Tag: statistics

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 16;9(12). doi: 10.5435/JAAOSGlobal-D-24-00398. eCollection 2025 Dec 1.

ABSTRACT

AIMS: Reconstructing hips in moderate-to-severe developmental dysplasia of the hip (DDH) in adults, such as Hartofilakidis type B-C, presents a notable challenge. Despite various surgical procedures available, no approach has shown consistent long-term success. This observational study aimed to report the long-term survivorship and outcomes of a “selective osteotomy treatment algorithm,” which involves selective osteotomy combined with anatomic hip restoration, for moderate-to-severe DDH.

METHODS: We retrospectively reviewed 24 patients with Hartofilakidis type B (moderate) or C (severe) DDH who underwent total hip arthroplasty with selective osteotomy approach at Siriraj Hospital, Mahidol University, Thailand from 2001 to 2021. We employed a Kaplan-Meier curve to assess procedure survivorship, with revision surgery as the end point. Clinical, functional outcomes assessed with Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement score, complications, and radiological assessments during follow-up were recorded.

RESULTS: The mean patient age was 56.8 ± 11.8 years (range 37 to 78 years), and mean height was 152.0 ± 11.7 cm (range 111 to 167 cm). The median surgical time was 84 minutes (range 50 to 300 minutes), with a median estimated blood loss of 450 mL (range 100 to 4000 mL). The median follow-up time was 7.8 years (range 4 to 21 years). The Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement score improved markedly from baseline, with a mean anchor-based increase of 23.70 ± 0.04 at 6 months postoperatively. Three cases encountered revision surgery due to osteotomy nonunion with stem fracture, early dislocation, and periprosthetic joint infection. The survival probability at 12 years was 83.7%. No sciatic nerve injuries were reported. No radiographic pathology was detected during follow-up.

CONCLUSION: Selective osteotomy combined with anatomic hip restoration is a feasible and effective approach for managing moderate-to-severe DDH, as it demonstrated favorable long-term outcomes. Our approach may serve as a treatment option for patients with similar challenging deformities.

PMID:41411505 | DOI:10.5435/JAAOSGlobal-D-24-00398

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 16;9(12). doi: 10.5435/JAAOSGlobal-D-24-00361. eCollection 2025 Dec 1.

ABSTRACT

INTRODUCTION: Musculoskeletal complications associated with end-stage renal disease (ESRD) are known to predispose patients to an increased risk of hip fractures. The aging population and the effects of treatments pose challenges to advancements in bone health management. This study is one of the largest to date, examining patient demographics and temporal trends among ESRDpatients with hip fractures.

METHODS: A retrospective analysis of data from the United States Renal Data System, spanning 1977 to 2012, was conducted. Two cohorts of 115,386 sex-matched and age-matched patients with ESRD were studied: those with hip fractures and patients without hip fractures. Statistical significance was determined by a P value <0.05. Clinical significance was assessed using effect size (ES).

RESULTS: The incidence of hip fractures among patients with ESRD increased by 3,369% between 1977 and 2007, followed by an 11% decrease from 2007 to 2012. ESRD patients with hip fractures were significantly more likely to be White (77.7% vs. 76.1%; P < 0.001, ES: 0.02) and older (71.6 vs. 71.2, P < 0.001; ES: 0.03). No difference in sex was observed between cohorts: male (47.0% vs. 47.0%) and female (53.0% vs. 53.0%).

DISCUSSION: The temporal trend reflects current ESRD literature but contrasts with trends seen in the general population, partly because of the increased lifespan of these patients and thus longer dialysis, a known risk factor of fractures. Our data support current literature that White race is an independent risk factor of hip fractures, which may be due to genetic variations in vitamin D, FGF-23 metabolism, and bioavailability. The earlier onset of hip fractures in patients with ESRD may offset the effect of menopause-driven fractures observed in the general population.

PMID:41411504 | DOI:10.5435/JAAOSGlobal-D-24-00361

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 16;9(12). doi: 10.5435/JAAOSGlobal-D-25-00057. eCollection 2025 Dec 1.

ABSTRACT

INTRODUCTION: Intermediate outcomes of foraminal decompression (FD) have not been reported using biportal endoscopic assistance (biportal endoscopic-foraminal decompression [BE-FD]). The goal of this study was to evaluate the clinical and radiologic outcomes of FD and analyzing risk factors for less successful outcomes.

METHODS: Patients who underwent BE-FD for single-level lumbar foraminal stenosis were enrolled. Demographic and radiographic parameters were collected. For clinical evaluation, Oswestry Disability Index and Visual Analog Scale (VAS) for back and leg pain were used. Patients were divided into group A with excellent and group B with less satisfactory results.

RESULTS: A total of 141 patients were selected for this study. Ninety-eight of 141 (69.5%) had excellent outcomes. Group B had improvement in Oswestry Disability Index and VAS leg but less than group A. VAS back did not differ between the groups. Fourteen of patients (9.9%) required revision fusion surgery. In univariate analysis, smaller preoperative intervertebral disk height (IVD), smaller preoperative foraminal height (FH), and more disk wedging (DW) were associated with poorer outcomes. Larger change in IVD, FH, and DW was also associated with suboptimal outcomes and lower level of surgery. In multivariate analysis, level of surgery, preoperative DW, and change in IVD, FH, and DW were notable.

CONCLUSION: BE-FD was able to provide notable symptom improvement; only 9.9% required revision surgery. Lumbar foraminal stenosis pathology in the lower lumbar, less preoperative IVD and FH, and higher disk wedge angle should be taken care with caution when FD is considered because clinical improvement may be less than those patients without those risk factors.

PMID:41411496 | DOI:10.5435/JAAOSGlobal-D-25-00057

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 16;9(12). doi: 10.5435/JAAOSGlobal-D-25-00106. eCollection 2025 Dec 1.

ABSTRACT

BACKGROUND: Second victim syndrome (SVS) occurs when healthcare providers experience emotional distress after an adverse medical event. Although studied in other specialties, research is limited on its prevalence in orthopaedic surgery, particularly among Hispanic surgeons. This study evaluated SVS among Hispanic orthopaedic surgeons using the Second Victim Experience and Support Tool and identified support disparities.

METHODS: A survey containing the Second Victim Experience and Support Tool questionnaire was sent through e-mail and completed by 70 orthopaedic surgeons in Puerto Rico. Responses were collected electronically from May to September 2024. Descriptive statistics and Likert scores assessed SVS dimensions and support preferences.

RESULTS: The prevalence of psychological distress was moderate (mean: 3.1; SD: 1.2), with emotional distress being the most pronounced. Physical symptoms were less prominent (mean: 2.3; SD: 1.4). Colleague (mean: 2.2; SD: 1.0) and supervisor support (mean: 2.4; SD: 0.9) were inadequate. Institutional support had moderate gaps (mean: 2.7; SD: 1.2). Non-work-related support was highly valued (mean: 1.8; SD: 1.1). Professional self-efficacy declined, increasing self-doubt (mean: 2.6; SD: 1.3). Turnover intention and absenteeism were low (2.2 each). Preferred support included peer discussions (mean: 3.9; SD: 0.8) and employee counseling services (mean: 3.5; SD: 0.9).

CONCLUSION: Hispanic orthopaedic surgeons experience notable distress and insufficient institutional support following adverse medical events. These findings highlight the importance of implementing strategies to mitigate the impact of SVS and improve resilience among healthcare providers.

PMID:41411493 | DOI:10.5435/JAAOSGlobal-D-25-00106

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 16;9(12). doi: 10.5435/JAAOSGlobal-D-25-00059. eCollection 2025 Dec 1.

ABSTRACT

INTRODUCTION: Proximal femoral fractures (PFFs) are a notable source of morbidity and mortality in elderly populations, with 1-year mortality rates ranging from 15% to 30% and projected incidence set to rise markedly. Interdisciplinary care models, including the integration of a nurse practitioner (NP), have shown the potential to improve outcomes in this vulnerable population.

METHODS: We held a retrospective cohort study to evaluate the impact of adding a geriatric NP to the orthopedic department on mortality and hospitalization outcomes in patients with PFFs. A total of 2,065 patients were included: 1,300 from the preintervention period (2017 to 2020) and 765 from the NP-intervention period (2021 to 2024).

RESULTS: Key outcomes revealed a notable reduction in in-hospital mortality from 5.6% to 2.4% (P = 0.0005) and an improvement in 1-year survival rates during the NP-intervention period. Kaplan-Meier analysis and Cox regression demonstrated a notable survival benefit with NP involvement, with average survival extending from 1.3 to 2.3 years (P < 0.001). The average length of stay decreased from 9.3 to 8.4 days (P = 0.003), and patient transfers to other departments were reduced by nearly one third.

CONCLUSION: These results highlight the positive effect of a geriatric NP on survival, hospital efficiency, and continuity of care for elderly PFF patients. The NP-led model, focusing on perioperative coordination, discharge planning, and comprehensive care, offers a promising approach to address the growing demand for geriatric fracture management, supporting its broader implementation to improve clinical and economic outcomes.

IMPLICATIONS FOR CLINICAL PRACTICE: Our findings support the adoption of geriatric-focused, NP-led interventions in orthopedic settings to optimize the care of elderly fracture patients, aligning with current trends in interdisciplinary approaches to geriatric health care. Expanding this model may improve outcomes on a larger scale, addressing the growing needs of an aging population while promoting high-quality, cost-effective care in geriatric fracture management.

PMID:41411485 | DOI:10.5435/JAAOSGlobal-D-25-00059

J Psychopathol Clin Sci. 2026 Jan;135(1):136-157. doi: 10.1037/abn0001050.

ABSTRACT

Since the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and the 11th revision of the International Classification of Diseases introduced dimensional assessment of personality functioning (PF), PF impairments have been linked to transdiagnostic mental-health risk factors. Using ecological momentary assessment data from 16,038 mental health app users, we tested whether baseline PF impairment, affect-event dynamics, and depression predict future PF impairment and depression severity, hypothesizing a central role of PF. In the first month, users completed 69.3 mood (range 31-142) and 63.3 event assessments (25-133) on average. Dynamic structural equation models linked baseline depression to lower concurrent and cross-lagged mood-positive event links, lower inertia, and reduced likelihood of positive events. In contrast, baseline PF impairment related to persistence, emotional impact, and volatility of interpersonal conflict and greater mood instability. Over 1-year follow-up (N = 1,464, M = 1,236 assessments per user), future PF impairment and depression were predicted by weaker concurrent mood-positive event links, lower volatility of positive events, and baseline average mood/events. Among affect-event dynamics, cross-lagged effects of interpersonal conflicts on mood explained the highest unique variance in future PF impairment (ΔR2 = 5.9%). Baseline PF showed the strongest overall predictive utility (ΔR2 = 19.5%), followed by baseline depression (ΔR2 = 11.9%); PF explained more variance in future depression than vice versa. PF assessment may inform duration, goals, and strategies of treatments beyond those focused on personality disorders. Results are interpreted considering limitations, particularly the single-method design. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41411045 | DOI:10.1037/abn0001050

Environ Sci Technol. 2025 Dec 18. doi: 10.1021/acs.est.4c13918. Online ahead of print.

ABSTRACT

There is increasing interest in addressing measurement error in gridded exposure estimates. Here, we provide a framework to account for exposure measurement error in gridded air pollution estimates used for health effects estimation, i.e., when numerical air quality models or satellite-derived data are the principal source of exposure data. We employed a two-stage Bayesian hierarchical modeling framework consisting of an exposure measurement error model and a health model, linking the unobserved true ambient exposure at the residential address for each participant in the cohort to health outcomes. In sensitivity analysis, we considered different health models, spatial smoothing parameters, and spatial resolutions (1.33 and 4 km grid cells) for observation-fused CMAQ output. In an example application, comparison of gridded observation-fused CMAQ estimates and spatially smoothed observation-fused CMAQ estimates by leave-one-out cross-validation at monitoring stations indicated that prediction accuracy at those locations is comparable between the 1.33 km resolution gridded estimates and the smoothed estimates, while the spatially smoothed estimates slightly outperform the 4 km resolution gridded estimates. Accounting for exposure measurement error also resulted in somewhat greater PM_2.5 health effect estimates on continuous neuroimaging outcomes and smaller health effect estimates on binary cardiovascular outcomes, although overall conclusions remained similar.

PMID:41411036 | DOI:10.1021/acs.est.4c13918

Psychol Trauma. 2025 Dec 18. doi: 10.1037/tra0002077. Online ahead of print.

ABSTRACT

OBJECTIVE: Although sexual minority women (SMW) veterans are disproportionately impacted by military sexual trauma and its negative consequences, little research has examined effective treatments in this population. This secondary analysis aims to address this gap by reporting outcomes of SMW veterans participating in a clinical trial of skills training in affective and interpersonal regulation (STAIR) compared with present-centered therapy (PCT) for the treatment of posttraumatic stress disorder.

METHOD: Women veterans who experienced military sexual trauma (N = 161) were randomly assigned to individual STAIR or PCT. Forty-two participants were SMW (M_age = 45.45, SD = 14.05; 69.0% White) and 119 were heterosexual (M_age = 44.19, SD = 12.53; 54.6% White). Participants completed baseline, posttreatment, and follow-up assessments that included self-report measures of posttraumatic stress disorder symptoms (Posttraumatic Stress Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition), social support (Interpersonal Support Evaluation List), emotion regulation (Difficulties with Emotion Regulation Scale), posttraumatic maladaptive beliefs (Posttraumatic Maladaptive Beliefs Scale), depression symptoms (Beck Depression Inventory, Revised), and working alliance (Working Alliance Inventory-Patient Version). Independent samples t tests and piecewise mixed-effects regression models were conducted to evaluate SMW veterans’ outcomes.

RESULTS: Both groups (sexual minority and heterosexual women) improved on posttraumatic stress disorder symptoms. SMW started off with comparable symptoms to heterosexual women but improved more on emotion regulation (p = .002), maladaptive beliefs (p = .002), and depression symptoms (p = .002) than heterosexual participants. Regardless of sexual orientation, participants had greater benefits in STAIR. Therapeutic alliance and treatment satisfaction were high in both STAIR and PCT with no difference between groups.

CONCLUSIONS: SMW veterans may particularly benefit from therapies that focus on emotion regulation, interpersonal skills, and/or provide strategies that address day-to-day stressors (e.g., STAIR, PCT). (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41411035 | DOI:10.1037/tra0002077

J Med Microbiol. 2025 Dec;74(12). doi: 10.1099/jmm.0.002106.

ABSTRACT

Introduction. Fungal keratitis, particularly in tropical and subtropical regions, poses significant therapeutic challenges due to biofilm formation by fungal pathogens. These biofilms confer increased resistance to antifungal treatments and are associated with poorer clinical outcomes.Hypothesis/Gap Statement. Despite growing recognition of their impact, there remains a lack of comprehensive synthesis on the role of fungal biofilms in corneal ulcers.Aim. This study aims to determine the impact of and how biofilm formation influences the chronicity and treatment outcomes in fungal corneal ulcers.Methodology. A comprehensive literature search was performed across PubMed, ScienceDirect, Scopus and the Cochrane Library in April 2025. Only English articles were included, and animal studies were excluded. Eligible studies included clinical and in vitro investigations that assessed biofilm formation in fungal corneal ulcers and its impact on antifungal susceptibility and treatment outcomes. This systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines and registered under PROSPERO (an international systematic review registry, ID:CRD420251017502). Independent data extraction was done by two reviewers. Data on MICs were synthesized using random-effects models, and heterogeneity was assessed with I² statistics and Cochran’s Q test. Clinical outcomes were analysed narratively due to reporting variability.Results. Seven studies were included, spanning Brazil, India, China and Mexico, and covering both in vitro and clinical designs. Meta-analysis showed significantly increased MIC values for biofilm-forming fungal isolates: amphotericin B [pooled log_₂ fold change=5.31; 95% confidence interval (CI): 2.92-7.70], voriconazole (6.06; 95% CI: 2.25-9.87) and natamycin (1.25; 95% CI: 0.48-2.02). High heterogeneity was noted for amphotericin B and voriconazole, while results for natamycin were consistent. Narrative synthesis of clinical data indicated that biofilm formation is associated with prolonged healing times, increased recurrence rates, reduced visual acuity and higher complication risks.Conclusion. Biofilm formation by fungal pathogens significantly reduces antifungal susceptibility and worsens clinical outcomes in fungal keratitis. Elevated MIC, delayed healing and increased rates of complications emphasize the need for targeted biofilm-disrupting therapies and standardized diagnostic protocols. Future research should focus on developing clinical strategies that integrate biofilm assessment to improve patient outcomes.

PMID:41411030 | DOI:10.1099/jmm.0.002106

Rehabil Psychol. 2025 Dec 18. doi: 10.1037/rep0000644. Online ahead of print.

ABSTRACT

OBJECTIVE: Examine the moderating effect of preinjury attention-deficit hyperactivity disorder (ADHD) and secondary ADHD on response to a family-based problem solving (FBPS) intervention following pediatric traumatic brain injury.

METHOD: Analyses included 233 participants (114 FBPS and 119 internet resource comparison group), aged 11-18 who had been hospitalized for a moderate-severe traumatic brain injury within the previous 18 months. Parents completed measures of child functioning and their own functioning at time of enrollment, 6-, 12-, and 18-month follow-ups. Linear mixed models examined the moderating effect of ADHD status on the effect of treatment over time.

RESULTS: Main effect of ADHD status was significant for executive functioning, F(2, 429) = 55.15, p < .0001; social competence, F(2, 421) = 22.94, p < .0001; parental depression, F(2, 420) = 4.83, p = .0085; and parental distress, F(2, 413) = 6.35, p = .0019. Consistently, those with ADHD demonstrated worse outcomes than those without ADHD. ADHD status moderated the effect of FBPS on functional impairment, F(6, 430) = 5.16, p < .0001. Among those who received FBPS, those without ADHD demonstrated the expected improvement in functional outcomes over time. The secondary ADHD group had a delayed improvement in outcomes, not present until the 18-month follow-up. The preinjury attention-deficit hyperactivity disorder group showed no change in outcomes over time.

CONCLUSIONS/IMPLICATIONS: ADHD status had a significant effect on adolescent and parent outcomes and moderated the effect of FBPS on functional outcomes. Findings highlight the importance of identifying children with preinjury ADHD as well as new onset ADHD symptoms after injury to guide intervention delivery. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41411026 | DOI:10.1037/rep0000644