Category: Statistics

Nurs Crit Care. 2026 Sep;31(5):e70611. doi: 10.1111/nicc.70611.

ABSTRACT

BACKGROUND: Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial.

AIM: To compare the benefits and risks of intensive versus liberal glucose control in ICU patients.

STUDY DESIGN: A Meta analysis of randomized controlled trials.

METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome.

RESULTS: Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion.

CONCLUSIONS: Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia.

RELEVANCE TO CLINICAL PRACTICE: These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.

PMID:42529895 | DOI:10.1111/nicc.70611

Pers Soc Psychol Bull. 2026 Jul 30:1461672261468870. doi: 10.1177/01461672261468870. Online ahead of print.

ABSTRACT

It is unclear whether Healthy Neuroticism is beneficial for health, potentially due to mismatches between how Healthy Neuroticism is often conceptualized and operationalized. The present study uses data from 212 to 672 Dutch adults (54.17% female, mean age = 62.46) to examine how 3 operationalizations of Healthy Neuroticism (at the domain, facet, and characteristic adaptation levels) are associated with preventive disease screenings. Using a series of hurdle models, we found that individuals who were higher on Neuroticism domain, facets (Anxiety, Depression), and characteristic adaptations (Disease Concern) were more likely to engage in preventive disease screenings. However, Healthy Neuroticism (operationalized as interactions between domain, facet, and characteristic adaptations with Conscientiousness) was largely not associated with the likelihood or count of disease screenings, though these results should be interpreted with caution until further replication due to limits on statistical power. We discuss the theoretical implications for the Healthy Neuroticism literature and practical implications for improving health.

PMID:42529892 | DOI:10.1177/01461672261468870

Disaster Med Public Health Prep. 2026 Jul 30;20:e138. doi: 10.1017/dmp.2026.10414.

ABSTRACT

OBJECTIVES: Children are disproportionately affected by disasters and represent a vulnerable population in such settings. However, no internationally recognized core competencies exist to guide health care providers in caring for children impacted by disasters (particularly non-pediatricians). This study aimed to establish consensus-based core competencies for pediatric disaster response through international expert agreement across disciplines.

METHODS: A three-round modified Delphi study was conducted following CREDES criteria, using competency statements generated via a comprehensive scoping review of pediatric disaster literature. International disaster medicine experts rated competency statements on a 7-point linear scale (1 = disagree, 7 = agree). Consensus was defined a priori as standard deviation (SD) ≤ 1.0. Data were collected and analyzed using the STAT59 online platform.

RESULTS: 57 competencies met consensus criteria across three Delphi rounds, with mean scores ranging from 5.4 to 6.6. The highest-ranked competencies (mean = 6.6) were pediatric vulnerabilities recognition, pediatric transport management, child identification and tracking, and child-parent reunification. Decontamination initiation was also highly ranked (mean = 6.5).

CONCLUSIONS: The 57 consensus-based core competencies for pediatric disaster medicine response, spanning 16 practice domains, provide a foundation to further develop standardized curricula, guide preparedness and response efforts, and define minimum training expectations for health care providers caring for children impacted by disasters.

PMID:42529878 | DOI:10.1017/dmp.2026.10414

Prim Health Care Res Dev. 2026 Jul 30;27:e81. doi: 10.1017/S146342362610142X.

ABSTRACT

BACKGROUND: Out-of-hours primary care (OOH-PC) has been introduced in many health systems to reduce non-urgent emergency department (ED) use. While prior studies suggest potential efficiency gains, economic evaluations rarely stratify outcomes by patient risk, limiting policy relevance. This study assesses the cost-effectiveness of diverting low-risk patients from ED to OOH-PC.

AIM: Compare direct medical costs, time spent at the facility, and hospitalization probability across risk and care setting subgroups from a societal perspective.

METHODS: We analysed data from a cluster-randomized trial conducted in Belgium that examined a nurse-led triage system. Under the study trial’s extended Manchester Triage System (eMTS) protocol, patients eligible for primary care were assigned to OOH-PC and are referred to in our study as low-risk, while those assigned to the ED are defined as high-risk. To complement previous work, we stratified costs and effects by risk group. Mixed-effects regression models estimated costs, time at the facility, and hospitalization, with bootstrap confidence intervals. We also calculated the incremental net monetary benefit (INMB).

RESULTS: Treating low-risk patients at the OOH-PC instead of at the ED reduced costs by €24 (€14-€39) per patient, shortened the time spent at the facility by 69 (52-94) minutes. From a societal perspective, the average INMB was €49.5 per low-risk patient. Aggregately, we estimated that the 37 intervention weekends in 2019 led to an average saving of €14,136 in direct medical costs and cumulative time savings of 28 days.

CONCLUSION: Diverting low-risk patients from the ED to OOH-PC resulted in cost- and time-savings for low-risk patients at the study site. These findings highlight the potential to improve out-of-hours healthcare delivery to maximize benefits for patients and healthcare systems, although confirmation in other healthcare settings is required before wider implementation.

PMID:42529876 | DOI:10.1017/S146342362610142X

Br J Math Stat Psychol. 2026 Jul 30. doi: 10.1111/bmsp.70065. Online ahead of print.

ABSTRACT

Bayesian statistics has gained popularity in psychological research due to its intuitive uncertainty quantification and convenient information-updating rules. In many applications, however, prior distributions are introduced merely as instruments to facilitate computation, rather than as representations of genuine subjective belief. Consequently, relying on standard Bayesian justifications for inferential procedures becomes conceptually ungrounded. In this paper, we recommend evaluating finite-sample performance over repeated sampling of data and parameters as an alternative justification for “pragmatic Bayes.” We demonstrate a key vulnerability in the usual posterior-based inference: when analysts’ chosen prior distribution mismatches the true parameter-generating process, Bayesian inference can be misleading in the long run. Given that this true process is rarely known in practice, we propose a safer alternative: calibrating Bayesian credible regions to achieve frequentist validity. This latter criterion is stronger and guarantees validity of Bayesian inference regardless of the underlying parameter-generating mechanism. To solve the calibration problem in practice, we propose a novel stochastic approximation algorithm. Monte Carlo experiments are conducted and reported, in which we observe that uncalibrated Bayesian inference can be liberal under certain parameter-generating scenarios, whereas our calibrated solution consistently maintain validity. We also illustrate the proposed calibration procedure using a real-data example involving location-scale regression.

PMID:42529865 | DOI:10.1111/bmsp.70065

CNS Neurosci Ther. 2026 Aug;32(8):e71066. doi: 10.1002/cns.71066.

ABSTRACT

BACKGROUND: Insomnia disorder (ID) is characterized by hyperarousal, yet the relationship between cortical excitability and large-scale network dynamics remains incompletely understood. While fMRI studies indicate network alterations in ID, high-temporal-resolution characterization of these dynamics across the sleep-wake cycle is lacking.

METHODS: Twenty-six patients with ID and 29 healthy controls underwent eyes-closed resting-state OPM-MEG recordings during evening (pre-sleep) and morning (post-awakening) sessions. We analyzed the aperiodic spectral exponent to index cortical excitability and employed microstate analysis to quantify fast network dynamics. A mediation analysis was conducted to explore the associations between electrophysiological features and sleep quality.

RESULTS: Compared to controls, patients with ID exhibited a significantly flatter aperiodic power spectrum in the evening, suggesting elevated cortical excitability. Microstate analysis revealed distinct spatiotemporal alterations: (1) an evening-specific increase in the coverage of a putative temporal-limbic microstate, and (2) a sustained elevation of a putative sensorimotor microstate observed in both evening and morning sessions. Mediation analysis indicated that the altered evening limbic microstate dynamics statistically mediated the association between the aperiodic exponent and subjective sleep disturbance measures.

CONCLUSIONS: These findings indicate that ID involves concurrent disruptions in aperiodic neural activity and microstate temporal organization. The study highlights distinct diurnal profiles for putative sensorimotor and limbic network alterations, suggesting that OPM-MEG can effectively capture the multifaceted electrophysiological signatures of the insomnia phenotype.

PMID:42529863 | DOI:10.1002/cns.71066

Knee Surg Sports Traumatol Arthrosc. 2026 Jul 30. doi: 10.1002/ksa.70553. Online ahead of print.

ABSTRACT

PURPOSE: Robotic-assisted total knee arthroplasty (TKA) is increasingly adopted worldwide, yet comparative data on the rotational accuracy of image-based and imageless platforms remain limited. The aim of this study was to compare the accuracy of image-based and imageless robotic platforms in achieving planned femoral rotation in primary TKA. We hypothesized that the two platforms would be equivalent, with any difference within ±1°.

METHODS: This single-surgeon retrospective cohort study included patients undergoing image-based and imageless robotic-assisted TKA for primary osteoarthritis. All patients underwent pre- and postoperative computed tomography (CT) scans. Native femoral rotation was defined using the transepicondylar axis (TEA)-posterior condylar axis (PCA) angle. Femoral rotation was planned intraoperatively relative to the PCA, and postoperative TEA-PCA was measured on CT. Accuracy was defined as the absolute difference between achieved and intended rotation. Measurements were independently performed by two blinded fellowship-trained knee surgeons. Statistical analysis included two one-sided tests (TOST) equivalence testing and analysis of covariance (ANCOVA). Significance was set at p < 0.05.

RESULTS: A total of 150 TKAs were included (imageless 79, image-based 71). Patients in the image-based group were younger (67.7 vs. 71.3 years, p = 0.007), with no other baseline differences. The mean rotational error was 1.3 ± 1.0° for imageless and 1.2 ± 1.2° for image-based TKA (p = 0.346; effect size -0.09). Equivalence testing confirmed statistical equivalence, with the 90% confidence interval (-0.23 to 0.31) lying within the predefined ±1° margin (p < 0.01). ANCOVA demonstrated a small adjusted difference of 0.51° (p = 0.045), with minimal explained variance (adjusted R² = 0.01). Intra-observer reliability was excellent (intraclass correlation coefficient [ICC] 0.91), while inter-observer reliability was good (ICC 0.82). No differences were observed in patient-reported outcomes, except lower pain scores in the image-based group at 12 months.

CONCLUSION: Image-based and imageless robotic platforms demonstrated equivalent accuracy in achieving planned femoral rotation in primary TKA. Any observed differences were not clinically meaningful.

LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.

PMID:42529843 | DOI:10.1002/ksa.70553

Nurs Crit Care. 2026 Sep;31(5):e70591. doi: 10.1111/nicc.70591.

ABSTRACT

BACKGROUND: Family Presence During Resuscitation (FPDR) is a key component of family-centred care in paediatric settings, supported by international guidelines. However, limited evidence exists regarding how nurses’ perceptions of FPDR relate to self-confidence during paediatric resuscitation.

AIM: This study investigated the relationship between FPDR perceptions and self-confidence levels among paediatric nurses in critical care units.

STUDY DESIGN: A descriptive, cross-sectional study was conducted between April 10 and June 20, 2025, with nurses working in paediatric critical care units of a tertiary city hospital. Data were collected through face-to-face survey administration using a Personal Information Form and the Family Presence Risk-Benefit Scale, and analysed using descriptive statistics, correlation analyses, and multiple linear regression.

RESULTS: A total of 194 eligible nurses were approached, of whom 138 completed the survey, yielding a response rate of 71.1%. The majority of nurses opposed FPDR, citing concerns related to team communication, increased stress, interruption of medical interventions and risk of violence. Mean total self-confidence and risk perception scores were 47.24 ± 18.06 and 32.75 ± 10.37, respectively. Age, professional experience and certificate status did not significantly predict risk perception or self-confidence. Postgraduate education significantly increased risk perception, while working in paediatric haematology units significantly decreased self-confidence levels. A weak but statistically significant positive correlation was found between risk perception and self-confidence (r_s = 0.25, 95% CI [0.09, 0.40], p = 0.013).

CONCLUSION: The findings indicate that paediatric nurses’ perceptions of family presence during resuscitation are influenced more by clinical and organisational context than by individual experience or certification. These results highlight the need for clear institutional policies and structured paediatric-specific training to support the safe implementation of family-centred resuscitation practices.

RELEVANCE TO CLINICAL PRACTICE: The findings may inform the development of context-sensitive institutional policies and structured educational programs to support safer implementation of family-centred resuscitation practices.

PMID:42529835 | DOI:10.1111/nicc.70591

JMIR Form Res. 2026 Jul 29;10:e71746. doi: 10.2196/71746.

ABSTRACT

BACKGROUND: People with dementia and their caregivers experience significant psychological distress, which may increase their vulnerability to trauma across the dementia diagnostic and caregiving trajectory. Specialist dementia helplines offer immediate emotional support, information, and signposting; however, little empirical evidence exists about how call handlers account for potential trauma in their responses.

OBJECTIVE: This study aimed to examine the extent to which call handlers’ responses on the United Kingdom’s only 24-hour dementia helpline reflected trauma-informed (TI) principles of safety, trust, choice, collaboration, and empowerment and to describe caller characteristics and reasons for contact during the COVID-19 pandemic.

METHODS: No participants were actively recruited. Instead, the study analyzed 198 anonymized, routinely collected helpline call logs (out of 200 randomly selected) drawn from 7357 calls received by Alzheimer Scotland’s 24-hour helpline between April 2020 and April 2021. A retrospective deductive framework analysis mapped narrative summaries to 5 TI principles (safety, trustworthiness and transparency, choice, collaboration, and empowerment). Double‑coding and calibration were undertaken in line with established guidance on intercoder reliability for qualitative research. Descriptive statistics summarized caller characteristics and theme frequencies; no inferential testing was conducted due to the exploratory nature of the analysis, sample properties, and the subjective nature of theme ratings.

RESULTS: Most calls were made during daytime hours (159/198, 79.5%) and were made by carers, family members, or friends (n=179, 89.5%). Emotional support was the most frequently recorded reason for contact (91 instances), followed by carer stress (66 instances) and information on caring (51 instances). Across call handlers’ responses, collaboration (126/179, 70.4%) and empowerment (108/179, 60.3%) were the most frequently observed TI principles, followed by safety (105/179, 58.7%), choice (66/179, 37.4%), and trust (56/179, 31.3%). Safety-focused responses were more prevalent in nighttime calls than daytime calls (76.9% vs 56%). Illustrative call log excerpts demonstrated empathetic listening, validation, shared problem-solving, and signposting practices aligned with TI principles.

CONCLUSIONS: In this exploratory retrospective evaluation, responses from a national dementia helpline commonly reflected TI principles, despite call handlers receiving primarily awareness-level TI content within their wider role preparation. Findings should be interpreted as descriptive and hypothesis-generating because they are based on call log summaries rather than recorded interactions and were obtained within the unique context of the COVID-19 pandemic. The results suggest that TI principles may be feasible and relevant in dementia helpline services and highlight the potential value of more structured approaches to TI workforce development. Future prospective research incorporating richer data sources such as recorded calls and call-reported outcomes is warranted to support service development and evaluation.

PMID:42529812 | DOI:10.2196/71746

Malays J Med Sci. 2025 Dec;32(6):131-142. doi: 10.21315/mjms-05-2025-349. Epub 2025 Dec 31.

ABSTRACT

BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysm is rare. Endovascular treatment does not provide a decompressive effect, and the complex morphological features of PICA aneurysm make treatment approaches challenging. The objective of this study was to formulate a decision-making guide for PICA aneurysm according to location, based on an illustrative case and a review of the literature.

METHODS: From January 2022 until April 2023, a total of 157 aneurysm cases were treated using surgical and endovascular intervention. Fourteen patients were confirmed to have PICA aneurysm based on cerebral DSA/CTA. Demographic data, clinical characteristics, radiological findings, treatment plans, and outcomes were analysed. Outcomes were assessed using the modified Rankin Scale (mRS), with scores of zero to three considered good. Statistical analyses included Fisher’s exact test, Chi-square test, and McNemar test, where appropriate.

RESULTS: Of the total aneurysm cases, 8.9% were ruptured PICA aneurysms. Seven cases were located at the proximal PICA (P1 = 4 cases, P2 = 3), two cases at the mid PICA (P3), and five cases at the distal PICA (P4, P5). Out of 14 PICA aneurysms cases, nine were saccular, four were fusiform, and one was a dissecting aneurysm. Three patients underwent endovascular intervention (two saccular and one dissecting), while 11 underwent surgery (1 PICA-PICA in situ bypass with vertebral artery ligation, and 10 craniotomies with aneurysm clipping, with or without aneurysm reconstruction). Seven of 14 patients initially presented with good mRS scores, and at discharge, 10 patients had good scores. At discharge, two of three patients who had endovascular intervention had good mRS scores, and eight of 11 patients who went for surgery achieved good outcomes. Comparative analyses revealed no statistically significant associations between intervention type, aneurysm complexity, or location and outcome (P > 0.05). The McNemar test showed no significant difference between pre- and postoperative mRS scores (P = 0.25). However, a clinical trend toward improvement was observed, with the proportion of patients achieving good functional outcomes increasing from 50% before surgery to 71.4% at discharge.

CONCLUSION: Favourable outcomes could be achieved when PICA aneurysm is treated with appropriate surgical strategies by experienced surgeons. Neurovascular surgeon must acquire knowledge of different surgical approaches and the technical skills required to perform these procedures.

PMID:42529789 | PMC:PMC13419060 | DOI:10.21315/mjms-05-2025-349