Tag: statistics

JMIR Mhealth Uhealth. 2026 Feb 5;14:e76862. doi: 10.2196/76862.

ABSTRACT

BACKGROUND: The use of mobile health (mHealth) apps can assist with the management of gestational diabetes (GDM). Although a number of studies have demonstrated their efficacy in improving maternal-fetal outcomes, opinions differ regarding their usability and overall quality. Poorly designed apps, with ill-conceived features or inappropriate content, may pose a threat to patient safety. Nevertheless, very few studies provide in-depth evaluations of app design quality, and the diversity of features and techniques used remains insufficiently explored.

OBJECTIVE: We aimed to evaluate the quality and multifunctionality of commercially available mHealth apps for GDM.

METHODS: This is a systematic app review guided by the TECH (target user, evaluation focus, connectedness, and health domain) framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist. Searches were conducted on the Apple App Store and Google Play. Apps were screened by name, description, and full navigation to identify inclusions. The quality of the apps was evaluated using the Mobile App Rating Scale and IMS Institute for Healthcare Informatics Functionality Score. Multifunctionality of the apps was evaluated using the GDM-adapted features and techniques list developed from the App Behavior Change Scale, NICE (National Institute for Health and Care Excellence) 2015 guidelines, and previous studies. The general features list, which contains instruction, data security, customization, and technical issues, was derived from previous studies.

RESULTS: The search (June 2024) identified 23 commercially available apps from UK app stores. The overall app quality was evaluated to be satisfactory (Mobile App Rating Scale: mean 4.0, SD 0.36; IMS Institute for Healthcare Informatics Functionality Score: mean 5.83, SD 3.03). The multifunctionality evaluation found that the apps had a mean of 17.95 and SD of 7.31 across all 45 items. Overall, our findings suggested that mHealth apps for GDM achieved a certain level of multifunctionality. However, their feature types and supporting digital techniques are relatively basic. The apps focused on education and managing blood glucose control rather than integrating other self-monitoring data and pregnancy-relevant management into their design. The digital techniques used to achieve these features included text and manual operation, rather than other automated features.

CONCLUSIONS: This is the first app review to consider the relationship between app features and usability for women with GDM. Future app development should integrate a wide range of pregnancy-relevant information and more automated features and use advanced digital techniques to enable a holistic digital solution for women with GDM.

PMID:41643159 | DOI:10.2196/76862

Chem Biodivers. 2026 Feb;23(2):e03761. doi: 10.1002/cbdv.202503761.

ABSTRACT

The study investigated Dactylonectria torresensis as a sustainable source of podophyllotoxin (PTOX), a key precursor for anticancer drugs such as etoposide and teniposide. The fungus was identified through morphological analysis and ITS rDNA sequencing. PTOX from the fungal extract was isolated and characterized using high-performance liquid chromatography, high-resolution mass spectrometry, and nuclear magnetic resonance spectroscopy. Antioxidant activity was evaluated via 2,2-diphenyl-1-picrylhydrazyl (DPPH) and reducing power assays, showing comparable 50% inhibition (IC₅₀) values for standard and fungal PTOX – 297.4 versus 309.8 µg/mL (DPPH) and 306.6 versus 316.3 µg/mL (reducing power). Cytotoxicity against MCF-7 breast cancer cells also revealed similar IC₅₀ values: 3.083 µM for standard and 3.188 µM for fungal PTOX. PTOX production was optimized through a two-phase statistical approach: Plackett-Burman Design followed by Face-Centered Central Composite Design. Initially, D. torresensis produced 78.46 µg/g dry weight (DW) of PTOX, which increased 6.35-fold to 498.76 µg/g DW after optimization.

PMID:41643155 | DOI:10.1002/cbdv.202503761

J Craniofac Surg. 2026 Feb 6. doi: 10.1097/SCS.0000000000012503. Online ahead of print.

ABSTRACT

OBJECTIVE: This study evaluated the optimal depth of anesthesia guided by closed-loop target-controlled infusion (TCI) in preschool-aged children undergoing dental surgery. Dental procedures in this population are frequently associated with heightened anxiety and procedural distress, often necessitating general anesthesia; however, the appropriate depth of anesthesia remains insufficiently defined.

METHODS: A randomized, double-blind, controlled trial was conducted involving 60 children aged 3 to 6 years scheduled for dental surgery. Participants were allocated to 3 groups (A, B, and C), with bispectral index (BIS) values maintained at 50, 55, and 60, respectively, using a closed-loop TCI system. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP), recorded at 7 intraoperative time points. Secondary outcomes included surgical duration, time to first eye opening (defined as eyelid movement in response to verbal command without implying full orientation), extubation time, discharge time, and total propofol dose.

RESULTS: No statistically significant differences were observed among groups in HR or MAP at any intraoperative time point (between-subject effect: HR, F=2.73, P=0.074; MAP, F=1.54, P=0.222). Surgical duration (F=0.521, P=0.596) and total propofol dosage (P=0.165) also did not differ significantly. Recovery parameters demonstrated significant group differences. Time to first eye opening was 37.75±8.81 minutes in group A, 28.35±2.45 minutes in group B, and 20.70±5.21 minutes in group C (P<0.001). Extubation time was 39.40±8.08 minutes, 29.60±2.58 minutes, and 22.70±5.63 minutes in groups A, B, and C, respectively (P<0.001). Discharge time was shortest in group C (135.6±30.9 min), followed by group B (160.5±25.3 min), and longest in group A (202.5±26.5 min) (F=29.77, P<0.001). The incidence of adverse events was comparable across groups, and no serious adverse events occurred.

CONCLUSIONS: Maintaining a BIS value of 60 (±5) with a closed-loop infusion system provided adequate anesthetic depth for dental procedures in preschool-aged children, while significantly reducing recovery and discharge times. This anesthetic strategy may support enhanced recovery and improve perioperative efficiency in pediatric populations.

PMID:41643152 | DOI:10.1097/SCS.0000000000012503

JMIR Form Res. 2026 Feb 5;10:e74418. doi: 10.2196/74418.

ABSTRACT

BACKGROUND: Falls are a leading cause of injury among older adults, often resulting from dynamic balance disturbances. It is influenced by a complex interplay of intrinsic and extrinsic fall-risk factors. To identify individual fall risks, it is important to understand the underlying associations.

OBJECTIVE: This study aimed to build an experimental setup modeling selected factors leading to a loss of balance, measured by the margin of stability (MoS) in an ecologically valid real-world example (tripping). Additionally, these analyses aimed to assess the feasibility and safety of the protocol and to explore the use of the MoS as part of a prototypical dynamic fall-risk model to differentiate between fall-risk groups.

METHODS: Nineteen community-dwelling older adults (mean age of 71, SD 3.67 y; n=7, 37% women) completed the tripping protocol involving perturbations under various conditions. Clinical assessments were used to identify relevant fall-related intrinsic fall-risk factors. MoS was measured using an 8-camera motion capture system. Receiver operating characteristic analyses determined the ability of MoS to distinguish between low and high fall-risk groups.

RESULTS: Approximately one-quarter of participants discontinued before or at the start of the tripping scenario because of discomfort or fear of perturbations, indicating that perceived safety is an important feasibility factor. Perturbations significantly disrupted MoS, with a median MoS of -106.05 (IQR -181.40 to -41.50) mm during the perturbed step compared to 114 (IQR 81.20-155.20) mm in the preperturbation step. Recovery steps showed progressive stabilization, with the second recovery step achieving a median MoS of 88.45 (IQR 47.50-137.80) mm. The second recovery step exhibited the highest predictive accuracy for fall-risk differentiation, with area under the curve values reaching 82.3% during slow walking with a series of right-sided perturbations. In contrast, fast walking with random perturbations yielded lower area under the curve values (64.9%). Slow walking conditions generally demonstrated the clearest separation between fall-risk groups.

CONCLUSIONS: This pilot and feasibility study demonstrates the applicability of a tripping paradigm to perturb MoS in older adults and provides preliminary insights into its association with fall-risk indices. While the protocol proved safe and feasible for fit older adults, perceived safety limited full participation. The findings are exploratory and intended to guide the design of larger prospective studies rather than to establish predictive conclusions. These data suggest that MoS during controlled tripping may help differentiate fall-risk strata, but confirmation will require adequately powered studies in more diverse and frailer older populations-and across multiple real-world scenarios-before any clinical implementation can be considered.

PMID:41643136 | DOI:10.2196/74418

J Am Assoc Nurse Pract. 2026 Feb 1;38(2):108-115. doi: 10.1097/JXX.0000000000001220.

ABSTRACT

BACKGROUND: Successful use of nurse practitioner (NP) and physician assistant (PA) care models is vital to delivering optimal patient care, maintaining financial stability, and reducing staff burnout and turnover.

LOCAL PROBLEM: A large cardiovascular surgery practice experienced substantial growth, leading to an obsolete NP and PA care model. Consequently, workplace satisfaction scores were reduced, and the NP and PA turnover rate in 2018 was unacceptably high.

METHODS: A multidisciplinary redesign team was formed to address gaps in the care model through a quality-improvement initiative. The team analyzed current workflows, collected external and internal survey data, conducted patient tracers, and observed staff. Seventeen collaborative care models were proposed by frontline staff members and presented to their peers for feedback. This feedback was used to select the best aspects of the proposed models to create a new model.

INTERVENTIONS: The updated care model consisted of several key changes, which included reducing NP- and PA-to-patient ratios, eliminating redundant tasks, shifting from location-based to surgical team-based coverage, ensuring top-of-scope practice, developing specialty service lines, and separating inpatient and outpatient practices.

RESULTS: After implementation of the new care model, NP and PA turnover rates decreased from baseline by an average of approximately 74% per year. Departmental work culture scores concomitantly increased from 68% to 85% after implementation of the new care model.

CONCLUSIONS: Adapting care models in conjunction with departmental growth is crucial to enhancing staff satisfaction and reducing burnout.

PMID:41643133 | DOI:10.1097/JXX.0000000000001220

Crit Pathw Cardiol. 2026 Jan 30. doi: 10.1097/HPC.0000000000000409. Online ahead of print.

ABSTRACT

Despite technological advancements, mortality remains high in patients with myocardial infarction complicated by cardiogenic shock. Impella is increasingly used as an adjunct to standard treatment due to its hemodynamic benefits, though mixed study results limit its adoption. This meta-analysis aims to clarify Impella’s efficacy by focusing on high-quality data from RCTs and cohort studies. A comprehensive literature search was conducted for randomized controlled trials and cohort studies comparing Impella with intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO). Assessed metrics included mortality, clinical events, and hematologic markers. Data was analyzed using the Mantel-Haenszel random-effects model. Of 787 articles, 12 studies (4918 patients) met the inclusion criteria. Impella groups showed significant increases in thrombosis risk (RR: 4.94) and had a higher bleeding risk compared to IABP (RR: 1.98) but a lower risk compared to ECMO (RR: 0.66). All other comparisons did not reach statistical significance. Despite updated data and a stringent quality threshold, the hemodynamic benefits of Impella and the device’s risk of thrombosis and bleeding were high. Future trials should emphasize patient selection, timing of placement, and operator proficiency to evaluate Impella’s efficacy and safety better.

PMID:41641616 | DOI:10.1097/HPC.0000000000000409

Crit Pathw Cardiol. 2026 Feb 3. doi: 10.1097/HPC.0000000000000419. Online ahead of print.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, a temporary policy change required Emergency Medical Services (EMS)-identified ST-elevation myocardial infarction (STEMI) patients to undergo COVID testing in the emergency department (ED) prior to percutaneous coronary intervention (PCI), suspending the standard ED bypass to the catheterization lab. We compared system performance metrics during this COVID-era routing to pre- and post-pandemic periods in a large rural health system.

METHODS: This was a retrospective single-center cohort study of consecutive EMS-identified STEMI activations across three periods: pre-COVID (5/27/2018-3/26/2020), COVID-era ED routing (3/27/2020-1/25/2022), and post-COVID with resumed ED bypass (1/26/2022-11/26/2023). Primary outcomes were standard STEMI system performance metrics; the secondary outcome was in-hospital mortality.

RESULTS: A total of 373 patients were included (pre-COVID: 132; COVID: 104; post-COVID: 137). Compared to pre-COVID, the median time from EMS first medical contact to device time increased by 13 minutes (p = 0.017). The median time from symptom onset to device time increased by 30 minutes (p = 0.0013). The median time of first EMS ECG to device placement was increased by 14 minutes (p=0.013). The median door to device time was increased by 6 minutes (p = 0.0007). There was a non-significant trend toward higher in-hospital mortality during the COVID era.

CONCLUSION: In a rural STEMI system, pandemic-era routing of EMS-identified patients through the ED was associated with significant delays in key reperfusion metrics. While in-hospital mortality did not differ significantly, likely due to limited statistical power, these findings underscore the importance of preserving streamlined STEMI pathways. Larger multicenter studies to assess outcomes are warranted.

PMID:41641615 | DOI:10.1097/HPC.0000000000000419

J Pediatr Orthop. 2026 Feb 5. doi: 10.1097/BPO.0000000000003227. Online ahead of print.

ABSTRACT

BACKGROUND: After successful treatment of developmental dysplasia of the hip (DDH) with a Pavlik harness, controversy exists about whether it’s best to continue harness use for an additional “weaning” period or simply terminate treatment. The purpose of this randomized controlled trial (RCT) was to compare radiographic outcomes between patients with stable hip dysplasia who were weaned (W) or not weaned (NW) after Pavlik harness treatment.

METHODS: This was a single-center RCT of infants with stable ultrasonographic dysplasia in whom a Pavlik harness was initiated at <3 months of age. After 23 hours/day of harness treatment and normalization of ultrasound indices, patients were randomized into W or NW groups. W patients continued harness use for an additional 4 to 6 weeks, progressively decreasing daily use. Primary outcome was acetabular index (AI) on AP radiographs of the pelvis at 6 months of age. Secondary outcomes were number of hips with AI ≥ 30 degrees at 6 months (our threshold for prescribing part-time abduction bracing for residual dysplasia) and AI at 1 year of age.

RESULTS: Seventy-two patients (36 W, 36 NW) met inclusion criteria. There were no differences between W and NW cohorts in age at Pavlik initiation or baseline alpha angle or percent femoral head coverage. At time of ultrasonographic normalization, there was no significant difference in mean time spent in the harness between W and NW cohorts (35.0 vs. 34.9 d, P=0.84). At 6 months, mean AI was significantly lower in the W cohort (24.8±3.9 deg.) compared with the NW cohort (26.9±3.4 deg.) (P=0.02). Fewer braces were prescribed for residual dysplasia at 6 months in the W versus NW cohort (17% vs. 22%), but this was not statistically significant (P=0.56). AI at 1 year of age was not significantly different between groups (W 24.6±3.4 deg.; NW 25.3±2.3 deg., P=0.84) but this likely was affected by the use of additional bracing.

CONCLUSIONS: A Pavlik weaning protocol resulted in improved AI at 6 months of age versus immediate termination of treatment. At 1 year, AI was not significantly different between W and NW cohorts, likely due to the use of additional part-time bracing in those who were dysplastic at 6 months.

LEVEL OF EVIDENCE: Level I-randomized controlled trial.

PMID:41641599 | DOI:10.1097/BPO.0000000000003227

Chin Med J (Engl). 2026 Feb 4. doi: 10.1097/CM9.0000000000003993. Online ahead of print.

ABSTRACT

BACKGROUND: Severe white matter lesions (WMLs) have been linked to poorer functional outcomes following endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). However, the absence of a control group in previous studies has limited the ability to determine the benefit of EVT to patients with severe WMLs.

METHODS: This work is a secondary analysis of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core trial, a multicenter, randomized controlled trial conducted at 46 comprehensive stroke centers across China, which enrolled 456 patients with AIS with anterior-circulation LVO and large ischemic cores between October 2020 and May 2022. WML severity was graded using the van Swieten Scale on pretreatment noncontrast computed tomography (CT). For supplementary analyses, WML severity was further assessed using T2 fluid-attenuated inversion recovery (T2-FLAIR) magnetic resonance imaging (MRI) and graded according to the Fazekas scale, with WMLs categorized into periventricular and deep subtypes. Treatment effect on the primary outcome (90-day modified Rankin Scale [mRS] score) was assessed using multivariable ordinal logistic regression, and a treatment-by-WML interaction term was tested to evaluate effect modification.

RESULTS: In patients with absent-to-moderate WMLs, EVT was associated with a favorable shift in the distribution of 90-day mRS scores (adjusted common odds ratio [cOR] 2.15, 95% confidence interval [CI, 1.48-3.13], P <0.001). However, this benefit was less pronounced in those with severe WMLs (adjusted cOR 2.25, 95% CI [0.95-5.30], P = 0.065). No significant interaction between WML severity and treatment effect was detected (Pinteraction = 0.888). Similarly, only among patients with absent-to-moderate WMLs, EVT significantly increased rates of mRS scores of 0-2 (adjusted OR 4.86, 95% CI [2.66-8.86], P <0.001), the rates of mRS scores of 0-3 (adjusted OR 2.23, 95% CI [1.39-3.57], P = 0.001), and the rates of early neurological improvement (adjusted OR 5.22, 95% CI [1.31-20.79], P = 0.019) compared to medical management alone. Supplementary analyses using T2-FLAIR MRI to stratify patients by WML burden yielded results consistent with those of the primary analyses.

CONCLUSIONS: EVT significantly improved functional outcomes in patients with LVO-AIS with absent-to-moderate WMLs, while the benefit in those with severe WMLs appeared less pronounced. However, estimates within subgroups were underpowered. Future pooled analyses of randomized clinical trials with adequate statistical power are needed to clarify the impact of WML severity on EVT outcomes and to refine patient selection criteria.

REGISTRATION: ClinicalTrials.gov, No. NCT04551664.

PMID:41641580 | DOI:10.1097/CM9.0000000000003993