Category: Statistics

Pain. 2026 Jan 6. doi: 10.1097/j.pain.0000000000003901. Online ahead of print.

ABSTRACT

Chronic pain is linked to accelerated brain aging, often measured through the brain-age gap (BAG), the difference between chronological age and neuroimaging-derived brain age. Whether endogenous pain modulation declines with brain aging remains unknown. We tested this in participants with temporomandibular disorder (TMD) in a cross-sectional study with 84 TMD participants and 84 age- and sex-matched healthy controls (HCs) from the Cambridge Centre for Ageing and Neuroscience database. Temporomandibular disorder participants completed the Graded Chronic Pain Scale and a placebo procedure combining verbal suggestion and classical conditioning. We estimated brain age using machine-learning and deep-learning approaches: a previously published Gaussian process regression (GPR) model trained on cortical thickness features, and a convolutional neural network (CNN) trained end-to-end on T1-weighted volumes. The brain-age gap was calculated as the difference between the estimated brain age and chronological age. Using both GPR and CNN models, we found that TMD participants exhibited an older estimated brain age compared with HCs. Higher estimated brain age was associated with greater pain severity and statistically mediated the link between chronological age and pain severity. In addition, the CNN model suggested that older brain age was associated with greater pain interference and a higher likelihood of experiencing high-impact pain, controlling for sex and race. However, neither estimated brain age nor BAG influenced the magnitude of placebo effects. These findings suggest that while older brain age is associated with greater chronic pain severity and interference, placebo effects remain robust despite age-related changes in the brain, highlighting the therapeutic potential of placebo effects for older adults living with chronic pain.

PMID:41494156 | DOI:10.1097/j.pain.0000000000003901

JMIR Hum Factors. 2026 Jan 6;13:e75465. doi: 10.2196/75465.

ABSTRACT

BACKGROUND: Entrapment of sickled red blood cells in the microvasculature leads to sudden painful vaso-occlusive crises (VOCs) in sickle cell disease (SCD). This is potentially triggered by autonomic nervous system-mediated vasoconstriction in the microvasculature. Indeed, vasoconstriction biomarkers derived from a single night of laboratory-based fingertip photoplethysmography (PPG) recording were predictive of a higher frequency of future VOC in SCD. Noninvasive, remote, and longitudinal monitoring of autonomic vasoreactivity will facilitate the development of predictive biomarkers of imminent VOC.

OBJECTIVE: This study aimed to assess the feasibility and performance of a wearable wristband device to longitudinally monitor nocturnal peripheral autonomic vasoreactivity and to cross-validate the vasoconstriction parameters across the “gold-standard” finger sensor.

METHODS: A total of 12 patients with SCD and 6 healthy controls were recruited to wear a wristband device (Biostrap) with a PPG sensor on a nightly basis. For cross-validation studies, 50% (3/6) controls wore both the wristband and a sleep monitoring device (AliceNightOne) with a finger PPG sensor. We quantified autonomic vasoreactivity by processing PPG signals and deriving vasoconstriction parameters-magnitude of vasoconstriction (Mvasoc) and photoplethysmography amplitude coefficient of variation (PPGampCV). We performed a correlation analysis of the vasoconstriction parameters within each device to investigate whether Mvasoc and PPGampCV can be used as surrogate markers of vasoconstriction, and then cross-validated the PPGampCV across the wristband and finger PPG devices.

RESULTS: A total of 131 nocturnal PPG recordings were made with a wristband device (1-19 nights per participant; patients with SCD: n=79, 60%; controls: n=52, 40%). A total of 9 nocturnal recordings (3 nights per participant) were made with both wristband and finger sensor devices. Longitudinal continuous PPG recordings were feasible with the wearable device, with significant within-night and night-to-night variability in vasoconstriction parameters, suggesting dynamic changes in autonomic vasoreactivity. Mvasoc and PPGampCV significantly correlated within devices-the maximum overnight correlation was 0.82 (P<.001) for the finger sensor and 0.69 (P<.001) for the wristband sensor, suggesting that PPGampCV can serve as a surrogate for Mvasoc. Cross-validation analysis of PPGampCV across wristband and fingertip sensors showed statistically significant correlations on all 9 nights (overnight correlation coefficient ranging from 0.24-0.7), with some nightly segments of PPGampCV showing very strong correlation across devices.

CONCLUSIONS: Wearable wristband devices are feasible tools for the collection of continuous PPG measurements and vasoconstriction parameters, which serve as objective markers of autonomic vasoreactivity in users with and without SCD. We have optimized the methods of quantifying vasoconstriction from wearable device PPG signals, and cross-validated them with standardized sensors. These findings enable large-scale, real-time monitoring of autonomic vasoreactivity along with pain outcomes for the development of vasoconstriction parameters as biomarkers imminent VOC in patients with SCD. This biomarker also has the potential to impact other diseases involving autonomic vascular dysregulation.

PMID:41494152 | DOI:10.2196/75465

Cochrane Database Syst Rev. 2026 Jan 6;1:CD006680. doi: 10.1002/14651858.CD006680.pub4.

ABSTRACT

RATIONALE: Peripheral arterial disease (PAD) is a condition most commonly caused by atherosclerotic narrowing of lower limb arteries, resulting in intermittent claudication, chronic limb-threatening ischaemia or acute limb ischaemia. There are various treatment strategies, including atherectomy, a technique used during endovascular surgery where the atheroma is cut or ground away within the artery. Another procedure, such as balloon angioplasty, is often performed at the same time. The studies investigating atherectomy for PAD have all been small-scale, with varying methodologies and, as a result, it is unclear if atherectomy is a more effective treatment for PAD compared to more conventional treatments. Despite this, rates of atherectomy use are increasing, especially in the United States. This review focuses on randomised controlled trials and is the second update of a Cochrane review, following the original publication in 2014 and the first update in 2020.

OBJECTIVES: To evaluate the benefits and harms of atherectomy as a treatment for peripheral arterial disease compared to other treatments.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers from 13 August 2019 to 28 January 2025.

ELIGIBILITY CRITERIA: We included all randomised controlled trials that compared atherectomy with other established treatments. All participants had symptomatic PAD with either claudication or chronic limb-threatening ischaemia and evidence of atherosclerotic lower limb arterial disease.

OUTCOMES: Outcomes of interest were: primary patency, all-cause mortality, fatal and non-fatal cardiovascular events, target vessel revascularisation rates and complication rates.

RISK OF BIAS: We used the Cochrane risk of bias tool (RoB 1) to assess the risk of bias in the studies. We judged all included studies to have a high risk of overall bias.

SYNTHESIS METHODS: Two review authors screened studies for inclusion, extracted data, assessed risk of bias and used the GRADE criteria to assess the certainty of the evidence. Any disagreements were resolved through discussion. We synthesised results for each outcome using meta-analysis where possible (random-effects model, dichotomous outcomes assessed using the Mantel-Haenszel method, continuous outcomes assessed using the inverse variance method).

INCLUDED STUDIES: We included 11 studies, with a total of 814 participants and 872 treated lesions.

SYNTHESIS OF RESULTS: We found two comparisons: atherectomy versus balloon angioplasty (atherectomy versus BA) and atherectomy versus BA with primary stenting (atherectomy versus stenting). No studies compared atherectomy with bypass surgery. Overall, the evidence from this review was of very low certainty, due to a high risk of bias, imprecision and inconsistency. Ten studies (659 participants, 717 treated lesions) compared atherectomy versus BA. There was no evidence of differences between atherectomy and BA for the primary outcomes: six-month primary patency rates (risk ratio (RR) 1.24, 95% confidence interval (CI) 0.92 to 1.68; 6 studies, 298 participants; very low-certainty evidence); 12-month primary patency rates (RR 1.13, 95% CI 0.96 to 1.34; 5 studies, 326 participants; very low-certainty evidence); mortality rates (RR 0.50, 95% CI 0.24 to 1.02; 7 studies, 493 participants; very low-certainty evidence) or cardiovascular events at 12 months (RR 0.59, 95% CI 0.13 to 2.70; 2 studies, 163 participants; very low-certainty evidence). There was no evidence of differences when examining: six-month target vessel revascularisation (TVR) rates (RR 0.61, 95% CI 0.24 to 1.56; 5 studies, 348 treated vessels; very low-certainty evidence), 12-month TVR (RR 0.68, 95% CI 0.41 to 1.12; 6 studies, 371 treated vessels; very low-certainty evidence) or complication rates (RR 0.84, 95% CI 0.34 to 2.04; 7 studies, 457 participants; very low-certainty evidence). One study (155 participants, 155 treated lesions) compared atherectomy versus stenting, so the comparison was extremely limited and subject to imprecision. This study did not report primary patency. There was no evidence of a difference in the atherectomy versus stenting arms for mortality rates (RR 0.38, 95% CI 0.04 to 3.23; 155 participants; very low-certainty evidence), cardiovascular events (RR 0.38, 95% CI 0.04 to 3.23; 155 participants; very low-certainty evidence) and TVR rates at six months (RR 2.27, 95% CI 0.95 to 5.46; 155 participants; very low-certainty evidence). The study did not report on TVR at 12 months. There was no evidence of a difference in complication rates between the two arms (RR 7.04, 95% CI 0.80 to 62.23; 155 participants; very low-certainty evidence). There are several limitations to the evidence. The studies were of small sample size, with poor methodological quality, considerable variations in protocols and a high overall risk of bias due to high attrition and a lack of blinding.

AUTHORS’ CONCLUSIONS: This review update shows that the evidence is still very uncertain about the effect of atherectomy on primary patency, mortality and cardiovascular event rates compared to plain balloon angioplasty with or without stenting alone. We identified no evidence of differences in target vessel revascularisation rates and complication rates, although this is again uncertain. The included studies were small, heterogeneous and at high risk of bias. Larger studies that are powered to detect clinically meaningful, patient-centred outcomes are required.

FUNDING: This Cochrane review had no dedicated funding.

REGISTRATION: Protocol and previous versions available via 10.1002/14651858.CD006680, 10.1002/14651858.CD006680.pub3.

PMID:41494151 | DOI:10.1002/14651858.CD006680.pub4

JMIR Ment Health. 2026 Jan 6;13:e78079. doi: 10.2196/78079.

ABSTRACT

BACKGROUND: Digital interventions play an innovative role in the treatment of mental health disorders, offering evidence-based solutions across a wide range of conditions. Blended therapy (BT), which integrates digitally delivered interventions with face-to-face therapy, has shown promise. However, challenges such as low uptake hinder widespread implementation. Mental health professionals are key stakeholders for the adoption of BT in routine care settings.

OBJECTIVE: This study explores mental health professionals’ perspectives on BT, specifically assessing their perceived knowledge of, acceptance of, usage of, and perceptions of different BT types. Additionally, it examines mental health professionals’ perceived advantages and disadvantages of BT, challenges associated with implementation, and wishes toward the future application of BT.

METHODS: A survey study was conducted among 203 mental health professionals (152 psychological psychotherapists and 51 psychiatrists, including also individuals in training) in Switzerland. The data were analyzed using both quantitative methods and qualitative content analysis.

RESULTS: Participants reported limited knowledge of BT (mean 2.71, SD 1.32), attitudes toward BT were somewhat positive (mean 5.25, SD 1.34), and acceptance was moderate (mean 3.64, SD 1.20). Among various digitally delivered interventions, teletherapy (video) was most frequently integrated with face-to-face treatment and considered more suitable for BT than chat, email, or new technologies. More than 75% (n=152) of the respondents deemed BT appropriate for the treatment of affective (mood) disorders (F30-F39) and for the treatment of neurotic, stress-related, and somatoform disorders (F40-F48; ICD-10). The qualitative analyses of open-ended questions highlighted key advantages of BT as perceived by mental health professionals. These include increased treatment flexibility, the ability to outsource therapy components, and enhanced treatment efficiency. However, disadvantages such as increased effort and potential disruptions to the therapeutic relationship were also noted. Participants identified barriers to BT implementation, including financing and data security concerns. To facilitate BT adoption, respondents emphasized the desire for better cost coverage, easy access to digitally delivered interventions, and seamless integration of digital tools into face-to-face therapy.

CONCLUSIONS: The findings indicate that mental health professionals report limited knowledge of BT and consider it more suitable for certain disorders than others. Moreover, from their perspective, while BT offers advantages, it also presents disadvantages. Addressing mental health professional knowledge gaps, alongside resolving perceived implementation barriers, may be key to the successful future implementation of BT in routine mental health settings.

PMID:41494150 | DOI:10.2196/78079

Paediatr Anaesth. 2026 Jan 6. doi: 10.1111/pan.70082. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric preassessment is recommended for all children undergoing general anesthesia. It has the potential to improve safety and quality outcomes for both the patient and the organization.

AIMS: This study aimed to establish the proportion of children who underwent preassessment before general anesthesia, the format of that preassessment, and the impact of preassessment on outcomes such as on-the-day cancelation, and patient anxiety.

METHODS: This multi-center prospective observational cohort study outlines preassessment delivery in the UK and its effect on outcome. Invitation to participate was via Pediatric Anesthetic Trainee Research Network. Data collected included demographic data, details of the patient’s preassessment, and their outcome.

RESULTS: Data were verified from 96 hospitals on 6818 patients between 1 and 16 years old having elective procedures under general anesthetic. The proportion of children ≤ 16 years old who received preassessment was 60.1% (4082 children). There was a large variation in the delivery of preassessment with the majority being nurse-led. The perioperative journey of most children proceeded as planned (6454 patients, 94.6% of cases). There was a significant difference in the proportion of children with perioperative anxiety between those who did (12.0%, n = 482) and did not (16.5%, n = 438) have a preassessment (p < 0.001). Preassessment did not make a statistically significant difference to overall cancelation rates. The most common reasons for cancelation were intercurrent illness and anxiety. A greater proportion of procedures were delayed or canceled if anxiety was identified as a perioperative challenge: 20.8% (n = 191) compared to 3.6% (n = 210, p < 0.001).

CONCLUSION: These data suggest that improved outcomes could be achieved through a reduction in anxiety. A service offering screening calls in the days before surgery could prevent on-the-day cancelation due to intercurrent illness. The priorities for preassessment in children require further clarification and standardization nationally to maximize the potential benefits from services.

PMID:41492692 | DOI:10.1111/pan.70082

Arch Esp Urol. 2025 Dec;78(10):1485-1492. doi: 10.56434/j.arch.esp.urol.20257810.193.

ABSTRACT

OBJECTIVE: To investigate the application value of an operating room nursing protocol based on the Enhanced Recovery after Surgery (ERAS) concept in patients with prostate cancer undergoing laparoscopic radical prostatectomy (LRP).

METHODS: A retrospective collection was conducted on patients who were scheduled to undergo LRP and admitted to the urology department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2024 to June 2025. The general preoperative, surgical-related and clinical data of the two groups of patients were collected and compared.

RESULTS: A total of 147 patients with LRP were collected during the study. These patients were divided into the traditional nursing (n = 73) and ERAS (n = 74) groups in accordance with different nursing plans. No significant difference was found in the general data of the two groups before surgery (p > 0.05). In the ERAS group, the moments marking the first discharge and exhaust, along with the lengths of time of urinary catheter indwelling and overall hospital stays, were all markedly shorter than those in the group receiving traditional nursing care, with the disparities between the two groups being statistically significant (p < 0.001). Additionally, the patients in the ERAS group exhibited a notably higher average urinary flow rate than their counterparts in the traditional nursing group (p < 0.001). The first voiding time of the patients in the ERAS group was earlier than that of the patients in the traditional nursing group (p < 0.001). At 8, 12, 24 and 48 h after surgery, the Numerical Rating Scale scores of the patients in the ERAS group were lower than those of the patients in the traditional nursing group (p < 0.001). The results of repeated analysis of variance revealed a significant difference in the time-group main effect (p < 0.001). The Incontinence Quality of Life Questionnaire scores of the patients in the ERAS group were higher than those of the patients in the traditional nursing group at three days after surgery and discharge (p < 0.001).

CONCLUSIONS: The operating room nursing protocol based on the ERAS concept has clinical value in patients with prostate cancer undergoing LRP.

PMID:41492681 | DOI:10.56434/j.arch.esp.urol.20257810.193

Arch Esp Urol. 2025 Dec;78(10):1410-1417. doi: 10.56434/j.arch.esp.urol.20257810.184.

ABSTRACT

OBJECTIVE: Catheter-associated urinary tract infection (CAUTI) is a common type of hospital-acquired infection in the emergency intensive care unit (EICU). The aim of this study was to explore effective nursing management programs to reduce the incidence of CAUTI in patients with EICU.

METHODS: This retrospective study collected the clinical data of critically ill patients from the Department of Emergency Medicine of Soochow University in China from January 2024 to December 2024. Patients admitted from January to June 2024 were treated in the usual care group, and patients admitted from July to December 2024 were treated in the CAUTI prevention care group. The monthly incidence of CAUTI, the duration of urinary catheter indwelling, the duration of bladder irritation symptoms, the number of days of hospitalisation and the adverse reaction rate of patients in the two time periods were compared.

RESULTS: A total of 833 patients were admitted to the EICU for observation, and they were divided into the usual care group (n = 427) and the CAUTI prevention care group (n = 406). Ninety-seven patients developed CAUTI, with an overall incidence rate of 11.64%. Among them, 64 cases (14.99%) of CAUTI occurred in the conventional nursing group, which was higher than that in the CAUTI prevention care group (33 cases, 8.13%), and the difference was statistically significant (p < 0.05). The duration of urinary catheterisation, duration of bladder irritation, length of hospital stay and incidence of adverse reactions in patients with CAUTI in the CAUTI prevention care group were lower than those in the usual care group (p < 0.05).

CONCLUSIONS: Reasonable nursing management program is related to a low incidence of CAUTI in EICU and has a certain effect on its prevention.

PMID:41492672 | DOI:10.56434/j.arch.esp.urol.20257810.184

Arch Esp Urol. 2025 Dec;78(10):1377-1384. doi: 10.56434/j.arch.esp.urol.20257810.180.

ABSTRACT

BACKGROUND: This study aims to evaluate long-term surgical outcomes and identify predictive factors associated with urethroplasty failure in patients with anterior urethral strictures.

METHODS: A retrospective study was conducted on 419 patients who underwent urethroplasty between January 2009 and December 2024. Eleven different surgical techniques were performed based on the location, length and aetiology of strictures as well as prior interventions. Clinical data including demographics, surgical history, stricture characteristics and complications were analysed. Surgical success was defined as the absence of any further urethral intervention and maximum voiding flow rate above 15 mL/s months or years after the surgery. Statistical analysis included Cox regression, Chi-square and Kaplan-Meier survival analysis.

RESULTS: The overall surgical success rate was 74.7% (313/419 patients), with a complication rate of 10.2%. Recurrence occurred in 25.3% of cases. Univariate analysis revealed that body mass index (BMI), stricture length, number of previous direct vision internal urethrotomies (DVIUs), prior urethroplasty and panurethral strictures (>10 cm) were significantly associated with surgical failure. Multivariate analysis identified increased BMI and number of previous DVIUs as independent predictors of failure (p < 0.05).

CONCLUSIONS: History of prior interventions and BMI are key factors influencing outcomes. Early referral for definitive surgical management is recommended to avoid progression and reduce failure risk.

PMID:41492668 | DOI:10.56434/j.arch.esp.urol.20257810.180

Arch Esp Urol. 2025 Dec;78(10):1353-1361. doi: 10.56434/j.arch.esp.urol.20257810.177.

ABSTRACT

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the preferred technique for kidney stones larger than 20 mm in maximum diameter. The objective of this study is to evaluate the effect of the nephrostomy tube technique vs. that of the tubeless technique in patients undergoing supine PCNL, focusing on postoperative complications and hospital stay duration.

METHODS: This retrospective observational study was conducted from January 2018 to June 2024. A total of 243 patients underwent supine PCNL. Clinical, surgical and postoperative variables were compared between patients with and without nephrostomy tubes. Complications were classified into clinically relevant categories: Infectious (fever ≥38 °C), haemorrhagic (postoperative haemoglobin drop >1 g/dL within 48 h or the requirement for blood transfusion) and severe (including nephrectomy and mortality). A binary logistic regression model was used to identify independent predictors of complications. Stone-free status was assessed by noncontrast computed tomography (CT) at six weeks. All analyses were performed with IBM SPSS Statistics 26.0.

RESULTS: In 50% of patients, a nephrostomy tube was placed at the end of the procedure. The overall complication rate was 14.4% and was significantly higher in patients with nephrostomy tubes (22.9% vs. 6.7%; p < 0.001) than in those without. Hospital stay was longer in patients with nephrostomy tubes (median 3 days (interquartile range (IQR) 2-4) vs. 1 day (IQR 1-2); p < 0.001) than in those without. Stone-free rate was comparable between groups (80.9% vs. 77.8%; p = 0.529). In multivariate analysis, nephrostomy remained independently associated with complications (odds ratio 4.15; 95% confidence interval 1.72-10.02; p = 0.001).

CONCLUSIONS: In this retrospective series, tubeless PCNL was associated with significantly reduced overall complication rates, mainly as a result of a low number of bleeding events, and short hospital stay without compromising stone-free rates. These findings support the safety of a tubeless approach in appropriately selected patients.

PMID:41492665 | DOI:10.56434/j.arch.esp.urol.20257810.177

Lancet Reg Health Eur. 2025 Nov 20;60:101508. doi: 10.1016/j.lanepe.2025.101508. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis.

METHODS: We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables.

FINDINGS: 6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17-1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62-1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05-3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80-5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01-1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50-1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15-1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21-2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025-0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011-0.035).

INTERPRETATION: A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups.

FUNDING: Dutch Ministry of Health, Welfare and Sport; TKI Health Holland.

PMID:41492655 | PMC:PMC12765169 | DOI:10.1016/j.lanepe.2025.101508