Category: Statistics

Am J Sports Med. 2026 Jan 16:3635465251399208. doi: 10.1177/03635465251399208. Online ahead of print.

ABSTRACT

BACKGROUND: There is no consensus regarding the appropriate indications for the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR).

PURPOSE: To determine if incomplete correction of the pivot shift during ACLR is an appropriate intraoperative indication to add the LET, in terms of clinical outcome.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: From January 2018, incomplete correction of the pivot shift relative to the contralateral knee was used as the indication to add LET to ACLR. Patients presenting before this date comprised group A and those after group B. Study criteria included first-ever ACL rupture, participating in pivoting sports, no other significant ligament injury, and surgery within 3 months of injury. Outcomes of interest were recurrent instability, meniscal tears, and patient-reported outcome measures (PROMs): Tegner activity score (TAS), Knee injury and Osteoarthritis Outcome Score subscales for sport and recreation (sport/rec) and knee-related quality of life, subjective International Knee Documentation Committee score, and Lysholm knee score. Statistical analysis was performed.

RESULTS: Group A (2258 patients; 51% male) and group B (2497 patients; 58% male) were similar regarding age, body mass index, knee dominance, time to surgery, graft diameter, and preinjury TAS (P > .05). Group A had a lower male-to-female ratio (P < .05) and lower posterior tibial slope (P = .01). After 2 years, group A had a higher incidence of ACL rerupture than group B (101/2258 [4.5%] vs 75/2497 [3%]; P = .01), with a significant sex and group interaction (P = .04). Males in group A (4.4%) had a higher rate of recurrence than males in group B (2.4%) at 2 years (P = .03), while in females the rate of recurrence was similar (4.5% vs 3.8%; P = .42). Group A had a higher incidence of experiencing a subsequent ipsilateral meniscal tear (58/2258 [2.6%] vs 35/2497 [1.4%]; P = .02). All PROMs were similar (P > .05). Pivot-shift grade before surgery did not correlate with risk of recurrence (P = .991). Uncorrected residual pivot shift was associated with a higher ACL graft rupture rate (P < .001).

CONCLUSION: Using incomplete correction of the pivot shift during ACL surgery as the primary indication to perform LET is associated with lower rates of recurrent ACL rupture, and ipsilateral meniscal tears. Pivot-shift grade before surgery was not associated with risk of recurrence, while residual pivot shift after surgery was.

PMID:41546441 | DOI:10.1177/03635465251399208

Psychophysiology. 2026 Jan;63(1):e70235. doi: 10.1111/psyp.70235.

ABSTRACT

Sighing generates a reliable sympathetic cardiovascular response that, like exercise, could be leveraged in a graded “stress test” to reveal preclinical changes in cardiovascular health and stress reactivity. This study presents the fixed-interval volitional sighing (FIVS) protocol, which rhythmically paces sighs at different frequencies to systematically load the cardiovascular system. Cardiovascular and autonomic responses during the FIVS protocol were statistically dissected to independently characterize physiological responses. Sex differences were explored as a preliminary step toward characterizing factors that affect sigh reactivity. Healthy college students (n = 250, 65% female) completed a baseline task and two sighing tasks: a longer inter-sigh interval task (1 sigh per 30 s, long interval), followed by a shorter inter-sigh interval task (1 sigh per 15 s, short interval). Heart rate (HR), blood pressure, and respiration were continuously measured. Mixed models with a priori cardiorespiratory assumptions isolated HR, low-frequency heart rate variability (LF-HRV), high-frequency HRV (HF-HRV), pulse transit time variability (PTTv), mean arterial pressure (MAP), low-frequency blood pressure variability (LF-BPV), and high-frequency BPV (HF-BPV) responses to the sighing tasks. HR, LF-HRV, PTTv, MAP, and LF-BPV increased significantly from baseline to both sighing tasks, with greater changes observed during short-interval sighing. HF-BPV increased similarly from baseline to both sighing tasks. HF-HRV decreased only during the short-interval sighing task. Males exhibited greater increases than females in HR, LF-HRV, LF-BPV, HF-BPV, and PTTv but smaller decreases in HF-HRV in response to sighing. Volitional sighing elicits cardiac, vascular, and autonomic responses consistent with sympathetic activation. As time under load and loading intensity increased, greater responses were observed in several vascular and sympathetic indices. Sex differences suggest that the FIVS protocol can detect person-specific differences in cardiovascular responding. Sighing is physically accessible for most people, and the FIVS protocol may be useful as a stress test to detect early-stage cardiovascular or autonomic dysfunction.

PMID:41546440 | DOI:10.1111/psyp.70235

Nurs Crit Care. 2026 Jan;31(1):e70343. doi: 10.1111/nicc.70343.

ABSTRACT

BACKGROUND: Anaemia in critically ill patients is often worsened by diagnostic blood sampling. Closed blood sampling devices (CBSDs) may reduce iatrogenic blood loss and transfusion needs. However, robust evidence of their effectiveness and feasibility in the intensive care unit (ICU) setting is lacking.

AIM: To assess the feasibility of conducting a multicentre randomised controlled trial (RCT) evaluating the effectiveness of CBSDs in reducing transfusion requirements in critically ill adults.

STUDY DESIGN: A two-centre, open-label, feasibility RCT was conducted in two Spanish university hospitals between November 2024 and March 2025. Patients with an ICU stay of 24 h who were expected to have an arterial catheter for at least 72 h longer were randomised to either a CBSD group (intervention) or standard practice (control). Primary outcome was feasibility (recruitment rate, intervention fidelity and dropout). Secondary outcomes included transfusion rates, discard volume and catheter-related adverse events. Data were collected over a maximum of 21 days or until ICU discharge or catheter removal. As this was a feasibility study with a small sample size, no statistical inference analyses were performed.

RESULTS: Of 678 patients screened, 9.3% (n = 63) were eligible, and of those eligible, 76.2% (n = 48) were enrolled. After exclusions and losses, 31 patients were analysed (12 intervention, 19 control). Low eligibility was mainly due to short catheter dwell times and advanced monitoring needs with a Flotrac system. Intervention fidelity was suboptimal in four patients in the intervention group because one of the ICUs routinely used a venous route for blood gas sampling, despite patients having the CBSD in an arterial line. Thirteen patients (27.1%) were lost to follow-up for the same reasons as the low eligibility findings. There were no missing data (0%). Transfusion rates per 100 catheter days were lower in the intervention group (5.2 vs. 15.6). Discard volume per 100 catheter days was substantially reduced (53.1 mL vs. 970.7 mL). No catheter-related bacteraemias occurred.

CONCLUSIONS: A full-scale RCT evaluating CBSDs in ICU patients is feasible with protocol modifications, including broader site participation and improved device integration with advanced monitoring systems. Preliminary data suggest that CBSDs may reduce transfusion requirements and blood loss in critically ill patients.

RELEVANCE TO CLINICAL PRACTICE: Nurses’ involvement in the prevention of iatrogenic anaemia is key. CBSDs appear to be a feasible strategy for reducing blood loss associated with blood tests, with preliminary results linking their use to a decrease in the need for transfusions. If this is confirmed in the final clinical trial, it would mean greater safety for patients by avoiding complications linked to transfusions and would contribute to environmental sustainability by reducing the production of carbon dioxide associated with the process of collecting, storing and distributing red blood cells.

TRIAL REGISTRATION: NCT06478160.

PMID:41546433 | DOI:10.1111/nicc.70343

Nurs Crit Care. 2026 Jan;31(1):e70337. doi: 10.1111/nicc.70337.

ABSTRACT

BACKGROUND: During the perinatal period, women and newborns require high-quality supportive care. While cognitive and emotional care support is central to family systems care, few quantitative studies have explored this in sub-Saharan Africa.

AIM: We investigated families’ perspectives on the support provided by healthcare professionals during maternal and newborn care, examining the impact of family demographics on their perceived support and identifying unmet support needs.

STUDY DESIGN: This cross-sectional survey was conducted in the Hohoe Municipality, Ghana. Participants included high-risk pregnant, birthing and postnatal women, mothers with small/sick newborns and their family members. Family support was assessed using the Icelandic Family Perceived Support Questionnaire (5-point Likert; scores: cognitive 5-25, emotional 9-45, overall 14-70). Descriptive and inferential statistics were conducted with STATA. Analysis of open-ended text elements was done in two cycles, employing open coding and thematic categorisation via NVIVO software.

RESULTS: Participants (N = 442) perceived their overall support from healthcare professionals, covering antenatal, labour, neonatal intensive care, postnatal and community-based primary care, as deficient (mean 45.3 ± 14.2). Emotional support (mean 16.6 ± 5.9) was rated lower than cognitive support (mean 28.6 ± 10.1). The highest rating was assigned to the item regarding taking respite (mean 4.0 ± 1.6). The item on family encouragement to narrate their illness experience, family strength and resilience received the lowest rating (mean 2.5 ± 1.8). Older family members and males felt excluded from care. Families requested consideration of their preferences, such as integrating alternative medicine and spirituality into care plans.

CONCLUSION: Cognitive support throughout the care continuum was perceived as average and emotional support was even lower. Family systems care guidelines and skills training are needed to strengthen healthcare professionals’ communication skills to provide psychologically and emotionally safe support along the perinatal care continuum.

RELEVANCE TO CLINICAL PRACTICE: Family meetings that address previous experiences, provide details regarding illnesses and outline care plans can improve family participation and resilience.

PMID:41546394 | DOI:10.1111/nicc.70337

J Prim Care Community Health. 2026 Jan-Dec;17:21501319251409914. doi: 10.1177/21501319251409914. Epub 2026 Jan 16.

ABSTRACT

INTRODUCTION/OBJECTIVES: Despite the efficacy of vaccines in preventing disease and disability and their cost-effectiveness, a proportion of the population remains reluctant to vaccination. Vaccination literacy is one of the main determinants of vaccine decision-making. The aims of this study were to assess the measurement properties of the Hungarian version of a vaccination literacy instrument and describe the level and determinants of vaccination literacy among the Hungarian adult population.

METHODS: A cross-sectional study was conducted on a sample of 1205 Hungarian adult respondents within the European Health Literacy Population Survey 2019-2021. The data were collected by computer-assisted telephone survey in December 2020. The questionnaire covered the following topics: sociodemographic data, self-perceived health, social support, and general and vaccination literacy. The instrument’s internal consistency was measured using Cronbach’s alpha, its reliability was assessed based on the Spearman-Brown correlation coefficient. The construct validity of the questionnaire was examined using principal component analysis based on a polychoric correlation matrix. Multivariate ordered logistic regression analyses investigated the relationship between vaccination literacy and other relevant variables.

RESULTS: The Cronbach’s alpha was 0.78, while the Spearman-Brown correlation coefficient was 0.725. The principal component analysis extracted 1 significant factor that explained 69% of the total variance. The Hungarian adult population had a good level of vaccination literacy (mean score: 82.4, 95% CI 74.9-89.8). We found that social support (OR for the moderate support: 1.93, OR for the strong support: 2.19; P < .001 for both), lack of financial deprivation (OR: 2.05, P < .001), and secondary education level (OR: 1.50, P: .024) are positively correlated with vaccination literacy.

CONCLUSION: We recommend using the vaccination literacy instrument to identify individuals with inadequate vaccination literacy. Interventions focusing on social support and education to promote vaccine-related information would contribute to enhancing vaccination literacy.

PMID:41546391 | DOI:10.1177/21501319251409914

Toxicol Sci. 2026 Jan 16:kfag001. doi: 10.1093/toxsci/kfag001. Online ahead of print.

ABSTRACT

A chronic bioassay investigating radiofrequency (RF) carcinogenicity, intentionally designed to be conducted simultaneously in Korea and Japan, using the same research protocol and experimental environment. The study aimed to assess the potential carcinogenicity of Code Division Multiple Access (CDMA)-modulated 900 MHz RF signals at a whole-body specific absorption rate (SAR) of 4 W/kg, which is the reference level of the international human safety guideline, and to verify the key findings from the National Toxicology Program (NTP) study at that SAR level. Two reverberation chamber systems were used for RF exposures, and the same study protocols were followed. Male Harlan Sprague-Dawley (Hsd: Sprague Dawley® SD®) rats were randomly assigned to cage-control, sham-exposed, or RF-exposed groups. The exposure started on gestational day 5 and lasted for 18 hours and 20 minutes each day, with 10-minute on/off cycles. The project included a 28-day toxicity study, a 2-year carcinogenicity study, and a 14-week genotoxicity test. Histopathological evaluations were conducted in a partially blinded manner. The results were independently analyzed and submitted separately based on each country’s research findings. In the Korean study, no statistically significant changes in tumor incidence or survival rates were observed. No significant RF-related effects were detected in the heart, brain, or adrenal glands. No changes in body temperature. Genotoxicity tests showed no evidence of DNA damage or mutation. In conclusion, the Korean part found that long-term exposure to CDMA-modulated 900 MHz RF was neither carcinogenic nor genotoxic at a SAR of 4 W/kg in male rats.

PMID:41546387 | DOI:10.1093/toxsci/kfag001

Gan To Kagaku Ryoho. 2025 Dec;52(13):1186-1188.

ABSTRACT

Previous studies have shown that intracorporeal anastomosis(IA)improves postoperative recovery. However, its short-term outcomes remain controversial in elderly patients. This study aimed to compare the short-term outcomes of IA versus extracorporeal anastomosis(EA)for minimally invasive right colectomy in elderly patients aged 80 years or older using a propensity score matching(PSM)analysis based on double centric cohort of patients with right colon cancer between April, 2020, and December, 2024. Initially, 97 patients were selected, including 49 IA patients. After PSM, 64 patients were compared. There was no statistically significant difference between IA and EA in terms of operative time and postoperative morbidity (6.2% in IA vs 12.5% in EA;p=0.67). The IA group had a longer resected distal margin length(130 vs 100 mm, p=0.04) and shorter length of stay(7.5 vs 10 days, p=0.02). This comparison shows several clinical outcomes advantages for the IA in minimally invasive right colectomy in elderly patients.

PMID:41546290

Am J Sports Med. 2026 Jan 16:3635465251403568. doi: 10.1177/03635465251403568. Online ahead of print.

ABSTRACT

BACKGROUND: Patellofemoral instability (PFI) is common in adolescents and may require surgical treatment. Patient-reported outcome scores (PROs) are frequently used to evaluate outcomes after treatment. Commonly used PROs for PFI include disease-specific Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) and region-specific measures such as the Kujala Anterior Knee Pain Scale (Kujala), Pediatric International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS).

HYPOTHESIS/PURPOSE: The study aimed to compare the performance of disease-specific and region-specific PROs in adolescents after PFI surgery, and to evaluate their sensitivity to change. It was hypothesized that disease-specific PROs would perform better than region-specific PROs.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: The JUPITER (Justifying Patellar Instability Treatment by Early Results) study database was used to evaluate PROs in 256 adolescents (263 knees) aged ≤18 years who underwent surgical treatment for PFI. Four commonly used PRO scores were analyzed at baseline and at least 1 year postoperatively. Statistical analysis included comparisons between pre- and postoperative scores, calculation of minimal clinically important difference (MCID), correlations among the 4 scores, and evaluation of their sensitivity to change, floor effects, and ceiling effects.

RESULTS: The median age was 15 years. Isolated medial patellofemoral ligament reconstruction was the most common procedure. The mean BPII 2.0 scores were lower at baseline and postoperatively, and showed the most substantial change at 1-year follow-up. There was a moderate correlation between the BPII 2.0 and the Kujala, Pedi-IKDC, and KOOS scores, and a strong correlation among the latter 3 scores. All scores were more sensitive to change among those at the lower 50th percentile of baseline scores. The BPII 2.0 was the only PRO that did not exhibit ceiling effects at follow-up.

CONCLUSION: When comparing the performance of disease-specific (BPII 2.0) and region-specific (Kujala, Pedi-IKDC, and KOOS) PROs, the BPII 2.0 was found to be the most sensitive to change after PFI surgery in adolescents, and the only scale that did not have a ceiling effect at baseline and 1-year follow-up. There was a moderate correlation-and thus limited interchangeability-between the BPII 2.0 and the Kujala, Pedi-IKDC, and KOOS scores, both at baseline and at 1-year follow-up, and a strong correlation among the latter 3 knee-specific PROs. The BPII 2.0 should be considered the PRO of choice when evaluating adolescent patients with PFI.

PMID:41546179 | DOI:10.1177/03635465251403568

Early Interv Psychiatry. 2026 Jan;20(1):e70122. doi: 10.1111/eip.70122.

ABSTRACT

BACKGROUND: Adverse events and substance misuse are rarely examined together among people in early phase psychosis, although both are frequently examined in isolation given their high prevalence in this population. As a result, the frequency of the three-way overlap is unclear. Moreover, adverse events are often limited to childhood abuse and rarely include illness-related events (e.g., threatening hallucinations). This study aims to explore the overlap between these variables and provide a more detailed understanding of adversity in this population and their desire to disclose experiences.

METHODS: We surveyed 110 individuals aged 16-35 years with early phase psychosis about substance misuse, lifetime adverse events, disclosure of adverse events, and PTSD symptoms.

RESULTS: Nearly all participants (97.2%) had experienced at least 1 adverse event, recalling an average of 8 adverse events over lifetime (SD = 3.8). Over 22% met the cutoff for a probable PTSD diagnosis on a validated measure. Substance misuse was present in 67% of participants, often involving multiple substances (M = 2.7 substances, SD = 1.5), most commonly alcohol, cannabis, and tobacco. There was an overlap between early phase psychosis, substance misuse, and a history of at least 1 adverse event in 66.4% of the sample. Most participants (78.7%) had disclosed their adverse events to someone, and 72.7% expressed interest in speaking to a mental health professional about their experiences.

CONCLUSION: Adverse events and substance misuse commonly co-occur in early phase psychosis, and these results have important clinical ramifications for assessment and treatment in an early phase psychosis population.

PMID:41546178 | DOI:10.1111/eip.70122

J Vasc Access. 2026 Jan 16:11297298251378615. doi: 10.1177/11297298251378615. Online ahead of print.

ABSTRACT

BACKGROUND: The SPECTRA study compared first-attempt success between ultrasound-guided and conventional peripheral intravenous catheter (PIVC) insertion. This subanalysis evaluated the control group results to determine the number of puncture attempts until successful or failed venous device insertion, stratified according to the Adult Difficult IntraVenous Access Scale (A-DIVA).

METHODS: Secondary analysis of the SPECTRA randomized clinical trial (RCT). Patients from the control group who underwent PIVC insertion without ultrasound guidance were included and stratified as high risk or low/moderate risk according to the A-DIVA. Statistical comparisons between the groups were conducted on the number of puncture attempts, insertion failures, catheter dwell time, and clinical outcomes related to PIVC insertion.

RESULTS: Of all 84 patients analyzed, 35 were classified as high risk, and 49 as low/moderate risk; 53 (63.1%) were female, mean age 59 ± 16 years. The main reason for hospitalization was infection; high-risk patients experienced more punctures, with 20 (57%) undergoing four punctures, compared to only 8 (16%) of the low/moderate-risk group, p < 0.001; the overall success rate of PIVC insertion was 17 (48.5%) in high-risk patients versus 43 (88%) in low/moderate-risk patients. Insertion failure occurred in 18 (51.5%) high-risk versus 6 (12%) low/moderate-risk patients, p < 0.001; the high-risk group had a shorter PIVC dwell time: 3 (2-8) days versus 8 (2-8) days in low/moderate-risk group, p = 0.065; PIVC removal due to negative outcomes (obstruction, infiltration, accidental removal) was higher in high-risk patients: 32 (91%) versus 24 (49%), p < 0.001.

CONCLUSIONS: Patients classified as high risk in the A-DIVA scale required more puncture attempts, had shorter PIVC dwell times, and experienced more negative outcomes. Using technologies such as ultrasound is beneficial for patients at high risk of failure on the first attempt.

PMID:41546176 | DOI:10.1177/11297298251378615