Tag: statistics

Rural Remote Health. 2026 Mar;26(1):10621. doi: 10.22605/RRH10621. Epub 2026 Mar 24.

ABSTRACT

INTRODUCTION: Rural health systems depend on family and other unpaid care partners to bridge gaps created by distance, workforce shortages, and limited infrastructure, yet evidence about their delivery-facing roles is dispersed. Therefore, the objective of this study was to map how unpaid caregivers contribute to rural health delivery, identify common enablers and barriers, and summarize reported outcomes for patients, caregivers, and health systems.

METHODS: We conducted a scoping review in accordance with PRISMA-ScR guidelines. We searched MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, and ProQuest from January 2000 to September 2025. Eligible English-language studies examined unpaid caregivers supporting individuals of any age in rural/remote/frontier settings where caregiver activities intersected with health service delivery.

RESULTS: Forty-five studies were included. Eight recurring domains described caregiver work: coordination and navigation; medication and treatment management; telehealth mediation; monitoring and early triage; transport and home or environmental adaptation; cultural and linguistic brokerage and trust-building; palliative, disability, and long-term support; and caregiver competence and burden. Barriers included device gaps, fragmented hand-offs, limited respite, and travel costs. Programs integrating caregivers reported improved adherence, continuity, and earlier escalation.

CONCLUSION: Unpaid caregivers are important members of rural care teams. Formal recognition, resourcing, and measurement, alongside investments in coordination infrastructure, broadband, respite, and financial supports, are essential for sustainable and equitable rural care.

PMID:41881822 | DOI:10.22605/RRH10621

Ann Otol Rhinol Laryngol. 2026 Mar 25:34894261428393. doi: 10.1177/00034894261428393. Online ahead of print.

ABSTRACT

BACKGROUND: Sinonasal malignancies (SNM) are rare cancers associated with poor prognosis and impaired quality of life (QOL). The 22-question Sino-Nasal Outcome Test (SNOT-22) has been used to assess QOL in patients with SNM.

OBJECTIVE: To determine the minimal clinically important difference (MCID) for the SNOT-22 in patients with SNM.

METHODS: About 264 patients with SNM were drawn from a prospective, longitudinal, multi-institutional study. SNOT-22 scores were collected at pre-treatment baseline and follow-up through 5 years post-treatment. Cronbach’s alpha was used to assess the internal consistency of the SNOT-22. Distribution-based approaches were used to estimate the MCID. Multivariable regression identified factors associated with SNOT-22 improvement exceeding the determined MCID.

RESULTS: Cronbach’s alpha was >.85. The estimated MCIDs were: 1.44 (Cohen’s effect size), 1.32 (standard error of the mean), 10.45 (1/2 of baseline standard deviation), and 3.67 (minimum detectable change). The mean MCID across methods was 4.22. Multivariable regression demonstrated higher odds of clinically meaningful improvement from baseline in patients with early-stage disease (odds ratio (OR) 3.510, P = .035), no neck irradiation (OR 11.050, P = .014), and neoadjuvant therapy (OR 16.667, P = .047).

CONCLUSIONS: The SNOT-22 MCID was estimated as 4.22 in a large multi-center cohort of patients with SNM, suggesting that relatively small QOL changes are clinically relevant. When applying the MCID to the current cohort, advanced stage, treatment of neck disease, and not requiring neoadjuvant therapy were predictive of worse QOL.

PMID:41881811 | DOI:10.1177/00034894261428393

Water Environ Res. 2026 Apr;98(4):e70355. doi: 10.1002/wer.70355.

ABSTRACT

Accurate identification of nitrate sources in aquatic environments is vital for implementing effective measures to prevent and control nitrate pollution. The combination of isotopes of nitrate with Bayesian models has proven effective in tracing nitrate pollution sources in aquatic environments. Nevertheless, broad systematic errors in both qualitative and quantitative assessments lead to significant uncertainties in quantifying the contributions of nitrate sources. This review initiates by outlining the fundamental principles and procedures of employing nitrate isotopes in conjunction with Bayesian models. It further consolidates the empirically determined values for two pivotal parameters, isotope abundances and effects, within these models and provides a detailed analysis of their spatial and temporal variability sources. Then it meticulously dissects the origins of systematic errors encountered in applying this technique, including overlooking isotope effects, disregarding the spatiotemporal variability of isotopes, and failing to validate whether data conform to the normal distribution assumption inherent in Bayesian models. Subsequently, the review compiles and discusses emerging strategies from both qualitative, including emerging isotopes that increase the precision of source identification, fecal-specific indicators, statistical tools, and fluorescence spectrum methods, and quantitative, including mathematical methods and/or their combination with mass balance models perspectives to mitigate these systematic errors. It also forecasts the trajectory of development within this technical domain. By examining the application of isotope technology for nitrate source identification from multiple angles, this review offers theoretical references for the prevention, control, and mitigation of nitrate in water, as well as for the formulation and implementation of pertinent policies by regulatory authorities.

PMID:41881806 | DOI:10.1002/wer.70355

Zhonghua Wai Ke Za Zhi. 2026 Mar 25;64:538-544. doi: 10.3760/cma.j.cn112139-20250820-00409. Online ahead of print.

ABSTRACT

Objective: To evaluate the efficacy and safety of rapamycin-eluting stents in treating stenosis of the vertebral artery V1 segment. Methods: This retrospective cohort study analyzed 191 patients with vertebral artery V1 segment stenosis who underwent stent implantation at our institution between January 2023 and August 2024. There were 161 male cases and 30 female cases. The age of the cohort was (68±8) years (range: 47 to 86 years). Patients were divided into two groups based on the stent type: the rapamycin-eluting stent (DES) group (n=93) and the bare-metal stent (BMS) group (n=98). Baseline characteristics showed no significant differences between the groups. Outcome measures included technical success rate, periprocedural (30-day) complications (stroke, mortality), and follow-up outcomes at 12 months (stent patency, stroke recurrence). Statistical analyses were performed using the independent sample t test, χ² test, or Fisher’s exact test, as appropriate. Survival analysis was conducted using the Kaplan-Meier method. Results: The operation time of patients in the DES group was (63±31) min (range: 24 to 120 min), with a technical success rate of 98.9% (92/93), and the periprocedural stroke rate within 30 d was 1.1% (1/93). The operation time of the BMS group was (58±24) min (range: 26 to 110 min), with a technical success rate of 100%, and the incidence of stroke within 30 d of the operation was 2.0% (2/98). There were no statistically significant differences in operation time, technical success rate, and the periprocedural stroke rates between the two groups (all P>0.05), and no deaths occurred in either group. A total of 91 cases in DEs group and 95 cases in BMS group were followed up for more than 12 months. The Kaplan-Meier survival analysis results showed that the patency rate at 12 months after operation, the DES group demonstrated significantly higher stent patency rates (94.5%(86/91) vs. 83.2%(79/95), χ²=5.838,P=0.016) and a higher stroke-free survival rate (97.8%(89/91) vs. 89.5%(85/95), χ²=5.410,P=0.020) compared to the BMS group. Conclusions: In the treatment of V1 segment vertebral artery stenosis, DES demonstrates a favorable perioperative safety profile, significantly higher stent patency and a lower stroke recurrence rate compared to BMS at 12 months follow-up. Further extended follow-up is required to evaluate their long-term efficacy.

PMID:41881799 | DOI:10.3760/cma.j.cn112139-20250820-00409

Zhonghua Wai Ke Za Zhi. 2026 Mar 25;64:531-537. doi: 10.3760/cma.j.cn112139-20250801-00386. Online ahead of print.

ABSTRACT

Objective: To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) performed with a China-made robotic surgical system versus the Da Vinci Xi system, and to evaluate the learning curve of the domestic system. Methods: This single-center, prospective, randomized controlled study enrolled patients scheduled for RAPN at Harbin Medical University Cancer Hospital from August 2024 to May 2025 who met predefined inclusion and exclusion criteria. Using simple randomization, patients were assigned to the domestic robotic system group (domestic group) or the Da Vinci Xi group. Perioperative variables were analyzed and compared between groups using the independent-samples t test, Mann-Whitney U test, or Fisher’s exact test, as appropriate. A cumulative sum (CUSUM) analysis of operative time in the domestic group was performed to determine the number of cases required for a surgeon to achieve proficiency when transitioning from the Da Vinci Xi to the SR2000 system. Results: Ninety patients undergoing robot-assisted laparoscopic RAPN were included and randomized (domestic group, n=45; Da Vinci Xi group, n=45). There were 56 males and 34 females,aged (M(IQR)) 57(48)years (range:31 to 79 years). TNM stages were T1N0M0 in 80 cases and T2N0M0 in 10 cases. All 90 procedures were successfully completed with robotic assistance, and no positive surgical margins occurred. Between-group differences in operative time, docking time, length of hospital stay, and intraoperative blood loss were not statistically significant (all P>0.05). The warm ischemia time of the domestic group was shorter than that of the Da Vinci Xi group(23 (10) min vs. 24 (8) min, Z=0.167, P<0.05). The CUSUM learning-curve fit for operative time in the domestic group showed an inflection at the 18th case, indicating that approximately 18 cases were required to complete the learning curve. When the domestic group was divided into a learning phase (cases 1 to 18) and a proficiency phase (cases 19 to 45), perioperative outcomes did not differ significantly between phases (all P>0.05). Conclusions: The domestic robotic surgical system can be used safely and effectively for partial nephrectomy. For surgeons already experienced with the Da Vinci Xi system, approximately 18 cases are required to attain proficiency with the SR2000 system.

PMID:41881798 | DOI:10.3760/cma.j.cn112139-20250801-00386

Zhonghua Wai Ke Za Zhi. 2026 Mar 25;64:494-501. doi: 10.3760/cma.j.cn112139-20251202-00557. Online ahead of print.

ABSTRACT

Objective: To evaluate the mid-term outcomes of transcatheter”valve-in-valve”replacement techniques for biological valve failure using different access approaches. Methods: This study is a retrospective cohort analysis. Clinical data were retrospectively analyzed for 101 patients with biological mitral valve failure who underwent transcatheter balloon-expandable “valve-in-valve” replacement at the Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University between May 2021 and July 2025. There were 35 males and 66 females, with an age of (74.5±6.3) years (range: 55 to 86 years). The transapical group comprised 33 patients (32.7%), while the transvenous group included 68 patients (67.3%). Postoperative outcomes were assessed using catheterization, transesophageal echocardiography, and CT scans, with surgical complications and adverse events recorded. Data comparisons were conducted using independent sample t-tests, χ² tests or Fisher’s exact probability method. Results: Among the 101 patients, 22 underwent post-implantation annuloplasty. Annuloplasty was performed on 19 (27.9%) patients in the transvenous group versus 3 (9.1%) in the transapical group, showing a statistically significant difference (χ²=8.471, P=0.031). No statistically significant differences were observed between groups in the incidence of wound infection, stroke, or third-degree atrioventricular block (all P>0.031). However, the acrosternal approach group showed significantly higher rates of postoperative pleural effusion (6.1%(2/33) vs. 0, P=0.040) and postoperative bleeding complications (9.1%(3/33) vs. 0, P=0.012) compared to the transvenous approach group. The peak and mean left atrial pressures in the transvenous femoral group after surgery were (23.9±4.8) mmHg (1 mmHg=0.133 kPa) and (15.8±3.2) mmHg, respectively, which were lower than those in the acrosternal approach group (29.2±6.5) mmHg and (20.4±5.6) mmHg,the differences were statistically significant (t=1.624, P=0.008; t=1.598, P=0.007). The postoperative follow-up period was (18±10) months (range: 1 to 36 months). During follow-up, 15 patients (14.9%) died. Five deaths (15.1%) occurred in the transapical group, including 3 due to heart failure and 2 due to pulmonary infection. Ten patients (14.7%) died in the transapical group, including 5 due to heart failure, 3 due to pulmonary infection, and 2 due to cerebrovascular accidents. There were no statistically significant differences in all-cause mortality or major adverse cardiovascular events between the two groups (all P>0.05). Conclusions: Transcatheter “valve-in-valve” mitral valve replacement is a viable clinical option for treating biological mitral valve failure, significantly improving hemodynamic status. Compared to the transapical approach, the transvenous approach resulted in fewer postoperative complications such as pleural effusion and bleeding, as well as shorter hospital stays. The impact of the access route on patients’ mid-to long-term outcomes requires further validation.

PMID:41881793 | DOI:10.3760/cma.j.cn112139-20251202-00557

Zhonghua Wai Ke Za Zhi. 2026 Mar 25;64:486-493. doi: 10.3760/cma.j.cn112139-20251208-00579. Online ahead of print.

ABSTRACT

Objectives: To investigate the outcomes of thoracoabdominal aortic aneurysm repair (TAAAR) following total arch replacement combined stented elephant trunk implantation (Sun’s procedure),and to compare the differences in surgical conditions and surgical outcomes between patients with hereditary aortic disease (HAD) and those without HAD. Methods: This is a retrospective cohort study. A retrospective analysis was conducted on the data of 199 patients who underwent TAAAR following a Sun’s procedure at the Department of Cardiovascular Surgery of Beijing Anzhen Hospital Affiliated Capital Medical University between July 2009 and January 2024. Among them, 150 were male (75.4%), and 49 were female(24.6%), with an age of (39.3±10.9) years (range: 16 to 66 years). The patients were stratified into the HAD group (n=97) and non-HAD group (n=102). The baseline characteristics, short-term and long-term outcomes were compared between groups using Mann-Whitney U test, independent-samples t-test, χ² test, or Fisher’s exact test, as appropriate. Survival analysis was conducted using the Kaplan-Meier method, and the Log-rank test was performed to compare the differences between groups. Results: The operative mortality was 6.5% (13/199) in the entire cohort. The patients in the HAD group had a higher incidence of prior cardiovascular intervention (38.1%(37/97) vs. 21.6%(22/102), χ²=5.84, P=0.016). The interval between Sun’s procedure and TAAAR was shorter in the HAD group (M(IQR), 2.2(4.0) years vs. 3.1(6.9) years,Z=-1.98,P=0.048). The non-HAD group had a significantly higher age than the HAD group ((34.7±9.2) years vs. (43.7±10.6) years, t=-6.41, P<0.01). No significant differences were observed between the two groups in operative morality, incidences of postoperative spinal cord injury, renal replacement therapy, or infection (all P>0.05). Median follow-up was 4.7(4.0)years (range 0.1 to 16.2 years) in 94.6% (176/186) patients. The 8-year overall survival and 8-year freedom from reoperation between the HAD and non-HAD groups were 78.9% (95%CI: 63.9% to 88.2%) and 88.1% (95%CI: 75.0% to 94.5%), 86.5% (95%CI: 72.2% to 93.7%) and 91.0% (95%CI: 79.2% to 96.3%), respectively, which showed no statistically differences (all P>0.05). Conclusion: TAAAR following Sun’s procedure is safe and reliable, offering favorable short-term and long-term survival and low reintervention rates for both TAAA patients with HAD or without HAD.

PMID:41881792 | DOI:10.3760/cma.j.cn112139-20251208-00579

Mol Ecol. 2026 Mar;35(6):e70328. doi: 10.1111/mec.70328.

ABSTRACT

Genotype-environment association (GEA) is widely used for identifying genetic variation linked to environmental pressures. Their proliferation over the past decade offers a critical opportunity to synthesize how adaptive variation is identified and distributed across broad taxonomic groups. Here, we reviewed 194 GEA studies from the Kingdom Animalia to summarize the analytical methods employed and the key predictors of adaptive variation. Our review revealed that latent factor mixed models (LFMM) and redundancy analyses (RDA) are the most frequently used methods, with most studies employing multiple analytical approaches. On average, studies sampled approximately 0.05% of the focal species’ genome (SD = 0.14%). Across studies using genome-representative markers, we identified a non-linear relationship between genome coverage and candidate loci detected, indicating diminishing returns beyond 0.45% genomic coverage, supporting the importance of factors beyond dataset size. Climatic variables reflecting extremes and variation were most consistent for detecting candidate loci, but these patterns varied greatly across taxa. We also identified influential taxon-specific environmental relationships for bony fishes, arthropods, mammals, birds, herpetofauna, and molluscs and highlighted influential variables to inform future research efforts. This synthesis confirms the tight linkage between adaptive variation and species’ ecology, offering a quantitative guide for future study design to improve statistical detection power, and prioritize the environmental drivers shaping evolution.

PMID:41881782 | DOI:10.1111/mec.70328

Farm Hosp. 2026 Mar 24:S1130-6343(26)00030-9. doi: 10.1016/j.farma.2026.02.018. Online ahead of print.

ABSTRACT

BACKGROUND: Serum creatinine-based equations are commonly used to estimate glomerular filtration rate (eGFR) in critically ill patients, despite not having been specifically developed for this population. This study aimed to assess and compare the performance of three widely used serum creatinine-based equations in this setting.

METHODS: Observational retrospective study conducted in four intensive care units of a tertiary university hospital. The most commonly used serum creatinine-based equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD-4), and Cockcroft-Gault (CG) equations were compared to the creatinine clearance from 24-hour urine collection (CrCl_24h), used as the reference method. Bland and Altman plots, bias and precision were performed to contrast CrCl_24h values with estimated GFR. Bias and its 95% confidence interval were calculated as the mean difference between the eGFR estimated by each equation and the measured CrCl_24h. Precision was reported as one standard deviation of the bias.

RESULTS: A total of 261 patients were included. In patients with CrCl_24h between 0-129 mL/min, no significant differences were observed between equations. However, in patients with augmented renal clearance (15.7%), with a mean CrCl_24h of 180 mL/min, there was a statistically significant bias between the CKD-EPI equation (66.4 mL/min/1,73m²) and both the CG and MDRD-4 equations (24.8 mL/min/m² and 29.3 mL/min/1,73 m², respectively; p < 0.01).

CONCLUSIONS: This study highlights that the most commonly used equations to estimate glomerular filtration rate in critically ill patients have remarkable limitations compared to creatinine clearance from 24-hour urine collection. In critically ill patients with CrCl_24h between 0-129 mL/min, no significant differences were found between the CG, MDRD-4, and CKD-EPI equations. However, for patients with augmented renal clearance, the CG and MDRD-4 equations performed statistically better than the CKD-EPI equation.

PMID:41881746 | DOI:10.1016/j.farma.2026.02.018

Farm Hosp. 2026 Mar 24:S1130-6343(26)00029-2. doi: 10.1016/j.farma.2026.02.017. Online ahead of print.

ABSTRACT

OBJECTIVE: Pivotal study on perioperative toripalimab in resectable non-small-cell lung cancer showed population differences by histological subtype compared with other immunotherapy regimens, raising doubts about therapeutic positioning. The aim of this study was to interpret the methodological analysis by subgroups according to histological subtype of perioperative toripalimab in resectable non-small-cell lung cancer.

METHODS: Validated subgroup analysis applicability tool was used. This tool had two parts: preliminary questions to directly rule out analysis without relevant minimum conditions, and checklist. This checklist assessed statistical association, biological plausibility and consistency of subgroup results, and related these criteria to recommendations on applicability.

RESULTS: Preliminary question regarding differences in effect between subgroups p(i) < 0.1 was answered negatively, and checklist was not applied due to direct discard. Even if the checklist had been applied, statistical association criterion would have been rated ‘null’ due to absence of statistically significant differences. Biological plausibility would have been rated ‘probable’ due to non-squamous histology being a negative prognostic factor. Consistency would have been rated ‘null’ for absence of heterogeneity between subgroups in similar studies.

CONCLUSIONS: This methodological interpretation recommended against applying histology-based subgroup results for perioperative toripalimab in resectable non-small-cell lung cancer, avoiding ruling out the use of toripalimab in the non-squamous subgroup.

PMID:41881745 | DOI:10.1016/j.farma.2026.02.017