Tag: statistics

JMIR Res Protoc. 2025 Sep 17;14:e72451. doi: 10.2196/72451.

ABSTRACT

BACKGROUND: Coronary artery disease (CAD) is a leading cause of global morbidity and mortality. Although CAD prevalence in the general population is well-documented, its occurrence among executive patients remains largely unexplored. An executive is an individual in a major leadership role, such as a C-suite officer, senior manager, board member, trustee, founder, or business owner, responsible for high-level decision-making and strategic direction. These roles often involve demanding schedules and significant stress. Despite their influence and better access to health care, this demographic faces unique challenges such as demanding work schedules, chronic stress, frequent travel, and reduced control over lifestyle. To address executives’ unique health needs, many health care organizations offer specialized programs emphasizing preventive cardiovascular care, using advanced tools such as lipid panels, stress tests, and coronary calcium scans not typically included in primary care, to detect risks early and to promote long-term wellness.

OBJECTIVE: This protocol aims to design a study to determine the prevalence of CAD in executive patients and compare it to the established prevalence in the US general population with the overarching goal of improving screening and care of CAD among executive patients.

METHODS: This protocol proposes a retrospective review of medical records for patients with CAD seen at the Mayo Clinic’s Executive Health Program from January 1, 2020, to December 31, 2023, with the aim of determining the prevalence of CAD in executive patients. The primary outcome is CAD prevalence, which will be identified through clinical diagnoses in the electronic medical records. Secondary outcomes include demographics, cardiovascular medications, social determinants of health, laboratory and diagnostic results, coronary calcium scores, and treatment interventions. The prevalence of CAD will be calculated as the proportion of patients with a documented CAD diagnosis relative to the total number of patients in the study cohort.

RESULTS: A total of 24,272 patients were seen in the executive health clinic between January 1, 2020, and December 31, 2023. After applying the inclusion criteria, 6466 executive patients were eligible, with 3290 identified as having a potential CAD diagnosis pending confirmation through a detailed chart review.

CONCLUSIONS: In this protocol, we outline a research design and methodology to address a critical gap in understanding the prevalence of CAD among executive patients. This demographic is often overlooked despite their unique risk factors such as high stress and lifestyle choices.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/72451.

PMID:40961480 | DOI:10.2196/72451

Health Informatics J. 2025 Jul-Sep;31(3):14604582251381233. doi: 10.1177/14604582251381233. Epub 2025 Sep 17.

ABSTRACT

Background: Large language models (LLM) still face challenges in accurately extracting and summarizing medical information from EHR and EMR. The variability in EHR and EMR formats across institutions further complicates information integration. Moreover, doctors need to spend a lot of time reviewing patient information, which affects the efficiency and effectiveness of clinical decision-making. Objective: This study aims to develop a medical record summarization system that uses the innovative X-RAG technique with GPT-4o to extract medical information from EHR and EMR and convert them into structured FHIR format. The system ultimately generates a doctor-friendly report to improve the efficiency and effectiveness of clinical decision-making. Methods: We propose an innovative X-RAG, which adds page-based chunking, chunk filtering, and guided extraction prompting to the basic framework of RAG and combines it with GPT-4o to extract medical measurement data, diagnostic reports, and medication history records from EHR and EMR with high accuracy. Results: The system achieved 96.5% accuracy in medical data extraction and reduced approximately 40% of the time doctors spend reviewing patient information in clinical applications. Conclusion: The proposed system improves the efficiency and effectiveness of clinical decision-making and provides a valuable tool to optimize medical information management and clinical workflows.

PMID:40961463 | DOI:10.1177/14604582251381233

Natl Vital Stat Rep. 2025 Aug 27;(11):1. doi: 10.15620/cdc/174614.

ABSTRACT

OBJECTIVES: This report presents and compares trends in U.S. births and deaths from 2010 through 2023. Births and deaths are shown by race and Hispanic origin and urbanicity of county of residence.

METHODS: Descriptive tabulations of trends in the numbers, rates, and ratios of births and deaths for the United States from 2010 through 2023 are presented and interpreted.

RESULTS: From 2010 through 2023, the number of births for the United States declined by a total of 10%. Births were essentially stable from 2010 through 2016, declined from 2016 through 2019, and then fluctuated from 2019 through 2023. In contrast, the number of deaths generally increased from 2010 through 2023, by a total of 25%. Deaths increased from 2010 through 2019 and fluctuated from 2019 through 2023. The crude birth rate decreased 18% from 2010 through 2023, declining 0.8% per year from 2010 through 2015 and 2.0% per year from 2015 through 2019; the rate then fluctuated from 2019 through 2023. In contrast, the crude death rate increased 15% from 2010 through 2023, rising 1.0% on average from 2010 through 2019, and then fluctuating from 2019 through 2023. The birth-to-death ratio declined from 2010 through 2023, by a total of 28%, with the ratio decreasing 1.6% per year from 2010 through 2014 and 2.8% per year from 2014 through 2019; the ratio then fluctuated from 2019 through 2023. The ratio generally declined for the three largest race and Hispanic-origin groups from 2010 through 2023, fluctuating but increasing from 2019 through 2023. The differences in the ratios among the groups narrowed from 2010 through 2023. The birth-to-death ratio declined for both urban and rural counties from 2010 through 2023, with differences between ratios narrowing.

PMID:40961445 | DOI:10.15620/cdc/174614

Lupus. 2025 Sep 17:9612033251375856. doi: 10.1177/09612033251375856. Online ahead of print.

ABSTRACT

ObjectiveTo investigate whether obesity is a risk factor for chronic kidney disease G3 (CKD G3; eGFR <60 mL/min/1.73 m²) in lupus nephritis (LN).MethodsWe retrospectively reviewed 132 cases of biopsy-proven class III, IV or V incident LN for which quarterly data were available during a long follow-up period (median 140 months). Rates of complete renal remission, renal flare and CKD G3 were compared between obese (body mass index ≥30 kg/m²) and non-obese patients. Complete renal remission was defined as a urine protein to creatinine ratio (uPCR) < 0.5 g/g and a serum creatinine value <120 % of baseline. Renal flare was defined as the reappearance of an uPCR >1 g/g, leading to a repeat kidney biopsy and/or treatment change.ResultsBaseline characteristics of obese patients did not differ from non-obese patients. By contrast, time to CKD G3 and time to renal flare were statistically shorter in obese patients. Obesity significantly increased long-term risk for the progression of CKD [HR = 2.72 (CI95% 1.11-6.64), p = .028]. In a multivariate analysis, obesity was an independent risk factor for CKD G3 (p = .029).ConclusionA BMI ≥30 kg/m² is an independent poor prognostic factor for the progression of CKD in LN. More attention should therefore be paid to weight control in LN patients.

PMID:40961424 | DOI:10.1177/09612033251375856

JCO Precis Oncol. 2025 Sep;9:e2500535. doi: 10.1200/PO-25-00535. Epub 2025 Sep 17.

ABSTRACT

PURPOSE: A biomarker to help predict outcomes after prostate cancer (PCa) focal therapy would be of considerable interest. We sought to assess the association between treatment failure after focal therapy and the Decipher score, a tumor-based genomic classifier (GC).

MATERIALS AND METHODS: We performed a post hoc analysis of a single-center phase II trial (ClinicalTrials.gov identifier: NCT03503643) in which patients with unilateral grade group (GG) 2-4 PCa (n = 108) underwent hemigland cryoablation of the prostate (2017-2021; n = 108). Pretreatment biopsy tissue was subjected to transcriptomic profiling to generate GC scores. The primary outcome was the association between GC-low (<0.45) versus GC-high (≥0.45) and in-field recurrence (GG ≥2) on magnetic resonance imaging-guided biopsy 6 months post-treatment, evaluated using multivariable logistic regression.

RESULTS: In the GC-high group (n = 37), treatment failure occurred in 17 patients (46%). In the GC-low group (n = 71), treatment failure occurred in 15 patients (21%). These differences were statistically significant (odds ratio [OR], 2.61 [95% CI, 1.05 to 6.51]; P = .04). Differences at 18 months were also significant (76% v 44%; OR, 3.58 [95% CI, 1.37 to 9.36], P = .009).

CONCLUSION: In patients with PCa otherwise suitable for management with focal therapy, a high GC score (≥0.45) was independently associated with treatment failure. A GC score derived from diagnostic biopsy can be used to help predict focal therapy outcomes.

PMID:40961406 | DOI:10.1200/PO-25-00535

J Clin Oncol. 2025 Sep 17:JCO2501148. doi: 10.1200/JCO-25-01148. Online ahead of print.

NO ABSTRACT

PMID:40961402 | DOI:10.1200/JCO-25-01148

Health Aff (Millwood). 2025 Sep 17:101377hlthaff202500050. doi: 10.1377/hlthaff.2025.00050. Online ahead of print.

ABSTRACT

Although COVID-19 vaccines have been shown to be highly effective in preventing severe illness, hospitalization, and death, information on the economic benefits of COVID-19 vaccination is lacking. Using data from a comprehensive, integrated health system, we linked health plan data and electronic health records to vaccination data to compare the average medical expenditures of vaccinated versus unvaccinated patients diagnosed with COVID-19. We examined expenditures during acute (within thirty days after diagnosis) and postacute (at least thirty days after diagnosis) periods from April 2021 through July 2022. Among children, average acute medical expenditures were $194 less for vaccinated than unvaccinated cases and among adults, $1,743 less for vaccinated than unvaccinated cases. Medical expenditures in the postacute period were not statistically different by vaccination status. The findings suggest that COVID-19 vaccination is associated with lower medical expenditures in the acute period. Vaccination continues to be important for reducing the economic impact of COVID-19.

PMID:40961389 | DOI:10.1377/hlthaff.2025.00050

Neurogastroenterol Motil. 2025 Sep 17:e70160. doi: 10.1111/nmo.70160. Online ahead of print.

ABSTRACT

INTRODUCTION: Functional defecation disorders (FDD) are a prevalent etiology of refractory constipation. The diagnosis of FDD requires specific physiology testing, including anorectal manometry (ARM) and balloon expulsion test (BET). The aims of our study were to evaluate whether the complaint of painful defecation added to the Rome III symptoms questionnaire could help to differentiate subtypes of refractory chronic constipation.

MATERIALS AND METHODS: One hundred and ninety-eight constipated patients (Rome III Criteria) who had failed a 30-day fiber/laxative trial were enrolled. Before entering the study (T0) the patients underwent a digital rectal examination, including the assessment of tenderness elicited by traction of the puborectalis muscles (DRE-tenderness). Patients reporting painful defecation (occurring at least once per week) were specifically assessed at T0. Thirty days after T0, the patients underwent: DRE with DRE-tenderness evaluation. ARM + BET. Barium defecography (when ARM and BET were discordant). Colonic transit time evaluation with radiopaque markers. Based on these tests, the patients were classified into five subgroups: dyssynergic defecation (DD), inadequate defecatory propulsion (IDP), isolated structural outlet obstruction (mostly large rectocele), isolated slow transit constipation, and normal transit constipation. The association between symptoms and diagnostic outcomes was assessed using multivariate analysis based on binary logistic regression.

RESULTS: Eighty-one patients (40.9%) reported weekly episodes of painful defecation, while 86 patients (43.3%) reported DRE-tenderness. Ninety-six patients (48.5%) showed features of FDD: 70 DD and 26 IDP; 25 (12.6%) showed isolated structural outlet obstruction, and 23 (11.6%) showed isolated slow transit constipation. No predictors were found for IDP.

CONCLUSIONS: The subjective complaint of painful defecation added to the Rome III criteria is critical to improve the identification of specific subtypes of refractory chronic constipation, thus improving care and potentially decreasing the need for physiology testing.

PMID:40961385 | DOI:10.1111/nmo.70160

Acta Orthop. 2025 Sep 17;96:684-691. doi: 10.2340/17453674.2025.44595.

ABSTRACT

BACKGROUND AND PURPOSE: Traditional surgery for arthritis of the distal radioulnar joint (DRUJ), which typically involves resecting the ulnar head, is being increasingly challenged by newer techniques, such as prosthetic ulnar head replacement. The aim of our prospective cohort study was to investigate the clinical and patient-reported functional results, up to 2 years postoperatively, among patients with DRUJ arthritis treated with ulnar head replacement or resection.

METHODS: 40 patients were included and underwent either ulnar head replacement (n = 22) or ulnar head resections (n = 18), due to DRUJ pathology between 2015 and 2020. Patients were followed up at 3, 6, 12, and 24 months postoperatively by the means of Patient-Rated Wrist Evaluation (PRWE) (primary outcome), and Disability of the Arm, Shoulder and Hand (DASH) questionnaires, pain, range of forearm rotation, and grip strength (secondary outcomes). Postoperative complications were recorded. 19 and 16 patients, respectively, responded at the 24-months follow-up. Female sex and inflammatory arthritis were more common in the resection group. General linear regression analyses adjusting for diagnosis and baseline PRWE score were performed for our primary outcome.

RESULTS: The median and interquartile range (IQR) improvement in PRWE from baseline to 24 months was 69 (IQR 49-87) to 27 (IQR 6-48) in the replacement group and 60 (IQR 50-86) to 23 (IQR 5-44) in the resection group, indicating that both groups improved from baseline. There were no differences in unadjusted estimates at any time point. The adjusted means in PRWE at 24 months were 35 and 26 points in the replacement and resection groups, respectively, corresponding to a statistically insignificant mean difference of 8.6 (95% confidence interval -11.7 to 28.2). We found no statistically significant group differences in any of the secondary outcomes at any time point. Postoperative complications affected 6 patients with ulnar head replacement, whereas none were reported for patients with ulnar head resection.

CONCLUSION: We found that the outcome after ulnar head replacement is not superior to ulnar head resection in the short term.

PMID:40961374 | DOI:10.2340/17453674.2025.44595

JMIR Med Educ. 2025 Sep 17;11:e62666. doi: 10.2196/62666.

ABSTRACT

BACKGROUND: Applying functional anatomy to clinical examination techniques in shoulder examination is challenging for physicians at all learning stages. Anatomy teaching has shifted toward a more function-oriented approach and has increasingly incorporated e-learning. There is limited evidence on whether the integrated teaching of professionalism, clinical examination technique, and functional anatomy via e-learning is effective.

OBJECTIVE: This study aimed to investigate the impact of an integrated blended learning course on the ability of first-year medical students to perform a shoulder examination on healthy volunteers.

METHODS: Based on Kolb’s experiential learning theory, we designed a course on shoulder anatomy and clinical examination techniques that integrates preclinical and clinical content across all 4 stages of Kolb’s learning cycle. The study is a randomized, observer-blinded controlled trial involving first-year medical students who are assigned to one of two groups. Both groups participated in blended learning courses; however, the intervention group’s course combined clinical examination, anatomy, and professional behavior and included a peer-assisted practice session as well as a flipped classroom seminar. The control group’s course combined an online lecture with self-study and self-examination. After completing the course, participants uploaded a video of their shoulder examination. The videos were scored by 2 blinded raters using a standardized examination checklist with a total score of 40.

RESULTS: Thirty-eight medical students were included from the 80 participants needed based on the power calculation. Seventeen intervention and 14 control students completed the 3-week study. The intervention group students scored a mean of 34.71 (SD 1.99). The control students scored a mean of 29.43 (SD 5.13). The difference of means was 5.3 points and proved to be statistically significant (P<.001; 2-sided Mann-Whitney U test).

CONCLUSIONS: The study shows that anatomy, professional behavior, and clinical examination skills can also be taught in an integrated blended learning approach. For first-year medical students, this approach proved more effective than online lectures and self-study.

PMID:40961369 | DOI:10.2196/62666