Ordinal Analysis Research Articles

Factors Influencing the Self-Management Stages of Older Patients With Chronic Pain: A Cross-Sectional Study

PurposeTo investigate the current status and related influencing factors of self-management stages in older patients with chronic pain. DesignA cross-sectional study. MethodsA total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages. ResultsThe self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain. ConclusionsIn this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages. Clinical ImplicationsNursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention and make timely adjustments to their pain management plans.

Femoral component size in total knee replacement: a retrospective study

Background: Osteoarthrosis is the most common articular disease in the developed world. The number of people affected by knee osteoarthrosis is exponentially increasing, and with total knee replacement (TKA) demand expected to continue growing. The study establishes the relationship between femoral size components used in TKA and patients’ demographics. Methods: A retrospective cohort study of 385 surgeries that underwent TKA at the tertiary hospital over the period between January 2018 and December 2021 was conducted. The patients’ demographics, including height, weight, body mass index, gender, and age, and the implanted component size and type of the component (gender or not) were collected. Results: A significant association was found between the gender of patients and the femoral component size (P<0.001). Furthermore, height and weight had a significant correlation with femoral component size (P=0.399, P<0.001 and P=0.114, P=0.025, respectively); however, body mass index and age were not statistically correlated with femoral component size (P=0.625, 0.138, respectively). Upon ordinal logistic regression analyses, height and gender were significant predictors of the implanted femur component size (P<0.001). However, age and weight were insignificant factors in the model (P=0.640 and P=0.211, respectively). Conclusion: The results described will help with the pre-operative predictions of the total knee replacement femoral component size, which will decrease the operating time and implant supply chain efficiency. Further advancement of the model could be achieved with future multicenter studies with a larger sample.

Association of first-line thrombectomy technique and outcome in late-window large vessel occlusion strokes: A post hoc analysis of the MR CLEAN-LATE trial.

This study aimed to compare direct aspiration, stent retriever, and the combined thrombectomy technique on clinical, safety, and technical outcomes in late-window stroke patients included in the MR CLEAN-LATE trial. This post hoc analysis of the MR CLEAN-LATE trial included patients treated with direct aspiration, stent retriever, or combined thrombectomy technique as first-line approach. Primary outcome was the modified Rankin Scale (mRS) score at 90 days follow-up, and compared between the three groups with ordinal logistic regression analysis. Secondary outcomes included mortality at 90 days, total technique switches, procedure time, recanalization rate measured with the expanded thrombolysis in cerebral infarction (eTICI) score, and symptomatic intracranial hemorrhage (sICH). Predefined variables were used for adjustments. In the MR CLEAN-LATE trial, 258 patients underwent endovascular treatment and 232 were included in our analyses. The mRS at 90 days did not differ (stent retriever vs. direct aspiration: adjusted common odds ratio (acOR) = 1.35, 95% confidence interval (CI) = 0.73 to 2.50; stent retriever vs. combined: acOR = 1.13, 95% CI = 0.64 to 2.00; direct aspiration vs. combined: acOR = 1.19, 95% CI = 0.64 to 2.21). Direct aspiration thrombectomy was accompanied with more switches to another technique compared to the stent retriever (adjusted odds ratio (aOR) = 6.50, 95% CI = 2.52 to 16.8) or combined group (aOR = 4.67, 95% CI = 1.80 to 12.1) and with higher sICH rates compared to the combined technique (13% vs. 2.5%; aOR = 8.19, 95% CI = 1.49 to 45.1). Mortality, procedure time, and eTICI did not differ. Stent retriever, direct aspiration, or the combined thrombectomy technique as first-line approach showed no differences in clinical outcome in late-window stroke patients. Direct aspiration was accompanied with higher sICH rates and more switcher to another technique compared to the combined group.

Community perceptions towards the ecosystem services of urban forests in Mekelle, Tigray, Ethiopia

Urban forests are crucial providers of ecosystem services, delivering significant benefits to residents and the environment. This study aimed to investigate how residents in Mekelle, Tigray, Ethiopia, perceive the ecosystem services provided by urban forests. Understanding these perceptions is essential, particularly in developing countries and the study area, where little research has been conducted on this topic. To achieve this objective, a questionnaire-based survey was conducted among randomly selected household heads from two sub-cities within Mekelle. The collected data were analyzed using both descriptive and inferential statistics, including Spearman rank correlation and ordinal regression analysis. These analyses helped identify the factors influencing inhabitants’ perceptions of ecosystem services. The findings revealed that residents placed a high value on the regulating ecosystem services provided by urban forests. In contrast, provisioning, supporting, and cultural ecosystem services were perceived at a medium level. Additionally, the analysis indicated that the level of education and age of respondents were significant factors influencing their overall perception of these ecosystem services. Higher educational attainment and older age were associated with a greater appreciation of the ecosystem services offered by urban forests. This study has important implications for urban forest management and policy. It highlights the necessity of incorporating community perceptions of ecosystem services into urban planning and management efforts. Moreover, the study recommends the need for local governments to focus on raising community awareness about the ecosystem services provided by urban forests. This can ensure more effective and inclusive urban forest management strategies that align with community values and needs.

How important is Forest Age in explaining the species composition of Near-natural Spruce Forests?

Multiple ecological drivers, along with forest age, determine the species composition of boreal forest ecosystems. However, the role of age in successional changes in forests cannot be understood without taking site conditions, the disturbance regime and forest structure into account. In this study, we ask two research questions: 1. What is the relationship between forest age and overall species composition in older near-natural spruce forests, i.e. forests of age beyond harvest maturity? 2. Do species associated with different forest habitats respond similarly to variation in forest age? Data were collected in 257 Norway spruce dominated 0.25 ha plots from three study areas in Southeastern and Central Norway. Species inventories were conducted for lichens and bryophytes on trees and rocks, vascular plants on the forest floor, and for deadwood-associated bryophytes and polypore fungi. Although NMDS ordination analyses of the total species composition identified a main axis related to the age of the oldest trees in two of the study areas, variation partitioning analyses showed that age explained a small fraction of variation of the species composition compared to site conditions, logging history, forest structure, and differences between the sites in all habitats. The unique variation explained by forest age species was, however, significant for all habitats. The fraction of variation in species composition explained by forest age was the largest for lichens and bryophytes on trees, and for deadwood-associated bryophytes and polypore fungi. Our results suggest that practical mapping of near-natural forests for management purposes inventories should include site conditions, forest structure and between site differences in addition to forest age.

Predictors of Meat Reduction: The Case of Slovenia.

Health, environmental, and animal advocacy organisations emphasise reducing or eliminating high meat consumption due to its adverse effects on health, sustainability, climate change, and animal welfare. Increasingly, people are deciding to reduce their meat consumption frequency. Our study aimed to examine predictors of meat reduction among Slovenian consumers, focusing on gender, age, partner and children status, size of residential settlement, socioeconomic status, and political orientation. We conducted a survey using non-probability sampling. We examined demographic, socioeconomic, and political predictors of individuals' self-assessed intent to reduce meat consumption in the month following the survey. Additionally, we analysed respondents' meat reduction during the three years prior. A correlation analysis revealed that higher age and education levels were significantly positively correlated with meat reduction patterns. An ordinal logistic regression analysis indicated that age was the only significant predictor of meat reduction intentions and past behaviour. Our findings suggest that middle-aged and elderly individuals are more likely than younger adults to report meat reduction behaviours. Future public health interventions should tailor approaches to different age groups, and, in particular, target younger individuals. Educational campaigns should highlight the health and environmental benefits of reducing meat and animal product consumption, particularly in primary and secondary schools.

Sleep disorders and hyperarousal among patients with endometriosis: A case-control survey study

BackgroundEndometriosis has been associated with sleep disorders, and hyperarousal appears to be involved in their pathogenesis; however, the presence of hyperarousal in the endometriosis population was never investigated. MethodsWe conducted a case-control survey study by sending a questionnaire to all endometriosis patients followed up at our Centers. Controls were recruited among the general population. The questionnaire included demographic information, symptoms and history of endometriosis, the Hyperarousal Scale (H-Scale), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). ResultsA total of 847 women completed the questionnaires: 430 (50.8 %) had endometriosis, and 417 (49.2 %) were controls. Endometriosis was associated with higher H-scale score (OR 2.9, 95 % CI 2.4–3.8, p = 0.000), higher PSQI score (OR 4.3, 95 % CI 3.2–5.7, p = 0.000), and higher ISI score (OR 4.6, 95 % CI 3.5–6.1, p = 0.000) in multivariable ordinal logistic regressions analysis. With path analysis, hyperarousal (H-Scale) reported a partial mediating role in the association between endometriosis and sleep disorders. The mediation effect represented 22.3–27.8 % of the entire association between endometriosis and sleep disturbances. ConclusionEndometriosis patients complaining sleep disorders may benefit by investigating the presence of hyperarousal given cognitive behavioral therapy was reported effective in improving hyperarousal and associated sleep disorders.

Effect of vaccine hesitancy on female college students’ willingness to receive the HPV vaccine in China: a multicenter cross-sectional study

ObjectiveTo analyse the influencing factors of vaccine hesitancy on HPV vaccination willingness of female college students in order to promote the promotion of HPV vaccine in female college student population.MethodsFrom September-October 2022, a convenience sampling method was used to conduct a questionnaire survey among freshman female students from four higher vocational colleges in Henan Province, China. The survey comprised a general information questionnaire, as well as inquiries regarding vaccine hesitancy and willingness to receive the human papillomavirus (HPV) vaccine. In PSM analyses, vaccine-hesitant students were matched with non-vaccine-hesitant students at a 1:1 ratio; subsequently, both univariate and multivariatble logistic regression analyses were applied to assess the impact of vaccine hesitancy on female university students’ willingness to receive the HPV vaccine.ResultsThe results revealed a vaccine hesitancy rate of 44.75% among female university students, with 82.9% expressing willingness to receive the HPV vaccine. The results of the multivariable ordinal logistic regression analysis indicated vaccine hesitancy is a risk factor for HPV vaccination intentions among female university students [OR = 4.38, 95% CI (2.74, 6.99), P < 0.001]. Furthermore, the field of study (P = 0.01) and independently seeking information about the HPV vaccine (P = 0.04) were identified as factors influencing female university students’ willingness to receive the HPV vaccine.ConclusionsNon-vaccine-hesitant students were more likely to be willing to receive the HPV vaccine than vaccine-hesitant students. Healthcare providers and educators should focus on vaccine attitudes among female college students to reduce vaccine hesitancy and enhance community education on cervical cancer, HPV infection and prevention through multichannel campaigns.

The influence of implant factors on patient outcomes in primary total knee arthroplasty

BackgroundThe influence of implant factors on patient-reported outcome measures (PROMS) after total knee arthroplasty (TKA) has previously been studied but findings are often inconsistent, restricted in scope and biased by confounding factors. This study aims to determine the association between implant-related factors and early post-operative PROMs after TKA. MethodsUsing data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program, the study included 9487 primary TKA procedures performed in 43 hospitals from July 31, 2018 to December 31, 2020. Data included baseline demographic data, surgical details and PROMs collected pre- and 6 months post-operatively. Seven prosthesis characteristics were incorporated in the multivariable model, with proportional odds ordinal regression analysis used to assess their effects on post-operative Oxford knee score (OKS) and joint pain. Adjustments were made for pre-operative OKS and joint pain, as well as potential patient confounders. ResultsAt six months, fixed bearing implants showed higher odds of better OKS compared to mobile bearing implants (odds ratio [OR] = 1.20, 95 % confidence interval [CI] 1.06–1.37. p < 0.004). Similar findings were found with the use of image derived instrumentation (IDI) (OR = 1.27, 95 % CI 1.11–1.46, p < 0.001), robotic assisted vs. non-navigated knees (OR = 1.21, 95 % CI 1.06–1.38, p < 0.005) and no patella resurfacing (OR = 1.10, 95 % CI 1.01–1.20, p < 0.032). For lower pain scores at six months, the use of highly crosslinked polyethylene (OR = 1.12, 95 % CI 1.02–1.22, p < 0.015), cemented femoral components (OR = 1.11, 95 % CI 1.01–1.22, p < 0.024), IDI (OR = 1.20, 95 % CI 1.05–1.37, p < 0.009) or no patella resurfacing (OR = 1.10, 95 % CI 1.01–1.20, p < 0.034) were associated. ConclusionUtilizing a fixed bearing or robotic assistance correlated with improved OKS scores, whereas highly crosslinked polyethylene or cemented femoral components were associated with improved pain scores. At six months, the use of IDI compared to non-navigated TKA, and patellar resurfacing showed both improved OKS and pain scores.

Resident Evaluation of Reconstruction Challenges and Lessons Learned from the Great East Japan Earthquake: Recommendations for Reconstruction and Industrial Policies 12 Years after the Disaster

The year 2023 marks the 12th anniversary of the Great East Japan Earthquake (GEJE). Immediately after the disaster, the number of evacuees reached approximately 470,000, but by November 2022, the number had decreased to approximately 31,000. The reconstruction of housing, disposal of debris, public infrastructure development, and overall restoration and reconstruction has progressed steadily. However, a re-examination of the status of industrial restoration and reconstruction reveals that restoration and reconstruction have not progressed in some areas. This research statistically analyzes how the Japanese public perceives the issues around the recovery process and what memories and records they would like to learn from regarding the GEJE. The purpose of this study is to ask about reconstruction issues and lessons learned from the GEJE by conducting a web-based survey with 2000 respondents in Japan. The method of estimation is the use of ordinal logistic regression analysis to statistically estimate whether there are differences in recovery issues and lessons learned depending on individual attributes. The results suggest that those who are interested in, remember, and express anxiety about the recovery issues and lessons learned tend to be men, do not have children, are highly educated, and have a higher income. In sum, many of Japan’s citizens are highly interested in the reconstruction of agriculture, forestry, fisheries, housing, urban development, living environment, industry, and livelihood in the affected areas. In the future, they will play a central role in modernizing, scaling up, and integrating the agriculture, forestry, and fisheries industries, as well as in rebuilding towns and livelihoods. In the affected areas, it will be necessary to draw on the lessons learned from the GEJE and create reconstruction plans for the future, and then, policymakers will need to formulate reconstruction policies that reflect the concerns of the Japanese people.

Assessment of Knowledge and Practice Regarding Psychological First Aid Among Secondary School Students in Erbil City.

Secondary school students in Erbil City face various stressors and challenges that may impact their mental well-being. This study aimed to assess the knowledge and practical application of psychological first aid (PFA) among these students. This cross-sectional study was conducted from June 10th to June 25th, 2024, in six high schools in Erbil City, Iraq. Participants were selected using a purposive sampling method. Data were collected using two self-structured questionnaires, which included demographic information, a knowledge assessment, and a practical application assessment of PFA. Statistical analysis was performed using SPSS version 28 (IBM Corp., Armonk, NY). Frequency and percentage were used for categorical variables, and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess the relationships between demographic variables and PFA knowledge and practice. Spearman correlation was used to determine the relationship between knowledge and practice. A p-value of less than 0.05 was considered statistically significant. A total of 412 students were enrolled in the study. The mean scores for knowledge and practice indicated fair levels, with mean scores of 7.66 ± 1.34 for knowledge and 7.01 ± 1.38 for practice. The analysis showed that 11 students (2.7%) had poor knowledge, 161 students (39.1%) had fair knowledge, and 240 students (58.2%) had good knowledge of PFA. In terms of practice, 15 students (3.6%) exhibited poor practice, 237 students (57.6%) demonstrated fair practice, and 160 students (38.8%) showed good practice of PFA. Significant associations were found between several demographic variables and PFA knowledge and practice. Males had higher knowledge scores (estimate = 1.22, 95% CI: 0.20, 2.24, P = 0.02), as did students from families with insufficient monthly income (estimate = 0.91, 95% CI: 0.10, 1.72, P = 0.03) and those residing in urban areas (estimate = 0.83, 95% CI: 0.17, 1.50, P = 0.01). For practice, the occupation of the father was significant, with unemployed fathers associated with lower practice scores (estimate = -1.08, 95% CI: -2.06, -0.09, P = 0.03). The study showed that students had fair knowledge and practice of PFA. To improve these scores, it is recommended that nurses and educators develop targeted interventions and training programs. These should focus on enhancing students' understanding and practical skills in PFA, ensuring they are better equipped to handle psychological distress among their peers.

Exploring causes and predictors of cyberbullying in gifted and non-gifted students: Academic success, psychological variables, parental and educators’ supervision, motivation, and reactions to cyber victimization

The purpose of this study is to explore the motivation of cyberbullying behaviors, their reactions to these behaviors, and the predictors of cyberbullying sensibility in gifted and non-gifted students. The study reached 258 participants, including 102 gifted and 156 non-gifted students. This research is a descriptive survey model. The study performed descriptive statistics, independent samples t-test, ordinal logistic regression analysis, and structural equation modeling to examine the status of the variables examined according to gifted and non-gifted students. The most important reason for cyberbullying behaviors in both gifted and non-gifted students was to take revenge, and the least important reason was to adapt. The most common reaction to cyber victimization is deleting shares or files that may cause harm. Gifted and non-gifted female students have more cyberbullying sensibility. Gifted students with a high academic average have more cyberbullying sensibility. In addition, students with gifted and non-gifted internal functional regulation of emotions skills have more cyberbullying sensibility. Students with low external dysfunctional regulation of emotions scores also have more cyberbullying sensibility. The results confirmed the importance of identifying students at risk, identifying the distinguishing factors for cyberbullying behaviors of gifted and non-gifted high school students, and evaluating the sources and reactions of cyberbullying behaviors. These results will provide important input for school-based prevention studies.

Childhood trauma and treatment resistance in first-episode psychosis: Investigating the role of premorbid adjustment and duration of untreated psychosis

BackgroundEarly identification of treatment non-response in first-episode psychosis (FEP) is essential to outcome. Despite indications that exposure to childhood trauma (CT) can have adverse effects on illness severity, its impact on treatment non-response and the interplay with other pre-treatment characteristics is sparsely investigated. We use a lack of clinical recovery as an early indicator of treatment resistance to investigate the relationship between CT and treatment resistance status at one-year follow-up and the potential mediation of this effect by other pre-treatment characteristics. MethodsThis prospective one-year follow-up study involved 141 participants recruited in their first year of treatment for a schizophrenia-spectrum disorder. We investigated clinical status, childhood trauma (CT), premorbid adjustment (PA), and duration of untreated psychosis (DUP) at baseline and clinical status at one-year follow-up. Ordinal regression analyses were conducted to investigate how PA and DUP affected the relationship between CT and one-year outcome in FEP. Results45 % of the FEP sample reported moderate to severe CT, with significantly higher levels of CT in the early treatment resistant group compared to participants with full or partial early recovery. Ordinal regression analysis showed that CT was a significant predictor of being in a more severe outcome group (OR = 4.59). There was a partial mediation effect of PA and a full mediation effect of DUP on the effect of CT on outcome group membership. DiscussionOur findings indicate that reducing treatment delays may mitigate the adverse effects of CT on clinical outcomes and support the inclusion of broad trauma assessment in FEP services.

Interaction of acoustic pressure and heat release rate fluctuations in a model rocket engine combustor.

We experimentally clarify the interaction of acoustic pressure and heat release rate fluctuations during a transition to high-frequency combustion instability in a model rocket engine combustor. The dynamical state of acoustic pressure fluctuations undergoes a transition from high-dimensional chaotic oscillations to strongly correlated limit cycle oscillations. The coherent structure in the heat release rate field emerges with the initiation of weakly correlated limit cycle oscillations. The effect of the heat release rate on acoustic pressure fluctuations predominates during high-dimensional chaotic oscillations. In contrast, the effect of acoustic pressure on the heat release rate fluctuations markedly increases during the correlated limit cycle oscillations. These are reasonably shown by an ordinal pattern-based analysis involving the concepts of information theory, synchronization, and complex networks.

Association of endothelial function and lower extremity perfusion in peripheral artery disease.

Background: The current study aims to investigate the association between endothelial function and lower extremity perfusion in patients with peripheral artery disease (PAD). Patients and methods: In total 229 patients with PAD (Rutherford stage 0-3) were enrolled in the current study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) and endothelial cell proliferation capacity (ECPC). Lower extremity perfusion was assessed by measuring oscillometry-based ankle brachial index (oABI) and pulse wave index (PWI). In addition, carotid intima-media-thickness (cIMT) was also measured as a surrogate marker for atherosclerosis. Correlations between FMD, ECPC, oABI, PWI, and cIMT were analysed using Pearson correlation coefficient. The relationship between the above variables and the severity of PAD was investigated using ordinal logistic regression analysis. Results: Correlation analysis showed that FMD negatively associated with PWI (r = -0.183, p = 0.005), ECPC positively associated with oABI (r = 0.162, p = 0.014), and oABI negatively associated with PWI (r = -0.264, p < 0.001). Ordinal logistic regression analysis showed that ECPC (β = -0.009, p = 0.048), oABI (β = -5.290, p < 0.001), and age (β = -0.058, p = 0.002) negatively associated with the PAD Rutherford stages. In addition, PWI (β = 0.006, p < 0.001), cIMT (β = 18.363, p = 0.043) positively associated with the PAD Rutherford stages. Conclusions: Endothelial function significantly associates with lower extremity perfusion in patients with PAD, and both are related to the severity of PAD.

Unveiling the Role of Arab Universities in Advancing Sustainable Development Goals: A Multi-Dimensional Analysis

In the global pursuit of sustainability, higher education institutions serve as powerful actors, leveraging their multifaceted contributions to advance the implementation of the United Nations’ Sustainable Development Goals (SDGs). This study employed a multi-dimensional analysis to evaluate the prioritization of these goals within the institutional framework of Arab universities and identify the key factors that drive their involvement with these goals. The methodology used involved a quantitative approach, utilizing a survey questionnaire to collect data from faculty members representing 30 public universities across the Arab region. The results of the study regarding prioritization analysis reveal that SDG4 (Quality Education) and SDG 8 (Decent Work and Economic Growth) are top priorities across all universities, with prioritization scores exceeding 65.4. Furthermore, the results of the ordinal logistic regression analysis demonstrate that institutional governance and research productivity are significant factors that influence Arab universities’ engagement with the SDGs. The findings of this study have important implications for higher education policies, practices, and interventions, aimed at fostering university engagement with the Sustainable Development Goals.

Functional Outcome and Hemorrhage Rates After Bridging Therapy With Tenecteplase or Alteplase in Patients With Large Ischemic Core.

IV tenecteplase is an alternative to alteplase before mechanical thrombectomy (MT) in patients with large-vessel occlusion (LVO) ischemic stroke. Little data are available on its use in patients with large ischemic core. We aimed to compare the efficacy and safety of both thrombolytics in this population. We conducted a retrospective analysis of patients with anterior circulation LVO strokes and diffusion-weighed imaging Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≤5 treated with tenecteplase or alteplase before MT from the TETRIS (tenecteplase) and ETIS (alteplase) French multicenter registries. Primary outcome was reduced disability at 3 months (ordinal analysis of the modified Rankin scale [mRS]). Safety outcomes were 3-month mortality, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage (sICH). We used propensity score overlap weighting to reduce baseline differences between treatment groups. We analyzed 647 patients (tenecteplase: n = 194; alteplase: n = 453; inclusion period 2015-2022). Median (interquartile range) age was 71 (57-81) years, with NIH Stroke Scale score 19 (16-22), DWI-ASPECTS 4 (3-5), and last seen well-to-IV thrombolysis and puncture times 165 minutes (130-226) and 260 minutes (203-349), respectively. After MT, the successful reperfusion rate was 83.1%. After propensity score overlap weighting, all baseline variables were well balanced between both treatment groups. Compared with patients treated with alteplase, patients treated with tenecteplase had better 3-month mRS (common odds ratio [OR] for reduced disability: 1.37, 1.01-1.87, p = 0.046) and lower 3-month mortality (OR 0.52, 0.33-0.81, p < 0.01). There were no significant differences between thrombolytics for PH (OR 0.84, 0.55-1.30, p = 0.44) and sICH incidence (OR 0.70, 0.42-1.18, p = 0.18). Our data are encouraging regarding the efficacy and reassuring regarding the safety of tenecteplase compared with that of alteplase in bridging therapy for patients with LVO strokes and a large ischemic core in routine clinical care. These results support its consideration as an alternative to alteplase in bridging therapy for patients with large ischemic cores. NCT03776877 (ETIS registry) and NCT05534360 (TETRIS registry). This study provides Class III evidence that patients with anterior circulation LVO stroke and DWI-ASPECTS ≤5 treated with tenecteplase vs alteplase before MT experienced better functional outcomes and lower mortality at 3 months.

Effects of an elimination diet and a healthy diet in children with Attention‐Deficit/Hyperactivity Disorder: 1‐Year prospective follow‐up of a two‐arm randomized, controlled study (TRACE study)

AbstractBackgroundAn Elimination Diet (ED) or Healthy Diet (HD) may be effective in reducing symptoms of Attention‐Deficit/Hyperactivity Disorder (ADHD), but long‐term maintenance effects and feasibility have never been examined.MethodsOne‐year prospective follow‐up of a sample of 165 children (5–12 years) with ADHD randomized (unblinded; 1:1) to 5 weeks treatment with either ED (N = 84) or HD (N = 81) and a non‐randomized comparator arm including 58 children being treated with Care as Usual (CAU). Dietary participants were allowed to add or switch to CAU treatment after 5 weeks. The primary outcome was a 5‐point ordinal measure of improvement based on both parent and teacher ratings on ADHD and dysregulation problems, determined after 1 year prospective follow‐up. Ordinal regression analyses and linear mixed models analyses were conducted on an intention to treat basis. In addition, as‐treated analyses were performed. The trial is closed and registered in the Dutch trial registry, number NL5324.ResultsAt 1 year follow‐up, 24% of the participants still complied with the ED and 37% still complied with the HD. In the ED (+CAU) trajectory, fewer participants showed (partial) improvement after 1‐year prospective follow‐up compared to the HD (+CAU) trajectory (47% vs. 64%, χ2 (4, N = 152) = 11.97, p = 0.018). The HD (+CAU) ‐ but not ED (+CAU) ‐ trajectory had comparable 1‐year outcomes compared to the non‐randomized CAU‐trajectory. Results for secondary outcomes (e.g. health, parental stress) did not differ between the ED (+CAU) and HD (+CAU) trajectories. The prevalence of psychostimulant use was lower in the ED (+CAU) and HD (+CAU) trajectories compared to the non‐randomized CAU‐trajectory (38%, 45%, 78%, respectively). Predictors for long‐term benefit from dietary treatments included high initial severity of ADHD problems, low severity of emotional problems and sufficient parental mental resources.ConclusionsIn line with the short‐term effects, prospective 1‐year follow‐up outcomes are in favor of treatment with HD and not ED. Initial 5‐week treatment with HD and if needed/preferred followed by CAU may reduce psychostimulant use without negatively impacting 1‐year outcomes.

Clinical applications of telemedicine services using a regional telemedicine platform for cancer treatment: a cross-sectional study

BackgroundTelemedicine is beneficial for improving treatment efficiency and reducing medical expenses of cancer patients. This study focuses on cancer patients participating in teleconsultations through a regional telemedicine platform in China, analyzes the consultation process, and provides references for the clinical application of telemedicine.MethodsWe collected information on teleconsultations of cancer patients conducted from 2015 to 2022 through the regional telemedicine platform. Utilizing SPSS 23.0 software, we conducted descriptive analysis to summarize the distribution of patient gender, age, region, and disease types. The ordinal logistic regression analysis was adopted to analyze the factors influencing the waiting time and consultation duration for teleconsultations.ResultsFrom 2015 to 2022, a total of 23,060 teleconsultations were conducted for cancer patients via regional telemedicine platform, with an average growth rate of 11.09%. The main types of consultations were for lung cancer, liver cancer, and breast cancer, accounting for 18.14%, 10.49%, and 9.46% respectively. 57.05% of teleconsultations had a waiting time of less than 24 h, while patient age, consultation expert level, and disease type were the main factors influencing the waiting time. 50.06% of teleconsultations had a duration of more than 20 min, and the inviting hospital level and the title of invited consultant were the main factors influencing the consultation duration.ConclusionsIn China, telemedicine has been widely employed in the clinical diagnosis and treatment of cancers, covering various types of oncological diseases. However, the waiting time for teleconsultations was generally more than 12 h, indicating the need to enhance consultation scheduling and allocate more expert resources to further optimize the efficiency of teleconsultations. Additionally, further exploration is required for remote health management of outpatients with cancers outside the hospital.

Assessing healthcare workers’ confidence level in diagnosing and managing emerging infectious virus of human mpox in hospitals in Amhara Region, Northwest Ethiopia: multicentre institution-based cross-sectional study

ObjectiveTo assess healthcare workers’ (HCWs) confidence level in diagnosing and managing mpox disease and its associated factors in hospitals in the Amhara Region.DesignInstitution-based cross-sectional study.SettingHospitals in the Amhara Region, Northwest...