Category: Statistics

Acad Radiol. 2026 Mar 18:S1076-6332(26)00119-4. doi: 10.1016/j.acra.2026.02.031. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Coronary artery disease is associated with cognitive and neuropsychiatric dysfunction through mechanisms that remain poorly understood. The glymphatic system-a cardiac-driven brain clearance network-may provide a mechanistic link. This study examined whether perivascular diffusivity DTI-ALPS differs between coronary disease patients and controls, correlates with disease severity and symptoms, and responds to revascularization.

METHODS: This cross-sectional study with seven-day post-revascularization follow-up enrolled 90 coronary artery disease patients and 90 matched controls. DTI-ALPS indices were calculated from 3.0 T MRI to assess periventricular water diffusivity. Cognitive function (Mini-Mental State Examination, Montreal Cognitive Assessment), fatigue (Fatigue Severity Scale), and depression (Hamilton Depression Rating Scale) were evaluated. Cardiac disease severity was quantified using myocardial perfusion imaging. Bootstrap mediation analysis examined whether DTI-ALPS statistically accounted for cardiac-symptom associations.

RESULTS: Coronary artery disease patients demonstrated reduced DTI-ALPS indices compared to controls (1.28±0.21 vs 1.38±0.18, P=0.001, Cohen’s d=0.52). DTI-ALPS correlated with cognitive screening performance (r=0.298-0.341, P<0.01) and symptom severity (r=-0.278 to -0.325, P<0.01). Mediation analysis revealed that reduced DTI-ALPS statistically accounted for 14.7-16.8% of cardiac-symptom associations (all bootstrap 95% confidence intervals excluded zero, P<0.05). DTI-ALPS demonstrated dose-response relationships with diseased vessels and myocardial perfusion deficits. Following revascularization, DTI-ALPS increased (P=0.013) alongside trends toward mood improvement, although neuropsychological screening measures did not reach statistical significance.

CONCLUSION: Reduced periventricular diffusivity assessed by DTI-ALPS is associated with both coronary artery disease and neuropsychiatric symptoms, statistically accounting for a modest proportion of their association. These cross-sectional findings suggest potential cardiac-brain clearance pathway connections that require prospective validation.

PMID:41856818 | DOI:10.1016/j.acra.2026.02.031

Acad Radiol. 2026 Mar 12:S1076-6332(25)01164-X. doi: 10.1016/j.acra.2025.12.030. Online ahead of print.

ABSTRACT

PURPOSE: This study assesses whether automated segmentation allows evaluation of subtle changes in volume and intrinsic tissue characteristics in an obese patient population undergoing metabolic surgery.

MATERIALS AND METHODS: Multiorgan segmentation and intrinsic Hounsfield Unit (HU) analyses were performed in 1877 preoperative/postoperative computed tomography (CT) examinations, processing nine compartments, organ systems, and musculoskeletal structures as follows: subcutaneous, peritoneal/retroperitoneal fat, skeletal muscle and liver, spleen, kidneys, pancreas, and first lumbar vertebral body. Statistical assessments utilized Wilcoxon signed-rank test and generalized linear mixed model comparisons successively using volumes and HU as dependent values, preoperative/postoperative state as fixed factor, and gender, age as covariates.

RESULTS: Metabolic surgery led to significant reductions of subcutaneous, retroperitoneal/peritoneal fat volumes averaging 25% and 29%, respectively, p<0.001. Subcutaneous and retroperitoneal/peritoneal fat compartments differed significantly in HU, p<0.001. Postoperative reduction in fat tissue was accompanied by a significant increase in corresponding median HU, increasing by 6% and 8%, respectively, p<0.001. Volumes of liver, spleen, pancreas, and kidneys were significantly impacted by metabolic surgery with intraindividual shrinkages of 7-11% postoperatively, p<0.001. Core striated musculature showed significant decreases in volume, averaging 4%, and a simultaneous significant increase in HU following metabolic surgery, averaging 4%. Throughout, gender was a significant covariate with larger volumes preoperatively, a more substantial volume loss postoperatively, as well as a higher HU increase, all observed in males.

CONCLUSION: Simultaneously, operator-independent and automated compartmental quantitative segmentation allows for assessment of subtle changes in volume and intrinsic structural tissue characteristics over time in patients undergoing metabolic surgery. Our results underline the complex transformation of fat, organs, and muscles after surgery-induced weight loss.

PMID:41856817 | DOI:10.1016/j.acra.2025.12.030

Geriatr Gerontol Int. 2026 Mar;26(3):e70458. doi: 10.1111/ggi.70458.

ABSTRACT

AIM: This study aimed to investigate how changes in outpatient care during the coronavirus disease (COVID-19) pandemic affected the quality of medical care provided by Japanese physicians.

METHODS: A cross-sectional, anonymous online survey was conducted among members of the Japan Geriatrics Society between October and December 2022. Physicians were asked about changes in outpatient care and their perceived impact on the quality of care. Descriptive statistics, χ² tests, and multivariate logistic regression analyses were used to examine the relationships between care changes and perceived declines in care quality.

RESULTS: Of the 321 respondents, 135 (42.1%) reported that the quality of their medical care was negatively affected during the pandemic. Significant associations were found between the perceived decline in care quality and a decrease in the number of new outpatients at outpatient clinics, extended intervals between return visits, and conduct of outpatient telephone consultations. Extended intervals between return visits and conduct of outpatient telephone consultations were also independently associated with difficulties in understanding patients’ conditions and living situations. These relationships remained significant after adjusting for covariates, such as physician experience and facility type.

CONCLUSIONS: Changes in outpatient care during the COVID-19 pandemic, particularly extended intervals between return visits and conduct of outpatient telephone consultations, were significantly associated with a decline in physician-perceived care quality. These disruptions impair physicians’ ability to assess patients comprehensively and underscore the need to maintain continuity of care and holistic evaluation practices, especially for older adults, during public health emergencies.

PMID:41856799 | DOI:10.1111/ggi.70458

eNeuro. 2026 Mar 19:ENEURO.0060-26.2026. doi: 10.1523/ENEURO.0060-26.2026. Online ahead of print.

ABSTRACT

The retina encodes a broad range of stimuli, adapting its computations to features like brightness, contrast, and motion. However, it is unclear whether it also adapts when switching between natural scenes and white noise. To address this, we analyzed the neural activity of male marmoset retinal ganglion cells (RGCs) in response to white noise and naturalistic movies. We trained linear-nonlinear models on both stimuli, evaluated their performance, and compared their receptive fields across stimulus domains. We found that models with spatial filters trained on one stimulus ensemble were less accurate when predicting neural activity on the other compared to models trained directly on the target stimulus. This suggests that spatial processing adapts to stimulus statistics. Different RGC types exhibited distinct changes: The OFF midget cells’ receptive fields became enlarged under natural movies, resulting in a lower cutoff frequency. Parasol cells and large OFF cells did not significantly change their receptive field sizes. All cell types exhibited stronger surrounds under natural movies, resembling the whitening filters predicted by efficient coding for stimulus decorrelation, prompting us to test whether these changes were related to the different spectral content of the two stimulus types. Quantifying the effects of the filters’ enhanced surrounds on the stimulus power spectrum showed a significant contribution towards whitening only in ON parasol cells, where a whitening effect emerged regardless of the training stimulus. These results suggest that while RGCs adapt to the differences between white noise and natural movie stimuli, efficient coding can only partially account for this adaptation.Significance statement Natural scenes differ from artificial stimuli in many properties, including spatial frequency structure. How the retina adapts to these differences remains unclear. To explore this, we studied responses of four primate retinal ganglion cell types to white noise and natural stimuli and compared their receptive field properties. We found that midget cells enlarge their receptive field centers and strengthen their surrounds under natural stimulation, whereas others show enhanced surrounds without center size changes. These modifications qualitatively match predictions of efficient coding based on differences in stimulus power spectra. However, in three of four cell types, stronger surrounds did not substantially whiten responses to natural movies, contrary to theoretical expectations. Thus, efficient coding alone cannot fully account for retinal adaptation mechanisms.

PMID:41856791 | DOI:10.1523/ENEURO.0060-26.2026

Laryngoscope. 2026 Mar 19. doi: 10.1002/lary.70511. Online ahead of print.

ABSTRACT

OBJECTIVE: High volume centers are trialing delayed extubation (DE) as an alternative management strategy to tracheostomy in patients undergoing head and neck reconstruction to bypass the pharyngolaryngeal oedema and ensure unobstructed ventilation. There remains a paucity of synthesized evidence in this area.

DATA SOURCES: This study represents the largest systematic review on this topic from databases including PubMed, Embase, and Scopus.

REVIEW METHODS: Review is conducted through JBI’s methodology for systematic reviews of effectiveness with findings reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A meta-analysis was conducted using the Mantel-Haenszel statistical method with risk ratios and 95% confidence intervals calculated.

RESULTS: For tracheostomy patients, weighted mean hospital and intensive care stay was 13.3 and 1.83 days respectively. For DE, the results were 12.25 and 1.47 days respectively. Meta-analysis for airway complications was statistically significant with a risk ratio of 4.14 (95% CI, 2.67-6.40) favoring the DE group. Risk ratio for flap complications was significant at 8.19 (95% CI, 3.41-19.65) favoring the DE group. One study reported overall survival and disease-free survival at 88.2% and 68.3% for tracheostomy group respectively, compared to 95.7% and 89.1% in the DE cohort.

CONCLUSION: Tracheostomy can no longer be considered routine and poses risks which should be considered in a shared decision-making model with the patient and assessed within a multidisciplinary setting. This study also highlights the emergence of DE, which can be considered in select patient populations. Further RCTs are required in this area.

PMID:41856784 | DOI:10.1002/lary.70511

Acta Anaesthesiol Scand. 2026 Apr;70(4):e70227. doi: 10.1111/aas.70227.

ABSTRACT

INTRODUCTION: Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals’ perceptions of rehabilitation activities in the ICU and to explore their self-reported estimates of the time devoted to these activities in Scandinavian ICUs.

METHODS: A cross-sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post-ICU rehabilitative services.

RESULTS: In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care.

CONCLUSION: Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities.

EDITORIAL COMMENT: This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.

PMID:41856774 | DOI:10.1111/aas.70227

Br J Ophthalmol. 2026 Mar 19:bjo-2025-328651. doi: 10.1136/bjo-2025-328651. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: To determine the proportion of progressive retinal nerve fibre layer thickness (RNFLT) change that can be attributed to normal ageing.

METHODS: This prospective, longitudinal, cohort study included one eye each of 200 patients treated for open-angle glaucoma and 73 healthy control subjects who were followed with optical coherence tomography (OCT) every 6 months. A linear mixed-effects (LME) model was used to estimate the mean RNFLT slope and the difference between the two groups to evaluate factors affecting the slope, while adjusting for other variables.

RESULTS: The median (IQR) age and follow-up of all participants was 68.3 (61.8 to 74.7) years and 10.1 (6.4 to 12.9) years, respectively. The median baseline mean deviation in patients with glaucoma was -3.79 (-6.84 to -1.57) dB. Among those classified within normal limits for baseline RNFLT (39 (19.5%) patients with glaucoma and 68 (93.2%) healthy subjects), the individual RNFLT slopes were significantly steeper in patients with glaucoma (median, -0.76 (-1.13 to -0.49) µm/year) compared with healthy subjects (-0.51 (-0.72 to -0.19) µm/year, p<0.01). The LME model showed a statistically significant negative RNFLT slope in healthy subjects (-0.54 µm/year, p<0.01). After adjusting for covariates, diagnosis of glaucoma contributed an additional -0.47 µm/year (p<0.01). Baseline global RNFLT had a slightly negative impact on RNFLT slope (-0.01/year, p<0.01), while baseline age had a significant positive effect (0.01 μm/year², p<0.01).

CONCLUSIONS: Normal ageing contributed around one half of RNFLT thinning observed in patients treated for glaucoma.

PMID:41856770 | DOI:10.1136/bjo-2025-328651

BMJ Open Respir Res. 2026 Mar 19;13(1):e004065. doi: 10.1136/bmjresp-2025-004065.

ABSTRACT

INTRODUCTION: Sarcoidosis frequently involves intrathoracic lymph nodes and lung parenchyma and requires histological confirmation for diagnosis. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended for obtaining mediastinal samples, its diagnostic yield frequently necessitates additional transbronchial lung biopsy (TBLB) and/or endobronchial biopsy (EBB). EBUS transbronchial mediastinal cryobiopsy (EBUS-TBMC) can yield larger, well-preserved tissue samples than EBUS-TBNA alone. However, whether EBUS-TBMC alone is equivalent to conventional multimodal sampling (EBUS-TBNA combined with TBLB and/or EBB), and whether TBLB and EBB provide incremental diagnostic value when added to EBUS-TBMC, is still unclear.

METHODS AND ANALYSIS: In this study, 410 patients with suspected stage I/II sarcoidosis will be randomly assigned in a 1:1 ratio to either the EBUS-TBMC or EBUS-TBNA group. All participants will then undergo TBLB and EBB. The primary outcome will be the granuloma detection rate. The diagnostic sensitivity, negative predictive value and procedure-related complications will be selected for secondary outcomes. Statistical analysis will be performed using SPSS V.24.0, with non-inferior testing for the primary comparison.

ETHICS AND DISSEMINATION: Approval for this DETECTION-SAR-II trial was obtained by the China-Japan Friendship Hospital Ethics Committee (Ethics number: 2025-KY-075). Participants will be fully informed of objectives, protocol and potential risks of the study before enrolment and will provide written informed consent.

TRIAL REGISTRATION NUMBER: NCT07246876.

PMID:41856756 | DOI:10.1136/bmjresp-2025-004065

Fam Med. 2026 Jan;58(1):20-26. doi: 10.22454/FamMed.2026.956887.

ABSTRACT

BACKGROUND AND OBJECTIVES: Family medicine residency faculty occupy multiple roles with residents, including teacher, adviser, evaluator, and supervisor. Faculty also might fill noncurricular roles in social settings and in providing health care services to residents. These overlapping responsibilities create potential for dual relationships that may blur boundaries and cause ethical concerns. While national guidelines prohibit overtly inappropriate relationships, little guidance exists for common noncurricular interactions. This study examined the prevalence, types, and consequences of faculty-resident dual relationships and assessed faculty awareness of related policies.

METHODS: We conducted a convergent mixed-methods survey of US family medicine faculty that included demographic items, questions about specific dual relationships and policy awareness, and an open-ended prompt concerning boundary crossings. Quantitative data were analyzed using descriptive statistics and χ2 tests; qualitative responses underwent thematic analysis.

RESULTS: We received 213 responses. Frequently reported dual relationships included social comingling (68%), provision of minor medical or behavioral services (54%), and personal relationships (36%); financial or contractual ties were rare (≤3%). We observed significant differences by faculty type: Behavioral health faculty were more likely to provide minor services (P = 0.004), while physician faculty more often provided intensive services (P = 0.011). Awareness of residency policies was low. Qualitative responses highlighted boundary crossings with negative impacts on residents, faculty, and programs.

CONCLUSIONS: Dual relationships are common in family medicine residencies, yet policy guidance is limited. Stronger institutional and professional guidelines would support resident wellness, faculty objectivity, and professional boundaries.

PMID:41854849 | DOI:10.22454/FamMed.2026.956887

Fam Med. 2026 Jan;58(1):12-19. doi: 10.22454/FamMed.2026.646169.

ABSTRACT

BACKGROUND AND OBJECTIVES: Maternal care in the United States is in crisis due to obstetrics workforce shortages. Family physicians, with whole-person training and geographical practice distribution, are well-positioned to address this crisis. Family physicians completing a family medicine obstetrics (FMOB) fellowship are trained in surgical skills and high-risk pregnancy management, and often practice in health care shortage areas. This study aimed to update and expand knowledge on FMOB fellowships, focusing on program characteristics and financial sustainability.

METHODS: We sent an email-based survey examining fellowship structure and financial information to 44 FMOB fellowships. Representatives of 22 fellowships (50%) anonymously completed the online survey. Authors used descriptive statistics, including frequency, mean, and standard deviation, to summarize the data.

RESULTS: Half the fellowships were housed in family medicine residency programs. Fellowships, mostly 1 year long, admitted on average 2.2 fellows annually. Financially, nearly half (45%) the fellowships operated at a budget deficit, with clinical revenue and federal funding being major funding sources. More than 50% of programs reported that fellows spent less than 20% of their time as an independent billing physician.

CONCLUSIONS: FMOB fellows are surgically trained and uniquely positioned to help address the current crisis, including filling obstetric care gaps in underserved and rural areas. Given funding challenges FMOB fellowships face, developing strategies for financial viability of FMOB fellowships going forward is crucial. Opportunities include increasing clinical revenue generation and attaining secure funding via pursuit of accreditation status for FMOB fellowship programs from the Accreditation Council for Graduate Medical Education.

PMID:41854848 | DOI:10.22454/FamMed.2026.646169