Category: Statistics

JMIR Nurs. 2026 Jan 23;9:e78560. doi: 10.2196/78560.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) continues to expand into nursing and health care. Many examples of AI applications driven by machine or deep learning are in use. Examples include wearable devices or alerts for risk prediction. AI tends to be promoted by nonnurses, creating a risk that AI is not designed to best serve registered nurses. Community health nurses (CHNs) are a small but essential group. CHNs’ familiarity with AI and their perceptions about its effect on their practice are unknown.

OBJECTIVE: The research aims to understand CHNs’ awareness, knowledge, and perceptions of AI in practice and gain insights to better involve them in AI.

METHODS: An online cross-sectional Canadian survey targeting CHNs was conducted from April to July 2023. Descriptive statistics summarized respondents’ characteristics and perceptions of AI, followed by a chi-square test used to determine a relationship between respondents’ level of AI knowledge and their AI perceptions, with odds ratio (OR) to determine the strength of association.

RESULTS: A total of 228 CHNs participated with varying response rates per question. Most respondents were female (172/188, 91.5%), average age of 45.5 (SD 11.7) years, and an average of 13.5 (SD 10.1) years of community practice experience. Most respondents (205/228, 89.9%) felt they welcomed technology into their practice. They reported their understanding of AI technologies as “good” (95/220, 43.2%) and “not good” (125/220, 56.8%). Overall, 39.6% (80/202) of respondents felt uncomfortable with the development of AI. They agreed that AI should be part of education (143/203, 70.4%), professional development (152/202, 75.2%), and that they should be consulted (195/203, 96.1%). Many respondents had concerns related to professional accountability if they accepted a wrong AI recommendation (157/202, 77.7%) or if they dismissed a correct AI recommendation (149/202, 73.8%). Respondents with “good” AI knowledge were significantly associated with, and twice as likely to indicate nursing will be revolutionized (P=.007; OR 2.28, 95% CI 1.25-4.18), nursing will be more exciting (P=.001; OR 2.52, 95% CI 1.42-4.47), health care will be more exciting (P=.004; OR 2.3, 95% CI 1.30-4.06), and agreed that AI is part of nursing (P=.01; OR 2.1, 95% CI 1.19-3.68). Respondents with “not good” AI knowledge were significantly associated with, and more likely to feel uncomfortable with AI developments (χ21=4.2, P=.04; OR 1.84, 95% CI 1.03-3.3).

CONCLUSIONS: CHNs reporting “good” AI knowledge had more favorable perceptions toward AI. Overall, CHNs had professional concerns about accepting or dismissing AI recommendations. Potential solutions include educational resources to ensure that CHNs have a sound basis for AI in their practice, which would promote their comfort with AI. Further research should explore how CHNs could be better involved in all aspects of AI introduced into their practice.

PMID:41576309 | DOI:10.2196/78560

JMIR Mhealth Uhealth. 2026 Jan 23;14:e84447. doi: 10.2196/84447.

ABSTRACT

BACKGROUND: Telehealth can improve access to care for people living with multiple sclerosis (MS), but information on its acceptance is limited in Switzerland.

OBJECTIVE: This study aimed to determine the proportion of people living with MS willing to accept telehealth as a new default and the factors associated with their acceptance.

METHODS: We conducted a cross-sectional analysis using survey data from the Swiss Multiple Sclerosis Registry. We defined “telehealth as a default” as a health care model where remote consultations (telephone and/or video calls) are the primary mode of interaction between patients and their physicians, with in-person visits based on clinical necessity. Multivariable logistic regression was performed to evaluate the association between telehealth acceptance and sociodemographic and health-related factors. Telehealth acceptance was described in relation to 3 survey variables that mirrored key constructs from the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. The variables were digital communication preferences, internet use for health provider searches, and experience with telemedicine.

RESULTS: Among 427 respondents, 15.5% (66/427) reported a willingness to accept telehealth as their default. In this group, only 21.2% (14/66) had experience using telemedicine. A descriptive analysis of our 3 NASSS-derived key constructs showed that among the 78.5% (335/427) respondents who generally agreed to digital access to health data, only 17.0% (57/335) accepted telehealth as a default. Notably, 30.7% (129/427) of participants stated a wish for support for using devices or the internet. Among those 129 individuals, 17.1% (22/129) were willing to accept telehealth as a default. Of the 89 people with prior telehealth experience, 15.7% (14/89) were willing to accept telehealth. In multivariable analysis, digital communication with health care providers (adjusted odds ratio [aOR] 14.56, 95% CI 6.18-39.04; P<.001), current internet use for health care provider search (aOR 7.78, 95% CI 1.34-45.32; P=.021), and a secondary progressive MS diagnosis (aOR 0.22, 95% CI 0.05-0.72; P=.021) were independently associated with accepting telehealth as a default.

CONCLUSIONS: Our findings suggest a low acceptance of telehealth as a default among people living with MS in Switzerland. While our 3 postulated NASSS-derived key constructs were not associated with telehealth acceptance, we noted additional behavioral factors, including previous digital communication with health care providers and using the internet to search for health care provider information, which were associated with telehealth acceptance. Moreover, advanced disease states like secondary progressive MS were negatively associated with telehealth acceptance. Thus, telehealth as a default will be most acceptable in people living with MS who already use the internet for their health, and those with less severe disease. Future research should explore provider perspectives and evaluate long-term strategies for the acceptance of telehealth in MS care.

PMID:41576299 | DOI:10.2196/84447

JAMA Netw Open. 2026 Jan 2;9(1):e2555339. doi: 10.1001/jamanetworkopen.2025.55339.

ABSTRACT

IMPORTANCE: Youth mental health crises have been increasing over the last decade, and there is an urgent need for clinicians to be more knowledgeable about patients with high emergency department (ED) utilization. Several disparities in ED utilization and outcomes have already been identified; however, little data exist on disparities affecting youths with histories of out-of-home placement (OOHP).

OBJECTIVE: To explore whether history of OOHP is associated with increased length of stay among child and adolescent patients who present to the emergency department with psychiatric symptoms.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, electronic health record (EHR)-based, cross-sectional study included patients aged 17 years or younger with a child and adolescent psychiatric consultation placed in the Mayo Clinic Rochester ED between January 1, 2021, and June 30, 2024. The Mayo Clinic Rochester is a tertiary referral center that serves as a regional hub for both primary and specialized psychiatric care.

MAIN OUTCOMES AND MEASURES: The primary outcome was the length of stay in the ED. Secondary outcomes were use of physical and pharmacological restraint. Associations between OOHP and length of stay were examined via linear mixed-effects regression models with length of stay log transformed.

RESULTS: Of the 1572 care encounters (median [IQR] age, 14,9 [13.3-16.3] years) among 1119 unique patients, there were 1244 with no history of OOHP and 328 with history of OOHP. Among the OOHP group, 158 (48%) were male and 170 (52%) female; 11 (4%) American Indian or Alaska Native, 7 (2%) Asian, 49 (16%) Black, 43 (14%) Hispanic, and 222 (71%) White. Among the 1244 encounters without OOHP, 820 (66%) were among female patients and 423 (34%) male; 21 (2%) American Indian or Alaska Native, 47 (4%) Asian, 121 (10%) Black, 125 (10%) Hispanic, and 971 (80%) White. Children and adolescents with history of OOHP were observed to spend 24% (95% CI, 12%-36%) more time in the ED even when adjusting for age at admission, sex, insurance, number of prior diagnoses, presenting concerns, and reasons for prolonged boarding (P = .004). Children and adolescents with history of OOHP had 2.05 (95% CI, 1.69-2.48) higher odds of being physically restrained (P < .001) and 2.15 (95% CI, 1.79-2.58) higher odds of receiving pharmacologic restraints (P < .001) while in the ED.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 1572 care encounters among 1119 patients, history of OOHP was associated with longer lengths of stay in the emergency department for children and adolescents who presented for mental health concerns. The findings highlight the need for further research on ways to mitigate the risk of extended emergency department stays for children with OOHP.

PMID:41575744 | DOI:10.1001/jamanetworkopen.2025.55339

Cardiovasc Drugs Ther. 2026 Jan 23. doi: 10.1007/s10557-026-07844-z. Online ahead of print.

NO ABSTRACT

PMID:41575651 | DOI:10.1007/s10557-026-07844-z

Target Oncol. 2026 Jan 23. doi: 10.1007/s11523-025-01194-w. Online ahead of print.

ABSTRACT

BACKGROUND: Given that immune checkpoint inhibitor-based regimens frequently yield delayed separation and late plateaus, conventional hazard ratio analyses that assume proportional hazards may misstate true benefit.

OBJECTIVE: We aimed to test the validity of the proportional hazards assumption in first-line metastatic clear cell renal cell carcinoma trials and to compare the immune checkpoint inhibitor-based regimens using restricted mean survival time.

METHODS: We performed a systematic review and network meta-analysis of phase III randomized controlled trials of first-line treatment for metastatic clear cell renal cell carcinoma, including immune checkpoint inhibitor-tyrosine kinase inhibitor combinations or dual-immune checkpoint inhibitor regimens. Individual patient data were reconstructed from the Kaplan-Meier curves of overall survival and progression-free survival. The restricted mean survival time differences were estimated.

RESULTS: Five trials (4206 patients; six treatment arms) were examined. Proportional hazards assumption was violated in 60% of both overall survival and progression-free survival comparisons. In the restricted mean survival time-based network meta-analysis of overall survival, immune checkpoint inhibitor-tyrosine kinase inhibitor combinations, especially Nivolumab + Cabozantinib, dominated at 12-48 months, whereas Ipilimumab + Nivolumab ranked highest beyond 48 months. In the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) favorable-risk subgroup, Avelumab + Axitinib showed a favorable long-term profile despite the lack of statistical significance. In IMDC intermediate/poor-risk, patterns mirrored the overall population. For progression-free survival, Pembrolizumab + Lenvatinib ranked best across IMDC subgroups. Limitations included the reliance on reconstructed data and heterogeneity across trials.

CONCLUSIONS: Given the frequent proportional hazards violations, hazard ratio-only syntheses are insufficient for modern immune checkpoint inhibitor-based regimens. In the restricted mean survival time-based network meta-analysis, Pembrolizumab + Lenvatinib delivered rapid disease control, and Ipilimumab + Nivolumab showed the greatest late survival advantage in IMDC intermediate/poor-risk.

PROSPERO REGISTRATION NUMBER: CRD420251143602.

PMID:41575641 | DOI:10.1007/s11523-025-01194-w

Discov Ment Health. 2026 Jan 23. doi: 10.1007/s44192-026-00376-w. Online ahead of print.

ABSTRACT

BACKGROUND: In a post-genocide context, mental health disorders among Rwandan genocide survivors and released perpetrators remain a critical concern. To date, no study has evaluated the effectiveness of the Community Resiliency Model (CRM) skills in addressing the mental health needs of both groups simultaneously. This study assessed the impact of CRM when delivered to a combined group of survivors and perpetrators, compared to groups trained separately.

METHODS: A total of 152 participants were recruited from Nyamagabe district, Rwanda. Participants were assigned into three groups including genocide survivors (n = 51), released genocide perpetrators (n = 51), and a combined group of both survivors and perpetrators (n = 50). Data were collected at three points: pre-intervention, immediately post-intervention, and six months post-intervention using validated psychometric scales for anxiety, depression, posttraumatic stress disorder (PTSD), emotional dysregulation, and anger. Repeated measures ANOVA and Bonferroni post hoc tests were used to analyze changes over time. A statistical significance of p < 0.005 and p < 0.001 was applied.

RESULTS: Our findings showed significant reduction of anxiety (F = 20.17, p < 0.001), depression (F = 37.03, p < 0.001), anger (F = 95.97, p < 0.001), and emotional dysregulation (F = 76.68, p < 0.001) across all groups of participants. These positive changes were sustained at 6 months post-intervention for anxiety, depression, anger, and emotional dysregulation. In contrast, PTSD symptoms only showed a slight, non-significant reduction over time (F = 0.59, p = 0.44). Additionally, there were no significant differences in outcomes between groups that received the intervention separately (survivor-only or perpetrator only) and those that received it in mixed survivor-perpetrator groups.

CONCLUSION: Although the CRM intervention does not replace psychotherapy, it produced lasting and positive effects on mental health symptoms among both genocide survivors and perpetrators, particularly in reducing anxiety, depression, and emotional dysregulation. Importantly, outcomes did not differ whether the intervention was delivered to separate or combined groups. A randomized controlled trial is recommended to further evaluate the long-term effects of CRM on community healing and cohesion.

PMID:41575623 | DOI:10.1007/s44192-026-00376-w

Aesthetic Plast Surg. 2026 Jan 23. doi: 10.1007/s00266-026-05617-5. Online ahead of print.

ABSTRACT

BACKGROUND: Removal of the skin and preseptal orbicularis oculi is the initial step in upper eyelid surgery. Preseptal orbicularis oculi removal has been strongly associated with dry eye symptoms due to sluggish eyelid closure and lagophthalmos. We aimed to investigate the effects of concurrent upper blepharoplasty and external levator advancement (ELA) surgery with or without orbicularis oculi resection on dry eye syndrome and eyelid morphology in Southeast Asian populations.

METHODS: This prospective, single-centre, double-blind, randomised controlled trial involved 20 Thai patients (40 eyes) with aponeurotic blepharoptosis and excess eyelid skin undergoing combined upper blepharoplasty and ELA surgery. Patients were randomised into a skin-muscle excision group (group A) or a skin-only excision group (group B). Dry eye parameters including tear break-up time, Oxford ocular surface staining, Ocular Surface Disease Index, eyelid appearance, and patient satisfaction were evaluated preoperatively and on postoperative days 7, 30, and 90.

RESULTS: Preseptal orbicularis oculi excision had no statistically significant impact on dry eye parameters, eyelid appearance, or patient satisfaction. For both groups, surgery increased the marginal reflex distance 1 without causing significant lagophthalmos, indicating successful ptosis correction irrespective of muscle excision. There were no discernible differences in postoperative appearance between the two groups, and the patients reported high satisfaction with their treatment.

CONCLUSIONS: Combined upper blepharoplasty and ELA surgery, with or without resection of the preseptal orbicularis oculi, may be a safe and potentially effective procedure for patients with aponeurotic blepharoptosis and excess eyelid skin. Our findings demonstrate no evidence of a difference in correlation between either of these techniques and postoperative dry eye parameters or eyelid appearance. Further studies with larger sample sizes and longer follow-up periods are warranted.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:41575571 | DOI:10.1007/s00266-026-05617-5

Eur Radiol. 2026 Jan 23. doi: 10.1007/s00330-025-12172-1. Online ahead of print.

ABSTRACT

OBJECTIVES: As post-mortem (PM) imaging in children becomes more common, there is a need to review the available evidence for its diagnostic yield in suspected child physical abuse. The aim of this review is to synthesise current evidence, assess study quality, and identify ongoing challenges.

MATERIALS AND METHODS: Following PRISMA guidelines, databases were searched until 31 December 2024. Original research articles reporting data on at least ten children with PM imaging in the context of physical abuse were included. Titles and abstracts were screened by two expert reviewers; full texts were assessed by a third, independent reviewer and one of the previous reviewers. Data was extracted by one of 12 experts and independently verified. The study risk of bias was evaluated with the ROBINS-I tool. Study heterogeneity precluded meta-analysis, resulting in descriptive synthesis.

RESULTS: Eighteen out of 1687 potential papers were included. Seven described PM radiography, five post-mortem computed tomography (PMCT), four both PM radiography plus PMCT, and two post-mortem magnetic resonance imaging (PMMR). All but one were retrospective, and most (11/18, 61%) had a moderate-to-high risk of bias. Post-mortem skeletal survey (PMSS) detected subtle fractures, particularly corner metaphyseal fractures. PMCT provided a high-resolution assessment of injuries, particularly rib fractures. PMMR contributed soft-tissue and intracranial detail. All studies emphasised the importance of correlating autopsy findings. Technical variation and potential biases limited direct comparisons between studies.

CONCLUSION: PM imaging can reveal important injury patterns that may be overlooked by autopsy. Nevertheless, standardised imaging methods and larger prospective trials are needed to reduce bias and establish best-practice guidelines.

KEY POINTS: Question What is the evidence for PM radiologic imaging in suspected physical abuse of children? Findings PM imaging complements autopsy, but diagnostic accuracy varies by modality. Study heterogeneity and bias limit current evidence. Clinical relevance PM imaging can detect injuries missed at autopsy in child abuse cases. Standardised protocols and higher-quality studies are urgently needed.

PMID:41575565 | DOI:10.1007/s00330-025-12172-1

Anaesthesiologie. 2026 Jan 23. doi: 10.1007/s00101-025-01631-5. Online ahead of print.

ABSTRACT

BACKGROUND: A comprehensive transesophageal echocardiography (TEE) examination is nowadays common practice in cardiac surgical procedures. The introduction of 3D technology enables a simultaneous multiplane display of 2D views (X-plane) which can shorten the duration of the TEE examination; however, X‑plane imaging results in a decrease in temporal resolution which can affect the accuracy of routine anatomical linear measurements. The 3D-TEE imaging enables multiplanar reconstruction of 3D datasets and to freely position perpendicular 2D planes to measure anatomical structures more accurately, which has been shown to strongly correlate to computed tomography and magnetic resonance imaging.

OBJECTIVE: Does the integration of multiplane imaging shorten the time of a comprehensive TEE examination without affecting the accuracy of routine 2D anatomical linear measures?

MATERIAL AND METHODS: In a prospective randomized comparative study, patients scheduled for elective cardiac surgery underwent a comprehensive intraoperative TEE examination (Philips CX 50 with X‑72T probe). They were divided into two groups. In the routine protocol (RP) group, the TEE examination was conducted according to the standardized departmental image acquisition protocol, while in the study protocol (SP) group, multiplane views were integrated into the RP to replace the corresponding 2D views. The examinations were conducted by two experienced echocardiographers. At the end of the assigned examination protocol the timer was stopped and the missing views were obtained (2D for the X‑plane and vice versa) as well 3D datasets of the mitral valve, aortic valve and left ventricle. Measurements of mitral and aortic annuli as well as left ventricular length from 2D and X-plane views were subsequently performed offline. Measurements obtained from a multiplanar reconstruction of a full volume (FV) 3D dataset from the same patient were used as the gold standard to compare measurements in RP and SP.

RESULTS: The examination time was significantly shorter in the SP group (SP: 481 ± 60 s; RP 595 ± 60 s; p < 0,001). There was no significant difference for any of the measurements using the SP and RP. The mean percentage error, although not statistically significantly different, was numerically smaller for the X‑plane than for 2D method compared to 3D except for the mitral valve annulus. Overall, X‑plane tended to show lower variability compared to 2D.

CONCLUSION: Integrating multiplane views into a standardized comprehensive TEE image acquisition protocol reduces the examination time. The accuracy of standardized linear measurements in X‑plane mode is comparable to that of conventional 2D imaging.

PMID:41575560 | DOI:10.1007/s00101-025-01631-5

Eur J Nucl Med Mol Imaging. 2026 Jan 23. doi: 10.1007/s00259-026-07772-y. Online ahead of print.

ABSTRACT

INTRODUCTION: We investigated whether prompt changes in prostate-specific-antigen (PSA) levels within two days after the first cycle of prostate-specific-membrane-antigen radioligand therapy (PSMA-RLT) with [¹⁷⁷Lu]Lu-PSMA-617 predicted treatment response and mean survival.

METHODS: In a retrospective study of 76 metastatic castration resistant prostate cancer (mCRPC) patients, we evaluated pretreatment PSA-values and their relative changes in PSA (dPSA) two days later. We tested for correlations between dPSA with long-term biochemical response (BCR) to treatment, using a priori criteria for relevant PSA decrease (dPSA < -10%), stable PSA (-10% ≤ dPSA ≤ + 10%) and relevant PSA increase (dPSA > 10%), along with evaluation of biochemical therapy outcome according to the Prostate-Cancer-Working-Group (PCWG3).

RESULTS: Two days after the first [177Lu]Lu-PSMA-617 cycle, 32 (42%) of the patientsshowed PSA decrease, of whom 19 (59%) had experienced a partial response according toPCWG3 criteria. Of the 37 patients with stable PSA, 17 (46%) showed partial response totreatment according to PCWG3 criteria. Among the seven patients with PSA increase, three(43%) showed partial response. Pearson correlation analysis showed statistically significantcorrelations between dPSA on day 2 and relative Nadir for the first two treatment cycles.Patients with PSA decrease or stable PSA compared to those with an increase of PSA two daysafter cycle 1 lived longer on average (399, 405 and 225 days, respectively).

CONCLUSION: Compared to those with increased PSA levels, patients with decreased or stable PSA levels two days after the first [¹⁷⁷Lu]Lu-PSMA-617 RLT cycle were more likely to have favorable biochemical response according to PCWG3 criteria and presented with a longer overall survival.

PMID:41575546 | DOI:10.1007/s00259-026-07772-y