Category: Statistics

JMIR Form Res. 2026 Mar 17;10:e76018. doi: 10.2196/76018.

ABSTRACT

BACKGROUND: Using social media platforms has been demonstrated to be a successful recruitment method, especially for young people. Two cited benefits of using social media for recruitment are its ability to quickly increase sample size and engage hard-to-reach participants.

OBJECTIVE: This study aimed to (1) provide a pragmatic depiction of co-designing and implementing a social media strategy with our advisory group and (2) compare demographic information of participants recruited via social media and other methods. Our objective was to provide evidence for future trials to implement social media recruitment with maximum efficiency.

METHODS: Participants were 2369 UK university students who consented to take part during the recruitment timeframe of 2 mental health trials. Our student advisory group advised on content, platform, and timing of engagement. We trialed 10 different adverts over a 12-month recruitment period. Descriptive analysis evaluated advert reach and link clicks using Meta/TikTok business data, website traffic using Google Analytics, screening consent, and enrollment using REDCap (Research Electronic Data Capture; Vanderbilt University) software. A cross-sectional observational analysis used chi-square and t tests to compare ethnicity, gender, sexual orientation, disability status, and university attended among 842 participants recruited via social media and 1527 participants recruited by other methods.

RESULTS: Through extensive student advisor input, an Instagram carousel advert led to a boost in participant recruitment. However, this fluctuated over the academic year, with numbers dropping completely over the summer months. All tests used α=.05. There was a difference in gender among those recruited through social media versus other recruitment methods on campus (χ²2=8.34, P=.02), with social media resulting in a higher proportion of gender-diverse students (27/370, 7% vs 30/711, 4%; 95% CI 3.4%-13.7%), but fewer male students (35/370, 4%, 95% CI [3.4%-13.7%] vs 99/711, 7%, 95% CI [1.6%-9.8%]). Those recruited from social media were younger than those recruited through other methods, with a mean difference of -3.49 years (SE=0.31, 95% CI [-3.94 to -3.04]; t1927.5=15.146, P<.001). A significantly higher proportion of students in the social media sample were from the LGBTQIA+ community (180/351, 51%, 95% CI [41.3%-60.6%] vs 350/711, 37%, 95% CI [28.2%-46.8%]; χ²1=17.87, P<.001). There was also a significant difference in the reported disability (103/375, 27.5%, 95% CI [19.7%-37.0%] vs 154/723, 21.3%, 95% CI [14.4%-30.3%]; χ²1=4.90, P=.03). There was no difference in ethnicity between the 2 groups (χ²1=2.4609, P=.12).

CONCLUSIONS: Our study describes how different recruitment approaches influence participant characteristics in clinical trials and highlights challenges in implementing a co-designed recruitment strategy in a university setting. This contributes to the field by providing research evidence on the efficacy of different recruitment strategies for planning future trials. Our key real-world recommendation is to allow time and resources for planning multiple recruitment strategies to ensure a diverse range of participants take part in research.

PMID:41843777 | DOI:10.2196/76018

JMIR Aging. 2026 Mar 17;9:e83078. doi: 10.2196/83078.

ABSTRACT

BACKGROUND: Rapid population aging and the intensifying digitalization of everyday life are unfolding simultaneously in China. While prior studies have largely examined pairwise associations among digital inclusion, social engagement, mental health, and overall health status, few have evaluated an integrated, theoretically grounded pathway linking these domains in later life.

OBJECTIVE: This study aims to quantify the direct and indirect pathways through which digital inclusion influences older adults’ overall health status, social engagement, and mental health, specified as sequential mediators.

METHODS: We analyzed the newly released, nationally representative data from the 2023 wave of the China Longitudinal Aging Social Survey, comprising 9918 adults aged 60 years or older. Overall health status was assessed using 3 self-rated health (SRH) indicators: current SRH, SRH relative to age peers, and SRH relative to last year. Digital inclusion was measured through digital access, device proficiency, and digital ability. Social engagement captured social support, frequency of participation in community or voluntary activities, and nononline activities. Mental health included depressive symptoms, social adaptation, and life satisfaction. Analyses included descriptive statistics, multivariable hierarchical linear regressions, and structural equation modeling to estimate direct and mediated effects (2-sided; α=.05).

RESULTS: Older age, chronic disease, and functional limitations were associated with poorer overall health status, whereas higher education and current employment were associated with better health status. Digital inclusion was positively associated with social engagement (β=.50), which in turn was positively associated with mental health. Mental health showed the strongest association with SRH (β=.74). The direct path from social engagement to overall health status was nonsignificant (P=.34), indicating that participation influences health primarily through psychological pathways. In regression analyses, digital inclusion modestly improved model fit for health status outcomes, while adding mental health produced a greater increase.

CONCLUSIONS: Digital inclusion promoted active aging indirectly, by expanding social engagement and enhancing mental health, thereby improving overall health status. Policy efforts should prioritize narrowing the digital divide by improving digital skills and capability, rather than access alone. Meaningful opportunities for social engagement should also be expanded to strengthen community-based mental health support. In addition, strategies should be tailored to the differing needs of urban and rural settings.

PMID:41843772 | DOI:10.2196/83078

Comput Inform Nurs. 2026 Mar 16. doi: 10.1097/CIN.0000000000001510. Online ahead of print.

ABSTRACT

Medication dosage calculation is a vital clinical skill essential for patient safety. However, many nursing students experience difficulties mastering this competency due to mathematical anxiety and limited practice. Artificial intelligence (AI)-based tools, such as ChatGPT, offer interactive and learner-centered educational experiences by providing personalized guidance and immediate feedback. This study aimed to evaluate the effects of ChatGPT-assisted medication dosage calculation training on nursing students’ knowledge, calculation accuracy, test completion time, and learning satisfaction. A single-group quasi-experimental pretest-post-test design was implemented in the nursing department of a public university in Turkey. A total of 41 first-year nursing students voluntarily participated. A 4-session ChatGPT-assisted training program was delivered, focusing on unit conversions, dilution, pediatric dosages, and infusion rate calculations. Data were collected through a medication knowledge test, stopwatch-measured test completion time, a Visual Analog Scale for satisfaction, and open-ended feedback. Data were analyzed using descriptive statistics, paired t tests, and Cohen’s d post-training knowledge scores increased from 49.85±21.83 to 77.36±19.19 (P<.001, d=1.26). Unanswered questions decreased from 7.95±5.30 to 1.17±2.08 (P<.001, d=1.28). Time per question decreased from 2.02±2.95 to 0.90±1.95 minutes (P=.019, d=0.38). The satisfaction score was 9.02±0.99. Most students (95.1%) preferred the AI-assisted method over traditional training. ChatGPT-assisted training significantly enhanced nursing students’ knowledge, accuracy, test efficiency, and satisfaction. These results support integrating AI tools into nursing education to improve clinical competence and engagement.

PMID:41843767 | DOI:10.1097/CIN.0000000000001510

JMIR Med Educ. 2026 Mar 17;12:e79134. doi: 10.2196/79134.

ABSTRACT

BACKGROUND: The exponential growth of medical knowledge presents a paradox for modern medical education. While access to information is immediate, applying it in a clinically meaningful way remains a challenge. Large language models (LLMs), such as ChatGPT, are widely used for information retrieval, yet their role in dynamic, high-pressure clinical learning remains poorly understood.

OBJECTIVE: This study aims to evaluate whether unstructured access to an LLM improves decision-making, teamwork, and confidence in trauma education for medical students.

METHODS: This randomized controlled pilot study involved 41 final-year medical students participating in a trauma simulation session. Students self-selected into teams of 4 to 6 and were randomized to either an LLM-assisted group (ChatGPT-4o mini) or a control group without LLM access. All teams completed 18 video-based trauma scenarios requiring time-sensitive clinical decisions. Prompting was unrestricted. Confidence and trauma exposure were assessed using pre- or postquestionnaires. Facilitators rated teamwork (1-5), decision accuracy, and response times. Knowledge retention was measured 4 weeks later via an online quiz.

RESULTS: Confidence in trauma management improved in both groups (P<.001), with larger gains in the non-LLM group (P=.02). LLM support did not enhance the decision accuracy or speed and was associated with longer response times in some complex cases. Teams without LLMs demonstrated more active discussion and scored higher in teamwork ratings (median 5.0 [IQR 5.0-5.0] vs median 3.5 [IQR 3.0-4.5]; P=.08). Students primarily used the LLM for fact-checking but reported vague or overly general responses. Knowledge retention was high across both groups and did not differ significantly (P=.33).

CONCLUSIONS: While students appreciated the inclusion of artificial intelligence (AI), unstructured LLM use did not improve performance and may have disrupted the group reasoning. The use of non-English prompting likely contributed to lower AI performance, underscoring the importance of language alignment in LLM applications. This pilot study highlights the need for structured AI integration and targeted instruction in AI literacy. Simulation-based trauma education proved effective and well received, but optimizing the educational value of LLMs will require thoughtful curricular design. Further studies with more students are needed to define best practices for LLM use in clinical education.

PMID:41843765 | DOI:10.2196/79134

J Med Internet Res. 2026 Mar 17;28:e80529. doi: 10.2196/80529.

ABSTRACT

BACKGROUND: Unplanned emergency department (ED) visits and hospital readmissions following discharge contribute to patient distress, increased health care costs, and system inefficiencies. Early postdischarge follow-up can improve care transitions, yet evidence on the effectiveness of telephone-based interventions remains mixed. Telephone calls, a low-barrier form of digital health, may enhance equity and accessibility by reaching patients who face challenges with in-person or higher-technology follow-up.

OBJECTIVE: This study evaluated the impact of a nurse-led postdischarge telephone intervention delivered by Fraser Health Virtual Care on short-term ED visits and hospital readmissions among recently discharged high-risk patients. Secondary objectives included examining patient experiences with the service and identifying care gaps addressed during follow-up calls.

METHODS: A pragmatic quasi-randomized trial was conducted (May 2022-September 2022). Participants were eligible if they were aged 18 years or older and classified as high-risk for readmission using the LACE (Length of stay, Acuity of admission, Comorbidities, and Emergency department use) index (≥10 or <9 and ≥45 y). Participants were allocated to either a postdischarge telephone intervention group or a standard care control group based on daily nurse availability. Intervention participants received a structured nurse-led call 48 hours after discharge assessing understanding of discharge instructions, medication management, follow-up appointments, and home supports. Primary outcomes were ED visits within 7 and 30 days post call; secondary outcomes were hospital readmissions and patient experience. Negative binomial regression models were used to calculate adjusted incident rate ratios (IRRs).

RESULTS: A total of 7091 participants were included (intervention: n=3911, of whom 1752 completed the call; control: n=3180). Postdischarge calls significantly reduced ED visits at both 7 days (adjusted IRR 0.719, 95% CI 0.617-0.837; P<.001) and 30 days (IRR 0.878, 95% CI 0.783-0.983; P=.02). No statistically significant reductions were observed in hospital readmissions at either 7 days (IRR 0.809; P=.13) or 30 days (IRR 0.942; P=.54). Forty percent of completed calls (n=701) identified at least 1 gap in discharge understanding or follow-up care. Most participants found the calls helpful and reported increased confidence in managing their care.

CONCLUSIONS: Structured nurse-led postdischarge telephone calls significantly reduced short-term ED utilization but did not impact readmission rates. These findings support the role of telephone-based virtual care as a scalable, low-barrier strategy to improve care transitions and reduce avoidable ED visits. Additional or ongoing interventions may be required to influence hospital readmission outcomes among high-risk patients.

PMID:41843752 | DOI:10.2196/80529

J Child Neurol. 2026 Mar 17:8830738261425433. doi: 10.1177/08830738261425433. Online ahead of print.

ABSTRACT

PurposeNeurogenic detrusor overactivity (NDO) can lead to elevated bladder pressure and pose significant risks to the upper urinary tract. This study aimed to evaluate the efficacy of combining solifenacin with biofeedback in treating pediatric NDO caused by primary tethered cord syndrome (TCS).MethodsThis study conducted a retrospective analysis of 32 children diagnosed with NDO caused by primary TCS, who were enrolled and assigned to two groups: group A (n = 16) received solifenacin alone, whereas group B (n = 16) underwent a combined regimen of solifenacin and biofeedback. Outcomes, including lower urinary tract symptoms, urodynamic parameters, and post-void residual urine (PVRU), were assessed at 4, 12, and 24 weeks.ResultsAt 4 and 12 weeks after the initial treatment, both groups showed improvement in lower urinary tract symptoms compared with baseline. However, no statistically significant differences were observed in both groups (P > .05). In assessments at 24 weeks, group B exhibited greater improvement in lower urinary tract symptoms and urodynamic parameters compared with group A (P < .05). These differences were particularly evident in bladder compliance and detrusor overactivity. Despite these superior outcomes, group B required lower cumulative doses of solifenacin than group A. Additionally, no statistically significant improvements were found in PVRU or detrusor function during voiding in either group throughout the follow-up period.ConclusionsThe combination of solifenacin and biofeedback proved to be an effective treatment for pediatric NDO caused by primary TCS, compared with solifenacin monotherapy. This combined approach not only enhanced clinical outcomes but also allowed for reduced solifenacin dosages.

PMID:41841338 | DOI:10.1177/08830738261425433

Epileptic Disord. 2026 Mar 17. doi: 10.1002/epd2.70223. Online ahead of print.

ABSTRACT

OBJECTIVE: Shortages of antiseizure medications (ASM) have been increasingly reported worldwide, threatening treatment continuity for patients with epilepsy. Since 2024, Colombia has experienced a nationwide shortage of medications for neurological diseases, particularly ASM, compromising disease control and healthcare outcomes. This study evaluated the impact of outpatient ASM shortages on seizure-related emergency department (ED) visits in a public hospital in Bogotá, Colombia.

METHODS: We conducted a retrospective, descriptive study of adult patients with epilepsy admitted to the ED between March-May 2023 (no shortage) and March-May 2024 (shortage period). Demographic, clinical, and hospitalization data were collected from medical records. Statistical analyses included Fisher’s exact and Mann-Whitney U tests, with significance set at p < .05.

RESULTS: A total of 281 patients were included (107 in 2023, 174 in 2024). Sixty-one admissions were directly related to lack of outpatient ASM (7 in 2023, 54 in 2024). ED visits due to ASM unavailability increased from 6.5% to 31% (p < .001; OR = 6.4; 95% CI 2.7-17.4). Patients affected by shortages showed a higher risk of seizure clusters (OR = 2.43; 95% CI 1.2-5.1; p = .012) and a trend toward longer hospital stays, though mortality and ICU admissions remained unchanged.

SIGNIFICANCE: Outpatient ASM shortages were associated with a marked rise in seizure-related ED visits and an increased risk of seizure clusters, reflecting greater hospital burden. Ensuring stable ASM supply through effective national distribution and monitoring strategies is essential to maintain seizure control and prevent avoidable complications in patients with epilepsy.

PMID:41841314 | DOI:10.1002/epd2.70223

JAMA. 2026 Mar 17. doi: 10.1001/jama.2026.2897. Online ahead of print.

ABSTRACT

IMPORTANCE: The effect of wrist-strap physical restraints on outcomes in patients receiving mechanical ventilation in the intensive care unit (ICU) remains uncertain.

OBJECTIVE: To investigate the effect of a low-use wrist-strap physical restraint strategy in critically ill patients receiving invasive mechanical ventilation.

DESIGN, SETTING, AND PARTICIPANTS: Open-label randomized clinical trial conducted across 10 ICUs in France. Between January 5, 2021, and January 2, 2024, 405 adult patients who had initiated invasive mechanical ventilation within the previous 6 hours and were expected to require ventilation for at least 48 hours were enrolled. Follow-up was completed on May 17, 2024. Statistical analysis was conducted from June 1, 2025, to December 15, 2025.

INTERVENTIONS: Patients were randomized to undergo either a restrictive, low-use physical restraint strategy (wrist straps avoided unless necessary because of severe agitation, defined as a Richmond Agitation-Sedation Scale score of ≥3 [on a scale from -5 (unresponsive) to 4 (combative)]; n = 201) or a liberal, high-use strategy (wrist straps applied systematically and reassessed daily; n = 204). Discontinuation of restraints was allowed in patients who were awake or extubated without delirium (measured via the Confusion Assessment Method for the ICU).

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of days alive without coma or delirium during the first 14 days after randomization. Secondary outcomes included incidence of self-extubation and day-90 mortality.

RESULTS: Among 396 patients with available primary outcome data, the median (IQR) age was 65 (56-73) years, 245 (62%) were male, and the median (IQR) Sequential Organ Failure Assessment score was 7 (4-10). The mean days alive without coma or delirium were 6.67 days (95% CI, 5.69-7.65) in the low-use strategy group and 6.30 days (95% CI, 5.35-7.24) in the high-use strategy group (adjusted mean difference, 0.37 days [95% CI, -0.71 to 1.46]; P = .51). Self-extubation occurred in 18 patients (9.2%) in the low-use strategy group and 17 (8.5%) in the high-use strategy group, and day-90 mortality was 37.2% and 41.0%, respectively.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, among adult patients receiving mechanical ventilation in the ICU, a low-use wrist-strap physical restraint strategy compared with a high-use strategy did not reduce days free of delirium or coma at 14 days.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04273360.

PMID:41841304 | DOI:10.1001/jama.2026.2897

Clin Nephrol. 2026 Mar 17. doi: 10.5414/CN111893. Online ahead of print.

ABSTRACT

We conducted a retrospective chart review of adult kidney transplant recipients (KTxR) with type 2 diabetes treated with a glucagon-like peptide-1 receptor agonist (GLP-1RA). A total of 211, 207, 161, and 92 KTxR were followed for 6, 12, 36, and 60 months, respectively. Over 5 years, we observed statistically significant reductions in the primary endpoints of weight, HbA1c, and major adverse cardiovascular events (MACE). The mean weight reduction was as follows: 1.17 kg at 6 months (p < 0.006), 1.2 kg at 12 months (p < 0.03), 3.7 kg at 36 months (p < 0.0001), and 4.1 kg at 60 months (p = 0.001) compared to baseline. The HbA1c levels showed reductions of 0.6 mmol/mol at 6 months (p < 0.0001), 0.5 mmol/mol at 12 months (p = 0.0004), 0.3 mmol/mol at 36 months (p = 0.04), and 0.35 mmol/mol at 60 months (p = 0.35). MACE rates fell from 45.5% at GLP-1RA initiation to 18.9% during follow-up (OR 3.6 (2.3 – 5.6), p < 0.0001). Insulin requirements decreased from 50 to 27 units over 5 years. Kidney function reduces over time in KTx, likely secondary to hemodynamic or vascular-mediated risk factors, chronic immunosuppressive agents, treatment for rejections, and solitary transplanted kidney. In our study, estimated glomerular filtration rate (eGFR) not only stayed stable but also showed a trend towards improvement (eGFR improved from 50 to 53 mL/min/1.73m²). Further prospective randomized trials are needed to assess GLP-1RA efficacy and safety in KTxR.

PMID:41841288 | DOI:10.5414/CN111893

Eur J Psychotraumatol. 2026 Dec;17(1):2638114. doi: 10.1080/20008066.2026.2638114. Epub 2026 Mar 17.

ABSTRACT

Background: Children and adolescents exposed to adversities, such as those in residential care or those affected by domestic violence (DV) but not in care, experience elevated rates of trauma, placing them at risk for both posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).Objective: Our objective is to validate the Portuguese adaptation of the International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA) to assess for ICD-11 PTSD and CPTSD in at-risk Portuguese-speaking youths.Methods: The ITQ-CA was translated and culturally adapted following established guidelines. This study included 160 participants aged 7-17 years, comprising children in residential care and those exposed to DV. Confirmatory factor analyses (CFA) were conducted to test competing ICD-11 consistent latent structural models of PTSD and disturbances in self-organisation (DSO). Convergent validity was examined using the CRIES-13 and ITEM-CA, and divergent validity was assessed using the WHO-5. Exploratory factor analysis and network analysis were conducted as supplementary analyses and are reported in the Supplementary Materials.Results: CFA supported the two higher order correlated factors model with two-factor higher-order (PTSD and DSO), yielding adequate fit indices, χ²(52) = 104.189, RMSEA = 0.079, CFI = 0.923, TLI = 0.903. Internal consistency is strong (ω = 0.872; α = 0.871). The ITQ-CA demonstrated significant correlations with the CRIES-13 and ITEM-CA, supporting convergent validity, while negative correlations with the WHO-5 confirmed divergent validity.Conclusion: The Portuguese version of the ITQ-CA demonstrated strong psychometric properties, supporting its use as a valid and reliable tool for identifying PTSD and CPTSD symptoms in children and adolescents. Its integration into practice could support targeted trauma-informed interventions.

PMID:41841273 | DOI:10.1080/20008066.2026.2638114