Category: Statistics

J Am Coll Cardiol. 2026 Aug 29:S0735-1097(26)07510-8. doi: 10.1016/j.jacc.2026.08.027. Online ahead of print.

NO ABSTRACT

PMID:42667277 | DOI:10.1016/j.jacc.2026.08.027

J Emerg Nurs. 2026 Aug 28:S0099-1767(26)00253-9. doi: 10.1016/j.jen.2026.07.015. Online ahead of print.

ABSTRACT

INTRODUCTION: Emergency departments are high-stress clinical environments where health care workers are exposed to unpredictable patient acuity, trauma, workplace violence, and rapid decision making. Animal-assisted interventions have demonstrated benefits for patients, with emerging evidence suggesting potential value for reducing health care worker stress and improving emotional well-being. However, objective physiological outcomes and emergency department-specific data remain limited.

METHODS: This descriptive, interventional study examined the association between therapy dog visits and perceived and physiological stress among emergency department health care workers. Patient- and nonpatient-facing staff completed measures of salivary cortisol, perceived stress, and blood pressure immediately before and after dog interactions. Participants also provided qualitative descriptions of their feelings pre- and postintervention.

RESULTS: A total of 76 staff members participated, accounting for 100 therapy dog interactions. Overall, pre- to postintervention changes in salivary cortisol were not statistically significant. Perceived stress decreased significantly for all participants (P < .001), and mean arterial pressure decreased at the α = 0.10 level. Qualitative findings revealed a shift from negative emotional states (stressed and overwhelmed) before dog visits to more positive emotions (calmer, happier, and reenergized) afterward.

DISCUSSION: Results of this study suggest that therapy dog visits were associated with lower perceived stress and were well received by staff. Pet therapy may be considered as 1 component of broader organizational strategies to support health care workers in high-stress clinical environments. Therapy dog programs may represent a feasible, low-cost approach for promoting a supportive healing environment.

PMID:42667276 | DOI:10.1016/j.jen.2026.07.015

Semin Ophthalmol. 2026 Aug 29:1-7. doi: 10.1080/08820538.2026.2725223. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the utility, rationality, and safety of glaucoma surgery recommendations generated by three prominent large language models (LLMs) – ChatGPT, Microsoft Copilot, and Google Gemini – when applied to real-world clinical scenarios.

METHODS: Retrospective records from a tertiary hospital were converted into standardized scenarios and stratified into “primary” and “complex” glaucoma groups. Each LLM was prompted to suggest a single surgical approach and provide a rationale. A blinded team of glaucoma specialists evaluated the outputs based on six criteria: appropriateness, rationale quality, specificity, adherence to guidelines, feasibility, and safety risk, using a normalized 0-100 scale.

RESULTS: Median overall quality scores across all cases were 80.7 for ChatGPT, 80.7 for Copilot, and 82.7 for Gemini, showing no statistically significant difference in general performance (p = .367). However, case complexity significantly affected performance. For Gemini, appropriateness and rationale quality scores dropped significantly in complex cases and were accompanied by a statistically significant increase in safety risk (p = .009). Although ChatGPT and Copilot demonstrated more stability across groups, their rationale quality was significantly lower in complex scenarios than in primary ones (p = .014 and <0.001, respectively). Pairwise analyses revealed that ChatGPT offered superior rationale quality compared to Copilot, while Gemini exhibited higher specificity.

CONCLUSIONS: LLM-based chatbots can provide acceptable surgical guidance for straightforward primary surgical cases, but their utility is limited in high-risk or complex clinical settings. The observed deficiencies in rationale and increased safety risks in complex cases suggest that LLMs should be integrated as auxiliary decision-support tools under expert supervision rather than used as autonomous decision-makers in glaucoma surgery planning.

PMID:42667272 | DOI:10.1080/08820538.2026.2725223

Semin Ophthalmol. 2026 Aug 29:1-13. doi: 10.1080/08820538.2026.2724546. Online ahead of print.

ABSTRACT

TOPIC: To evaluate the visual and refractive outcomes of corneal refractive surgery (PRK, LASIK, and SMILE) for hyperopic and mixed astigmatism. The clinical question addressed was: in adults with hyperopic or mixed astigmatism, how effective and safe are modern corneal refractive procedures, without alternative surgical comparators, in reducing refractive cylinder and improving uncorrected distance visual acuity?

CLINICAL RELEVANCE: Hyperopic and mixed astigmatism are less predictable to correct than myopic errors due to biomechanical and ablation-profile complexity. Historically, these treatments showed higher regression and retreatment rates. With advances in excimer and femtosecond platforms, updated evidence is needed to inform clinical decision-making and patient counseling regarding expected efficacy, predictability, and safety.

METHODS: A systematic review and meta-analysis were conducted following PRISMA 2020 and Cochrane guidelines. PubMed, Scopus, and Web of Science were searched from January 2010 to March 2025. Eligible studies included prospective, retrospective, or randomized human studies evaluating PRK, LASIK, or SMILE for hyperopic or mixed astigmatism. Case reports, small series (<10 eyes), intraocular procedures, and presbyopia treatments were excluded. Risk of bias was assessed using the NIH Quality Assessment Tool for Case Series Studies. Random-effects meta-analyses were performed, and heterogeneity was quantified with I² statistics.

RESULTS: Twenty-three studies (3,561 eyes) were included. Mean preoperative cylinder was 2.45 ± 1.23 D. Pooled residual astigmatism was 0.47 D (95% CI, 0.04-0.90) for hyperopic and 0.67 D (95% CI, 0.37-0.97) for mixed astigmatism. Approximately 66% (hyperopic) and 50% (mixed) achieved ≤ 0.50 D residual cylinder; 81% and 83%, respectively, were within ≤ 1.00 D. Uncorrected distance visual acuity (UDVA) of 20/20 or better was achieved in 60% (hyperopic) and 63% (mixed). Loss of ≥1 line of corrected distance visual acuity (CDVA) occurred in 6% (95% CI, 0.01-0.14) of hyperopic and 5% (95% CI, 0.03-0.15) of mixed eyes (pooled random-effects estimates). No significant differences were found between groups in comparative meta-analysis.

CONCLUSION: Modern corneal refractive surgery provides substantial cylinder reduction, high predictability, and excellent safety in hyperopic and mixed astigmatism. Although heterogeneity and predominantly non-randomized designs limit certainty, current laser technologies achieve clinically meaningful outcomes comparable between groups, supporting their use in appropriately selected patients.

PMID:42667270 | DOI:10.1080/08820538.2026.2724546

J Neuropsychol. 2026 Aug 29. doi: 10.1111/jnp.70075. Online ahead of print.

ABSTRACT

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication, and conventional therapies often struggle to facilitate the generalization of these skills to real-world settings. This study aimed to determine the effectiveness of a virtual reality (VR)-based communication rehabilitation intervention as a supplement to conventional treatment for improving the linguistic and social communication skills of Arabic-speaking Egyptian children with ASD. A clinical trial with a pretest-posttest control group design was employed, wherein 60 children aged 4-6 years with mild to moderate ASD were assigned to either VR plus conventional therapy (Group I, n = 30) or conventional therapy alone (Group II, n = 30). Over 6 months, participants received 2 weekly 30-min sessions. Outcomes were measured at baseline, immediately post-intervention and at a 3-month follow-up using the Preschool Language Scale-Fourth Edition, the Childhood Autism Rating Scale-Second Edition and an ASD Social Skills Scale. Group I demonstrated statistically significant improvements in receptive and expressive language ages (p < .001) and total social skills scores (p < .001) compared to Group II. Crucially, these therapeutic gains were sustained at the 3-month follow-up with no significant deterioration (p > .05). VR-based communication rehabilitation is a highly effective and sustainable intervention for supplementing language and social skills in young children with ASD. Its integration into clinical practice provides a scalable, engaging and culturally adaptable platform for neurodevelopmental care.

PMID:42667252 | DOI:10.1111/jnp.70075

Arthroscopy. 2026 Aug 29. doi: 10.1002/arj.70498. Online ahead of print.

ABSTRACT

PURPOSE: To compare arthroscopic bone grafting (ABG) with autograft and allograft for the treatment of scaphoid nonunion.

METHODS: Between 2012 and 2024, this retrospective comparative study included patients with unstable scaphoid nonunion who underwent ABG with either autograft or allograft. Eligible patients had symptomatic scaphoid nonunion treated with ABG and internal fixation and were followed for a minimum of 12 months. Radiographic assessments included healing of the nonunion site, scaphoid length, scapholunate angle, and radiolunate angle. Functional assessments included wrist range of motion, grip and pinch strength, pain scores measured using the visual analog scale, and patient-reported outcomes evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and modified Mayo Wrist Score.

RESULTS: There were 47 and 27 patients in the autograft and allograft groups, respectively. The mean follow-up was 20.4 months (range, 12-76) and 18.7 months (range, 12-130), with no significant difference (P = .715). There were 3 cases of nonunion in each group (6.4% vs. 11.1%; P = .667), with no significant difference (P = .667). The mean healing times were 3.4 ± 0.7 and 3.7 ± 1.1 months in the autograft and allograft groups, respectively, with no significant difference (P = .266). No other postoperative complications or donor-site morbidity were observed. Both groups showed significant restoration of scaphoid length compared with preoperative measurements. The allograft group showed significant postoperative improvement and achieved a more favorable mean scapholunate angle than the autograft group. Moreover, both groups showed significant postoperative improvement in the radiolunate angle. In the autograft and allograft groups, respectively, visual analog scale decreased from 3.9 to 0.4 and from 4.3 to 0.5, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire improved from 28.9 to 8.4 and from 29.0 to 9.1, and modified Mayo Wrist Score improved from 68.9 to 89.3 and from 70.2 to 87.9 (all P < .001). Minimal clinically important difference was achieved in 93.6% of the autograft group and 96.3% to 100% of the allograft group, with no significant differences (P > .05).

CONCLUSIONS: ABG using autograft or allograft resulted in satisfactory union and acceptable radiographic and functional outcomes. Most patients achieved clinically meaningful improvement based on minimal clinically important difference. However, there is a possibility of low statistical power and a risk of type II error.

LEVEL OF EVIDENCE: Level III, retrospective comparative case series.

PMID:42667251 | DOI:10.1002/arj.70498

Schizophr Bull. 2026 Aug 20;52(5):sbag104. doi: 10.1093/schbul/sbag104.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Psychotic-like experiences (PLEs) confer increased risk for adverse mental health outcomes. Sleep disturbances are associated with PLEs, yet evidence largely relies on retrospective assessments and average sleep parameters, limiting insight into daily-life dynamics. Moreover, the roles of stress exposure in sleep-PLEs associations remain insufficiently understood. This study aimed to address these gaps by examining sleep characteristics, momentary stress, and childhood trauma in relation to PLEs using experience sampling. We hypothesized that individuals with PLEs show poorer and more variable sleep, bidirectional sleep-PLEs associations, stronger stress-related sleep disturbances, and trauma-related alterations in sleep regulation.

STUDY DESIGN: Altogether, 99 individuals with PLEs and 102 controls completed the experience sampling across 7 consecutive days.

STUDY RESULTS: Individuals with PLEs reported poorer average sleep quality, shorter sleep duration, and greater variability in sleep quality, although differences in sleep quality and its variability were attenuated after adjustment for negative affect. Within the PLEs group, sleep quality, but not sleep duration, showed robust bidirectional within-person associations with PLEs. Daily stress fluctuations were not associated with next-morning sleep, whereas higher between-person stress exposure was related to poorer average sleep quality, with no moderation by PLEs group status. Childhood trauma was not significantly associated with sleep outcomes.

CONCLUSIONS: Reduced sleep duration might be a stable feature of PLEs independent of negative affect, while sleep quality is dynamically linked to momentary PLEs. Sleep disturbances in individuals with PLEs seem more closely related to symptom dynamics than to momentary stress and distal developmental risk factors.

PMID:42667249 | DOI:10.1093/schbul/sbag104

Schizophr Bull. 2026 Aug 20;52(5):sbag077. doi: 10.1093/schbul/sbag077.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Positive and negative symptoms are core features of schizophrenia and key indicators of antipsychotic efficacy. We aimed to explore the relationship between antipsychotic doses and changes in positive/negative symptoms.

STUDY DESIGN: We reviewed the Cochrane Schizophrenia Group register (updated on July-26-2024) and prior systematic reviews to identify fixed-dose randomized controlled trials that assessed the monotherapy effects of 21 antipsychotic drugs in acute schizophrenia. The primary outcome measure was the average change in positive and negative symptoms from the studies’ baseline to endpoint, calculated using standard mean differences as the effect size metric. Dose-response relationships were analyzed using random-effects meta-analyses with restricted cubic splines.

STUDY RESULTS: Finally, a total of 165 studies were identified. 112 studies with 385 dose arms (37 096 participants) reported positive or negative symptoms and were evaluated in meta-analyses. Most antipsychotics showed parallel dose-response curves for positive and negative symptoms, with a smaller magnitude of effect on negative symptoms-except a few drugs, in particular partial dopamine agonists which had at least equal effect sizes for positive and negative symptoms. In most cases both curves declined until reaching an inflection point, then plateaued or efficacy decreased.

CONCLUSIONS: The effects of antipsychotics on negative symptoms are smaller than those on positive symptoms, at least in studies of mostly acutely exacerbated patients. Nevertheless, the dose-response curves for both types of symptoms are relatively parallel. This information can assist clinicians in dosing antipsychotics and has implications for the understanding of the antipsychotic mechanism.

PMID:42667248 | DOI:10.1093/schbul/sbag077

Schizophr Bull. 2026 Aug 20;52(5):sbag147. doi: 10.1093/schbul/sbag147.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Individuals with schizophrenia are at increased risk of type 2 diabetes and diabetes-related complications. Whether the detection of hyperglycemia in individuals with schizophrenia is followed by timely clinical action remains insufficiently understood. We hypothesized that glucose-lowering drug (GLD) treatment would be initiated later in individuals with schizophrenia with elevated glycated hemoglobin (HbA1c) than in matched individuals without schizophrenia, and that this delay would be reflected in worse HbA1c trajectories.

STUDY DESIGN: We identified all individuals with schizophrenia aged ≥30 years at the time of the first elevated HbA1c (≥48 mmol/mol) in nationwide Danish registers. These individuals were matched on age, sex, year of elevated HbA1c, and baseline HbA1c with up to five individuals without schizophrenia. In the year following the detection of elevated HbA1c, we compared time to GLD treatment between individuals with and without schizophrenia using a Cox proportional hazard model. Mean HbA1c levels over time were illustrated graphically and compared using linear mixed-effects models.

STUDY RESULTS: We identified 1527 individuals with schizophrenia and 7492 matched comparison individuals. In the year following detection of elevated HbA1c, schizophrenia was associated with a slower rate of GLD treatment initiation (hazard rate ratio [HRR] = 0.88, 95% confidence interval [CI]: 0.81-0.94). Consistently, HbA1c decreased more slowly among individuals with schizophrenia. Notably, schizophrenia was associated with a slower rate of GLD treatment initiation among males (HRR = 0.82, 95%CI: 0.74-0.90) but not females (HRR = 0.99, 95%CI: 0.87-1.11).

CONCLUSIONS: Schizophrenia was associated with a slower rate of GLD treatment initiation and slower reductions in HbA1c following detection of elevated HbA1c, particularly among males.

PMID:42667247 | DOI:10.1093/schbul/sbag147

J Vis Exp. 2026 Aug 28;(234). doi: 10.3791/71709.

ABSTRACT

Cellular behaviour and morphology are usually influenced by various intra- and extracellular factors in a microbial community. Different approaches available to study microbial communication could be tedious and/or require specialised facilities and expertise. Here, two complementary contactless co-culture approaches are described, the membrane insert well plate co-culture assay and the Cell-Free Supernatant (CFS)-based assay, which are based on morphological transition as a measurable response to investigate the role of various factors in a given inter-species interaction. The membrane insert well plate system, while permitting diffusion of extracellular molecules, allows real-time interaction between physically separated species. In comparison, the CFS-based assay provides a simplified, scalable approach for evaluating responses to conditioned media. The protocol presented here includes standardized procedures for culture preparation, generation of conditioned supernatants, assay setup, microscopy, image acquisition, quantitative morphometric analysis using Fiji, and statistical evaluation. This has been demonstrated with an example of fungal morphological response to intrinsic and extrinsic factors. The methods presented here offer accessible and adaptable alternative tools for studying novel microbial interactions in a community, and could be readily extendable to investigate mechanisms underlying multi-species co-existence in a community.

PMID:42667226 | DOI:10.3791/71709