Category: Statistics

BMC Pharmacol Toxicol. 2026 Jun 5. doi: 10.1186/s40360-026-01159-3. Online ahead of print.

ABSTRACT

BACKGROUND: Individual variability of therapeutic response and adverse effects of diazepam is frequently observed in pediatric cohorts. It might be related to the genetic polymorphisms in cytochrome P450 2C19 (CYP2C19), a principal enzyme mediating diazepam metabolism.

OBJECTIVES: To investigate the association between CYP2C19*2 (c.681G > A), CYP2C19*3 (c.636G > A), and CYP2C19*17 (-806 C > T) polymorphisms and clinical outcomes-specifically treatment efficacy and respiratory adverse effects-following intravenous diazepam administration in children with seizures.

METHODS: This prospective, single-center cohort study enrolled 100 pediatric patients (0-18 years) treated with IV diazepam for febrile/afebrile seizures. Genetic analysis was performed using next-generation sequencing. Clinical endpoints included seizure control following one or two diazepam doses and the incidence of respiratory complications. Statistical analyses assessed associations between CYP2C19 genotypes and seizure control outcomes.

RESULTS: The median age was 4.5 years (IQR: 2.4-8.5); 61% were male. Overall, seizure cessation was achieved in 76% with the first dose of IV diazepam and in 79% cumulatively. Respiratory side effects were observed in 15% of patients, with 9% requiring positive pressure ventilation. The CYP2C19*2 and CYP2C19*17 alleles were identified in 19% and 49% of participants, respectively. However, the CYP2C19*3 variant was absent. Notably, the presence of the CYP2C19*17 CT/TT genotype-particularly in combination with the CYP2C19*2 GG genotype-was significantly associated with both diazepam treatment failure (p = 0.038) and increased risk of respiratory adverse effects (p = 0.005).

CONCLUSION: This study is the first to delineate the clinical relevance of CYP2C19 polymorphisms in a Turkish pediatric population treated with diazepam. The findings underscore the potential utility of pharmacogenetic profiling to predict therapeutic response and enhance the safety of benzodiazepine use in pediatric seizure management.

PMID:42249455 | DOI:10.1186/s40360-026-01159-3

Arthritis Res Ther. 2026 Jun 6. doi: 10.1186/s13075-026-03834-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To propose and evaluate a CDASI-informed, medical-record-based site-by-lesion cutaneous phenotyping framework for anti-MDA5-positive dermatomyositis, using established systemic and immunological markers as reference anchors to examine whether this framework provides additional phenotypic resolution beyond conventional binary skin assessment.

METHODS: This single-centre retrospective cross-sectional study enrolled 339 anti-MDA5-positive DM patients. Cutaneous involvement was coded as binary ulceration, itch, and scale features across seven prespecified anatomical regions. The framework was CDASI-informed but did not use formal CDASI activity or damage scores. FLATCAN components, PAH, IgG, and IgM were used as systemic and immunological reference markers. Analyses included FDR-corrected univariate screening, hypothesis-driven multivariable association models, restricted cubic spline analysis, exploratory internal model-performance summaries, cross-correlation SVD (CC-SVD), and exploratory clustering.

RESULTS: The framework revealed complementary skin-systemic association patterns. First, the spatial extent of ulceration refined a conventional binary ulcer signal: any cutaneous ulceration was associated with CD8 + T-cell depletion (OR = 3.35, P < 0.001; FDR q = 0.026), and ulcer site count remained independently associated with CD8 + depletion (OR = 1.43 per site, P = 0.008). Second, anatomical location contributed distinct information: facial ulceration was associated with PAH (OR = 2.28, P = 0.003) more strongly than overall ulcer site count. Third, lesion-feature type separated different immunological patterns, with ulceration preferentially associated with CD8+/IgG-related signals and itch with IgM-related signals. CC-SVD organised these observations into exploratory dimensions, including a bootstrap-stable facial involvement-PAH/infection dimension and a statistically less stable acral ulcer-CD8+/IgG dimension.

CONCLUSION: Site-by-lesion cutaneous phenotyping may provide a useful framework for studying phenotypic heterogeneity in anti-MDA5-positive dermatomyositis. The observed associations are exploratory and require prospective validation using standardised skin assessment and clinical outcome follow-up.

PMID:42249434 | DOI:10.1186/s13075-026-03834-6

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08783-9. Online ahead of print.

ABSTRACT

BACKGROUND: Despite National Oral Health Programme launched in India significant knowledge-practice gaps persist in rural populations. This study evaluates oral health literacy, behavioural determinants, and clinical outcomes among rural Odisha residents using contemporary health behaviour frameworks. However, evidence on behavioural pathways and public dental service utilisation under NOHP in rural populations remains limited.

METHODS: A community based cross-sectional study was conducted among 417 adults (≥ 18 years) through two-stage stratified random sampling in Satyabadi Block, Puri District (May-September 2024). Data was collected using a validated 20-item questionnaire assessing knowledge, attitudes and practices (KAP) regarding National Oral Health Programme (NOHP) and WHO 2013 for oral health examination. Statistical analyses included descriptive statistics, regression models, and structural equation modelling (SEM) to examine complex pathways linking knowledge, attitudes, practices, and clinical outcomes.

RESULTS: Oral health program knowledge was low (6.7%), while attitudes were favourable (75.5-84.7%). Despite this, service utilisation remained minimal (2.4%). Mean DMFT was 3.69 ± 1.80. SEM showed significant pathways from knowledge to practice (β = 0.458, p < 0.001), explaining 34.2% of variance in behaviour. A substantial knowledge-practice gap (95.2%) was observed.

CONCLUSIONS: This study reveals a critical “know-do” gap where favourable attitudes fail to translate into preventive behaviours or service utilization. Structural barriers like geographic isolation, financial constraints, poor infrastructure may play a dominant role in individual-level factors. Multi-level interventions addressing systemic barriers, community health worker training, mobile dental units and behaviour change communication are imperative for NOHP effectiveness. Findings suggest that utilisation is likely influenced by structural barriers such as accessibility and service availability.

PMID:42249431 | DOI:10.1186/s12903-026-08783-9

Pilot Feasibility Stud. 2026 Jun 6. doi: 10.1186/s40814-026-01855-1. Online ahead of print.

ABSTRACT

BACKGROUND: Occupational therapy interventions can improve the ability to perform activities of daily living (ADL) in individuals with chronic conditions. The group-based ADAPT program was developed as an alternative to usual one-to-one occupational therapy (UOT), aiming to enhance ADL ability through structured problem-solving processes and implementation of adaptational strategies. This pilot and feasibility study evaluated the feasibility of delivering ADAPT 3.0 in a municipal setting and informed the design of a future full-scale randomised controlled trial (RCT).

METHODS: A two-armed pilot RCT was conducted in a Danish municipality, comparing outcomes of ADAPT 3.0 to UOT. Eligible clients (≥ 18 years, chronic conditions, decreased ADL ability) were randomised to either intervention or control group. Outcomes included recruitment and retention, trial participation, impact on staff, access to UOT documentation, completion of outcome measures, and fidelity to the ADAPT manual. Descriptive statistics, logbook notes, and predefined progression criteria guided the evaluation.

RESULTS: Twelve clients and four ADAPT-trained occupational therapists participated. ADAPT 3.0 was delivered with high fidelity and dose. Most progression criteria were met, including access to UOT documentation and successful delivery of ADAPT 3.0. However, recruitment was slower than anticipated, and clients in the UOT group reported to receive limited trial-related information. Completion rates of follow-up evaluations were acceptable in the ADAPT group but lower in the UOT group. Minor structural and procedural challenges were identified.

CONCLUSION: The study supports the feasibility of delivering ADAPT 3.0 in a municipal setting and progressing to a full-scale RCT. To ensure robust trial conduct, key refinements are needed in recruitment procedures, participant information for the UOT group, and clarity of outcome measures.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05775653.

PMID:42249425 | DOI:10.1186/s40814-026-01855-1

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08802-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To clinically and radiographically compare two osseodensification techniques in terms of implant stability and osseointegration in a split-mouth design.

MATERIALS AND METHODS: 7 patients with an edentulous maxillary anterior area who need implant placement were divided into 2 groups. Group A included 7 implants and was prepared using the Densah Bur technique (DB-Group), while Group B included 7 implants and was prepared using the Magnetic Mallet technique (MM-Group). Surgery was performed, followed by clinical and radiographic follow-up to evaluate implant stability in both groups. A linear mixed model (LMM) statistical analysis was utilized to handle the clustering effect of the data.

RESULT: The mixed model revealed a stable data analysis owing to the significant intercept for all of the dependent variables (P < 0.001). Densah Burs technique demonstrated lower postoperative pain, faster wound healing, higher implant stability, and greater preservation of labial bone thickness, while both methods showed similar long-term bone density and crestal width outcomes.

CONCLUSION: Within the confines of this study, the rotary-based Densah Bur osseodensification technique was associated with higher implant stability and labial plate thickness, alongside comparable bone density. These findings suggest potentially more predictable osteotomy compaction and autografting in the maxillary anterior esthetic zone implant osteotomy preparation.

TRIAL REGISTRATION: Trial was retrospectively registered at pactr.samrc.ac.za [PACTR202412717492416-(2024-12-31)].

PMID:42249424 | DOI:10.1186/s12903-026-08802-9

BMC Musculoskelet Disord. 2026 Jun 5. doi: 10.1186/s12891-026-10048-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate and compare the efficiency, safety and accuracy of robot-assisted internal fixation and traditional freehand percutaneous screw in talar neck fracture treatment.

METHODS: This study included 23 patients in the robot-assisted group and 23 patients in the traditional group. Age, injured side, average post-operative follow-up time, time from injury to surgery, operation time, intraoperative blood loss, intraoperative fluoroscopic dose, fracture healing time, American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score, Visual Analogue Scale (VAS) score and 12-item Short-Form Survey (SF-12) score were recorded and compared.

RESULTS: This study revealed no statistical difference in baseline characteristics between the two groups, as well as the average post-operative follow-up time, injury to operation time, intraoperative blood loss, fracture healing time, VAS score, 12-item Short-Form Survey (SF-12) score and AOFAS score (P > 0.05). A significant difference was found between the robot-assisted group and the traditional group at the time of operation and intraoperative fluoroscopic dose (P < 0.05).

CONCLUSION: Robot-assisted screw placement for talar neck fractures achieved clinical outcomes comparable to those of traditional surgery, with the advantages of significantly shorter operation time and lower intraoperative fluoroscopic dose. Robot-assisted surgery appears to be a safe, effective, and low-radiation alternative for selected talar neck fractures (Hawkins type II).

PMID:42249405 | DOI:10.1186/s12891-026-10048-z

BMC Health Serv Res. 2026 Jun 5. doi: 10.1186/s12913-026-14895-3. Online ahead of print.

ABSTRACT

BACKGROUND: Medical error under-reporting remains a critical barrier to patient safety, often driven by hierarchical organizational structures and fear-related mechanisms. This study aimed to examine the mediating role of fear of negative evaluation in the relationship between power distance and attitudes toward medical error reporting among healthcare professionals.

METHODS: A multicenter study of physicians and nurses was conducted in five tertiary hospitals in Istanbul, Turkey. Data were collected using anonymous, paper-based questionnaires with a stratified quota-based convenience sampling approach. The survey included validated scales assessing organizational power distance, fear of negative evaluation, and attitudes toward medical errors. Mediation analysis was conducted using regression-based models with bias-corrected and accelerated (BCa) bootstrap confidence intervals based on 5,000 resamples. Statistical significance was set at p < 0.05.

RESULTS: A total of 705 healthcare professionals participated (mean age: 32.3 [SD 8.5] years; 43.7% physicians, 56.3% nurses). More than half (51.9%) reported witnessing a medical error in the past year, whereas only 4.5% demonstrated positive attitudes toward error reporting. Internal medicine staff exhibited higher fear of negative evaluation and greater instrumental use of power compared with surgical staff (p < 0.01). Physicians reported higher fear of negative evaluation and greater use of instrumental power compared with nurses (p < 0.01). Fear of negative evaluation was positively associated with all power distance dimensions (p < 0.05). Mediation analysis showed that fear of negative evaluation mediates the relationship between instrumental use of power and medical error reporting attitudes (standardized β = 0.020, p = 0.013).

CONCLUSION: Despite the high prevalence of witnessed medical errors, negative attitudes toward error reporting remained live. The findings suggest that hierarchical organizational dynamics and fear-related mechanisms may contribute to barriers to transparent reporting, highlighting the importance of psychologically safe and nonpunitive communication environments in hospital settings.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42249402 | DOI:10.1186/s12913-026-14895-3

BMC Med Educ. 2026 Jun 5. doi: 10.1186/s12909-026-09596-8. Online ahead of print.

ABSTRACT

BACKGROUND: The number of combined Doctor of Medicine and Master of Business Administration (MD/MBA) programs in the United States has increased fivefold over the past two decades, reflecting a shift toward integrating medical and business education. While most MD/MBA programs follow a 5-year structure with a dedicated year for business coursework, some offer 4-year programs that integrate both degrees concurrently. This study evaluated the structure and characteristics of MD/MBA programs in the United States in 2025, comparing 4-year and 5-year program structures and examining how 4-year programs integrate medical and business training.

METHODS: In January 2025, 93 U.S. MD/MBA programs were identified using AAMC and Association of MD/MBA Programs databases. Programs were categorized by duration (4-year vs. 5-year) and analyzed for admissions requirements, credit loads, degree integration, and institutional characteristics. Findings were compared to a 2022 analysis by Laditi et al. Additional analyses compared 4-year and 5-year programs in 2025, including how 4-year programs integrate business coursework into medical training. Statistical analyses used chi-square or Fisher’s exact tests (α = 0.05).

RESULTS: In total, 93 MD/MBA programs were identified in 2025, compared to 92 in 2022. From 2022 to 2025, significant changes included programs requiring full-time MBA credit loads (9% to 37%, p < 0.001) and a reduction in GMAT requirements (34% to 15%, p = 0.01). Of the 93 programs, 12 (13%) offered a 4-year track. Compared to 5-year programs, 4-year programs offered significantly more MBA specializations (83% vs. 15%, p < 0.001) and required fewer than 50 MBA credits (100% vs. 66%, p = 0.03). Among 4-year programs, 42% delivered MBA coursework online, 25% in-person, and 33% in a hybrid format.

CONCLUSIONS: The overall number of MD/MBA programs remained stable between 2022 and 2025, but program structures and admission requirements continued to evolve. This study highlights the differences between 4-year and 5-year MD/MBA programs and describes how 4-year programs integrate business training within medical education. These findings may inform prospective students, program administrators, and medical education policymakers seeking to design, improve, or select MD/MBA programs that best prepare future physician-leaders.

PMID:42249401 | DOI:10.1186/s12909-026-09596-8

Orphanet J Rare Dis. 2026 Jun 5. doi: 10.1186/s13023-026-04410-6. Online ahead of print.

ABSTRACT

BACKGROUND: Xeroderma Pigmentosum (XP), is a rare genetic condition characterised by extreme sensitivity to ultra violet (UV) radiation, conferring a 2,000- to 10,000-fold increased risk of developing melanoma and non-melanoma skin cancers. Families affected by XP face intense emotional strain, ongoing medical surveillance and intervention, and stringent lifelong adaptations to minimise UV exposure. Despite these challenges, little is known about the psychosocial burden experienced by children with XP and their immediate family members. This study explored the lived experiences and support needs, both medical and psychosocial, of families caring for a child with XP.

METHOD: We conducted qualitative semi-structured interviews, in person or via Zoom, with parents and children affected by XP, examining diagnostic experiences, psychosocial impacts, care preferences, and informational needs. The interview guide was developed by a multidisciplinary expert panel. Eligible participants included parents of children with XP, and patients or siblings aged 5-18 years without intellectual disability. Participants were recruited via the Australian Paediatric XP Support Group, representing the full known XP cohort in Australia. Of the seven identified families, five contributed at least one parent participant. Among eight identified children, four were ineligible, and one was not enrolled. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive, line-by-line coding in NVivo Pro. Descriptive statistics summarised participant demographics.

RESULTS: Eight parents (63% female, mean age 45 years) and three children (67% female, mean age 10 years) participated. Four themes emerged: (1) a prolonged and distressing diagnostic journey, often marked by misdiagnosis and uncertainty; (2) strong preferences for integrated, multidisciplinary care to reduce fragmentation; (3) significant psychosocial impacts, including isolation, anxiety-driven vigilance, and challenges adapting to absolute UV-protective routines; and (4) substantial unmet information needs at diagnosis, leaving families feeling overwhelmed and underprepared.

CONCLUSION: Families affected by XP experience significant and enduring psychosocial burden. Findings highlight the urgent need for coordinated, interdisciplinary support that extends beyond medical care. This study contributes to the growing call within the rare disease community for integrated care models that centre patient and family wellbeing.

PMID:42249400 | DOI:10.1186/s13023-026-04410-6

Mol Cancer. 2026 Jun 5;25(1):151. doi: 10.1186/s12943-026-02671-0.

NO ABSTRACT

PMID:42249396 | DOI:10.1186/s12943-026-02671-0