus (GOAL) cohort from 2011 to 2013. The GOAL cohort is a population-based SLE cohort that collects yearly self-report surveys covering participants’ sociodemographic characteristics, clinical characteristics and perceived SLE symptoms (using the Systemic Lupus Activity Questionnaire (SLAQ)). GOAL data were linked to the Georgia Hospital Discharge Database to collect participants’ all-cause hospitalisation events in the 6 months following survey completion. A two-step approach was used to predict all-cause hospitalisations-logistic regressions selected a list of GOAL predictors that were subsequently included in the classification and regression tree (CART) models to generate patient subsets based on estimated hospitalisation rates.

RESULTS: There were 846 participants who completed 1486 surveys. Participants who were hospitalised within 6 months after survey completion were more likely to be younger, living in poverty and have more reported SLE symptoms than participants without a hospitalisation. CART modelling identified participants who reported any weight loss without trying, severe fatigue and Raynaud’s symptoms as most likely to have an all-cause hospitalisation: one in three (34%) patients in this subset were hospitalised in the 6 months following survey completion, 2.6-fold the hospitalisation rates of the overall GOAL cohort (13%) and 6.8-fold the rate in the subset with the lowest hospitalisation rate (5%).

CONCLUSIONS: This study suggests that patient-reported SLE symptoms and disease activity, specifically certain components of the SLAQ, may be of value in SLE risk management when considering hospitalisation reduction as a treatment goal.

PMID:40122582 | DOI:10.1136/lupus-2024-001406

BMJ Open Qual. 2025 Mar 23;14(1):e003198. doi: 10.1136/bmjoq-2024-003198.

ABSTRACT

BACKGROUND: Diagnostic errors (DEs) are a significant global patient safety issue, often associated with increased morbidity and mortality due to overlooked, delayed, or incorrect diagnoses. Our aim was to study the occurrence of DEs and adverse events (AEs), patient-related harm to identify vulnerable steps in the diagnostic process.

METHODS: A retrospective analysis of data from two public, national databases-National Health Care Compensation Claims Database (2009-2018) and Danish Patient Safety Database with AEs (2015-2020). Vulnerable steps in the diagnostic process were identified using a scoring tool developed by The Controlled Risk Insurance Company.

RESULTS: In the analysis of patient compensation claims, 14.5% of all settled cases (n=90 000) were classified as due to a DE, with a 59% compensation rate for DEs, twice the rate compared with other compensated cases (25%). DEs constituted 29% of all compensated cases. Death due to DEs was 8.3% (n=680 cases), 1.8 times higher compared with other cases and DEs resulted in higher degrees of disability.In the overall reported AEs, 0.3% of AEs were fatal and 1.7% AEs caused severe patient harm, per year. In a representative sample of AEs with a severe or fatal consequence (n=269), 33% were due to DEs.The initial clinical assessment was a cause or contributor to the DE in 80% of the compensation cases and in 83% of the severe or fatal AEs. The follow-up and coordination phase were a cause in 33% of compensation cases and 46% of severe or fatal AEs.

CONCLUSIONS: Errors and AEs in the diagnostic process are prevalent and a significant patient safety issue in Danish healthcare. This study identifies vulnerable steps in the diagnostic process, with patterns correlated to different degrees of severity, and highlights steps for future improvements efforts needed to mitigate the risk of DEs.

PMID:40122576 | DOI:10.1136/bmjoq-2024-003198

BMJ Open Qual. 2025 Mar 23;14(1):e003142. doi: 10.1136/bmjoq-2024-003142.

ABSTRACT

INTRODUCTION: Choosing Wisely Canada (CWC) Hepatology published recommendations in 2017 aiming to reduce low-value care and testing, including serum ammonia tests for hepatic encephalopathy (HE) and transfusion of blood products for minor invasive procedures. We explored the impact of these recommendations in reducing rates of low-value testing and care.

METHODS: We included all medicine inpatients from 23 hospitals in Ontario, Canada from the GEMINI database between April 2015 and March 2022. Weekly rates of low-value care were measured before and after the CWC Hepatology recommendations (19 July 2017). Interrupted time-series regression models were used to assess time trends for rates of low-value care. Subgroup analysis was completed on hospitalisations under hepatology or gastroenterology services.

RESULTS: Of 59 155 patients identified with liver disease, 17 906 developed HE and 11 676 cirrhosis patients underwent minor invasive procedures. In the HE cohort, there was no immediate change in the rate of ammonia tests with recommendations, but the overall rate decreased by 0.002 tests per hospitalisation per week (95% CI -0.00413 to -0.000009). With recommendations, we observed an increase in the rate of 0.242 (95% CI 0.010 to 0.474 transfusions/hospitalisation), but no significant difference in the rate change nor in the rate of platelet and vitamin K transfusions. There was no significant change in the rate of platelet and vitamin K transfusions. Hospitalisations under hepatology or gastroenterology services also did not have a change in rates of low-value care overall, except for ammonia tests where the rate decreased by 0.012 tests (95% CI -0.0177 to -0.00626 tests/hospitalisation) per week after recommendations.

CONCLUSIONS: The CWC recommendations were associated with a reduction in the rate of serum ammonia tests, but not with transfusion of blood products. Thus, there remains an opportunity to reduce low-value care and application of clinical guidelines.

PMID:40122575 | DOI:10.1136/bmjoq-2024-003142

BMJ Open Qual. 2025 Mar 23;14(1):e002959. doi: 10.1136/bmjoq-2024-002959.

ABSTRACT

Eating disorders are serious mental health conditions associated with significant morbidity and mortality. High levels of demand on services have led to increases in wait times to access support. Early intervention of eating disorders is critical to prevent entrenchment of illness and improve prognosis, with long wait times associated with higher rates of relapse.The East London Community Eating Disorder Service has seen an increase in wait time for routine referral from the 2-week local target to 17 weeks. Additionally, there have been long wait times to access treatment, including therapy and psychiatry support.A quality improvement (QI) framework was used in June 2022 to tackle the issues with capacity and flow with an aim to reduce wait times for routine referral from 17 weeks to 2 weeks in 12 months.A QI project team was formed which sought to understand the demands and capacity of the system using process mapping.From this, the team created a driver diagram and used Plan, Do, Study, Act cycles to test change iteratively. Measurements and data were displayed on control and run charts to help learn from the change ideas tested.Improvements were made and sustained, including reduction of routine referral wait time from 17 weeks to 2 weeks in 12 months. Additionally, internal wait lists reduced from 73 patients on the psychiatry list to 0 in 3 months and from 50 families waiting for therapy to 0 in 7 months.A number of inactive cases reduced from 65 to 0 during testing, thus contributing to improved flow through the service. A striking £130 233.21 annual savings in agency staff expenditure was achieved by January 2023.This has enabled a positive culture shift in the service.

PMID:40122574 | DOI:10.1136/bmjoq-2024-002959

BMJ Open Qual. 2025 Mar 23;14(1):e002277. doi: 10.1136/bmjoq-2023-002277.

ABSTRACT

BACKGROUND: The quality of care provided during the first golden hour after birth in preterm neonates significantly impacts both short- and long-term outcomes. However, implementation of these care processes varies across centres, is not standardised and affects the quality of care.

AIM: To improve the quality of care provided during the first golden hour in neonates born at <34 weeks’ gestation.

METHODS: This quality improvement initiative was conducted in a 30-bedded tertiary care teaching hospital in southern India over 28 months (April 2019-July 2021). Evidence-based interventions to improve admission temperature, respiratory care and administering parenteral nutrition and antibiotics during the golden hour were implemented through Plan-Do-Study-Act cycles in four phases for eligible neonates. The effect of these practice changes on clinical outcomes, including intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and survival ratewere studied.

RESULTS: A total of 311 eligible neonates were included in the study. Admission hypothermia significantly reduced from 79% to 22% (p=0.003), and adherence to the respiratory bundle improved from 13% to 77% (p<0.001). The time taken for administration of parenteral nutrition improved from 102±23 min to 62.5±26.7 min (mean±SD) (p<0.001). The median time for administration of antibiotics improved from 162 (135, 173) min to 74 (69, 102) min (median±IQR) (p=0.001) and improvement in mean blood glucose from 35 (12) mg/dL to 54 (14) mg/dL (mean±SD) (p<0.001) at neonatal intensive care unit (NICU) admission, and admission time to NICU from 66.4±16 min to 41±13.8 min (p<0.001).

CONCLUSION: Quality improvement project of improving care in the golden hour after birth in < 34 weeks neonates reduces admission hypothermia and hypoglycaemia and improves the time of admission to NICU, and time of administration of parenteral nutrition and antibiotics.

PMID:40122573 | DOI:10.1136/bmjoq-2023-002277

BMJ Open. 2025 Mar 22;15(3):e090614. doi: 10.1136/bmjopen-2024-090614.

ABSTRACT

OBJECTIVE: Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.

DESIGN: We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.

SETTING: This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.

PARTICIPANTS: We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.

RESULTS: The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection.

CONCLUSIONS: We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients’ lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

PMID:40122562 | DOI:10.1136/bmjopen-2024-090614

BMJ Open. 2025 Mar 22;15(3):e091212. doi: 10.1136/bmjopen-2024-091212.

ABSTRACT

INTRODUCTION: Domestic violence (DV) is a major public health problem for women around the world, and more commonly for women in Latin American countries (LACs). DV poses a threat to women’s health and can have more severe effects in women at midlife and older (aged 50 and above), including a decline in physical and mental abilities leading to a reduced independence. Low- and middle-income countries, including LACs, are projected to experience the greatest population growth in women at midlife and older worldwide over the next few decades. Current LAC literature about DV in relation to women at midlife and older is predominantly prevalence focused. The objective of this review is to identify what is known about DV among women at midlife and older in LACs.

METHODS AND ANALYSIS: This review will be conducted in accordance with JBI scoping review methodology. This includes a three-step search strategy: first, a search to identify articles from databases in MEDLINE, Scopus and LILACS; then, a second search using all key words and index terms identified from the articles in step one across select databases; and third, screening the reference lists of included studies and reports for additional studies. All studies which focus on DV in LACs among women at midlife and older will be eligible for inclusion, including those related to definitions, frameworks, cultural norms, risk factors, interventions, evaluations, measurement tools, and health and social consequences. Titles, abstracts and full texts will be assessed by two independent reviewers. A data extraction tool will be used, and findings will be presented in a narrative accompanied by diagrams and tables that address the review questions.

ETHICS AND DISSEMINATION: Ethics approval is not required for this review. Findings will be disseminated through a range of traditional approaches, including publication in a peer-reviewed publication and conference presentations.

TRIAL REGISTRATION: This review has been registered with Open Science Framework https://doi.org/10.17605/OSF.IO/SZMF7.

PMID:40122559 | DOI:10.1136/bmjopen-2024-091212

Med Oral Patol Oral Cir Bucal. 2025 Mar 23:26799. doi: 10.4317/medoral.26799. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the comprehensive classifications provided by the WHO, the most common lesions include radicular cysts, dentigerous cysts, odontogenic keratocysts, ameloblastomas, and odontomas. The piezoelectric technique has shown effectiveness in removing intraosseous pathologies by relying on ultrasonic microvibrations, which help preserve soft and vascular tissues. Precision in manipulating intraosseous pathology can impact the prognosis and improve the surgical procedure by controlling hemorrhage and promoting microscopic benefits. While previous research has compared the advantages of piezoelectric surgery and rotational methods, a systematic review is needed to consolidate the available information on this specific clinical issue.

MATERIAL AND METHODS: A search strategy was developed with de PRISMA statement. PubMed, Web of Science, Scopus, and Embase electronic databases were searched. The bibliographic search was conducted in December 2023. The methodological quality of the studies followed the Joanna Briggs Institute (JBI) critical evaluation tool for randomized clinical trials.

RESULTS: The final sample comprised 5 clinical trials, involving 231 cysts and 120 tumors in the experimental group. The mean age of participants was 30.6 years, with 196 men and 141 women included in the study. However, conventional surgery is faster than piezosurgery, both techniques exhibited similarities in epithelial perforation, soft tissue damage, edema, postoperative infections, and occurrences of paresthesia. Regarding recurrence, no statistically significant difference was observed between the two techniques (p-value=0.339; 95% confidence interval, -0.093-0.270).

CONCLUSIONS: The surgical removal of benign odontogenic cysts and tumors in the jaws using piezosurgery yielded slight intraoperative and postoperative advantages compared to conventional rotary surgery, except for the duration of surgical procedures. It shows reduced intraoperative hemorrhage and postoperative pain but similar outcomes in other variables. The results should be interpreted with caution, more studies are needed to obtain a more robust result.

PMID:40121687 | DOI:10.4317/medoral.26799

Med Oral Patol Oral Cir Bucal. 2025 Mar 23:26848. doi: 10.4317/medoral.26848. Online ahead of print.

ABSTRACT

BACKGROUND: The association between Rheumatoid arthritis (RA) and Periodontitis (PD) has been increasingly recognised, yet traditional epidemiological studies face challenges in establishing associations. Therefore, this study aims to genetically assess the association between RA and PD through Mendelian randomisation (MR) analysis, using genetic variations as instrumental variables.

MATERIAL AND METHODS: Data on RA and PD were downloaded from the EBI website. The RA data contained 8,255 cases and 409,001 controls, with a total of 24,175,266 SNPs; the chronic PD data contained 950 cases and 409,001 controls, with a total of 11,842,647 SNPs; the acute PD data contained 128 cases and 456,220 controls, with a total of 11,842,647 SNPs. Additionally, the potential association between RA and PD was investigated. The intercept between Mendelian randomisation (MR)-Egger regression, MR-PRESSO test results and funnel plots was used to analyse the horizontal pleiotropy of SNPs along with the effect of individual SNPs on inverse-variance weighting (IVW) analysis results, assessed using the leave-one-out method.

RESULTS: In total, 26 SNPs highly associated with RA were screened; MR-Egger regression (OR=1.242, 95% CI (1.032-1.494), P=0.031), WM (OR=1.190, 95% CI (1.015-1.395), P=0.032), IVW (OR=1.191, 95% CI (1.053-1.348), P=0.006) and weighted mode (OR=1.212, 95% CI (1.043-1.409), P=0.019) suggested that RA was a likelihood factor for chronic PD, whereas RA was not associated with the incidence of acute PD, and the Cochran’s Q test indicated no statistical heterogeneity between SNPs highly associated with RA. Moreover, analyses using the intercept between the MR-Egger regression, MR-PRESSO test results and funnel plot revealed no horizontal pleiotropy in SNPs highly associated with RA.

CONCLUSIONS: Rheumatoid arthritis was genetically identified as a likelihood factor for PD and the onset of chronic PD, but no association was observed between RA and acute PD.

PMID:40121685 | DOI:10.4317/medoral.26848