Tag: statistics

Scand J Trauma Resusc Emerg Med. 2025 Jan 6;33(1):4. doi: 10.1186/s13049-024-01314-x.

ABSTRACT

INTRODUCTION: Chest pain is one of the most common reasons for contacting the emergency medical services (EMS). It is difficult for EMS personnel to distinguish between patients suffering from a high-risk condition in need of prompt hospital care and patients suitable for non-conveyance. A vast majority of patients with chest pain are therefore transported to the emergency department (ED) for further investigation even if hospital care is not necessary. Improved prehospital assessment and risk stratification, thus accurately and safely identifying patients suitable for non-conveyance, could prevent unnecessary transport to the ED. This would reduce ED crowding and overburdening sparse EMS resources. It would thus also probably reduce healthcare costs. Little is known about the prehospital use of the 5th generation, i.e. high-sensitivity troponin analyses. The aim of this project is to develop an EMS decision support tool using high-sensitivity troponin I for risk assessment of chest pain patients.

METHODS AND ANALYSIS: This is a prospective, multicentre, cohort study including adult unselected EMS patients with chest pain. Data is being collected from 20 May 2023 to 31 December 2025, aiming to include at least 2,000 patients. High-sensitivity troponin I is being analysed bedside using Siemens Healthineers Atellica VTLi. In addition to prehospital troponin I, data is being collected on patient medical history, onset, vital signs, symptoms, ECG and diagnosis at hospital discharge. Several statistical analyses (random forest, logistic regression, gradient boosting) will be conducted to identify the best model for identifying patients with low-risk conditions suitable for non-conveyance.

ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethical Review Authority (Dnr 2022-01066-01 and 2022-06846-02). Patients are being informed about the study both orally and in writing. The results of the study will be published in a peer-reviewed journal and will be presented at national and/or international conferences.

REGISTRATION DETAILS: The study is registered at ClinicalTrials.gov (NCT05767619).

PMID:39762958 | DOI:10.1186/s13049-024-01314-x

Diagn Progn Res. 2025 Jan 7;9(1):1. doi: 10.1186/s41512-024-00183-3.

ABSTRACT

BACKGROUND: The initial theme of the PROGRESS framework for prognosis research is termed overall prognosis research. Its aim is to describe the most likely course of health conditions in the context of current care. These average group-level prognoses may be used to inform patients, health policies, trial designs, or further prognosis research. Acquired brain injury, such as stroke, traumatic brain injury or encephalopathy, is a major cause of disability and functional limitations, worldwide. Rehabilitation aims to maximize independent functioning and meaningful participation in society post-injury. While some observational studies can allow for an inference of the overall prognosis of the level of independent functioning, the context for the provision of rehabilitation is rarely described. The aim of this protocol is to provide a detailed account of the clinical context to aid the interpretation of our upcoming overall prognosis study.

METHODS: The study will occur at a Danish post-acute inpatient rehabilitation facility providing specialised inpatient rehabilitation for individuals with moderate to severe acquired brain injury. Routinely collected electronic health data will be extracted from the healthcare provider’s database and deterministically linked on an individual level to construct the study cohort. The study period spans from March 2011 to December 2022. Four outcomes will measure the level of functioning. Rehabilitation needs will also be described. Outcomes and rehabilitation needs will be described for the entire cohort, across rehabilitation complexity levels and stratified for relevant demographic and clinical parameters. Descriptive statistics will be used to estimate average prognoses for the level of functioning at discharge from post-acute rehabilitation. The patterns of missing data will be investigated.

DISCUSSION: This protocol is intended to provide transparency in our upcoming study based on routinely collected clinical data. It will aid in the interpretation of the overall prognosis estimates within the context of our current clinical practice and the assessment of potential sources of bias independently.

PMID:39762957 | DOI:10.1186/s41512-024-00183-3

BMC Sports Sci Med Rehabil. 2025 Jan 6;17(1):4. doi: 10.1186/s13102-024-01038-6.

ABSTRACT

BACKGROUND: “Active” heat acclimation (exercise-in-the-heat) can improve exercise performance but the efficacy of “passive” heat acclimation using post-exercise heat exposure is unclear. Therefore, we synthesised a systematic review and meta-analysis to answer whether post-exercise heat exposure improves exercise performance.

METHODS: Five databases were searched to identify studies including: (i) healthy adults; (ii) an exercise training intervention with post-exercise heat exposure via sauna or hot water immersion (treatment group); (iii) a non-heat exposure control group completing the same training; and (iv) outcomes measuring exercise performance in the heat (primary outcome), or performance in thermoneutral conditions, V̇O₂max, lactate threshold, economy, heart rate, RPE, core temperature, sweat rate, and thermal sensations. Study quality was assessed using the Cochrane Risk of Bias 2 tool. To determine the effect of post-exercise heat exposure, between-group ratio of means or standardized mean differences (SMD) were calculated for each outcome and weighted by the inverse of their variance to calculate an overall effect estimate (ratio of mean or Hedges’g) in a random effects meta-analysis, with 95% confidence intervals (CI) and prediction intervals (PI). Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

RESULTS: Ten studies (199 participants: 156 male, 43 female, age 20-32 years) were included. The effect of post-exercise heat exposure on performance in hot conditions (33-40 °C) was trivial (ratio of means = 1.04) with poor precision (95%CI 0.94-1.15, P = 0.46) and low predictive certainty (95%PI 0.81-1.33). There were also trivial effects on performance in thermoneutral conditions (18-24 °C) and speed at lactate threshold, small effects on V̇O₂max, heart rate, core temperature, and sweat rate, and a moderate effect on thermal sensations. However, the certainty in the effect estimates was graded as low to very low across all outcomes due to small sample sizes, high risk of bias, risk of publication bias, imprecision in the effect estimates, and low statistical power.

CONCLUSIONS: The use of post-exercise heat exposure for improving exercise performance is uncertain. Further high-quality trials are needed to make firm conclusions.

PROTOCOL REGISTRATION: Open Science Foundation ( https://doi.org/10.17605/OSF.IO/256XZ ).

PMID:39762944 | DOI:10.1186/s13102-024-01038-6

Anim Microbiome. 2025 Jan 6;7(1):2. doi: 10.1186/s42523-024-00368-7.

ABSTRACT

The gastrointestinal (GI) microbiota plays a crucial role in host health and disease in dogs, but the knowledge regarding the mucosal associated microbiota along the GI tract is limited in dogs. Therefore, the objective of this study was to characterize the phylogeny and predicted functional capacity of microbiota residing on the gut mucosa across five GI regions of healthy young adult and geriatric dogs fed different diets. Twelve weanling (8 weeks old) and 12 senior (11.1 years old) beagles were randomly assigned to be fed an animal product-based diet or plant product-based diet for 12 months. At that time, mucosal samples from the stomach, duodenum, jejunum, ileum, and mid-colon were collected. DNA was extracted and the hypervariable region 4 (V4) of the 16S rRNA gene was amplified to assess microbiota using Illumina MiSeq sequencing. Data were analyzed using QIIME 1.9.1. and Statistical Analyses of Metagenomic Profiles software 2.1.3. Gene predictions were made using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States. Taxonomic assessment revealed a greater (p < 0.05) species richness in the mid-colon compared with other segments. Principal coordinates analysis of weighted UniFrac distances demonstrated distinct clusters of stomach, ileum, and mid-colon samples, indicating the presence of unique microbial communities in these regions. The predominant phyla in all five segments were Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria and Fusobacteria, but their relative abundances varied between segments. Proteobacteria had a decreasing relative abundance from the stomach to mid-colon (q < 0.05). The ileum had the highest while the stomach had the lowest relative abundance of Firmicutes (q < 0.05). The duodenum had a higher abundance of Bacteroidetes than the stomach and ileum (q < 0.05). The mid-colon had a higher Fusobacteria relative abundance than other regions (q < 0.05). The predicted functional capacities of the microbiota in the stomach differed from those in the other segments. Age and diet of dog did not significantly impact the taxonomy or predicted functional capacities of the mucosal microbiota. In conclusion, our findings demonstrate distinct characteristics of the mucosal microbiota across various segments of canine GI tract.

PMID:39762940 | DOI:10.1186/s42523-024-00368-7

Infect Chemother. 2024 Dec;56(4):502-509. doi: 10.3947/ic.2024.0083.

ABSTRACT

BACKGROUND: Wound infections significantly impact morbidity, mortality, and healthcare costs globally. The Kashmir Valley’s unique geographical and climatic conditions, coupled with resource constraints and antibiotic misuse, complicate managing these infections effectively. This study aimed to identify predominant bacterial pathogens in wound infections at a tertiary care hospital in Kashmir, determine their antibiotic susceptibility profiles, and estimate the prevalence of multidrug-resistant (MDR) strains.

MATERIALS AND METHODS: A prospective cross-sectional study was conducted from January to June 2023 at the Government Medical College, Srinagar. Pus samples from wound infections were aseptically collected and processed following standard microbiological protocols. Antibiotic susceptibility testing utilized the Kirby-Bauer disk diffusion method, adhering to Clinical and Laboratory Standards Institute guidelines. Data were analyzed using IBM SPSS statistics.

RESULTS: Out of 4,378 samples analyzed, bacterial growth was observed in 1,921 samples, representing 43.9% of the total. Among the bacterial isolates, Gram-negative bacilli accounted for 73.5%, with Escherichia coli being the most prevalent at 27.9%. Among Gram-positive cocci, Staphylococcus aureus predominated, comprising 25.9% of the isolates. Methicillin-resistant S. aureus exhibited 100% susceptibility to linezolid but low susceptibility to erythromycin (27.0%) and clindamycin (24.0%). E. coli demonstrated high susceptibility to tigecycline (97.4%) and amikacin (75.0%), but lower susceptibility to imipenem (45.0%) and piperacillin-tazobactam (57.8%).

CONCLUSION: The substantial wound infection burden and high MDR prevalence in Kashmir necessitate comprehensive antimicrobial stewardship and infection control programs. Regular surveillance, education, and research are crucial to address antibiotic resistance and ensure effective wound infection management in the region.

PMID:39762926 | DOI:10.3947/ic.2024.0083

J Anim Sci Biotechnol. 2025 Jan 6;16(1):5. doi: 10.1186/s40104-024-01135-z.

ABSTRACT

BACKGROUND: Meat goat production is a worldwide industry with products such as meat, milk, soap, and fiber being produced. There are approximately 2.6 million meat goats in the United States. For breeding female ruminants, early pregnancy loss is estimated to be 30% within the first month of gestation. Extracellular L-citrulline (a precursor to L-arginine) is not degraded by ruminal microbes due to the lack of uptake. L-Arginine and thus L-citrulline, have beneficial impacts on placentation and, subsequently, fetal-placental development and survival. This study aimed to determine the impact of feeding L-citrulline to meat goats during gestation to improve reproductive success. Meat goats were fed either a control (CON) or L-citrulline (CIT) supplemented diet from d 12 to 82 of gestation. Blood samples were collected and sera were subjected to high-performance liquid chromatography analyses to quantify the abundance of amino acids. Pregnancy rates were determined on d 30, 61, and 90 of gestation, and litter weight, individual birth weights, and 90 d adjusted weaning weights were collected.

RESULTS: The concentrations of citrulline, ornithine, and arginine were greater in CIT does compared to CON does, but there was no difference in pregnancy rates between CON and CIT does. Birth weight was greater for male kids born as singles when compared to females, but this phenotype was not observed for kids born as twins or triplets. Further, males born to CON does had greater 90 d adjusted weaning weights than females, but this was not observed in the CIT group. Female kids born to CON and CIT Boer goats had heavier 90 d adjusted weaning weights than those born to Spanish or F1 Boer-Spanish does.

CONCLUSION: This study provides proof of concept that feeding dietary L-citrulline increases concentrations of citrulline and arginine in blood of gestating meat goats. However, further studies are needed to understand the cellular mechanisms impacted by feeding this supplement. Regardless, this study demonstrated that feeding L-citrulline has the potential to increase reproductive performance in gestating ruminants.

PMID:39762898 | DOI:10.1186/s40104-024-01135-z

Trials. 2025 Jan 6;26(1):6. doi: 10.1186/s13063-024-08713-6.

ABSTRACT

BACKGROUND: Leptospirosis is a zoonotic bacterial infection occurring worldwide. It is of particular public health concern due to its global distribution, epidemic potential and high mortality without appropriate treatment. The method for the management of leptospirosis, particularly in severe disease, is clouded by methodological inconsistency and a lack of standardized outcome measures. The study this protocol details aims to develop a core outcome set (COS) for leptospirosis research. A COS is a set of outcomes with international consensus as a minimum for reporting in future studies focusing on leptospirosis. Establishing a COS will contribute to harmonizing Leptospirosis treatment research and will be instrumental in constructing a high-quality evidence base to feed into a planned future rigorous international clinical trial on leptospirosis.

METHODS: The COS-LEP study will employ a COS development methodology standardized by the COMET initiative framework. This includes (1) a systematic review of available quantitative and qualitative literature reporting therapeutic response and safety outcomes and measures; (2) focused interviews with healthcare professional and people treated for leptospirosis exploring outcomes of interests using qualitative methodology; (3) narrowing the choice of outcomes by international consensus using a Delphi survey process; and (4) undertaking a hybrid consensus meeting with key stakeholders to build the final COS.

DISCUSSION: This protocol describes the method to develop the first core outcome set for use in human leptospirosis studies. This will not only be a key feature in the design of a future definitive randomized controlled trial, but also provide a structure for clinicians and researchers collecting treatment cohort data in the various settings where leptospirosis is a public health issue.

PMID:39762892 | DOI:10.1186/s13063-024-08713-6

BMC Nurs. 2025 Jan 6;24(1):9. doi: 10.1186/s12912-024-02581-w.

ABSTRACT

BACKGROUND: Negotiating is a common occurrence and a significant part of everyday tasks for head nurses. The ability of the head nurse to effectively negotiate is a crucial management tool for work management in healthcare facilities.

AIM: The present study aimed to assess the effect of negotiation skills training program on head nurses’ knowledge and behavior.

METHODS: A pretest-posttest, one-group quasi-experimental design was conducted at Menoufia University Hospitals. It is located in Shebeen, Elkom City, Cairo, Egypt. All head nurses and their assistants and their number 64 head nurses.

RESULTS: The results indicated that a minority of head nurses had satisfactory knowledge regarding negotiation in the pretest phase and obviously increased in the posttest to be more than three quarters and slightly decreased in the follow-up phase. Also, a minority had a high negotiation behavior level in the pretest phase and increased to be more than half in the posttest with a slight decrease in the follow-up stage. There was a highly statistically significant difference between pre-, post-, and follow-up results regarding negotiation knowledge and behavior.

CONCLUSION: The study revealed that the head nurse’s knowledge and behavior increased markedly after implementing the negotiation skills training program.

RECOMMENDATIONS: Conduct continuous education and training programs for stimulating and developing head nurses’ knowledge, behavior regarding negotiation, and hospital administration should support the importance of negotiation skills to both head nurses and organizations. TRIAL REGISTRATION NUMBER [TRN]: The study protocol was approved by the Research Ethics Committee of the Faculty of Nursing, Ain Shams University (code number: NUR 23.10.131).

PMID:39762889 | DOI:10.1186/s12912-024-02581-w

BMC Health Serv Res. 2025 Jan 6;25(1):32. doi: 10.1186/s12913-024-11782-7.

ABSTRACT

BACKGROUND: Voice barriers among frontline healthcare workers hinder safety related to work and patients. Understanding these barriers and practices is crucial to improve voice behavior in healthcare settings. Therefore, this study aims to identify the voice barriers and practices among healthcare workers in Pakistan.

RESEARCH METHOD: The study has adopted a mixed-method research design. Data was collected from 15 frontline healthcare workers through semi-structured interviews to achieve study objectives. Descriptives and content analysis were conducted to explore voice barriers and alternative practices to solve their concerns. After that, a quantitative study was conducted to determine the statistical significance of the identified voice barriers and the magnitude of their effect. For this purpose, data was collected from 480 frontline healthcare workers in the primary, secondary, and territory healthcare units. A questionnaire survey was used for data collection. Then, multistage hierarchical regression analysis was employed for data analysis.

RESULTS: Study findings highlight the determinants of two key factors: withholding patient safety concerns and withholding worker safety concerns. First, the study identifies several factors that increase the likelihood of healthcare workers withholding concerns about patient safety. These factors include professional designation, work experience, blackmailing, overconfidence, longer work tenure, feelings of insult, early career stage, fear of patient reactions, bad past experiences, job insecurity, and uncooperative management. Fear of increased workload also plays a significant role. Second, when it comes to work-related safety concerns, factors such as gender, shyness, lack of confidence, fear of duty changes, management issues, interpersonal conflicts, and resource shortages contribute to the withholding of concerns. To navigate these challenges, healthcare workers often resort to strategies such as seeking political connections, personal settlements, transfers, union protests, quitting, using social media, engaging in private practice, or referring patients to other hospitals.

CONCLUSION: Findings demonstrates that healthcare workers in Pakistan often withhold safety concerns due to hierarchical pressures, personal insecurities, and fear of repercussions. Their reliance on external mechanisms, such as political influence or social media, underscores the need for significant reforms to improve safety culture and management support. Addressing these issues is crucial for ensuring both patient and worker safety.

PMID:39762886 | DOI:10.1186/s12913-024-11782-7

Health Res Policy Syst. 2025 Jan 6;23(1):5. doi: 10.1186/s12961-024-01260-1.

ABSTRACT

BACKGROUND: An increasing number of people live with chronic disease or multi-morbidity. Current consensus is that their care requires an integrated model bringing different professionals together to provide person-centred care. Although primary care has a central role in managing chronic disease, and integration may be important in strengthening this role, previous research has shown insufficient attention to the relationships between primary care and integration. This review summarizes primary care involvement in integrated care interventions and assesses the effect of those interventions on a range of measures of primary care functions and wider outcomes.

METHODS: We searched Medline and Embase using terms for “integrated care”, “chronic disease” and “multimorbidity”. We included integrated care interventions involving different levels of care organizations or different care sectors. Risk of bias was appraised, and the contents of integrated care interventions assessed using the Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE (SELFIE) conceptual framework. Effectiveness of integrated care interventions was assessed using meta-analysis of primary care functions (access, continuity, comprehensiveness and coordination) and wider outcomes (patient health and mortality, hospital admissions and costs). Sub-group analyses were conducted for different types of primary care involvement.

RESULTS: From 17,752 studies screened, 119 studies on integrated care were identified, of which 69 interventions (58%) involved primary care. Meta-analyses showed significant beneficial effects on two measures of primary care function: access (effect size: 0.17, 95% CI 0.05-0.29) and continuity (effect size: 0.32, 95% CI 0.14-0.50). For wider outcomes, the only statistically significant effect was found on costs (effect size: 0.02, 95% CI 0.02-0.03).

CONCLUSIONS: Integrated care interventions involving primary care can have positive effects on strengthening primary care functions, but these benefits do not necessarily translate consistently to wider outcomes.

PMID:39762867 | DOI:10.1186/s12961-024-01260-1