Category: Statistics

Nervenarzt. 2025 Sep 11. doi: 10.1007/s00115-025-01877-9. Online ahead of print.

ABSTRACT

With the introduction of the 11th revision of the World Health Organization (WHO) “International Statistical Classification of Diseases and Related Health Problems” (ICD-11), structural and content-related adjustments were made to the diagnostic guidelines for affective disorders, which are presented in this review article. The update has resulted in some changes to the diagnostic classification of affective disorders, based on the American Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). The ICD-11 assigns depressive symptoms to so-called clusters, the main symptoms of depressed mood and joylessness can be accompanied by cognitive, behavioral or neurovegetative symptoms. In the case of remission of depressive episodes, the ICD-11 distinguishes between partial and complete remission. A persistent depressive disorder is present if the depressive episode lasts continuously for more than 2 years. In future, bipolar disorder will be divided into type I and type II. Manic episodes can still only be coded in the context of bipolar disorders and cannot be diagnosed as an independent, separate disorder. The concept of persistent affective disorders in the ICD-10 is abandoned, dysthymia is categorized as a depressive disorder and cyclothymia as a bipolar disorder.

PMID:40932648 | DOI:10.1007/s00115-025-01877-9

J Neurooncol. 2025 Sep 11. doi: 10.1007/s11060-025-05218-3. Online ahead of print.

ABSTRACT

PURPOSE: Surveillance of patient outcomes with real-world data is essential to uncover regional disparities in clinical practice or quality of care. This study explored survival differences among glioblastoma patients in Norway and investigated the role of demographic and treatment factors.

METHODS: We analyzed real-world data from the Norwegian Cancer Registry on 1158 adults with histologically confirmed glioblastoma during 2019-2023. Surgical treatment rates per 100,000 inhabitants per region (South-East, West, Mid, North) were compared using adjusted Poisson models. Full treatment included surgical resection, radiotherapy (≥ 55 Gy for ≤ 70 years; ≥30 Gy for > 70 years), and temozolomide. Standardized survival was estimated with flexible parametric models, standardized for age, sex, year, and distances to treatment facilities.

RESULTS: Patients from the North were older and lived further from treatment centers. For patients aged 18-70, treatment and survival did not significantly differ across regions; national median standardized survival was 14.4 months (95%CI:13.6-15.2). For elderly patients (71-89 years), the North demonstrated a higher surgical treatment rate (rate ratio = 1.32; 95%CI = 0.99-1.77), but lesser use of postoperative radiotherapy and temozolomide. Median standardized survival for elderly patients in the North was 4.5 months (95%CI: 3.5-5.7) versus 7.7 (6.9-8.6) months nationally. Early mortality was particularly high for elderly patients in the North, yet those surviving beyond six months matched other regions’ survival probability.

CONCLUSION: Lower glioblastoma survival in the North was associated with higher early mortality among elderly patients, likely due to selecting frailer patients for surgery, who less often subsequently received anti-neoplastic treatment.

PMID:40932639 | DOI:10.1007/s11060-025-05218-3

Psychol Res. 2025 Sep 11;89(5):141. doi: 10.1007/s00426-025-02153-w.

ABSTRACT

Congenital amusia is a neurodevelopmental disorder resulting in impaired pitch perception and memory. Here we investigated whether participants with congenital amusia have deficits in temporal processing of auditory information, in addition to pitch processing deficits. Individuals with amusia (n = 19) and matched controls (n = 21) were presented with sequences of five tones in which one tone was sometimes shifted in pitch or in time, and we adaptively assessed psychophysical thresholds for detecting these shifts. Pitch thresholds of the amusia group were higher (i.e., worse) than those of the control group as expected, and, crucially, time thresholds were too, although the group difference for time thresholds was smaller. Across participants, time thresholds correlated with pitch thresholds. Principal component analysis revealed that all pitch- and time-related variables (thresholds and amusia battery scores) were correlated to one component that also distinguished between amusics and controls; whereas a second component captured additional variability on the time task. Simulations suggest that prior studies had not found these time processing deficits because they had less statistical power, likely due to smaller sample sizes. The observed time processing deficit is in agreement with amusic individuals’ subjective reports about their difficulties following the rhythm of the music. These data suggest that amusia deficits are not restricted to pitch, but extend to the time domain, yet with a smaller effect size, and at least when the stimuli have a clear pitch content, such as for tone sequences or music.

PMID:40932635 | DOI:10.1007/s00426-025-02153-w

Breast Cancer Res Treat. 2025 Sep 11. doi: 10.1007/s10549-025-07794-4. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examines the intermittent discontinuation of palbociclib based on its availability and its clinical outcomes during the Lebanese economic crisis in patients with metastatic Breast Cancer (BC) HR+ between the years 2019 and 2023.

METHODS: This study carries out a retrospective analysis on 46 patients treated with palbociclib – Letrozole during the years 2019 and 2023 in Lebanon. It used descriptive tables and figures to summarize demographic, clinical, and outcome characteristics. It analyzed the data using Student T test for parametric variables, Wilcoxon and Kruskal-Wallis tests for non-parametric variables, and Chi-squared and Fisher tests for qualitative variables. Pearson’s correlation and regression models were used to associate between the intermittent administration of palbociclib and its clinical outcomes.

RESULTS: Our sample had a mean age of 59.33 +/-13.27 years. 87% had ductal carcinomas and 13% had lobular carcinomas. 52.2% of patients had treatment for their metastases prior to palbociclib, and a discontinuation was observed in 63.1 %. Intermittent discontinuation is associated with advanced age (p=0.048) and statistically reduces PFS (p=0.026). The intermittent drug intake also affects PFS (p=0.03) but has no effect on the disease progression.

CONCLUSION: This study is the only research in the world focused on intermittent intake of palbociclib. The intermittent discontinuation of palbociclib is influenced by age and affects the PFS. These results highlight the significance of adherence and protocol compliance.

PMID:40932628 | DOI:10.1007/s10549-025-07794-4

Eur J Orthop Surg Traumatol. 2025 Sep 11;35(1):391. doi: 10.1007/s00590-025-04516-w.

ABSTRACT

BACKGROUND AND OBJECTIVE: Multi-ligament knee injuries (MLKIs) are debilitating injuries, often managed with surgical reconstruction. Our purpose was to determine whether acute or delayed reconstruction led to better functional and patient-reported outcomes.

MATERIALS AND METHODS: An institutional dataset was queried for patients who underwent MLKI reconstruction from 2012 to 2019 and completed postoperative functional and patient-reported outcome surveys with minimum 2-year follow-up. Exclusion criteria included single ligament reconstruction, revision surgery, and periarticular tumors. Patient-reported outcomes measurement system (PROMIS) and multi-ligament quality of life (ML-QoL) outcomes were compared between patients who underwent acute (< 2 weeks) and delayed (> 2 weeks) reconstruction.

RESULTS: Thirty-three patients were included for analysis (16 acute, 17 delayed): mean follow-up 3.6 years, mean BMI 29.8 ± 5.9, mean age 37.7 ± 13.5, sex: 19(58%) females, 14(42%) males. At final follow-up, there was no statistical difference between groups in most PROMIS scores, including Lysholm knee score (63 vs. 72, p = 0.13), pain (53 vs. 47, p = 0.11), or mobility (45 vs. 49, p = 0.18). Patients who underwent delayed reconstruction demonstrated significantly higher physical function scores (46 vs. 53, p = 0.05). There was no statistical difference in majority of ML-QoL scores, including physical impairments (42 vs. 29, p = 0.09), emotional impairments (45 vs. 30, p = 0.12), and societal involvement (38 vs. 24, p = 0.09). Patients who underwent acute reconstruction reported statistically greater activity limitations than delayed reconstruction (36 vs. 21, p = 0.02). There were no significant differences in complication rates between groups.

CONCLUSION: Delayed MLKI reconstruction had comparable results to acute reconstruction for PROMIS and ML-QoL outcomes, and had greater physical function and lower activity limitation postoperatively. These data demonstrate that delayed reconstruction may be an appropriate management option for MLKI reconstruction.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort study.

PMID:40932627 | DOI:10.1007/s00590-025-04516-w

CNS Drugs. 2025 Sep 11. doi: 10.1007/s40263-025-01225-0. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with schizophrenia and comorbid substance use disorder (SUD) often experience poor treatment adherence, leading to worse clinical outcomes. However, high-quality evidence from randomized trials on the preferred mode of antipsychotic treatment in this population remains limited.

AIMS: The aim was to examine whether long-acting injectable (LAI) antipsychotic treatment reduces the risk of all-cause discontinuation (ACD) compared with oral antipsychotics in individuals with early phase schizophrenia and comorbid SUD.

METHODS: This study was a secondary analysis of the European Long-Acting Antipsychotics in Schizophrenia Trial (EULAST), a multisite, randomized, open-label trial conducted across multiple European healthcare settings. A total of 471 individuals with early phase schizophrenia were included in this secondary analysis, stratified by presence (n = 143) or absence (n = 328) of comorbid SUD. The observation period lasted 18 months. Participants were randomly assigned to second-generation LAI or oral second-generation antipsychotic treatment. The primary outcome was ACD, an indirect measure of treatment efficacy, defined as discontinuation of the initially assigned treatment for any reason. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models, adjusted for relevant covariates.

RESULTS: Among 143 individuals with schizophrenia and SUD, LAI treatment was associated with a 36% lower risk of ACD compared with oral antipsychotics (adjusted HR = 0.641; 95% CI, 0.438-0.938; P = 0.022). Kaplan-Meier curves showed longer median time to ACD for LAI treatment (158 days) versus oral antipsychotics (97 days). By contrast, among the 328 individuals without SUD, LAI treatment did not significantly reduce ACD risk (P = 0.282). Crude HRs were also assessed, replicating the adjusted hazard findings.

CONCLUSIONS: LAI antipsychotics significantly delayed treatment discontinuation compared with oral antipsychotics in participants with early phase schizophrenia and comorbid SUD but not in those without SUD. While these findings provide robust evidence supporting the use of LAIs in people with schizophrenia and comorbid SUD, future studies are needed to more precisely quantify the potential clinical benefits and tolerability of LAIs in this high-risk population. EULAST was registered at ClinicalTrials.gov (NCT02146547).

PMID:40932600 | DOI:10.1007/s40263-025-01225-0

Mol Biol Rep. 2025 Sep 11;52(1):896. doi: 10.1007/s11033-025-11002-3.

ABSTRACT

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection and a major cause of genital warts and anogenital cancers in both sexes. This study assessed HPV genotype distribution in a large outpatient population in southwestern Iran to inform preventive strategies.

MATERIALS AND METHODS: In this cross-sectional study, 10,739 outpatient samples were collected from 2018 to 2023. Specimens included urine from men and vaginal swabs from women with normal cytology. HPV genotypes were assessed using DNA extraction, PCR and Direct Flow Chip method.

RESULTS: HPV prevalence was 41.6% (94.8% in females, 5.2% in males). Women had a higher positivity rate (42.0%) than men (34.2%). The highest prevalence (44.3%) occurred in the 31-40 age group. High-risk types were present in 65.8% of positive cases. Women were more affected by high-risk genotypes, while low-risk types predominated in men. The most frequent high-risk genotypes were HPV-16, -53, -52, -66, and – 39; the most common low-risk types were HPV-6, -54, -42, -62, and – 44. Most individuals had a single infection. Mixed infections, more common in women, often involved both high- and low-risk types and showed greater diversity with age.

CONCLUSION: HPV prevalence, particularly of high-risk types, is notably high among women in southwestern Iran. The peak age of infection is higher than in developed countries. Differences in genotype distribution compared to American and other Iranian studies highlight the need for region-specific vaccination strategies targeting locally prevalent genotypes.

PMID:40932599 | DOI:10.1007/s11033-025-11002-3

Clin Drug Investig. 2025 Sep 11. doi: 10.1007/s40261-025-01481-4. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Direct head-to-head evidence of propranolol and amitriptyline for migraine prophylaxis is limited. This clinical trial compared the efficacy, safety, and cost-effectiveness of low-dose propranolol versus amitriptyline for episodic migraine prophylaxis over a 3-month period.

METHODS: This randomized, controlled, open-label, prospective, parallel, single-center trial was conducted at a tertiary care hospital in India. A total of 60 prophylaxis-naïve patients with episodic migraine were randomized 1:1 to receive either low-dose propranolol (80 mg/day) or amitriptyline (10 mg/day). The primary outcome was the improvement in the monthly headache frequency at 3 months from baseline, while the secondary outcomes included improvements from baseline in the proportions of patients achieving a ≥ 50% reduction in monthly headache days, headache severity, headache-induced disability, monthly rescue medication intake, quality of life, and cost-effectiveness (measured by the average cost-effectiveness ratio [ACER] and incremental cost-effectiveness ratio [ICER]).

RESULTS: At 3 months, propranolol showed a significantly greater reduction in monthly headache frequency compared with amitriptyline (- 3.67 ± 1.47 versus – 2.87 ± 1.36 days, P = 0.03). More patients in the propranolol group (60%) achieved a ≥ 50% reduction in monthly headache days compared with the amitriptyline group (43.33%) (P = 0.02). Propranolol also showed a greater reduction in monthly rescue medication intake (P = 0.01), but differences in headache severity, headache-induced disability, and quality of life were not significant. Both groups experienced mild adverse drug reactions. Cost-effectiveness analysis revealed propranolol had a higher ACER (US $5.44) and ICER (US $0.40/1% reduction) than amitriptyline.

CONCLUSIONS: In our trial, low-dose propranolol demonstrated superior efficacy to amitriptyline in episodic migraine prophylaxis. Both drugs were well tolerated. Our study suggests that amitriptyline was more cost-effective than propranolol.

TRIAL REGISTRATION NUMBER: Clinical Trial Registry-India (Date: 27 October 2020; registration no.: CTRI/2020/01/022972).

PMID:40932597 | DOI:10.1007/s40261-025-01481-4

J Adv Nurs. 2025 Sep 11. doi: 10.1111/jan.70216. Online ahead of print.

ABSTRACT

AIMS: To assess self-reported practices and knowledge of nurses and prescribers (i.e., physicians and nurse practitioners) on intravenous fluid therapy, and to evaluate how this is documented through a clinical documentation review.

DESIGN: Multicentre cross-sectional study, between April 2022 and July 2022, across 13 wards from four Dutch hospitals.

METHODS: A survey study was conducted to assess self-reported practices related to intravenous fluid therapy. A 12-item questionnaire evaluated knowledge. To gain insights into documentation practices, a retrospective chart review was performed. Data analysis involved descriptive statistics, with group differences analysed using the chi-squared test or Fisher’s exact test, as appropriate.

RESULTS: Three hundred and four healthcare professionals completed the questionnaire (92% nurses). The majority of prescribers (n = 20/25; 80%) expected that nurses would start, stop or change intravenous fluid therapy. Overall, the median number of correct answers to knowledge questions was eight (IQR 7-9, range 0-12); four participants (1%) answered all knowledge questions correctly. Knowledge about the composition of sodium chloride 0.9% solution was limited. Analysis of patient charts revealed that 54% (196/362) received intravenous fluids, most commonly 0.9% sodium chloride infusion (168/195; 86%), although the indication was described in 3% (6/196). Thirty-one percent (61/196) of patients received intravenous fluids to keep the vein open (< 30 mL/h).

CONCLUSION: The study identified shared responsibility, a knowledge gap, and limited documentation concerning intravenous fluids. Prescribers expect nurses to adjust intravenous fluids without consulting a prescriber, which aligns with what nurses do, although they are not legally authorised. Given the limited documentation of the indication for intravenous fluids, it is plausible that several patients received intravenous fluids unnecessarily.

IMPLICATIONS: The perceived shared responsibility presents an opportunity to develop a protocol engaging both prescribers and nurses, aiming to guide more targeted infusion therapy.

IMPACT: Reducing unnecessary infusions to keep-the-vein-open can help eliminate low-value care.

REPORTING METHOD: CROSS guideline.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:40931896 | DOI:10.1111/jan.70216

Arthritis Care Res (Hoboken). 2025 Sep 11. doi: 10.1002/acr.25633. Online ahead of print.

NO ABSTRACT

PMID:40931879 | DOI:10.1002/acr.25633