Category: Statistics

AANA J. 2026 Feb 1;94(1):36-41. doi: 10.70278/AANAJ/.0000001045.

ABSTRACT

Anxiety is a common preoperative occurrence in children having surgery, and it can compromise surgical results, have long-term psychological effects, and lead to future healthcare challenges. In the surgical setting, preoperative anxiety is frequently treated with a combination of pharmaceutical and nonpharmacological interventions. One nonpharmacological approach is the use of virtual reality (VR), a computer-generated environment accessed by headset or goggles. This evidence-based practice initiative utilized VR goggles to address the question: to what degree would previous research on virtual reality distraction in the preoperative area and in the operating room impact preoperative anxiety levels among pediatric patients undergoing surgery at an outpatient surgery center? A preoperative registered nurse assessed and scored the patient for preoperative anxiety utilizing the modified Yale preoperative anxiety scale (mYPAS) tool while a certified registered nurse anesthetist intraoperatively obtained a second mYPAS score. The findings demonstrated how VR goggles utilized preoperatively and intraoperatively improved patients’ anxiety with innovative technology indicating that results were clinically and statistically significant.

PMID:41632459 | DOI:10.70278/AANAJ/.0000001045

J Med Econ. 2026 Dec;29(1):308-318. doi: 10.1080/13696998.2026.2618930. Epub 2026 Feb 3.

ABSTRACT

OBJECTIVES: To assess all-cause healthcare resource utilization (HCRU) and costs among patients with α- or β-non-transfusion-dependent thalassemia (NTDT) vs. matched controls in the United States.

METHODS: Adults with ≥1 inpatient setting or ≥2 outpatient settings claims for α- or β‑thalassemia between January 1, 2013 and June 30, 2021 were identified from the Merative MarketScan Commercial/Medicare database. Patients with <8 transfusions or ≥6 weeks between any two adjacent transfusions in a 1-year period post-index date (date of first observed α- or β-thalassemia diagnosis code) were considered to have NTDT. Patients were required to have mean hemoglobin (Hgb) levels <10 g/dL during follow-up as an additional measure to ensure exclusion of patients with thalassemia trait. Each patient was matched with five controls based on age, sex, length of follow-up, availability of lab data, and payer type. All-cause HCRU and costs were assessed over ≥12 months post-index. Data were also analyzed for the non-transfusion-dependent α- and β-thalassemia subgroups.

RESULTS: A total of 149 patients with NTDT and Hgb levels <10 g/dL were matched with 745 controls. The mean follow-up period was approximately 3 years. All-cause inpatient admissions (48.3% vs. 16.5%; p < 0.001) and emergency room visits (61.1% vs. 39.1%; p < 0.001) during follow-up were higher with NTDT vs. controls, and total costs (total medical + outpatient pharmacy) were $29,107 per patient per year (PPPY) in patients with NTDT vs. $9,042 PPPY in controls (p < 0.001). Similar trends were seen in the subgroups of patients with non-transfusion-dependent α- and β-thalassemia vs. matched controls.

CONCLUSIONS: Patients with NTDT in the United States, including those with α- and β-thalassemia, have significantly higher all-cause HCRU and costs vs. matched controls. There is a need for effective treatment options to reduce the healthcare burden of NTDT and improve patient outcomes.

PMID:41632448 | DOI:10.1080/13696998.2026.2618930

Clin Drug Investig. 2026 Feb 3. doi: 10.1007/s40261-025-01507-x. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: This study evaluated the pharmacokinetics (PK), safety, and tolerability of TV-44749 in patients with schizophrenia or schizoaffective disorder. TV-44749 is a novel, long-acting, subcutaneous (SC) olanzapine injection designed to leverage the benefits of long-acting injectable treatment, reduce the risk for post-injection delirium/sedation syndrome (PDSS), and maintain the efficacy of olanzapine.

METHODS: In this open-label phase I study, patients completed an oral olanzapine treatment period followed by administration of TV-44749 single doses (SD cohort; 318 mg, 425 mg, or 531 mg) or multiple doses (MD cohort; three consecutive monthly doses of 283 mg or 566 mg). For the SD cohort, the follow-up period was up to 84 days (i.e., day 85) after TV-44749 administration. Patients in the MD cohort received TV-44749 on days 1, 29, and 57 over an 84-day treatment period and were followed until the end of the study. Evaluations included PK, adverse events (AEs), clinical assessments, and injection-site pain.

RESULTS: A total of 71 (SD, 42; MD, 29) patients each received ≥ 1 dose of TV-44749. Both cohorts had overall similar baseline characteristics. Following subcutaneous administration, TV-44749 reached clinically relevant plasma concentrations (≥ 10 ng/mL) within 1-2 days, with a maximum observed plasma drug concentration (Cmax) within 11-14 days, followed by a sustained release profile over the dosing period of 1 month. The mean beta half-life values ranged from 5 to 10 days, and the mean apparent terminal half-life range was 11-17 days. The systemic exposure (Cmax and area under the plasma concentration-time curve (AUC)) of olanzapine and its two major metabolites, 10N‑glucuronide and N-desmethyl olanzapine, increased in an approximate dose-proportional manner over the clinically relevant dose range of 283 mg through 566 mg. The relative bioavailability of TV-44749 SD and MD compared with oral olanzapine after single or multiple doses was 112% (90% confidence interval (CI) 97, 129%) and 95% (90% CI 86, 106%), respectively. There were no grade ≥3 adverse events, no serious treatment-related adverse events, no suspected or confirmed post-injection delirium/sedation syndrome events, and no deaths.

CONCLUSION: TV-44749 administration resulted in a sustained release profile and comparable exposure to daily therapeutic doses of oral olanzapine over a monthly dosing interval. The TV-44749 systemic safety profile was consistent with approved oral olanzapine. The local tolerability was acceptable, and there were no PDSS events. These results contributed to the dose selection of TV-44749 in a phase III study evaluating its efficacy and safety in adults with schizophrenia (SOLARIS; NCT05693935).

PMID:41632432 | DOI:10.1007/s40261-025-01507-x

Photochem Photobiol Sci. 2026 Feb 3. doi: 10.1007/s43630-025-00843-3. Online ahead of print.

ABSTRACT

The widespread presence of pharmaceuticals and antibiotics in aquatic environments poses a serious ecological and public health risk, necessitating effective removal strategies. This study investigates a Z-scheme Ag/Ag₃PO₄/g-C₃N₄ photocatalyst for the simultaneous photodegradation of sulfamethoxazole, trimethoprim, naproxen, and diclofenac under visible light, a topic that has not been previously reported. The photocatalyst was comprehensively characterized using XRD, XPS, FTIR, BET, FESEM-EDX, TEM, EIS, PL, and DRS. Among the synthesized variants, Ag/Ag₃PO₄/g-C₃N₄ (80%) exhibited the highest photocatalytic efficiency. Optimal operational parameters (pH 6, 30 min irradiation, and 1.170 g L⁻¹ catalyst dosage) were established using response surface methodology based on a central composite design. Under these conditions, complete pollutant removal was achieved, with a total organic carbon (TOC) reduction of 88.62% after 180 min. Kinetic studies followed a pseudo-first-order model, and scavenger tests identified photogenerated holes (h⁺) as the dominant reactive species. Transformation products were identified using LC/MS. The photocatalyst retained high activity after five reuse cycles, confirming its stability and reusability. The superior performance is attributed to the Z-scheme mechanism and silver-induced surface plasmon resonance (SPR). The integration of advanced nanostructuring, heterojunction interface engineering, and statistical optimization enables efficient degradation of pharmaceutical mixtures at environmentally relevant concentrations in real water samples, highlighting its strong potential for sustainable water purification applications.

PMID:41632422 | DOI:10.1007/s43630-025-00843-3

Dig Dis Sci. 2026 Feb 3. doi: 10.1007/s10620-026-09678-z. Online ahead of print.

ABSTRACT

BACKGROUND: Propofol is the most commonly used intravenous anesthetic for endoscopic surgery, although it comes with various adverse effects. Research indicates that Remimazolam, which is considered a safe general anesthetic, is being increasingly adopted as an alternative to propofol in clinical settings. Our meta-analysis sought to evaluate whether the rate of adverse reactions associated with Remimazolam in gastrointestinal endoscopic procedures is acceptable, and whether its surgical success rate is at least comparable to that of propofol.

METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies published up to January 2025. Using R version R.4.4, we reported outcomes as risk ratios (RRs) or mean differences (MDs) and confidence intervals (CIs). A P-value of ≤ 0.05 is considered statistically significant.

RESULTS: Our meta-analysis included 37 studies encompassing 8533 patients. The results, analyzed using a random effects model, demonstrated no statistically significant difference in induction time between the two sedative groups, with an overall MD of 0.11 min (95% [- 0.10; 0.31], p = 0.2977). Patients in the Remimazolam group experienced longer total sedation times than those receiving Propofol, with an MD of 1.84 min (95% CI [0.61; 3.07], p = 0.0033). The pooled analysis indicated low heterogeneity (I² = 4.2%). There was no statistically significant difference between the two sedatives in procedure time, with an MD of 0.16 (95% CI: [-0.13; 0.45], p = 0.2689). The pooled analysis displayed moderate heterogeneity (I² = 43.5%, p = 0.0052).

CONCLUSION: Remimazolam has demonstrated safety, showing a reduced incidence of hypotension, bradycardia, respiratory depression, and hypoxemia compared to propofol. However, efficacy outcomes including the induction time and total procedure time were comparable between the two groups. However, the results were heterogeneous, which could be due to variability in the perfumed procedures, co-analgesics or dosing.

PMID:41632411 | DOI:10.1007/s10620-026-09678-z

Insights Imaging. 2026 Feb 3;17(1):33. doi: 10.1186/s13244-026-02215-6.

ABSTRACT

OBJECTIVES: In the context of a global appraisal of the environmental impact of radiology, this survey among members of the European Society of Breast Imaging (EUSOBI) investigated procedural aspects of ultrasound-guided core-needle breast biopsy that may impact its environmental sustainability.

MATERIALS AND METHODS: A 25-item online questionnaire, developed by a panel of nine breast imaging experts, was distributed from September 25th to December 25th, 2024, within the EUSOBI mailing list and social media platforms. The survey investigated materials routinely used for ultrasound-guided core-needle biopsies, waste disposal practices, the relationship between perceived procedural hygiene levels and self-reported frequency of post-procedural infectious complications, and results’ communication methods. Replies were analysed with descriptive and non-parametric statistics.

RESULTS: Among the 787/823 respondents (95.6%) who routinely perform ultrasound-guided core-needle biopsy, most (460/787, 58.4%) perceived to attain aseptic conditions, without significant associations (p = 0.334) of hygiene levels with post-procedural infectious complications (never seen by 549/776 respondents, 70.7%). For most disposable materials, the majority of respondents used no more than one unit per procedure, including sterile gloves (551/787, 70.0%), sterile drapes (651/787, 82.7%), and sterile gel packets (729/787, 92.6%), also avoiding to use prepackaged biopsy kits (424/787, 53.9%). However, most respondents did not use recycling bins (404/787, 51.3%) and employed at least one resource-intensive modality to communicate benign results (in-person or by letter, 584/787, 74.2%).

CONCLUSION: Procedural aspects of ultrasound-guided core-needle biopsy carrying an environmental impact vary widely. In the absence of significant associations between perceived hygiene levels and post-procedural infectious complications, resource-intensive habits could be safely streamlined to improve sustainability.

CRITICAL RELEVANCE STATEMENT: This EUSOBI survey demonstrates that, despite widely varying procedural aspects in ultrasound-guided core-needle breast biopsy, higher perceived sterility levels are not associated with fewer infections, highlighting opportunities to safely reduce resource use and environmental impact.

KEY POINTS: This EUSOBI survey investigated how procedural habits and the use and amount of material in ultrasound-guided core-needle breast biopsy impact its environmental sustainability. Procedural aspects varied widely among the 787/823 respondents who routinely perform ultrasound-guided core-needle breast biopsy. While some economically driven sustainable behaviours are already in place, there are several opportunities to reduce materials use and waste. As no association was found between perceived hygiene levels and post-procedural infections, resource-intensive hygiene-related practices could be streamlined to improve sustainability.

PMID:41632394 | DOI:10.1186/s13244-026-02215-6

CJEM. 2026 Feb 3. doi: 10.1007/s43678-026-01091-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Management of febrile neutropenia in previously healthy, presumed immunocompetent children varies. Unnecessary treatment impacts the patients, families, and the healthcare system. With guidance from a Canadian Paediatric Society Practice Point, most well-appearing children with a first episode of febrile neutropenia can be managed with reduced exposure to antibiotics and close outpatient follow-up. The aim of this initiative was to safely reduce antibiotic use in this low-risk population presenting to the emergency department (ED).

METHODS: A multidisciplinary team designed a quality improvement (QI) initiative. From July 2022 to July 2024, treatment with antibiotics was classified as indicated or non-indicated according to guidance from the Practice Point. Interventions involved guideline dissemination, provider education, and point-of-care tools to facilitate clinical decision-making and follow-up. Outcome measures included the proportion of children receiving antibiotics, hospital admission, and appropriate laboratory follow-up. Re-presentation to ED and missed serious bacterial infections were monitored as balancing measures. Analysis of the primary outcome was by statistical process control.

RESULTS: Three hundred and ninety-eight (398) children with febrile neutropenia were included. The proportion of non-indicated antibiotics was 6.7% at baseline. Statistical process control analysis of the G-chart demonstrated special cause variation with 97 consecutive cases occurring without error (non-indicated antibiotics). Following the occurrence of special cause variation until the end of the study, only 1.6% of children received non-indicated antibiotics. There was no increase in re-presentations to ED (9% vs 8%; p = 0.65) nor missed serious bacterial infections (0% vs 0%).

CONCLUSIONS: Quality improvement methodology can facilitate the timely adoption of best practices to align local clinical care with new national guidelines. Implementation of the national guideline allowed low-risk children with febrile neutropenia to avoid overtreatment.

PMID:41632376 | DOI:10.1007/s43678-026-01091-9

Eur J Nutr. 2026 Feb 3;65(2):38. doi: 10.1007/s00394-026-03893-0.

ABSTRACT

PURPOSE: Cocoa is a significant source of theobromine, a bioactive compound proposed to provide cardiovascular protection. However, relatively few studies have provided conclusive evidence of the potential beneficial health effects. The aim of this study was to determine the relationship between the consumption of cocoa products containing theobromine and cardiovascular risk factors in the U.S. population sample using 2015-2020 National Health and Nutrition Examination Survey (NHANES) data.

METHOD: This cross-sectional study included 8531 individuals aged 20-70 years and 3808 people in a fasting sub-sample. Theobromine and cocoa product intake levels were obtained from 24-h dietary recalls and linked to the Food and Nutrient Database for Dietary Studies database. Primary outcomes included systolic and diastolic blood pressure, hypertension, serum total, HDL and LDL cholesterol, triglyceride, glycohemoglobin, insulin, plasma glucose, and high-sensitivity C-reactive protein (hs-CRP). Linear regression models were applied to analyze the associations between theobromine or cocoa product consumption and cardiovascular risk factors.

RESULTS: The consumption of cocoa was not associated with cardiovascular disease risk factors compared to non-consumption. The amounts of cocoa consumed were inversely associated with glycohemoglobin levels (mean ± SE, – 0.04 ± 0.02% per 100 g, P = 0.04). Theobromine intake (vs. no intake) was positively associated with serum insulin (1.85 ± 0.85 μU/mL; P = 0.03). Theobromine levels consumed were inversely associated with glycohemoglobin (- 0.05 ± 0.03% per 100 mg, P = 0.04), serum triglycerides (- 5.4 ± 2.73 mg/dL, P = 0.05), and hs-CRP levels (- 0.26 ± 0.12 mg/L, P = 0.04). These associations were also mostly observed in people with healthier profiles.

CONCLUSION: Increased cocoa consumption is associated with reduced glycohemoglobin levels, while higher theobromine intake is associated with reduced triglyceride, glycohemoglobin, and hs-CRP levels compared to a lower intake. The positive link between theobromine intake, as opposed to no intake, and serum insulin required further investigation. Overall findings support the inclusion of cocoa-derived compounds in healthy diets.

PMID:41632311 | DOI:10.1007/s00394-026-03893-0

Support Care Cancer. 2026 Feb 3;34(2):159. doi: 10.1007/s00520-026-10331-8.

ABSTRACT

PURPOSE: To assess the effect of patient education on quality of life, fatigue, and anxiety in patients diagnosed with lung cancer.

METHODS: An electronic search was conducted across four databases (PubMed, Web of Science, CINAHL, and Scopus) using a combination of terms including lung neoplasms, health education, educat (truncated), quality of life, fatigue, and anxiety. The Cochrane RoB 2 tool and the TIDieR checklist were used to assess risk of bias and intervention replicability, respectively. The GRADE approach was applied to evaluate the certainty of the evidence. Study selection, data extraction, and all assessments were carried out independently by two reviewers. Where appropriate, data were pooled using meta-analysis (95% confidence interval [CI]).

RESULTS: Seventeen studies were included in the qualitative synthesis, and thirteen in the quantitative analysis, comprising a total sample of 1799 participants. The meta-analysis demonstrated that, compared with controls, patient education interventions had a statistically significant and large effect on improving quality of life (SMD = 0.98; 95% CI [0.26, 1.69], p = 0.007, I² = 96%), anxiety (SMD = -1.75; 95% CI [-2.74, -0.77], p = 0.0005, I2 = 98%) and fatigue (SMD = -0.091; 95% CI [-1.61, -0.22], p = 0.01, I2 = 88%). In all cases, heterogeneity remained high. However, the educational content of the interventions was generally consistent, with most being delivered in a face-to-face format.

CONCLUSIONS: Patient education appears to be an effective approach for improving quality of life, fatigue, and anxiety in individuals with lung cancer. Nevertheless, these findings should be interpreted with caution, as the certainty of the evidence was rated as very low.

PMID:41632307 | DOI:10.1007/s00520-026-10331-8

Cancer Immunol Immunother. 2026 Feb 3;75(3):66. doi: 10.1007/s00262-026-04318-x.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitor doublet (ICI-ICI) and ICI plus tyrosine kinase inhibitor (ICI-TKI) regimens are the cornerstone of treatment for metastatic renal cell carcinoma (mRCC), although no head-to-head comparisons are currently available. This study aimed to compare the real-world effectiveness of ICI-ICI versus ICI-TKI combinations in patients with intermediate- and poor-risk mRCC according to International Metastatic RCC Database Consortium (IMDC).

METHODS: The Meet-URO 33 study is a multicentre retrospective-prospective registry collecting real-world data on patients with mRCC. Multivariable logistic and Cox models were built for objective response rate (ORR), PFS and OS, with a propensity score (PS) adjustment for baseline imbalances.

RESULTS: Among 1497 patients, 755 were intermediate-risk (199 ICI-ICI, 556 ICI-TKI) and 312 poor-risk (77 ICI-ICI, 212 ICI-TKI). Median follow-up was 14.2 months (8.0 months and 14.5 months in poor- and intermediate-risk subgroups, respectively). In poor-risk patients, median OS was 20.3 versus 12.9 months (HR 0.87, 95% CI 0.59-1.28, p = 0.49), and median PFS was 6.7 versus 8.7 months (HR 1.10, 95% CI 0.79-1.54, p = 0.53), for ICI-ICI versus ICI-TKI, respectively. In the intermediate-risk patients treated with ICI-ICI versus ICI-TKI, median OS was 37.8 versus 35.5 months (HR 1.08; 95% CI 0.77-1.50; p = 0.65), and median PFS was 17.8 versus 18.6 months (HR 1.29, 95% CI 1.00-1.66, p = 0.050). ORR was 42.9% versus 45.8% in poor-risk patients (OR 0.72, 95% CI 0.39-1.34, p = 0.303) and 48.1% versus 54.3% in intermediate-risk patients (OR 0.71, 95% CI 0.48-1.04, p = 0.075).

CONCLUSIONS: No statistically significant differences in survival or response were observed between ICI-ICI and ICI-TKI combinations in patients with IMDC intermediate- and poor-risk mRCC.

PMID:41632305 | DOI:10.1007/s00262-026-04318-x