Category: Statistics

Crit Care. 2025 May 26;29(1):213. doi: 10.1186/s13054-025-05451-2.

ABSTRACT

INTRODUCTION: Renal replacement therapy (RRT) is commonly used in critically ill patients with acute kidney injury (AKI). However, optimal timing of RRT liberation remains controversy. This meta-analysis evaluates novel biomarkers to predict successful RRT liberation in critically ill AKI patients.

METHODS: The systematic review reported following PRISMA guidelines, PubMed, Embase, and Scopus were searched up to May 2, 2025, and were screened using predefined criteria. Methodological quality was assessed using the Newcastle-Ottawa scale. Pooled ROC-AUCs with 95% CIs were calculated; heterogeneity was evaluated using I² statistics.

RESULTS: Sixteen studies (3020 patients) involving 23 biomarkers were included. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) demonstrated fair predictive performance with 4 studies (AUC 0.766, I² = 39.8%). When excluding a study focused on long-term outcomes, the result showed a better predictive ability with low heterogeneity (AUC 0.801, I² = 0%). Plasma proenkephalin A (PENK) and serum NGAL also showed potential, but quantitative synthesis was limited by study number and heterogeneity. The cut-off value also varied widely, complicating clinical translation. In addition, multivariable models combining novel biomarkers with clinical indicators have also demonstrated promising predictive potential. However, due to the limited number of studies and inconsistent conclusions, further exploration is needed.

CONCLUSION: uNGAL moderately predicts short-term RRT liberation, while other biomarkers (e.g., PENK) require further validation. Standardizing definitions of successful liberation and integrating dynamic biomarker changed with clinical indicators (e.g., urine output) may enhance predictive accuracy. Further large-scale, prospective, and multicenter studies are needed to validate these findings.

PMID:40420198 | DOI:10.1186/s13054-025-05451-2

Int J Behav Nutr Phys Act. 2025 May 26;22(1):60. doi: 10.1186/s12966-025-01756-1.

ABSTRACT

BACKGROUND: Overweight and obesity disproportionately affect Black and Hispanic children who also play more video games. Narratives, coupled with home-based active video games (AVGs), may enhance PA and mitigate these disparities. This study tested the effect of narrative-enhanced home-based AVGs among predominantly Black and Hispanic children with overweight and obesity.

METHODS: This 6-month three-group RCT recruited 135 children aged 7-14 from pediatric clinics in Boston, MA (January 2020 – May 2022) during the COVID-19 pandemic. Participants were randomized into: [Narrative + AVG], receiving an Xbox/Kinect with six AVGs interspersed with a narrative animation Ataraxia (72 episodes over six months), which accompanied the AVGs; [AVG Only], receiving the Xbox/Kinect and AVGs without narrative animation; and [Waitlist Control], receiving the intervention post-RCT. The primary outcome was objectively assessed daily moderate-to-vigorous PA (MVPA). Secondary outcomes included body composition (fat and lean mass, total region fat), BMI%, fasting insulin, glucose, lipid panel (Cholesterol, HDL, LDL, and Triglycerides), and C-reactive protein. Assessments occurred at baseline, 3, and 6 months. It was hypothesized that [Narrative + AVG] would outperform [AVG Only], which would outperform [Waitlist Control].

RESULTS: 79 children completed all three visits (Age = 10.9 ± 1.7; 63% Boys; 62% Black; 25% Latino; 11% Mixed; and 1% Asian). No statistically significant improvements in MVPA were observed within any condition at 3 or 6 months. A post-hoc exploratory analysis revealed that over the first three months, [Narrative + AVG] increased daily MVPA by 6.8 min compared to [Waitlist Control]. Over the same period, the [AVG Only] group exhibited 815 g less lean mass gain and 7.2 mg/dL lower HDL cholesterol levels relative to the [Waitlist Control].

CONCLUSIONS: While neither narrative-enhanced AVGs nor AVGs alone consistently increased daily MVPA across the 6-month RCT, participants in the narrative AVGs group demonstrated greater daily MVPA compared to the control group during the initial three months. During this same period, the AVG-only group exhibited reduced lean mass gain and lower HDL cholesterol levels compared to the waitlist control. The added advantage of narratives was inconclusive, likely due to implementation challenges encountered during the pandemic. These findings highlight the need for addressing these challenges in future research in a fully powered study.

TRIAL REGISTRATION: Active Video Games on Physical Activity (Main Trial), NCT04116515. Registered December 25, 2019, https//clinicaltrials.gov/study/NCT04116515.

PMID:40420195 | DOI:10.1186/s12966-025-01756-1

J Orthop Surg Res. 2025 May 26;20(1):516. doi: 10.1186/s13018-025-05928-4.

ABSTRACT

OBJECTIVE: Rotator cuff injuries are common shoulder disorders, particularly affecting middle-aged and older women, and postoperative rehabilitation plays a vital role in restoring function and preventing recurrence. To investigate the knowledge, attitudes, and practices (KAP) related to postoperative rehabilitation among female patients who had undergone rotator cuff repair surgery.

DESIGN: A cross-sectional study.

METHODS: This cross-sectional study was conducted between January and July 2024 at two orthopedic centers in Chengdu, China, using convenience sampling. Demographic data and KAP scores were collected using a validated self-administered questionnaire (Cronbach’s α = 0.851). The primary outcome measures were knowledge, attitude, and practice scores, assessed using a validated KAP questionnaire. Data were analyzed using descriptive statistics, group comparisons via t-tests or ANOVA, Spearman correlation analysis, and structural equation modeling (SEM) to examine the relationships between knowledge, attitudes, and practices.

RESULTS: A total of 499 female participants who met the inclusion criteria were enrolled with a response rate of 99.60%. Among the participants (mean age: 59.8 ± 7.2 years), the mean scores for knowledge, attitude, and practice were 14.59 ± 4.24, 35.17 ± 5.70, and 27.91 ± 4.71, respectively. Knowledge demonstrated positive correlations with practice (rs = 0.106, p = 0.018), while attitude showed strong correlation with practice (rs = 0.572, p < 0.001). SEM analysis showed that practice was directly influenced by knowledge (β = 0.084, 95% CI: 0.013-0.155, p = 0.021), attitude (β = 0.514, 95% CI: 0.441-0.587, p < 0.001), surgery (β = -0.170, 95% CI: -0.301 to -0.039, p = 0.011), training (β = -0.125, 95% CI: -0.207 to -0.044, p = 0.002), and therapy (β = -0.129, 95% CI: -0.212 to -0.046, p = 0.002). Additionally, income (β = 0.035, p = 0.010) had indirect effect on attitude. Knowledge (β = 0.067, p = 0.005), exercise (β = 0.097, p < 0.001), and therapy (β = -0.113, p < 0.001) had indirect effects on practice.

CONCLUSION: Females with rotator cuff injuries demonstrated adequate knowledge and positive attitudes but exhibited suboptimal practices towards postoperative rehabilitation. These findings suggest the need for targeted interventions to bridge the gap between knowledge and practice, with particular focus on enhancing positive attitudes, which were the strongest predictors of rehabilitation adherence. Healthcare providers should consider implementing comprehensive educational programs that address both knowledge transfer and behavioral change strategies to improve patient outcomes.

PMID:40420194 | DOI:10.1186/s13018-025-05928-4

Int J Behav Nutr Phys Act. 2025 May 26;22(1):61. doi: 10.1186/s12966-025-01752-5.

ABSTRACT

BACKGROUND: The out-of-home (OOH) food sector holds the potential to promote healthier and more sustainable diets on a large scale given the high number of people eating OOH regularly. However, information about socioeconomic and dietary characteristics of OOH eaters is limited. This study aimed to identify a typology of OOH consumers by frequency and type of meal consumed OOH and their associated sociodemographic, lifestyle, nutritional, and environmental characteristics.

METHODS: Based on a sub-sample of adults of the French NutriNet-Santé cohort who completed a food frequency questionnaire and a questionnaire on OOH consumption habits in 2014 (n = 29,140, mean age: 53.6 (SD = 14.0) years, 74.3% women), we conducted a Multiple Factor Analysis followed by a clustering procedure. AN(C)OVA models were then used to examine the associations between the identified clusters and socio-demographic, lifestyle, and diet-related characteristics (using dietary scores and environmental indicators including greenhouse gas emissions, land use and energy consumption).

RESULTS: We identified five clusters based on their OOH consumption patterns: Weekday-only eaters (19%), Frequent weekday and weekend eaters (24%), Organic eaters (6%), Weekend and evening eaters (19%), and Home-only eaters (32%). Weekday-only eaters were younger, more likely to be professionally active and to have children at home than the other groups. Frequent weekday and weekend eaters, with the highest OOH consumption, had the lowest dietary quality and the highest diet-related environmental impacts and consisted mostly of younger women with higher socioeconomic status. Organic eaters, often living in urban areas and following specific diets such as vegan or vegetarian ones, had the best dietary quality and the lowest diet-related environmental impacts. Weekend and evening eaters and Home-only eaters had a higher proportion of retired individuals, with Weekend and evening eaters also showing a greater proportion of high-income individuals.

CONCLUSIONS: Our findings indicate a lower dietary quality and higher dietary environmental impacts among frequent OOH eaters, whereas those with higher organic consumption showed opposite trends. This study contributes to the understanding of different OOH consumer characteristics and could provide a basis for further research in the field.

TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT03335644).

PMID:40420193 | DOI:10.1186/s12966-025-01752-5

Vaccine. 2025 May 25;59:127297. doi: 10.1016/j.vaccine.2025.127297. Online ahead of print.

ABSTRACT

PURPOSE: Studies of influenza vaccination during pregnancy and major birth defects generally provide reassuring findings. To maintain public confidence, it is important to continue evaluating the safety of maternal vaccination using well characterized, population-based data. This study extended previous research to examine associations between maternal influenza vaccination and selected birth defects using data from the Birth Defects Study To Evaluate Pregnancy exposureS, a US, multisite case-control study.

METHODS: Mothers of case children (diagnosed with a birth defect) and control children (without a birth defect diagnosis) were identified from population-based birth defect surveillance programs and recruited to complete a telephone interview. Data from 2675 case and 1575 control mothers (participants) with deliveries during 2014-2019 were analyzed. Influenza vaccination exposure during the critical exposure period (one month before pregnancy through the first pregnancy month [B1P1] for spina bifida or through the third pregnancy month [B1P3] for other selected birth defects) was assessed controlling for several participant covariates. Logistic regression with propensity score adjustment was used to estimate adjusted odds ratios (aORs) and 95 % confidence intervals (CIs). Several secondary analyses were conducted. A probabilistic bias analysis examined the effect of exposure misclassification.

RESULTS: The aOR observed between B1P1 influenza vaccination exposure and spina bifida was 0.9 (95 % CI: 0.4-2.0). The aORs for B1P3 exposure and other selected birth defects examined ranged from 0.4 to 1.3, with 95 % CIs including the null except those for cleft lip ± cleft palate (aOR: 0.6; 95 % CI: 0.4-0.9) and gastroschisis (aOR: 0.4; 95 % CI: 0.2-0.7). Results from secondary analyses were similar to the primary analyses, and those from probabilistic bias analysis were similar to respective primary and secondary analyses.

CONCLUSION: Findings showed no statistically significant positive associations between influenza vaccination and the selected birth defects, supporting public health efforts to promote optimal vaccination coverage among pregnant women.

PMID:40418866 | DOI:10.1016/j.vaccine.2025.127297

Eur J Surg Oncol. 2025 May 20;51(9):110180. doi: 10.1016/j.ejso.2025.110180. Online ahead of print.

ABSTRACT

OBJECTIVE: Limited data exists on health-related quality of life (HRQoL) after robot-assisted surgery (RAL) for rectal cancer beyond one-year post-surgery. This study compares long-term HRQoL following RAL total mesorectal excision (TME) to conventional laparoscopic (CL) TME.

METHODS: All rectal carcinoma patients from the 63-center Prospective National CRC cohort (PLCRC) who completed pre- and post-operative HRQoL questionnaires (EQ-5D, QLQ-C30, and QLQ-CR29) were retrospectively included. Delta scores per parameter were calculated by subtracting pre-operative scores from scores at one year. Sensitivity analysis included all patients with beyond one-year post-operative questionnaires, regardless of a pre-operative questionnaire. Data were analyzed using multivariate linear regression.

RESULTS: Patients undergoing RAL TME more often had low rectal tumors, more post-operative complications and more stomas. In patients with both pre- and post-operative questionnaires, no significant differences were found in the EQ-5D delta score (n = 591). The QLQ-C30 (n = 709) showed statistically significant and clinical relevant difference in fatigue favored CL TME (4.4 ± 1.9, p = 0.021). The QLQ-CR29 (n = 696) showed small, statistically significant differences favoring RAL in body image and stoma-related issues, but no clinical relevance. Sensitivity analysis EQ-5D (n = 1250), QLQ-C30 (n = 1423) or QLQ-CR29 (n = 1453) showed no clinically relevant differences.

CONCLUSION: This is the first study comparing long-term HRQoL between CL and RAL surgery for rectal cancer. Although several statistically significant differences were found, no clinically relevant differences were observed except for a small difference in the subdomain fatigue of the EORTC QLQ-C30 favoring CL surgery. Furthermore, the current study underlines the relevance of a pre-operative HRQoL assessment.

PMID:40418864 | DOI:10.1016/j.ejso.2025.110180

JMIR Rehabil Assist Technol. 2025 May 26;12:e68967. doi: 10.2196/68967.

ABSTRACT

BACKGROUND: An accurate tongue strength and endurance assessment is necessary for pediatric dysphagia. TongueFit is a new, portable orofacial manometer for measuring tongue strength and endurance and a game-based training app for children.

OBJECTIVE: This study aimed to test the validity of TongueFit compared with a standard manometer as the current gold standard for measuring air pressure.

METHODS: This laboratory study compared TongueFit and a standard manometer as the gold standard for measuring air pressure. This study was conducted in 3 different experimental conditions. The first experiment compared TongueFit and the standard manometer using a force tester (MCT-2150), with pressure controlled by MSatLite software. The second and third experiments involved 2-cm and 3-cm bulbs between the 2 devices. This study used Lin concordance correlation to measure the level of agreement.

RESULTS: There was a mean absolute difference of 0.005 kilopascals (kPa) between the TongueFit and the standard manometer (n=35, ρC=1). Statistical analysis showed perfect agreement correlation (ρC=1). By using the 2-cm bulb, TongueFit’s mean was 0.007 kPa lower, also showing perfect agreement (ρC=1). Furthermore, using the 3-cm bulb, results showed almost perfect agreement (ρC=0.999) with the TongueFit’s mean, which was 0.044 kPa lower.

CONCLUSIONS: This study confirms the high validity of TongueFit as an orofacial manometer compared with a standard manometer, with negligible mean differences, as well as near-perfect and perfect agreement in the experiments. These results confirm that TongueFit is a valid and accurate tool for assessing tongue strength.

PMID:40418854 | DOI:10.2196/68967

Biomed Tech (Berl). 2025 May 23. doi: 10.1515/bmt-2025-0026. Online ahead of print.

ABSTRACT

OBJECTIVES: Identification of bony landmarks in medical images is of high importance for 3D planning in orthopaedic surgery. Automated landmark identification has the potential to optimize clinical routines and allows for the scientific analysis of large databases. To the authors’ knowledge, no direct comparison of different methods for automated landmark detection on the same dataset has been published to date.

METHODS: We compared 3 methods for automated femoral landmark identification: an artificial neural network, a statistical shape model and a geometric approach. All methods were compared against manual measurements of two raters on the task of identifying 6 femoral landmarks on CT data or derived surface models of 202 femora.

RESULTS: The accuracy of the methods was in the range of the manual measurements and comparable to those reported in previous studies. The geometric approach showed a significantly higher average deviation compared to the manually selected reference landmarks, while there was no statistically significant difference for the neural network and the SSM.

CONCLUSIONS: All fully automated methods show potential for use, depending on the use case. Characteristics of the different methods, such as the input data required (raw CT/segmented bone surface models, amount of training data required) and/or the methods robustness, can be used for method selection in the individual application.

PMID:40418844 | DOI:10.1515/bmt-2025-0026

Int J Risk Saf Med. 2025 May 26:9246479251346181. doi: 10.1177/09246479251346181. Online ahead of print.

ABSTRACT

BackgroundPatient safety is a global public health issue. It aims to reduce medical errors to ensure patients’ health and achieve the best possible outcomes.PurposeThis study aims to examine the perceptions of healthcare workers about medical errors in a tertiary hospital in Jordan.Methodology/approachThe descriptive-analytical cross-sectional study included 246 healthcare workers in a tertiary hospital in Jordan. Systematic random sampling technique was used to select the participants. Data were collected using a questionnaire that was used in previous literature. The Statistical Package for the Social Sciences Software (SPSS), version 27, was used to analyze the data. Descriptive and inferential statistics were used to address research objectives.ResultsThe majority of the participants were females and had a bachelor’s degree. Human error, lack of resources and failure of the communication system were the most frequently reported causes of errors (38.2%, 32.5%, and 30.0%, respectively). The findings show that disclosure of patient errors was perceived by 78% of the participants as a method to reduce the effect of medical errors on patient health. Raising awareness and training were perceived as the most impactful way in which hospitals could reduce medical errors. Reporting errors was stated by 52% of the respondents as a method to deal with medical errors. However, the commonest barriers to reporting errors were identified as culture (38.2%) and a long complicated process of errors reporting (28.9%). The emergency department was reported as the commonest place for medical errors occurrence.ConclusionThe findings revealed the experience of a Jordanian hospital regarding medical errors. Healthcare organizations and policymakers can utilize the findings presented in this paper to reduce medical errors, therefore promoting quality healthcare and patient safety.

PMID:40418842 | DOI:10.1177/09246479251346181

J Complement Integr Med. 2025 May 23. doi: 10.1515/jcim-2025-0054. Online ahead of print.

ABSTRACT

OBJECTIVES: Diabetic neuropathy results in chronic pain. Traditional treatments often offer limited relief, prompting the exploration of alternative therapies like Evening Primrose Oil (EPO). This study aimed to assess the efficacy of EPO in the treatment of painful diabetic neuropathy.

METHODS: In this interventional clinical trial, Patients were randomly assigned to three groups. Group A, consisted of 24 patients, received 1,000 mg of EPO soft gel capsules every 12 h. Group B, consisted of 21 patients, received 1,000 mg of EPO soft gel capsules daily. Group C, also with 21 patients, was divided so that half of the patients received placebo capsules daily and the other half every 12 h. After 4 weeks, patients returned, and questionnaires were completed. Statistical analysis of the data was conducted using SPSS version 25.

RESULTS: Groups A and B showed significant reductions in visual analog scale (VAS) pain scores, with Group A achieving the most improvement (mean pre-test: 5.96; post-test: 4.63). Analysis of covariance (ANCOVA) revealed significant differences in post-intervention scores (p<0.001) for VAS and Neuropathy total symptom score-6 (NTSS-6), indicating effective interventions. Treatment A was more effective than Treatment B for reducing pain (VAS mean difference= -0.52; p=0.044) and McGill Pain Questionnaire (MPQ) scores (mean difference= -9.56; p<0.001).

CONCLUSIONS: EPO could serve as a valuable alternative therapy for managing painful diabetic neuropathy with fewer side effects than traditional treatments. Further research is warranted to validate these results and explore EPO treatment long-term efficacy and safety.

PMID:40418820 | DOI:10.1515/jcim-2025-0054