Tag: statistics

Radiol Med. 2026 Jul 21. doi: 10.1007/s11547-026-02261-6. Online ahead of print.

ABSTRACT

PURPOSE: To compare qualitative reader-based image quality and anatomical detail of hepato-bilio-pancreatic structures between photon-counting detector CT (PCCT) and third-generation dual-source energy-integrating detector CT (EID-CT) in the same patient cohort.

MATERIALS AND METHODS: This retrospective, single-center qualitative study included 25 patients who underwent contrast-enhanced abdominal CT with both PCCT (Siemens NAEOTOM Alpha pro) and EID-CT (Siemens SOMATOM Force) within a 3-month interval using comparable acquisition protocols, with the exception of reconstructed section thickness (0.4-0.6 mm for PCCT vs 1.0 mm for EID-CT). Four independent radiologists (two with > 10 years and two with < 5 years of experience) evaluated six parameters using a five-point Likert scale: overall image quality, arterial vascular visualization, venous vascular visualization, pancreatic ductal tree, biliary ductal tree, and peripancreatic lymph nodes. All readers were blinded to scanner type. Paired t-tests and non-parametric Wilcoxon signed-rank tests compared mean scores between PCCT and EID-CT. Inter-reader agreement was assessed using intraclass correlation coefficients. Statistical significance was set at p < 0.05. No quantitative image metrics or diagnostic performance outcomes were assessed; analyses were limited to reader-based Likert scale image quality scores.

RESULTS: PCCT demonstrated statistically significant superiority across all six parameters compared with EID-CT (overall image quality 4.82 vs 3.80, arterial vascular visualization 4.87 vs 3.98, venous vascular visualization 4.84 vs 3.91, pancreatic ductal tree 4.83 vs 3.51, biliary ductal tree 4.87 vs 3.63, peripancreatic lymph nodes 4.86 vs 3.81; all p < 0.0001). Mean score improvements with PCCT ranged from 0.89 to 1.32 points across all parameters. Inter-reader agreement was good to excellent for PCCT (ICC 0.70-0.92) and poor to moderate for EID-CT (ICC 0.43-0.70). Reader experience level did not significantly influence assessments (p = 0.94). These findings derive from a qualitative head-to-head comparison of image quality scores and were consistent across all four readers.

CONCLUSION: In this preliminary intra-patient comparison, photon-counting CT provided significantly superior image quality and anatomical detail in the hepato-bilio-pancreatic region compared to third-generation dual-source EID-CT. Enhanced visualization of ductal structures, distal vessels, and lymph nodes may support improved diagnostic confidence and more precise staging, although diagnostic performance was not assessed in this study. Because reconstructed section thickness differed between systems, these qualitative advantages cannot be attributed to detector technology alone and require confirmation in larger studies with matched protocols and diagnostic-accuracy endpoints.

PMID:42479320 | DOI:10.1007/s11547-026-02261-6

Musculoskelet Surg. 2026 Jul 21. doi: 10.1007/s12306-026-00965-6. Online ahead of print.

ABSTRACT

PURPOSE: Spondylodesis is performed to stabilize and immobilize spinal regions impacted by conditions such as degenerative disorders, deformities, trauma, tumors, or infections. To improve the accuracy of pedicle screw placement, computer-assisted navigation systems were introduced in spine surgery. The objective of this study was to compare the accuracy of pedicle screw placement and the patient outcomes in robotic-guided versus intraoperative 3D navigation techniques for thoraco-lumbar spine surgery.

METHODS: The search was conducted on 30 September 2025 on Scopus, Cochrane Central Library and PubMed. Prospective and retrospective studies that compared pedicle screw placement, clinical outcomes and complications using robotic versus intraoperative 3D navigation technique in the thoracolumbar segment were included. Hospital stay, operative time and blood loss were evaluated as continuous outcomes with mean difference. Screw accuracy, FJV, intraoperative and postoperative screw revisions, complications and complications were evaluated as dichotomous outcomes with odds ratio. Statistical significance was set at p < 0.05.

RESULTS: Among the 14 studies included in the meta-analysis, statistically significant results in favor of robotic group were described for hospital stay (p = 0.003) and pedicle screw accuracy (p < 0.00001). However, no significant differences were observed in terms of intraoperative or postoperative screw revisions, facet joint violations, operative time and blood loss.

CONCLUSION: Robotic-guided pedicle screw fixation represents a safe and highly effective technique, showing statistically significant superiority in screw placement accuracy compared to CT-guided navigation.

PMID:42479318 | DOI:10.1007/s12306-026-00965-6

Adm Policy Ment Health. 2026 Jul 21. doi: 10.1007/s10488-026-01515-9. Online ahead of print.

ABSTRACT

Despite policy efforts to expand integrated behavioral health care in the United States, substantial gaps remain in service delivery for people with co-occurring mental health (MH) and substance use disorders (SUD). Certified Community Behavioral Health Clinics (CCBHCs) are intended to close these gaps through enhanced financing and certification standards that mandate comprehensive, integrated MH-SUD services. Using the 2023 National Survey of Substance Use and Mental Health Services (N-SUMHSS) data for 1,480 facilities (198 CCBHCs, 448 community mental health centers [CMHCs], and 834 other outpatient MH facilities), this study compared service availability across three domains: engagement services, outpatient SUD treatment, and recovery support. Descriptive statistics characterized service provision, and multivariable logistic regressions estimated adjusted odds of service availability by facility type, controlling for ownership, government funding, and being a part of a multisite organization. Relative to other outpatient MH facilities, CCBHCs had significantly higher odds of providing engagement services, including interim services, outreach, and transportation, as well as outpatient SUD services, including outpatient detoxification and medication-assisted treatment. CCBHCs also exhibited greater availability of recovery-oriented support, including employment counseling, assistance obtaining social services, and housing supports. These findings provide some of the first national evidence that the CCBHC model is associated with substantially broader SUD-related service offerings than traditional CMHCs and other outpatient MH settings. By expanding both clinical SUD care and enabling services that reduce access barriers and address social determinants, CCBHCs appear well positioned to improve care continuity and recovery for individuals with co-occurring MH and SUD conditions.

PMID:42479310 | DOI:10.1007/s10488-026-01515-9

Psicol Reflex Crit. 2026 Jul 21. doi: 10.1186/s41155-026-00406-0. Online ahead of print.

ABSTRACT

Work status in later life has been linked to psychological resilience, social engagement, and overall well-being, all of which may shape how individuals experience and manage stress as they ageObjective This study examined the moderating effects of resilience and work status on the relationship between perceived stress and successful aging among older adults.Methods Participants were N = 538 brazilian community-dwelling older adults (≥ 60 years) of both sexes. Measures included a sociodemographic questionnaire, the Brief Resilience Scale, the Perceived Stress Scale (independent variable), and the Successful Aging Scale (dependent variable). Resilience and current work status (employed vs. not employed) were tested as moderators using a cross-sectional, quantitative design. Data were analyzed through descriptive and inferential statistics, followed by a moderated moderation analysis. Results The three-way interaction among perceived stress, resilience, and work status was statistically significant (p < .05). Among non-working older adults, perceived stress was negatively associated with successful aging at all levels of resilience, with this association being attenuated at higher levels of resilience. In contrast, among working older adults, perceived stress was not significantly associated with successful aging at any level of resilience.Conclusion Perceived stress is negatively associated with successful aging, moderated by resilience and work status. Resilience buffered this association among non-working older adults, whereas no significant association was observed among those employed. These findings suggest that employment may alter stress processes and highlight the importance of supporting adaptive transitions into retirement and access to psychosocial resources.

PMID:42479275 | DOI:10.1186/s41155-026-00406-0

Neurol Sci. 2026 Jul 21;47(8):649. doi: 10.1007/s10072-026-09201-2.

ABSTRACT

BACKGROUND: This study validated the Italian version of the In-Person Telephone Interview for Cognitive Status (IP-TICS).

METHODS: 468 healthy Italian individuals (176 males; age: 57.5 ± 15.4, education: 13.2 ± 3.7) completed the TICS, IP-TICS, MMSE and MoCA. Correlational analyses explored the construct validity of the IP-TICS against the TICS, MMSE and MoCA. Hierarchical Confirmatory Factor Analyses tested the configural, metric and scalar invariance between the TICS and IP-TICS. Statistical equivalence was assessed via a two one-sided test (TOST) procedure. Equating norms were derived via log-linear smoothing equipercentile equating (LSEE) analyses, with TOST procedures assessing equivalence between empirical and LSEE-derived scores.

RESULTS: The IP-TICS converged with the TICS, MMSE and MoCA, showing configural and metric invariance and equivalence with the TICS. Empirical and LSEE-derived scores were statistically equivalent.

DISCUSSION: Findings support the convergence, equivalence and invariance between the TICS and the IP-TICS. The IP-TICS converges with established in-person screeners.

PMID:42479254 | DOI:10.1007/s10072-026-09201-2

J Patient Rep Outcomes. 2026 Jul 21. doi: 10.1186/s41687-026-01144-8. Online ahead of print.

ABSTRACT

BACKGROUND: Systematic collection of patient-reported outcomes via electronic health records can improve symptom assessment and supportive care delivery in oncology, yet implementation is often hindered by inadequate attention to end-user needs and organizational context. Guided by an implementation science framework, we conducted a formative evaluation to inform design and implementation planning of an electronic patient-reported outcome supportive care screening system in ambulatory oncology care, using head and neck cancer as a use case.

METHODS: A prospective mixed-methods observational study was conducted using semi-structured interviews as part of a pre-implementation formative evaluation. Eligible participants were target users of the proposed supportive care screening system, including (1) clinical staff and (2) patients with head and neck cancer from a single health care system. Using the Consolidated Framework for Implementation Research as a guiding framework, we elicited user feedback through interview and prototype engagement. Quantitative measures included patient symptom burden and validated pre-implementation measures of acceptability, appropriateness, feasibility, and usability. For data analyses, we used directed content analysis and matrix analysis for qualitative data, and descriptive and comparative statistics for quantitative assessments.

RESULTS: Forty-six target users (20 clinical staff, 26 patients) participated. Both groups expressed strong tension for change, recognizing many inadequacies of the current approach to symptom assessment. Clinical staff described current practices as “haphazard,” while patients recounted missed opportunities for support and preventable harm. Electronic health record integration enhanced perceived compatibility, though time constraints and alert fatigue emerged as potential barriers. Clinical staff emphasized the need for clear symptom thresholds and actionable referral criteria; patients emphasized that their sustained engagement depended on evidence of clinicians using the data in their care. Pre-implementation scores indicated strong readiness across both groups: acceptability (clinical staff 4.47/5, patients 4.21/5), appropriateness (4.46/5, 4.24/5), feasibility (4.41/5, 4.35/5), and usability (82.2/100, 85.6/100). Findings informed key design priorities and implementation strategies.

CONCLUSIONS: Systematic pre-implementation formative evaluation revealed important barriers, facilitators, and contextual insights that shaped both intervention design and implementation approach. High scores on leading indicators suggest strong organizational readiness and perceived value. This user-informed development process provides a replicable model for optimizing electronic patient-reported outcome systems before deployment.

PMID:42479244 | DOI:10.1186/s41687-026-01144-8

Eur J Trauma Emerg Surg. 2026 Jul 21;52(1):224. doi: 10.1007/s00068-026-03265-7.

ABSTRACT

PURPOSE: The aim of this exploratory pilot study was to describe First Person View drone (FPV) related, blast-mechanism thoracic trauma with no rib fractures in Ukrainian military patients sustained during the Russia-Ukraine Conflict, and report the prevalence of persistent neuropathic pain symptoms at three months among patients admitted to a rehabilitation and pain medicine service.

METHODS: A retrospective, single-centre observational, exploratory study design was used. Military patients (≥ 16 years old) with blast-mechanism thoracic injuries with no rib fractures, admitted to a hospital’s rehabilitation and pain medicine service in Ukraine for ≥ 24 h were included. The PainDETECT survey was completed at three months post-injury. Participant characteristics were summarised using descriptive statistics. Exploratory univariate and multivariate analyses were performed to explore possible associations between variables and the development of persistent neuropathic pain symptoms.

RESULTS: 217 patients were included in the final analysis. Median age was 39 years (IQR: 32-47.5). 131 (60.4%) patients were admitted to critical care with 91 (41.9%) patients requiring mechanical ventilation. The median hospital length of stay was 22 days (IQR: 16-25) and critical care length of stay was 4 days (IQR: 2-5). Persistent neuropathic pain symptoms were reported in 173 out of 217 patients (79.7% absolute event rate). Univariate analysis revealed a stark contrast in absolute rates based on the mechanism: 99.4% (172/173) of patients exposed to blasts developed persistent symptoms compared to just 0.6% (1/45) in the low-energy and bullet-like injury group, representing an absolute risk difference of 0.97 (95% CI: 0.93-0.99, p < 0.001).

CONCLUSIONS: The results of this pilot study demonstrate a very high rate of persistent neuropathic pain symptoms at three months in this cohort of military patients admitted to a rehabilitation and pain medicine service, highlighting significant implications for rehabilitation of long-term complications. We highlight that FPV-drone blasts can lead to significant soft tissue injuries to the thorax, in the absence of rib fractures.

PMID:42479227 | DOI:10.1007/s00068-026-03265-7

Eur J Nutr. 2026 Jul 21;65(5):218. doi: 10.1007/s00394-026-04069-6.

ABSTRACT

PURPOSE: To simulate realistic dietary scenarios aligned with the EAT-Lancet reference diet and evaluate their impact on diet-related greenhouse gas emissions (GHGE), land use (LU), and obesity status in paediatric age.

METHODS: Dietary intake of children (3-9 y) and adolescents (10-17 y) from the last National Food, Nutrition, and Physical Activity Survey, Portugal (n = 1153), was assessed using food diaries (children) and 24-h recalls (adolescents) and an automated multiple-pass method with portion size estimations. The World Index for Sustainability and Health (WISH) measured adherence to the EAT-Lancet reference diet, reflecting dietary quality aligned with planetary health principles. Diet-related environmental indicators (greenhouse gas emissions [GHGE] and land use [LU]) were estimated using the SHARP-Indicators database. BMI (measured) z-scores were classified according to WHO criteria. Dietary patterns (DP) were derived using latent class analysis. Simulations aligned current dietary intake with the EAT-Lancet reference diet. The potential to prevent obesity cases was estimated by Potential Impact Fractions (PIF).

RESULTS: Overall, current diets are not aligned with the Planetary Health Diet. Among children, reducing the consumption of eggs, meats, fish, and soft drinks improved WISH scores and decreased environmental indicators. For adolescents, the greatest reductions of these indicators were achieved by reducing dairy and red meat. The scenario that led to the largest significant reduction in obesity cases involved a shift towards a plant-based dietary pattern (PIF = 0.7% children, 0.2% adolescents), which also increased environmental impact (with mean GHGE increasing from 3.9 to 4.1 kg CO₂-eq), as it replaced diets already low in animal products with a plant-based pattern of greater overall food intake.

CONCLUSIONS: To effectively enhance adherence to the EAT-Lancet diet, promoting plant-based foods should be coupled with reductions in dairy, meat, soft drinks, and total dietary quantity.

PMID:42479223 | DOI:10.1007/s00394-026-04069-6

Eur J Pediatr. 2026 Jul 21;185(8):595. doi: 10.1007/s00431-026-07257-y.

ABSTRACT

The purpose of the study is to compare the efficacy and safety of available interventions for infantile hemangioma against oral propranolol and to evaluate the certainty of the comparative evidence. We conducted a Bayesian network meta-analysis in accordance with PRISMA-NMA guidelines and systematically searched PubMed, Embase, the Cochrane Library, and CNKI from January 2008 to June 2026. A random-effects consistency model was fitted using the BUGSnet package. Evidence certainty was assessed using the CINeMA framework, and risk of bias was evaluated using the revised Cochrane RoB 2 tool. Thirty randomized controlled trials (RCTs) including 2,639 patients across nine treatment nodes were included in the efficacy analysis, and 12 RCTs involving 1,143 patients across eight nodes were included in the safety analysis. Using oral propranolol as the reference treatment, no active intervention demonstrated statistically significant superiority in efficacy, whereas placebo was significantly inferior. Corticosteroids were the only intervention associated with substantially higher adverse event rates, whereas atenolol showed a trend toward fewer adverse events. By anchoring all comparisons to oral propranolol and integrating CINeMA certainty assessments with inconsistency testing, these findings are consistent with the continued role of oral propranolol as the reference systemic treatment for infantile hemangioma. For patients intolerant to propranolol, atenolol may represent a reasonable alternative.

CONCLUSIONS: By anchoring all comparisons to oral propranolol and integrating CINeMA certainty assessments with inconsistency testing, these findings are consistent with the continued role of oral propranolol as the reference systemic treatment for infantile hemangioma. For patients intolerant to propranolol, atenolol may represent a reasonable alternative.

WHAT IS KNOWN: • Oral propranolol is the established first-line systemic therapy for infantile hemangioma. • Previous network meta-analyses have reported treatment rankings, but the clinical meaning of these rankings relative to oral propranolol remains uncertain.

WHAT IS NEW: • Despite favorable point estimates for combination therapy and nadolol, this benchmark-anchored analysis found no included active intervention statistically superior to oral propranolol. • Certainty assessment showed that treatment rankings were limited by heterogeneity, inconsistency, risk of bias, and imprecision; atenolol had the largest body of direct comparative evidence among the alternatives.

PMID:42479211 | DOI:10.1007/s00431-026-07257-y

Eur J Clin Pharmacol. 2026 Jul 21;82(8):213. doi: 10.1007/s00228-026-04140-5.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) may be a significant complication in medical patients, and infectious disease has been highlighted as an additional risk factor. Pharmacological thromboprophylaxis can prevent VTE and is recommended in at-risk populations, but not routinely in patients with infectious diseases.

METHODS: We conducted a systematic review and meta-analysis of studies on the effectiveness of pharmacological thromboprophylaxis in patients with acute infections, excluding those involving COVID-19. The primary outcome was VTE events. Secondary outcomes were mortality and adverse events related to anticoagulant therapy.

RESULTS: Data from seven studies (four randomized controlled trials and three observational studies) involving 16,994 patients with infectious diseases were analyzed. Pharmacological thromboprophylaxis regimens consisted of unfractionated heparin, low-molecular-weight heparin (enoxaparin or dalteparin), and fondaparinux. The severity of the disease varied from acute infections to sepsis. Six studies reported fewer VTE events with thromboprophylaxis. The meta-analysis yielded a pooled odds ratio of 0.50 [95% CI: 0.37-0.69, I² = 47%]. Three studies reported bleeding or bruising outcomes: one observational study reported significantly more bleeding with thromboprophylaxis, while two randomized trials reported either no significant difference in severe bleeding or in mild bleeding-related adverse events. Two studies assessed mortality, but neither found a statistically significant difference with or without thromboprophylaxis. One study was at high risk of bias, and another was at critical risk of bias.

CONCLUSION: This analysis quantifies the effect of thromboprophylaxis in patients with acute infectious diseases. Although available results show that thromboprophylaxis is associated with fewer VTE events, limited data, sparse safety and mortality reporting, and heterogeneity among studies preclude reliable risk-benefit evaluation. Further prospective research is warranted.

PMID:42479201 | DOI:10.1007/s00228-026-04140-5