Category: Statistics

Palliat Support Care. 2026 Jan 13;24:e24. doi: 10.1017/S1478951525101508.

ABSTRACT

OBJECTIVE: This study aims to adapt and validate a Spanish (Argentina) version of the Caregiver Indirect and Informal Care Cost Assessment Questionnaire (CIIQ) to enable the measurement of informal care-related costs in the Argentine context, addressing the current lack of Spanish-language tools for assessing indirect costs.

METHOD: The CIIQ was translated, cross-culturally adapted, and validated for the Spanish-Argentine language and culture. Psychometric properties were evaluated in a purposive sample of relatives of patients with advanced chronic disease and limited life expectancy in Argentina. Missing data and internal consistency (Cronbach’s α) were assessed, along with discriminant capacity, content, and construct validity. Construct validity was examined through principal component analysis (PCA) and confirmatory factor analysis (CFA).

RESULTS: The translation and cultural adaptation process was completed without major difficulties. A total of 154 caregivers completed the baseline questionnaire and 90 completed the follow-up assessment, with missing data remaining below 10% across items. Internal consistency was high for the overall instrument (α = 0.802) and for the unpaid care cost domain (α = 0.866). The productivity loss domain showed moderate reliability (α = 0.362). Low correlations with unrelated domains (ρ < 0.2) supported adequate discriminant validity. PCA identified 2 components – informal care costs (51.5% of explained variance) and productivity loss costs (20.3%) – which were further supported by CFA.

SIGNIFICANCE OF RESULTS: The Spanish-Argentine version of the CIIQ is a reliable and culturally appropriate instrument for assessing the economic burden of informal care in Argentina. While the unpaid care items demonstrated strong psychometric performance, productivity-related items may require refinement to improve reliability in future applications.

PMID:41527721 | DOI:10.1017/S1478951525101508

Palliat Support Care. 2026 Jan 13;24:e33. doi: 10.1017/S1478951525101545.

ABSTRACT

OBJECTIVES: Clinical pharmacists are increasingly recognized as essential members of multidisciplinary palliative care teams, yet their specific roles and impact have not been comprehensively summarized. This scoping review aimed to systematically map and synthesize published evidence on the clinical roles, interventions, and professional contributions of pharmacists within multidisciplinary palliative care services for patients with non-communicable diseases.

METHODS: A scoping review was conducted by searching PubMed, Embase, Web of Science, and Scopus from January 2000 to May 2024. Eligible studies reported clinical pharmacist interventions in palliative care. Data were extracted on study characteristics, pharmacist activities, and clinical outcomes.

RESULTS: Twelve studies were included, predominantly from the United States. Pharmacist-led interventions encompassed medication reconciliation (91.7%), symptom management (83.3%), adverse drug event prevention (75.0%), patient and caregiver education (58.3%), and policy-level contributions (33.3%). High physician acceptance rates (≥90%) were consistently reported. Outcomes included improved symptom control, reduced drug-related problems, and enhanced patient-reported quality of life.

SIGNIFICANCE OF RESULTS: This scoping review synthesizes current evidence on the roles of clinical pharmacists in palliative care teams. The findings highlight their essential contributions to medication safety, symptom management, deprescribing, and opioid stewardship, reinforcing the need for pharmacist integration into multidisciplinary palliative care models to improve patient-centered outcomes. Future research should focus on implementation models, cost-effectiveness analyses, and service expansion in community-based settings.

PMID:41527714 | DOI:10.1017/S1478951525101545

Asian J Endosc Surg. 2026 Jan-Dec;19(1):e70236. doi: 10.1111/ases.70236.

ABSTRACT

BACKGROUND: Tubal ligation is a common permanent contraception method. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a scarless alternative to laparoscopy, but comparative evidence for interval tubal ligation is limited.

OBJECTIVE: To compare surgical outcomes and recovery between vNOTES and conventional laparoscopic tubal ligation.

METHODS: Retrospective cohort at a tertiary center (August 2024-May 2025). Women aged 30-50 seeking permanent contraception with ASA ≤ 3 were included.

EXCLUSIONS: prior pelvic surgery or known pelvic pathology, salpingectomy or non-contraceptive indications (e.g., hydrosalpinx), concomitant procedures, incomplete records. Patients were grouped by technique: vNOTES (n = 20) or laparoscopy (n = 27).

OUTCOMES: operative time, hospital stay, time to mobilization, analgesia use, Δhemoglobin/Δhematocrit, complications.

TESTS: t-test/Mann-Whitney, Chi-square/Fisher; effect sizes (Cohen’s d) and 95% CIs reported (α = 0.05).

RESULTS: Baseline demographics were comparable. Operative time did not differ (mean difference -3.77 min, 95% CI -9.70 to 2.15; p = 0.199; d = -0.32). vNOTES was associated with shorter hospitalization (-3.40 h, 95% CI -6.51 to -0.29; p = 0.033; d = 0.47), earlier mobilization (-0.80 h, 95% CI -1.27 to -0.33; p < 0.001; d = 0.94), and lower postoperative analgesia use (-1.05 doses, 95% CI -1.48 to -0.63; p < 0.001; d = 1.55). Changes in hemoglobin and hematocrit were similar (both p > 0.40). One vNOTES case required conversion to laparoscopy due to adhesions; no conversions occurred in the laparoscopy group.

CONCLUSIONS: vNOTES and laparoscopy are both safe for interval tubal ligation. vNOTES confers clinically meaningful recovery advantages-shorter hospitalization, faster mobilization, and reduced analgesic need-while maintaining comparable operative time and blood loss surrogates. These findings support vNOTES as a promising, patient-centered alternative.

PMID:41527687 | DOI:10.1111/ases.70236

Cureus. 2026 Jan 10;18(1):e101230. doi: 10.7759/cureus.101230. eCollection 2026 Jan.

ABSTRACT

Hip osteoarthritis is a common cause of pain and disability, and total hip arthroplasty (THA) is an effective treatment for advanced disease. Despite surgical success, many patients experience prolonged postoperative deficits, and conventional rehabilitation does not always restore full function. Virtual reality-based rehabilitation (VR-R) has recently emerged as a potential tool to enhance recovery through increased engagement and non-pharmacological pain modulation. We aim to comprehensively evaluate the effectiveness of VR-R after THA in improving functional recovery, reducing pain and opioid use, and enhancing overall rehabilitation outcomes. We systematically searched the following databases: PubMed, Scopus, Web of Science, Cochrane Library, and Embase until November 14, 2025. The quality of the included randomized clinical trials (RCTs) was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Statistical analysis was performed using the RevMan tool (v. 5; The Cochrane Collaboration, London, UK), with mean difference (MD) or standardized MD (SMD) for continuous data. Heterogeneity was evaluated using the I² statistic, and random-effects models were used when I² exceeded 50%. This systematic review was prospectively registered on PROSPERO (CRD420251268393). Seven studies met the inclusion criteria, comprising 397 patients. VR-R demonstrated a significant reduction in postoperative stress (SMD = -1.18; 95% confidence interval (CI): (-1.69, -0.67); p < 0.00001; I² = 0%). In contrast, no significant differences were observed between VR-R and conventional rehabilitation for pain (SMD = -0.87; p = 0.11), opioid consumption (SMD = -0.42; p = 0.40; I² = 87%), general mobility (SMD = 0.18; p = 0.32), or functional independence as measured by the Barthel index (MD = 8.00; p = 0.37). VR-R significantly reduces postoperative stress following THA but shows no significant benefits for pain, opioid consumption, mobility, or functional independence compared to standard care. Despite substantial heterogeneity across studies, VR-R represents a safe adjunctive tool for addressing psychological aspects of recovery. Standardized protocols and large-scale trials are needed to establish optimal implementation strategies.

PMID:41527675 | PMC:PMC12790695 | DOI:10.7759/cureus.101230

F1000Res. 2025 Dec 2;14:1018. doi: 10.12688/f1000research.166713.2. eCollection 2025.

ABSTRACT

OBJECTIVE: This study examined the application of Modified Flanders Interaction Analysis during mathematics lessons in senior secondary schools in the Festac area of Lagos State, Nigeria.

METHODS: The study employed a descriptive survey design to observe and analyse classroom interactions between teachers and students, focusing on verbal and non-verbal communication. Researchers used a structured observation schedule to collect data from a purposively selected sample of 10 mathematics teachers and 725 students across five schools. The researchers designed the instrument to collect information on teachers’ and students’ interaction patterns in the classroom. They analysed the data using mean scores, standard deviation, percentages, and t-test statistics, applying a 0.05 significance level for hypothesis testing.

FINDINGS: The results of the analysis revealed that teachers dominate all the activities in the classroom; that is, the teachers were the active people in the classes, while the students were just passive listeners and moderate engagement through non-verbal behaviours. Statistical analysis showed significant differences between teacher and student patterns, particularly verbal behaviours. The study underscores that mathematics classes in senior secondary schools in the Festac area of Lagos State were teachers-centered.

CONCLUSION: Based on the study findings, the researchers recommended that mathematics teachers adopt more student-centered teaching approaches to enhance active student participation and engagement during lessons. Also, they should not be too strict, but they should be approachable, friendly, and accommodating so that the students will not be afraid to ask questions during or after the lesson, enhancing their performance. Hence, the government should ensure that teacher training programs incorporate observation techniques to effectively equip teachers with the skills to assess and improve classroom interaction.

PMID:41527665 | PMC:PMC12790597 | DOI:10.12688/f1000research.166713.2

Cureus. 2025 Dec 11;17(12):e98998. doi: 10.7759/cureus.98998. eCollection 2025 Dec.

ABSTRACT

Introduction Children were exposed to excessive screen time during the COVID-19 pandemic due to online classes, which led to increased use of digital devices for social connections and recreation. Children who continue to use digital devices for longer periods at younger ages are at higher risk of developing myopia and digital eye strain (DES), which remains a public health concern even after schools have reopened. Aims To determine the prevalence of DES and its associated factors among adolescent schoolchildren (11-17 years) in the Chengalpattu District. Settings and design A cross-sectional study was carried out in schools in Chengalpattu District. Materials and methods To assess the prevalence of DES and its contributing factors, a semi-structured questionnaire was used. The study included all students in schools selected using simple random sampling. Statistical analysis Data were analyzed using IBM SPSS Statistics version 21. For categorical variables, Fisher’s exact test and the chi-square test were used, and p < 0.05 was considered statistically significant. Results The mean age of the 546 participants was 12.77 ± 1.7 years. During the lockdown, the average time spent using digital devices was 6.7 ± 2.5 hours. Overall, 93% (n = 508) of children had screen time >5 hours during the lockdown. About 51.5% of adolescents had DES. Conclusions This study underscores the need to reduce DES among children through eye health education and by promoting periodic eye check-ups.

PMID:41527654 | PMC:PMC12790465 | DOI:10.7759/cureus.98998

Cureus. 2025 Dec 11;17(12):e99013. doi: 10.7759/cureus.99013. eCollection 2025 Dec.

ABSTRACT

Coronary artery bypass grafting (CABG) is one of the most common surgical procedures, contributing to improved long-term survival and quality of life for patients with coronary artery disease (CAD). However, surgical site infections (SSIs) remain a serious complication, increasing mortality, morbidity, and hospital length of stay.

BACKGROUND/OBJECTIVES: The study aimed to determine the incidence of SSIs and to identify factors associated with their development in patients at intermediate- to high-risk of infection undergoing CABG. It also aimed to provide context-specific evidence to inform targeted preventive strategies.

METHODS: The study included 51 patients (39 (76.5%) men, 12 (23.5%) women; mean age 67.2 ± eight years) who underwent CABG via median sternotomy. Patients were preoperatively stratified for SSI risk using the Brompton Harefield Infection Score (BHIS), and only those classified as intermediate or high risk were included. The occurrence of SSIs was evaluated postoperatively using the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay as inpatient prolonged over 14 days (ASEPSIS) scoring system. Data were analyzed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA).

RESULTS: Infections were observed in 17 (33%) patients. The occurrence of SSIs was positively associated with prolonged hospital stay (ρ = 0.512, p < 0.001) and obesity (f = 0.348, p = 0.013). Age, gender, smoking, diabetes mellitus, and ejection fraction were not statistically significantly associated with infection occurrence.

CONCLUSIONS: Obesity and prolonged hospital stay were significantly associated with higher SSI rates in patients after CABG. The high incidence of SSIs highlights the urgent need for targeted interventions in patients at increased risk. Early identification and proactive management of patients at increased risk may help reduce infection rates, improving postoperative outcomes and patient quality of life. The small sample size of this study, the data collection from a single cardiothoracic surgery center, and the limited number of examined variables are limitations that indicate the need for further research.

PMID:41527653 | PMC:PMC12790610 | DOI:10.7759/cureus.99013

Cureus. 2025 Dec 12;17(12):e99020. doi: 10.7759/cureus.99020. eCollection 2025 Dec.

ABSTRACT

Total laparoscopic hysterectomy (TLH) is a widely accepted minimally invasive procedure for benign gynecologic diseases. Transvaginal retrieval avoids additional abdominal incisions but may be technically challenging in nulliparous women because of narrower vaginal dimensions and less distensible tissues, particularly in cases with a large uterus. We retrospectively analyzed 368 nulliparous patients who underwent TLH at our institution between February 2021 and August 2025. Among them, 267 underwent transvaginal retrieval and 101 underwent transabdominal retrieval, with all cases performed using contained in-bag morcellation. In the high-difficulty subgroup defined as uterine weight ≥500 g (n = 147), 62 underwent transvaginal and 85 underwent transabdominal retrieval. No conversion from transvaginal to transabdominal extraction was required. Compared with the abdominal route, transvaginal retrieval was associated with significantly shorter operative time (median 203.5 vs. 207.0 minutes, p = 0.016) and retrieval time (28.5 vs. 34.0 minutes, p = 0.024), while blood loss did not differ significantly (25 vs. 25 ml, p = 0.142). Retrieval efficiency (uterine weight ÷ retrieval time) tended to be higher in the transabdominal group (median 25.69 vs. 24.14 g/min, p = 0.083), but the difference was not statistically significant. No major complications occurred, and only minor events such as vaginal wall lacerations and vaginal cuff infections were observed (vaginal wall laceration: 1/62 [1.6%] vs. 2/85 [2.4%]; vaginal cuff infection: 1/62 [1.6%] vs. 1/85 [1.2%] in the transvaginal and transabdominal groups, respectively); all were managed conservatively or with simple intraoperative repair. These findings suggest that even in nulliparous women with large uteri, transvaginal retrieval during TLH using contained in-bag morcellation can be considered a safe and effective first-line option for specimen removal when intraoperative conditions permit, potentially providing superior cosmetic results and reducing surgical morbidity without increasing perioperative risks. Prospective, multicenter studies are warranted to validate these results.

PMID:41527651 | PMC:PMC12790631 | DOI:10.7759/cureus.99020

Cureus. 2025 Dec 12;17(12):e99061. doi: 10.7759/cureus.99061. eCollection 2025 Dec.

ABSTRACT

Background Right ventricular (RV) strain detected via transthoracic echocardiography (TTE) has emerged as a potential prognostic marker in patients with COVID-19, given the virus’s cardiovascular implications. However, data on the prognostic utility of point-of-care ultrasound (POCUS) in this context remains limited. This study evaluated whether RV strain identified through limited POCUS TTE at emergency department (ED) presentation correlates with adverse clinical outcomes or mortality in SARS-CoV-2 positive patients without pre-existing cardiovascular disease. Methods This study followed 29 patients at a medical center in the United States, in a prospective cohort design. Participants included patients who tested positive for COVID-19 via polymerase chain reaction (PCR) and had no history of myocardial infarction, congestive heart failure, percutaneous coronary intervention, pulmonary embolism, or atrial fibrillation. Each underwent bedside POCUS TTE to assess for RV strain. Follow-up was conducted via structured phone surveys at 30, 60, and 90 days using a four-question instrument developed by the study team. The study was conducted from initial enrollment through the final 90-day follow-up period, with data collected between September 2020 and August 2021. We used chi-square tests to examine the relationship between echocardiographic findings and clinical outcomes. Results Among those with RV strain (D Sign positive), 60% experienced adverse outcomes, compared to 73.7% in those without RV strain. This difference was not statistically significant (p = 0.7). Mortality was also lower in the RV strain group (10%) compared to those without RV strain (31.6%), though this difference did not reach statistical significance (p = 0.2). Conclusion In this preliminary cohort, RV strain identified via limited POCUS TTE was not significantly associated with adverse outcomes or mortality in COVID-19 patients without prior cardiovascular disease. To better understand whether bedside echocardiography can predict clinical outcomes for this group, more extensive research is necessary.

PMID:41527650 | PMC:PMC12790843 | DOI:10.7759/cureus.99061

Cureus. 2025 Dec 12;17(12):e99058. doi: 10.7759/cureus.99058. eCollection 2025 Dec.

ABSTRACT

Objective The main objective of this study is to assess the frequency and management of thoracic complications following supracostal mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients. Methods This retrospective cross-sectional study was conducted in the Department of Urology, Institute of Kidney Diseases, Peshawar, Pakistan, from June 2017 to December 2019. A total of 80 pediatric patients (52 males, 65%, and 28 females, 35%) who underwent supracostal mini-PCNL were included. Patients were categorized according to the level of puncture: Group 1 (between the 11th and 12th ribs; n = 62, 77.5%), Group 2 (between the 10th and 11th ribs; n = 15, 18.75%), and Group 3 (between the 9th and 10th ribs; n = 3, 3.75%). Postoperative thoracic complications, including hydrothorax and hemothorax, were documented and managed either conservatively, by needle aspiration, or by intercostal chest tube insertion. Results Among the 80 patients, 12 (15%) developed hydrothorax. Although thoracic complications were observed in 6/62 (9.6%) in Group 1, 3/15 (20%) in Group 2, and 3/3 (100%) in Group 3, the interpretation of the 100% complication rate in Group 3 should be made with caution, because this group contained only three patients, limiting the statistical power despite the anatomical plausibility of higher complications at higher intercostal levels. Of the affected patients, six (50%) were managed conservatively, four (33.3%) required needle aspiration, and two (16.6%) underwent intercostal chest tube insertion. The mean hospital stay among patients with thoracic complications was 2.3 days. Conclusion The likelihood of thoracic complications following supracostal mini-PCNL in pediatric patients increases with higher intercostal access. While punctures above the 10th rib carry a 100% risk of hydrothorax, most cases can be managed conservatively through timely recognition and multidisciplinary collaboration among urologists, anesthetists, and pulmonologists. A meticulous surgical approach and careful perioperative monitoring significantly reduce morbidity.

PMID:41527648 | PMC:PMC12790831 | DOI:10.7759/cureus.99058