Tag: statistics

JMIR Res Protoc. 2026 Jan 23;15:e82696. doi: 10.2196/82696.

ABSTRACT

BACKGROUND: Mental disorders are highly prevalent, and they significantly impact individuals and society. Patients experiencing long-term, severe mental disorders with functional impairment and reduced quality of life often have a history of adolescent onset anxiety and depressive disorders. Despite the long-term costs to both patients and society, studies examining treatment effects over time and across diagnoses are scarce.

OBJECTIVE: The Norwegian Adult Mental Health Registry (NAMHR) aims to systematically reuse health data to monitor and improve treatment outcomes, patient safety, health service quality, and research. The registry addresses the need for comprehensive data on the effects and utility of mental health services, interventions, and therapy variants in specialized mental health care.

METHODS: The NAMHR is a nationwide naturalistic registry, including all Norwegian adults eligible for treatment in specialized mental health care services who have not opted out. Patients are automatically enrolled when treated in these services. The population includes patients treated in public specialized services and those treated in private services having a contract with public health services. The registry is based on secondary data from the Norwegian Patient Registry (NPR), patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), the Norwegian Registry for Primary Health Care (KPR), and several other sources, including electronic health records (EHRs). Data linkage uses unique national identity numbers, ensuring high-quality data. The registry collects information on diagnoses, treatments, medication, and patient-reported outcomes, providing a holistic approach to mental health care. Statistical analyses will be defined in each project.

RESULTS: As of December 2025, the NAMHR is approved and is being constructed. The registry anticipates enrolling up to 170,000 participants, with a new incidence rate of around 10,000 patients per year. Key predictors and outcomes include PROMs and PREMs, and automatically reported measures involving a wide range of data, including EHR data from inpatient and outpatient treatments, data from primary health care, data on job and education status, and data on cause of death. Enrollment is planned to start in 2026, initially by adding journal data and patient-reported data. Other sources will be included. The NAMHR has no planned end date. Results will be made available for internal quality improvement purposes, and data for research are expected to be available around mid-2026 for approved projects.

CONCLUSIONS: The NAMHR will promote quality improvement initiatives and research, including registry-based randomized clinical trials. It will also be possible to link the NAMHR to a similar registry for children and adolescents, making it possible to follow patients from birth to death and supporting the monitoring of diagnostic drift. The NAMHR will inform health policy decisions at local, regional, national, and international levels, contributing to the evaluation and development of clinical guidelines and enhancing personalized treatment approaches.

PMID:41576321 | DOI:10.2196/82696

Neurology. 2026 Feb 24;106(4):e214644. doi: 10.1212/WNL.0000000000214644. Epub 2026 Jan 23.

ABSTRACT

BACKGROUND AND OBJECTIVES: Although stroke technology and care infrastructure have advanced significantly, it remains unclear whether recent expansions of certified stroke centers have benefited rural patients equitably across income levels. This study assessed whether rural communities of varying income experienced similar gains in access to certified stroke centers and whether such expansions were associated with improvements in acute stroke treatment and outcomes.

METHODS: We conducted a retrospective cohort study using 100% Medicare Provider and Analysis Review data from January 1, 2009, to December 31, 2019. This study included all Medicare fee-for-service beneficiaries diagnosed with acute ischemic stroke who resided in rural US communities. Communities were classified as exposed if a newly certified stroke center-acute stroke ready hospital (ASRH), primary stroke center, thrombectomy-capable stroke center (TSC), or comprehensive stroke center (CSC)-opened within a 30-minute drive. A community fixed-effects linear probability model was used to evaluate changes in outcomes after stroke center certification. Primary outcomes included the following: (1) admission to a stroke-certified hospital, (2) receipt of thrombolytic therapy, (3) receipt of thrombectomy, and (4) one-year mortality.

RESULTS: Among 590,191 rural stroke patients, 4% of low-income and 22% of high-income patients had access to a nearby certified stroke center in 2009. By 2019, 30% of low-income and 50% of high-income communities had gained access to at least 1 newly certified stroke center; high-income communities were 3 times more likely than low-income communities to be exposed to a newly certified TSC or CSC (5.4% vs 1.8%). Exposure to ASRHs increased the probability of thrombolysis by 0.63 percentage points (95% 0.05-1.22), whereas exposure to TSC/CSCs increased the probability by 1.39 points (95% CI 0.28-2.49) and thrombectomy by 1.12 points (95% CI 0.41-1.83). No differences in 1-year mortality were observed.

DISCUSSION: During the study period, high-income rural communities experienced more frequent and higher tier stroke center expansion than low-income rural communities. These access disparities were associated with differential gains in advanced stroke treatments, suggesting that expansions may have inadvertently widened income-based disparities in rural stroke care. These findings underscore the need for equity-focused implementation strategies, ensuring that infrastructure improvements translate into equitable clinical benefits.

PMID:41576313 | DOI:10.1212/WNL.0000000000214644

J Clin Oncol. 2026 Jan 23:JCO2501625. doi: 10.1200/JCO-25-01625. Online ahead of print.

ABSTRACT

PURPOSE: There is growing scientific interest in incorporating patient-reported outcomes (PROs) in early phase dose-finding oncology trials (DFOTs) to assess tolerability, inform dose selection, and guide later stage trial design. However, research indicates that PRO objectives in DFOTs are often unclear. The Incorporating Patient-Reported Outcomes in Dose-Finding Trials-Research Objectives Recommendations (OPTIMISE-ROR) project was established to support trialists to effectively incorporate PROs into DFOTs.

METHODS: Using the Enhancing Quality and Transparency of Health Research (EQUATOR) Network’s methodological framework, guideline development included the following: (1) a methodological review of published DFOTs incorporating PROs; (2) candidate item generation, refined through expert consultation; (3) a two-round international multistakeholder Delphi survey (N = 109 in Round 1 [October 2024]; N = 96 in Round 2 [December 2024]); and (4) an independently chaired virtual consensus meeting (N = 31; January 2025) where multidisciplinary, international experts reviewed and voted to finalize items for inclusion.

RESULTS: Consensus was reached on six recommendations emphasizing three core PRO tolerability concepts: overall side effect impact, symptomatic adverse events, and overall health-related quality of life. The integration of PROs to inform final dose recommendations in dose escalation and optimization trials should be considered, regardless of trial design. The recommendations highlight the importance of PRO data analysis over time and across dose levels, defining PRO research objectives as descriptive or statistically powered, and assessing PRO-related end points to guide end point selection for subsequent studies.

CONCLUSION: This foundational guidance outlines key PRO research objectives in DFOTs. By facilitating the systematic integration of PROs, this guidance supports the utilization of patient-centered evidence for the tolerability and efficacy assessment of therapies to inform dose escalation, optimization, and regulatory evaluation-ultimately contributing to the development of safer, more effective therapies.

PMID:41576310 | DOI:10.1200/JCO-25-01625

JMIR Nurs. 2026 Jan 23;9:e78560. doi: 10.2196/78560.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) continues to expand into nursing and health care. Many examples of AI applications driven by machine or deep learning are in use. Examples include wearable devices or alerts for risk prediction. AI tends to be promoted by nonnurses, creating a risk that AI is not designed to best serve registered nurses. Community health nurses (CHNs) are a small but essential group. CHNs’ familiarity with AI and their perceptions about its effect on their practice are unknown.

OBJECTIVE: The research aims to understand CHNs’ awareness, knowledge, and perceptions of AI in practice and gain insights to better involve them in AI.

METHODS: An online cross-sectional Canadian survey targeting CHNs was conducted from April to July 2023. Descriptive statistics summarized respondents’ characteristics and perceptions of AI, followed by a chi-square test used to determine a relationship between respondents’ level of AI knowledge and their AI perceptions, with odds ratio (OR) to determine the strength of association.

RESULTS: A total of 228 CHNs participated with varying response rates per question. Most respondents were female (172/188, 91.5%), average age of 45.5 (SD 11.7) years, and an average of 13.5 (SD 10.1) years of community practice experience. Most respondents (205/228, 89.9%) felt they welcomed technology into their practice. They reported their understanding of AI technologies as “good” (95/220, 43.2%) and “not good” (125/220, 56.8%). Overall, 39.6% (80/202) of respondents felt uncomfortable with the development of AI. They agreed that AI should be part of education (143/203, 70.4%), professional development (152/202, 75.2%), and that they should be consulted (195/203, 96.1%). Many respondents had concerns related to professional accountability if they accepted a wrong AI recommendation (157/202, 77.7%) or if they dismissed a correct AI recommendation (149/202, 73.8%). Respondents with “good” AI knowledge were significantly associated with, and twice as likely to indicate nursing will be revolutionized (P=.007; OR 2.28, 95% CI 1.25-4.18), nursing will be more exciting (P=.001; OR 2.52, 95% CI 1.42-4.47), health care will be more exciting (P=.004; OR 2.3, 95% CI 1.30-4.06), and agreed that AI is part of nursing (P=.01; OR 2.1, 95% CI 1.19-3.68). Respondents with “not good” AI knowledge were significantly associated with, and more likely to feel uncomfortable with AI developments (χ21=4.2, P=.04; OR 1.84, 95% CI 1.03-3.3).

CONCLUSIONS: CHNs reporting “good” AI knowledge had more favorable perceptions toward AI. Overall, CHNs had professional concerns about accepting or dismissing AI recommendations. Potential solutions include educational resources to ensure that CHNs have a sound basis for AI in their practice, which would promote their comfort with AI. Further research should explore how CHNs could be better involved in all aspects of AI introduced into their practice.

PMID:41576309 | DOI:10.2196/78560

JMIR Mhealth Uhealth. 2026 Jan 23;14:e84447. doi: 10.2196/84447.

ABSTRACT

BACKGROUND: Telehealth can improve access to care for people living with multiple sclerosis (MS), but information on its acceptance is limited in Switzerland.

OBJECTIVE: This study aimed to determine the proportion of people living with MS willing to accept telehealth as a new default and the factors associated with their acceptance.

METHODS: We conducted a cross-sectional analysis using survey data from the Swiss Multiple Sclerosis Registry. We defined “telehealth as a default” as a health care model where remote consultations (telephone and/or video calls) are the primary mode of interaction between patients and their physicians, with in-person visits based on clinical necessity. Multivariable logistic regression was performed to evaluate the association between telehealth acceptance and sociodemographic and health-related factors. Telehealth acceptance was described in relation to 3 survey variables that mirrored key constructs from the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. The variables were digital communication preferences, internet use for health provider searches, and experience with telemedicine.

RESULTS: Among 427 respondents, 15.5% (66/427) reported a willingness to accept telehealth as their default. In this group, only 21.2% (14/66) had experience using telemedicine. A descriptive analysis of our 3 NASSS-derived key constructs showed that among the 78.5% (335/427) respondents who generally agreed to digital access to health data, only 17.0% (57/335) accepted telehealth as a default. Notably, 30.7% (129/427) of participants stated a wish for support for using devices or the internet. Among those 129 individuals, 17.1% (22/129) were willing to accept telehealth as a default. Of the 89 people with prior telehealth experience, 15.7% (14/89) were willing to accept telehealth. In multivariable analysis, digital communication with health care providers (adjusted odds ratio [aOR] 14.56, 95% CI 6.18-39.04; P<.001), current internet use for health care provider search (aOR 7.78, 95% CI 1.34-45.32; P=.021), and a secondary progressive MS diagnosis (aOR 0.22, 95% CI 0.05-0.72; P=.021) were independently associated with accepting telehealth as a default.

CONCLUSIONS: Our findings suggest a low acceptance of telehealth as a default among people living with MS in Switzerland. While our 3 postulated NASSS-derived key constructs were not associated with telehealth acceptance, we noted additional behavioral factors, including previous digital communication with health care providers and using the internet to search for health care provider information, which were associated with telehealth acceptance. Moreover, advanced disease states like secondary progressive MS were negatively associated with telehealth acceptance. Thus, telehealth as a default will be most acceptable in people living with MS who already use the internet for their health, and those with less severe disease. Future research should explore provider perspectives and evaluate long-term strategies for the acceptance of telehealth in MS care.

PMID:41576299 | DOI:10.2196/84447

JAMA Netw Open. 2026 Jan 2;9(1):e2555339. doi: 10.1001/jamanetworkopen.2025.55339.

ABSTRACT

IMPORTANCE: Youth mental health crises have been increasing over the last decade, and there is an urgent need for clinicians to be more knowledgeable about patients with high emergency department (ED) utilization. Several disparities in ED utilization and outcomes have already been identified; however, little data exist on disparities affecting youths with histories of out-of-home placement (OOHP).

OBJECTIVE: To explore whether history of OOHP is associated with increased length of stay among child and adolescent patients who present to the emergency department with psychiatric symptoms.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, electronic health record (EHR)-based, cross-sectional study included patients aged 17 years or younger with a child and adolescent psychiatric consultation placed in the Mayo Clinic Rochester ED between January 1, 2021, and June 30, 2024. The Mayo Clinic Rochester is a tertiary referral center that serves as a regional hub for both primary and specialized psychiatric care.

MAIN OUTCOMES AND MEASURES: The primary outcome was the length of stay in the ED. Secondary outcomes were use of physical and pharmacological restraint. Associations between OOHP and length of stay were examined via linear mixed-effects regression models with length of stay log transformed.

RESULTS: Of the 1572 care encounters (median [IQR] age, 14,9 [13.3-16.3] years) among 1119 unique patients, there were 1244 with no history of OOHP and 328 with history of OOHP. Among the OOHP group, 158 (48%) were male and 170 (52%) female; 11 (4%) American Indian or Alaska Native, 7 (2%) Asian, 49 (16%) Black, 43 (14%) Hispanic, and 222 (71%) White. Among the 1244 encounters without OOHP, 820 (66%) were among female patients and 423 (34%) male; 21 (2%) American Indian or Alaska Native, 47 (4%) Asian, 121 (10%) Black, 125 (10%) Hispanic, and 971 (80%) White. Children and adolescents with history of OOHP were observed to spend 24% (95% CI, 12%-36%) more time in the ED even when adjusting for age at admission, sex, insurance, number of prior diagnoses, presenting concerns, and reasons for prolonged boarding (P = .004). Children and adolescents with history of OOHP had 2.05 (95% CI, 1.69-2.48) higher odds of being physically restrained (P < .001) and 2.15 (95% CI, 1.79-2.58) higher odds of receiving pharmacologic restraints (P < .001) while in the ED.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 1572 care encounters among 1119 patients, history of OOHP was associated with longer lengths of stay in the emergency department for children and adolescents who presented for mental health concerns. The findings highlight the need for further research on ways to mitigate the risk of extended emergency department stays for children with OOHP.

PMID:41575744 | DOI:10.1001/jamanetworkopen.2025.55339

Cardiovasc Drugs Ther. 2026 Jan 23. doi: 10.1007/s10557-026-07844-z. Online ahead of print.

NO ABSTRACT

PMID:41575651 | DOI:10.1007/s10557-026-07844-z

Target Oncol. 2026 Jan 23. doi: 10.1007/s11523-025-01194-w. Online ahead of print.

ABSTRACT

BACKGROUND: Given that immune checkpoint inhibitor-based regimens frequently yield delayed separation and late plateaus, conventional hazard ratio analyses that assume proportional hazards may misstate true benefit.

OBJECTIVE: We aimed to test the validity of the proportional hazards assumption in first-line metastatic clear cell renal cell carcinoma trials and to compare the immune checkpoint inhibitor-based regimens using restricted mean survival time.

METHODS: We performed a systematic review and network meta-analysis of phase III randomized controlled trials of first-line treatment for metastatic clear cell renal cell carcinoma, including immune checkpoint inhibitor-tyrosine kinase inhibitor combinations or dual-immune checkpoint inhibitor regimens. Individual patient data were reconstructed from the Kaplan-Meier curves of overall survival and progression-free survival. The restricted mean survival time differences were estimated.

RESULTS: Five trials (4206 patients; six treatment arms) were examined. Proportional hazards assumption was violated in 60% of both overall survival and progression-free survival comparisons. In the restricted mean survival time-based network meta-analysis of overall survival, immune checkpoint inhibitor-tyrosine kinase inhibitor combinations, especially Nivolumab + Cabozantinib, dominated at 12-48 months, whereas Ipilimumab + Nivolumab ranked highest beyond 48 months. In the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) favorable-risk subgroup, Avelumab + Axitinib showed a favorable long-term profile despite the lack of statistical significance. In IMDC intermediate/poor-risk, patterns mirrored the overall population. For progression-free survival, Pembrolizumab + Lenvatinib ranked best across IMDC subgroups. Limitations included the reliance on reconstructed data and heterogeneity across trials.

CONCLUSIONS: Given the frequent proportional hazards violations, hazard ratio-only syntheses are insufficient for modern immune checkpoint inhibitor-based regimens. In the restricted mean survival time-based network meta-analysis, Pembrolizumab + Lenvatinib delivered rapid disease control, and Ipilimumab + Nivolumab showed the greatest late survival advantage in IMDC intermediate/poor-risk.

PROSPERO REGISTRATION NUMBER: CRD420251143602.

PMID:41575641 | DOI:10.1007/s11523-025-01194-w

Discov Ment Health. 2026 Jan 23. doi: 10.1007/s44192-026-00376-w. Online ahead of print.

ABSTRACT

BACKGROUND: In a post-genocide context, mental health disorders among Rwandan genocide survivors and released perpetrators remain a critical concern. To date, no study has evaluated the effectiveness of the Community Resiliency Model (CRM) skills in addressing the mental health needs of both groups simultaneously. This study assessed the impact of CRM when delivered to a combined group of survivors and perpetrators, compared to groups trained separately.

METHODS: A total of 152 participants were recruited from Nyamagabe district, Rwanda. Participants were assigned into three groups including genocide survivors (n = 51), released genocide perpetrators (n = 51), and a combined group of both survivors and perpetrators (n = 50). Data were collected at three points: pre-intervention, immediately post-intervention, and six months post-intervention using validated psychometric scales for anxiety, depression, posttraumatic stress disorder (PTSD), emotional dysregulation, and anger. Repeated measures ANOVA and Bonferroni post hoc tests were used to analyze changes over time. A statistical significance of p < 0.005 and p < 0.001 was applied.

RESULTS: Our findings showed significant reduction of anxiety (F = 20.17, p < 0.001), depression (F = 37.03, p < 0.001), anger (F = 95.97, p < 0.001), and emotional dysregulation (F = 76.68, p < 0.001) across all groups of participants. These positive changes were sustained at 6 months post-intervention for anxiety, depression, anger, and emotional dysregulation. In contrast, PTSD symptoms only showed a slight, non-significant reduction over time (F = 0.59, p = 0.44). Additionally, there were no significant differences in outcomes between groups that received the intervention separately (survivor-only or perpetrator only) and those that received it in mixed survivor-perpetrator groups.

CONCLUSION: Although the CRM intervention does not replace psychotherapy, it produced lasting and positive effects on mental health symptoms among both genocide survivors and perpetrators, particularly in reducing anxiety, depression, and emotional dysregulation. Importantly, outcomes did not differ whether the intervention was delivered to separate or combined groups. A randomized controlled trial is recommended to further evaluate the long-term effects of CRM on community healing and cohesion.

PMID:41575623 | DOI:10.1007/s44192-026-00376-w

Aesthetic Plast Surg. 2026 Jan 23. doi: 10.1007/s00266-026-05617-5. Online ahead of print.

ABSTRACT

BACKGROUND: Removal of the skin and preseptal orbicularis oculi is the initial step in upper eyelid surgery. Preseptal orbicularis oculi removal has been strongly associated with dry eye symptoms due to sluggish eyelid closure and lagophthalmos. We aimed to investigate the effects of concurrent upper blepharoplasty and external levator advancement (ELA) surgery with or without orbicularis oculi resection on dry eye syndrome and eyelid morphology in Southeast Asian populations.

METHODS: This prospective, single-centre, double-blind, randomised controlled trial involved 20 Thai patients (40 eyes) with aponeurotic blepharoptosis and excess eyelid skin undergoing combined upper blepharoplasty and ELA surgery. Patients were randomised into a skin-muscle excision group (group A) or a skin-only excision group (group B). Dry eye parameters including tear break-up time, Oxford ocular surface staining, Ocular Surface Disease Index, eyelid appearance, and patient satisfaction were evaluated preoperatively and on postoperative days 7, 30, and 90.

RESULTS: Preseptal orbicularis oculi excision had no statistically significant impact on dry eye parameters, eyelid appearance, or patient satisfaction. For both groups, surgery increased the marginal reflex distance 1 without causing significant lagophthalmos, indicating successful ptosis correction irrespective of muscle excision. There were no discernible differences in postoperative appearance between the two groups, and the patients reported high satisfaction with their treatment.

CONCLUSIONS: Combined upper blepharoplasty and ELA surgery, with or without resection of the preseptal orbicularis oculi, may be a safe and potentially effective procedure for patients with aponeurotic blepharoptosis and excess eyelid skin. Our findings demonstrate no evidence of a difference in correlation between either of these techniques and postoperative dry eye parameters or eyelid appearance. Further studies with larger sample sizes and longer follow-up periods are warranted.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:41575571 | DOI:10.1007/s00266-026-05617-5