Category: Statistics

Biomarkers. 2026 Aug 30:1-13. doi: 10.1080/1354750X.2026.2726961. Online ahead of print.

ABSTRACT

BACKGROUND: C-reactive protein (CRP) is a biomarker of vascular inflammation with prognostic value for future cardiovascular events. This meta-analysis investigates the effect of colchicine, a cheap and widely available anti-inflammatory medication, on CRP levels in the months following myocardial infarction (MI).

METHODS: PubMed, EMBASE, and Cochrane were queried from inception to April 2026 to identify randomized controlled trials comparing colchicine to placebo for at least 1 month following MI. The primary outcome was mean CRP level at follow-up. Effect estimates were pooled with random-effects models and reported as mean differences for continuous variables using 95% confidence intervals.

RESULTS: Four studies met inclusion criteria comprising 3384 patients (mean age 60.7 years; 78.3% male), including 1669 patients randomized to the colchicine arm, and 1715 to placebo. Median follow-up period was 3 months (range: 1-6 months). Colchicine following MI resulted in a statistically significant decrease in mean CRP level (mg/L) at follow-up versus placebo (MD: -0.69; [-1.21, -0.17], p = 0.009). Heterogeneity of effect size estimates was high (I² = 97%).

CONCLUSION: Daily colchicine following MI decreases CRP at a median follow-up period of 3 months compared to placebo. The correlation between CRP reduction with colchicine and adverse cardiovascular event reduction warrants additional study.

PMID:42669068 | DOI:10.1080/1354750X.2026.2726961

Eur Heart J. 2026 Aug 30:ehag740. doi: 10.1093/eurheartj/ehag740. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Randomized trials demonstrated that in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) direct oral anticoagulants (DOAC) and a P2Y12 inhibitor reduce bleeding compared with vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT) with no increase in ischemic risk; however, important gaps in knowledge remain, limiting certainty and generalizability of these findings.

METHODS: In this patient-level meta-analysis of randomized trials evaluating antithrombotic strategies in patients with AF undergoing PCI, Cox proportional hazard models, stratified by trial, were used to estimate hazard ratios and 95% confidence intervals (HR, 95%CI). The primary efficacy and safety outcomes were the composite of cardiovascular death, myocardial infarction, or stroke, and TIMI major bleeding, respectively. The study was registered in PROSPERO (CRD420251130025).

RESULTS: Six trials (10,634 patients) comparing DOAC plus P2Y12 inhibitor (4,083), VKA plus single antiplatelet therapy (SAPT, 1,247), VKA plus DAPT (3,715), and DOAC plus DAPT (1,589) were included. The transition from DAPT to SAPT was recommended at 1 (1-3) and 3 (1-7) days in the DOAC plus P2Y12 inhibitor and VKA plus SAPT groups, respectively. At 1 year, the risk of the primary efficacy outcome did not differ across the antithrombotic strategies (reference group: VKA plus DAPT; DOAC plus P2Y12 inhibitor: HR 1.16, 95%CI 0.97-1.41; VKA plus SAPT: 1.14, 0.85-1.54, DOAC plus DAPT: 0.99, 0.75-1.30), without any statistically significant interaction between treatment effects and all prespecified subgroups, including age, sex, bleeding risk, and thrombotic risk. However, 14-day landmark analysis showed an increased risk of myocardial infarction and definite/probable stent thrombosis in patients receiving DOAC plus P2Y12 inhibitor or VKA plus SAPT in the early phase after PCI. DOAC plus P2Y12 inhibitor reduced the risk of the primary safety outcome compared with VKA plus DAPT (0.48, 0.38- 0.65) and VKA plus SAPT (0.62, 0.40-0.97); only a borderline reduction was observed compared to DOAC plus DAPT (0.66, 0.44-1.01). DOAC plus P2Y12 inhibitor reduced intracranial hemorrhage compared with VKA plus DAPT (0.21, 0.07-0.64).

CONCLUSIONS: In patients with AF undergoing PCI, the risk of cardiovascular death, myocardial infarction, or stroke did not significantly differ according to whether patients received a DOAC or VKA, whereas a modest increase in risk with single compared with dual antiplatelet therapy cannot be excluded, given the higher risk of early coronary events. DOACs compared with VKAs reduced the risk of bleeding across all severity grades, including intracranial hemorrhage, whereas omission of a second antiplatelet agent reduced the risk of TIMI major or minor bleeding.

PMID:42669062 | DOI:10.1093/eurheartj/ehag740

Ann Med. 2026 Dec;58(1):2722412. doi: 10.1080/07853890.2026.2722412. Epub 2026 Aug 30.

ABSTRACT

BACKGROUND: Whether a laryngeal mask airway (LMA) can be safely used during liver transplantation remains unclear. However, in clinical practice, the choice of an airway device may also reflect a broader recovery-oriented perioperative strategy rather than an isolated technical substitution.

METHODS: We retrospectively reviewed adult patients who underwent primary elective liver transplantation at our center between January 2024 and November 2025. The patients were grouped according to their primary intraoperative airway device (LMA or endotracheal tube [ETT]). Propensity score matching was used to reduce baseline imbalance. Intraoperative variables, postoperative airway-related events, postoperative pulmonary complications (PPCs), intensive care unit (ICU) stays, and postoperative hospital stays were compared.

RESULTS: After matching, 25 and 44 patients in the LMA and ETT groups, respectively, were analyzed. The LMA group showed a higher rate of immediate airway device removal, lower rocuronium use during anesthetic maintenance, less postoperative noninvasive ventilation, less postoperative sore throat, and a shorter postoperative hospital stay. PPCs were numerically less frequent in the LMA group, but the between-group difference was not statistically significant after matching. No increase in major airway-related adverse events was observed in the LMA group.

CONCLUSIONS: In carefully selected liver transplant recipients, use of LMA within a recovery-oriented perioperative context appeared feasible and was associated with several favorable early postoperative outcomes.

PMID:42669055 | DOI:10.1080/07853890.2026.2722412

Eur Heart J. 2026 Aug 30:ehag729. doi: 10.1093/eurheartj/ehag729. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Hypertension is a common attributable cause of chronic kidney disease (CKD). Mineralocorticoid receptor overactivation can lead to hypertension and contributes to CKD progression. In FIND-CKD, finerenone reduced kidney function decline in participants with CKD without diabetes. This prespecified FIND-CKD analysis assessed finerenone efficacy and safety in participants with hypertensive nephropathy.

METHODS: Adults with estimated glomerular filtration rate (eGFR) 25-<90 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) 200-3500 mg/g were randomized 1:1 to once-daily finerenone or placebo. Hypertensive nephropathy was investigator-reported. Total eGFR slope from baseline to Month 32 was assessed, along with a kidney-cardiovascular composite of sustained ≥57% eGFR decline, kidney failure, hospitalization for heart failure, or cardiovascular death.

RESULTS: Of 1584 randomized participants, 459 (29.0%) had hypertensive nephropathy. Mean blood pressure (± SD) was 134/80 ± 14/10 mmHg, mean eGFR was 44 ± 15 mL/min/1.73 m2, median UACR was 797 mg/g (Q1, Q3: 566, 1247). In participants with hypertensive nephropathy, finerenone slowed total eGFR decline versus placebo by 0.65 mL/min/1.73 m2/year (95% CI: 0.02, 1.29; P = .044) and was associated with a reduction in composite kidney-cardiovascular outcome events (HR: 0.61; 95% CI: 0.38, 0.99; P = .045). These effects were consistent irrespective of baseline systolic blood pressure (SBP) (P-interaction: eGFR slope, 0.96; composite outcome, 0.91). Finerenone reduced SBP by -3.5 mmHg and UACR by 33% at Month 6 vs placebo. Hyperkalaemia occurred more frequently with finerenone (17.1%) than placebo (9.8%); related discontinuation was uncommon (1.3% vs 0.0%, respectively).

CONCLUSIONS: Finerenone slowed eGFR decline and reduced kidney-cardiovascular outcome risk in participants with hypertensive nephropathy, supporting its use in this population. ClinicalTrials.gov registration: NCT05047263.

PMID:42669052 | DOI:10.1093/eurheartj/ehag729

Europace. 2026 Aug 4;28(8):euag214. doi: 10.1093/europace/euag214.

ABSTRACT

AIMS: Population-based screening for atrial fibrillation (AF) should be considered in elderly individuals to enable AF detection. However, participation in systematic screening programmes is often suboptimal. STROKESTOP III evaluated whether opportunistic screening could improve participation compared with systematic screening.

METHODS AND RESULTS: STROKESTOP III is a cluster-randomized trial including individuals aged 75-76 years from 16 primary care centres in Region Värmland, Sweden. Centres were randomized to systematic screening, using mailed invitations, or opportunistic screening, using invitations during visits.In the systematic arm, 1312 individuals were eligible and invited, of whom 607 participated (46.3%). In the opportunistic arm, 1390 individuals attended participating primary care centres and were potentially eligible for invitation. However, 641 individuals (46.1%) were not assessed for eligibility. Among the 749 assessed individuals, 609 were eligible and 374 participated.Participation among invited eligible individuals was significantly higher with opportunistic than systematic screening (374/609, 61.4% vs. 607/1,312, 46.3%; P < 0.005). However, overall reach was lower in the opportunistic arm because of incomplete assessment for invitation (374/1,479, 25.3% vs. 607/1,437, 42.2%; P < 0.005). Participants in the opportunistic arm had a higher cardiovascular risk burden, including more hypertension, diabetes, and a higher CHA2DS2-VASc-score (3.99 vs. 3.60; P < 0.005). Exclusion rates were higher (18.7% vs. 8.7%; P < 0.005), mainly due to previously diagnosed AF and cognitive impairment.

CONCLUSION: Opportunistic screening increased participation among invited individuals and identified a higher-risk population, but its overall population reach was limited by incomplete eligibility assessment. Combining opportunistic and systematic strategies may optimize reach and participation in AF screening programmes.

PMID:42669050 | DOI:10.1093/europace/euag214

Pediatr Pulmonol. 2026 Sep;61(9):e71817. doi: 10.1002/ppul.71817.

ABSTRACT

BACKGROUND: Parapneumonic pleural effusion (PPE) is a frequent complication of pediatric pneumonia. Some cases progress to complicated PPE (cPPE), which is associated with greater morbidity, longer treatment, and a higher likelihood of need for pleural drainage. Early identification of children at risk of progression remains difficult at presentation, and pediatric evidence on early predictors is scarce and inconsistent.

METHODS: We conducted a retrospective observational study including children aged <18 years admitted with PPE between 2015 and 2025. cPPE was defined through standard laboratory and/or imaging criteria. Twenty clinical, laboratory, and radiological candidate predictors available at initial evaluation were assessed. After univariate screening, variables with statistical association and clinical relevance were entered into a multivariate logistic regression model. After model assessment, a simplified score was derived from the original model for bedside use.

RESULTS: A total of 122 children were included, 77 (63%) with cPPE and 45 (37%) with uncomplicated PPE. In univariate analyses, younger age, dyspnea, chest wall retractions, reduced lung sounds, C-reactive protein, lower hemoglobin, pleural effusion thickness, and mediastinal shift were associated with cPPE. In the final multivariate model, five variables remained independently associated: age (OR 0.73, 95% CI 0.63-0.84), retractions (OR 3.23, 95% CI 1.16-8.95), C-reactive protein ≥176.5 mg/L (OR 2.83, 95% CI 1.02-7.82), pleural effusion thickness (OR 2.16, 95% CI 1.27-3.70), and mediastinal shift (OR 10.75, 95% CI 2.24-51.64). The model showed good discriminatory performance, with an AUC of 0.883 (95% CI 0.817-0.948). The optimal probability threshold was 0.49, yielding a sensitivity of 92.2% and a specificity of 71.1%. A simplified additive clinical score derived from the model demonstrated similar performance, allowing stratification into four risk groups with progressively increasing observed rates of cPPE.

CONCLUSIONS: Early risk stratification of pediatric PPE is feasible using a small set of readily available clinical, laboratory, and radiological variables. The proposed model and the adapted clinical score showed good discriminatory ability and may help identify children at increased risk of progression to cPPE who could benefit from closer monitoring and early optimized management. External validation is needed before routine clinical implementation.

PMID:42669040 | DOI:10.1002/ppul.71817

J Nurs Manag. 2026;2026(1):e5594415. doi: 10.1155/jonm/5594415.

ABSTRACT

BACKGROUND: Empowerment in nurses is a multidimensional construct that has favorable results for both the patient and the employee and is emphasized in order to provide high-quality healthcare. For this concept to be translated into practice, measurement tools developed in this field are of critical importance. Although several validated instruments assess structural, psychological, or behavioral empowerment separately, each having been validated independently, using distinct samples, scoring frameworks, and item structures, no instrument evaluating all three dimensions simultaneously within a single scale has been identified. This gap limits nurse managers in comprehensively diagnosing empowerment and in evaluating the effectiveness of empowerment interventions.

OBJECTIVE: The study was conducted to develop a valid and reliable measurement tool aiming to determine the empowerment levels of nurses in a multidimensional manner in terms of structural, psychological, and behavioral dimensions.

METHODS: In this methodological study, the standard scale development and validation procedures required for instruments to be psychometrically sound were employed. An initial 256-item pool was generated based on a comprehensive literature review and an autoethnographic approach involving 36 nurses. Subsequently, face and content validity (Lawshe’s technique) were evaluated. Data were collected between May and September 2017 from nurses (N = 1992) working across 10 hospitals affiliated with a regional health group in Istanbul; the study was completed with a final sample of 743 nurses (37.3%). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to determine the construct validity of the scale. Cronbach’s alpha, item analyses, and test-retest analyses were employed to assess reliability.

RESULTS: The draft nursing empowerment scale (NES), developed as a result of the face and content validity studies, consisted of 136 items and was administered to the sample group. The EFA conducted resulted in a NES consisting of 103 items and three factors (structural, psychological, and behavioral), explaining 49.95% of the total variance (KMO = 0.97; Bartlett χ² = 58,144.65, p < 0.001). The scale factor structure was supported by supplementary CFA. The goodness-of-fit indicators (χ²/df = 3.75; RMSEA = 0.06; CFI = 0.92; NFI = 0.90; GFI = 0.90; AGFI = 0.88) were favorable. Internal consistency was observed (Cronbach’s α = 0.98 overall; subscale α = 0.91-0.98) and 15-day test-retest correlation was r = 0.86 (subscale r = 0.73-0.83).

CONCLUSIONS: The NES demonstrates good psychometric properties as a comprehensive, multidimensional research instrument. Future research should test the scale on independent and diverse samples. Its considerable length (103 items) is acknowledged as a practical limitation, and the development of a shorter, practice-oriented form is planned.

IMPLICATIONS FOR NURSING MANAGEMENT: The NES enables the simultaneous, multidimensional measurement of structural, psychological, and behavioral empowerment within a single instrument. It could be useful in determining empowerment levels and evaluating the effectiveness of targeted empowerment strategies.

PMID:42669038 | DOI:10.1155/jonm/5594415

Anticancer Drugs. 2026 Aug 24. doi: 10.1097/CAD.0000000000001842. Online ahead of print.

ABSTRACT

Oxaliplatin-induced peripheral vascular pain (OIVP) often requires central venous port placement. Conventional preventive strategies have limited efficacy, and the use of some effective analgesics is restricted. This single-center retrospective study evaluated the efficacy and safety of prophylactic tramadol. Electronic medical records of patients who received oxaliplatin-based chemotherapy via a peripheral intravenous line and experienced vascular pain [numerical rating scale (NRS) score ≥ 4] were reviewed. Patients who received prophylactic tramadol in a subsequent cycle were included (n = 23). The primary endpoint was the response rate (≥30% reduction in the NRS score from baseline). The secondary endpoint was the change in NRS score compared with the baseline score in the previous cycle. The response rate was 73.9% [95% confidence interval (CI): 51.6-89.8%]. The median NRS score for OIVP decreased significantly from 7.0 at baseline to 3.0 following tramadol administration (P < 0.0001). Administration greater than or equal to 60 min before infusion was associated with a higher response rate (88.9%; 95% CI: 51.8-99.7%) than administration at 30 min (64.3%; 95% CI: 35.1-87.2%), although this difference was not statistically significant (P = 0.208). Adverse events were mild, with grade 2 nausea reported in two (8.7%; 95% CI: 1.1-28.0%) patients. This exploratory study suggested that prophylactic tramadol was associated with a reduction in pain severity in OIVP, with a favorable safety profile. Thus, tramadol may be a promising and accessible prophylactic option, particularly when access to controlled analgesics is limited.

PMID:42669037 | DOI:10.1097/CAD.0000000000001842

J Nurs Manag. 2026;2026(1):e7889163. doi: 10.1155/jonm/7889163.

ABSTRACT

AIMS: To identify the latent profiles of Chinese Generation Z new nurses’ job crafting, explore their demographic characteristics, and examine the predictive role of innovative behaviors in distinct job crafting profiles.

BACKGROUND: New nurses experience high levels of stress and turnover intention during early career transition, highlighting the importance of proactive work behaviors. Although job crafting and innovative behavior are both considered important for professional development and workforce sustainability, evidence on their association and heterogeneity among new nurses remains limited.

METHODS: This cross-sectional study was conducted using convenience sampling among new nurses from three tertiary hospitals in Midwestern China between March and May 2023. Participants completed the Innovative Behavior Scale, the Job Crafting Scale, and a demographic questionnaire. Latent profile analysis (LPA) was applied to identify potential subgroups of job crafting among new nurses. LPA was conducted using Mplus 8.3, while descriptive statistics, chi-square tests, analysis of variance, and multinomial logistic regression were performed using SPSS 27.0.

RESULTS: Three job crafting profiles were identified: “low job crafting profile” (43.3%), “moderate job crafting profile” (47.5%), and “high job crafting profile” (9.2%). Significant differences were observed in age, marital status, educational attainment, and innovative behavior (P< 0.05). Multinomial logistic regression further indicated that innovative behavior was a significant predictor of profile membership (P< 0.05).

CONCLUSION: Heterogeneity in job crafting among Chinese Generation Z new nurses and the key role of innovative behavior in shaping job crafting patterns are evident, with implications for targeted managerial strategies to support professional development.

IMPLICATIONS FOR NURSING MANAGEMENT: Practical implications include tailoring management strategies to each profile: supporting foundational skills and psychological safety for nurses in the low job crafting profile, promoting gradual task enhancement and professional confidence-building for nurses in the Moderate job crafting profile, and sustaining empowerment and leadership development among nurses in the high job crafting profile.

PMID:42669036 | DOI:10.1155/jonm/7889163

J Magn Reson Imaging. 2026 Aug 30. doi: 10.1002/jmri.70520. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebrovascular aging is characterized by progressive reductions in cerebral blood flow and vascular compliance. Although long-term endurance exercise has been associated with improved brain health, its relationship with cerebrovascular aging remains incompletely understood.

PURPOSE: To assess associations between long-term endurance exercise and intracranial arterial structural and hemodynamic characteristics, and to determine whether these associations differ with age.

STUDY TYPE: Prospective cross-sectional study.

POPULATION: Fifty-one endurance runners (≥ 5 h/week endurance exercise for ≥ 3 years) and 51 matched sedentary controls.

FIELD STRENGTH/SEQUENCE: Intracranial four-dimensional velocity-encoded gradient echo sequence (4D Flow MRI) at 3.0 T.

ASSESSMENT: Luminal cross-sectional area, blood flow, pulsatility index (PI), and resistive index (RI) were quantified in the bilateral internal carotid arteries and basilar artery. Total cerebral blood flow (TCBF) was calculated from these vessels.

STATISTICAL TESTS: Univariable analysis was used to compare groups. Multivariable linear regression and linear mixed-effects models were used to assess associations of age and long-term endurance exercise with cerebrovascular structural and hemodynamic parameters, with additional testing for age-by-exercise interactions. A p value < 0.05 was considered significant.

RESULTS: Endurance runners had significantly higher TCBF than sedentary controls (586.2 ± 85.7 vs. 540.7 ± 85.6 mL/min). Older age was independently associated with lower cerebral blood flow (β = -2.636 mL/min per year) and higher PI (β = 0.003 per year), whereas long-term endurance exercise was independently associated with larger luminal cross-sectional area (β = 1.119 mm²) and higher TCBF (β = 52.929 mL/min) and higher vessel-level blood flow (β = 19.313 mL/min). In addition, endurance exercise was associated with higher RI (β = 0.054) but not PI (β = 0.026). No significant age-by-exercise interactions were observed.

DATA CONCLUSION: Long-term endurance exercise was associated with larger intracranial arterial luminal dimensions and higher cerebral blood flow, without significant differences in age-related hemodynamic changes between groups.

STAGE OF TECHNICAL EFFICACY: 2.

PMID:42669028 | DOI:10.1002/jmri.70520