Category: Statistics

Oral Dis. 2026 Apr 14. doi: 10.1111/odi.70315. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the effectiveness of a formulated 5% thyme mouthwash with 0.2% aqueous chlorhexidine solution for improving oral health in ventilator-dependent intensive care unit (ICU) patients.

METHODS: This prospective, triple-blinded, randomized controlled trial (RCT) allocated 46 mechanically ventilated patients to the thyme (n = 23) or 0.2% aqueous chlorhexidine solution (n = 23) groups. Oral health indices, including the Oral Health Assessment Tool (OHAT), were evaluated at baseline and re-evaluated 5 days (Day 5) after the intervention commenced.

RESULTS: Baseline characteristics were comparable. Both mouthwashes significantly improved oral health indicators from baseline (p < 0.001). However, on Day 5, the thyme group showed a statistically greater improvement in key OHAT components compared to the 0.2% aqueous chlorhexidine solution group (e.g., Oral Hygiene score, p = 0.004). Importantly, no adverse reactions or tolerability issues were reported in either group.

CONCLUSION: The 5% thyme mouthwash demonstrated comparable effectiveness to the 0.2% aqueous chlorhexidine solution by Day 5. This positions the thyme-based mouthwash as a viable, well-tolerated alternative to conventional 0.2% aqueous chlorhexidine solution for oral care in invasively ventilated ICU patients.

PMID:41981720 | DOI:10.1111/odi.70315

J Magn Reson Imaging. 2026 Apr 14. doi: 10.1002/jmri.70338. Online ahead of print.

ABSTRACT

BACKGROUND: Slab-selective radiofrequency (RF) pulses are commonly required in three-dimensional (3D) turbo spin echo (TSE) in brachial plexus magnetic resonance neurography (MRN). However, their long selective RF pulses lead to violation of Carr-Purcell-Meiboom-Gill conditions, which might increase imaging artifacts.

HYPOTHESIS: That VERSE STIR-TSE would yield comparable motion artifact to conventional STIR-TSE with superior nerve conspicuity and greater subjective appeal.

STUDY TYPE: Prospective, cross-sectional study.

POPULATION: Twenty-four subjects (16 females; mean age: 43.7 years; range: 19-76 years) evaluated for clinical suspicion of brachial plexopathy, undergoing brachial plexus MRI (10 left, 9 right, 5 bilateral, 29 total scans analyzed). Agar phantoms mimicking nerve and muscle were also evaluated.

FIELD STRENGTH/SEQUENCE: 3-Tesla, 3D STIR-TSE with and without VERSE.

ASSESSMENT: Three radiologists, blinded to the sequence type and clinical data, qualitatively evaluated nerve conspicuity, motion, and preferred sequence on a 5-point scale.

STATISTICAL TESTS: Wilcoxon signed-rank tests compared nerve conspicuity (0-4 scale), motion artifact (0-4 scale), and preferred series between the non-VERSE and VERSE pulse sequences. Gwet’s AC2 assessed inter-rater agreement. A p-value < 0.05 was considered statistically significant.

RESULTS: The VERSE STIR-TSE sequence was significantly preferred by all raters. Motion artifact was not significantly different between the sequences (p = 0.11). Conspicuity of the suprascapular nerve was significantly greater with VERSE for both its proximal segments (median: 3, interquartile range: (2, 4), vs. 3 (1, 4)) and distal segments (4 (2, 4) vs. 3 (2, 4)), but conspicuity of the axillary nerve was not significantly different between the sequences (p = 0.27-0.61). Phantom scans confirmed a 74% and 49% increase in signal with VERSE in the muscle and nerve-mimicking phantoms, respectively.

DATA CONCLUSION: STIR-TSE with VERSE provided overall superior image quality for brachial plexus MRN as compared to conventional STIR-TSE.

EVIDENCE LEVEL: 2.

TECHNICAL LEVEL: 1.

PMID:41981719 | DOI:10.1002/jmri.70338

Alzheimers Dement. 2026 Apr;22(4):e71387. doi: 10.1002/alz.71387.

ABSTRACT

INTRODUCTION: We investigated the association between traumatic brain injury (TBI) and incidence of early-onset dementia (EOD) versus late-onset dementia (LOD).

METHODS: We included 501,710 UK Biobank participants (average age 56.5). Over a median 13.6 years of follow-up, 836 developed EOD (before 65) and 8947 developed LOD (after 65). We estimated hazard ratios (HRs) for TBI’s association with EOD and LOD using Cox proportional hazard models with TBI as a time-varying exposure and coefficient.

RESULTS: TBI was associated with higher risk of both EOD (HR: 4.06 [95% confidence interval: 3.13, 5.26]) and LOD (HR: 2.51 [2.31, 2.72]. Among participants included in both EOD and LOD analyses, the effect estimate was higher for EOD (3.41 vs. 2.80), but the difference was not statistically significant. The association of TBI with EOD was stronger in those with more severe TBIs.

DISCUSSION: TBI is associated with an increased risk of EOD, with a higher risk observed in more severe injuries.

HIGHLIGHTS: Traumatic brain injury (TBI) is a significant risk factor for early-onset dementia (EOD). TBI was analyzed as a time-varying exposure and time-varying coefficient. Moderate/severe/penetrating TBIs have a heightened risk of developing EOD. TBI is more strongly associated with an earlier age cut-off for dementia.

PMID:41981712 | DOI:10.1002/alz.71387

Inj Epidemiol. 2026 Apr 14. doi: 10.1186/s40621-026-00673-6. Online ahead of print.

ABSTRACT

BACKGROUND: Pickleball has grown rapidly in popularity in recent years, accompanied by an increasing number of reported injuries among players. Our aim is to determine the epidemiology of pickleball-related injuries at a single academic center and evaluate patient-specific factors such as incidence and type of injury, mechanisms of injury, and treatment outcomes.

METHODS: This is a cross-sectional study at a tertiary academic outpatient orthopedic and physical medicine and rehabilitation clinic. We reviewed 164 cases of patients presenting with pickleball-related injuries from 2019 to 2023 involving the shoulder (n = 23), elbow (n = 8), wrist/hand (n = 30), hip/thigh (n = 9), knee (n = 52), foot/ankle (n = 32), and spine (n = 10). Independent variables included age, gender, and hand dominance. Outcome measures included injury type, laterality, treatment modality, and follow-up duration. Demographic and epidemiologic data were analyzed, and comparisons between injury characteristics were performed using appropriate statistical tests (Fisher’s exact tests and Kruskal-Wallis tests).

RESULTS: The most common pickleball-related injuries included lateral epicondylitis at the elbow (75%), rotator cuff tears at the shoulder (70%), distal radius fractures after a fall at the hand/wrist (60%), Achilles tendon tears at the foot/ankle (50%), radicular pain and spinal stenosis at the spine (50% each), medial meniscus tears at the knee (48%), and hamstring strain or rupture and iliopsoas tendinitis at the hip/thigh (33% each).Rates of injury were similar between male and female players except in the hand/wrist, which was higher among female players (77%). Non-paddle side injuries in the upper extremity occur disproportionally higher in the hand/wrist (52%) when compared to the shoulder (7%) or elbow (17%) (p < 0.01). There was no significant difference in laterality for lower extremity and spine injuries.

CONCLUSIONS: As pickleball has become the fastest growing sport in America, the incidence of pickleball-related injuries has risen dramatically. Characterizing the wide spectrum of musculoskeletal injuries unique to pickleball may inform athletes on injury prevention considerations and allows for targeting modifiable risk factors.

PMID:41981700 | DOI:10.1186/s40621-026-00673-6

Clin Transl Sci. 2026 Apr;19(4):e70541. doi: 10.1111/cts.70541.

ABSTRACT

Fluoroquinolones (FQs) are among the most frequently prescribed antibiotic classes worldwide. Despite their therapeutic versatility in treating bacterial infections, regulatory authorities recognized risks of persistent and potentially irreversible adverse effects, particularly peripheral neuropathy (PN). However, a comprehensive pharmacovigilance assessment of PN-related adverse events (AEs) across all six FDA-approved FQs remains limited. We therefore analyzed adverse event reports (AERs) associated with these six agents from the FDA Adverse Event Reporting System (FAERS) Public Dashboard spanning 2007-2024 Q3, following READUS-PV guidelines. Disproportionality analysis was conducted to identify potential safety signals for PN-related AEs reported with FQ use following deduplication and exclusion of cases involving non-FQ concomitant medications. Positive disproportionality signals were observed for the commonly prescribed FQs (ciprofloxacin, levofloxacin, moxifloxacin, and ofloxacin), with seven distinct PN manifestations generating signals. Notably, we detected PN-related signals for gemifloxacin, a relatively new FQ with limited prior evaluation of neurotoxicity. Univariate logistic regression revealed that women and adults aged 18-64 years were more frequently represented in FQ-associated PN-related AERs, whereas men and patients aged ≥ 65 years were disproportionately represented among cases with fatal outcomes. Combination therapy with multiple FQs generated disproportionality signals exceeding those with FQ monotherapy. These findings underscore the need for increased vigilance when prescribing FQs, particularly for mild infections where risks may outweigh benefits. Strengthened clinical monitoring for early signs of PN is advisable when FQ treatment becomes unavoidable. Further controlled epidemiological studies are needed to validate these signals and define at-risk groups, alongside mechanistic research aimed at supporting the development of neuroprotective strategies.

PMID:41981685 | DOI:10.1111/cts.70541

BMC Psychol. 2026 Apr 14. doi: 10.1186/s40359-026-04510-9. Online ahead of print.

ABSTRACT

BACKGROUND: Willpower and self-regulation are central developmental capacities associated with children’s academic success, psychosocial adjustment, and long-term well-being. Although these constructs have been widely studied in preschoolers and adults, limited research has explored how school-aged children themselves perceive and experience willpower in their everyday lives. This study aimed to explore school-aged children’s lived experiences of willpower and self-regulation, focusing on their emotional processes, strategies, role models, and metaphorical meanings.

METHODS: A qualitative phenomenological design was employed. The study was conducted with 21 children aged 6-12 years attending a public primary and secondary school in the Anatolia region of Türkiye. Participants were selected using purposeful criterion sampling. Data were collected between September and October 2025 through three focus group interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi’s seven-step phenomenological analysis method. Sociodemographic data were analyzed using descriptive statistics. Trustworthiness was ensured following Lincoln and Guba’s criteria.

RESULTS: Four main themes emerged: (1) Being caught between desire and responsibility, (2) Persisting despite difficulty and associated emotions, (3) Perceptions of strong willpower and role models, and (4) Self-regulation strategies. Children described willpower as navigating internal conflicts between immediate desires (e.g., play, screen time) and responsibilities (e.g., studying, helping at home). Emotional experiences were central; persistence was initially accompanied by hesitation or discomfort but ultimately reinforced by pride and satisfaction. Children identified parents and teachers as key role models, emphasizing patience, planning, and consistency as indicators of strong willpower. They reported diverse self-regulation strategies, including planning, time management, goal setting, cognitive redirection, pairing tasks with enjoyable activities, and breaking tasks into smaller parts. Metaphorically, willpower was described as a “shield” or a “robot,” symbolizing protection, strength, and control.

CONCLUSIONS: School-aged children experience willpower and self-regulation as dynamic, emotionally charged, and socially shaped processes enacted through context-sensitive strategies. Understanding children’s subjective meanings may inform educational and pediatric nursing practices aimed at fostering flexible and developmentally appropriate self-regulatory capacities.

PMID:41981682 | DOI:10.1186/s40359-026-04510-9

Implement Sci Commun. 2026 Apr 14. doi: 10.1186/s43058-026-00941-y. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding how implementation strategies work is vitally important for the deployment of evidence-based practices (EPBs) in healthcare settings. Specifically, mechanistic inquiry provides information on specific targets (e.g., buy-in, saliency) that must be engaged for a strategy to be successful. We used mixed-methods to investigate mechanisms of facilitation as part of a trial to implement S.A.F.E. Firearm, a brief evidence-based practice which includes firearm storage counseling and offering free cable locks in pediatric primary care during well-child visits.

METHODS: We used a mixed-methods approach to ascertain mechanisms. Quantitative analyses determined whether clinic-level adaptive reserve (e.g., mechanism) mediated the impact of facilitation (e.g., strategy) on reach (e.g., primary outcome). Adaptive reserve, evaluated via clinician survey, refers to a clinic’s ability to broadly make and sustain change and includes multiple components (i.e., relationship infrastructure, facilitative leadership, sensemaking, teamwork, work environment, and culture of learning). Importantly, adaptive reserve is not the specific capacity to implement a given EBP. Second, qualitative interviews guided by the updated Consolidated Framework for Implementation Research, and analyzed using deductive and inductive approaches, were conducted with pediatric clinicians, clinic change agents, and health system leaders to ascertain other mechanisms. Mixed methods integration occurred at completion of both activities.

RESULTS: Quantitative analyses indicated that adaptive reserve did not mediate the effect of facilitation on reach. Qualitative findings illustrated other potential mechanisms of facilitation including: increasing buy-in and saliency to help overcome initial inertia and to support application of training principles in practice; strong collaborative relationships between facilitators and clinics to improve accountability; in-person visits or electronic communications that serve as reminders; reinforcing the why and how of the intervention (sensemaking); and fostering team collaboration to troubleshoot logistical barriers.

DISCUSSION: While prior studies have found that adaptive reserve was related to facilitation, our mediation analysis did not support this hypothesis. Contextual factors may offer potential explanations, particularly a lower-intensity facilitation in this context commensurate with a smaller practice change (e.g., a brief program intended to take < 1 min), but further study is needed. Our qualitative results offer a potentially new mechanistic model of facilitation to be investigated in future studies.

PMID:41981665 | DOI:10.1186/s43058-026-00941-y

BMC Nutr. 2026 Apr 14. doi: 10.1186/s40795-026-01322-3. Online ahead of print.

NO ABSTRACT

PMID:41981659 | DOI:10.1186/s40795-026-01322-3

Syst Rev. 2026 Apr 14. doi: 10.1186/s13643-026-03175-0. Online ahead of print.

ABSTRACT

BACKGROUND: Cancers of the oesophagus, gastroesophageal junction (GEJ), and proximal stomach share epidemiological, molecular, and therapeutic characteristics. Despite their similarities, treatment guidelines vary, and the classification of GEJ tumours remains debated. While multiple meta-analyses have addressed subsets of these malignancies, a comprehensive synthesis comparing all treatment modalities across this disease spectrum is lacking. This study aims to perform a systematic review and network meta-analysis (NMA) to compare the overall survival outcomes of different treatment modalities, including surgery, chemotherapy, chemoradiotherapy, immunotherapy, and multimodal approaches, in patients with oesophageal, GEJ, and gastric cancers.

METHODS AND ANALYSIS: We will conduct a systematic literature search in MEDLINE (PubMed) and The Cochrane Library (CENTRAL) without date restrictions. Randomised controlled trials (RCTs) comparing eligible treatments will be included. The primary outcome will be overall survival, defined as time from diagnosis to death from any cause. Secondary outcomes will include progression-free survival, disease-specific survival, dropout rates, treatment-related adverse effects, patterns of relapse, R0 resection rates, surgical morbidity, and mortality. We will look for individual patient data (IPD) from primary studies’ authors and registries. We will assess risk of bias with the Cochrane risk of bias RoB2 tool. We plan to present each pairwise comparison with risk ratios and 95% confidence intervals from random-effects meta-analysis. A random-effects NMA model will simultaneously compare all treatments in the network. We will rank interventions using P-scores. In case we manage to access IPD and we believe the transitivity assumption does not hold for a specific comparison (or we have a disconnected network), we will use population adjustment methods to estimate an indirect treatment comparison. We will apply CINeMA to assess confidence in the findings and we will report results according to PRISMA-NMA.

DISCUSSION: Neoplasms of the oesophagus, the gastroesophageal junction, and the stomach are increasingly being studied together in clinical trials, a trend driven by continuous research on their molecular characteristics and shared therapeutic patterns. This NMA aims to pool evidence employing recent advances in meta-analytic models and critically assess the confidence in the results by implementing the CINeMA approach.

SYSTEMATIC REVIEW REGISTRATION: Registered in PROSPERO (CRD42025634169).

PMID:41981647 | DOI:10.1186/s13643-026-03175-0

Arthroplasty. 2026 Apr 14;8(1):29. doi: 10.1186/s42836-026-00384-9.

ABSTRACT

BACKGROUND: Conventional robotic-assisted total knee arthroplasty (RA-TKA) relies on rigid limb fixation to suppress intra-operative motion, adding complexity and potential inefficiency. A novel motion-following control system dynamically compensates for limb movement, allowing real-time adjustment of the tool-bone relationship without immobilization. This study evaluated whether motion-following improves efficiency and osteotomy accuracy while preserving alignment and early function.

METHODS: Sixty consecutive primary RA-TKA cases performed with the SkyWalker robotic platform (MicroPort, Shanghai, China) between September 2022 and August 2024 were retrospectively reviewed. Thirty procedures used conventional rigid fixation (control group) and thirty employed motion-following tracking (motion-Following group). Primary endpoints were operative time and resection thickness error, measured intraoperatively with a caliper. Secondary outcomes included coronal alignment assessed by HKA (hip-knee-ankle angle), CFCA (coronal femoral component angle), and CTCA (coronal tibial component angle), as well as functional recovery assessed by WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) at 6 months. Values are expressed as mean ± standard deviation unless otherwise specified.

RESULTS: Mean operative time was shorter with motion-following (118.8 ± 9.3 min) than with conventional fixation (133.9 ± 11.9 min; p < 0.001). Mean resection-thickness error was lower with motion-following (0.53 mm vs 0.82 mm), with 93.9% versus 68.3% of cuts within ≤ 1 mm. At the plane level, motion-following achieved smaller errors on all six surfaces, with four planes: DF-M (distal femur medial), distal femur lateral (DF-L), posterior femur medial (PF-M), and tibial plateau lateral (TP-L) reaching statistical significance (p < 0.05). Post-operative coronal alignment closely reproduced the pre-operative plan in both groups, with mean deviations of approximately 1° across all parameters and no statistically significant between-group differences. WOMAC scores improved substantially in both groups, with no significant between-group difference (ΔWOMAC 32.8 ± 8.5 vs 30.1 ± 7.9; p = 0.21).

CONCLUSIONS: Motion-following robotic control streamlines TKA by eliminating rigid fixation, improving workflow efficiency, and slightly enhancing osteotomy precision without compromising alignment or recovery. This dynamic, real-time tracking approach refines execution of the surgical plan and may represent a meaningful evolution toward more efficient, surgeon-friendly robotic arthroplasty.

PMID:41981645 | DOI:10.1186/s42836-026-00384-9