Category: Statistics

Nutr Clin Pract. 2025 Nov 25. doi: 10.1002/ncp.70075. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 significantly affected traditional nutrition assessment methods, forcing experts to quickly adjust to new constraints. This study examined practices in clinical nutrition during the pandemic in Latin America based on professional background or experience.

METHODS: A cross-sectional survey from July to November 2021 involved clinical nutrition experts from 18 Latin American countries. A 70-item questionnaire assessed anthropometric, biochemical, and dietetic indicators; screening and diagnostic tools; and methods for estimating nutrient requirements. For statistical analyses we used nonparametric tests and latent profile analyses.

RESULTS: Among the 398 participants, the sample included dietitians/nutritionists (63%), physicians (25%), and nurses (12%). Biochemical indicators were used by 87%, dietetic indicators by 71%, and anthropometric measurements by 65%. Only one-third used GLIM criteria, whereas nearly 30% indicated that they did not use any screening tools. Variations in professional practices were observed regarding laboratory test requisitions and dietary assessment methodologies. Dietitians favored the use of recalls, whereas physicians generally ordered a greater number of biochemical tests. There was a significant variation in the estimation of protein and energy requirements, particularly outside of critical care environments. The influence of seniority on assessment practices was negligible.

CONCLUSION: Nutrition evaluation throughout the pandemic has demonstrated considerable variability with an individual’s profession demonstrating a more substantial impact than their level of seniority. The limited utilization of standardized tools highlights continued fragmentation and emphasizes the necessity for interprofessional education and institutional policies to ensure consistent, evidence-based nutrition care.

PMID:41291368 | DOI:10.1002/ncp.70075

Sports Med. 2025 Nov 25. doi: 10.1007/s40279-025-02346-8. Online ahead of print.

ABSTRACT

BACKGROUND: Soccer is a high-intensity sport that requires high levels of physical fitness, including balance, change of direction (CoD), speed and power. The FIFA 11 + program has been widely promoted to enhance physical fitness and reduce injury occurrence.

OBJECTIVE: This meta-analysis set out to examine how the FIFA 11 + program, implemented as a warm-up versus conventional warm-up (soccer-specific and alternative warm-ups), impacts physical fitness attributes in youth and adult soccer players.

METHODS: After a priori defined inclusion and exclusion criteria, 17 intervention studies with 611 male and female soccer players (Tier 2-4) aged 9-29 years were eligible to be included. The FIFA 11 + program implemented in the warm-up was contrasted with conventional warm-up programs (control) on outcome measures such as dynamic balance, CoD speed, linear sprint and proxies of muscle power (vertical jump height). The influence of potential moderators (e.g., training duration, frequency, session duration, age, sex, training and performance calibre) on study outcome measures was examined using subgroup analyses with the median split method.

RESULTS: Findings demonstrated small-to-moderate improvements in favour of FIFA 11 + compared with conventional warm-ups on dynamic balance (small standardized mean differences [SMDs] = 0.37, p < 0.001, heterogeneity [I²] = 7), CoD speed (moderate SMDs = – 0.65, p = 0.005, I² = 84), and vertical jump height (small SMDs = 0.56, p < 0.001, I² = 71). Results from the sub-analyses showed that, for dynamic balance, shorter training durations (< 9 weeks) produced larger effects than longer durations (≥ 9 weeks) (SMDs = 0.62 versus SMDs = 0.17). For vertical jump height, < 9 weeks also yielded greater improvements (SMDs = 0.79 versus SMDs = 0.26). In terms of weekly training frequency, ≥ 3 sessions/week elicited larger gains in change-of-direction speed (SMDs = – 1.05 versus SMDs = – 0.12) and vertical jump height (SMDs = 0.73 versus SMDs = 0.01) compared with < 3 sessions/week. Regarding participant characteristics, players aged ≥ 18 years showed greater improvements than those < 18 years in change-of-direction speed (SMDs = – 1.45 versus SMDs = – 0.06) and vertical jump height (SMDs = 0.64 versus SMDs = 0.22). For sex differences, males experienced greater benefits than females in change-of-direction speed (SMDs = – 0.79 versus SMDs = – 0.04) and vertical jump height (SMDs = 0.54 versus SMDs = 0.09). Finally, higher-level players (≥ tier 3) demonstrated greater improvements in vertical jump height than lower-tier players (< Tier 3) (SMDs = 0.75 versus SMDs = 0.01). The observed benefits were statistically significant but generally of small-to-moderate magnitude and affected by study heterogeneity and program implementation differences. Most studies included male participants, limiting generalizability to female and underrepresented populations. Several studies also lacked rigorous methodological design, particularly in allocation, concealment and blinding. Reporting of training and demographic variables was often incomplete. These limitations highlight the necessity for rigorously designed, low-bias randomized controlled trials with standardized implementation of the FIFA 11 + program and thorough reporting to enhance the reliability of causal conclusions and improve clinical interpretation.

CONCLUSION: The FIFA 11 + program was more effective than conventional soccer warm-up programs to enhance soccer players’ physical fitness (i.e., dynamic balance, CoD speed, vertical jump height). A shorter training duration (< 9 weeks) and more weekly training sessions (≥ 3 sessions/week) induced larger performance effects. FIFA 11 + was more effective in older (≥ 18 years) and male players and in players of higher performance calibre (≥ Tier 3). These findings underscore the versatility of the FIFA 11 + program to improve soccer players’ physical fitness, supporting its integration into the warm-up of regular soccer training sessions.

PROTOCOL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633810 , PROSPERO: CRD42025633810.

PMID:41291351 | DOI:10.1007/s40279-025-02346-8

J Bone Miner Metab. 2025 Nov 25. doi: 10.1007/s00774-025-01665-0. Online ahead of print.

NO ABSTRACT

PMID:41291339 | DOI:10.1007/s00774-025-01665-0

Langenbecks Arch Surg. 2025 Nov 26;411(1):19. doi: 10.1007/s00423-025-03914-2.

ABSTRACT

PURPOSE: Ventral hernias are frequently encountered in general surgery. In recent years, minimally invasive techniques, including the Extended View Totally Extraperitoneal Repair (eTEP), have gained popularity. Meta-analyses suggest that eTEP may offer both intraoperative and postoperative advantages over alternative approaches. This retrospective study aimed to evaluate intra- and postoperative complications, length of hospital stay, and the potential association between American Society of Anesthesiologists (ASA) Physical Status Classification and complication rates in patients who underwent eTEP. The findings may inform preoperative risk stratification and surgical planning based on ASA score.

METHODS: A monocentric, retrospective study of 95 patients who underwent eTEP for ventral hernia repair between January 2019 and December 2021 was conducted. Descriptive statistics and binary logistic regression analyses were performed to explore the association between the ASA score and perioperative complications.

RESULTS: Intraoperative complications occurred in 2.1% (n = 2), and postoperative complications were observed in 7.4% (n = 7). The median length of hospital stay was three days (IQR = 1). Logistic regression analysis did not identify a statistically significant association between the ASA score and the occurrence of either intra- or postoperative complications. Nonetheless, all observed complications arose in patients with ASA scores of ≥ II.

CONCLUSION: eTEP repair was associated with a low complication rate and short hospitalization. While ASA classification was not a statistically significant predictor of perioperative complications in this cohort, the absence of complications in ASA I patients suggests potential relevance. These findings highlight the need for larger, prospective studies to further evaluate the role of ASA classification in risk assessment for eTEP procedures.

PMID:41291335 | DOI:10.1007/s00423-025-03914-2

Surg Endosc. 2025 Nov 25. doi: 10.1007/s00464-025-12318-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Parastomal hernia is a common and challenging complication after stoma formation, often requiring complex surgical management. To address limitations of conventional techniques, we developed the Hybrid Parastomal Endoscopic Repair (HyPER) technique, which combines laparoscopic and open approaches. This case series aimed to evaluate the long-term safety, efficacy, and technical considerations of the HyPER method in a large, consecutive cohort of patients.

METHODS: This retrospective, single-center case series included 200 consecutive patients treated between 2014 and 2024. Adult patients with symptomatic or recurrent parastomal hernias were included; exclusion criteria were severe comorbidities precluding surgery or lack of follow-up data. Demographic and operative variables, perioperative outcomes, and recurrence rates were analyzed. Descriptive statistics were used (mean, SD, range); no hypothesis testing was applied.

RESULTS: The majority of patients had EHS Type III or IV hernias. The mean operative time was 171 min. In 10% of cases, a cost-effective “Baldachin modification” using polypropylene mesh was employed. Stoma relocation was required in 87% of Type IV cases. Postoperative complications occurred in 12.5%, primarily wound infections. The recurrence rate was 5.5%, and quality of life significantly improved (VAS score increased from 3.15 to 9.15). No mortality was observed.

CONCLUSION: HyPER proved to be a safe and effective technique for treating parastomal hernias, especially in complex and recurrent cases. The approach allowed for thorough anatomical correction and yielded low recurrence rates with acceptable morbidity. The Baldachin modification may offer a viable low-cost alternative in resource-limited settings. Further multicenter studies are warranted to validate these findings and establish standardized protocols.

PMID:41291329 | DOI:10.1007/s00464-025-12318-8

Support Care Cancer. 2025 Nov 26;33(12):1134. doi: 10.1007/s00520-025-10182-9.

ABSTRACT

PURPOSE: Lorlatinib is the preferred first-line treatment for patients with ALK+ metastatic non-small cell lung cancer. However, this drug carries high rates of neurocognitive adverse events. This study further characterized these neurocognitive adverse events, examined risk factors, and, for the first time, explored social support as a mitigation strategy.

METHODS: The Mayo Clinic medical record was interrogated for patients prescribed lorlatinib between July 2017 and May 2022, and medical records were reviewed in detail.

RESULTS: Sixty-three patients were prescribed lorlatinib (median age: 59 years (range: 37-82); 31 (49%) men). Twenty-five (40%) developed a neurocognitive adverse event, which had been characterized as follows: “hallucinations,” “noise confusion,” “obtunded,” “memory loss,” “trouble doing simple tasks,” “mental fogginess,” “vivid dreams,” and “nightmares.” In univariable analyses, age, gender, prior brain metastases, concomitant CYP3A inducers or inhibitors, and married/partner status were not statistically significantly predictive of the neurocognitive adverse event. In multivariable analyses, older age (≥ 65 years) was predictive (HR: 2.6 (95% CI: 1.09, 6.26); p = 0.03). Notably, 3 of 14 married/partnered patients (21%) and 5 of 6 non-married/partnered patients (83%) were hospitalized for a neurocognitive adverse event (p = 0.02, Fisher’s Exact test). Medical record content corroborated the importance of married/partnered (“spouse is very supportive”) and of non-married/partnered status (“patient lives alone” and “children some distance away”).

CONCLUSIONS: This study further characterized lorlatinib-associated neurocognitive adverse events and confirmed older age as a risk factor. Importantly, social support may prevent hospitalization for a neurocognitive adverse event, and, thus, merits further study, perhaps in older patients.

PMID:41291327 | DOI:10.1007/s00520-025-10182-9

Support Care Cancer. 2025 Nov 25;33(12):1132. doi: 10.1007/s00520-025-10217-1.

ABSTRACT

PURPOSE: This prospective longitudinal study evaluated nutritional changes in patients with oral cavity cancer undergoing multimodal treatment and examined the impact of nutritional status on clinically meaningful outcomes, including mortality and 30-day readmissions.

METHODS: One hundred patients undergoing surgery followed by radiotherapy were assessed at five time points (V0-V4). Nutritional evaluations included body weight, body mass index (BMI), bioelectrical impedance analysis (BIA), handgrip strength (HGS), serum albumin, and dietary intake. Primary outcomes were mortality 30-day readmissions and mucositis severity. Secondary outcomes included length of hospital stay (LOHS), and radiotherapy compliance. Statistical analyses included repeated-measures ANOVA, chi-square tests, logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards modeling.

RESULTS: Significant declines in weight, BMI, fat mass, muscle mass, and HGS occurred throughout treatment (p < 0.01), with the greatest deterioration during radiotherapy. Weight loss > 5% was associated with severe mucositis (p < 0.05), and low muscle mass was associated with longer LOHS (p < 0.05). Hypoalbuminemia (< 3.5 g/dL) predicted higher mortality (41.7% vs. 12.5%) and 30-day readmissions (50.0% vs. 13.6%). Lower albumin and reduced muscle mass showed trends toward poorer survival on Kaplan-Meier analysis; however, these differences did not reach statistical significance.

CONCLUSION: Nutritional deterioration is progressive and clinically significant in oral cavity cancer and directly influences mortality and readmissions. Early identification of at-risk patients and structured, multimodal nutritional surveillance are essential. Standardized primary outcomes and robust statistical modeling strengthen clinical relevance and provide a methodological framework for designing future nutritional intervention trials.

PMID:41291316 | DOI:10.1007/s00520-025-10217-1

J Neurooncol. 2025 Nov 25;176(1):97. doi: 10.1007/s11060-025-05348-8.

ABSTRACT

INTRODUCTION: For larger meningiomas, higher radiation doses need to be delivered to the tumor, increasing the chances of radiation induced toxicity. Hypofractionated stereotactic radiosurgery (HSRS) imparts overall high dose in small multiple fractions, minimising this risk over single session SRS (SSRS). This meta analysis was conducted to homogenize the role of SRS for large meningiomas (> 8 cc) and run a comparative analysis between HSRS and SSRS.

METHODOLOGY: Pubmed and Cochrane databases were systematically reviewed to include the relevant articles and meta analysis was performed to estimate pooled favorable clinical outcomes, tumor control and peritumoral edema (PTE) rates. Statistical tests were utilized to compare SSRS and HSRS modalities.

RESULTS: 791 lesions underwent SSRS while 273 tumors were administered HSRS. Significantly higher percentage of Skull base tumors underwent HSRS over SSRS (84.6% vs. 76%, p = 0.003) and mean tumor size was significantly higher in the HSRS cohort (17.6 cc vs. 14.6 cc, p = 0.014). The pooled tumor control and favorable clinical outcome rates were 90% and 85% respectively, with no significant differences in HSRS and SSRS cohorts (95% vs. 90%, logit difference: 0.645, p = 0.10 and 87% vs. 85%, logit difference: 0.26, p = 0.48 respectively). Post radiosurgical PTE incidence was statistically similar for both cohorts with an overall pooled incidence of 7.9% (logit difference = 0.03, p = 0.95). Follow up period was significantly higher in patients undergoing SSRS (67 vs. 49 months, p = 0.037).

CONCLUSION: Despite having significantly larger tumor volume, HSRS could achieve similar outcomes with SSRS. However, the inadequacy of data on direct comparative studies between HSRS and SSRS warrants prospective multicenter trials with international collaboration and long term follow up for HSRS.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41291309 | DOI:10.1007/s11060-025-05348-8

Evid Based Dent. 2025 Nov 25. doi: 10.1038/s41432-025-01191-y. Online ahead of print.

ABSTRACT

A COMMENTARY ON: Santonocito S, Cicciù M, Ronsivalle V. Evaluation of the impact of AI-based chatbot on orthodontic patient education: a preliminary randomized controlled trial. Clin Oral Investig 2025; 29:278.

DESIGN: Randomized controlled trial (RCT).

CASE SELECTION: A sample of 100 patients was enrolled in the study between June 2023 and August 2024. Participants were randomly allocated into two intervention groups of 50 each, using a computer-generated sequence to maintain a 1:1 ratio. The Chatbot group received oral hygiene (OH) and orthodontic treatment guidance via a chatbot accessed through a QR code, while the control group was given standard educational material by means of information leaflets compiled by the leading scientific societies in orthodontics. Each main group was further divided into two subgroups: Leaflet-fixed therapy (LF, n = 27), Leaflet-aligner (LA, n = 23), Chatbot-fixed therapy (CF, n = 24), and Chatbot-aligner (CA, n = 26). The chatbot was built on the open-source Botpress platform and was refined using expert-reviewed training materials. When the participant opens the chatbot application, the interface displays a menu containing 4 questions, with the 3rd question focusing on home oral hygiene procedures.

DATA ANALYSIS: The evaluation included a clinical examination at baseline (T0) and after 5 weeks of starting orthodontic treatment (T1), along with a questionnaire at T1 assessing participants’ oral hygiene knowledge and compliance. Modified gingival index (MGI) and plaque index (PI) were used for clinical examination of oral hygiene. The questionnaire comprised four domains: Knowledge Evaluation (KE_S), Understanding Scale (US_S), Compliance and Adherence Scale (CAAS_S), and Satisfaction Scale (SS_S). It employed a 5-point Likert scale, with scores ranging from 0 (strongly negative) to 4 (strongly positive), with intermediate values representing negative, neutral, and positive responses.

RESULTS: MGI and PI showed a statistically significant increase from T0 to T1 in both groups. While comparing the change in MGI from the start of treatment between the groups, a statistically significant increase was found in the control group than the chatbot group. Further analysis reported statistically lower increase in MGI in the CF and CA groups as compared to the LF and LA subgroups. There were no differences between the control and chatbot groups with respect to questionnaire section scores.

CONCLUSIONS: The study concluded that the use of an AI-based chatbot positively influences patient compliance with oral hygiene maneuvers. Furthermore, it could not be established whether the AI-based chatbot enhanced the patient’s knowledge, understanding, and satisfaction with the information received compared to the information leaflets.

PMID:41291283 | DOI:10.1038/s41432-025-01191-y

Parasitol Res. 2025 Nov 25;124(11):141. doi: 10.1007/s00436-025-08535-8.

ABSTRACT

Plasmodium vivax is a malaria parasite with a broad geographic distribution worldwide. The unique biological characteristics of P. vivax, such as early gametocytogenesis and its latent hypnozoite stage, make it more difficult to control compared to P. falciparum. Malaria remains a significant global health concern, particularly in regions with limited diagnostic infrastructure. This study aims to develop a computer-assisted method for characterizing and classifying malaria parasites using a machine learning approach based on light microscopic images of peripheral blood smears. One of the major challenges in malaria diagnostics is the inadequacy of current detection methods. To address this, the study introduces a convolutional neural network (CNN)-based pipeline for the automated detection and staging of malaria infections from Giemsa-stained blood smear images. The dataset used in this study was annotated into four classes: Ring Form, Trophozoite, Schizont, and Uninfected Red Blood Cells (RBCs), encompassing diverse staining qualities and morphological variations. The dataset was divided into training (70%), validation (15%), and testing (15%) subsets. The CNN achieved an overall classification accuracy of 92.4%, with precision, recall, and F1-scores exceeding 0.90 across all classes. Statistical metrics, including mean accuracy (92.4% ± 2.1%), precision (93.1% ± 1.8%), and recall (92.8% ± 1.9%), demonstrated the robustness of the model. Class-specific analysis revealed that the Schizont stage achieved the highest classification accuracy (94.7%), while the Ring Form stage showed slightly lower performance (91.2%), likely due to inherent morphological overlaps with early Trophozoite forms. Visualizations, including confusion matrices and class probability distribution overlays, provided detailed insights into the model’s decision-making processes. The pipeline was further evaluated using cross-validation techniques, showing high reliability across various dataset splits. This approach offers scalability and adaptability, with the potential for deployment in real-world diagnostic workflows, particularly in resource-constrained settings.

PMID:41291252 | DOI:10.1007/s00436-025-08535-8