Tag: statistics

J Orthop Surg Res. 2026 Apr 26. doi: 10.1186/s13018-026-06865-6. Online ahead of print.

ABSTRACT

Anterior cruciate ligament (ACL) ruptures are prevalent, particularly among young athletes. Although ligament reconstruction is the gold standard treatment, the rehabilitation process is extensive and has high reinjury rates. Recovery is often hindered by muscle inhibition and psychological factors like kinesiophobia and associated fear of reinjury. Emerging evidence suggests that motor imagery and action observation could enhance rehabilitation outcomes. Immersive virtual reality (VR) offers a novel way to integrate these techniques, potentially accelerating recovery. In this parallel randomized controlled trial, patients undergoing ACL reconstruction were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation plus VR training. Our VR content incorporated several novel elements, including embodiment in a virtual body, first-person perspective, and the performance of virtual exercises guided by a virtual physiotherapist. Another innovative feature was that patients conducted the daily VR training independently at home using a standalone head-mounted display. The VR group performed a 20-min daily VR rehabilitation program for 4 weeks post-surgery, visualizing, planning, and executing movements using an embodied virtual avatar. Self-reported disability (International Knee Documentation Committee score, IKDC), quadriceps strength limb symmetry, active knee extension range of motion (ROM) limb symmetry, and kinesiophobia (Tampa Scale of Kinesiophobia-short form, TSK-11) were measured at baseline, 4, 12, and 36 weeks. Forty-seven participants were randomized, with 44 completing treatment. IKDC scores were not statistically significantly different between groups, despite moderate effect sizes at 4 and 36 weeks (Cohen’s d = 0.559, and d = 0.722, respectively). The VR intervention group showed significantly lower kinesiophobia at 4 weeks post-surgery compared to controls (27.00 ± 6.58 vs. 33.35 ± 5.07, Cohen’s d = – 0.971, p = 0.045). Both groups demonstrated significant improvements in all outcomes over time (p < 0.001). No significant differences were found for range of motion or quadriceps strength limb symmetry. No adverse events were reported related to the intervention. Reducing kinesiophobia is crucial for timely and effective rehabilitation and return to sport, and for reducing reinjury risk. To our knowledge, this is the first clinical study to investigate the independent use of therapeutic VR at home during post-orthopedic surgery rehabilitation. Future research should explore different VR interventions, including more active exercises and personalized programs, to enhance adherence and optimize recovery. The study was pre-registered with the National Library of Medicine (NCT05080894; first registered 09/20/2021).

PMID:42036710 | DOI:10.1186/s13018-026-06865-6

Syst Rev. 2026 Apr 27. doi: 10.1186/s13643-026-03181-2. Online ahead of print.

ABSTRACT

BACKGROUND: There are no established evidence-based guidelines for the administration of intraoperative local anesthesia (LA) during dental rehabilitation under general anesthesia (GA). This systematic review aims to evaluate the effects of intraoperative LA on physiological parameters and pain control in children undergoing GA for comprehensive dental treatment.

METHODS: Comprehensive search was conducted across four electronic databases: PubMed, Cochrane Central Register of Controlled Trials, EBSCO, and Scopus. Search strategy was structured, yielding 14 articles that follow the study inclusion criteria. Risk of bias was performed using Cochrane Collaboration’s tool for randomized trials and confidence of recommendation according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Whenever there were sufficient studies with comparable data, meta-analysis was performed.

RESULTS: Pain levels were significantly lower in the LA group compared to controls (OR = 0.32, 95% CI 0.14-0.70, P = 0.005). Lip and/or cheek biting occurred more frequently in the LA group, though this difference was not statistically significant. Although reductions were observed in physiological parameters, only the decrease in end-tidal CO₂ volume reached statistical significance (P = 0.02). The included studies were rated as having low confidence and quality based on the GRADE assessment.

CONCLUSION: While the intraoperative use of LA under GA reduced postoperative pain and end-tidal CO₂ volume, other effects were negligible, making its routine use optional. Evidence suggests targeting LA for high-pain procedures, such as multiple extractions, while exercising caution or withholding it during deep sedation to mitigate potential drops in tidal volume.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022340846.

PMID:42036699 | DOI:10.1186/s13643-026-03181-2

J Eat Disord. 2026 Apr 26. doi: 10.1186/s40337-026-01621-x. Online ahead of print.

ABSTRACT

BACKGROUND: Eating disorders can result in inpatient admissions. The transition of care between this tier of service and outpatient support can be challenging, particularly without intensive outpatient options. The potential benefits of providing intensive outpatient options during this transition period are significant, however there is limited research in this area. This study aimed to understand the experiences and needs of persons with lived experience, carers and health professionals before and after this transition in care for adults in Australia.

METHODS: Using mixed quantitative and qualitative methodology, and experience based co-design principles and processes, we gathered individual experience (stage 1) and developed an understanding of the care transition (stage 2). In stage 1, persons with lived experience and carers were interviewed. Health professionals were surveyed using an online questionnaire. In stage 2, preferences for support were explored in workshops. Findings were analysed using descriptive statistics (quantitative data) and inductive content analysis (qualitative data).

RESULTS: Stage 1: Five persons with lived experience and six carers were interviewed. Seventy-three health professionals completed the questionnaire. Stage 2: Two persons with lived experience, two carers and three health professionals participated in workshops. Given the small sample sizes, findings should be interpreted as exploratory. We identified three themes in stage 1: (1) Eating disorder care has the potential to be disempowering, traumatic and isolating but can also be motivating and hopeful, (2) Inpatient care does not always prepare patients for success prior to discharging, (3) Transitioning into outpatient care has the potential to be inequitable, expensive or non-existent. Preferred priority areas for improvement (stage 2) included individualised holistic and empathetic care, practical and timely post-discharge support, additional supportive networks, cultural change in healthcare, workforce training and development, and consistency in service offerings and equity of access.

CONCLUSIONS: The return home from inpatient care can be difficult to navigate, marked by a lack of continuity of care and insufficient resources. This research highlights areas to target in co-designing a support system for adult patients with eating disorders after discharge from inpatient care.

PMID:42036689 | DOI:10.1186/s40337-026-01621-x

BMC Med Educ. 2026 Apr 27. doi: 10.1186/s12909-026-09045-6. Online ahead of print.

ABSTRACT

BACKGROUND: In dentistry, moral judgment skills are a fundamental competency that helps dentists make the best decisions when faced with challenging clinical problems and ethical dilemmas. The aim was toexamine the moral sensitivity levels of fourth- and fifth-grade dentistry students and orthodontic clinicians.

METHODS: The study included fourth-grade (n = 116) and fifth-grade dentistry students (n = 106) as well as orthodontic clinicians, including residents and specialists (n = 117). Data were collected using a sociodemographic form and the self-administered Moral Sensitivity Questionnaire (MSQ) including six sub-dimensions: autonomy, holistic approach, conflict, orientation, providing benefit, and application. Participants were asked to rate the questionnaire on a 7-point Likert-type scale. Cronbach’s alpha coefficient was used in reliability analysis. Continuous variables were presented as mean and standard deviation, and categorical variables were summarized as frequency and percentage. Intergroup differences were assessed by one-way ANOVA. Pairwise comparisons were further identified with Tukey’s post-hoc test. Two-way ANOVA was performed to assess the combined effects of group and demographic variables on the total scale score.

RESULTS: The overall reliability of the MSQ scale was 0.84. The total moral sensitivity scores for fourth-grade, fifth-grade students, and orthodontic clinicians were 92.7 ± 15.7, 92.4 ± 17.8, and 93.8 ± 14.4, respectively, revealing no statistically significant difference. Fifth-grade students scored significantly lower than orthodontic clinicians on the Holistic Approach and Conflict sub-dimensions but scored significantly higher on the Orientation sub-dimension compared to orthodontic clinicians.

CONCLUSIONS: Undergraduate dentistry students and orthodontic clinicians exhibited moderate levels of moral sensitivity. Fifth-grade students were found to have higher moral sensitivity thanorthodontic clinicians on the holistic approach and conflict sub-dimensions, while orthodontic clinicians were found to be more sensitive on the orientation sub-dimension. These differences suggest that integrating case-based ethics training into the dental curriculum, regardless of academic year, can help students better identify ethical issues and develop strategies to address them effectively.

PMID:42036666 | DOI:10.1186/s12909-026-09045-6

BMC Gastroenterol. 2026 Apr 27. doi: 10.1186/s12876-026-04831-4. Online ahead of print.

ABSTRACT

Liver transplantation remains the definitive therapy for end-stage liver disease, yet Early Allograft Dysfunction (EAD) continues to challenge post-transplant outcomes. Several models have been developed to predict graft dysfunction and survival, including Olthoff’s static definition, and three kinetic prediction scores: the Model for Early Allograft Function (MEAF), the Liver Graft Assessment Following Transplantation score (L-GrAFT), and the more recent Early Allograft Failure Simplified Estimation (EASE). While these scores have been validated in Western populations, data from Eastern Europe are limited. This retrospective study aimed to externally validate and compare these recipient-centred prediction models for EAD, Early Allograft Failure (EAF), and patient/graft survival in the Romanian national transplant program.Between January 2019 and May 2025, 281 adult recipients of donation-after-brain-death grafts at Fundeni Clinical Institute met inclusion criteria. EAD (Olthoff’s definition) occurred in 79 patients (28.1%), while EAF (re-transplantation or death by POD 90) occurred in 27 patients (9.6%). The median recipient age was 52 years, with viral hepatitis representing the predominant aetiology. At 12 months, overall survival reached 86%. By Olthoff’s criteria, survival was lower in EAD vs. non-EAD, though differences were not statistically significant. Risk stratification using L-GrAFT10 and EASE identified significant survival differences across patient groups, whereas MEAF stratification failed to reach significance. Among the models, EASE demonstrated the strongest predictive accuracy for both patient and graft survival at 3 and 6 months, outperforming Olthoff’s classification. L-GrAFT10 showed the strongest association with mortality across strata, while MEAF provided robust prediction of EAD comparable to L-GrAFT10, with the advantage of relative computational simplicity.Findings confirm that established scores perform reliably within this Eastern European cohort, suggesting that regional differences in disease epidemiology do not diminish their predictive value. MEAF offered practical utility for early postoperative assessment of EAD, while EASE appeared to be the most accurate model for survival stratification. Broader multicentre studies – such as the ongoing global IMPROVEMENT study – remain necessary to optimize kinetic prediction models and guide clinical decision-making in liver transplantation.

PMID:42036635 | DOI:10.1186/s12876-026-04831-4

Eur J Dent Educ. 2026 Apr 26. doi: 10.1111/eje.70169. Online ahead of print.

ABSTRACT

PURPOSE: Effective communication and empathy are core competencies in patient-centred dental care. However, structured training in these skills is often limited in dental curricula. This study explored the association between a structured communication and body language course and dental students awareness of nonverbal communication, empathy-related attitudes, and patient-centred perspectives.

METHODS: A cross-sectional study was conducted among 390 final-year dental students at Ankara University Faculty of Dentistry. Group 1 (n = 195) had not received formal communication training, whereas Group 2 (n = 195) had completed a 39 h structured course including theoretical and practical components. Data were collected using a structured questionnaire covering sociodemographic characteristics, communication awareness, nonverbal communication practices, and empathy-related attitudes. Group differences were analysed using chi-square tests for categorical variables and independent samples t-tests for composite scores, with a p < 0.05 considered statistically significant.

RESULTS: Students who received training reported significantly higher awareness of the role of body language (p = 0.035), greater support for its inclusion in the curriculum (p = 0.037), and increased attention to instructors’ nonverbal cues (p = 0.0028). They also reported more frequent use of positive nonverbal behaviours, such as maintaining eye contact (97.4% vs. 92.0%, p = 0.042), using gestures and facial expressions (93.8% vs. 84.3%, p = 0.028), and adjusting tone of voice (90.8% vs. 80.1%, p = 0.014). Empathy-related attitudes were significantly stronger in the trained group, including better recognition of patients’ emotions (88.3% vs. 76.5%, p = 0.015), greater comfort in showing empathy (85.3% vs. 70.8%, p = 0.007), and a stronger belief that empathy can be taught (88.5% vs. 74.1%, p = 0.008). The overall mean scores for communication awareness, nonverbal communication, and empathy-related attitudes were all significantly higher in the trained group (p < 0.05).

CONCLUSIONS: Structured communication and body language training significantly enhance dental students awareness and use of nonverbal communication and strengthen empathy-related attitudes. Integrating experiential communication training into dental education may support the development of more empathetic, patient-centred clinical practice.

PMID:42036634 | DOI:10.1111/eje.70169

Acta Anaesthesiol Scand. 2026 Jul;70(6):e70235. doi: 10.1111/aas.70235.

ABSTRACT

BACKGROUND: Air pollution, especially particle pollution, is increasingly recognized as a potential perioperative risk factor, yet modeling environmental exposures in surgical cohorts remains methodologically underdeveloped. We demonstrate a Bayesian hierarchical framework to quantify probabilistic associations between preoperative fine particulate matter (PM_2.5) exposure and postoperative complications, highlighting its interpretability and flexibility for clinical environmental epidemiology.

METHODS: We conducted a single center, retrospective cohort study using data from 49,615 surgical patients in Utah who underwent elective surgical procedures from 2016 to 2018. Patients’ addresses were geocoded and linked to daily Census-tract level PM_2.5 estimates. The exposure variable was defined as the maximum PM_2.5 concentrations in the 7 days prior to surgery. The binary outcome was a composite of postoperative complications: pneumonia, surgical site infection, urinary tract infection, sepsis, stroke, myocardial infarction, or thromboembolic event. A hierarchical Bayesians regression model with weakly informative priors was used adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities with census tract as a group (random) effect. We present posterior estimates with credible intervals, highlight model transparency and sensitivity, and discuss contrasts with standard frequentist methods.

RESULTS: Postoperative complications were associated in a dose-dependent manner with higher concentrations of PM_2.5 exposure. We found a relative increase of 8.2% in the odds of complications (OR = 1.082) for every 10.ug/m³ increase in the highest single-day 24-h PM_2.5 exposure during the 7 days prior to surgery. For an increase in PM_2.5 from 1 to 30 ug/m³, the odds of complication rose to over 27% (95% CI: 4%-55%). The results were robust across prior choices and model specifications. We report full posterior distributions and highlight advantages of Bayesian modeling for uncertainty quantification and clinical interpretability.

CONCLUSIONS: This case study demonstrates the application of hierarchical Bayesian modeling to quantify the probabilistic associations between preoperative PM_2.5 exposure and postoperative complications, highlighting transparent risk estimation and uncertainty characterization that may inform the design of future multicenter perioperative environmental studies.

EDITORIAL COMMENT: Using Bayesian statistical analysis, the authors demonstrate a dose-dependent risk for postoperative complications in patients exposed to air polluted with fine particulate matter with a size of less than 2.5 μm.

PMID:42036603 | DOI:10.1111/aas.70235

Adv Exp Med Biol. 2026;1502:3-13. doi: 10.1007/978-981-95-6872-7_1.

ABSTRACT

The diagnostic frameworks for major depression in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and DSM-5 revision process (DSM-5-TR) have been largely defined by the significant transition from a categorical approach to a hybrid concept incorporating dimensional concepts. The main updates in the DSM-5 diagnostic framework of major depression are the addition of hopelessness as a descriptor for depressed mood, the removal of the bereavement exclusion, and the introduction of specifiers, including “with anxious distress,” “with mixed features,” and “peripartum onset.” The DSM-5-TR has newly added the depression-related diagnostic entities, including unspecified mood disorder, persistent grief disorder, suicidal behavior, nonsuicidal self-injury, and hikikomori. However, the symptom-based operation criteria for major depression remain challenging, including high clinical heterogeneity, high comorbidity, transdiagnostic nature of overlapping symptoms, and lack of integration with neurobiological markers. To overcome these limitations, the etiology-based classifications with integrating biomarkers and the digital phenotyping with ecological momentary assessments have been suggested as diagnostic practices in the level of research. The neuroinflammatory biomarkers and brain imaging have been regarded as a promising tool, but their issues regarding reproducibility and cost remain challenging in clinical applications. In addition, the digital tools with big data, wearable devices, and natural language processing may enhance the diagnostic precision, despite their issues of ethics and standardizations. Future diagnostic frameworks can be discussed in terms of personalized and biologically informed approaches in response to address the complexities of clinical practice. Integrating innovative methods with symptom-based diagnostic systems may contribute to more accurate and effective diagnostic classifications of major depression.

PMID:42036558 | DOI:10.1007/978-981-95-6872-7_1

Arch Orthop Trauma Surg. 2026 Apr 26;146(1):162. doi: 10.1007/s00402-026-06327-y.

ABSTRACT

INTRODUCTION: Revision total hip arthroplasty (THA) for acetabular bone loss is challenging. The modified Kerboull-type (KT) plate has been adopted; nonetheless, mid- to long-term clinical outcomes remain poorly understood. We evaluated survival rates and radiographic outcomes of acetabular reconstruction using the KT plate and investigated risk factors for plate breakage or re-revision.

MATERIALS AND METHODS: We retrospectively included 120 patients (130 hips) who underwent acetabular reconstruction using the KT plate (1997-2024) and evaluated perioperative outcomes, Harris Hip Score (HHS), survival rates, and key radiographic parameters.

RESULTS: Mean age at surgery and follow-up duration were 69.0 ± 10.4 years and 107.4 ± 71.7 months, respectively. Mean blood loss and operative time were 630.2 mL and 284.3 min, respectively. HHS improved from 56.2 to 86.4. Fractures (5.3%) and dislocations (3.0%) were observed. Ten-year survival rates were 95.6% for re-revision and 93.0% for plate breakage. Failure and head migration occurred in 11 (8.5%) and 6 (4.6%) hips, respectively. Multivariate analysis identified younger age, use of morselized bone chips alone, and postoperative head migration as independent predictors of failure. In revision THA cases with ≥ 5-year follow-up and Paprosky classification type 3 A or 3B defects, age, Knight classification, and head migration differed significantly between hips with and without failure. Hips with plate breakage requiring re-revision showed greater horizontal head migration than those managed nonoperatively.

CONCLUSIONS: KT plate-based acetabular reconstruction achieved excellent mid- to long-term outcomes, with a 10-year survival rate exceeding 95% and significant functional improvement. Younger age, bone chip grafting alone, and femoral head migration were associated with failure. Even when plate breakage occurred, re-revision was avoided if bulk bone grafts provided sufficient mechanical support and head migration remained minimal. Surgical outcomes were better in the later period than in the early period due to improved learning, surgical techniques, and grafting strategies.

PMID:42036554 | DOI:10.1007/s00402-026-06327-y

Plant Reprod. 2026 Apr 27;39(2):3. doi: 10.1007/s00497-026-00536-6.

ABSTRACT

Heteranthery is widespread among angiosperms and is classically linked to nectarless flowers that offer pollen as a reward, where the division of labour in the androecium helps to decrease the consumption of viable pollen grains. However, heteranthery also occurs in lineages with non-pollen-rewarding flowers. This is the case of some neotropical species of Malpighiaceae, which depend on oil-collecting bees for pollination, and offer floral oils. This study analyzes the androecium of Mamedea pulchella to assess the presence of division of labour and whether such specialization functions primarily in pollinator attraction rather than pollen economy. Anther traits from flowers of different populations were measured and analyzed statistically, complemented by anatomical and histochemical studies. Fertile stamens show significantly bigger anther area while sterile stamens bear antherodes with a significantly larger glandular connective. Occasional abortive anthers in usually fertile stamens and fertile anthers in usually sterile stamens were observed. Histochemical reactions indicate that connective glands secrete mainly terpenes. Differences between anthers and antherodes are consistent across populations, suggesting that heteranthery is a stable condition in M. pulchella, with a clear division of labour: anthers of large stamens supply pollen for fertilization whereas antherodes of smaller stamens act as osmophores, emitting scents that attract and guide oil-collecting bees to the elaiophores. This case highlights a potential alternative role for heteranthery in oil-rewarding flowers, where stamen specialization may contribute to pollinator attraction rather than solely mitigating the “pollen dilemma”, suggesting that heteranthery can evolve through multiple functional pathways in pollination systems.

PMID:42036546 | DOI:10.1007/s00497-026-00536-6