Category: Statistics

Emerg Med Australas. 2026 Aug;38(4):e70333. doi: 10.1111/1742-6723.70333.

ABSTRACT

OBJECTIVE: Fiji has a high morbidity and mortality sepsis burden, but little is known about the utility of prognostic tools for septic patients presenting to hospital in the limited-resource Fijian context. This study aims to compare the ability of the quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) and national early warning score (NEWS) at predicting in-hospital mortality.

METHODS: A prospective observational study was conducted over 3 months in 2024 at a single Fijian tertiary hospital. Data was collected using an online tool from patients who presented to the Emergency Department with suspicion of sepsis and subsequently required admission. The prognostic accuracy at detecting in-hospital mortality was assessed and compared for qSOFA, SIRS and NEWS.

RESULTS: A total of 181 cases were included with an overall in-hospital mortality of 17.13%. In-hospital mortality in patients with a qSOFA ≥ 2 was 16 (34%), SIRS ≥ 2 was 25 (19.2%) and NEWS ≥ 7 was 23 (35.9%). qSOFA ≥ 2 yielded the highest specificity (79%, 95% CI 72%-86%) and SIRS ≥ 2 the highest sensitivity (81%, 95% CI 63%-93%). The NEWS ≥ 7 yielded intermediate sensitivity (74%, 95% CI 55%-88%) and specificity (73%, 95% CI 66%-80%). The AUROC for NEWS ≥ 7 was highest at 0.77 (0.68-0.87) with qSOFA ≥ 2 and SIRS ≥ 2 being 0.69 (0.58-0.79) and 0.62 (0.51-0.73) respectively.

CONCLUSIONS: NEWS demonstrated higher prognostic accuracy compared to qSOFA and SIRS in predicting in-hospital mortality for suspected sepsis patients. Our study provides a benchmark for future ED-based sepsis research in the Pacific.

PMID:42629168 | DOI:10.1111/1742-6723.70333

BMJ Paediatr Open. 2026 Aug 21;10(1):e004614. doi: 10.1136/bmjpo-2026-004614.

ABSTRACT

BACKGROUND: Rising antibiotic resistance threatens to reverse health gains from antibiotic access, especially in low- and middle-income countries. Identifying factors influencing prescribing patterns and appropriateness is vital to optimising antibiotic use and strengthening antimicrobial stewardship. However, evidence on this in paediatric outpatient care in Ghana is limited.

OBJECTIVES: To identify patient-related and prescriber-related factors associated with antibiotic prescribing patterns and the appropriateness of antibiotic use among paediatric patients.

METHODS: A retrospective review of outpatient records at the Princess Marie Louise Children’s Hospital in Ghana was conducted from 1 April to 30 June 2022. Logistic regression and generalised estimating equations analyses were used, where appropriate, to assess associations between patient age and sex, prescriber rank, prior antibiotic use, fever status and the appropriateness of antibiotic prescribing by indication, choice, dosage, duration, antibiotic tier and multiple-antibiotic use.

RESULTS: Among 16 555 outpatient consultations, 3244 (20%) resulted in an antibiotic prescription, of which 2862 records were analysed. Most patients were male (54%). Male sex was associated with antibiotic prescribing when not indicated (p=0.007), whereas older children (p=0.030) and patients presenting with fever (p=0.036) were less frequently prescribed antibiotics when not indicated. Compared with house officers, specialised nurses and physician assistants were associated with inappropriate use of antibiotics (p<0.001 and p=0.005, respectively); however, they were less likely to prescribe multiple or higher-tier antibiotics. Medical officers and residents were associated with appropriate antibiotic dosing and duration (p=0.004 and p=0.005, respectively), and prior antibiotic use doubled the odds of receiving higher-tier antibiotics (p<0.001).

CONCLUSION: Patient and prescriber characteristics were significantly associated with antibiotic prescribing patterns and appropriateness. Targeted interventions leveraging these findings are needed to improve prescribing and strengthen antimicrobial stewardship.

PMID:42629162 | DOI:10.1136/bmjpo-2026-004614

BMJ Open. 2026 Aug 21;16(8):e114374. doi: 10.1136/bmjopen-2025-114374.

ABSTRACT

OBJECTIVES: To examine the association between institutional reporting and support structures and the reporting behaviour, perceived support and satisfaction with the handling of sexual harassment among medical students in Germany.

DESIGN: Cross-sectional multi-method study combining a nationwide student survey with a structured survey of medical school deaneries and a structured documentary analysis of publicly available institutional information.

SETTING: All medical faculties offering a full undergraduate medical curriculum in Germany.

PARTICIPANTS: A total of 5681 medical students from 44 faculties participated in an anonymous online survey (77.8% women). Additionally, 34 of 42 medical faculties (81.0%) responded to a structured questionnaire regarding institutional support and reporting structures. Publicly accessible documents and faculty websites were analysed using a structured documentary analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included (1) availability and visibility of reporting structures, (2) reporting of sexual harassment and (3) satisfaction with the reporting process. Secondary outcomes included perceived accessibility of reporting pathways, awareness of support structures, psychosocial support and perceived institutional consequences. Associations between student-reported outcomes, deanery responses and institutional characteristics were examined using multiple logistic and linear regression analyses.

RESULTS: Most medical faculties (88.2%) indicated the presence of a dedicated advisory service for medical students. However, only a minority provided online reporting forms (29.4%) or chat-based options (8.8%). Institutional guidelines were available at almost all (97.6%) faculties. 44.2% of students reported having experienced sexual harassment during medical training, but only 12.7% of affected students reported an incident. Nearly half of the affected students (48.5%) indicated that they did not know where or how to report. Reporting behaviour was strongly associated with the perceived psychological burden (OR 3.48; 95% CI 1.67 to 7.27), and secondarily with prior non-medical vocational experience or later stage of study. Satisfaction with the reporting process and willingness to report again in the future were positively associated with perceived consequences (β=0.49; p<0.001) and psychosocial support (β=0.35; p<0.001). Awareness and perceived accessibility of structures were particularly low among those affected.

CONCLUSIONS: Most medical faculties provide counselling and reporting services, yet students, particularly those affected, often do not perceive them as visible, accessible or effective. We propose four additional strategies for medical faculties: (1) Awareness and Competence-Building, (2) Visibility and Active Communication, (3) Psychosocial Support as a Core Function and (4) Transparent Processes and Feedback. Transparent processes, clear communication of consequences and accessible psychosocial support are key to increasing trust and reporting willingness. Faculties should therefore ensure low-threshold access to advisory services, actively communicate reporting pathways, raise awareness and systematically monitor the effectiveness of institutional responses. Future research should evaluate whether implementing and strengthening these measures improves student satisfaction, institutional trust and ultimately contributes to reducing sexual harassment in medical education.

PMID:42629156 | DOI:10.1136/bmjopen-2025-114374

BMJ Open. 2026 Aug 21;16(8):e115914. doi: 10.1136/bmjopen-2025-115914.

ABSTRACT

OBJECTIVE: To explore the association between serum 25-hydroxyvitamin D (25-OH-D) levels and mild cognitive impairment (MCI) and further analyse the association between serum 25-OH-D levels and different dimensions of cognitive function.

DESIGN: Cross-sectional study.

SETTING: Tianjin, China.

PARTICIPANTS: A total of 866 participants aged 65 and above were enrolled in this study.

OUTCOME: MCI was diagnosed based on the revised Petersen diagnostic criteria. Cognitive function was assessed by the Wechsler Adult Intelligence Scale Revised in China.

RESULTS: The prevalence of MCI was 12.0%. Higher serum 25-OH-D levels were significantly associated with lower odds of MCI, as well as with MCI across all subgroups (p<0.05). Serum 25-OH-D levels were significantly and positively associated with full intelligence quotient (FIQ), verbal intelligence quotient (VIQ), information, similarity and vocabulary (p<0.05). The associations between serum 25-OH-D levels and cognitive function did not significantly differ by age, gender or education level, with no statistical evidence of interactive effects.

CONCLUSION: Higher serum 25-OH-D levels were significantly associated with lower odds of MCI. Furthermore, serum 25-OH-D levels were significantly and positively associated with different dimensions of cognitive function, specifically FIQ, VIQ, information, similarity and vocabulary. There was no statistically significant interaction observed between serum 25-OH-D levels and age, gender or education level.

PMID:42629155 | DOI:10.1136/bmjopen-2025-115914

BMJ Open. 2026 Aug 21;16(8):e120631. doi: 10.1136/bmjopen-2026-120631.

ABSTRACT

INTRODUCTION: Fracture misdiagnosis is a common diagnostic error in emergency departments (EDs) and minor injury units (MIUs), leading to poor patient outcomes, unnecessary treatments and significant healthcare costs. Artificial intelligence (AI)-assisted fracture detection tools are now available for use in radiology workflows; however, the impact of these technologies on patient outcomes, experiences and overall care pathways in the real-world clinical setting is limited.

METHODS AND ANALYSIS: We will conduct a prospective cluster randomised cross-over trial over a 6-month period, assessing the impact of an AI-assisted fracture detection tool in EDs and MIUs across 4 healthcare Trusts in the UK. Patients aged over 2 years old undergoing a plain film radiography for a suspected fracture as part of routine clinical care will be eligible for study enrolment. The trial will deploy Radiobotics’ RBfracture, a CE-approved AI-assisted medical device software for fracture detection at each site for 6 months. Randomisation will be at a cluster-level; a site will be randomised to begin with ‘AI on’ or ‘AI off’ for a month, followed by alternating active status each month for the remaining 5 months. The primary outcome will evaluate the incidence of ‘inappropriate healthcare contacts’ among patients receiving imaging for suspected fractures. This composite metric encompasses inappropriate referrals to fracture clinics, repeated hospital attendances and subsequent follow-up communications regarding missed fractures. The rates of these measures will be compared in the ‘AI on’ versus ‘AI off’ stages. Secondary outcomes will include patient-reported outcomes, clinician surveys, a predefined health economic evaluation assessing cost-effectiveness and budget impact and the diagnostic performance of the algorithm.

ETHICS AND DISSEMINATION: The study has received ethical approval from the South Central-Oxford Research Ethics Committee (Reference: 25/SC/0252, approval date: 23 October 2025), and subsequently from the Health Research Authority (IRAS 3 57 391-A). The results of this study will be presented at relevant scientific conferences and peer-reviewed publications will be disseminated on wider public forums such as traditional and social media.

REGISTRATION DETAILS: This is an ongoing, actively recruiting trial (ISRCTN23087950). Recruitment began in January 2026 and will run for 6 months at each site, with per-patient follow-up of 30 days and subsequent data analysis. This manuscript describes protocol version 1.1. The full protocol and statistical analysis plan are available from the corresponding author on request and will be deposited on the study’s public repository (https://github.com/Jason-L-Oke/SAMURAI) prior to publication of results.

TRIAL REGISTRATION NUMBER: ISRCTN23087950.

PMID:42629153 | DOI:10.1136/bmjopen-2026-120631

BMJ Open. 2026 Aug 21;16(8):e123424. doi: 10.1136/bmjopen-2026-123424.

ABSTRACT

OBJECTIVES: To explore the association between a four-item cardiopulmonary instability (CPI) score assessed during the first 24 hours of intensive care unit (ICU) admission and in-hospital mortality among critically ill adults with cardiovascular disease.

DESIGN: Retrospective multicentre cohort study.

SETTING: The eICU Collaborative Research Database, comprising ICU admissions from hospitals in the USA during 2014-2015.

PARTICIPANTS: Eligible ICU stays among adults aged ≥18 years with cardiovascular disease and known hospital outcome status. The ICU stay was the unit of analysis.

EXPOSURE: The first 24-hour CPI score assigned one point each for hypotension, hypoxaemia, tachycardia and mechanical ventilation, yielding a total score ranging from 0 to 4.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was in-hospital mortality. Secondary outcomes were ICU mortality and prolonged ICU and hospital stays.

RESULTS: The cohort included 61 273 eligible ICU stays contributed by 49 991 patients across 206 hospitals; 8238 stays (13.4%) resulted in in-hospital death. All four CPI components were available for 55 601 stays (90.7%). Mortality increased from 1.4% with CPI 0 to 4.6%, 11.6% and 28.0% with CPI 1, 2 and 3-4, respectively. In the adjusted analysis, CPI≥2 was associated with in-hospital mortality (OR 4.45, 95% CI 4.06 to 4.89; relative risk 3.64, 95% CI 3.35 to 3.97). CPI alone had moderate apparent discrimination (area under the receiver operating characteristic curve 0.732, 95% CI 0.726 to 0.738). At the CPI≥2 threshold, sensitivity was 90.4%, specificity 39.4%, positive predictive value 18.8% and negative predictive value 96.3%. Findings were consistent in analyses excluding mechanical ventilation, restricting stays to >24 hours and accounting for repeated stays. CPI ≥2 was also associated with secondary outcomes.

CONCLUSIONS: In this retrospective multicentre eICU cohort, higher first-day CPI scores were associated with progressively greater in-hospital mortality, while CPI≥2 was associated with ICU mortality and prolonged ICU and hospital stays. CPI provides a simple descriptive summary of first-day CPI, but its moderate apparent discrimination and low positive predictive value do not support stand-alone use for individual prognostication or treatment decisions.

PMID:42629150 | DOI:10.1136/bmjopen-2026-123424

BMJ Open. 2026 Aug 21;16(8):e116194. doi: 10.1136/bmjopen-2026-116194.

ABSTRACT

OBJECTIVES: The 2014 genocide perpetrated by Islamic State in Iraq and Syria (ISIS) against the Yazidi community resulted in widespread psychological trauma, mass displacement and targeted destruction of cultural heritage. This exploratory study examined a therapeutic arts and photography intervention with formerly captured Yazidi women, alongside the participatory development of a cultural archive, as an integrated approach to supporting mental health, cultural resilience and survivor authorship in a postconflict setting.

DESIGN: Mixed-methods exploratory study using a pre-post quantitative design integrated with qualitative semistructured interviews and participatory focus groups.

SETTING: Humanitarian, camp-based and community settings in northern Iraq within a Yazidi-led psychosocial support programme in a postconflict context.

PARTICIPANTS: Twelve formerly captured Yazidi women initially enrolled, with 10 completing the intervention and quantitative assessments; all were adult women who had survived captivity by ISIS and were engaged with local psychosocial services.

PRIMARY OUTCOME MEASURES: Primary quantitative outcomes were psychological distress, flourishing and coping, assessed using a modified Refugee Health Screener (RHS-15); qualitative outcomes focused on participants’ experiences of wellbeing, coping and meaning-making through arts engagement and cultural archiving.

RESULTS: Quantitative analyses indicated statistically significant reductions in psychological distress (p=0.015) and increases in flourishing (p=0.046); corresponding effect sizes suggested large but imprecise changes consistent with the small sample and exploratory nature of the study. Qualitative analyses identified outcomes related to enhanced social-emotional well-being, occupational justice and renewed future orientation, alongside therapeutic mechanisms including emotional expression, social connection, skill development, positive distraction and artistic medium-specific processes. The participatory archive development process yielded four primary functions: cultural and religious preservation, community well-being and resilience, education and understanding and participant-defined purpose and preferred forms of artistic expression. Mixed-methods integration demonstrated convergence between improvements in well-being and qualitative accounts of agency, identity reconstruction and cultural continuity.

CONCLUSIONS: This study provides preliminary evidence that therapeutic arts and photography, integrated with participant-led cultural archiving, may support reductions in distress and increases in flourishing among formerly captured Yazidi women. Positioning cultural archiving as a psychosocial and community-based practice highlights its potential to support collective resilience, survivor authorship and occupational justice alongside individual healing. Further research is needed to examine long-term outcomes, scalability and comparative effectiveness across contexts and to develop accessible, culturally grounded models for integrating such interventions into clinical and community services.

PMID:42629149 | DOI:10.1136/bmjopen-2026-116194

BMJ Open. 2026 Aug 21;16(8):e120018. doi: 10.1136/bmjopen-2026-120018.

ABSTRACT

BACKGROUND: Early obstetric ultrasound improves gestational age estimation, detection of fetal anomalies and management of pregnancy complications. The WHO recommends at least one ultrasound examination before 24 weeks of gestation. However, uptake of early obstetric ultrasound in many low-resource settings remains poorly documented, including in post-conflict Northern Uganda. This study assessed the prevalence and factors associated with uptake of obstetric ultrasound before 24 weeks of gestation among pregnant women attending antenatal care at a tertiary hospital in Northern Uganda.

METHODS: A facility-based cross-sectional study was conducted among 428 pregnant women attending antenatal care at Gulu Regional Referral Hospital between December 2024 and May 2025. Participants were selected using systematic sampling. Data were collected using a pretested interviewer-administered questionnaire. The facility does not routinely offer a dedicated second-trimester (20-24 weeks) anatomy scan; ultrasound is largely opportunistic and clinician or patient initiated. Multivariable Poisson regression with robust SEs was used to estimate adjusted prevalence ratios (aPR) and 95% CIs.

RESULTS: The prevalence of at least one obstetric ultrasound scan before 24 weeks of gestation was 64.0%. Independent predictors of early ultrasound uptake included access to transportation (aPR=1.96, 95% CI 1.19 to 3.25), history of congenital anomaly (aPR=1.27, 95% CI 1.09 to 1.48), not being in a union (ie, unmarried and not cohabiting with a partner) (aPR=1.29, 95% CI 1.07 to 1.56) and being satisfied with the results of an ultrasound scan in a previous pregnancy (aPR=1.38, 95% CI 1.06 to 1.57).

CONCLUSIONS: Uptake of early obstetric ultrasound in Northern Uganda remains suboptimal even in tertiary health facilities. Structural access barriers, obstetric history and previous service experience influence utilisation. Strategies aimed at improving transport access, strengthening provider counselling and improving service quality may enhance early ultrasound uptake.

PMID:42629148 | DOI:10.1136/bmjopen-2026-120018

Lupus Sci Med. 2026 Aug 21;13(2):e001979. doi: 10.1136/lupus-2026-001979.

ABSTRACT

OBJECTIVE: (1) To explore practice patterns and variability in the management of systemic lupus erythematosus (SLE) in Spain, including the adoption of the treat-to-target (T2T) strategy; (2) to identify key multilevel contextual factors, barriers and facilitators; and (3) to propose strategies to overcome the identified barriers.

METHODS: A qualitative analysis was conducted using a contextual analysis (CA) framework based on the components of the Basel Approach for coNtextual ANAlysis. This involved collecting contextual data through a literature review and other relevant sources, as well as collecting primary data to address gaps via structured focus groups with rheumatologists.

RESULTS: Considerable variability in SLE management was described by rheumatologists across regions and healthcare centres. Major barriers included disease complexity, delayed diagnosis, workforce shortages, limited training and awareness among healthcare professionals, insufficient multidisciplinary collaboration, underutilisation and lack of standardisation of clinical indices, inadequate patient education and poor integration of patient-reported outcomes into electronic medical records. Implementing T2T and clinical guidelines was rare due to perceived complexity, time constraints, a lack of digital support and limited training. Rheumatologists proposed several strategies, including improved training, structured referral pathways, digital solutions, shared decision-making tools, practical checklists and the development of multidisciplinary care networks.

CONCLUSIONS: This CA highlights significant challenges in implementing evidence-based SLE management in Spain, particularly regarding the adoption of the T2T strategy. Addressing contextual factors at the healthcare provider, organisational and patient levels is crucial for improving the quality of care and patient outcomes. These findings lay the groundwork for designing tailored national-level implementation initiatives.

PMID:42629144 | DOI:10.1136/lupus-2026-001979

Food Res Int. 2026 Oct 31;242(Pt 1):119873. doi: 10.1016/j.foodres.2026.119873. Epub 2026 Jun 26.

ABSTRACT

Gardenia fruit possesses significant medicinal and edible value; however, its quality control remains challenging due to adulterant confusion and geographical diversity. Herein, an integrated mass spectrometry (MS¹)/MS² similarity filtering strategy including polygonal mass defect filtering, diagnostic ion and neutral loss analysis, and feature-based molecular networking was established to profile diverse chemicals of Gardenia fruit, preliminarily screening 3675/1942 flavonoids, 5642/2329 phenylpropanoids, 2502/1061 iridoids, 937/250 non-iridoid monoterpenes, 825/486 diterpenes, and 76/33 triterpene aglycones in ESI⁺/ESI^– mode, and finally identifying 5 potentially new phenylpropanoid derivatives. Moreover, multivariate statistics and machine learning informed UPLC-Q-TOF-MS/MS-based untargeted metabolomics analysis were applied to compare metabolic differences and screen potential markers for their species authentication and geographic chemotyping. The key species marker set composed of d-mannitol, fumaric acid and asiatic acid generated a binary classifier with 100% accuracy that discriminated Gardenia fruit from its adulterants according to their characteristic abundance. And key geographic chemotyping markers were screened as genipin 1-gentiobioside combined with jasminoside B, a binary classifier built on their abundance also achieved 100% accuracy. This study offers robust technical and methodological support for the quality assessment, authentication and geographic chemotyping of Gardenia fruit.

PMID:42629093 | DOI:10.1016/j.foodres.2026.119873