Category: Statistics

Neurosurg Focus. 2025 Oct 1;59(4):E6. doi: 10.3171/2025.7.FOCUS25531.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical pathologies. Despite the optimization of surgical approaches, outcomes such as recurrence and complication rates remain unacceptably high. Consolidated evidence-based pathways have demonstrated a clear impact on surgical outcomes. Herein, the authors aggregated literature evidence and institutional experience to design and implement an enhanced recovery pathway for cSDH.

METHODS: A multicenter cohort study was conducted over two periods: prior to (July 2021 to June 2022) and after (July 2022 to June 2023) pathway implementation. All adult patients with surgically evacuated cSDH or subacute subdural hematoma (SDH) were included in the study. Patients with SDHs that were managed conservatively, acute SDH treated with craniotomy or craniectomy, or subdural empyemas were excluded. Demographic details as well as preoperative clinical and radiological data were collected. Outcome measures included hospital length of stay (LOS), complication rate, discharge location, 30-day mortality, and 3-month recurrence. An excellent outcome was defined as discharge within a week of burr hole evacuation to a location similar to or better than premorbidly and no 3-month recurrence.

RESULTS: One hundred seventy prepathway and 169 postpathway patients were included in the final analysis and were comparable both demographically and clinically. After multivariable logistic regression analysis, the postpathway group had a shorter median LOS (9 vs 7 days, p = 0.003) and were more likely to be discharged to home or a rehabilitation facility (OR 2.77, 95% CI 1.45-5.56, p = 0.002). The 3-month recurrence rate reduced from 11.8% prepathway to 7.7% postpathway, although the difference between the two was not statistically significant (p = 0.13). Excellent outcomes were more likely postpathway, increasing from 34.7% to 49.7% (OR 1.92, 95% CI 1.19-3.13, p = 0.008).

CONCLUSIONS: The treatment of cSDH is ever evolving with newer adjuncts and treatment modalities described in the literature. However, with the simple standardization of care in patients with cSDH, a reduced LOS, an optimized patient discharge location, and an increase in the proportion of patients with excellent outcomes were noted.

PMID:41032893 | DOI:10.3171/2025.7.FOCUS25531

Transplantation. 2025 Sep 24. doi: 10.1097/TP.0000000000005515. Online ahead of print.

ABSTRACT

BACKGROUND: The spirometric response to standard-of-care (SOC) immunosuppressive therapy for the management of bronchiolitis obliterans syndrome (BOS) has been sparsely reported in the literature. Data from a Medicare-approved Registry were analyzed to characterize the effectiveness/durability of a wide range of SOC interventions to manage the decline of lung function and to validate the study spirometric criteria for initiation of rescue therapy.

METHODS: Lung transplant recipients with refractory BOS at 21 US collaborating centers were enrolled in the Registry. Data included both nonspirometric (eg, demographic, Immunosuppressive Regimens for management of BOS) and spirometric parameters (ie, FEV1 measurements and derived indices). The utility of study forced expiratory volume in 1 s (FEV1) criteria for treatment (ie, statistically significant rate of FEV1 decline >30 mL/mo) was evaluated by comparing the spirometric course between participants who met or did not meet this criterion.

RESULTS: Only 21% of participants treated with SOC therapy had >50% decrease (76 ± 25% decrease) in the rate of FEV1 decline. Although 51% of participants had a partial response (rate of FEV1 decline decreased on average 71%), 49% of participants had a substantial increase (mean increase 224%). The FEV1 criterion for treatment was able to identify 19% of participants (48/258) who achieved durable stabilization (ie, nonsignificant rate of FEV1 <30 mL/mo) with SOC therapy.

CONCLUSIONS: Patients with BOS have a widely variable response to SOC therapy. Our findings support the use of FEV1 rate of decline to assess response to SOC therapy and to assure appropriate assignment of participants with refractory BOS to rescue therapy treatment cohorts.

PMID:41032890 | DOI:10.1097/TP.0000000000005515

JMIR Res Protoc. 2025 Oct 1;14:e73040. doi: 10.2196/73040.

ABSTRACT

BACKGROUND: Photoplethysmography (PPG) is an optical method for measuring blood volume changes in microcirculation through noninvasive photodetection. It has become a widespread and essential clinical tool, used in pulse oximeters and wearable devices. However, technical aspects of PPG make it susceptible to intrinsic bias, with the potential to adversely affect particular patient and consumer populations. Developments in PPG technology, increasingly driven by openly accessible datasets as opposed to de novo experimentation, have the potential to help monitor an array of physiological variables. However, some populations may be underrepresented in PPG datasets. We describe a protocol for a systematic review to assess the biases within open access PPG datasets.

OBJECTIVE: This review aims to evaluate the underlying reporting patterns and structure of openly accessible PPG datasets. We will provide insight into the measured biosignals and demographic variables included in the datasets in the hope of shedding light on what PPG data parameters are being used to develop medical devices. Therefore, we can elucidate current gaps and areas for improvement to reduce bias in medical device development.

METHODS: This review will be reported in accordance with the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We will include primary studies that mention PPG and specifically reference openly accessible datasets since 2000. The datasets must contain physiological parameters such as heart rate, blood pressure, or respiratory rate, as well as the PPG waveform data, collected from humans. Searches will be conducted in literature databases and data repositories, including MedLine OVID, IEEE Xplore, Scopus, and PhysioNet. Studies will be evaluated in accordance with the Standing Together Initiative recommendations, which are urging for health care technologies supported by representative data. Biosignal and demographic variables will be extracted from the PPG datasets, with steps taken to harmonize and store this information. Statistical analysis will be performed, including descriptive statistics and the chi-square test for comparisons. Additional statistical analyses will be performed after data extraction is completed and the level of heterogeneity is characterized.

RESULTS: We will analyze the dataset diversity and the structural basis of PPG datasets. This includes statistically analyzing the demographic and biosignal variables in the datasets. By using statistical test fit for nominal variable comparisons, we will evaluate the frequencies of characteristics like the devices used, biosignals collected, clinical parameters, demographic characteristics, and geographic information. This systematic review is expected to be completed by September 2025. The screening and review of the articles is currently being conducted.

CONCLUSIONS: This review will provide insight into the potential gaps of existing open access PPG datasets. It will inform future data collection and design of openly available PPG datasets for training medical devices, including wearables, to avoid perpetuating biases, allowing for application in diverse clinical settings.

PMID:41032881 | DOI:10.2196/73040

JMIR Form Res. 2025 Oct 1;9:e68052. doi: 10.2196/68052.

ABSTRACT

BACKGROUND: Depression in women results in elevated morbidity rates, functional impairment, diminished quality of life, and an increased risk of suicide. Numerous obstacles impede access to mental health treatment for women in India. Digital mental health solutions can bridge the treatment gap, but it is important to tailor these solutions to the context and to end-users.

OBJECTIVE: We conducted a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary effectiveness of a mental health app deployed in community-based organizations in improving depression outcomes.

METHODS: The Multiuser Interactive Health Response Application (MITHRA) is a multiple-user mobile app used in community-based organizations for screening, tracking, and supporting stepped-care treatment for depression. MITHRA is based on the healthy activity program, a brief psychological intervention based on behavioral activation. It includes audio, video, and enhanced touchscreen capabilities to overcome the barrier of illiteracy and lack of access. It was developed in collaboration with a participatory design group consisting of primary and secondary end-users and is available on tablets installed in self-help groups (SHGs), which are community-based organizations in India. The SHGs were randomized to MITHRA (n=3) or enhanced usual care (EUC; n=3). During SHG meetings, women completed the Patient Health Questionnaire-9 (PHQ-9). Based on their PHQ-9 scores, they were assigned different modules. In the EUC SHGs, women viewed one module of education on symptoms of depression. Primary outcomes include feasibility and acceptability, and secondary outcomes include depressive symptoms and functioning. Repeated-measures ANOVA was performed to compare the change in the outcome scores over time between study groups. A P value of<.05 was considered statistically significant.

RESULTS: MITHRA was found to be feasible and acceptable. A total of 96% of intervention arm participants completed at least half of their assigned modules. Although not powered for effectiveness outcomes, in this trial, we found that the change at 6 months from baseline in depressive symptoms (PHQ-9) were significantly different between MITHRA and EUC (P=.037), with greater improvement in the intervention group. Similarly, significant improvement in the World Health Organization Disability Assessment Scale score was noted in the MITHRA group (P=.005).

CONCLUSIONS: MITHRA is feasible and acceptable for use in women’s SHGs. Larger studies should examine the effectiveness of this approach in identifying and treating depression.

PMID:41032879 | DOI:10.2196/68052

JMIR Nurs. 2025 Oct 1;8:e72846. doi: 10.2196/72846.

ABSTRACT

BACKGROUND: “Internet Plus Nursing Service” (IPNS) offers innovative solutions for China’s growing home health care demands. Understanding primary care nurses’ participation intentions is crucial for service optimization.

OBJECTIVE: This study evaluates primary health nurses’ intention to participate in IPNS-a technology-mediated home care model combining mobile health platforms with in-person visits-and examines how digital readiness, safety perceptions, and organizational factors influence participation decisions, to guide policy optimization for scalable digital home health care delivery.

METHODS: A cross-sectional survey was conducted in Jiangsu Province, China (December 2023-December 2024) using the validated Participation Intention of Nurses on IPNS Scale. Convenience sampling enrolled 3952 nurses from 13 prefecture-level cities in Jiangsu-the second-tier administrative divisions in China that typically encompass both urban and rural areas, each with independent health care systems governed by municipal health authorities. Statistical analyses included t tests and ANOVA with SPSS 22.

RESULTS: A total of 3952 surveys were completed. The participation intention scale yielded a mean (SD) total score of 66.13 (7.89) across respondents. Subscale analysis revealed mean (SD) scores of 18.57 (2.68) for participation attitude, 18.87 (2.49) for subjective norms, and 25.67 (3.48) for perceived behavioral control. Significant demographic predictors of participation intention were identified through statistical analysis. Male nurses demonstrated stronger intention (t72.974=-23.139, P<.0001), as did those over 30 years old (F39,51=27.215, P<.0001) and bachelor’s degree holders (t2185.018=-4.994, P<.0001). Workplace characteristics also showed significant associations, with nursing management department staff (F39,51=45.877, P<.0001) and those with less organizational workloads (F39,51=9.829, P<.0001) displaying greater intention. Professional factors including higher positional rank (F39,51=37.32, P<.0001), more advanced titles (F39,51=30.176, P<.0001), and over 11 years of experience (F39,51=5.242, P=.001) predicted stronger participation intent. Finally, nurses earning 5000-10,000 RMB (a currency exchange rate of RMB 1=US $0.71 is applicable) monthly showed significantly higher intention scores (F39,51=16.141, P<.0001).

CONCLUSIONS: Policymakers should prioritize 3 interventions: (1) develop IPNS-specific safety protocols and legal safeguards, (2) optimize workload allocation through intelligent scheduling systems, and (3) establish tiered incentive mechanisms targeting middle-income nurses and experienced practitioners.

PMID:41032878 | DOI:10.2196/72846

JMIR Form Res. 2025 Sep 30. doi: 10.2196/80917. Online ahead of print.

ABSTRACT

BACKGROUND: Discharge instructions are essential for patient post-hospital care, but are time-consuming to write. With the rise of large language models (LLMs), there is strong potential to automate this process. This study explores the use of open-source LLMs for generating discharge instructions.

OBJECTIVE: We investigated whether a Mistral model can reliably generate patient-oriented discharge instructions. Two distinct instruction-tuning paradigms were compared, each using a different mechanism for embedding guidance during fine-tuning.

METHODS: In our experiment, we applied Mistral-NeMo-Instruct, a large language model, in combination with two distinct instruction strategies for fine-tuning. The first were detailed instructions tailored to the task of discharge instruction generation. The second was a basic instruction with minimal guidance and no task-specific detail. The independent variable in this study is the instruction strategy (detailed vs. generic), while the dependent variables are the evaluation scores of the generated discharge instructions. The generated discharge instructions were evaluated against 3,621 ground-truth references. We used BLEU-1 to BLEU-4, ROUGE (ROUGE-1, ROUGE-2, ROUGE-L), SentenceTransformer similarity, and BERTScore as evaluation metrics to assess the quality of the generated outputs in comparison to the corresponding ground-truth instructions for the same discharge summaries.

RESULTS: The detailed instruction model demonstrated superior performance across all automated evaluation metrics compared with the generic instruction model. BERTScore increased from 78.92% to 87.05%, while structural alignment measured by ROUGE-L improved from 8.59% to 26.52%. N-gram precision (BLEU-4) increased from 0.81% to 21.24%, and METEOR scores rose from 15.33% to 18.47%. Additional metrics showed consistent gains: ROUGE-1 improved from 16.59% to 42.72%, and ROUGE-2 increased from 1.97% to 45.84%. All improvements were statistically significant (P < .001), indicating that detailed, task-specific instruction design substantially enhances model performance.

CONCLUSIONS: The use of detailed, task-specific instruction strategies significantly enhances the effectiveness of open-source large language models in generating discharge instructions. These findings indicate that carefully designed instructions during fine-tuning substantially improve model performance.

PMID:41032874 | DOI:10.2196/80917

JMIR Form Res. 2025 Oct 1;9:e75335. doi: 10.2196/75335.

ABSTRACT

BACKGROUND: Menopause is a significant time in a woman’s life, but only recently has there been an open discussion about it in the media, workplaces, and general society. With increasing frequency, women are using the internet to research menopause, making it essential that online sources provide safe, high-quality, and relevant information.

OBJECTIVE: This study aimed to investigate the current state of the online information landscape for menopause from the perspective of information seekers, exploring (1) information-seeking behavior and (2) perceptions of online resources for menopause.

METHODS: A 10- to 15-minute online survey was conducted asking about the respondents’ use of and opinions about online resources specifically for menopause. We distributed the survey via social media, email, and word of mouth. Quantitative data were explored using means and frequencies. Group differences between menopausal groups were analyzed using chi-square, Fisher exact, or Kruskall-Wallis tests as appropriate. Qualitative data were analyzed using data-driven thematic analysis.

RESULTS: Data from 627 participants were analyzed (early perimenopause: n=171, 27.3%, late perimenopause: n=125, 19.9%, postmenopause: n=262, 41.8%, and surgical menopause: n=69, 11%). The majority of respondents had used the internet as a source of information (581/627, 92.7%), with the internet being the first choice of information source (489/581, 84.2%). The most searched-for information online was about menopause symptoms (479/581, 82.4%), menopause treatment options (442/581, 76.1%), and self-help tips or strategies (318/581, 54.7%). The majority of participants trusted online information to some extent (615/627, 98.1%), with many also considering online information accurate to some extent (555/627, 88.5%). Many participants reported finding some but not all of the information they were looking for online (379/581, 65.2%). Thematic analysis revealed 10 themes related to information quality and accessibility and sought-after information (eg, symptom specifics, treatment, and nonformal management strategies). Analysis also indicated that information is lacking for several groups, including those in medically induced or surgical menopause.

CONCLUSIONS: The study showed that online informational resources are widely accessed and widely perceived as useful and trustworthy. However, it is crucial that the quality of online information is evaluated, especially considering the large number of users who rely on it as their first or only informational source. Online searches were usually performed to find information related to symptoms, treatment, and self-help recommendations, with differences in search behaviors observed across menopausal stages and groups, highlighting the need for tailored informational resources. Thematic analysis revealed gaps in the provision of online information both in terms of content and quality. Participants noted a lack of comprehensive symptom information, inadequate information for groups such as those experiencing medical or surgical menopause, and concerns about outdated content and a lack of source transparency. Future research with more diverse samples is needed to better understand variations in online health information-seeking behaviors across groups.

PMID:41032866 | DOI:10.2196/75335

JMIR Mhealth Uhealth. 2025 Oct 1;13:e68464. doi: 10.2196/68464.

ABSTRACT

BACKGROUND: Management of noncommunicable diseases (NCDs) is an increasing challenge for health care systems. Although remote patient monitoring presents a promising solution by utilizing technology to monitor patients outside clinical settings, there is a lack of knowledge about the effect on resource utilization.

OBJECTIVE: This systematic review aimed to review the effects of remote patient monitoring on health care resource utilization by patients with NCDs.

METHODS: Eligible randomized controlled trials (RCTs) involved digital transmission of health data from patients to health care personnel. Outcomes included hospitalizations, length of stay, outpatient visits, and emergency visits. A systematic literature search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials in June 2024. Titles, abstracts, and full texts were screened individually by 2 authors. Risk of bias was assessed, and data were extracted, analyzed, and pooled in meta-analysis when possible. Confidence in the estimates was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS: We included 40 RCTs published between 2017 and 2024. The largest group of NCDs was cardiovascular disease (16 studies). Remote patient monitoring may slightly decrease the proportion of hospitalizations compared with usual care (risk ratio [RR] 0.86, 95% CI 0.77 to 0.95; low certainty). Compared with usual care, remote patient monitoring had fewer or an equal number of hospitalizations (mean difference -0.13, 95% CI -0.29 to 0.03; low certainty). Hospital length of stay may be slightly reduced with remote patient monitoring compared with usual care (mean difference -0.84, 95% CI -1.61 to -0.06 days; low certainty). The proportion of outpatient visits showed probably little to no difference between remote patient monitoring and usual care (RR 0.94, 95% CI 0.87 to 1.02; moderate certainty). Compared with usual care, remote patient monitoring had slightly more outpatient visits, but the CI was wide (mean difference 0.41, 95% CI -0.22 to 1.03; low certainty). The results indicate a small or no difference between remote patient monitoring and usual care regarding proportion of emergency visits (RR 0.91, 95% CI 0.79 to 1.05; low certainty). We are uncertain whether remote patient monitoring increases or decreases the number of emergency visits, as the evidence was of very low certainty.

CONCLUSIONS: This systematic review showed that remote patient monitoring possibly led to lower proportions of patients being hospitalized, fewer hospitalizations, and shorter hospital length of stay compared with usual care. Patients undergoing remote monitoring had possibly more outpatient visits compared with usual care. The proportions of patients with outpatient visits or emergency visits were probably similar. Finally, we had very low certainty in the number of emergency visits. The results should be considered with caution as the certainty of evidence was moderate to very low. We did not find results regarding institutional stay.

PMID:41032865 | DOI:10.2196/68464

Medwave. 2025 Oct 1;25(9):e3106. doi: 10.5867/medwave.2025.09.3106.

ABSTRACT

INTRODUCTION: Surgical waiting lists for conditions not covered by the Explicit Health Guarantees represent unmet needs and structural gaps within the Chilean public health system. The field of orthopedics and traumatology accounts for a high volume of pending procedures, with total knee arthroplasty being the most frequently delayed. The coexistence of deferrable pathologies not formally recorded, combined with the low efficiency in the use of operating rooms, aggravates this problem. This study aims to characterize the surgical waiting list for conditions not covered by the Explicit Health Guarantees in Chile between 2022 and 2024, with a focus on orthopedics and traumatology. Additionally, we identify the most delayed procedures, the most affected health services, and the current capacity for resolution.

METHODS: A descriptive observational study based on official data requested from the Ministry of Health through transparency and public records, including the Department of Health Statistics and Information and the National Health Fund. Surgical procedures awaiting treatment were analyzed by specialty, region, establishment, sex, and age for the period from 2022 to 2024.

RESULTS: Orthopedics and traumatology were the specialties with the highest number of pending procedures (22 to 24% of the total). Knee arthroplasty consistently ranked first, with over 20 000 cases annually. The O’Higgins Health Service had the highest burden. In 2022, the rate of arthroplasties performed on patients covered by the National Health Fund was four times lower than on patients covered by Social Security Health Institutions. No region achieved a surgical volume sufficient to reduce the waiting list significantly.

CONCLUSIONS: The problem of waiting lists in orthopedics is mainly due to organizational shortcomings. Creating the role of trauma emergency ward, optimizing the use of wards, and creating outpatient surgical units are short- and medium-term measures to reverse this trend.

PMID:41032845 | DOI:10.5867/medwave.2025.09.3106

Opt Lett. 2025 Oct 1;50(19):6145-6148. doi: 10.1364/OL.571324.

ABSTRACT

Harmonically mode-locked soliton fiber laser can host an ensemble of identical solitons in parallel, providing a unique many-body system for exploring the intrinsic stochasticity of soliton dynamics in nonlinear optical systems. We report in this work the experimental observation of parallel soliton dynamics under homogeneous perturbation in a harmonically mode-locked fiber laser. Given an abrupt and transient decrease in the pump power, the parallel solitons exhibit evolution trajectories of probabilistic nature, featuring prominent re-distribution of soliton energies followed by random collapse and recovery after the perturbation. We investigate statistical dependences of the soliton collapse upon the perturbation parameters, while revealing threshold behaviors of the recovery dynamics. This work provides unique insight into the stochasticity of the nonlinear soliton evolution in mode-locked fiber lasers and may help to improve laser stability.

PMID:41032814 | DOI:10.1364/OL.571324