Category: Statistics

Trials. 2026 May 14. doi: 10.1186/s13063-026-09465-1. Online ahead of print.

ABSTRACT

BACKGROUND: Fidelity is defined as the extent to which an intervention is delivered as intended. Without a clear understanding of fidelity to an intervention, variability in implementation may be confounded with observed outcomes, making valid conclusions about the intervention’s efficacy challenging. The MIRROR-TCM (Multisite Replication of a Randomized Controlled Trial – Transitional Care Model) implementation evaluation, discussed here, sought to examine the delivery of the transitional care model (TCM) intervention and factors that influenced fidelity to the implementation of the intervention protocol over time. The TCM includes 10 core components, which aim to support older adults transitioning from the hospital back to the community. The objective of this paper is to describe the operationalization of a fidelity measure for the TCM intervention.

METHODOLOGICAL DEVELOPMENT OF THE FIDELITY SCORE: Fidelity was operationalized at the element, component, and overall intervention levels. The TCM fidelity score examines 38 elements, which are broken into 8 components. Rules to evaluate an element-level, binary (0/1) fidelity scores were established by the study team, which consisted of clinicians and statisticians, and updated through feedback from the advanced practice registered nurses delivering the intervention. Component-level fidelity was assessed as the proportion of total elements completed from each component. Finally, overall fidelity is calculated as the proportion of required elements completed multiplied by 38 or the total possible elements to complete.

CONCLUSION: Proper evaluation of fidelity to the delivery of an intervention is key in evaluating its implementation. This paper provides new methods to calculate fidelity for a complex intervention, which required the incorporation of 38 elements and nuances that did not require all patients to receive all elements, requiring the creation of clear rules for the exclusion of elements for a participant. The fidelity measure was employed throughout implementation and used to give feedback to the study team and improve fidelity. This paper outlines a novel methodology for flexible fidelity scoring in multicomponent interventions, incorporating rule-based exemptions to accommodate variability in real-world implementation. Future work needs to include validation of the metric through evaluation of fidelity at the participant level to examine its association with clinical outcomes in the parent MIRROR-TCM study, overall and by site.

PMID:42135827 | DOI:10.1186/s13063-026-09465-1

J Cardiothorac Surg. 2026 May 14. doi: 10.1186/s13019-026-03994-1. Online ahead of print.

ABSTRACT

BACKGROUND: ECG-gated computed tomography (CT) is not commonly utilized as the primary imaging modality for the diagnosis and management of degenerative mitral valve (MV) disease and preparation for MV intervention typically involves the use of several imaging studies. We hypothesized that CT can accurately identify MV pathology and exclude obstructive coronary artery disease (CAD) in this population potentially obviating the need for routine use of additional imaging modalities.

METHODS: CT was compared to invasive coronary angiography (ICA), transthoracic (TTE) and transesophageal (TEE) echocardiography for identification of coronary artery patency and mitral valve pathology respectively in patients undergoing MV evaluation between January 1, 2019, and December 31, 2023.

RESULTS: 240 patients underwent TTE, TEE, and CT for mitral valve evaluation prior to intervention. Agreement was moderate when CT was compared to TTE for identifying prolapse (71%) and poor for flail segments (51%), with CT being superior. Compared to TEE, CT showed 96% agreement for prolapse (sensitivity 96.5%, CI 92.5-98.7% and specificity 82.3%, CI 71.2-90.5%) and 83% agreement for flail segments (sensitivity 75%, CI 67.8-81.8% and specificity 90.8%, CI 81.9-96.2%). Cohen’s κ statistic was 0.81 and 0.65 for prolapse and flail respectively. 215 patients underwent ICA and CT evaluation followed by valve intervention. CAD prevalence was low at 6.0%. Compared to ICA, CT was 83.3% sensitive (CI 58.6-96.4%) and 97.9% specific (CI 94.9-99.4%) for CAD with excellent agreement (Cohen’s κ = 0.81).

CONCLUSION: As compared to TEE, CT has excellent sensitivity and specificity for diagnosing prolapse and good agreement for flail segments. CT also shows strong agreement with ICA in evaluating CAD. CT provides a non-invasive alternative to TEE and ICA to accurately identify MV pathology and exclude significant CAD.

PMID:42135824 | DOI:10.1186/s13019-026-03994-1

J Cardiothorac Surg. 2026 May 14. doi: 10.1186/s13019-026-04119-4. Online ahead of print.

ABSTRACT

This study aims to compare the early and mid-term follow-up results of total thoracoscopic mitral valve repair versus median sternotomy mitral valve repair. Data from patients with mitral regurgitation treated in our hospital from January 2020 to December 2024 were collected, including 165 cases of total thoracoscopic mitral valve repair and 160 cases of median sternotomy mitral valve repair. Demographic characteristics, technical indicators, complications, and follow-up results were compared between the two groups. The results showed that the total thoracoscopic mitral valve repair group had a shorter ICU stay (30.2 ± 6.1 h vs. 75.3 ± 15.6 h, P < 0.001), shorter postoperative mechanical ventilation time (12.5 ± 4.2 h vs. 28.1 ± 4.6 h, P < 0.001), shorter hospital stay (8.6 ± 4.5d vs. 13.8 ± 7.6d, P < 0.001), and less postoperative drainage (157.2 ± 47.1 ml vs. 382.5 ± 181.5 ml, P < 0.001). There was no perioperative mortality in either group. Cardiac ultrasound follow-up results at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years post-surgery showed no statistically significant difference in the recurrence rate of mitral regurgitation (Grade IV) between the two groups (1.21% vs. 1.25%, P = 0.536). Total thoracoscopic mitral valve repair is reliable, minimally invasive, with fewer complications, faster recovery, and satisfactory perioperative outcomes.

PMID:42135819 | DOI:10.1186/s13019-026-04119-4

Crit Care. 2026 May 14. doi: 10.1186/s13054-026-06037-2. Online ahead of print.

ABSTRACT

PURPOSE: In comatose patients at risk of death by neurologic criteria (DNC), spinal-mediated movements (SMM) and movements of unclear neuroanatomic origin (MUO) are occasionally challenging to discriminate from cerebral-mediated movements. Our objectives were to assess the respective prevalence and semiology of SMM and of MUO in this population and to estimate the associations between these movements with cerebral blood flow and perfusion.

METHODS: In this prospective cohort study conducted in 15 intensive care units across Canada, we enrolled consecutive, brain-injured adults with an unconfounded Glasgow Coma Scale score of 3. Physicians conducted standardized DNC clinical evaluation, and participants underwent a brain CT-perfusion scan with CT-angiography reconstructions within a 2-h delay. We assessed the prevalence and semiology of SMM and MUO with descriptive statistics. We estimated the associations between SMM and MUO with cerebral blood flow and brain perfusion using generalized linear mixed models with a logit link function, age and sex as covariates, and random intercepts for study sites.

RESULTS: We included 282 participants with a median [IQR] age of 60 [47-69] years. The respective prevalence of SMM and MUO were 27% (95% CI: 22-32%) and 12% (95% CI: 9-16%). SMM and MUO were not associated with the presence of cerebral blood flow on CT-angiography (aOR for SMM: 1.14, 95% CI: 0.63-2.05; aOR for MUO: 1.36, 95% CI: 0.61-3.01) or brain perfusion on CT-perfusion (aOR for SMM: 1.44, 95% CI: 0.77-2.68; aOR for MUO: 1.75, 95% CI: 0.77-3.97). Findings were similar in the subgroup of 204 patients fulfilling clinical criteria for DNC.

CONCLUSIONS: SMM and MUO are common among comatose patients at risk of DNC. Their prevalence is similar among alive comatose patients and patients fulfilling clinical criteria for DNC. These movements are not associated with cerebral blood flow on CT-angiography or brain perfusion on CT-perfusion.

TRIAL REGISTRATION: Registered on ClinicalTrials.gov: NCT03098511 on March 27, 2017.

PMID:42135815 | DOI:10.1186/s13054-026-06037-2

Arch Public Health. 2026 May 14. doi: 10.1186/s13690-026-01958-4. Online ahead of print.

ABSTRACT

BACKGROUND: Extensive population testing played a crucial role in mitigating the COVID-19 pandemic. However, scaling up testing capacity requires a considerable workforce and infrastructure. Furthermore, sampling and testing delays can hinder timely interventions. We therefore sought to improve pre-test triage through an ensemble model based on self-reported information.

METHODS: We trained an XGBoost classifier to predict individual risk of COVID-19 infection for higher education students in Leuven (Belgium) from real-world social and health data related to 38,180 test results. The model could recommend isolation, testing, or release of individuals at high, moderate, or low risk of infection, respectively, based on two parametrizable probability thresholds. We then studied the epidemiological impact of the ensemble triage tool in silico, by simulating its implementation in our context to control an epidemic over time.

RESULTS: The predictive model achieved a ROC AUC of [Formula: see text], but its performance varied across rolling retraining windows. The epidemiological simulations highlight the potential of the ensemble-enhanced triage system to control a surge of infections in the student population of Leuven. Given a rapid implementation at the onset of an infection surge, it could reduce the effective reproduction number below 1.0 while reducing the testing requirements by [Formula: see text]. The predictions of the ensemble model were strongly influenced by the number of contacts which individuals reported, the reason for testing, and the onset of symptoms.

CONCLUSIONS: Our study suggests that pre-test triage guided by ensemble models could play an important role in allocating testing resources efficiently. Given timely implementation and isolation compliance within the population, it could also help rapidly control a surge of infections. Future research could validate this approach for other pathogens, in other settings, and with deep learning models.

PMID:42135808 | DOI:10.1186/s13690-026-01958-4

Mol Autism. 2026 May 14. doi: 10.1186/s13229-026-00719-y. Online ahead of print.

ABSTRACT

BACKGROUND: Sensory perception in autism is strikingly heterogeneous, with individuals showing both hypo- and hypersensitivity across different sensory domains. While sensory differences are widely recognized as a core feature of autism, the structure and underlying patterns of this variability remain poorly understood. Previous studies have yielded mixed findings, often examining sensory processing in isolation within single domains, thereby limiting a comprehensive understanding of sensory sensitivity in autism.

METHODS: We compiled psychophysical data from 107 autistic and 408 age- and IQ-matched non-autistic individuals across 32 experimental conditions spanning multiple perceptual domains, including size, brightness, orientation, pitch, and face processing. Two complementary statistical approaches were used: segmented regression and a Bayesian hierarchical model.

RESULTS: Despite substantial inter- and intra-individual variability, both models revealed a consistent domain-specific pattern: on average, autistic individuals showed reduced sensitivity to faces and speech, while performance on basic non-social tasks was comparable to or exceeded that of the comparison group. Bayesian modelling further indicated that social relevance, rather than domain alone, accounted for the primary source of divergence between groups.

LIMITATIONS: This study focused on sensory sensitivity thresholds and did not assess perceptual biases or changes in subjective appearance of the stimuli. A full account of perception in autism requires considering these broader alterations.

CONCLUSIONS: The current findings suggest that sensory differences in autism reflect a structured perceptual profile shaped by social relevance, stimulus complexity, and individual variability. The results highlight the importance of individualized sensory profiling and may inform both theoretical models and personalized approaches to intervention in autism.

PMID:42135798 | DOI:10.1186/s13229-026-00719-y

BMC Med Educ. 2026 May 14;26(1):760. doi: 10.1186/s12909-026-09434-x.

ABSTRACT

BACKGROUND: Standardized residency training constitutes a pivotal element of postgraduate medical education in China, playing an essential role in augmenting clinical competence and ensuring patient safety. In the gastroenterological sphere, the complexity of diseases and the need to deal with acuteness of cases require residents to develop strong critical thinking abilities and flexibility. The conventional method of ward round teaching has some limitations, and the scenario-based simulation and video-assisted debriefing have shown that they might be beneficial. In this research, the researchers examine the effectiveness of combining these new practices in improving the training of residents.

METHODS: The study encompassed 80 trainees who underwent standardized residency training in the department of Gastroenterology at Dongguan People’s hospital from August 2023 to October 2024. Participants were randomly assigned into two groups: the traditional teaching group (control group) and the scenario-based simulation ward rounds combined with video feedback teaching group (intervention group), with 40 trainees in each cohort. Evaluations were conducted using a 100-point standardized assessment form for teaching rounds, the Chinese version of the Critical Thinking Disposition Inventory (CTDI-CV, score range 70-420), and a 25-item satisfaction questionnaire (5-point Likert scale). Statistical analysis was performed using SPSS software (version 29.0). Continuous data were analyzed using t-tests, and categorical data were analyzed using chi-square tests.

RESULTS: 1. Upon completion of the course, the assessment scores for teaching ward rounds in the intervention group were significantly higher than those in the control group (87.10 ± 3.24 vs. 80.20 ± 2.30, P < 0.001). 2. The critical thinking scores in the intervention group also exceeded those of the control group (307.20 ± 14.25 vs. 273.03 ± 13.20, P < 0.001). 3. Teaching satisfaction levels were higher in the intervention group compared to the control group (96.70 ± 4.64 vs. 90.88 ± 3.58, P < 0.001).

CONCLUSION: The integration of scenario-based simulation ward rounds with video feedback is more effective than traditional teaching methods in enhancing critical thinking abilities and teaching satisfaction in the standardized residency training of gastroenterology. This approach could serve as a novel clinical teaching model.

TRIAL REGISTRATION: Chinese Clinical Trials Registry, ChiCTR2600124086. Registered on 7 May 2026. Retrospectively registered.

PMID:42135796 | DOI:10.1186/s12909-026-09434-x

BMC Oral Health. 2026 May 14. doi: 10.1186/s12903-026-08589-9. Online ahead of print.

ABSTRACT

This study was conducted to assess the knowledge, attitude, and clinical practices of undergraduate dental students in their clinical years about the use of advanced endodontic instruments. A cross-sectional, questionnaire-based study was executed over six months among all 220 undergraduate dental students from three dental colleges in Saudi Arabia: King Saud University, Imam Abdurrahman University, and King Faisal University. Information was gathered using a pre-validated, self-administered questionnaire that included sections on demographics, knowledge, clinical practices, and attitudes. Statistical analysis was performed using SPSS version 23. The chi-square and Fisher’s exact tests were applied to explore the influence of gender and the clinical years on the knowledge, attitude and practices. A p-value of less than 0.05 considered statistically significant. Among 220 respondents, 156 (70.9%) were male, with most in the sixth year (30.9%) and from King Saud University (40.0%). Knowledge of rotary instruments was moderate; 137 (62.3%) correctly identified the effect of increased pitch, with significant improvement across academic years (p = 0.005). Awareness of reduced fracture risk also increased significantly (p = 0.002). Knowledge of electronic apex locators was high, with 193 (87.7%) correctly identifying the need to remove metallic restorations, showing significant improvement with academic year (p < 0.001). Attitudes were predominantly positive, as 158 (71.8%) strongly agreed that combined use of rotary files and EALs reduces chair time, with positivity increasing significantly across academic years (p = 0.031). This study concluded that knowledge, clinical practice, and positive attitudes toward rotary endodontic files and electronic apex locators improved significantly with increasing academic year. Senior students and interns showed greater understanding, higher clinical exposure, and more favorable perceptions of the effectiveness and convenience of these technologies.

PMID:42135771 | DOI:10.1186/s12903-026-08589-9

BMC Musculoskelet Disord. 2026 May 14. doi: 10.1186/s12891-026-09971-y. Online ahead of print.

ABSTRACT

PURPOSE: Increasing numbers of spine surgery cases and an aging society led to challenges during revision surgery with osteoporotic bone. Safe and stable operative techniques are required.

METHODS: In this ex vivo study, human lumbar vertebrae were prepared and then screened for assessing bone density. Eighteen donors (65 vertebrae) with osteoporotic conditions were included. Primary dorsal instrumentation was performed using either standard pedicle screws (6.35 mm diameter; Group A, n = 50) or vertebroplasty screws (VT, 6.35 mm; Group B, n = 15). This was followed by a standardized pull-out test cycle, after which the vertebrae of group A exhibited pedicle perforations replicating revision conditions. Subsequently, 50 vertebrae from Group A were reassigned to simulate revision conditions and divided into two subgroups (n = 25 each): Group A1 received conventional pedicle screws with an increased diameter (7.5 mm), while Group A2 was treated with cement-augmented pedicle screws (VT, 6.35 mm). A second pull-out test was performed, and statistical analysis was conducted.

RESULTS: The specimens with conventional screws had a lower mean pull-out strength compared to primarily cement-augmented screws during the first pull-out cycle 662.8 ± 365.1 N vs. 1066.1 ± 213.7 N. In the revision model, cement-augmented screws (Group A2) demonstrated a significant higher median pull-out strength compared to larger-diameter conventional screws (Group A1) (687.5 N [IQR: 448.8-1137.5 N]; vs. 486.5 N [IQR: 338.8-605.0 N]).

CONCLUSION: In this ex vivo revision model of osteoporotic bone, increasing screw diameter alone resulted in reduced pull-out strength compared to primary instrumentation, whereas cement-augmented pedicle screws consistently demonstrated superior fixation in both test cycles. These findings highlight the limited effectiveness of increasing screw diameter under revision conditions and support cement augmentation as a biomechanically advantageous strategy in osteoporotic bone, while clinical validation remains necessary.

PMID:42135770 | DOI:10.1186/s12891-026-09971-y

BMC Public Health. 2026 May 14;26(1):1560. doi: 10.1186/s12889-026-27712-7.

ABSTRACT

BACKGROUND: Parenting practices, such as emotional support and warmth, are key determinants of adolescent mental health, whereas the role of parental knowledge is less well understood. Parental warmth is thought to foster openness and disclosure, raising the question of whether parental knowledge independently predicts mental health outcomes or primarily reflects the quality of the parent-adolescent relationship. The present study used prospective data to test whether parental knowledge in late adolescence contributes independently to depression and anxiety symptoms in young adulthood after accounting for parental warmth and relevant covariates.

METHODS: Data from two waves of the national Swedish cohort study Futura01 were used (n = 2,697). Parental warmth and parental knowledge were measured at age 18, each using two items. Depression and anxiety symptoms were measured at age 21 with the Patient Health Questionnaire-4 (PHQ-4). Covariates included participant sex, parental education, immigration background, living arrangements at age 18, and indicators of mental health problems at age 18. Linear probability models were performed.

RESULTS: In unadjusted analyses, higher parental warmth and parental knowledge during late adolescence were both associated with a lower probability of reporting depressive and anxiety symptoms in young adulthood. However, when mutually adjusting for parental warmth and parental knowledge, the effect of parental knowledge was no longer statistically significant, indicating that its association with mental health outcomes was confounded by parental warmth. In contrast, parental warmth remained significantly associated with lower probabilities of both depression and anxiety symptoms, even after accounting for parental knowledge, sociodemographic characteristics, and earlier mental health problems. There were no significant interactions between parental warmth and parental knowledge, and participant sex did not moderate the associations.

CONCLUSION: This study highlights the protective role of parental warmth during late adolescence for depression and anxiety symptoms in young adulthood, with warmth showing a consistent association with lower probabilities of these outcomes. However, parental knowledge did not demonstrate an independent effect on mental health after accounting for warmth and covariates. The findings underscore the importance of fostering warm, supportive parent-adolescent relationships during late adolescence, as these relationships appear to have lasting benefits into young adulthood.

PMID:42135768 | DOI:10.1186/s12889-026-27712-7