Tag: statistics

Am J Surg. 2026 Feb 17;255:116873. doi: 10.1016/j.amjsurg.2026.116873. Online ahead of print.

ABSTRACT

BACKGROUND: The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with supplementary metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, during the early years of the MIPS program (2017 to 2020), physicians in non-primary care specialties have had few quality measures to choose from. This has resulted in a disadvantage for physicians of non-primary care specialties to receive a positive Medicare part B adjustment. The aim of this study is to determine if significant variation still exists in the number and characteristics of quality measures in the MIPS program across specialties from 2021 to 2024.

METHODS: This longitudinal quality improvement study uses Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) public use file data from 2021 to 2024 to collect descriptive statistics about the number and characteristics of MIPS measures and Qualified Clinical Data Registry (QCDR) measures available for reporting within the Traditional MIPS reporting pathway. Primary outcomes included the number of measure-and-collection-type combinations, number of unique MIPS measures, number of QCDRs, and number of QCDR measures available for reporting within each medical specialty. Secondary outcomes included quality measure characteristics such as each measure’s Donabedian class, topped out status, and capped status. All outcomes were established prior to data collection.

RESULTS: The average number of unique quality measures and measure-and-collection-type combinations available for reporting by non-primary care specialties is significantly lower than that for primary care specialties (p < 0.001, p < 0.001, respectively). Process measures outnumber outcome and structure measures within all specialties except neurosurgery, orthopedic surgery, and vascular surgery. A large percentage (40.9%) of all measure-and-collection-type combinations in 2024 are topped out and therefore fail to stratify physician performance effectively.

CONCLUSION: In this longitudinal study of MIPS and QCDR quality measures, results show that significant variability still exists in the number of quality measures available for reporting in 2024, with non-primary care specialties having the lowest number of reportable measures. Policymakers should ensure that future modifications to the MIPS program provide equal opportunity for physicians to achieve a positive Medicare Part B payment adjustment.

PMID:41723892 | DOI:10.1016/j.amjsurg.2026.116873

Contact Dermatitis. 2026 Feb 22. doi: 10.1111/cod.70116. Online ahead of print.

ABSTRACT

BACKGROUND: Allergic contact dermatitis (ACD) is a chronic inflammatory skin disorder associated with substantial impairment in quality of life (QoL). Few studies have comprehensively assessed the multidimensional impact of ACD using validated QoL instruments and healthy controls.

OBJECTIVES: To evaluate the impact of ACD on QoL compared to a control group and to explore the association between clinical variables and patient-reported outcomes.

METHODS: This cross-sectional study included 225 patients with confirmed ACD (positive and clinically relevant patch tests) and 225 healthy controls. All participants completed the Dermatology Life Quality Index (DLQI), the EuroQoL-5D (EQ-5D-5L) and the Skindex-29. Disease severity was assessed using the modified Investigator’s Global Assessment (mIGA). Statistical analyses included nonparametric Mann-Whitney U tests for between-group comparisons, correlation analyses, and multivariate linear and ordinal regression models to identify predictors of quality-of-life impairment.

RESULTS: Patients with ACD showed significantly greater impairment across all QoL measures compared to controls (p < 0.001). Pruritus was the most frequently reported symptom (45.0%), and emotional distress and functional limitations were prominent. Higher mIGA scores were significantly associated with poorer QoL across all instruments.

CONCLUSIONS: ACD has a marked negative impact on multiple dimensions of QoL, comparable to that observed in other chronic dermatoses. These findings underscore the importance of integrating standardised QoL assessments into the routine management of ACD and support the adoption of multidimensional approaches in both clinical evaluation and therapeutic decision-making, while also highlighting the relevance of psychosocial screening as an essential component of comprehensive patient care.

PMID:41723879 | DOI:10.1111/cod.70116

Disabil Rehabil Assist Technol. 2026 Feb 22:1-11. doi: 10.1080/17483107.2026.2632735. Online ahead of print.

ABSTRACT

Acquired brain injury (ABI) is a major cause of long-term cognitive and communication impairments and is frequently associated with complex communication needs. Augmentative and alternative communication (AAC) interventions are commonly used to support communication in individuals with severe acquired brain injury (SABI), yet evidence regarding their cognitive and neurophysiological effects remains limited. This pilot feasibility and exploratory study examined preliminary effects of low- and high-tech AAC interventions on cognitive, communicative, functional, and neurophysiological outcomes in individuals with SABI. Twenty participants were quasi-randomly assigned to an experimental group (EG) receiving high-tech AAC (Grid 3) or a control group (CG) receiving low-tech AAC. Cognitive functioning, functional independence, communication abilities, and P300 event-related potential latency were assessed at baseline and post-intervention. Non-parametric statistics were applied due to the small sample size. Within-group changes were examined using Wilcoxon signed-rank tests, and exploratory between-group comparisons were conducted using Mann-Whitney U tests. Effect sizes with 95% confidence intervals were calculated, and Bonferroni correction was applied. Both groups showed significant within-group improvements in functional communication (EG p = 0.007, CG p = 0.014). The EG demonstrated significant gains in cognitive functioning (p = 0.005) and reduced P300 latency (p = 0.003), whereas no significant changes were observed in the control group. Changes in functional independence were modest and not statistically significant in either group. These findings support the feasibility of AAC interventions in SABI and suggest potential benefits for communication and selected cognitive processes. Larger randomised studies are needed to clarify comparative effects and mechanisms.

PMID:41723848 | DOI:10.1080/17483107.2026.2632735

Oncologist. 2026 Feb 22:oyag054. doi: 10.1093/oncolo/oyag054. Online ahead of print.

ABSTRACT

BACKGROUND: The management of initially unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) has been revolutionized by conversion therapy combining locoregional and systemic modalities. While successful downstaging followed by salvage surgery offers potential for cure, the optimal duration of postoperative adjuvant targeted-immunotherapy remains poorly defined. This multicenter study aimed to determine the relationship between adjuvant therapy duration and survival outcomes in this specific patient population.

METHODS: We conducted a retrospective cohort analysis of 124 patients with initially unresectable HCC and PVTT who achieved successful conversion using combined local-systemic therapy and subsequently underwent R0 resection at four tertiary medical centers between September 2019 and December 2022. Patients were stratified into four groups according to adjuvant targeted-immunotherapy duration: no adjuvant therapy (0 month, n = 26), short-term therapy (1-3 months, n = 28), medium-term therapy (4-6 months, n = 25), and extended therapy (≥7 months, n = 45). Primary endpoints were overall survival (OS) and progression-free survival (PFS), analyzed using Kaplan-Meier methods and Cox proportional hazards models.

RESULTS: With a median follow-up of 28.3 months, significant differences in both OS and PFS were observed among the four groups (both P < 0.0001). Compared to the no-adjuvant group, all treatment durations showed significant survival benefits, with hazard ratios of 0.49 (P = 0.004) for OS and 0.44 (P = 0.010) for PFS in the 1-3 month group, improving to 0.22 (P < 0.001) for OS and 0.15 (P < 0.001) for PFS in the 4-6 month group. Critically, the medium-term therapy (4-6 months) demonstrated statistical non-inferiority compared to extended therapy (≥7 months) for both OS (P = 0.85) and PFS (P = 0.30), establishing a clear efficacy plateau. Treatment-related adverse events were manageable and comparable across all duration groups.

CONCLUSIONS: This study provides compelling evidence that adjuvant targeted-immunotherapy duration significantly impacts survival outcomes in converted unresectable HCC patients with PVTT. The 4-6 month adjuvant regimen represents the optimal therapeutic window, maximizing survival benefits while avoiding unnecessary extended treatment. These findings should inform clinical practice and guide the design of future prospective trials.

PMID:41723827 | DOI:10.1093/oncolo/oyag054

Acad Med. 2026 Feb 22:wvag047. doi: 10.1093/acamed/wvag047. Online ahead of print.

ABSTRACT

PROBLEM: To advance health equity, residents need preparation to address structural contributors to disparities and mitigate bias in clinical decision-making. Experiential learning around health equity, however, is lacking, and specialty-specific interventions often fail to reflect the interdisciplinary nature of clinical practice. This report describes an institution-wide longitudinal simulation-based health equity educational intervention for first-year residents, comprising experiential education on structural determinants of health (SDOH) and spaced reflection opportunities.

APPROACH: In 2024, first-year residents from all specialties at one academic medical center participated in two simulated encounters with standardized patients (SPs), followed by SP feedback, individual narrative reflection, and group debriefing, which leveraged visual arts-based exercises to generate dialogue. Three to six months later, residents reviewed recordings of their encounters and completed a semi-structured metacognitive activity. Surveys conducted before, immediately after, and 3-6 months after the simulations captured self-reported impacts on decision-making and communication in clinical encounters, understanding SDOH, and performance on the Multidimensional Cultural Humility Scale, which measures dimensions of intercultural interactions (e.g. openness, self-awareness).

OUTCOMES: Of 235 eligible residents, 216 participated. One hundred sixty-four, 116, and 130 consented to have their pre-, immediate post-, and interval- (3-6 months post) responses included for analysis. 99.1% (115) found programming quality to be high. Immediately after simulation experiences, there was a statistically significant improvement in participants’ cultural humility and confidence in addressing stigmatizing language, bias, and SDOH during patient encounters; communicating with diverse patients; and advocating for patients. At interval follow-up, most improvements were sustained; nearly 70% (89) found the experience had impacted their patient interactions.

NEXT STEPS: Next steps include offering advanced iterations of this experience to senior residents. Other institutions may replicate this activity with cases tailored to site-specific patient populations to give learners opportunities to practice equity-focused skills and signal organizational commitment to meeting their patient populations’ needs.

PMID:41723820 | DOI:10.1093/acamed/wvag047

J Anim Sci. 2026 Feb 22:skag054. doi: 10.1093/jas/skag054. Online ahead of print.

ABSTRACT

Water intake (WI) in beef cattle is influenced by animal class, breed, production system, and environmental conditions, yet current models rely on limited, outdated data. We analyzed 130,000+ daily records of individual WI, dry matter intake (DMI), and body weight (BW) across 10 breeds from grazing and drylot systems over five years. WI varied significantly by class (P < 0.001), with bulls consuming the most water (25.62 ± 0.03 L/day), followed by heifers (23.21 ± 0.07 L/day) and steers (21.83 ± 0.06 L/day), but heifers and steers had higher WI per 100 kg BW (P < 0.001). Breed effects were also significant (P < 0.001), with Red Angus and Limousin exhibiting the highest weight-adjusted WI. Drylot cattle drank more than grazing cattle (24.66 vs. 21.60 L/day; P < 0.001). WI increased with heat load; animals in THI ≥ 90 consumed 8.47 ± 0.03 L/100 kg BW compared to 5.53 ± 0.01 in THI < 72. However, relationships between WI and BW or DMI were weak (R2 = 0.06). These results challenge assumptions embedded in current recommendations (e.g., NASEM 2016) and highlight the need for individualized, context-sensitive models. Our findings support future efforts in water-efficient selection, climate resilience, and sustainable beef production.

PMID:41723815 | DOI:10.1093/jas/skag054

Eur Arch Paediatr Dent. 2026 Feb 22. doi: 10.1007/s40368-026-01189-9. Online ahead of print.

NO ABSTRACT

PMID:41723796 | DOI:10.1007/s40368-026-01189-9

J Med Econ. 2026 Dec;29(1):433-454. doi: 10.1080/13696998.2026.2623789. Epub 2026 Feb 22.

ABSTRACT

AIMS: A systematic review of the economic burden of advanced non-small-cell lung cancer (NSCLC).

METHODS: Articles from 2011 onwards reporting the economic burden of locally advanced (stage IIIB/C)/metastatic (stage IV) NSCLC were identified through systematic and supplementary searches. Outcomes included hospitalizations, emergency department (ED) and outpatient visits, and direct and indirect costs, amongst others.

RESULTS: Across 50 publications (43 studies), patients with advanced NSCLC had high rates of healthcare resource utilization (HCRU), with most reporting hospitalization (ranging from 13.0% to 98.2% of patients), ED visits (2.5% to 83.1%), outpatient visits (74.6% to 100.0%), and diagnostic or monitoring tests (45.9% to 92.0%). HCRU (hospitalizations, ED visits and pharmacy visits) appeared to be lower with immunotherapy as compared to chemotherapy. Brain/central nervous system (CNS) metastases were the major clinical factor influencing HCRU. Mean direct costs ranged from US$5,647 (Brazil) to US$158,908 (US) over 12-24 months, and were generally higher in the US, Korea, Germany, and the UK (vs. Brazil, France, and Italy). The main direct cost drivers were drug-related costs (9.5-76.0% of total), overall outpatient costs (39-70.6%), and inpatient costs (5.0-58.1%). Costs were higher for chemotherapy than for immunotherapy. In China, indirect medical costs were US$1,413 per case. In general, mean total healthcare costs were higher for metastatic disease. Disease severity/diagnosis, presence of brain/CNS metastases, targeted therapy and chemotherapy (vs. immunotherapy) and the presence of comorbidities were the main factors influencing higher costs.

LIMITATIONS AND CONCLUSIONS: Patients with advanced NSCLC had high rates of HCRU, and costs were substantial, though varying greatly across countries. HCRU and costs were higher in patients with brain/CNS metastases. Since this was a qualitative review, no formal quantitative synthesis was attempted. Costs reported in different currencies and heterogeneity across studies limited comparability. Finally, a single reviewer extracted data.

PMID:41723781 | DOI:10.1080/13696998.2026.2623789

Dermatol Ther (Heidelb). 2026 Feb 22. doi: 10.1007/s13555-026-01672-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Although recognition of prurigo nodularis (PN) and lichen simplex chronicus (LSC) of the scalp is usually straightforward, they may sometimes pose difficulties in terms of differential diagnosis with other similar dermatoses. The aim of this observational retrospective study was to assess dermoscopic features of PN and LSC of the scalp across fair- and dark-skinned individuals and compare them with those of clinical mimickers.

METHODS: Fair-skinned (Fitzpatrick phototypes I-III) and dark-skinned (Fitzpatrick phototypes IV-VI) patients with a histological diagnosis of PN/LSC of the scalp, along with controls, were considered. All the images were randomly evaluated by two independent investigators to identify findings according to standardized criteria. Interobserver agreement was evaluated through Cohen’s kappa coefficient, while Fisher’s exact test with p value set at 0.01 was used for comparative analyses between cases and controls.

RESULTS: The study included 79 cases, including 40 instances of PN/LSC of the scalp (27 with fair skin and 13 with dark skin) and 39 controls. The most common dermoscopic findings (> 1/3 of cases) of PN/LSC in both light and dark phototypes included sparse follicular plugs, broken hairs, purple structureless areas, broom-like hairs, and erosions. Additionally, purple dots, perivascular white halo and dotted vessels with unspecific distribution were also common in fair skin, while white lines (peripheral-radial) and structureless areas turned out to be as frequent in dark skin. Comparative analysis showed that dotted vessels, follicular plugs, broken hairs, broom-like hairs, purple structureless areas, and perivascular white halo were more common compared to control in light phototypes, whereas only erosions, peripheral white lines, and purple structureless areas reached statistical significance in dark-skinned patients (p < 0.01). Kappa values were 0.88 and 0.81 for fair and dark skin, respectively.

CONCLUSION: Dermoscopy is a valuable adjunct in the non-invasive diagnosis of PN and LSC of the scalp, with good reproducibility across skin phototypes.

PMID:41723776 | DOI:10.1007/s13555-026-01672-7

Dermatol Ther (Heidelb). 2026 Feb 22. doi: 10.1007/s13555-026-01690-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Atopic dermatitis (AD) involving special areas such as the hands, head and neck, and genital region poses important therapeutic challenges owing to distinct barrier fragility, environmental exposure, and mixed Th1/Th2/Th17 activation. These sites often drive treatment escalation despite limited overall body surface involvement. Evidence on the real-world effectiveness of upadacitinib in these anatomical locations remains limited.

METHODS: A retrospective, observational multicenter study was conducted across five Spanish dermatology departments (November 2024 to November 2025). Adults and adolescents with moderate-to-severe AD and involvement of at least one special area treated with upadacitinib (15 or 30 mg) for ≥ 16 weeks were included. Disease severity was assessed using the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus numeric rating scale (NRS), Dermatology Life Quality Index (DLQI), Investigator’s Global Assessment (IGA), and local 0-4 Physician Global Assessment (PGA). Minimal disease activity (MDA) was defined as EASI ≤ 3 plus pruritus-NRS 0-1. Descriptive statistics were applied. Distribution-shift plots were used to analyze categorical changes in special areas.

RESULTS: Overall, 57 patients were included (mean age 47.9 ± 17.6 years, 59.6% women). Facial/neck, hand, and genital involvement were present in 73.7%, 61.4%, and 21.1% of patients, respectively; 31.9% had ≥ 2 special areas affected. Upadacitinib induced rapid improvement, with EASI decreasing from 18.9 to 2.7 at week 16 and 2.4 at week 52. MDA was reached by 61% at week 16 and 69% at week 52. Special-area PGA improved markedly across all sites.

CONCLUSIONS: Upadacitinib provided rapid, sustained, and clinically meaningful improvement in AD involving special areas, supporting its use in anatomically sensitive areas.

PMID:41723774 | DOI:10.1007/s13555-026-01690-5