Tag: statistics

J Endocrinol Invest. 2025 Jul 9. doi: 10.1007/s40618-025-02644-y. Online ahead of print.

ABSTRACT

PURPOSE: The optimal management of locally advanced differentiated thyroid cancer (DTC) remains a topic of debate, and the adoption of adjuvant external beam radiotherapy (EBRT) is discussed. This study aimed to evaluate the efficacy of EBRT with volumetric modulated arc radiotherapy (VMAT) in improving locoregional relapse-free survival (LRFS) in addition to surgery and radioiodine therapy (RAI). Secondary objective was to assess the tolerability of EBRT with VMAT.

METHODS: This monocentric, retrospective study included patients with locally advanced DTC, positive resection margins (R1) or lymph node metastases with extra-nodal extension who underwent total thyroidectomy and RAI. Patients were grouped based on whether they received adjuvant EBRT after surgery and RAI, and outcomes were compared.

RESULTS: Overall, 25 patients were included. EBRT group comprised 10 patients and non-EBRT group 15 patients. In the EBRT group, none experienced locoregional recurrence, compared to 60% in the non-EBRT group. Comparison of the survival curves showed a statistically significant difference (p = 0.043). Additionally, no severe treatment-related adverse effects were reported, indicating good tolerability of EBRT. Distant Disease-Free Survival (DDFS) was similar between the groups.

CONCLUSION: Adjuvant EBRT using VMAT improves LRFS in patients with locally advanced DTC, without adding significant toxicity. Locoregional control potentially avoid repeated neck surgeries and their associated side effects. Despite some limitations, our findings support the integration of EBRT into treatment protocols for selected high-risk patients. Further studies are needed to confirm these results and to evaluate the long-term impact of EBRT on survival and quality of life.

PMID:40632443 | DOI:10.1007/s40618-025-02644-y

J Robot Surg. 2025 Jul 9;19(1):366. doi: 10.1007/s11701-025-02549-1.

ABSTRACT

Colorectal surgeons have been early adopters of MIS. The objective of this study was to evaluate whether use of minimally invasive surgery (MIS) for colorectal cancers (CRC) has had an impact on use of MIS for hepatic, pancreatic, biliary, and gastric cancer (HPB/gastric) at the hospital level. We hypothesized that there is cross-specialty, hospital-level impact between colorectal and HPB/gastric surgeons in their use of MIS. Using the 2010-2019 National Cancer Database, we identified patients with histologically confirmed cancers who underwent curative-intent surgery. The hospital-level use of MIS for CRC and HPB/gastric cancers was standardized by adjusting hospital and patient covariates. Using these adjusted MIS rates as covariates, the yearly-level odds of receiving MIS for HPB/gastric cancers were estimated using logistic regression models. 87,241 and 134,019 patients (median age 65 years) with HPB/gastric cancers and CRC, respectively, were included. The proportion of hospitals performing more than 50% of their cases via MIS for both groups of cancers increased from 1% in 2010 to 27% in 2019. The proportion of hospitals performing more than 10% of their cases via a robotic approach increased from 1 to 33%. The odds of receiving MIS among patients with HPB/gastric cancers were more strongly associated with the level of MIS use for HPB/gastric cancer in the previous year than with MIS use for CRC. Adoption of MIS for HPB/gastric cancers appears to be influenced to a greater degree by intra-specialty factors rather than by cross-specialty use of MIS for CRC.

PMID:40632432 | DOI:10.1007/s11701-025-02549-1

Ophthalmol Ther. 2025 Jul 9. doi: 10.1007/s40123-025-01196-x. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examined visual outcomes and complication rates after early pars plana vitrectomy (PPV) in eyes with endophthalmitis.

METHODS: The study was designed as a single-center, retrospective, observational database study. A total of 92 eyes treated with early PPV for endophthalmitis at the University Hospital Zurich between 2006 and 2016 were included. Endophthalmitis cases following cataract surgery (CAT, n = 44), intravitreal injection (IVI, n = 12), trabeculectomy (TRAB, n = 6), and Others (e.g., trauma or endogenous, n = 30) were assessed. Visual acuity (VA) and intraocular pressure (IOP) from prior to endophthalmitis to 12 months after PPV were analyzed. Secondary outcomes included complications following the procedure.

RESULTS: CAT and IVI groups showed good visual outcomes. Final VA in CAT and IVI groups was not statistically different to prior to endophthalmitis (CAT p = 0.840, IVI p = 0.933). In the CAT group, 78.9% of eyes with a starting VA of > light perception achieved ≥ 20/40 final VA. The highest rate of patients with at least one complication was observed in TRAB (100%), followed by Others (63.3%), IVI (50.0%), and CAT groups (40.9%).

CONCLUSION: Early PPV may be beneficial in endophthalmitis following cataract surgery and intravitreal injection, regardless of initial VA.

PMID:40632428 | DOI:10.1007/s40123-025-01196-x

J Exp Biol. 2025 Jul 9:jeb.250379. doi: 10.1242/jeb.250379. Online ahead of print.

ABSTRACT

Onymacris plana (Coleoptera: Tenebrionidae) is a black beetle that runs at high speed for a pedestrian insect in direct solar radiation in the Namib Desert, a behaviour expected to impose potentially lethal body temperature within minutes. We measured the body temperature of beetles active in their natural habitat using fine thermocouples inserted into the prothorax. The measurements revealed that when beetles sprinted in conditions of low wind, high radiation and moderate ambient temperature, their body temperature dropped rather than rose. The effect depended on convective cooling and efficient locomotion, i.e., sprinting with low energy expenditure. We confirmed the convection effect in the laboratory by exposing beetles to combinations of radiation, air temperature and wind speed comparable to those found in the Namib Desert and simulating the forced convection of running in a headwind. Under these simulated conditions, peak radiation caused the temperature of stationary male beetles to rise at about 6°C min-1 and females at almost 4°C min-1. However, in wind-calm conditions at peak radiation, the convection of simulated running dropped the equilibrium body temperature of live beetles by about 13°C. We believe that ours is the first report of exercise-induced cooling in a pedestrian animal and that O. plana’s diurnal lifestyle depends on that exercise-induced cooling.

PMID:40631420 | DOI:10.1242/jeb.250379

Am J Hum Biol. 2025 Jul;37(7):e70105. doi: 10.1002/ajhb.70105.

ABSTRACT

OBJECTIVE: To determine the association between relative leg length and insulin resistance according to rural, urban, and rural-urban migrant groups.

METHODS: Cross-sectional study using data from the PERU MIGRANT study (2007-2008). The exposure was relative leg length categorized as short, normal, or long, and the outcome was insulin resistance (logarithm of homeostatic model assessment log-HOMA2-IR). Linear regression models with log transformation, adjusted for sex, age, parental education, hip circumference, and physical activity level, were employed to estimate geometric mean ratios of insulin resistance across leg length categories. Interaction effects of population groups (rural, urban, and migrants) on insulin resistance were explored, along with mediation analysis of central obesity and excess body fat in the main relationship.

RESULTS: Using data from 947 participants, 52.7% female, mean age 47.7 years (SD = 11.9), we found a robust inverse association between relative leg length and insulin resistance. The geometric mean of insulin resistance in subjects with long leg length was 43% (e^β1: 0.57, 95% CI: 0.47-0.69) lower than those in the normal category. A significant interaction effect of the population group on relative leg length categories (p < 0.001) was observed, particularly in the migrant and rural groups. Excess body fat and abdominal obesity explained 33% and 12% of the association between relative leg length and insulin resistance, respectively.

CONCLUSIONS: Longer leg length was associated with lower insulin resistance values, with a greater interaction effect observed among the rural-urban migrant and urban groups. These findings support the hypothesis that metabolic disorders in adults may be traceable to nutritional and developmental conditions early in life.

PMID:40631411 | DOI:10.1002/ajhb.70105

Cancer Med. 2025 Jul;14(13):e71026. doi: 10.1002/cam4.71026.

ABSTRACT

INTRODUCTION: Digital symptom monitoring effectively reduces symptom burden in cancer patients receiving treatment. However, concerns persist about whether digital interventions are equitable across racial groups, and limited studies have reported on differences between racial groups. This secondary analysis compared engagement, satisfaction, and cancer symptom reduction benefits in Black and White participants utilizing an electronic capture of patient-reported outcome (ePRO) reporting system, symptom care at home (SCH), throughout chemotherapy.

METHODS: Participants undergoing cancer treatment at a comprehensive cancer center reported daily on the 11 common oncology symptoms via electronic patient reporting (ePRO) on a scale of 0-10. The mean symptom burden over time was compared between Black and White patients. End-of-study patient satisfaction ratings were completed and compared between Black and White patients receiving chemotherapy at a comprehensive cancer center in Atlanta, Georgia, USA.

RESULTS: Of the 357 self-identified participants, 239 (66.95%) were Black, and 118 (33.05%) were White. Black participants were more likely to be female, have breast cancer, not currently married, and have less than a 4-year college degree compared to Whites. Black participants had lower adherence to daily symptom reporting (65.25%; SD = 26.90 vs. 72.75%; SD 22.45; p = 0.01), but both groups reported the majority of days. The intervention produced a significant improvement in symptom burden (p < 0.001), with a mean improvement of 0.14 symptom burden points per week with equal benefit between Blacks and Whites (p = 0.27). Overall satisfaction was high for both groups, with a trend toward higher Black satisfaction (p = 0.06).

CONCLUSION: Carefully designed digital health technologies can be acceptable and beneficial in reducing symptom burden for both Blacks and Whites. All patients, but particularly Black patients, may benefit from tailored encouragement strategies to report their symptoms. This paper provides evidence that ePRO reporting systems do not perpetuate inequity but, in fact, benefit cancer patients across racial groups.

PMID:40631393 | DOI:10.1002/cam4.71026

Stat Methods Med Res. 2025 Jul 9:9622802251338409. doi: 10.1177/09622802251338409. Online ahead of print.

ABSTRACT

Many randomized trials have used overall survival as the primary endpoint for establishing non-inferiority of one treatment compared to another. However, if a treatment is non-inferior to another treatment in terms of overall survival, clinicians may be interested in further exploring which treatment results in better health utility scores for patients. Examining health utility in a secondary analysis is feasible, however, since health utility is not the primary endpoint, it is usually not considered in the sample size calculation, hence the power to detect a difference of health utility is not guaranteed. Furthermore, often the premise of non-inferiority trials is to test the assumption that an intervention provides superior quality of life or toxicity profile without compromising survival when compared to the existing standard. Based on this consideration, it may be beneficial to consider both survival and utility when designing a trial. There have been methods that can combine survival and quality of life into a single measure, but they either have strong restrictions or lack theoretical frameworks. In this manuscript, we propose a method called health utility adjusted survival, which can combine survival outcome and longitudinal utility measures for treatment comparison. We propose an innovative statistical framework as well as procedures to conduct power analysis and sample size calculation. By comprehensive simulation studies involving summary statistics from the PET-NECK trial, we demonstrate that our new approach can achieve superior power performance using relatively small sample sizes, and our composite endpoint can be considered as an alternative to overall survival in future clinical trial design and analysis where both survival and health utility are of interest.

PMID:40631392 | DOI:10.1177/09622802251338409

J Health Serv Res Policy. 2025 Jul 9:13558196251358761. doi: 10.1177/13558196251358761. Online ahead of print.

ABSTRACT

BackgroundThere is a growing debate on whether avoidable emergency department (ED) visits, those involving health issues that could have been managed in community settings, represent a significant workload for the department. Until recently an ED physician-validated measure of avoidable visits has not been available, hindering our understanding of these patients, services rendered in the ED and the nature of their conditions. We examined patient characteristics of ED visits retrospectively classified as avoidable and potentially avoidable at a Canadian academic hospital.MethodsWe conducted a retrospective cohort study using administrative ED data from an academic hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023. We categorized all ED visits as avoidable, potentially avoidable, and not avoidable using the Emergency Department Avoidability Classification (EDAC). For each class, we analyzed patient characteristics and the top five physician interventions and diagnoses. We applied linear regression, locally weighted scatterplot smoothing (LOWESS) regression, and statistical process methods to examine monthly trends in avoidable and potentially avoidable visits. Additionally, we reported annual totals and length of stay for patients transported to the ED by paramedics.ResultsOverall, 58,528 (29.0%) of 201,741 ED visits were classified as either avoidable (11,302; 5.6%) or potentially avoidable (47,226; 23.4%). These patients were predominantly young-to-middle aged, with average visit durations of 3 hours 33 minutes (avoidable) and 4 hours 26 minutes (potentially avoidable). Their primary interventions were predominantly diagnostic imaging, skin repairs and mental health assessments. The proportion of ED visits in the study period that were avoidable increased from 2.1% to 7.7% and potentially avoidable from 18.2% to 21.2%. Approximately one-in-five paramedic transported patients were classified as having either an avoidable or potentially avoidable ED visit. Transported patients had an average length of stay of 4 hours 22 minutes for avoidable visits and 4 hours 35 minutes for potentially avoidable visits.ConclusionsA notable rise in the proportion of ED visits that could have been managed in non-ED settings was observed. Providing community clinicians with resources and capacity to manage and refer patients for diagnostic imaging, skin repairs and mental health assessments may reduce avoidable ED attendance. Further exploration of avoidable ED visits transported by paramedics could support refining ED diversion care models. Hospitals and health service policymakers could benefit from similar analyses using validated measures to identify care gaps that inform the development of new health services and models tailored to the specific needs of their communities.

PMID:40631383 | DOI:10.1177/13558196251358761

Violence Against Women. 2025 Jul 9:10778012251356959. doi: 10.1177/10778012251356959. Online ahead of print.

ABSTRACT

Despite the continuous efforts of different generations to eradicate violence against women, statistics reveal that the problem has not been solved. The aim was to identify convergences and divergences in the perceptions of young people and adults and highlight possible future solutions. This mixed study used questionnaires (N = 628) and involved focus groups with both youth and adults (N = 19). The study contributes to understanding the age-differentiated victimization of those who witness violent acts. Both groups agreed that the solution to violence is an individual responsibility with the victims even if it affects interpersonal relationships with the perpetrators.

PMID:40631379 | DOI:10.1177/10778012251356959

Eur J Psychotraumatol. 2025 Dec;16(1):2514327. doi: 10.1080/20008066.2025.2514327. Epub 2025 Jul 9.

ABSTRACT

Background: The global immigrant population is increasing annually, and Asian immigrants have a substantial representation within the immigrant population. Due to a myriad of challenges such as acculturation, discrimination, language, and financial issues, immigrants are at high risk of mental health conditions. However, a large-scale mapping of the existing literature regarding these issues has yet to be completed.Objective: This study aimed to investigate the mental health conditions, help-seeking behaviours, and factors affecting mental health service utilization among East Asian immigrants residing in Western countries.Method: This study adopted the scoping review methodology based on the Joanna Briggs Institute framework. A comprehensive database search was conducted in May 2024 in PubMed, CINAHL, Embase, Cochrane, and Google Scholar. Search terms were developed based on participants, concept, context framework. The participants were East Asian immigrants and their families, and the concept of interest was mental health help-seeking behaviours and mental health service utilization. Regarding the context, studies targeting East Asian immigrants in Western countries were included. Data were summarized narratively and presented in a tabular and word cloud format.Results: Out of 1990 studies, 31 studies were included. East Asian immigrants often face mental health conditions, including depression, anxiety, and suicidal behaviours. They predominantly sought help from informal sources such as family, friends, religion, and complementary or alternative medicine, rather than from formal sources such as mental health clinics or healthcare professionals. Facilitators of seeking help included recognizing the need for professional help, experiencing severe symptoms, higher levels of acculturation, longer length of stay in the host country. Barriers included stigma, cultural beliefs, and language barriers.Conclusions: The review emphasizes the need for culturally tailored interventions to improve mental health outcomes in this vulnerable population. These results can guide future research and policymaking to address mental health disparities in immigrant communities.

PMID:40631378 | DOI:10.1080/20008066.2025.2514327