Category: Statistics

Dtsch Arztebl Int. 2025 Apr 18;(Forthcoming):arztebl.m2025.0015. doi: 10.3238/arztebl.m2025.0015. Online ahead of print.

ABSTRACT

BACKGROUND: It is important for patients with back pain to be well-informed. The well-informed patient is better prepared for self-management and for joint decision-making with the physician. This is why we developed tala-med, a web portal providing up-to-date, evidence-based, independent information on back pain. Primary care physicians can use it in their practices and make it accessible to their patients.

METHODS: A cluster randomized controlled trial (registration number DRKS00014279) was carried out in which the primary care physicians (PCPs) in the intervention group (IG: 33 physicians) were directed to use the tala-med web portal in their consultations with patients who had back pain (180 patients). The PCPs in the control group (CG: 12 physicians) were not given access to tala-med and treated their patients with back pain (136 patients) as they had done before. The patients’ informedness about back pain was the primary endpoint: it was assessed by the patients themselves in terms of their subjective degree of knowledge and subjective state of informedness about back pain. Pain intensity, the second endpoint, was assessed with a visual analog scale.

RESULTS: Intention-to-treat analyses revealed that the patients’ subjective degree of knowledge about back pain increased to a greater extent in the intervention group than in the control group (B = 0.25, 95% confidence interval [0.07; 0.43]), as did their subjective state of informedness about back pain (B = 0.51 [0.13; 0.89]). Patients in the intervention group also reported a larger reduction of pain intensity compared to patients in the control group (B = -10.46 [-18.52; -2.38]).

CONCLUSION: Use of the tala-med web portal by primary care physicians and their patients made patients better informed about back pain and lessened the intensity of their pain. These improvements, although statistically significant, were not large enough to be clinically important.

PMID:40152763 | DOI:10.3238/arztebl.m2025.0015

Scand J Gastroenterol. 2025 Mar 28:1-13. doi: 10.1080/00365521.2025.2479193. Online ahead of print.

ABSTRACT

BACKGROUND: This meta-analysis and trial sequential analysis (TSA) aimed to evaluate the efficacy and safety of triple therapy with tyrosine kinase inhibitors (TKIs) combined with transcatheter arterial chemoembolization (TACE) plus programmed death 1 (PD-1) inhibitors (T-T-P) and dual therapy with TKIs combined with TACE (T-T) for the treatment of advanced unresectable hepatocellular carcinoma (uHCC).

METHODS: Literature related to the efficacy of TKIs combined with TACE plus PD-1 inhibitors in uHCC was searched using the Embase, PubMed, and Cocrane libraries. TSA was used to reduce false positive results due to random error.

RESULTS: Seventeen articles were included in this meta-analysis, including 2,561 patients. In the T-T-P group, OS [HR 0.45, 95% confidence interval (CI) 0.39-0.52; p = 0.000], PFS [HR 0.43, 95% CI 0.38 – 0.48; p = 0.000], were significantly prolonged compared to those in the T-T group; ORR (RR 1.59 [95% CI 1.39-1.81]; p = 0.000) and DCR (RR 1.26 [95% CI 1.15-1.37]; p = 0.000) were significantly higher. TSA analysis showed early results without further testing. Prognostic factor analysis demonstrated that portal vein tumor thrombus (PVTT) and extrahepatic metastasis were common independent risk factors for OS and PFS. Regarding grade 3/4 adverse events results showed no statistically significant differences in any of them.

CONCLUSIONS: Compared with T-T treatment group, the T-T-P treatment group exhibited a notable improvement in OS and PFS, particularly in cases of PVTT and extrahepatic metastasis. Furthermore, it can markedly enhance the ORR and DCR in patients with uHCC.

PMID:40152031 | DOI:10.1080/00365521.2025.2479193

Clin Physiol Funct Imaging. 2025 May;45(3):e70005. doi: 10.1111/cpf.70005.

ABSTRACT

PURPOSE: Inasmuch as they are deemed valid, noninvasive measurement of cardiac output techniques present advantages of ease and safety for use in humans. Few studies have compared the use of thoracic bioimpedance and inert gas rebreathing techniques for cardiac output (CO) assessment at rest and exercise. This manuscript reports on differences between Physioflow® and Innocor® CO measurements at rest and during cycling in a population of healthy subjects.

METHODS: Fifty healthy subjects (52 ± 16 years) underwent an incremental cycle exercise testing (IET) during which standardized Physioflow® and Innocor® CO assessments were achieved. Measurements were completed in a subgroup of twelve subjects during two constant-load 10-min cycling bouts at moderate and high intensities.

RESULTS: Mean difference between Physioflow® and Innocor® was of 0.002 ± 0.98 l/min at rest and 0.38 ± 1.31 l/min during IET without statistical difference. Correlation coefficient values were higher for exercise (r = 0.83) than resting (r = 0.40) measurements. Good reproducibility of the two devices was observed on different graded exercises with intraindividual variability lower than 6%, except for rest Innocor® CO measurements (CV = 18%).

CONCLUSION: Physioflow® and Innocor® can be easily used concomitantly for noninvasive measurement of CO. Despite finding a strong agreement between techniques for exercise CO, results should not be interpreted as being interchangeable as values are derived from different flow measurements: systemic blood flow for Physioflow® and pulmonary blood flow for Innocor®. However, the concomitant use of both techniques could be of value in clinical setting for noninvasive intrathoracic shunt quantification.

PMID:40152027 | DOI:10.1111/cpf.70005

J Back Musculoskelet Rehabil. 2025 Mar 28:10538127251324728. doi: 10.1177/10538127251324728. Online ahead of print.

ABSTRACT

BackgroundPes planus is characterized by the flattening of the medial longitudinal arch of the foot, which can alter the biomechanics of the lower extremities and affect overall athletic performance. This randomized double-blinded controlled study was designed to investigate the effects of pes planus on jumping and balance performance.MethodsOne hundred thirty-one participants were assigned to the pes planus group (n = 66) and the control group (n = 65). Foot posture index (FPI) was used to determine pes planus. The vertical jump was measured by the VertiMetric device; horizontal jump performance by using the single leg hop test. Y Balance Test (YBT) was used to evaluate dynamic balance. The Mann-Whitney U test has been used for comparison of the groups and the alpha level is set at 0.05.ResultsVertical jump results of the pes planus group have been found statistically lower compared to the control group (p < 0.05). However, there were no statistically significant differences in the horizontal jump and YBT measurements between groups (p > 0.05). A weak negative correlation was found between the vertical jump distance and FPI scores (p < 0.05). There was a significant weak positive relationship between the FPI scores and anterior parameter of YBT in both sides (p < 0.05) and there were no statistically significant correlations between the posteromedial and posterolateral parameters in both sides (p > 0.05).ConclusionPes planus is associated with the only anterior reach of YBT, and vertical jumping performance; therefore, it is recommended to include strengthening and correction exercises for pes planus to improve vertical jumping performance and reduce risk of injuries.

PMID:40152012 | DOI:10.1177/10538127251324728

Asian Cardiovasc Thorac Ann. 2025 Mar 28:2184923251328119. doi: 10.1177/02184923251328119. Online ahead of print.

ABSTRACT

IntroductionInfective endocarditis (IE) is a severe infection of the endocardium, primarily affecting the heart valves, exhibiting high morbidity and mortality rates. Cardiac surgery for IE with cardiopulmonary bypass (CPB) can further exacerbate the inflammatory response and cytokine production from IE. The current meta-analysis evaluates the use of CytoSorb^® hemoadsorption in IE patients undergoing cardiac surgery to determine its efficacy in reducing inflammatory mediators and improving clinical outcomes.MethodsPubMed, Cochrane, Google Scholar, Clinical Trials, and Google Scholar were searched for articles until July 2024. After performing a risk of bias and quality assessment, data on operative times, mortality, and morbidity were extracted for meta-analysis. Statistical Software R (version 4.4.0) was used to calculate odds ratio (OR) and standardized mean differences using a random-effect model with a 95% confidence interval (CI) and p-value less than 0.05.ResultsEight studies, encompassing 1076 patients, were included in the analysis. These comprised three randomized controlled trials and five nonrandomized studies. The majority of these studies exhibited some concerns regarding bias. Hemoadsorption group showed lower discharge mortality (OR: 0.58, 95% CI: 0.33-1.00, p = 0.05) compared to controls, but no significant disparity is observed in other outcomes. In-hospital outcomes also showed higher heterogeneity, with an I² value greater than 50%.ConclusionCytoSorb use in patients undergoing cardiac surgery with CPB used for IE has no impact on operative mortality and morbidity but has a beneficial effect on discharge mortality.

PMID:40152004 | DOI:10.1177/02184923251328119

J Med Internet Res. 2025 Mar 7. doi: 10.2196/69351. Online ahead of print.

ABSTRACT

BACKGROUND: Escalating mental health demand exceeds existing clinical capacity, requiring scalable digital solutions. However, engagement remains challenging. Conversational agents enhance engagement by making digital programs more interactive and personalized but have not been widely used. This study evaluated a digital program for anxiety against external comparators. The program used an AI-driven conversational agent to deliver clinician-written content via machine learning, with clinician oversight and user support.

OBJECTIVE: This study aimed to evaluate the engagement, effectiveness, and safety of this structured, evidence-based digital program with human support for mild, moderate and severe generalized anxiety. Statistical analyses aimed to determine whether the program reduced anxiety more than a propensity-matched waiting control and was statistically non-inferior to real-world propensity-matched face-to-face and typed cognitive behavioral therapy (CBT).

METHODS: Prospective participants (N=299) were recruited from the NHS or social media in the UK and given the digital program to use for up to 9 weeks (study conducted from October 2023 to May 2024). Endpoints were collected before, during and after the digital program, and at one-month follow-up. External comparator groups were generated through propensity-matching of the digital program sample with NHS Talking Therapies (NHS TT) data from ieso Digital Health (typed-CBT) and Dorset Healthcare University NHS Foundation Trust (DHC) (face-to-face CBT). Superiority and non-inferiority analyses were conducted to compare anxiety symptom reduction (change on GAD-7 scale) in the digital program group and the external comparator groups. The program included human support and clinician time spent per participant was calculated.

RESULTS: Participants used the program for a median of 6 hours over 53 days, with 78% (n=232) engaged (i.e. completed a median of 2 hours over 14 days). There was a large clinically meaningful reduction in anxiety symptoms for the digital program group (per-protocol (PP; n=169): change on GAD-7 = -7.4, d = 1.6; intention-to-treat (ITT; n=299): change on GAD-7 = -5.4, d=1.1). The PP effect was statistically superior to the waiting control (d = 1.3), and non-inferior to the face-to-face CBT group (p <.001) and the typed-CBT group (p <.001). Similarly, for the ITT sample, the digital program showed superiority to waiting control (d=0.8) and non-inferiority to face-to-face CBT (p=.002) with non-inferiority to typed-CBT approaching significance (p=.06). Effects were sustained at one-month follow-up. Clinicians overseeing the digital program spent a mean of 1.6 hours (31 – 200 minutes) of clinician time in sessions per participant.

CONCLUSIONS: By combining AI and human support, the digital program achieved clinical outcomes comparable to human-delivered care while significantly reducing the required clinician time by up to 8 times relative to global care estimates. These findings highlight the potential of technology to scale evidence-based mental healthcare, address unmet need, and ultimately impact quality of life and economic burden globally.

CLINICALTRIAL: ISRCTN id: 52546704.

PMID:40152000 | DOI:10.2196/69351

Phys Chem Chem Phys. 2025 Mar 28. doi: 10.1039/d5cp00646e. Online ahead of print.

ABSTRACT

The more than 100-year-old Debye-Hückel theory displays the most widely used approach for modeling ionic activities in electrolytes. The Debye-Hückel theory finds widespread application, such as in equations of state and Onsager’s theory for conductivities. Here, a theoretical inconsistency of the Debye-Hückel theory is discussed, which originates from the employed Poisson-Boltzmann framework that violates the statistical independence of states presumed for the Boltzmann statistics. Furthermore, the static permittivity of electrolytic solutions is discussed as not directly measurable, while common methods for its extraction from experimental data are assessed as erroneous. A sensitivity analysis of modeled activity coefficients with respect to the permittivity and ionic radii as input parameters is conducted, showing that their influences overshadow physicochemical differences of common variations of Debye-Hückel models. Eventually, this study points out that the justification of the traditional and still often used Debye-Hückel models by experimental validation is affected by fitting ambiguities that eventually impede its predictive capabilities.

PMID:40151984 | DOI:10.1039/d5cp00646e

Popul Health Manag. 2025 Mar 28. doi: 10.1089/pop.2024.0232. Online ahead of print.

ABSTRACT

Virtual urgent care (VUC) and emergency department at home (ED at home) are two emerging interventions that may help address avoidable health care costs driven by inadequate access to primary care. This study evaluates the integration of VUC and ED at home as a combined mobile integrated care program, into a value-based primary care model that serves Medicaid and dual-eligible populations. Use of embedded VUC and ED at home among individuals with claim-identified physical health needs was associated with a statistically significant 27% reduction in inpatient admissions (P = 0.05), a 61% reduction in readmission (P = 0.04), and a 240% increase in engagement with primary care and care coordination (P < 0.001). Use of these services was also associated with a total cost of care decrease of $550 per member per month (P = 0.07). Findings suggest that virtual and home-based acute care services may be a promising lever for value-based payment models to enhance engagement and realize goals of improved cost and outcomes among populations with complex medical and social needs.

PMID:40151977 | DOI:10.1089/pop.2024.0232

Occup Ther Health Care. 2025 Mar 28:1-17. doi: 10.1080/07380577.2025.2482929. Online ahead of print.

ABSTRACT

This study measured the effectiveness and feasibility of therapeutic drumming for autistic children, targeting the meaningful occupational components of authentic social and personal participation of children. A 6-week therapeutic drumming intervention was implemented interprofessionally in two early-childhood classrooms with ten autistic children (N = 10), ages two through six. Two outcome measures were completed pre- and post-intervention: the Behavior Assessment System for Children, Third Edition (BASC-3), the Social and Personal Relationship Scale (SPRS). Descriptive statistics on pre- and post-intervention mean scores were generated and Wilcoxon signed rank tests were used to determine the areas where mean score changes were statistically significant. Significant differences were found between each component of the SPRS, and on two BASC-3 subsections (e.g. response to teacher, transition movement). Misalignment between language on the BASC-3 and neurodiversity affirming practice was identified as a notable limitation of the study. Feedback collected from lead facilitators regarding efficacy and implementation feasibility was collected via interview following the program. The implication of this pilot study provides preliminary evidence supporting the effectiveness and feasibility of therapeutic drumming, which must be further explored.

PMID:40151974 | DOI:10.1080/07380577.2025.2482929

Conserv Biol. 2025 Mar 28:e70016. doi: 10.1111/cobi.70016. Online ahead of print.

ABSTRACT

Wild game harvesting in Amazonia provides rural residents with protein and cash income but can threaten wildlife populations and forest ecosystem functions. As yet, the socioeconomic and environmental drivers that shape hunter livelihoods remain poorly understood. We studied hunting behavior in the Peruvian Amazon through a quantitative characterization of hunters accounting for community and household factors. Data on livelihood activities from a sample of nearly 3800 households in 232 stratified and randomly selected communities were drawn from a survey of the environmental and socioeconomic characteristics of 919 communities. Our double-hurdle model (i.e., 2-stage statistical model that describes whether a household participates in an activity and the amount they participate) separated household game harvesting decisions into 2 parts: first, based on a selection equation that estimated the decision to engage in hunting as a livelihood strategy and, second, based on a truncated lognormal regression equation that estimated total amount of game harvested by households engaged in hunting. We found that 28% of households surveyed reported hunting and that community factors, such as forest cover and distance to the city, drove hunting participation and harvests, although the factors predicting whether a household hunted differed from those that explained game harvests. Household traits, including initial land assets and household head age, were helpful in identifying hunters in communities. Government and nongovernmental organizations should consider socioeconomic and ecological interactions beyond the individual hunter when developing conservation initiatives. Informed targeting of communities in remote areas of Amazonia promises better allocation of scarce resources for wildlife conservation.

PMID:40151970 | DOI:10.1111/cobi.70016