Category: Statistics

J Back Musculoskelet Rehabil. 2025 May 21:10538127251344497. doi: 10.1177/10538127251344497. Online ahead of print.

ABSTRACT

BackgroundAcupuncture, a traditional oriental therapy, is increasingly being adopted globally as a method of complementary intervention for pain relief in patients with fibromyalgia (FM). The aim of this study was to evaluate the effectiveness of acupuncture compared to placebo, pharmacotherapy, or physiotherapy in reducing pain and improving function in patients with FM.MethodsAn electronic search was performed in the MEDLINE, Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases. The eligibility criteria were systematic reviews of clinical trials that compared acupuncture versus control interventions for pain intensity and other clinical outcomes in women with FM.ResultsA total of 10 systematic reviews met the eligibility criteria for the quantitative synthesis. For pain intensity, the mean difference (MD) was -1.30 cm (95% CI = -1.85 to 0.76, p < 0.001). For functional status, the MD was -10.18 points (95% CI = -13.56 to -6.79, p < 0.001). For sleep quality, the MD was 0.46 points 95% CI = -1.85 to 0.76, p < 0.001). For fatigue, the standard mean difference (SMD) was -0.18 (95% CI = -0.86 to 0.51, p = 0.55). For depression, the MD was -6.28 points (95% CI = -9.80 to -2.76, p = 0.0005). Most of the differences were in favor of acupuncture, except for sleep quality.ConclusionCompared to pharmacotherapy and physiotherapy interventions, acupuncture showed statistically significant differences in pain intensity, functional status, and depression symptoms; however, all differences did not reach the minimum threshold to be considered clinically important in patients with FM. The quality of evidence was low to very low according to GRADE ratings.

PMID:40397389 | DOI:10.1177/10538127251344497

Anat Sci Int. 2025 May 21. doi: 10.1007/s12565-025-00853-2. Online ahead of print.

ABSTRACT

This study examines the effects of virtual reality (VR) and tablet-based mobile applications (TBMA) in teaching heart anatomy to middle school students. A randomized-controlled trial was conducted in which 84 middle school students were divided into three groups: VR (n = 28), TBMA (n = 28), and control (n = 28). The students’ knowledge levels regarding heart anatomy were assessed before and after the applications. In addition, the student’s metacognitive awareness and satisfaction levels were measured after the TBMA and VR applications. The participants’ opinions regarding the applications were evaluated using qualitative analysis techniques. Descriptive statistics, variance analysis, and t tests were used to analyze quantitative data, and Colaizzi’s education method was prepared sevenfold to examine qualitative data. A significant increase in heart anatomy knowledge levels was observed in the distribution of VR and TBMA. However, no significant difference was found between the groups (p > 0.05). In addition, while the metacognitive awareness of heart anatomy was higher in the students in the VR group, the students in the TBMA group were more satisfied with the learning process. Students stated that learning heart anatomy with VR and TBMA methods was fun, informative, and enjoyable and that such applications should be used more in classes. This study reveals that technology-supported teaching methods can positively affect students’ learning processes while teaching heart anatomy. More comprehensive research should be conducted with randomized-controlled and mixed-method studies in different age groups and various course subjects to evaluate the sustainability and effectiveness of technology-based applications.

PMID:40397374 | DOI:10.1007/s12565-025-00853-2

AIDS Behav. 2025 May 21. doi: 10.1007/s10461-025-04725-8. Online ahead of print.

ABSTRACT

Amphetamine-type stimulants (ATS) have become prevalent among men who have sex with men (MSM), often associated with a higher risk of HIV acquisition. However, little is known about ATS use among MSM in Thailand. This study identifies ATS use patterns and associated factors among MSM in Bangkok, Thailand. Between January 2018 and May 2019, Thai MSM aged 18 years and older were recruited from an HIV testing center in Bangkok, for an 18-month longitudinal study. At each 6-month visit, participants underwent HIV testing and completed a self-administered questionnaire on demographics, substance use, sexual behavior and, mental health. Baseline characteristics and substance use patterns were summarized using descriptive statistics. Determinants of ATS use were identified by logistic regression analysis. Of 1375 MSM enrolled (median age 26), 146 (10.6%) reported using ATS in the past six months. They had more sexual partners, were more likely to engage in sex work, and were more likely to use multiple substances. HIV prevalence was higher among MSM who reported recent ATS use (19.9% vs. 10.0%, p-value < 0.001). Among those reporting ATS use, 92.5% used crystal methamphetamine, 44.4% used it via injection, and 94.5% used multiple substances. ATS use was associated with monthly income > 30,000 baht, group sex, current PrEP use or interest, and Post-Traumatic Stress Disorder and depressive symptoms. These findings highlight the patterns and determinants of ATS use among MSM, underscoring the necessity for integrated sexual and mental health services in harm reduction strategies to effectively address the complex needs of this population.

PMID:40397372 | DOI:10.1007/s10461-025-04725-8

Intern Emerg Med. 2025 May 21. doi: 10.1007/s11739-025-03968-6. Online ahead of print.

ABSTRACT

Coronary functional assessment plays a critical role in guiding decisions regarding coronary revascularization. Traditional methods for evaluating functional myocardial ischemia, such as invasive procedures or those involving radiation, have their limitations. Echocardiographic myocardial strain has emerged as a non-invasive and convenient indicator. However, the interpretation of strain values can be subject to inter-operator variability. Artificial intelligence (AI) and machine learning techniques may promise to reduce the variability. By training AI algorithms on a diverse range of echocardiographic data, including strain values, and correlating them with ischemia, it may be possible to develop a robust and automated diagnostic tool. This study aims to provide a non-invasive and effective solution for automated myocardial ischemia detection that can be used in clinical practice. To construct the machine learning model, we used an automatic left ventricular endocardium tracing tool to extract myocardial strain data and integrated it with six clinical features. A coronary angiography-derived fractional flow reserve (caFFR) ≤ 0.80 was defined as the indicator of myocardial ischemia. A total of 636 suspected coronary artery disease subjects were enrolled in this pilot study, where 282 cases (44.3%) had myocardial ischemia. These subjects were randomly divided into training (n = 508) and testing (n = 128) sets at a 4:1. Using ensemble-learning algorithms to train and optimize the model, its diagnostic performance versus caFFR was diagnostic accuracy 85.9%, sensitivity 88.9%, specificity 83.1%, positive predictive value 83.6%, negative predictive value 88.5%. The optimized model achieved an area under the receiver operating characteristic curve (AUC) of 0.915 (95% confidence interval [CI] 0.862-0.968). Our machine learning prototype model based on echocardiographic myocardial strain shows promising results in detecting myocardial ischemia. Further studies are needed to validate its robustness and generalizability on larger patient populations.

PMID:40397367 | DOI:10.1007/s11739-025-03968-6

Eur J Epidemiol. 2025 May 21. doi: 10.1007/s10654-025-01228-7. Online ahead of print.

ABSTRACT

There is an unsettled concern that treatment with aromatase inhibitors (AIT) may adversely affect lipid-levels. In light of the improved survival of women with breast cancer and increased risk of atherosclerotic cardiovascular disease in older people, unfavorable effects on lipid-levels may represent a significant health concern for this group of patients. We used linked data from nationwide registries, including a clinical breast cancer database with information about allocated and dispensed AIT. Based on these, we investigated changes in plasma lipid-levels (primary outcome: low-density lipoprotein (LDL)-cholesterol, secondary outcomes: high-density lipoprotein (HDL)-cholesterol, total cholesterol, and triglycerides) following AIT in a nationwide cohort of postmenopausal women with early breast cancer, Denmark, 2009-2020. Included women had at least one LDL-cholesterol measurement before and after breast cancer diagnosis. Exposure was allocated and dispensed AIT as compared with not allocated to and no dispensed AIT. Outcome was the adjusted difference in lipid-level-change (from before to after breast cancer diagnosis) according to AIT. Among 10,461 women, there were 22,693 pre-breast cancer LDL-cholesterol measurements and 42,750 post-breast cancer LDL-cholesterol measurements. Overall, 7919 of the women were exposed to AIT and 2542 women were unexposed. For AIT exposed, the LDL-cholesterol-change was – 0.16 mmol/L (mM), and for unexposed, – 0.15 mM, respectively. The corresponding adjusted difference in LDL-cholesterol change for AIT exposed versus unexposed was – 0.03 mM (95% CI – 0.07 to 0.003). We found similar results in analysis of secondary outcomes. This study does not support the concern that AIT adversely affects lipid-levels.

PMID:40397354 | DOI:10.1007/s10654-025-01228-7

Ann Biomed Eng. 2025 May 21. doi: 10.1007/s10439-025-03747-6. Online ahead of print.

ABSTRACT

PURPOSE: Accurate quantification of head acceleration event (HAE) exposure is critical for investigating brain injury risk in contact sports athletes. However, missing HAEs may be unavoidable in real-world data collection. This study introduces missing data imputation methods to estimate complete video- and sensor-based HAE exposure.

METHODS: We captured and verified university men’s ice hockey HAEs using video and instrumented mouthguards (iMGs) in one varsity season (n_athletes = 27, n_games = 31). A statistical mapping technique was first introduced to impute missing video-based HAEs during away games with limited camera angles. We then applied multiple imputation to impute missing iMG-based HAEs using captured data, including the complete video-based HAE exposure. This enabled estimation of complete exposure data at a per-athlete level over all games of the season.

RESULTS: Among 591 athlete-games, 45% did not have any recorded iMG data. We find that data imputation increased the median values of per-athlete-season video- and iMG-based HAE counts by 10% and 69%, respectively. Consequently, common head kinematics- and brain deformation-based cumulative exposure metrics also increased substantially (median per-athlete-season cumulative peak linear acceleration by 95%, peak angular acceleration by 109%, and corpus callosum strain by 69%).

CONCLUSION: This study highlights the potential underestimation of exposure metrics due to missing HAEs and fills a critical gap in sports HAE exposure research. Future studies should incorporate missing data imputation methods for more accurate estimation of HAE exposure in investigating acute and long-term brain trauma risks.

PMID:40397312 | DOI:10.1007/s10439-025-03747-6

Target Oncol. 2025 May 21. doi: 10.1007/s11523-025-01146-4. Online ahead of print.

ABSTRACT

Treatment strategies to improve outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) are evolving. Of particular interest are therapies that target DNA damage responses in tumor cells by inhibiting poly(ADP-ribose) polymerase (PARP) activity. Several PARP inhibitors have recently received regulatory approval for the treatment of patients with mCRPC, of which olaparib was the first for prostate cancer. Olaparib received approval as a monotherapy following the PROfound study (NCT02987543) and in combination with abiraterone following the PROpel study (NCT03732820) for mCRPC. Both PROfound (homologous recombination repair mutation biomarker-selected) and PROpel (biomarker unselected) patients demonstrated statistically significant longer radiographic progression-free survival (rPFS) with olaparib versus their respective control arms in the intention-to-treat population. In both studies, the greatest clinical benefit with olaparib was seen in patients with BRCA1 and/or BRCA2 mutations (BRCAm): PROfound rPFS hazard ratio (HR) 0.22 (95% confidence interval [CI] 0.15-0.32); PROpel rPFS HR 0.23 (95% CI 0.12-0.43). Clinical benefit was also observed in terms of overall survival: PROfound HR 0.63 (95% CI 0.42-0.95); PROpel HR 0.29 (95% CI 0.14-0.56). We provide a comprehensive overview of the utility of olaparib for patients with mCRPC harboring a BRCAm. Key clinical and safety data in BRCAm subgroup populations are discussed, predominantly based on findings from PROfound and PROpel, as well as investigator-initiated studies, to help inform treatment decision-making in this patient population. We also discuss the importance of genetic testing to identify patients who may optimally benefit from treatment with olaparib, either as a monotherapy or in combination with abiraterone.

PMID:40397306 | DOI:10.1007/s11523-025-01146-4

CJEM. 2025 May 21. doi: 10.1007/s43678-025-00935-0. Online ahead of print.

ABSTRACT

OBJECTIVE: In 2018, Royal College emergency medicine residency programs shifted to a competency-based medical education framework. This study sought to explore the impact of this transition on simulation-based education activities, including the use of simulation for assessment, in emergency medicine programs across Canada.

METHODS: An interview guide was created by the authors evaluating the current role of simulation in emergency medicine programs based on the Core Components framework of competency-based medical education. Semi-structured interviews of emergency medicine simulation directors across Canada were conducted virtually between May 2022 and December 2022. Descriptive statistics of quantitative data are reported and qualitative responses were analyzed using thematic analysis.

RESULTS: Interviews represented 11/14 (78.5%) emergency medicine programs in Canada. Competency-based medical education national standards were commonly used to identify gaps in training experiences, particularly with high acuity low opportunity scenarios that could be addressed using simulation. Furthermore, competency-based medical education provided a framework where simulation curricula were revised and allowed for mapping of simulation scenarios to specific required training experiences and assessment requirements. All programs reported a new role of assessment in simulation largely in the form of entrustable professional activity assessments to satisfy the requirement of competency-based medical education. However, concerns were raised around the increasing role of assessment and its impact on psychological safety of the simulation learning environment.

CONCLUSION: The introduction of competency-based medical education has elevated the role of simulation as a means of assessing learner competencies. This shift has been largely positive, by facilitating resident assessment of required training experiences, but with some possible negative consequences related to the impact of assessments on the psychological safety traditionally afforded by the simulation environment. As such, educators must be intentional in how simulation is used in their program with particular attention given to the validity of assessments and the impact on safety of the learning environment.

PMID:40397303 | DOI:10.1007/s43678-025-00935-0

Curr Med Sci. 2025 May 21. doi: 10.1007/s11596-025-00063-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Heat wave exposure significantly impacts human health. Nevertheless, studies on the long-term effects of heat wave exposure during adolescence on adverse pregnancy outcomes (APOs) are rare. This study aimed to investigate the relationship between the long-term effects of heat wave exposure during adolescence and APOs.

METHODS: We analyzed data from 3,376 female and 3,013 male participants across 31 provinces in China. All adolescents (10-19 years old), early adolescents (10-14), and late adolescents (15-19) were chosen as exposure windows. Heat waves were defined as periods lasting 2‒4 consecutive days with the daily temperature exceeding the 75th, 90th, and 92.5th percentiles. We employed multivariate logistic regression models to assess the associations between exposure to heat waves during adolescence and APOs.

RESULTS: The results revealed significant associations between male exposure to heat wave events during late adolescence and spontaneous abortion (P < 0.05), which was more pronounced in South China. In contrast, no statistically significant associations were detected between males’ exposure to heat wave events during adolescence and their partners’ preterm birth (P > 0.05 for all comparisons). The exposure of females to heat waves during adolescence was not significantly associated with subsequent spontaneous abortion or preterm birth (P > 0.05 for all comparisons).

CONCLUSIONS: This study demonstrates that spontaneous abortion in females is associated with heat wave exposure in their male partner during adolescence.

PMID:40397301 | DOI:10.1007/s11596-025-00063-x

Int J Clin Pharm. 2025 May 21. doi: 10.1007/s11096-025-01916-0. Online ahead of print.

ABSTRACT

BACKGROUND: Anticoagulation therapy presents a high risk of adverse drug events (ADEs) in hospitalized patients, highlighting the need for effective detection strategies in clinical practice.

AIM: The review aimed to identify triggers for detecting anticoagulation-associated ADEs in hospitalized patients and describe the performance of these triggers.

METHOD: PubMed, Cochrane, and Embase were queried until April 19, 2024. We included studies on trigger tools for detecting anticoagulation-related ADEs in hospitalized patients. The study quality was assessed using the Quality Assessment Trigger framework based on the QUADAS-2 tool for diagnostic accuracy. We performed random-effects meta-analyses to pool positive predictive values (PPV), with heterogeneity assessed via I² statistic and Cochran’s Q test.

RESULTS: Twenty-three studies were included. Seventeen triggers were reported and categorized into three modules: abnormal laboratory values (11 triggers), medications or antidotes (three triggers), and care (three triggers). Elevated international normalized ratio (INR) was the most prevalent trigger (16 studies) with a PPV of 0.539 (95% Confidence Interval [CI] 0.310-0.768). Other triggers exhibited lower pooled PPVs than elevated INR, including vitamin K administration (15 studies, PPV 0.222, 95% CI 0.153-0.290), abrupt medication cessation (14 studies, PPV 0.418, 95% CI 0.169-0.667), and activated partial thromboplastin time > 100 s (11 studies, PPV 0.336, 95% CI 0.173-0.498). Importantly, in-hospital stroke (three studies) had the highest pooled PPV of 0.964 (95% CI 0.803-1.000).

CONCLUSION: This review demonstrated the variability in PPVs of triggers for anticoagulation-associated ADEs, emphasizing the necessity for a specialized trigger tool for hospitalized patients on anticoagulants.

PMID:40397288 | DOI:10.1007/s11096-025-01916-0