Category: Statistics

JMIR Med Educ. 2026 Jan 21;12:e80048. doi: 10.2196/80048.

ABSTRACT

BACKGROUND: Game-based learning has emerged as an effective learning strategy in health care education. However, no games have been specifically designed to support cognitive improvement for diverse learning styles in oral microbiology and immunology.

OBJECTIVE: This study aimed to develop and evaluate an educational card game designed to support diverse learning styles in oral microbiology and immunology, using a duel-style format.

METHODS: An explanatory sequential mixed methods study was conducted with 40 third-year dental students, where half of them were assigned to the first group, starting as the host, while those in the other group began as the microbe. Participants alternated between the microbe and host roles during gameplay. Active engagement through playing as the microbe facilitated knowledge acquisition through observation, supporting inductive learning. On the other hand, the host role aimed to promote the application of knowledge for decision-making, facilitating deductive learning. Quantitative data were collected using pre- and postknowledge assessments and satisfaction questionnaires. Qualitative insights were obtained through semistructured interviews exploring learning experiences when playing as the microbe compared to the host.

RESULTS: Students demonstrated significant improvements in knowledge scores across the 3 assessments (P<.001), with no difference between groups (P=.85). They also perceived the game positively in all 3 aspects (usefulness, ease of use, and enjoyment). Qualitative findings revealed that role variation supported both inductive and deductive learning processes. Participants valued the combination of pedagogical and entertaining components, leading to the game’s motivation and engagement. A conceptual framework demonstrated key emerging themes relevant to the game design and implementation, including learner profile, learning setting, game design, learning process, and learning outcomes.

CONCLUSIONS: The card game demonstrated its potential in enhancing knowledge acquisition and student engagement in oral microbiology and immunology. Role-switching between the host and microbe was perceived by participants to facilitate different learning experiences. Further research is recommended to investigate long-term retention and broader practicality.

PMID:41564344 | DOI:10.2196/80048

JMIR Res Protoc. 2026 Jan 21;15:e80483. doi: 10.2196/80483.

ABSTRACT

BACKGROUND: More than 20 million individuals worldwide, especially in the Vidarbha region of India, are affected by sickle cell anemia (SCA), a hereditary condition that results in aberrant hemoglobin S and red blood cell distortion. The condition leads to anemia, organ complications, and recurrent pain crises, making region-specific data necessary for efficient therapy and public health initiatives.

OBJECTIVE: The goal of the study is to examine the clinical characteristics and unusual manifestations of SCA in the Vidarbha region, with an emphasis on dietary practices, clinical presentations, demographic distribution, and lifestyle factors such as alcohol consumption and smoking.

METHODS: This observational cross-sectional study with random sampling will be conducted at Acharya Vinoba Bhave Rural Hospital in Wardha for 3 months. We will recruit 131 individuals aged 18 to 50 years with dominant hemoglobin S and a positive sickling test. A standardized questionnaire addressing clinical symptoms, nutrition, substance use, inheritance patterns, and demographic information will be used to gather data. SPSS (version 17; IBM Corp) will be used for statistical analysis. Data will be summarized using descriptive statistics. Group differences will be evaluated using inferential tests such as 1-way ANOVA, independent 2-tailed t tests, and chi-square tests. Associations between symptoms and lifestyle variables will be investigated by correlation analysis. Statistical significance is defined as a 2-tailed P value <.05.

RESULTS: The anticipated findings may support the need for targeted regional public health initiatives and underscore the importance of comprehensive screening, detailed patient history, and tailored care strategies for individuals with SCA. As of January 2026, this observational study has not received external funding. Participant recruitment and data collection commenced in January 2026 and are currently ongoing. Data analysis will be undertaken following completion of data collection, and the final results are expected to be submitted for publication in April 2026.

CONCLUSIONS: The findings will support the need for focused regional public health initiatives and emphasize the need for thorough screening, patient history, and customized care techniques for SCA.

PMID:41564337 | DOI:10.2196/80483

JMIR Mhealth Uhealth. 2026 Jan 21;14:e78960. doi: 10.2196/78960.

ABSTRACT

BACKGROUND: Approximately one-third of university students are overweight or obese, and a similar proportion experience anxiety or depression. Despite the interrelated nature of weight and mental health, interventions rarely address these issues simultaneously in young adults. Digital peer support interventions have the potential to promote healthy lifestyle and mental well-being. However, evidence is limited on whether a digital peer-driven approach can concurrently improve weight management and mental health in university populations with preobesity.

OBJECTIVE: This randomized controlled trial (RCT) evaluated the efficacy of a digital peer support program in concurrently improving weight management and mental health outcomes among university students with preobesity.

METHODS: In a single-blind parallel group RCT, 216 students with preobesity were allocated equally among three 6-month arms, which were a peer support intervention, an active wellness control, and a waitlist control. The peer support arm began with an interactive online workshop followed by moderated WeChat (Tencent) group discussions, daily micro tasks, biweekly group challenges, and digital badges to reinforce engagement. The active control group received the same schedule and formats but focused on general wellness topics. The waitlist group completed the same assessments without any intervention during the study period. The primary outcome measured the change in BMI from baseline to 6 months. Secondary outcomes included weekly physical activity measured in metabolic equivalent of task minutes, self-esteem, loneliness, anxiety, and depression assessed at 0, 2, 4, and 6 months. Analyses used linear mixed effects models.

RESULTS: Retention exceeded 90%. At 6 months, the peer-support group achieved a greater BMI reduction than the active control by 0.47 (95% CI -0.89 to -0.04) kg/m² and waitlist by 0.54 (95% CI -0.85 to -0.01) kg/m². Weekly metabolic equivalent of task-minutes was 129.5 higher than active control (95% CI 53.3-205.6) and 152.9 higher than waitlist (95% CI 68.4-237.4). Self-esteem increased by 1.81 points versus active control (95% CI 0.22-3.39) and 1.99 points versus waitlist (95% CI 0.21-3.76). Loneliness scores fell by 3.79 points relative to active control (95% CI -7.03 to -0.56) and by 5.02 points relative to waitlist (95% CI -8.38 to -1.66). No significant differences emerged for anxiety or depression.

CONCLUSIONS: A comprehensive digital peer-support program delivered via WeChat produced modest but clinically meaningful improvements in weight management, physical activity, self-esteem, and social connectedness among undergraduates with preobesity compared with wellness control and no intervention. These findings suggest that integrating peer support into scalable digital platforms can simultaneously address physical and psychosocial health in at-risk university populations.

PMID:41564335 | DOI:10.2196/78960

Surg Innov. 2026 Jan 21:15533506261418202. doi: 10.1177/15533506261418202. Online ahead of print.

ABSTRACT

BackgroundWithin the competencies in education for general surgery residents, the development of Laparoscopic Surgery Skills is of the utmost importance. We evaluated the usefulness of cadavers preserved with a formaldehyde-free solution in the acquisition/development of Skills for Laparoscopic Surgery once basic skills have been developed.MethodsThis is a single-center, single-blind, randomized educational intervention clinical trial. Participants took a theoretical and practical module on the acquisition of skills in laparoscopy and took a pre-test focused on intracorporeal enterorrhaphy. Subsequently, they were randomized by blocks into 3 branches continuing their training in skill acquisition models, silicone models, or Formaldehyde-free solution preserved corpses, and finally they performed a post-test. Two blind experts evaluated participants using the GOALS and OSATS scales for laparoscopic surgery.ResultsN = 37 participants were obtained. No relationship was found between the branch and the results of the GOALS and OSATS tests in pre and post-test, which implies comparability between the training methods. Also, the Pillai’s Trace statistical test for the MANOVA (0.95, F(12, 54) = 4.0988, P < 0.05) and (0.66, F(2, 31) = 30.18, P < 0.05) indicates that the educational level of the participant does have a statistically significant association with the results obtained in the pre- and post-test.ConclusionsEducation and development of laparoscopic surgery skills using cadavers preserved with the presented formaldehyde-free solution is comparable to other simulation models for the acquisition of skills in minimally invasive surgery. Also, this tool improves the learning curve in subjects with no prior experience.

PMID:41564334 | DOI:10.1177/15533506261418202

JMIR Form Res. 2026 Jan 21;10:e79957. doi: 10.2196/79957.

ABSTRACT

BACKGROUND: Smartphone-based ecological momentary assessment (EMA) methods highlight the impact of minority stress and socialization (eg, discrimination and social support) on smoking behaviors in lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adults; however, studies among LGBTQ+ adolescents are limited. The Puff Break EMA protocol was developed to address this gap.

OBJECTIVE: This study aims to report on the acceptability, feasibility, and appropriateness of the Puff Break EMA protocol.

METHODS: We utilized a multimethod design to evaluate the acceptability, feasibility, and appropriateness of the Puff Break EMA protocol. Participants who reported tobacco/nicotine or cannabis product use within the last 30 days engaged in a 2-week EMA trial, receiving 5 daily assessments measuring tobacco, nicotine, and cannabis use, stress and socialization, and product craving. Posttrial, participants completed a 15-minute exit survey and 60-minute semistructured exit interview. The exit survey used the 12-item Weiner acceptability, appropriateness, and feasibility measures and 6-item Mobile Application Rating Scale, app-specific subscale and also included 7 open-ended responses. The exit interview focused on a review of participants’ data to help understand smoking patterns and experiences with the Puff Break EMA protocol along with questions guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to understand how a future EMA mobile intervention aimed at monitoring and reducing tobacco, nicotine, and cannabis product use could effectively be disseminated to, accessed by, and implemented with LGBTQ+ adolescents. Lastly, lessons learned were obtained through feedback and data collected throughout the study.

RESULTS: All 50 adolescents between the ages of 15-19 (mean 17.82, SD 1.19) were enrolled in the study August 2023 and July 2024. Participants predominantly reported using vaporized tobacco and nicotine products (47/50, 94%), followed by cannabis products (39/50, 78%). The study sample was diverse regarding sexual orientation and gender identities with 32% (16/50) identifying as gay or lesbian, 32% (16/50) bisexual or pansexual, and 14% (7/50) transgender (neither transmasculine nor transfeminine). The median EMA response rate was 75% (~53 of 70 EMA surveys). Results indicated high feasibility (mean 4.43, SD 0.77), acceptability (mean 4.15, SD 0.83), and appropriateness (mean 4.46, SD 0.67) of the Puff Break EMA protocol. The Mobile Application Rating Scale app-specific subscale also indicated high acceptability and feasibility for the EMA method to increase knowledge, awareness, and intentions to monitor tobacco/nicotine use (mean 4.14, SD 1.01). Triangulated results from closed and open-ended survey responses identified 5 key themes related to feasibility, acceptability, and appropriateness. Participants highlighted the ease of the Puff Break EMA protocol, prompt survey reminders, and increased product use awareness. Key feedback from exit interviews included increased flexibility for survey timing, better response-option alignment, and appropriate only for populations interested in monitoring or reducing their product use.

CONCLUSIONS: Findings indicate that using EMA methods to understand the impact of stress and socialization experiences on smoking behaviors in LGBTQ+ adolescents is feasible, appropriate, and acceptable.

PMID:41564333 | DOI:10.2196/79957

Perit Dial Int. 2026 Jan 21:8968608251413925. doi: 10.1177/08968608251413925. Online ahead of print.

ABSTRACT

Care teams and patients want to know what happens next, and researchers have put together a lot of tools, such as predictive models, to help them predict the future. While these researchers are well-intentioned, the tools they develop are not always helpful. Most researchers know enough to perform various tests of their predictive models, such as statistical tests that answer the question: “Are the predictions based on this model better than a coin flip?” We urge researchers to add another test to their existing lists: “Does this model tell care teams anything they don’t already know?”

PMID:41564328 | DOI:10.1177/08968608251413925

Dentomaxillofac Radiol. 2026 Jan 21:twag006. doi: 10.1093/dmfr/twag006. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the measurement accuracy of cone-beam computed tomography (CBCT), high-resolution ultrasound (US), and intraoral scanning (IOS) with the gold-standard direct method in the measurement of peri-implant bone defects.

METHODS: Forty standard-threaded and thirty-eight aggressive-threaded (Aggressor®) implants-identical in diameter and length (4.3/10 mm) but differing in macro-thread design-were placed into bovine rib bones in vitro. Dehiscence, 2/3-wall, and 4-wall (circumferential) defects were prepared around the implants. Each defect was measured for maximum width, depth, and height using CBCT, US, IOS, and direct manual measurement. Analyses were performed using the General Linear Model (ANOVA). A p-value < 0.05 was considered statistically significant.

RESULTS: Intra-operator and inter-operator agreement showed high reliability (Gage R&R below 10%). For maximum width, defect type (F = 894.81, p < 0.001), method (F = 6.76, p < 0.001), and implant type (F = 5.39, p = 0.021) were significant. For maximum depth, defect type (F = 861.12, p < 0.001) and method (F = 3.39, p = 0.018) were significant. For maximum height, method (F = 12.62, p < 0.001) and defect type (F = 38.91, p < 0.001) were significant. The model demonstrated high explanatory power for width (R2=75.9%) and depth (R2=76.6%) measurements but lower for height (R2=20.7%). CBCT provided the most consistent results relative to direct measurements, followed by US, whereas IOS showed greater deviations.

CONCLUSIONS: CBCT showed the highest agreement with direct measurements, followed by US, while IOS exhibited greater variability. Defect type and measurement modality were the primary determinants of accuracy. These findings indicate that CBCT and US can be considered reliable tools for assessing peri-implant bone defects.

PMID:41564309 | DOI:10.1093/dmfr/twag006

JMIR Res Protoc. 2026 Jan 21;15:e90010. doi: 10.2196/90010.

NO ABSTRACT

PMID:41564303 | DOI:10.2196/90010

JMIR Med Inform. 2026 Jan 21;14:e81048. doi: 10.2196/81048.

ABSTRACT

BACKGROUND: Opioids are a widely prescribed class of medication for pain management. However, they have variable efficacy and adverse effects among patients, due to the complex interplay between biological and clinical factors. Pharmacogenetic testing can be used to match patients’ genetic profiles to individualize opioid therapy, improving pain relief and reducing the risk of adverse effects. Despite its potential, the pharmacogenetic testing uptake (use of pharmacogenetic testing) remains low due to a range of barriers at the patient, health care provider, infrastructure, and financial levels. Since testing typically involves a shared decision between the provider and patient, predicting the likelihood of a patient undergoing pharmacogenetic testing and understanding the factors influencing that decision can help optimize resource use and improve outcomes in pain management.

OBJECTIVE: This study aimed to develop machine learning (ML) models, identifying patients’ likelihood of pharmacogenetic uptake based on their demographics, clinical variables, medication use, and social determinants of health.

METHODS: We used electronic health record data from a single center health care system to identify patients prescribed opioids. We extracted patients’ demographics, clinical variables, medication use, and social determinants of health, and developed and validated ML models, including a neural network, logistic regression, random forest, extreme gradient boosting (XGB), naïve Bayes, and support vector machines for pharmacogenetic testing uptake prediction based on procedure codes. We performed 5-fold cross-validation and created an ensemble probability-based classifier using the best-performing ML models for pharmacogenetic testing uptake prediction. Various performance metrics, uptake stratification analysis, and feature importance analysis were used to evaluate the performance of the models.

RESULTS: The ensemble model using XGB and support vector machine-radial basis function classifiers had the highest C-statistics at 79.61%, followed by XGB (78.94%), and neural network (78.05%). While XGB was the best-performing model, the ensemble model achieved a high accuracy (32,699/48,528, 67.38%), recall (537/702, 76.50%), specificity (32,162/47,826, 67.25%), and negative predictive value (32,162/32,327, 99.49%). The uptake stratification analysis using the ensemble model indicated that it can effectively distinguish across uptake probability deciles, where those in the higher strata are more likely to undergo pharmacogenetic testing in the real world (320/4853, 6.59% in the highest decile compared to 6/4853, 0.12% in the lowest). Furthermore, Shapley Additive Explanations value analysis using the XGB model indicated age, hypertension, and household income as the most influential factors for pharmacogenetic testing uptake prediction.

CONCLUSIONS: The proposed ensemble model demonstrated a high performance in pharmacogenetic testing uptake prediction among patients using opioids for pain. This model can be used as a decision support tool, assisting clinicians in identifying patients’ likelihood of pharmacogenetic testing uptake and guiding appropriate decision-making.

PMID:41564302 | DOI:10.2196/81048

JMIR Med Educ. 2026 Jan 21;12:e71628. doi: 10.2196/71628.

ABSTRACT

BACKGROUND: Cancer immunotherapy represents a transformative advancement in oncology, offering new avenues for treating malignancies by harnessing the immune system. Despite its growing clinical relevance, immunotherapy remains underrepresented in undergraduate medical education, particularly in curricula integrating foundational immunology with clinical application. To address this gap, we developed and implemented a fully online elective for fourth-year medical students focused on core immunology concepts, immunotherapy mechanisms, Food and Drug Administration-approved treatments, immune-related adverse events, and patient-centered therapeutic decision-making.

OBJECTIVE: This study aimed to evaluate the effectiveness of an asynchronous-synchronous online cancer immunotherapy elective in improving medical student knowledge, engagement, and critical-thinking skills. We hypothesized that participation in the elective would be associated with perceived improvements in knowledge and clinical preparedness and inform future strategies for integrating cancer immunotherapy into medical curricula.

METHODS: We conducted a mixed methods study with fourth-year medical students enrolled in a 2-week elective at a US medical school. The curriculum included a self-paced foundational module, online discussion board, and a capstone oral presentation requiring students to propose a novel immunotherapy approach. Participants completed pre- and postcourse quizzes assessing immunotherapy knowledge and an anonymous postcourse Likert-scale survey. Quantitative data were summarized descriptively, and Likert responses were reported using medians and IQRs. Due to the small sample size, 2-tailed unpaired t tests comparing pre- and postcourse quiz averages were underpowered to detect statistically significant differences. Qualitative data were analyzed using inductive thematic analysis with investigator triangulation.

RESULTS: A total of 35 students completed the elective, and 20 submitted the postcourse survey (response rate: 57%). Across all Likert-scale items, students reported a median response of 5 (Strongly Agree), with IQR values ranging from 0 to 1, indicating uniformly positive perceptions and minimal variability in their evaluation of the course. Descriptively, average postcourse quiz scores were higher than precourse scores, suggesting improved conceptual understanding. Qualitative thematic analysis revealed three major themes: (1) increased confidence engaging with complex immunotherapy mechanisms, (2) appreciation for the flexibility and interactivity afforded by the hybrid asynchronous-synchronous model, and (3) enhanced understanding of the real-world clinical application of immunotherapy across interdisciplinary settings.

CONCLUSIONS: Descriptive quantitative and qualitative findings suggest that a targeted online cancer immunotherapy elective may enhance learners’ perceived knowledge and critical-thinking capacity related to emerging cancer therapies. The course’s hybrid structure offered flexibility, accessibility, and potential scalability. As immunotherapy continues to expand in clinical practice, this model provides a promising framework for integration into medical curricula. Future work should include larger cohorts and longitudinal follow-up into residency to more rigorously assess educational impact.

PMID:41564300 | DOI:10.2196/71628