Category: Statistics

Fluids Barriers CNS. 2026 Apr 24. doi: 10.1186/s12987-026-00803-8. Online ahead of print.

ABSTRACT

OBJECTIVE: Cerebrospinal fluid (CSF) over-drainage is an unintended sequela of using a shunt valve to treat hydrocephalus, and a second valve may be added in series to better control drainage. In this study, we tested whether the opening pressures of two valves in series-Codman Hakim ball valve (HBV) and the Miethke M.blue^Ⓡ adjustable gravitational valve (AGV)-can be treated as being additive using a novel in vitro benchtop model.

METHODS: Six dual-valve circuits were tested in triplicates for different combinations of HBV and AGV settings adding up to a summed opening pressure (OP) of either 20 or 40 cmH₂O. This “theoretical” sum was based on the addition of the nominal OP settings as stated by the manufacturer. Kruskal-Wallis tests and linear mixed-effect models were employed to analyze the flow rates for HBV-AGV settings with the same theoretical OP.

RESULTS: Kruskal-Wallis analysis demonstrated that HBV-AGV settings for each circuit, at a theoretical OP of 20 and 40 cmH₂O, showed statistically significant differences in flow rate. In linear mixed-effects models, as HBV OP was increased and composed a larger fraction of the theoretical OP, the flow rate decreased (effect size: -1.567 × 10^{– 3} mL/min/cmH₂O, standard error: 1.663 × 10^{– 4} mL/min/cmH₂O, p < 2 × 10^{– 16} at 20 cmH₂O, and effect size: -3.735 × 10^{– 3} mL/min/cmH₂O, standard error: 1.475 × 10^{– 4} mL/min/cmH₂O, p < 2 × 10^{– 16} at 40 cmH₂O, respectively).

CONCLUSION: An analysis of the flow data demonstrated statistically significant differences between combinations of HBV-AGV settings adding up to the same theoretical opening pressure. These findings suggest that in practice, the nominal OPs of Hakim and M.blue^Ⓡ valves may not be additive. Clinicians should be aware that drainage patterns can change when adjusting OPs of Hakim^Ⓡ and M.blue^Ⓡ valves under the assumption that HBV-AGV settings with the same summed theoretical OP behave alike.

PMID:42032645 | DOI:10.1186/s12987-026-00803-8

BMC Oral Health. 2026 Apr 24. doi: 10.1186/s12903-026-08355-x. Online ahead of print.

NO ABSTRACT

PMID:42032633 | DOI:10.1186/s12903-026-08355-x

J Cardiothorac Surg. 2026 Apr 24. doi: 10.1186/s13019-026-04170-1. Online ahead of print.

ABSTRACT

PURPOSE: Given the systemic nature of connective tissue diseases (CTD), open surgical intervention for aortic stenosis is often considered high risk, making transcatheter aortic valve replacement (TAVR) a potentially preferable alternative. However, data on the impact of CTD on TAVR outcomes remain limited. Therefore, we conducted a nationwide analysis using the National Inpatient Sample (NIS) to examine trends and in-hospital outcomes of TAVR in patients with CTD in the United States.

METHODS: A total of 90,298 patients undergoing TAVR between 2016 and 2022 were identified, representing over 451,000 weighted hospitalizations, including 3,821 (4.2%) with CTD. Multivariable regression was used to adjust for demographic, clinical, and hospital-level characteristics. CTD patients were more frequently female and had higher comorbidity indices, although many differences were small in absolute magnitude.

RESULTS: In-hospital mortality was comparable between CTD and non-CTD groups (1.0% vs. 1.2%, p = 0.345). Rates of permanent pacemaker implantation and major complications, including vascular events, were similar. CTD patients demonstrated modestly shorter length of stay and lower inflation-adjusted hospitalization costs. Lower rates of cardiogenic shock, cardiac arrest, and mechanical ventilation were observed in the CTD cohort. In-hospital mortality declined significantly over time in the overall cohort, with a similar directional trend in CTD patients that did not reach statistical significance, likely due to smaller sample size.

CONCLUSION: Overall, TAVR appears to be a safe and feasible therapeutic option in patients with CTD, with outcomes comparable to those without CTD.

PMID:42032618 | DOI:10.1186/s13019-026-04170-1

Trials. 2026 Apr 24. doi: 10.1186/s13063-026-09726-z. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: A Study Within A Trial (SWAT) is a research study embedded within a larger trial which aims to investigate different strategies for a particular trial process, such as trial recruitment. It is imperative such studies, which are often underpowered, employ efficient and informative analytical methods. The use of Bayesian methods and interpretation of SWAT results in this context requires exploration. Bayesian methods provide direct probability statements about intervention effects and readily enable ACceptability Curve Estimation using Probability above Threshold (ACCEPT) analyses, which consider the probability of the tested intervention being effective for different threshold values. Additionally, they provide an opportunity to incorporate the results of previous similar studies within the analysis using informative priors. This proof-of-concept study re-analysed two previous SWATs using Bayesian methods and ACCEPT analyses.

METHODS: A SWAT conducted by Du et al. in 2009 and a subsequent SWAT by Mattock et al. in 2020 compared a video intervention against standard patient information on trial recruitment. For each SWAT, a primary Bayesian analysis was performed using a logistic model with non-informative priors. Sensitivity analysis explored informative priors informed by meta-analysis of previous similar studies; this included an analysis of the Mattock et al. SWAT incorporating the result of the earlier Du et al. SWAT. ACCEPT curves were constructed. Results were compared with frequentist analyses.

RESULTS: For the Du et al. SWAT, the primary Bayesian analysis gave an OR for recruitment for the video relative to standard information of 2.12, 95% CrI: 0.38-4.65 and a posterior probability of the video being effective (OR > 1) of 0.86. When taking into account results of previous SWATs by using an informative prior there remained a moderately high probability of video benefit (0.82). For the latter Mattock et al. SWAT, the primary Bayesian analysis gave an OR for recruitment for the video relative to standard information of 0.26, 95% CrI: 0.07-0.51 and the posterior probability of the video being effective was 0.0005, indicating very little chance of effectiveness; ACCEPT plots facilitated interpretation by showing the probability that the video was better than standard information for OR > 0.8 was very small (0.0032). When taking into account the results of previous SWATs using an informative prior, including Du et al., the probability of the video being effective was still very small (0.12).

CONCLUSIONS: Bayesian methods and ACCEPT analyses offer solutions to challenges experienced in the analysis and interpretation of SWATs, which are often underpowered. Greater use of these analytical approaches within SWATs will lead to a more accessible, improved evidence base on how to effectively conduct trials.

PMID:42032615 | DOI:10.1186/s13063-026-09726-z

BMC Public Health. 2026 Apr 24. doi: 10.1186/s12889-026-27451-9. Online ahead of print.

NO ABSTRACT

PMID:42032562 | DOI:10.1186/s12889-026-27451-9

BMC Oral Health. 2026 Apr 24. doi: 10.1186/s12903-026-08421-4. Online ahead of print.

NO ABSTRACT

PMID:42032553 | DOI:10.1186/s12903-026-08421-4

BMC Public Health. 2026 Apr 24. doi: 10.1186/s12889-026-27399-w. Online ahead of print.

NO ABSTRACT

PMID:42032535 | DOI:10.1186/s12889-026-27399-w

BMC Public Health. 2026 Apr 24. doi: 10.1186/s12889-026-27499-7. Online ahead of print.

NO ABSTRACT

PMID:42032509 | DOI:10.1186/s12889-026-27499-7

Health Policy. 2026 Apr 18;170:105638. doi: 10.1016/j.healthpol.2026.105638. Online ahead of print.

ABSTRACT

Violence against healthcare workers has prompted policy responses across health systems that often emphasise security measures, legal sanctions, and behavioural interventions. While these approaches are essential to protect healthcare workers, their effectiveness remains limited. This Policy Comment argues that such framing may underemphasise determinants of violence arising at multiple levels of health systems, including broader policy choices (e.g., workforce planning, financing, and service configuration), governance arrangements (e.g., performance monitoring, administrative control, and regulatory standards), and organisational conditions (e.g., staffing shortages, workload, and care pathway bottlenecks), within a context influenced by international policy frameworks and societal factors. Drawing on a multi-level conceptual framework and examples from different countries, we suggest that violence can also be understood as an indicator of systemic strain arising from the persistent gap between healthcare needs and available capacity, reflecting how healthcare systems are organised, governed, and resourced. Rebalancing prevention efforts to address these policy and governance drivers may offer more sustainable solutions.

PMID:42030594 | DOI:10.1016/j.healthpol.2026.105638

J Neurosurg Pediatr. 2026 Apr 24:1-12. doi: 10.3171/2025.12.PEDS25560. Online ahead of print.

ABSTRACT

OBJECTIVE: Several studies have reported that a shorter duration of epilepsy is associated with better surgical seizure outcomes; however, most of these findings have been based on adult populations. Data on children remain limited, and it is still unclear whether the duration of drug-resistant epilepsy (DRE) or the duration of overall epilepsy is more associated with seizure outcomes. The primary research question of this study focused on the association between total epilepsy duration and seizure outcome at the 2-year follow-up, whereas the secondary research question centered on the role of DRE duration.

METHODS: The authors conducted a retrospective analysis of pediatric patients with epilepsy who underwent resective surgery between 2002 and 2022 at a single institution. Seizure outcome data were obtained at the 2-year follow-up after the last surgery. A subgroup analysis of patients with a known time for DRE onset was performed. Predictors of seizure recurrence were assessed using multiple adjusted logistic regression models, accounting for multicollinearity.

RESULTS: A total of 239 patients underwent epilepsy surgery in the study period. Among them, 154 patients (71.0% of those with DRE) had an identifiable time of DRE onset. Compared to those with ongoing seizures, seizure-free patients had a significantly shorter median duration of epilepsy (4.25 vs 5.98 years, p < 0.001) and a shorter median duration of DRE (1.75 vs 3.13 years, p < 0.001). Due to the multicollinearity between time-related variables, epilepsy duration and DRE duration were entered into separate models for adjusted logistic regression. In the epilepsy duration-based models, a longer epilepsy duration was associated with seizure recurrence (OR 1.10, 95% CI 1.03-1.18, p = 0.008). In the DRE-based models, a longer DRE duration was associated with worse outcomes (OR 1.20, 95% CI 1.00-1.43, p = 0.045), while epilepsy duration was not statistically significant.

CONCLUSIONS: In this unselected population-based, pediatric, resective epilepsy surgery cohort, longer epilepsy duration is associated with worse seizure outcomes. Similarly, a prolonged duration of DRE was correlated with worse seizure outcomes. The findings emphasize the importance of early surgical referrals. Future multicenter studies are warranted to further clarify the relative prognostic value of DRE duration versus total epilepsy duration and to guide evidence-based criteria for surgical timing in children with epilepsy.

PMID:42030572 | DOI:10.3171/2025.12.PEDS25560