Category: Statistics

BMC Health Serv Res. 2025 Nov 4;25(1):1440. doi: 10.1186/s12913-025-13613-9.

ABSTRACT

BACKGROUND: The medicines’ pathway in nursing homes (NHs) is complex and challenging, resulting in processes that are prone to medication errors and lack person-centredness. There is a clear need for quality improvement initiatives, for which a systems approach – rather than isolated interventions – is considered more effective. In this context, the Process Optimization Of the Medicines’ pAthway in nursing Homes (POOMAH) study was established. The study aims to evaluate the effectiveness of different formats and intensities of support provided to NHs to improve the quality of the medicines’ pathway.

METHODS: The intervention includes four arms, each offering a different level of support: access to toolbox, intervision meetings, external coaching and integration of a coordinating pharmacist. In total, 100 NHs participate in this study, with stratified randomization used to allocate them to the intervention arms. The primary outcome is the overall quality of the medicines’ pathway, through the calculation of performance scores. The key secondary outcome is the number of (psychoactive) medications used by NHRs. Other secondary outcomes include the quality of specific processes and KAs of the medicines’ pathway, represented by process-specific and activity-specific performance scores, and the number of falls and hospitalizations of NHRs. A comprehensive process evaluation will also be conducted. Both quantitative and qualitative data will be collected and analyzed using (generalised) linear mixed models and content/thematic analysis, respectively.

DISCUSSION: The POOMAH study will assess and compare the effectiveness of four support levels aimed at improving the quality of the medicines’ pathway in NHs. The findings will contribute to the evidence base on quality improvement in this context and inform future strategies, including the role of pharmacists in optimizing medication management.

CLINICAL TRIAL NUMBER: Not applicable. Although this study was not classified as a clinical trial by the ethics committee, it was retrospectively registered in the ISRCTN registry (ISRCTN17231220) on 07 May 2025 ( https://www.isrctn.com/ISRCTN17231220 ).

PMID:41188918 | DOI:10.1186/s12913-025-13613-9

Respir Res. 2025 Nov 4;26(1):306. doi: 10.1186/s12931-025-03378-4.

ABSTRACT

BACKGROUND: There is limited real-world evidence on the use and positioning of inhaled long-acting muscarinic antagonists (LAMAs) for treating severe asthma.

OBJECTIVE: We aimed to assess the differences in clinicians’ perspectives on prescribing LAMA for severe asthma across Europe.

METHODS: Within the Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) network, we conducted a multi-country survey of 470 respiratory clinicians in 2023-24.

RESULTS: Most participants were pneumonologists (83%). 68% reported using specific criteria for prescribing LAMA for severe asthma, primarily fixed bronchial obstruction (68%), frequent asthma exacerbations (65%), and a history of smoking (53%). Improved quality of life, lung function improvement, and reduction of asthma exacerbations were the three expected outcomes of LAMA treatment that showed the largest agreement across clinicians (85-95%). As compared to non-severe asthma specialists (about 50% of the sample), severe asthma specialists were more likely to report always prescribing LAMA before biologics (54 vs. 41%) and before oral corticosteroids (OCS) (51 vs. 40%). Approximately 90% of participants prioritised tapering or discontinuing OCS before stopping LAMA. Overall, participants in Northern (n = 73) and Western Europe (n = 71) appeared less prone to prescribe LAMA and less confident in their benefits compared to those from Eastern (n = 88) and Southern Europe (n = 238). In particular, most participants from Latvia (91%) and Lithuania (67%) reported that LAMAs are not reimbursed for severe asthma in their countries. Most participants who expressed their opinion favoured triple therapy (n = 236) over single inhaler therapy (n = 91).

CONCLUSION: Our findings show that barriers and heterogeneous approaches still limit LAMA prescription for severe asthma in Europe, potentially leading to the underuse of this treatment option. Establishing a clear role for LAMA within a precision medicine framework is crucial; this aspect is not yet firmly supported by current international recommendations.

PMID:41188910 | DOI:10.1186/s12931-025-03378-4

Child Adolesc Psychiatry Ment Health. 2025 Nov 4;19(1):119. doi: 10.1186/s13034-025-00974-6.

ABSTRACT

BACKGROUND: The severity of tics may influence executive function in children and adolescents diagnosed with tic disorders. The underlying mechanism is still inadequately researched. This study investigates the mediating role of premonitory urges in the relationship between tic severity and executive functioning, alongside the moderating effect of comorbidities.

METHODS: A total of 154 children and adolescents, aged 6 to 15 years, diagnosed with tic disorders, were recruited from Fujian, China. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urges for Tics Scale (PUTS), and Behavior Rating Inventory of Executive Function (BRIEF) were utilized to evaluate tic severity, premonitory urges, and executive functioning. R software version 4.4.3 was used for descriptive statistics and Pearson correlation studies. The moderated mediator models were tested using Bayesian Structural Equation Modeling (BSEM).

RESULTS: A Bayesian simple mediation model revealed that the premonitory urge fully mediated the association between tic severity and executive functioning. Additionally, comorbidity was found to independently predict both the premonitory urge and executive functioning. In the context of a moderated mediation model, comorbidity intensified the association between tic severity and the premonitory urge, resulting in more pronounced indirect effects on behavioral regulation (BRI) and metacognition (MI). The Index of Moderated Mediation was significant for both BRI and MI, thereby confirming the enhancement of the mediation pathway driven by comorbidity.

CONCLUSIONS: This study is the first application of BSEM to clarify the mediating mechanism through which tic severity affects executive functioning via the premonitory urge, while concurrently validating the moderating effect of comorbidities. This finding supports the optimization of clinical assessment and intervention strategies.

PMID:41188908 | DOI:10.1186/s13034-025-00974-6

J Transl Med. 2025 Nov 4;23(1):1219. doi: 10.1186/s12967-025-07227-2.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly being applied in healthcare; however, their performance in specialized fields, such as oncology, is subject to temporal factors, including knowledge decay and concept drift. The impact of these temporal dynamics on LLM question-answering accuracy in oncology remains inadequately evaluated. This study aims to systematically assess the temporal evolution of LLM accuracy in responding to oncology-related questions using real-world data.

METHOD: We systematically collected relevant literature through 2025 by searching LLM-related keywords in PubMed, Google Scholar, and Web of Science databases. The inclusion criteria were as follows: (1) cancer-related research; (2) clear and complete question descriptions; and (3) complete answers. The final sample (n = 23) contained 614 research questions, comprising subjective questions (n = 223) and multiple-choice questions (n = 391). Following randomization of responses generated by three LLMs (ChatGPT-3.5, ChatGPT-4, and Gemini), we evaluated their accuracy across different cancer categories using both original scoring criteria and Likert scale scoring methods. Data analysis was performed using R statistical software, employing random or fixed effects models to calculate pooled mean differences (MD) and relative risks (RR) with their 95% confidence intervals (CI).

RESULTS: The findings demonstrated that in both subjective and objective oncology assessments, ChatGPT-3.5 (subjective questions MD = -3.30; objective questions RR = 0.92) and ChatGPT-4 (subjective questions MD = -7.17; objective questions RR = 0.93) showed declining performance trends over time, while Gemini exhibited significant improvements over time (subjective questions MD = 11.48; objective questions RR = 1.15). Notably, ChatGPT-3.5’s performance on subjective questions revealed a significant turning point between March 14, 2023, and April 26, 2023, shifting from initially superior performance on newer questions to inferior performance compared with original questions, with the performance gap progressively widening.

CONCLUSIONS: Our meta-analysis reveals temporal performance degradation in ChatGPT-3.5 and ChatGPT-4, which contrasts with the consistent improvement observed in Gemini. These findings provide essential guidance for the evidence-based deployment of LLMs in oncology.

PMID:41188901 | DOI:10.1186/s12967-025-07227-2

BMC Med Educ. 2025 Nov 4;25(1):1543. doi: 10.1186/s12909-025-08122-6.

ABSTRACT

BACKGROUND: Head trauma is the most common injury from accidents, making rapid and accurate assessment crucial. Incorrect evaluations can lead to serious complications, including brain dysfunction and death. Thus, it is vital to teach nursing students proper assessment techniques. This study evaluates the effectiveness of a digital game-based study guide for enhancing nursing students’ knowledge and practical skills in head trauma assessment.

METHODS: This quasi-experimental study involved nursing students in their 8th semester at Shahid Beheshti University of Medical Sciences in 2024, randomly assigned to control and intervention groups. Data collection occurred from May to July 2024. Both groups received two 2-hour face-to-face educational sessions in one week. The intervention group then utilized the digital game-based study guide. Knowledge and practical skills were assessed using a trauma evaluation tool and compared between groups, with data analyzed using SPSS version 20.

RESULTS: Ninety-three nursing students participated (44 males and 49 females), with a mean age of 22.78 years (SD = 1.24). A paired samples t-test showed statistically significant knowledge improvement in both groups (P < 0.05). An independent samples t-test indicated statistically significant differences in knowledge and practical skills between groups post-intervention (P < 0.05).

CONCLUSION: The study shows that a digital game-based study guide significantly enhances nursing students’ knowledge and skills in head trauma assessment.

TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir ) with the IRCT ID: IRCT20210131050189N10, and it received approval on July 21, 2024.

PMID:41188890 | DOI:10.1186/s12909-025-08122-6

BMC Med Educ. 2025 Nov 4;25(1):1540. doi: 10.1186/s12909-025-08113-7.

ABSTRACT

BACKGROUND: Malnutrition and poor dietary intake are major health challenges today. There are well-established benefits of nutrition interventions, but a lack of formalized nutrition training in medical school and residency. There is also little published information regarding nutrition training impact on residents. Physicians lack knowledge, skills, confidence, and training to effectively counsel in daily practice. Consequently, there is urgent need to improve nutrition training in medicine.

METHODS: This pre-post study evaluated the impact of an online nutrition course provided to family medicine residents. Time was provided at Academic Half Day to complete the course as well as pre- and post-course surveys with knowledge tests through SurveyMonkey. Descriptive statistics were used to evaluate responses. The project was approved by the University of Saskatchewan Behavioural Research Board (Beh 4433).

RESULTS: Thirteen residents completed the pre-course questionnaire (response rate = 54%). Of these, ten (77%) felt they had received inadequate nutrition training, and all thought patients would benefit from improved nutrition counselling. Six residents completed the post-course questionnaire (response rate = 24%). All post-course respondents thought the course was beneficial and that it should be offered to all Canadian family medicine residents, with majority believing it should be mandatory. Respondents’ nutrition knowledge, confidence, beliefs on importance of nutrition counselling, and nutrition counselling in practice appear to increase/improve after training.

CONCLUSIONS: Implementation of formal nutrition training during residency is important and has the potential to positively influence family medicine residents’ nutrition knowledge, attitudes, and rates of nutrition counselling.

RECOMMENDATIONS: Future research with larger sample sizes is needed to support these conclusions and improve nutrition training during residency. Future studies should look at nutrition training in other specialties as well as examine the rate and quality of nutrition counselling after residency completion.

PMID:41188879 | DOI:10.1186/s12909-025-08113-7

Int Breastfeed J. 2025 Nov 4;20(1):79. doi: 10.1186/s13006-025-00777-7.

ABSTRACT

BACKGROUND: Autism spectrum condition (ASC) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and repetitive behaviors. Emerging evidence suggests that early nutrition, particularly reduced breastfeeding exposure, may be associated with an increased risk of ASC. However, this evidence is limited, especially in non-Western populations.

METHODS: We conducted an unmatched case-control study in Saudi Arabia to investigate the association between breastfeeding practices and ASC. Data were collected through an online questionnaire from mothers of children with and without ASC. Cases were children with a confirmed ASC diagnosis, and controls were neurotypical children without a diagnosis of ASC. Breastfeeding exposure was categorized according to the World Health Organization definitions (from highest to lowest exposure) as follows: exclusive, predominant, partial, or no breastfeeding. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI).

RESULTS: Between 1 October 2024 and 25 January 2025, a total of 283 participants (126 cases and 157 controls) were recruited. A dose-response relationship was observed, where decreased breastfeeding exposure was associated with progressively higher odds of ASC (OR for trend: 1.58; 95% CI 1.24, 2.01). In univariable analyses, using exclusive breastfeeding as the reference category, partial breastfeeding was associated with increased odds of ASC (OR: 2.49; 95% CI 1.40, 4.42). Similarly, children who were not breastfed had significantly higher chance of ASC than the reference category (OR: 3.46; 95% CI 1.47, 8.13). The strength of these associations was attenuated after multivariable adjustment but remained statistically significant (OR: 2.28; 95% CI 1.22, 4.25 for partial versus exclusive breastfeeding and OR: 2.86; 95% CI 1.12, 7.26 for no breastfeeding versus exclusive breastfeeding).

CONCLUSIONS: Our findings suggest that reduced breastfeeding exposure is associated with increased odds of ASC. However, these results should be interpreted cautiously, considering the inherent limitation of case-control studies and the potential of reverse causality.

PMID:41188878 | DOI:10.1186/s13006-025-00777-7

J Orthop Surg Res. 2025 Nov 4;20(1):954. doi: 10.1186/s13018-025-06393-9.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) remains the definitive treatment for end-stage knee osteoarthritis (OA). Despite its success, post-operative rehabilitation continues to be challenged by limited access to care, inconsistent patient compliance, and a lack of standardized protocols. In response, smart device-assisted telerehabilitation has gained attention for its capacity to deliver real-time monitoring and individualized feedback. However, its comparative effectiveness relative to traditional rehabilitation approaches remains inconclusive.

METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing smart device-assisted telerehabilitation to conventional rehabilitation following TKA. Databases searched included PubMed, Web of Science, EMBASE, and Cochrane Library. Key outcomes assessed were pain (Visual Analog Scale (VAS)), functional recovery (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), and range of motion (ROM) (knee flexion and extension angles). Meta-analysis was performed using Stata 16.0, with heterogeneity evaluated via the I² statistic. Subgroup and sensitivity analyses were also conducted.

RESULTS: A total of 22 RCTs encompassing 2,181 participants were included. Overall, there were no significant differences between smart and conventional rehabilitation regarding VAS (SMD = 0.02, 95% CI: – 0.24 to 0.28) and WOMAC scores (SMD = – 0.27, 95% CI: – 0.60 to 0.06). Subgroup analyses revealed that augmented reality (AR) interventions were associated with greater pain reduction (VAS: SMD = – 1.12, 95% CI: – 1.98 to – 0.25), and virtual reality (VR) interventions led to significant functional improvement (WOMAC: SMD = – 0.47, 95% CI: – 0.82 to – 0.13). Furthermore, smart rehabilitation yielded superior outcomes in knee extension angle (SMD = – 0.15, 95% CI: – 0.28 to – 0.02). Sensitivity and publication bias analyses confirmed the stability of the results.

CONCLUSION: Smart device-assisted telerehabilitation is comparable to conventional rehabilitation in overall outcomes after TKA. However, AR and VR technologies demonstrate added value in specific domains of recovery, suggesting that future rehabilitation programs should consider integrating these modalities to enhance effectiveness and personalization of care.

PMID:41188876 | DOI:10.1186/s13018-025-06393-9

BMC Health Serv Res. 2025 Nov 4;25(1):1441. doi: 10.1186/s12913-025-13628-2.

ABSTRACT

BACKGROUND: Telemedicine has revolutionized healthcare delivery, significantly improving accessibility and efficiency. In China, the predominant mode of telemedicine service delivery is Business-to-Business (B2B). However, the utilization of B2B telemedicine is relatively low. Within the B2B context, primary care physicians (PCPs) are critical users. There is a lack of knowledge regarding PCPs’ continuous intention to use the B2B. To address this gap, the study aims to study and unveil factors affecting PCPs’ continuous usage intention for B2B telemedicine.

METHOD: This study proposes an integrated Technology-Individual-Environment theoretical framework to analyze factors and mechanisms influencing PCPs’ continuous usage intention for B2B telemedicine, considering exogenous, technology, and endogenous dimensions. We used Partial Least Squares Structural Equation Modeling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to test the research model. A cross-sectional study was conducted among PCPs with prior B2B telemedicine usage experience across more than 30 primary healthcare institutions in China. Overall, 421 (63.88%) out of 659 questionnaires were valid.

RESULTS: The PLS-SEM results revealed that within the individual dimension, attitude, perceived behavioral control, and intrinsic motivation positively influence PCPs’ continuous usage intention, while perceived risk had a negative impact. Within the technological dimension, assurance and reliability demonstrated direct positive effects on continuous usage intention, whereas tangibility indirectly influenced intention through attitudinal mediation. Notably, the environmental dimension showed no statistically significant effects on continuous usage intention. Complementing the PLS-SEM findings, fsQCA analysis identified three configurations that lead to high continuous usage intention and three configurations leading to low intention. Based on these results, factors influencing PCPs’ continuous usage intentions are classified into foundation factors, performance factors, and enhancement factors.

CONCLUSION: Within B2B telemedicine, this study focuses on the factors and mechanisms influencing PCPs’ continuous usage intention. These findings provide a robust theoretical foundation for policymakers and healthcare administrators seeking to enhance PCPs’ engagement with B2B telemedicine platforms, ultimately contributing to the advancement of integrated healthcare delivery systems.

PMID:41188874 | DOI:10.1186/s12913-025-13628-2

Malar J. 2025 Nov 4;24(1):371. doi: 10.1186/s12936-025-05614-0.

ABSTRACT

BACKGROUND: Malaria in pregnancy contributes significantly to poor maternal health outcomes, accounting for 17.6% of outpatient visits in Ghana. The Ashanti Region, particularly Sekyere South District, bears a high burden despite interventions, such as ITN distribution and intensified IPTp education. Limited evidence exists on how pregnant women’s knowledge, attitudes and practices (KAP) influence preventive behaviours and ANC use in this setting.

METHODS: A cross-sectional survey was conducted among 422 pregnant women using structured questionnaires. Descriptive statistics and logistic regression were applied to assess predictors of malaria prevention behaviours and ANC attendance.

RESULTS: Most respondents (78%) had adequate knowledge, though misconceptions persisted (56% believed malaria could spread person-to-person). Only 48% knew the recommended ≥ 3 IPTp doses, and ITN use was 63%, with non-use linked to heat discomfort and unavailability. Knowledge of IPTp dosage was significantly associated with uptake (p < 0.001), but socio-demographic factors were not predictors of ANC attendance.

CONCLUSION: Gaps in malaria prevention stem from misconceptions, incomplete IPTp adherence, and inconsistent ITN use rather than supply shortages. Priorities include strengthening ANC counselling, correcting myths, introducing reminder prompts, and expanding outreach with ITN replacement. Enhancing implementation fidelity is critical to improving maternal health outcomes.

PMID:41188873 | DOI:10.1186/s12936-025-05614-0