Category: Statistics

BMJ Neurol Open. 2026 Feb 12;8(1):e001481. doi: 10.1136/bmjno-2025-001481. eCollection 2026.

ABSTRACT

BACKGROUND: Oscillatory whole-body vibration (WBV) training improves strength and movement skills in healthy adults and individuals with various medical conditions. Studies examining the effects of WBV on gait disorder in people with multiple sclerosis (PwMS) of progressive disease form (progressive MS (PMS)), however, produced inconsistent results.

OBJECTIVES: To assess the feasibility and explore effects of WBV training on spastic gait in PwMS.

DESIGN AND METHODS: Single-centre randomised, single-blind, pilot study involving 30 PwMS with mild-to-moderate spastic gait disorder (Expanded Disability Status Scale (EDSS) 3.0-6.5). Patients were randomised 1:1 into arm 1 (12-week standard-of-care before WBV) and arm 2 (immediate WBV). WBV was delivered using a side-alternating Galileo Med 25 TT platform as a home-training programme, complemented by a standardised exercise protocol. The primary endpoint was the 6-minute walking distance (6MWD).

RESULTS: The distribution between arms concerning age, sex, body mass index, EDSS and baseline 6MWD was balanced. Adherence to the protocol was similar across both arms, with 70% of all patients completing all three study visits, with four dropouts per arm. Efficacy analyses included participants completing ≥50% of WBV sessions, comprising 17 participants (57%). 67% of all participants experienced AEs, which were equally distributed across both groups and not severe. Participant satisfaction with the intervention was high, with 70% indicating willingness to repeat the training. After 12 weeks of WBV training, a non-significant numerical increase in median 6MWD was observed. Patient-reported spasticity, assessed using the MSSS88 (Multiple Sclerosis Spasticity Scale), showed a non-significant numerical decrease following WBV.

CONCLUSIONS: In this exploratory pilot study, we could demonstrate feasibility of a WBV intervention study in PwMS. As only 57% of the participants were able to complete the per-protocol training specifications, larger studies that intend to explore the efficacy of the WBV intervention in PMS should consider a less ambitious and a more individualised training protocol.

TRIAL REGISTRATION NUMBER: DRKS00022962.

PMID:41710925 | PMC:PMC12911677 | DOI:10.1136/bmjno-2025-001481

Front Microbiol. 2026 Feb 3;17:1741007. doi: 10.3389/fmicb.2026.1741007. eCollection 2026.

ABSTRACT

Brucellosis in water buffalo remains endemic in southern Italy, particularly in areas of the province of Caserta characterized by high animal density. This retrospective cohort study (2016-2021) assessed the effectiveness of stamping out (whole-herd depopulation) versus selective culling in counteracting brucellosis in water buffalo herds. Data from 222 outbreaks were analyzed using Cox regression, incorporating herd size, buffalo density, eradication method, and co-infection with Mycobacterium bovis. Stamping out reduced reinfection risk by 80% (HR = 0.2; p < 0.001), especially in municipalities exceeding 200 buffaloes/km². Co-infection with M. bovis was not statistically associated with reinfection. These results indicate that control strategies should prioritize stamping out, coupled with reinforced structural and operational biosecurity measures, even in high-density settings, to achieve disease-free status. Integrated surveillance and education, in line with One Health principles, are essential for sustainable eradication and protection of the buffalo dairy sector.

PMID:41710922 | PMC:PMC12909548 | DOI:10.3389/fmicb.2026.1741007

JAC Antimicrob Resist. 2026 Feb 17;8(1):dlag016. doi: 10.1093/jacamr/dlag016. eCollection 2026 Feb.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the impact of switching population pharmacokinetic models used for model-informed precision dosing (MIPD) of vancomycin on target attainment, acute kidney injury rates, dosing, and sampling burden in 90 295 patients across nineteen hospital systems.

METHODS: We assessed sites that changed their default vancomycin MIPD model on primary endpoints, including vancomycin area under the concentration-time curve (AUC) target attainment, time to target attainment, and vancomycin-associated AKI rates using an interrupted time series model. Secondary endpoints included vancomycin dosing (day 1 and total course) and sampling frequency. Hospital systems that did not change models served as controls.

RESULTS: In BMI < 40 kg/m² patients, the Goti-to-Thomson model transition significantly improved AUC target attainment on day 1 (+2.1%, P < 0.001), day 2 (+3.1%, P < 0.001), and across the whole treatment course (+2.7%, P < 0.001). Small increases occurred in vancomycin sampling per course (+0.06 samples/course, P < 0.05) and time to target attainment (+0.26 hours, P < 0.05). AUC improvements occurred without statistically significant increases in AKI incidence (KDIGO Stage 1: +0.314%, P > 0.05/3; Stage 2: +0.347%, P > 0.05/3, Stage 3: +0.034%, P > 0.05/3). No significant differences were observed in the BMI ≥ 40 kg/m² or control cohorts.

CONCLUSIONS: This large quasi-experimental study shows that switching from one pair of well-validated and highly predictive models to another improves vancomycin target attainment while maintaining low adverse event rates.

PMID:41710913 | PMC:PMC12910383 | DOI:10.1093/jacamr/dlag016

Front Oral Health. 2026 Feb 3;7:1759348. doi: 10.3389/froh.2026.1759348. eCollection 2026.

ABSTRACT

BACKGROUND: Despite increasing interest in patient-reported outcomes in implant dentistry, there is a lack of consensus on tool selection and outcome prioritization to assess patient-reported outcomes in implant dentistry. This study validates an instrument designed to support clinicians in evaluating patient experience and knowledge for personalized implant therapy.

METHODOLOGY: Patients with dental implants that had been functioning for at least one year were included in this cross-sectional study. A five-point Likert questionnaire (Implant Treatment Experience and Knowledge Scale; ITEKS) was administered to measure patients’ perceived knowledge of peri-implant health/disease and their satisfaction with the treatment. The reliability of the questionnaire was analyzed using Cronbach’s alpha. Exploratory factor analysis was used to examine the underlying structure of the questionnaire. Correlations between the OHIP-14, a widely used instrument for assessing oral health-related quality of life, and the administered scales were analyzed to examine convergent validity. The potential influence of patient-related factors (age, gender, education, source of information, and peri-implant diagnosis) was investigated.

RESULTS: A 28-item tool was used to assess dental implant treatment related awareness, satisfaction, post-treatment attitudes, and the etiology, treatment, and risk factors of peri-implantitis. The mean functional time of dental implants was 6.69 years. Psychometric properties were evaluated using exploratory factor analysis and Cronbach’s alpha. Cronbach’s alpha values for these tools were.864 and.779, respectively. Peri-implantitis was significantly associated with decreased patient satisfaction (p < .001). No statistically significant gender differences were observed for OHIP, Implant Treatment Experience Metric (ITEM), or Implant Patients Knowledge-Awareness Scale (IPKAS) scores (p > .05). Participants with advanced education exhibited significantly higher ITEM scores than those with basic education (p = .028). Furthermore, OHIP scores were significantly higher in the peri-implantitis group compared to both the peri-implant health and peri-implant mucositis groups (p < .001). Conversely, ITEM scores were significantly lower in the peri-implantitis group compared to the health and mucositis groups (p < .001).

CONCLUSIONS: The instrument demonstrated methodological suitability for assessing patient-related outcomes in individuals undergoing implant treatment, as confirmed by reliability and validity tests. These results indicate that the ITEKS is a reliable and valid instrument for assessing patient experience in implant dentistry.

PMID:41710907 | PMC:PMC12909526 | DOI:10.3389/froh.2026.1759348

Acad Med. 2026 Feb 18:wvag045. doi: 10.1093/acamed/wvag045. Online ahead of print.

ABSTRACT

PURPOSE: The gender composition of the physician workforce in the United States (US) is constantly evolving. This study aimed to determine how female physician representation has changed from 2014-2024 with attention to geographic and temporal trends.

METHOD: Data were obtained on US physicians from the Centers for Medicare and Medicaid Services (CMS) Doctors and Clinicians national downloadable file (2014-2024). Pediatricians were excluded due to Medicare data limitations. Gender diversity was quantified using the Gender Diversity Index (GDI), a metric that relates to the likelihood that two randomly selected providers in a given area are of different genders. Local Indicators of Spatial Association (LISA) mapping of counties identified statistically significant areas with higher and lower GDIs than average.

RESULTS: Female physician representation across the US rose in 2014 from 159,850 (28.7%) to 224,377 (34.9%) in 2024, and the mean GDI per state rose from 79.4 in 2014 to 88.7 in 2024 (P <.001). Female physician representation increased from 2014 to 2024 in urban areas from 142,354 (29.7%) to 198,667 (36.3%) and in rural areas from 17,496 (22.5%) to 25,710 (26.7%). Clustering revealed GDI “hotspots” primarily in the Northeast, West Coast, and other urban hubs, with “coldspots” concentrated in the Midwest and South.

CONCLUSIONS: Although there have been broad increases in female representation in many regions throughout the US, variations persist across specialties, geographic regions, and degrees of rurality that underscore the complexity of achieving gender balanced representation. Initiatives focused on recruiting and retaining female physicians should target the regions highlighted by this analysis.

PMID:41707238 | DOI:10.1093/acamed/wvag045

Acad Med. 2026 Feb 18:wvag034. doi: 10.1093/acamed/wvag034. Online ahead of print.

ABSTRACT

PROBLEM: Development of foundational scholarship and research skills is a core competency that resident physicians must achieve. Evaluating trainee progress in scholarly activities is challenging due to a lack of evidence-informed assessment tools, and residency programs struggle to engage learners in these activities. In 2019, the University of Alberta (UofA) Physical Medicine and Rehabilitation residency program developed a new Research In Training Evaluation Report (R-ITER) to improve resident engagement in scholarly work and assessment of scholarly competencies. The development, implementation and utility of this innovative tool is described.

APPROACH: A sequential mixed methods approach was employed beginning with a qualitative analysis of program documents outlining the context and need for R-ITER creation, followed by a survey of R-ITER users to evaluate the tool’s utility. Thematic analysis of documents and survey comments identified the impetus for the innovation and interest-holder experiences using the new tool. Descriptive statistics summarized user experiences. Thematic analysis generated insights driving the development and implementation of the R-ITER: inadequate support and direction for research projects, limited research time, residents’ research knowledge gaps, and unclear research opportunities.

OUTCOMES: Survey respondents included 9/22 residents (40.9%) and 2/11 supervisors (18.2%). Participants found the R-ITER easy to access, well-organized, and effective for tracking progress. However, participants were unclear regarding the frequency at which the R-ITER should be used to assess progress. Following R-ITER implementation, 10/16 (62.5%) resident physicians who graduated between 2021-2025 have published 12 peer-reviewed papers representing projects initiated and completed during residency training. The R-ITER provides an effective, accessible, and well-structured innovation for assessing resident research performance.

NEXT STEPS: Future steps include gathering more research supervisor feedback, including explicit expectations pertaining to its use and completion, utilizing the R-ITER to implement additional research programs, and exploring the use of the R-ITER in other residency programs nationally or internationally.

PMID:41707228 | DOI:10.1093/acamed/wvag034

Traffic Inj Prev. 2026 Feb 18:1-10. doi: 10.1080/15389588.2026.2617455. Online ahead of print.

ABSTRACT

OBJECTIVE: The proportion of older drivers has increased with the aging population. In order to solve the problem of high accident tendency at unsignalized intersections caused by improper driving behavior of older drivers (OD-ER), this study analyzed turning behavior differences between OD-ERs and young and middle-aged drivers (YM-ERs), and then a petri net was used to describe the change in the behavior characteristics of two driver groups. The shortcoming of OD-ER’s behavior can be found through the information transfer model, thereby improving driving safety.

METHODS: Virtual scenarios of unsignalized intersections were built for drivers who were recruited from the general population for the study. Data on vehicle operation, driver visual behavior and physiological information were collected and analyzed. A petri net was applied to construct an information transfer model of turning behavior for two driver groups.

RESULTS: YM-ERs performed better than OD-ERs in three types of data. The most significant difference was observed in the vehicle operation data, for which all examined metrics showed statistically significant differences (p < 0.05). The information transfer model indicated that the primary limitation for OD-ERs is saccade behavior, which introduced additional transmission delays and constrained information flow compared with YM-ERs, particularly during left turning scenarios.

CONCLUSION: OD-ERs exhibit weaker turning ability than YM-ERs in terms of vehicle operation, information processing and judgment. Driver’s turning behavior characteristic can be described from the turning information transfer model and then evaluate the driving quality, OD-ERs can identify their areas of focus from the graph for training and improvement of driving safety. It can be used for the application of improvement face to the older driver when they enter into the unsignalized intersection.

PMID:41707221 | DOI:10.1080/15389588.2026.2617455

Traffic Inj Prev. 2026 Feb 18:1-11. doi: 10.1080/15389588.2026.2616385. Online ahead of print.

ABSTRACT

OBJECTIVE: On April 1, 2024, cannabis was partially legalized in Germany, accompanied by an increase in the statutory Δ9-tetrahydrocannabinol (THC) threshold for administrative traffic offenses from 1.0 to 3.5 ng THC/mL serum in August 2024. A key legislative objective was to protect frequent cannabis users who separate consumption from driving but still display THC levels exceeding 1.0 ng/mL from disproportionate sanctions. The law mandates a statistical evaluation of its impact after three years. Since no national statistics differentiate substance-impaired driving offenses by a specific drug class, we analyzed all traffic-related blood samples containing THC or THC-carboxylic acid detected in our laboratory over four years.

METHODS: Included were cases from three federal states between April 1, 2021, and March 31, 2025, submitted for toxicological analysis with the legal context of administrative (§24 German Road Traffic Act) or criminal offenses (§316/§315c German Criminal Code). We examined case frequencies, age distributions, co-use of other substances, time intervals between incident and blood collection, consumption patterns, THC and THC-carboxylic acid concentrations, and frequencies of sanctions and driving errors.

RESULTS: Among 48,058 total cases, 83% were administrative and 17% criminal offenses. 46% of drivers were aged 21-30 years; the proportion of those below 21 years decreased from 18.2% to 13.3%. In administrative offenses, THC alone was detected in 74% of cases, compared to only 30% in criminal cases. The time from incident to blood sampling was under 1.5 h in 82% of cases. Based on THC-carboxylic acid concentrations, four consumption categories were established: occasional, regular, repeated and chronic. The distribution across these groups was 47%, 22%, 19%, and 11%, respectively and median THC concentrations were 1.3, 4.5, 8.4, and 14.9 ng/mL serum. Remarkably, median THC levels in administrative and criminal offenses were identical: 3.44 ng/mL serum. Across individual years, the highest THC medians in serum occurred in the year following legalization (3.95 and 3.97 ng/mL). Applying the new 3.5 ng/mL limit to our case cohort would exempt 899 frequent and 11,855 occasional users with serum THC levels between 1.0 and < 3.5 ng/mL from sanctions.

CONCLUSION: Our data indicate a modest upward shift in THC concentrations, continuing beyond April 2024, alongside a demographic shift toward older drivers. The nearly identical THC medians between drivers with and without conspicuous driving performance challenge the validity of the new threshold. Notably, almost half of the unimpaired drivers exceeded 3.5 ng/mL, whereas half of the impaired drivers remained below it. 7.4% of the frequent users benefited from the raised threshold, while at the same time 58.3% of occasional users-whose driving ability at THC concentrations between 1 and <3.5 ng/mL may be compromised-fell out of legal sanction. While substantial doubt remains if the initial goal was achieved, the question of an appropriate THC threshold remains unresolved and calls for alternative legal approaches.

PMID:41707218 | DOI:10.1080/15389588.2026.2616385

Surg Laparosc Endosc Percutan Tech. 2026 Feb 4. doi: 10.1097/SLE.0000000000001447. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the impact of preoperative nasopancreatic duct stent placement on local resection of benign pancreatic tumors, particularly its efficacy in reducing secondary surgeries due to postoperative pancreatic fistula.

METHODS: The clinical data of 306 patients with benign pancreatic tumors larger than 2 cm who underwent local resection at the Department of Pancreatic Surgery, Hubei Provincial People’s Hospital, over the past 6 years were retrospectively analyzed. Propensity score matching was used to minimize the selection bias.

RESULTS: The incidence of grade C pancreatic fistula in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 20% (32/160) observed in the non-nasopancreatic duct placement group, with a statistically significant difference (Fisher exact test, P=0.02). In addition, the rate of secondary surgery in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 16% (29/160) in the non-nasopancreatic duct placement group (Fisher exact test, P=0.04). However, there was no significant difference in the incidence of postoperative complications such as septic shock, overall pancreatic fistula, and postoperative mortality between the 2 groups.

CONCLUSION: Preoperative nasopancreatic duct stent placement is a safe and effective procedure that significantly reduces the incidence of grade C pancreatic fistula following surgery for benign pancreatic tumors. Consequently, this decreases the necessity for secondary interventions related to grade C pancreatic fistula, ultimately enhancing patient prognosis and quality of life.

PMID:41707215 | DOI:10.1097/SLE.0000000000001447

JMIR Public Health Surveill. 2026 Feb 18;12:e79720. doi: 10.2196/79720.

ABSTRACT

BACKGROUND: The growing use of artificial intelligence (AI) chatbots for seeking health-related information is concerning, as they were not originally developed for delivering medical guidance. The quality of AI chatbots’ responses relies heavily on their training data and is often limited in medical contexts due to their lack of specific training data in medical literature. Findings on the quality of AI chatbot responses related to health are mixed. Some studies showed the quality surpassed physicians’ responses, while others revealed occasional major errors and low readability. This study addresses a critical gap by examining the performance of various AI chatbots in a complex, misinformation-rich environment.

OBJECTIVE: This study examined AI chatbots’ responses to human papillomavirus (HPV)-related questions by analyzing structure, linguistic features, information accuracy and currency, and vaccination stance.

METHODS: We conducted a qualitative content analysis following the approach outlined by Schreier to examine 4 selected AI chatbots’ (ChatGPT 4, Claude 3.7 Sonnet, DeepSeek V3, and Docus [General AI Doctor]) responses to HPV vaccine questions. These questions, simulated by young adults, were adapted from items on the Vaccine Conspiracy Beliefs Scale and Google Trends. The selection criteria for AI chatbots included popularity, accessibility, countries of origin, response update methods, and intended use. Two researchers, simulating a 22-year-old man or woman, collected 8 conversations between February 22 and 28, 2025. We used a deductive approach to develop initial code groups, then an inductive approach to generate codes. The responses were analyzed based on a comprehensive codebook, with codes examining response structure, linguistic features, information accuracy and currency, and vaccination stance. We also assessed readability using the Flesch-Kincaid Grade Level and Reading Ease Score.

RESULTS: All AI chatbots cited evidence-based sources from reputable health organizations. We found no fabricated information or inaccuracies in numerical data. For complex questions, all AI chatbots appropriately deferred to health care professionals’ suggestions. All AI chatbots maintained a neutral or provaccine stance, corresponding with scientific consensus. The mean and range of response lengths varied [word count; ChatGPT: 436.4 (218-954); Claude: 188.0 (138-255); DeepSeek: 510.0 (325-735); and Docus: 159.4 (61-200)], as did readability [Flesch-Kincaid Grade Level; ChatGPT: 10.7 (6.0-14.9); Claude: 13.2 (7.7-17.8); DeepSeek: 11.3 (7.0-14.7); and Docus: 12.2 (8.9-15.5); and Flesch-Kincaid Reading Ease Score; ChatGPT: 46.8 (25.4-72.2); Claude: 32.5 (6.3-67.3); DeepSeek: 43.7 (22.8-67.4); and Docus: 40.5 (19.6-58.2)]. ChatGPT and Claude offered personalized responses, while DeepSeek and Docus lacked this. Occasionally, some responses included broken or irrelevant links and medical jargon.

CONCLUSIONS: Amidst an online environment saturated with misinformation, AI chatbots have the potential to serve as an alternative source of accurate HPV-related information to conventional online platforms (websites and social media). Improvements in readability, personalization, and link accuracy are still needed. Furthermore, we recommend that users treat AI chatbots as complements, not replacements, to health care professionals’ guidance on clinical settings.

PMID:41707197 | DOI:10.2196/79720