Category: Statistics

Cancer Med. 2026 Jun;15(6):e71998. doi: 10.1002/cam4.71998.

ABSTRACT

BACKGROUND: Early diagnosis of colorectal cancer (CRC) can significantly improve prognosis, but currently there is a lack of simple and effective screening methods in clinical practice.

METHODS: This single-center retrospective study included patients with CRC and benign colorectal polyps (BCP) diagnosed at our hospital between December 2020 and December 2023, as well as healthy controls (HCs). Eligible participants were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Univariable and multivariable logistic regression analyses were performed in the training cohort to identify independent diagnostic predictors of CRC. A diagnostic nomogram was then constructed based on these predictors and internally validated.

RESULTS: Six hundred forty seven CRC, 365 BCP, and 400 HC were ultimately included in the study. Univariate and multivariate analysis showed that sex, HB, CEA, CA19-9, CONUT score, and HALP score were independent diagnostic predictors associated with CRC. The internal validation results indicated that the predictive ability of the nomogram (AUC_nomogram = 0.896) is significantly stronger than that of each individual indicator (AUC_HB = 0.78, AUC_CEA = 0.73, AUC_CA19-9 = 0.72, AUC_CONUT = 0.64, AUC_HALP = 0.72) (p < 0.05). The calibration curves confirmed the high consistency between the predicted probability and observed probability of the nomogram, and the decision curve analysis demonstrated its good clinical utility.

CONCLUSION: This study integrated multiple independent diagnostic predictors of CRC and developed an internally validated diagnostic nomogram with good discrimination and calibration in this single-center retrospective cohort.

PMID:42249647 | DOI:10.1002/cam4.71998

Urol J. 2026 May 29;23(1):35-36. doi: 10.22037/uj.v22i.8797.

ABSTRACT

We conducted a retrospective cross-sectional analysis of 288 complaints filed against urologists between 2017 and 2023 at the Forensic Medicine Organization in Shemiranat, Tehran. The number of complaints increased steadily, peaking in 2023 (n = 66) and reaching a nadir in 2020 (n = 13), likely reflecting the impact of the COVID-19 pandemic. Most complainants were male (89.6%), and patients aged >60 years comprised the largest group (31.3%). Complaints were overwhelmingly directed at specialist urologists (97.6%), with subspecialists accounting for only 2.4%. Cases more frequently originated from public hospitals (66.3%) than from private institutions (33.7%).

PMID:42249634 | DOI:10.22037/uj.v22i.8797

Oral Dis. 2026 Jun 5. doi: 10.1111/odi.70380. Online ahead of print.

ABSTRACT

BACKGROUND: This research was designed to establish an innovative diagnostic strategy employing whole-slide imaging (WSI) technology to address the diagnostic difficulties arising from the intricate histological architecture and morphological diversity observed in oral squamous cell carcinoma (OSCC).

METHODS: We proposed a cutting-edge multi-task learning architecture (MILGDF) that combines local-global attention mechanisms with dynamic weighted fusion. This model utilizes instance-level category-specific attention to enhance feature extraction efficacy while overcoming the limitations inherent in traditional bag-level attention methods. An adaptive weighting system was incorporated to dynamically adjust the contribution of local and global features, ensuring optimal performance in diverse prediction tasks.

RESULTS: Rigorous validation on the HIDOC and TCGA-OSCC datasets revealed the exceptional predictive performance of our model. The MILGDF framework attained an AUC of 0.952 (accuracy: 0.909) on HIDOC and 0.745 (accuracy: 0.725) on TCGA-OSCC, demonstrating statistically significant superiority over existing comparative models in both staging classification and diagnostic prediction.

CONCLUSIONS: The MILGDF model is capable of effectively utilizing information from wide-field images (WSI) for the accurate diagnosis and staging of oral squamous cell carcinoma (OSCC); its performance surpasses that of existing methods, demonstrating significant potential for clinical application.

PMID:42249621 | DOI:10.1111/odi.70380

Womens Health (Lond). 2026 Jan-Dec;22:17455057261456875. doi: 10.1177/17455057261456875. Epub 2026 Jun 5.

ABSTRACT

BackgroundPrenatal stress is linked to adverse perinatal outcomes. Indigenous women in Canada face high risks for adverse maternal and perinatal health.ObjectivesThis project aimed to understand levels and sources of stress experienced by Indigenous women during pregnancy and utilization of and experiences with available support.DesignThe project employed a mixed-methods cross-sectional design.MethodsThe project was conducted in three communities in Northwest Territories, Canada with varying road and healthcare accessibility. Indigenous women who were pregnant or had given birth within three years were invited to participate in a semi-structured interviewer-administered questionnaire, which included open and close-ended questions on pregnancy history, stress levels, healthcare access, available support, and experiences during and after giving birth. Descriptive statistics, regression modelling, and deductive thematic analysis were used.ResultsOf 156 participants between the ages of 17 and 47 years (mean age: 29.7 years; SD=6.0), 93.0% had given birth in the past three years, 18.0% were pregnant, and 85.3% were multiparous. Most participants reported pregnancy as somewhat stressful (49.7%) or very stressful (27.5%). Multiparity was associated with greater odds of reporting stressful pregnancy compared to first-time pregnancies (OR = 3.31, 95% CI: 1.22-8.97, p = 0.0186). Qualitative themes included reaction to pregnancy, stress during pregnancy, community support, and professional support. Factors contributing to prenatal stress included personal responsibilities, financial insecurity, housing concerns, and family issues. Support varied, with some feeling inadequately supported.ConclusionWhile various social supports exist, some participants reported inadequate support. The findings suggest the urgent need to expand community support programs in remote areas, both in numbers and access, is crucial for addressing maternal health concerns. Including kin and community supports and supporting community-driven initiatives would be effective strategies and require future exploration as to the impacts on addressing prenatal stress in Indigenous women in remote communities.

PMID:42249615 | DOI:10.1177/17455057261456875

Clin Oral Implants Res. 2026 Jun 5. doi: 10.1111/clr.70140. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate implant placement with Computer-Assisted Implant Surgery (CAIS) is critical to ensure long-term success. Dynamic-CAIS systems enhance surgical precision through real-time feedback, though comparative data on their accuracy and efficiency remain limited. This study evaluated how different registration methods in d-CAIS systems influence implant placement accuracy and procedural time.

MATERIALS AND METHODS: In this laboratory study, three registration methods were assessed: ND group, XC group, and XM group. Five experienced operators placed 25 implants per group (75 total) in partially edentulous maxillary models. Postoperative CBCT scans were used to measure deviations at the implant entry point, apex, vertical depth, and angle. One-way ANOVA and Tukey’s HSD test were used for statistical analysis.

RESULTS: Mean 3D deviations at the implant entry point were 1.06 mm (ND), 0.71 mm (XC), and 0.90 mm (XM); at the apex 1.23 mm, 0.83 mm, and 1.07 mm, respectively. Vertical depth deviations at the apex were similar across groups: 0.61 mm (ND), 0.59 mm (XC), and 0.64 mm (XM). Angular deviation was highest in the ND group (2.96°) compared to XC (1.17°) and XM (1.02°), with a significant difference between ND and XM (p = 0.028). The average procedural time was shortest in the XM group (7.20 ± 2.48 min), though differences were not statistically significant.

CONCLUSIONS: Although registration methods minimally affect overall accuracy, system-specific factors may influence angular deviation. Future studies should prioritize clinical trials with larger sample sizes and explore the influence of operator experience and learning curves.

PMID:42249609 | DOI:10.1111/clr.70140

Int Wound J. 2026 Jun;23(6):e70969. doi: 10.1111/iwj.70969.

ABSTRACT

Diabetic foot ulceration (DFU) contributes significantly to diabetes-related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six-week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6 months at Barbados’ sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6 weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (p > 0.05). No statistically significant association was found between educational attainment and healing outcomes at 6 weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six-week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.

PMID:42249595 | DOI:10.1111/iwj.70969

J Hand Surg Eur Vol. 2026 Jun 5:17531934261457024. doi: 10.1177/17531934261457024. Online ahead of print.

ABSTRACT

INTRODUCTION: Thumb metacarpophalangeal arthrodesis may be done by a variety of techniques. This study examines range of motion, complications and patient-reported outcomes after arthrodesis using different fixations.

METHODS: Patients treated at a single institution from 2013 to 2025 were retrospectively identified. The fixation techniques were categorized as plate, screw, Kirschner wires with tension band or Kirschner wires alone. Indications included degenerative osteoarthritis and post-traumatic instability; patients with inflammatory arthritis were excluded. Outcomes included range of motion, visual analogue scale pain scores, Patient-Reported Outcome Measurement Information System scores and complications. A secondary cohort treated by arthrodesis alone excluded patients with concurrent procedures.

RESULTS: A total of 106 patients were included (49 plate, 21 screw, 24 Kirschner wire with tension band and 12 Kirschner wire only). Range of motion, postoperative Patient-Reported Outcome Measurement Information System scores and pain scores were statistically similar for all fixation techniques. Complication rates were similar for all techniques except for removal of fixation, which was most frequent in patients treated by Kirschner wire and tension band (27%). This was also found in the pure arthrodesis cohort. Nonunion rates were low and did not differ by fixation technique.

CONCLUSION: Thumb metacarpophalangeal arthrodesis has similar functional and patient-reported outcomes in different fixation techniques. However, Kirschner wire fixation with tension bands is associated with a higher instance of fixation removal.

LEVEL OF EVIDENCE: III.

PMID:42249580 | DOI:10.1177/17531934261457024

Med Decis Making. 2026 Jun 5:272989X261450971. doi: 10.1177/0272989X261450971. Online ahead of print.

ABSTRACT

ObjectiveTo evaluate the clinical and cost-effectiveness of SHARE TO CARE (S2C), a complex intervention for hospital-wide, systematic implementation of shared decision making.MethodsWe analyzed clinical effectiveness, health care resource utilization, and implementation costs of S2C from the statutory health insurance perspective using a quasi-experimental difference-in-differences approach with evidence from the Department of Neurology. Clinical outcomes included inpatient hospital admissions, emergency department admissions, and rates of standard and advanced imaging procedures. Implementation costs comprised those related to the conception, development, process integration, ongoing support, and auditing of S2C. Health care utilization data covered inpatient and outpatient care, pharmaceuticals, therapeutic services, assistive devices, and nursing care. We conducted sensitivity analyses to account for uncertainties.FindingsS2C was associated with a reduction in inpatient hospital admissions, emergency department admissions, and imaging rates in the intervention group. The cost analyses aligned with these findings, showing reduced total costs and health care resource utilization in the intervention group. Although none of the estimates reached the predefined thresholds for statistical significance, the primary analysis yielded weak evidence (P < 0.1) of a reduction in emergency department admissions in the intervention group. Overall, savings outweighed the costs of implementing S2C, suggesting cost-effectiveness.ConclusionsS2C has the potential to reduce emergency department admissions and overall health care costs from the statutory health insurance perspective. Further research should investigate generalizability, the timing of the treatment effect, and potential biases introduced by the COVID-19 pandemic. The demonstrated effects of shared decision making (SDM) have encouraged statutory health insurances in Germany to offer additional reimbursement for clinics certified under the S2C program. The S2C model illustrates how payers and providers can collaborate to facilitate the nationwide implementation of SDM.HighlightsThe implementation of SHARE TO CARE (S2C) was associated with a statistically nonsignificant reduction in emergency department admissions after 1 y from the statutory health insurance perspective, based on data from the Department of Neurology.The cost savings from reduced health care utilization outweighed the implementation costs, and despite not reaching statistical significance, the results support the potential cost-effectiveness of S2C.S2C has the potential for nationwide implementation as a systematic form of shared decision making.Future research should investigate the generalizability of the results to other health care settings.

PMID:42249569 | DOI:10.1177/0272989X261450971

Int J Qual Health Care. 2026 Jun 5:mzag081. doi: 10.1093/intqhc/mzag081. Online ahead of print.

ABSTRACT

BACKGROUND: Performance measurement tools, such as quality indicators, shape how services are organized, delivered, and evaluated; they are central to monitoring and improving health system performance. This study examines five years of implementing occupational therapy quality indicators within a large public healthcare organisation and assesses how structured performance measurement can support routine monitoring, accountability, and quality improvement in occupational therapy service delivery.

METHODS: We conducted this retrospective, repeated cross-sectional study within Clalit Health Services, Israel’s largest public healthcare organisation, serving more than 4.9 million members across nine districts. We analysed performance trends (2021 to 2025) for five occupational therapy quality indicators implemented system-wide: children-parental conversations, children-treatment interruption, frail older adults, stroke, and hip fracture. Data were extracted from electronic health records and administrative databases. The analytic sample included all CHS members eligible for at least one occupational therapy quality indicator during the study period. Performance for each occupational therapy quality indicator was calculated as numerator/denominator * 100 national-level longitudinal trends and subgroup associations were analysed.

RESULTS: Four of the five OT-QIs improved significantly over time. from 8.1% to 3.7%, occupational therapy service delivery to frail older adults increased from 51.8% to 77.4%, and occupational therapy after stroke increased from 52.2% to 59.9% (P < 0.001 for all). The hip fracture indicator showed no statistically significant overall change, increasing slightly from 71.3% to 71.8% (P = 0.706), despite fluctuations during the monitoring period. Methodological changes to the denominator definition highlighted the sensitivity of performance metrics to operational definitions. Subgroup analyses further identified socio-demographic and geographic variation in occupational therapy quality indicator performance, particularly by age, socio-economic position, ethnicity, and peripherality, although patterns differed across indicators.

CONCLUSIONS: Implementing occupational therapy quality indicators within a nationwide community rehabilitation system enabled routine longitudinal monitoring of access, timeliness, family engagement, continuity of care, and service consistency. These indicators provided a structured framework for identifying service gaps, improving national-level visibility, and informing organisational decision-making. The findings support the feasibility and value of profession-specific quality indicators as a scalable model for performance monitoring and quality improvement in rehabilitation and allied health services. Future research should link occupational therapy quality indicator performance to patient-level functional, participation, and quality-of-life outcomes and examine geographic and socio-demographic inequities in service delivery.

PMID:42249556 | DOI:10.1093/intqhc/mzag081

Orthop Surg. 2026 Jun 5. doi: 10.1111/os.70356. Online ahead of print.

ABSTRACT

OBJECTIVES: Shaft-anchored prostheses have long been the gold standard in shoulder arthroplasty, but there is a growing trend toward bone-preserving, stemless designs. Despite promising short- and midterm results, long-term data remain limited. This study aims to report the long-term outcomes of a stemless anatomic shoulder prosthesis in patients with primary osteoarthritis and seeks to answer the question of whether it is comparable to other prostheses.

METHODS: This retrospective single-center study included 27 shoulders in 24 patients (mean age 75 ± 8.3 years), who were operated from 2009 to 2011. Outcomes assessed were Constant-Murley score, range of motion, patient satisfaction, revision rate, and radiological findings. Mean follow-up was 142 ± 12.2 months. Twenty-one shoulders underwent total shoulder arthroplasty; six hemiarthroplasty. For the analysis of continuous variables, the Wilcoxon test was used following normality testing. Dichotomous variables were evaluated using the chi² test, with a significance level set at p < 0.05.

RESULTS: The Constant-Murley score improved significantly from 23.1 ± 9.4 (27.5% age-adjusted) preoperatively to 58.8 ± 18.6 (72.3% age-adjusted) postoperatively (p < 0.001). Range of motion increased in flexion (89.5°-137.2°), abduction (70.9°-117.2°), and external rotation (10°-36.8°), all statistically significant. Overall, 85% of patients were (very) satisfied. Four revisions were performed: two with conversion to alternative treatment, two within the same system due to loosening and infection. Ten- and 12-year survival rates were 89% and 85%, respectively. A 30% risk of loosening was observed (per Molé), though no glenoid loosening occurred; humeral loosening was seen in one case.

CONCLUSION: The clinical, functional, and radiological outcomes of the investigated stemless shoulder arthroplasty system remain satisfactory even in long-term follow-up. High patient satisfaction was observed. The data, which are unique in terms of the length of follow-up, are comparable to those of other stemless anatomic shoulder arthroplasty designs.

PMID:42249544 | DOI:10.1111/os.70356