Category: Statistics

J Appl Gerontol. 2026 Aug;45(8):1615-1624. doi: 10.1177/07334648251383625. Epub 2025 Oct 14.

ABSTRACT

ObjectivesTo develop a predictive model for nasogastric tube (NGT) removal and examine survival-related factors among community-dwelling residents.DesignRetrospective cohort study (2016-2020) using medical records.Setting and ParticipantsA total of 255 home care residents with NGTs from a regional hospital in Taiwan.MethodsThis retrospective study was conducted to identify predictors across 30 variables from clinical records and nursing assessments. Logistic regression and Cox proportional hazards models assessed predictors of successful NGT removal, with model performance evaluated using ROC curve.ResultsKey predictors of successful NGT removal (18.0%, n = 46) and 12-month survival were activities of daily living, instrumental activities of daily living, and upper limb strength. Survival was higher in the removal group, and the model showed good accuracy (AUC = 0.811).ConclusionThis model provides a clinically applicable tool that incorporates functional and medical indicators to assess NGT removal readiness, demonstrating strong predictive validity.

PMID:42400250 | DOI:10.1177/07334648251383625

Nurs Open. 2026 Jul;13(7):e70669. doi: 10.1002/nop2.70669.

ABSTRACT

AIMS: To explore the effects of different family breastfeeding interventions on improving exclusive breastfeeding rates from 0 to 6 months postpartum and to identify the key characteristics of effective interventions.

METHODS: This systematic review and meta-analysis follows the Cochrane Handbook for Systematic Reviews of Interventions. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool.

RESULTS: Nineteen studies were included in this systematic review. Family-based interventions significantly improved exclusive breastfeeding rates at 6 months postpartum compared with routine care (OR = 2.93, 95% CI [1.90, 4.50], p < 0.001). Interventions underpinned by theoretical frameworks enhanced exclusive breastfeeding within 2 months postpartum compared with non-theoretical ones (OR = 5.50, 95% CI [2.30, 13.19], p < 0.001). Multi-component interventions were more effective than single-method approaches (OR = 2.70, 95% CI [2.04, 3.57], p < 0.001). Programmes spanning both prenatal and postnatal periods achieved higher exclusive breastfeeding rates at 4-6 months than those implemented in a single phase (OR = 4.84, 95% CI [2.50, 9.40], p < 0.001).

CONCLUSIONS: Family-based breastfeeding interventions could improve exclusive breastfeeding rates within the first 6 months postpartum. Future breastfeeding interventions should include key family members, consider the guidance of theoretical frameworks on the intervention design, cover both the prenatal and postnatal periods, and use multiple methods to meet the needs of breastfeeding families.

IMPLICATIONS FOR NURSING PRACTICE: Nurses, midwives, lactation nurses, and public health nurses should actively involve fathers, grandparents, and other key family members in breastfeeding education and support. Family-centred breastfeeding interventions may help improve exclusive breastfeeding outcomes and strengthen family support for breastfeeding.

REGISTRATION: Not registered.

PMID:42400223 | DOI:10.1002/nop2.70669

Paediatr Anaesth. 2026 Jul 3. doi: 10.1002/pan.70259. Online ahead of print.

NO ABSTRACT

PMID:42400216 | DOI:10.1002/pan.70259

Nurs Open. 2026 Jul;13(7):e70667. doi: 10.1002/nop2.70667.

ABSTRACT

AIM: Exploration of factors associated with clinical placements in nursing homes for first-year nursing students which may impact their career choices.

DESIGN: This paper reports on Stage I of a larger study which comprised a 2-stage sequential mixed-methods design.

METHODS: Stage I was a national survey conducted as a telephone interview with nurse academics involved in arranging clinical placements for first-year student nurses; and Stage II which included: interviews with student nurses before and after their first clinical placement in a nursing home, and interviews with clinical supervisors. The Stage I national survey was conducted as a telephone interview and was audio recorded. Transcripts of the interviews were analysed using descriptive statistics, content analysis, and reflexive thematic analysis.

RESULTS: All Australian nursing schools that offered a Bachelor of Nursing in 2023 were invited to participate. Twenty-nine (81%) participated. The first clinical placement for most (79%) Australian student nurses is in a nursing home. Four themes were identified from the data analysis: (1) clinical placements are increasingly organised by centralised teams (48%); (2) the supervision model and the clinical supervisor are determined by placement agreements where students can be supervised by someone ill equipped for the role; (3) the purpose of this first-year clinical placement is difficult to articulate, other than to practise fundamental skills; and (4) nursing homes can provide positive learning experiences for student nurses, if they are prepared for the setting and supervised appropriately.

CONCLUSION: While many of these findings have been documented for decades, clinical placements in nursing homes may provide student nurses with valuable experiences. Schools of nursing need to better prepare students for clinical placements in nursing homes (especially if it is their first clinical placement) and ensure they are appropriately supervised. If not, graduate nurses will not consider aged care nursing as a career option.

IMPLICATIONS FOR PRACTICE: These findings should encourage nursing schools to reconsider their curriculum design, especially the timing of clinical placements in nursing homes, and their employment of clinical supervisors. The Australian Nursing and Midwifery Accreditation Council (ANMAC) should mandate a care of older persons subject in all undergraduate nursing curricula to be undertaken before students undertake a clinical placement in a nursing home.

PUBLIC CONTRIBUTION: There was no public contribution to this research. All participants were nurse academics from participating Australian schools of nursing.

PMID:42400213 | DOI:10.1002/nop2.70667

Paediatr Anaesth. 2026 Jul 3. doi: 10.1002/pan.70254. Online ahead of print.

ABSTRACT

INTRODUCTION: Ambulatory surgery has become the dominant model of surgical care in the United States as surgical procedures increasingly shifted from inpatient to outpatient sites of practice. Similar growth in volumes has been observed in pediatric practice. Investigators have highlighted the challenges and opportunities in this current climate, including increasing medical and procedural complexity, difficulties matching pediatric-specific resources to meet the child’s perioperative needs and unique risk profile, and limited availability of pediatric ambulatory surgical and anesthesia guidelines of care. Further, they call out the complete lack of pediatric outcomes data to help inform the creation and modification of national care guidelines.

METHODS: To address these challenges, we chose to complete a comprehensive, single center retrospective review of our process, outcome, and balancing metrics contained in our EMR from our free-standing pediatric ambulatory surgery center (ASC) since its opening in July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system’s EMR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.

RESULTS: Patient and procedural acuity increased as the system matured via lower age cutoffs and higher ASA physical status scores. This higher acuity was managed with a dynamic and evolving screening process, resulting in no change in unplanned emergency visit or hospital admissions. The COVID-19 pandemic had profound impacts on ASC operations and case mix, including a temporary closure.

DISCUSSION: This retrospective, observational assessment created a detailed picture of our ASC practice changes over time. A pediatric-specific ASC with appropriate patient selection processes, practice guidelines, and clinical expertise successfully mitigated the risk of complications. These results are not generalizable to non-academic, community ambulatory facilities due to the unique characteristics of our pediatric-specific academic center.

PMID:42400211 | DOI:10.1002/pan.70254

Paediatr Anaesth. 2026 Jul 3. doi: 10.1002/pan.70252. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric ambulatory surgery has become the dominant model of surgical care in the United States, driven primarily by economic forces. There is variability in regional practice patterns, quality improvement cycles, and outcomes. Opportunity exists to overcome knowledge gaps and provide sustainable pathways of quality improvement. Our unique capability of describing the evolution of our pediatric ambulatory quality improvement practice allows us to contribute a single center’s perspective.

METHODS: We chose to complete a comprehensive retrospective review of our quality improvement process, outcome, and balancing metrics contained in our electronic health record (EHR) from our free-standing pediatric ambulatory surgery center (ASC) from July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system’s EHR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.

RESULTS: Improvement themes (opioid-free anesthesia and stewardship, enhanced recovery, environmental efforts, positive deviance, and learning healthcare system) are described. Improvements in all six domains of quality (effectiveness, efficiency/timeliness, patient experience, equity, and safety) are illustrated with reliable sustainability. Our system achieved approximately a 13-fold increase in quality improvement (QI) project completion rate with self-serve, real-world data access; enabling the team to take on improvement tasks previously deemed too big, lengthy, or risky to complete.

DISCUSSION: We provide preliminary evidence that these methods may be generalizable. Requirements include engaged leadership, a standard framework for improvement with experienced leadership or accessible support, and easy access to real-world electronic medical record data (i.e., learning healthcare system [LHS]). Lastly, leaders must create a culture supportive of teamwork, change, and continuous improvement. Systems facilitate adoption and hinder resistance to standards, always with implementation and sustainability in mind. Meaningful, large-scale improvements in healthcare outcomes require collaboration across LHSs.

PMID:42400184 | DOI:10.1002/pan.70252

Asian J Endosc Surg. 2026 Jan-Dec;19(1):e70341. doi: 10.1111/ases.70341.

ABSTRACT

PURPOSE: A high proportion of elderly patients have multiple comorbidities, and postoperative complications may contribute to poor outcomes. The purpose of this study is to investigate whether operation time could affect the occurrence of postoperative complications in elderly patients who have undergone colorectal surgery.

METHODS: The study included 1316 colorectal cancer patients aged ≥ 80 years who underwent colorectal cancer surgery between 2016 and 2024. We classified patients into two groups based on operative time (≥ 250 min [n = 418] and < 250 min [n = 898]). Clinical and perioperative features were compared between the groups.

RESULTS: Blood loss was higher (39 mL vs. 16 mL; p < 0.001), postoperative complications were higher (30.4% vs. 19.8%; p < 0.001), and hospital stay was longer (16 days vs. 14 days; p < 0.001) in the ≥ 250 group. Multivariate analysis revealed that open surgery (p = 0.003; odds ratio 2.438; 95% confidence interval 1.350-4.402) and operative time ≥ 250 min (p = 0.004; odds ratio 1.966; 95% confidence interval 1.233-3.135) were independent predictors for postoperative severe complications.

CONCLUSION: In elderly patients undergoing colorectal cancer surgery, high-risk cases should be managed by expert surgeons using minimally invasive techniques and with efforts to minimize operative time.

PMID:42400183 | DOI:10.1111/ases.70341

Biomed Res Int. 2026;2026(1):e9725971. doi: 10.1155/bmri/9725971.

ABSTRACT

INTRODUCTION: This meta-analysis evaluates the efficacy of traditional Chinese medicine, alone or in combination with Western medicine, for the treatment of adult Henoch-Schönlein purpura.

METHODS: We searched clinical randomized controlled trials on the treatment of adult Henoch-Schönlein purpura with traditional Chinese medicine from the Chinese Journal Literature Database (CNKI), Wanfang Database, Embase, PubMed, Cochrane, Scopus, the Journal of Pharmacopuncture, and the National Library of China. After removing duplicate literature and reviewing titles, we selected the final studies based on our inclusion and exclusion criteria. These studies were assessed for bias using the Cochrane risk of bias assessment tool, and statistical analysis was performed using Review Manager 5.3.0 software. The PRISMA guidelines were followed when conducting the meta-analysis.

RESULTS: Eighteen studies were included, with a combined sample size of 1632 cases, including 811 in the experimental group and 821 in the control group. The results indicated that traditional Chinese medicine, whether used alone or in combination with Western medicine, was more effective than Western medicine alone in terms of overall effectiveness and improvement in skin purpura, digestive tract, and joint symptoms. We found that the total clinical effective rate of patients in the experimental group was higher than that of the control group (OR = 6.04, 95% CI [4.01, 9.10], p < 0.001). Meta-analysis indicates that the difference between the control and experimental groups in improving skin purpura symptoms is statistically significant (SMD = -1.09, 95% CI [-1.22, -0.96], p < 0.001). We found that a more significant improvement occurred in the experimental group than in the control group (SMD = -0.95, 95% CI [-1.08, -0.82], p < 0.001). People in the experimental group showed a greater decrease in joint symptoms than those in the control group (SMD = -0.95, 95% CI [-1.08, -0.82], p < 0.001).

CONCLUSION: Traditional Chinese medicine, either alone or combined with Western medicine, is more effective than Western medicine alone in treating Henoch-Schönlein purpura. It also shows superior efficacy in improving skin purpura, digestive tract, and joint symptoms.

PMID:42400181 | DOI:10.1155/bmri/9725971

J Dermatol. 2026 Jul 3. doi: 10.1111/1346-8138.70377. Online ahead of print.

ABSTRACT

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive cutaneous tumor characterized by infiltrative growth and a high risk of local recurrence if incompletely excised. Although Mohs micrographic surgery is recommended, wide local excision (WLE) remains widely used in clinical practice; however, the clinical utility of preoperative imaging for surgical margin assessment has not been fully established. We retrospectively analyzed 42 patients with DFSP, including fibrosarcomatous DFSP (FS-DFSP), who underwent MRI-based surgical planning followed by WLE between 2009 and 2023. Lateral margins were defined based on preoperative MRI, and deep tumor extent was assessed according to the relationship with the fascia. Analyses were performed in 36 patients after excluding cases without identifiable pathological tumor. The median planned lateral margin was 20 mm, whereas the median pathological margin was 16.5 mm. The median difference (pathological – planned) was -5 mm (interquartile range -10.25 to -1 mm; range -18 to +15 mm), with planned margins significantly larger (p < 0.001). A weak positive correlation was observed between planned and pathological margins (ρ = 0.32), but it did not reach statistical significance (p = 0.060). Importantly, the maximum underestimation of tumor extent was 18 mm, indicating that the discrepancy between imaging-based planning and pathological findings did not exceed 20 mm in any case. Lesions classified as fascia-contacting or beyond on MRI showed a higher likelihood of deep invasion (OR 27.0, 95% CI 1.5-483). Residual tumor was identified in 71% of patients undergoing additional resection after unplanned excision. All patients achieved R0 resection without local recurrence, and distant metastases occurred only in FS-DFSP. Preoperative MRI provides clinically useful information for surgical margin assessment in DFSP. A lateral margin of approximately 20 mm appears sufficient to achieve complete resection, and fascia-based evaluation may help stratify the risk of deep invasion.

PMID:42400167 | DOI:10.1111/1346-8138.70377

Am J Sports Med. 2026 Jul 3:3635465261453085. doi: 10.1177/03635465261453085. Online ahead of print.

ABSTRACT

BACKGROUND: Radial meniscal tears (RMTs) interrupt circumferential collagen fibers, disrupt hoop stress transmission, and accelerate compartmental cartilage wear. Despite their clinical and biomechanical importance, reporting remains inconsistent because widely used taxonomies are heterogeneous and often assessed with nominal agreement statistics that overlook the ordered nature of tear morphology.

PURPOSE: To (1) quantify the interobserver and intraobserver reliability of a 5-type morphology-based classification system for RMTs using ordinal agreement metrics and (2) evaluate criterion validity against arthroscopy and construct validity against a prespecified morphology→treatment matrix.

STUDY DESIGN: Cross-sectional study; Level of evidence, 3.

METHODS: A harmonized case bank of 400 unique RMTs (80 per type I-V; 55.0% medial and 45.0% lateral) was assembled across 5 centers. There were 7 expert knee surgeons (>10 years’ experience) who performed test-retest classifications at T1 and T2 (mean washout time, 24.7 ± 3.6 days); a broader panel of 40 knee surgeons (>10 years’ experience) conducted classifications at T1 only. Raters were blinded; used a 1-page atlas with explicit criteria (depth/extent, gap thresholds of ≤3/>3 mm, vascular zone); and recorded type (I-V), confidence (Likert), and recommended treatment. The primary endpoint was the Light kappa (κ) (mean of pairwise Cohen κ; quadratic weighting) with bootstrap 95% confidence intervals (CIs) (5000 resamples, stratified by type). The coprimary endpoint was the Gwet AC2 (ordinal). Criterion validity was determined using an arthroscopy-referenced subcohort (n = 260). Construct validity examined concordance between assigned type and the prespecified treatment matrix. Secondary endpoints included exact agreement and ±1-category agreement, the Fleiss κ (nominal), and subgroup analyses (compartment, gap magnitude).

RESULTS: Interobserver ordinal agreement was high (Light κ = 0.902 [95% CI, 0.889-0.914]) (AC2 = 0.918 [95% CI, 0.906-0.929]). Agreement was stable by compartment (medial: κ = 0.897; lateral: κ = 0.909) and gap magnitude (no/≤3 mm: κ = 0.907; >3 mm: κ = 0.893). Exact agreement was 83.5%, and ±1-category agreement was 96.8%; nonadjacent misclassifications were 3.2%, with a predictable boundary at type III↔IV. Intraobserver reliability among experts was excellent (mean weighted Cohen κ = 0.913 [range, 0.882-0.942]). Criterion validity versus an arthroscopic reference was strong (weighted κ = 0.887 [95% CI, 0.871-0.902]). Construct validity showed 86.2% exact agreement (κ = 0.842; AC1 = 0.861). Sensitivity analyses (category collapsing, alternative weights, leave-one-rater-out) confirmed robustness.

CONCLUSION: This 5-type classification system demonstrated high reproducibility (ordinal κ≈ 0.90) and clinical validity, providing a practical framework for standardized reporting and treatment selection and a defensible stratification scheme for future trials and meta-analyses.

PMID:42400149 | DOI:10.1177/03635465261453085