Tag: statistics

Anaesthesia. 2025 Sep 1. doi: 10.1111/anae.16757. Online ahead of print.

ABSTRACT

INTRODUCTION: Postoperative delirium is a common complication following cardiac surgery. Despite its known impact on patient outcomes, effective preventative strategies remain elusive. We aimed to perform a comprehensive Bayesian network meta-analysis of randomised controlled trials assessing the effect of pharmacological interventions on the incidence of postoperative delirium.

METHODS: Databases were searched from inception to September 2024. Our search was updated in January 2025. Eligible studies included randomised controlled trials reporting the incidence of postoperative delirium in patients having cardiac surgery treated with pharmacological interventions. Bayesian models were used to estimate risk ratios (RR) and mean differences with 95%CrI through Markov chain Monte Carlo. Interventions were ranked using the surface under the cumulative ranking curve. Sensitivity analyses and grading of recommendations, assessment, development and evaluation assessment were conducted to evaluate the robustness and certainty of evidence.

RESULTS: Seventy-nine randomised controlled trials comprising 24,827 patients were included, with 29 pharmacological interventions compared. Dexmedetomidine combined with melatonin was the most effective intervention, reducing the incidence of postoperative delirium compared with placebo (risk ratio 0.31, 95%CrI 0.13-0.69; low certainty). Dexmedetomidine with melatonin also significantly decreased intensive care unit stay (2.4 days, 95%CrI -3.50-1.10) and hospital stay (1.32 days, 95%CrI -2.09 to -0.57). Other interventions, including ketamine and risperidone, showed potential efficacy but with low or very low certainty of evidence.

DISCUSSION: We identified dexmedetomidine with melatonin as the most effective pharmacological strategy for preventing postoperative delirium following cardiac surgery. Whilst these findings highlight potential benefits, the low certainty of evidence underscores the need for more high-quality primary evidence.

PMID:40888048 | DOI:10.1111/anae.16757

J Environ Qual. 2025 Sep 1. doi: 10.1002/jeq2.70079. Online ahead of print.

ABSTRACT

Korea and the Netherlands historically developed highly fertilized cropping systems, resulting in the highest nitrogen (N) and phosphorus (P) surpluses among Organization for Economic Cooperation and Development (OECD) countries. However, their nutrient balances changed differently over the past three decades. The Netherlands reduced its N and P balances dramatically, from 328 to 166 kg ha^-1 and 35 to 4 kg ha^-1, respectively, while Korea’s balances remained unchanged with the highest levels in 2019 (230 kg N ha^-1 and 46 kg P ha^-1). To find solutions for Korea’s persistent nutrient surpluses, changes in nutrient balances and related parameters were compared using OECD statistics. Despite Korea’s efforts to reduce chemical fertilizer use, a 33% decline in agricultural land area and increased manure production offset the reduction. Conversely, the Netherlands rapidly decreased nutrient balances by reducing N and P inputs by 35% and 52%, respectively. Nutrient outputs in the Netherlands, primarily driven by forage harvest, were over twice as high as in Korea, helping lower its balances despite minor output declines. By the late 2010s, Dutch P input and output were nearly equilibrated, indicating no P surplus. As a result, the Netherlands has improved its nutrient use efficiency substantially, which inversely correlates with nutrient balance, but Korea has not shown considerable changes. Therefore, to address Korea’s nutrient balances, nutrient inputs should be reduced while increasing outputs. Determining the level of nutrient inputs, coupled with advanced agronomic practices and technologies to improve nutrient use efficiency, is essential for achieving reductions in nutrient balances while enhancing crops and forage production.

PMID:40888011 | DOI:10.1002/jeq2.70079

Pediatr Allergy Immunol. 2025 Sep;36(9):e70195. doi: 10.1111/pai.70195.

ABSTRACT

BACKGROUND: Hymenoptera venom allergy is a significant cause of morbidity and mortality, also in pediatric patients, highlighting the importance of effective management through venom immunotherapy (VIT). This study aimed to evaluate the safety profile of VIT, identify factors associated with adverse reactions (ARs), assess the accuracy of insect identification and its impact on VIT extract selection, and determine treatment efficacy by analyzing ARs following re-sting.

METHODS: The medical charts of patients followed up at the Allergy Unit of Meyer Children’s Hospital IRCCS, Florence, Italy, who completed a VIT cycle between 1997 and 2021 were retrospectively analyzed. VIT extract selection was guided by a diagnostic workup following the European Academy of Allergy and Clinical Immunology guidelines and the Italian Consensus on Hymenoptera venom allergy management. We implemented a cluster protocol and adjusted it as needed for ARs during VIT.

RESULTS: Fifty-eight patients, from a total of 60 VIT (2 patients underwent VIT for both Vespula and Polistes) were included, using the following extracts: 17 Apis mellifera (28.4%), 20 Vespula (33.3%), 20 Polistes (33.3%), and 3 Vespa crabro (5.0%). Upon the 3739 injections administered, 355 ARs (9.5%) occurred: local reactions (LRs), 306 (8.2%); extended local reactions (ELRs), 34 (0.9%); and systemic reactions (SRs), 15 (0.4%). The build-up phase was associated with a higher number of ARs and LRs compared with the maintenance phase during VIT (p < .0001), normalized by the number of injections. No other significant factors related to the risk of developing any ARs were highlighted. The highest SR rate was found in the VIT for Polistes, with no significant differences in AR proportions among the venom extracts. Thirty patients reported 51 re-stings following VIT, with only 2 of 51 (3.9%) resulting in SRs. These reactions occurred in individuals stung by a different Hymenoptera species from the one targeted during the VIT.

CONCLUSION: Cluster protocol VIT is safe and effective in pediatric patients.

PMID:40888008 | DOI:10.1111/pai.70195

EuroIntervention. 2025 Aug 30:EIJ-D-25-00826. doi: 10.4244/EIJ-D-25-00826. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend beta blockers after myocardial infarction (MI) regardless of left ventricular ejection fraction (LVEF), aiming to reduce reinfarction and ventricular arrhythmias. However, recent trials have challenged this practice in patients without reduced LVEF. Whether beta blocker withdrawal in these patients increases short-term or recurrent ischaemic events remains uncertain.

AIMS: We aimed to evaluate the short-term ischaemic safety of beta blocker withholding or withdrawal at hospital discharge in patients with MI and LVEF >40% and to determine the effect of beta blocker therapy on a broad composite ischaemic endpoint.

METHODS: This is a post hoc analysis of the REBOOT trial, in which patients with MI and LVEF >40% were randomised to beta blocker therapy or no beta blocker at discharge. The incidence of short-term (3-month) and recurrent ischaemic events (a composite of cardiac death, reinfarction, sustained ventricular tachycardia/fibrillation, resuscitated cardiac arrest, or unplanned revascularisation) was assessed overall and according to prior beta blocker use.

RESULTS: From the 8,438 patients in the intention-to-treat population of the trial, information regarding beta blocker history was available for 8,401. Of these, 12.1% were on chronic beta blocker therapy before MI. Overall, withholding or withdrawing beta blockers was not associated with increased short-term ischaemic risk (hazard ratio [HR] 1.13, 95% confidence interval [CI]: 0.74-1.72). Over a median follow-up of 3.7 years, there were no differences in recurrent ischaemic events between groups (HR 0.98, 95% CI: 0.82-1.16), nor significant interactions with prior beta blocker therapy. In patients who were on a beta blocker before the index MI, randomisation to no beta blocker (withdrawal) was not associated with an increased risk of ischaemic events during trial follow-up (composite ischaemic endpoint HR 0.93, 95% CI: 0.64-1.34).

CONCLUSIONS: In patients with MI and LVEF >40%, beta blocker withholding or withdrawal at discharge was not associated with increased short-term or recurrent ischaemic events, supporting the safety of this strategy in contemporary clinical practice.

PMID:40887991 | DOI:10.4244/EIJ-D-25-00826

Int J Nurs Pract. 2025 Oct;31(5):e70049. doi: 10.1111/ijn.70049.

ABSTRACT

AIM: To identify patterns and predictors of nurse turnover intentions based on years of nursing experience using a cluster analysis approach.

BACKGROUND: Nurses with varying years of experience have different characteristics. These differences can also lead to distinct patterns and predictors of turnover intentions.

METHODS: For this descriptive study, 785 nurses from hospitals across different regions of Türkiye participated in a survey. Data was collected through online questionnaires between April and May 2022. The K-means unsupervised machine learning algorithm was employed to classify nurses into distinct clusters based on their experience. Multiple linear regression analyses were conducted to identify the predictors of turnover intention specific to each cluster. The STROBE guideline was followed for reporting.

RESULTS: Cluster analysis grouped nurses into three categories by experience level: low, medium and high. The medium-experience group had the highest turnover intention, whereas the high-experience group had the lowest. Work stress was the only common predictor across all groups. Low income predicted turnover only for the low-experience group, and gender was significant only for the medium-experience group.

CONCLUSION: This study revealed that turnover intention and its predictors vary by experience level, indicating a need for retention strategies tailored to nurses’ years of experience. By considering subgroup characteristics, policymakers can develop targeted interventions to enhance nurse retention.

PMID:40887975 | DOI:10.1111/ijn.70049

Scand J Caring Sci. 2025 Sep;39(3):e70101. doi: 10.1111/scs.70101.

ABSTRACT

BACKGROUND: The Managerial Ethical Profile (MEP) scale was developed to measure the perceived impact of different elements of common ethical frameworks on managerial ethical decision-making.

AIM: To translate, culturally adapt and perform preliminary psychometric testing of the MEP scale in the Finnish health and social care sector.

DESIGN: The MEP scale was translated and culturally adapted according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) protocol based on a cross-sectional online survey.

PARTICIPANTS: Finnish health and social care managers and experts.

ETHICAL CONSIDERATION: Research permits were obtained from all participating organisations in accordance with the organisations’ guidelines. Participation was voluntary and participants gave informed consent.

METHODS: Translation and cultural adaptation of the Finnish version of the MEP scale (MEP-Fin) was performed and perceived relevance and content validity were assessed. An online survey was distributed to homecare service managers in 2022, and a total of 68 managers participated. The data were analysed using descriptive statistics (means, standard deviations, Pearson’s correlation coefficients and Cronbach’s alphas).

RESULTS: The translation, cultural adaptation and preliminary psychometric testing process identified issues regarding the understanding of the MEP scale in the Finnish context. The MEP-Fin showed high overall content validity (S-CVI/Ave 0.91). The mean score for the comprehensibility of the scale was 8.4. Content validity was high for all individual items (I-CVI range: 0.56 to 1.00), except for one item (0.38). The Cronbach’s alphas for the eight subscales were between 0.51 and 0.93, and for the whole scale, 0.84.

CONCLUSIONS: The systematic translation and cultural adaptation process resulted in a conceptually equal MEP-Fin, which was perceived as thorough and relevant. It showed good coverage, content validity and internal consistency. Preliminary psychometric testing provided information on the characteristics of the MEP-Fin for validation. Further studies with larger data sets and different cultures are needed.

PMID:40887714 | DOI:10.1111/scs.70101

Ear Nose Throat J. 2025 Aug 31:1455613251374489. doi: 10.1177/01455613251374489. Online ahead of print.

ABSTRACT

BACKGROUND: Microplastics are widespread in nature and have been detected in various human tissues and organs. They are thought to contribute to the occurrence and development of various diseases.

OBJECTIVES: To explore the relationship between microplastic exposure and allergic rhinitis (AR).

MATERIALS AND METHODS: Thirty-three patients with AR and 22 individuals in the control group were included in this study. All the participants completed the total nasal symptom score (TNSS) and nasal irrigation. The nasal irrigation solution was under microplastic analysis.

RESULTS: There were no significant differences in age and gender between the AR group and the control group. A statistically significant difference was noted in the TNSS questionnaire scores between the groups (P < .001). The density of microplastics in individuals with AR was significantly higher than that in the control group (9.96 (7.04-12.19); 7.22 ± 2.63; P = .003).

CONCLUSIONS AND SIGNIFICANCE: The concentration of microplastics in the nasal cavities of patients with AR was significantly higher than that in healthy individuals.

PMID:40887712 | DOI:10.1177/01455613251374489

Ying Yong Sheng Tai Xue Bao. 2025 Aug;36(8):2379-2387. doi: 10.13287/j.1001-9332.202508.006.

ABSTRACT

We examined the responses of leaf functional traits and their adaptation strategies of four dominant species (Lespedeza davurica, Carex duriuscula, Potentilla chinensis, and Cleistogenes chinensis) to desertification in the Zhanggutai desertified grassland, Liaoning Province. We measured the morphological and chemical functional traits under five desertification levels (0%, 10%, 30%, 50%, and 70% of sand addition by mass). The results showed that desertification significantly affected leaf functional traits in the natural grasslands of northwestern Liao-ning, but with significant species-specific difference. With the increases of desertification intensity, specific leaf area of C. duriuscula and P. chinensis increased initially and then decreased, peaking at 30% and 10% sand addition levels, respectively. Leaf dry matter content of the four species all showed a decreasing trend with aggravated desertification, but the changes were not statistically significant. Desertification significantly increased leaf N and P contents of C. duriuscula and C. chinensis, with N content being increased by 45.8% and 28.2%, and P content being increased by 87.1% and 50.3%, respectively under 70% sand addition treatment. The four species adapted to desertification through trade-offs among morphological and chemical traits. P. chinensis exhibited a “low-input, high-benefit” resource-conservative strategy. L. davurica maintained relatively stable leaf nutrient content. Both species exhibited a relatively strong adaptability to desertification.

PMID:40887687 | DOI:10.13287/j.1001-9332.202508.006

Matern Health Neonatol Perinatol. 2025 Sep 1;11(1):26. doi: 10.1186/s40748-025-00222-x.

ABSTRACT

This pilot randomized trial study evaluated the effectiveness of the Pebbles of Hope Thrive Guide, an interactive educational course designed for parents of premature infants. The study assessed changes in breastfeeding practices, maternal nutrition, and use of Kangaroo Care among 50 mothers in total randomized to one of three groups: Supervised, Independent, or Control. The purpose of the study was to assess the provision of mother’s breast milk, improved material nutrition behaviors, and adoption of Kangaroo Care among mothers that received access to the course compared to those that received standard education without Thrive Guide access. The primary outcome assessed was the provision of breast milk at three months post-intervention, while secondary outcomes included improvements in maternal confidence, changes in maternal nutrition behaviors, the adoption and frequency of providing Kangaroo Care, and the impact of educator supervision. Although the intervention improved mothers’ confidence and knowledge, it did not significantly impact breast milk provision or maternal nutrition behaviors at 3 months. Breast milk provision declined across all groups, but the amount of decline was not statistically different between them. Similarly, no significant differences were observed in the number of nutritional improvements made between the two periods. However, Independent users exhibited a notable increase in Kangaroo Care frequency. Qualitative interviews highlighted the importance of ongoing support and addressing practical barriers to following nutritional guidelines. These findings suggest that further research is needed to explore the conditions that enhance long-term behavior change and to identify strategies that optimize the impact of educational interventions on caregiving practices.

PMID:40887668 | DOI:10.1186/s40748-025-00222-x

J Health Popul Nutr. 2025 Aug 31;44(1):317. doi: 10.1186/s41043-025-01063-2.

ABSTRACT

OBJECTIVE: The present study aimed to evaluate the association between advanced lung cancer inflammation index (ALI) and all-cause mortality in a population of patients with Coronary Heart Disease(CHD) using a retrospective cohort study design.

METHODS: Data were obtained from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). ALI was calculated as BMI × albumin level ÷ NLR, integrating anthropometric, nutritional, and inflammatory biomarkers. History of CHD was obtained using a questionnaire. We used Cox regression analysis to explore potential relationships and examined the nonlinear relationship using Restricted Cubic Splines (RCS).

RESULTS: A total of 1,295 participants were included in the study. Cox regression results revealed that a higher ALI was associated with lower all-cause mortality in patients with CHD. The subgroup and interaction analyses showed that the results were consistent. After adjusting for all covariates, participants in quartile 4 of ALI showed a 39% reduction in all-cause mortality compared to quartile 1. RCS analysis indicates a U-shaped relationship with a breaking point of 117.33.

CONCLUSION: In the United States, higher ALI was associated with lower all-cause mortality among patients with CHD. These findings suggest a potential association between ALI and all-cause mortality in CHD patients that warrants further investigation in prospective studies. Future interventional studies are needed to determine whether strategies targeting the components of ALI could improve clinical outcomes in this population.

PMID:40887663 | DOI:10.1186/s41043-025-01063-2