Category: Statistics

Endocrinol Diabetes Metab. 2026 Mar;9(2):e70180. doi: 10.1002/edm2.70180.

ABSTRACT

INTRODUCTION: Concerns about diabetic ketoacidosis (DKA) and euglycemic ketoacidosis (eKA) are balanced against possible organ-protective benefits in the debated perioperative management of sodium-glucose cotransporter-2 (SGLT2) inhibitors. This meta-analysis compared the perioperative clinical and laboratory outcomes associated with perioperative exposure to SGLT2i.

METHODS: Through July 31, 2025, we searched PubMed, Web of Science, Scopus, and CENTRAL for observational studies and randomised controlled trials comparing the outcomes of preoperative use of SGLT2 inhibitors with non-use in patients undergoing cardiac or non-cardiac surgery. We pooled data using a random-effects model and investigated heterogeneity using leave-one-out sensitivity analyses.

PROSPERO-ID: CRD420251155809.

RESULTS: There were 10 studies comprising 246,242 patients. Due to considerable heterogeneity, the primary pooled analysis revealed no significant association between SGLT2 inhibitor use and either eKA (OR 4.86; p = 0.11) or DKA (OR 2.21; p = 0.11). However, a significant increase in the risk of eKA (OR 1.11; p < 0.001) and DKA (OR 5.33; p < 0.001) was observed using leave-one-out sensitivity analysis to identify outliers. On the other hand, the usage of SGLT2 inhibitors was associated with a statistically significant decrease in both mortality (OR 0.73; p = 0.006) and acute renal injury (OR 0.68; p < 0.0001). The SGLT2 inhibitor group had significantly lower perioperative pH, base excess, and blood glucose levels.

CONCLUSION: The use of perioperative SGLT2 inhibitors poses a clinical paradox between significant renoprotection and survival advantages and a latent risk of ketoacidosis concealed by considerable heterogeneity. While metabolic monitoring is essential, current surgeries requiring more prolonged withholding may need to weigh metabolic risk against the drug’s significant benefit in reducing acute kidney injury and mortality.

PMID:41721639 | DOI:10.1002/edm2.70180

Nurs Open. 2026 Feb;13(2):e70407. doi: 10.1002/nop2.70407.

ABSTRACT

AIM: To provide a comprehensive understanding of how nurse managers’ leadership styles affect staff engagement and to identify key themes that influence engagement from both statistical and experiential perspectives within a multicultural healthcare context.

DESIGN: Explanatory sequential mixed-methods design, with integration occurring across the design, methods and reporting stages using the Pillar Integration Process.

METHODS: The study was conducted in four public hospitals in western Saudi Arabia. Quantitative data were collected from 278 registered nurses using the validated Multifactor Leadership Questionnaire (MLQ-5X) and Utrecht Work Engagement Scale (UWES-9). Thirteen nurses participated in follow-up semi-structured interviews. The study adhered to the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines.

RESULTS: Four integrated themes emerged: relational leadership, recognition and reward, impact of neglectful leadership and cultural competence in leadership. Saudi and non-Saudi nurses perceived leadership differently, influenced by cultural norms.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:41721584 | DOI:10.1002/nop2.70407

Int J Gynaecol Obstet. 2026 Feb 21. doi: 10.1002/ijgo.70869. Online ahead of print.

ABSTRACT

OBJECTIVE: Novel human papillomavirus (HPV) tests must undergo thorough validation before implementation in the cervical cancer screening population. The MyGene HPV sexually transmitted infection (STI) assay (MHSA), an emerging test based on emerging next-generation sequencing, presents as a promising tool for enhancing detection capabilities in screening settings. This study aims to conduct a comparative analysis of the clinical performance of two assays (Cobas 4800 vs. MHSA) in detecting 14 high-risk (GR)-HPV genotypes for the identification of high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) in longitudinal cervical cancer screening among Chinese women.

METHODS: A total of 2985 consecutive specimens from a cervical screening program in Erdos City were examined using both MHSA and Cobas 4800 assays. Follow-up study was also conducted for 3 years.

RESULTS: The overall percent agreement (OPA), percentage of negative agreement (PNA), and Kappa statistics for 14 HR-HPV positivity, type-specific HPV16, HPV18, and 12 other HR-HPV demonstrated strong concordance between the two assays. The clinical performance of MHSA was comparable to the Cobas 4800 assay at both baseline and over the 3-year cumulative follow-up. Moreover, MHSA effectively reduced unnecessary colposcopy referrals and showed better triage efficiency both at baseline and at the 3-year follow-up. When combined with HPV typing and cytology results, MHSA outperforms the Cobas 4800 in terms of clinical performance and triage efficiency.

CONCLUSION: Our study indicated that MHSA could be considered a valuable option for cervical cancer screening in China.

PMID:41721577 | DOI:10.1002/ijgo.70869

J Med Virol. 2026 Feb;98(2):e70848. doi: 10.1002/jmv.70848.

ABSTRACT

Since the initial recommendations for universal infant hepatitis B vaccination in the United States, vaccination coverage has increased significantly. However, a trend of declining antibody levels has been observed among early vaccinees. This study aims to investigate hepatitis B vaccination coverage and vaccine-associated immunity among US-born children and adolescents. We used data from the 2017-2020 National Health and Nutrition Examination Survey to include US-born participants aged 2 to 18 years who had complete hepatitis B serological data and vaccination history. We determined the prevalence of completing the hepatitis B vaccination series and the prevalence of vaccine-associated immunity. A total of 2,852 US-born children and adolescents were included in the study, achieving a complete hepatitis B vaccination coverage rate of 83.9% (95% CI: 81.5%-86.3%). Among the 2,317 individuals who had complete hepatitis B vaccination series, the vaccine-related immunity rate was 35.2% (95% CI: 32.5%-37.8%). Multivariable logistic regression analysis identified age group, race/ethnicity, family income to poverty ratio, and hepatitis A antibody as significant factors associated with complete vaccination coverage (p < 0.05). Additionally, the hepatitis B surface antibody levels decreased with age (p < 0.05). Hepatitis B vaccination coverage among US-born children and adolescents declined during the 2017-2020 period. Targeted vaccination efforts in underserved populations may help improve vaccination coverage. Future continuous monitoring of trends in both vaccination and seropositivity rates is needed.

PMID:41721575 | DOI:10.1002/jmv.70848

Int J Gynaecol Obstet. 2026 Feb 21. doi: 10.1002/ijgo.70886. Online ahead of print.

ABSTRACT

OBJECTIVE: The accurate diagnosis of multicompartment pelvic organ prolapse (POP) is fundamental to surgical success. This study aims to compare the diagnostic performance of transperineal ultrasound against clinical examination (pelvic organ prolapse quantification, POP-Q) for the detection of compartmental defects in patients with multicompartment POP, using assessment under spinal anesthesia as the reference standard.

METHOD: A prospective randomized diagnostic accuracy study was designed, including 129 patients scheduled for multicompartment POP surgery. Patients were randomly assigned to undergo either a preoperative POP-Q two-dimensional transperineal ultrasound assessment. The reference standard for all patients was the intraoperative POP-Q assessment, conducted under spinal anesthesia immediately before surgery. Sensitivity, specificity, and likelihood ratios (LR) were calculated for each method and compartment.

RESULTS: Both techniques demonstrated high sensitivity for the diagnosis of cystocele (100% vs 98.3%). However, their performance varied across the other compartments. Ultrasound showed superior specificity for uterine prolapse (73.4% vs 45.4%) and rectocele (86.3% vs 66.0%) and was particularly robust in confirming enterocele (LR+ of 10.5). In turn, clinical examination had a higher sensitivity for detecting rectocele (61.5% vs 21.4%) and was highly reliable for ruling out cystocele and uterine prolapse (LR- of 0).

CONCLUSION: Clinical examination and ultrasound are complementary in the diagnosis of prolapse. Their combined use is key to accurate surgical planning.

PMID:41721567 | DOI:10.1002/ijgo.70886

J Dent Educ. 2026 Feb 21. doi: 10.1002/jdd.70181. Online ahead of print.

ABSTRACT

OBJECTIVES: This study provides a descriptive, multi-institutional comparison of dental students’ recognition accuracy and management decisions of oral soft tissue pathological entities across four US dental schools. While prior single-institution studies have evaluated diagnostic ability, this work provides a multi-institutional comparison to identify recognition and decision-making variability as well as potential educational implications.

MATERIALS AND METHODS: A voluntary, anonymous online survey with twenty image-based multiple-choice questions was administered to 160 students. Each question included an image, patient demographics, and key case details. Management questions were provided with reference diagnoses to prevent conflation of diagnostic and management errors. Descriptive statistics, t-tests, logistic regression, chi-square tests, and multi-rater kappa statistics were used to analyze performance, with effect sizes, reference groups, and 95% confidence intervals reported. Model fit for logistic models was assessed using likelihood ratio tests.

RESULTS: Students demonstrated a high level of recognition for conditions like candida (84%) and tobacco keratosis (95%). Subtle or clinically variable lesions were more challenging, such as erosive lichen planus (50%) and idiopathic leukoplakia (58%). Management accuracy frequently lagged behind recognition accuracy. Significant inter-school differences were observed for both recognition (χ² = 27.66, p < 0.0001) and management (χ² = 30.80, p < 0.0001), with students from School #4 outperforming peers. Kappa values remained low (< 0.2 for most items), indicating wide variability and limited internal agreement.

CONCLUSION: Students demonstrated strong theoretical knowledge of common oral pathological entities but variability in identifying and managing rare or diagnostically nuanced conditions. Because this survey evaluates recognition rather than competence, findings highlight the need for case-based, competency-aligned teaching approaches to strengthen diagnostic reasoning and management decision-making.

PMID:41721556 | DOI:10.1002/jdd.70181

Mol Genet Genomic Med. 2026 Mar;14(3):e70188. doi: 10.1002/mgg3.70188.

ABSTRACT

BACKGROUND AND AIM: Hereditary spherocytosis (HS) is a common disease in hereditary hemolytic anemia. Advancements in sequencing technology have enabled the identification of a growing number of mutation sites associated with HS. This study analyzed the clinical characteristics and gene mutations of HS in our center.

METHODS: Retrospective collection of data on 59 Chinese pediatric patients with HS admitted to the Hematology Department of Chongqing Medical University Affiliated Children’s Hospital from 2013 to 2022. Second-generation gene sequencing was performed on participants, with verification of detected variants using Sanger sequencing. Data analysis was conducted using various databases, and statistical methods were used for differential analysis.

RESULT: We collected clinical data of 59 Chinese children with HS phenotype, including 27 males (45.8%) and 32 females (54.2%), all unrelated. The age of onset ranged from 0 to 180 months, with a median age of 60 months. Our study found that ANK1 and SPTB gene mutations were the primary causes of HS, with missense and frameshift mutations being the most common. De novo mutations were present in 37 (62.7%) patients, while the remaining mutations were inherited. We noted a higher proportion of females (p = 0.032) and lower total bilirubin levels (p = 0.014) in patients with multiple gene mutations. Patients with ANK1 gene mutations experienced more severe anemia compared to those with SPTB gene mutations (p = 0.041). Additionally, there were significant differences in mean corpuscular hemoglobin concentration (MCHC) between different mutation types (p = 0.036), indicating lower MCHC levels in the missense mutation group. No differences in clinical phenotypes were observed among different structural domains of ANK1 and SPTB mutations. Splenectomy significantly alleviated the symptoms in HS patients.

CONCLUSION: We identified unique genetic and clinical characteristics mutations of HS in Chongqing, China. These findings expand the mutation spectrum of HS and have implications for early diagnosis and treatment of the disease.

PMID:41721551 | DOI:10.1002/mgg3.70188

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261421476. doi: 10.1177/21501319261421476. Epub 2026 Feb 21.

ABSTRACT

BACKGROUND: Persistent high healthcare utilization has rarely been analyzed in adolescent populations although there are specific chronic health issues also among adolescents, like mental health challenges and some somatic illnesses, which need long-term treatments. Therefore, it remains unclear whether such high utilization is persistent among adolescents. Recognizing patterns of high service utilization and its’ persistence are essential for preventing avoidable healthcare use.

MATERIALS AND METHODS: This population-based study focused on all adolescents born in 2004 (n = 1483) from North Karelia, Finland. Healthcare service use data (2018-2021) was extracted from the electronic patient register. A high utilizer of healthcare (HU: the abbreviation also refers to high utilization) was defined as a person having been in contact with healthcare services during at least 12 days a year (attendance days). A persistent HU (pHU) was a person identified as being HU during 3 or 4 of all 4 follow-up years. The prevalence of diagnoses set to young people was compared in accordance with ICD-10 diagnostic categories between pHU and non-pHU groups.

RESULTS: pHUs accounted for 18.5% (n = 275) of all adolescents born in 2004. A total of 53.5% (n = 793) of adolescents met the criteria of single-year HU during the follow-up period, and of these, 34.7% were also identified as pHU. The pHU group was particularly emphasized in mental and behavioral disorders (RR = 4.5, CI: 3.6-5.5, P < .001), as well as the diseases of the nervous system (RR = 3.4, CI: 2.2-5.1, P < .001) and musculoskeletal system/connective tissue (RR = 3.2, CI: 2.4-4.3, P < .001).

CONCLUSIONS: The continuation from single-year to multi-year HU was relatively high. Thus, single-year high utilization is a strong indicator of future persistence in healthcare service utilization. Further research is needed to identify differences in clinical and psychosocial characteristics between single-year high utilizers and those whose high-utilization continues for years.

PMID:41721530 | DOI:10.1177/21501319261421476

Hand (N Y). 2026 Feb 21:15589447261416974. doi: 10.1177/15589447261416974. Online ahead of print.

ABSTRACT

BACKGROUND: Dupuytren’s disease causes progressive flexion contractures and impaired hand function. While percutaneous needle aponeurotomy (PNA) provides rapid correction with low morbidity, the effect on grip strength remains unclear. Grip strength is a key surrogate of hand function and overall health, yet it has been inconsistently evaluated as an outcome in Dupuytren’s disease.

METHODS: A prospective study was conducted at a tertiary referral center including 53 patients (80 digits) treated with PNA between February 2024 and March 2025. Standardized assessments included grip strength (Jamar dynamometer, American Society of Hand Therapists protocol), joint extension deficits, patient-reported outcomes (Southampton, Unité Rhumatologique des Affections de la Main [URAM]), and return-to-work data. Grip strength was reassessed at 2 months postprocedure to capture early functional recovery. Statistical analysis used paired t tests and Wilcoxon signed-rank tests, with significance set at P < .05.

RESULTS: Mean grip strength improved from 24.9 to 28.7 kg (mean change + 3.8 kg, P < .001). Extension deficits decreased significantly at all levels, with mean correction of 25.5° at the metacarpophalangeal joint (MCPJ) and 29.3° at the proximal interphalangeal joint (PIPJ) (P < .001). At 2 months, the median URAM score was 4 out of 45, and the Southampton score was 3 out of 20, reflecting excellent functional recovery. Forty-four employed patients returned to work within 1 week. Complications were minor (skin tears n = 9, transient hypersensitivity n = 1) with no major adverse events.

CONCLUSIONS: Percutaneous needle aponeurotomy (PNA) not only corrects digital contracture but also yields clinically significant improvements in grip strength, reinforcing its value as a functional outcome measure. These findings support PNA as a safe, effective first-line treatment for selected patients with Dupuytren’s disease.

PMID:41721527 | DOI:10.1177/15589447261416974

Phys Sportsmed. 2026 Feb 20. doi: 10.1080/00913847.2026.2636506. Online ahead of print.

ABSTRACT

BACKGROUND: Horse riding is a common sport, but no study specifically addresses joint dislocations. The purpose of this study is to describe joint dislocations due to equines using a national emergency department (ED) database. Such data can be helpful in injury prevention strategies.

METHODS: The National Electronic Injury Surveillance System (NEISS) database for the years 2000-2023 was used. The NEISS database is a statistically representative sample of injuries seen in EDs across the US giving national estimates. Mechanism of injury was tabulated into groups: 1) did the patient fall from the horse 2) was the patient bucked, thrown, or kicked off of the horse, 3) was there equipment (tack) malfunction, 4) was the patient stepped on by the horse, 5) was the patient struck by/against an object, 6) was the patient kicked by the, 7) and others.

RESULTS: There were 625 dislocations which involved the shoulder (289, 46.2%), elbow (95, 15.2%), finger (85, 13.6%), acromioclavicular joint (48, 7.7%), patellofemoral joint (39, 4.8%), hip (22, 3.5%), pubic symphysis (16, 2.6%), and ankle (7, 1.1%). The average age was 41 years; 49.7% were male and 50.3% female. Mechanisms of injury were falling from the horse (54.1%), bucked/thrown off (27.7%), equipment malfunction (7.3%), stepped on by the horse (2.1%), struck by/against an object (1.9%), kicked (0.6%), and others (4.0%). Those with elbow dislocations were the youngest (average 32 years) and pubic symphysis the oldest (average 52 years) (p < 10^-4). Females had the highest percentage of patellofemoral dislocations (70.2%) and males the highest percentage of pubic symphysis dislocations (92.9%) (p = 0.0018).

CONCLUSION: Although joint dislocations due to equestrian activity are uncommon, the majority occurred in the upper extremity. Male/female involvement is equal, different than the typical female predominance in equestrian activity and overall equestrian related injuries.

PMID:41721521 | DOI:10.1080/00913847.2026.2636506