Category: Statistics

J Am Coll Clin Pharm. 2026 Aug;9(8):e70263. doi: 10.1002/jac5.70263.

ABSTRACT

BACKGROUND: Despite strong evidence supporting cardiovascular and kidney benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in patients with type 2 diabetes, prescribing rates remain suboptimal. The aim of this study was to assess clinicians’ knowledge and comfort prescribing SGLT2i and GLP-1 RA in clinical practice and factors influencing prescribing of these agents.

METHODS: This multi-methods study used questionnaires to assess self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, and semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR) to assess factors affecting prescribing decisions among 21 clinicians (12 primary care physicians, 4 pharmacists, 5 nurse practitioners) at a large community-based health system in Virginia. Questionnaire results were analyzed using descriptive statistics, and interviews used a two-phase analytic approach combining inductive and deductive coding.

RESULTS: Clinicians self-reported high knowledge (7.9/10) and comfort (8.1 and 8.4/10) prescribing SGLT2i and GLP-1 RA but identified multiple implementation barriers. The most significant barriers were insurance coverage and out-of-pocket costs, with prior authorization requirements delaying therapy initiation. Medicare beneficiaries faced particularly challenging access due to coverage gaps and ineligibility for manufacturer assistance programs. Organizational factors, including high workload, limited appointment time, and the absence of automated patient identification systems, hindered consistent prescribing. Medication burden, side effects, and aversion to injectable medications emerged as patient-related barriers. Facilitators included strong clinical evidence supporting these agents, organizational culture supportive of innovation, and access to pharmacist support.

CONCLUSION: Despite high self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, clinicians identified barriers to their use in clinical practice at the patient, clinician, organizational, and medication access levels. Future work should identify the best implementation strategies to address these barriers.

PMID:42522049 | DOI:10.1002/jac5.70263

Cardiovasc Diabetol Endocrinol Rep. 2026 Jul 29;12(1):49. doi: 10.1186/s40842-026-00315-2.

ABSTRACT

BACKGROUND: The cholesterol, high-density lipoprotein, and glucose (CHG) index has been linked to stroke risk. However, evidence is largely based on single-time-point measurements and has not been compared with cumulative exposure, nor evaluated in individuals with cardiovascular-kidney-metabolic syndrome (CKM) stages 0-3. This study aimed to compare the associations of baseline and cumulative CHG index with incident stroke risk in this population.

METHODS: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). The exposure measures were the baseline and cumulative levels of the CHG index. Multivariable logistic regression models were employed to examine the association between the baseline and cumulative CHG index and stroke risk. Restricted cubic spline (RCS) analysis was used to test potential dose-response relationships. The receiver operating characteristic (ROC) curve was used to compare the predictive performance of the two measures. Subgroup analyses were conducted to evaluate the consistency of these associations in different populations.

RESULTS: Among 4,661 participants with CKM stages 0-3, 476 (10.2%) developed incident stroke during follow-up. After adjustment for demographic characteristics, lifestyle factors, anthropometric measurement, laboratory parameters, medication use and comorbidities, both the baseline CHG index (OR = 1.42, 95% CI: 1.12-1.81) and cumulative CHG index (OR = 1.14, 95% CI: 1.03-1.26) were positively associated with stroke risk. Participants in the highest tertile (T3) of the baseline CHG index had a 35% higher stroke risk than those in the lowest tertile (T1) (OR = 1.35, 95% CI: 1.03-1.76), and a 34% elevated risk was observed for the cumulative CHG index (OR = 1.34, 95% CI: 1.03-1.76). RCS analysis revealed linear relationships for both measures (p for non-linear = 0.331 and 0.817, respectively; overall p < 0.05 for both). ROC curve analysis showed no statistically significant difference in the area under the curve (AUC) between the two measures (0.672 vs. 0.671, p = 0.330). Subgroup analyses indicated that the associations might be modified by gender and drinking status.

CONCLUSIONS: Among individuals with CKM stages 0-3, both baseline and cumulative CHG indices were independently associated with incident stroke risk. Given its moderate discriminatory capacity, the CHG index-derived from routine blood tests-may serve as a preliminary screening tool to flag high-risk individuals, prompting more comprehensive stroke risk evaluation.

PMID:42522042 | DOI:10.1186/s40842-026-00315-2

BMC Med Educ. 2026 Jul 28;26(1):1216. doi: 10.1186/s12909-026-09978-y.

ABSTRACT

BACKGROUND: Student mistakes are common in bedside teaching (BST) and can serve as important learning opportunities. However, little is known about how frequently mistakes occur in authentic clinical settings, what types of learning content they involve, and how teacher and patient presence shape teachers’ handling of these mistakes. This study investigated (RQ1) the relevance of learning content during student mistakes, (RQ2) associations between mistake types and teachers’ reactions, and (RQ3) whether patient presence influences clinical teachers’ responses to mistakes.

METHODS: We conducted an observational study based on video recordings of 36 BST sessions across internal medicine, neurology, and orthopaedics (78.4 h). Using a hierarchical coding scheme, we identified mistakes, classified their learning content and mistake types, and coded teacher reactions as well as teacher and patient presence. Interrater reliability ranged from substantial to excellent. Descriptive statistics were used to determine the frequency of mistakes per hour and their distribution across the learning content. Associations between mistake types and teacher reactions were analysed via Spearman’s rank correlations (RQ2). Mann-Whitney U tests (RQ3) were used when examining whether teachers’ mistake-related behaviours differed depending on the presence or absence of the patient.

RESULTS: Across all BST sessions, the students made an average of 4.9 mistakes per hour. Mistakes occurred most often during theoretical knowledge and clinical reasoning, predominantly as reproduction mistakes, whereas an incorrect application of skills was most frequent during clinical examination and case presentations. Teacher presence was positively associated with the number of observed mistakes, particularly reproduction mistakes. During the physical examination, the students were supervised for only 72% of the active practice time. Teachers’ reactions – including elaboration, directness of feedback, and time provided for correction – did not differ significantly depending on patient presence.

CONCLUSIONS: Student mistakes are common in BST and hold considerable didactic value; however, this value is not fully realised when supervision is inconsistent or when feedback remains limited. Enhancing clinical teachers’ capacity to detect errors, providing structured and supportive feedback, and adapting their approach to the presence of patients may strengthen their ability to learn from mistakes. Interventions that cultivate psychological safety and promote effective error-management practices could further improve the pedagogical quality of BST.

PMID:42522036 | DOI:10.1186/s12909-026-09978-y

Trop Dis Travel Med Vaccines. 2026 Jul 28;12(1):27. doi: 10.1186/s40794-026-00311-5.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) infection remains a major public health challenge in sub-Saharan Africa despite the availability of a safe and effective vaccine. In Nigeria, adult vaccination coverage and completion rates are not well characterized within hospital-based populations.

METHODS: A hospital-based cross-sectional study was conducted among 1,200 adults attending Federal Medical Centre (FMC) Keffi, Nasarawa State, Nigeria. Data on socio-demographics, HBV-related knowledge, attitudes, perceived barriers, vaccination uptake, and completion were collected using a structured questionnaire. Knowledge and attitude scores were categorized into poor, fair, and good levels. Associations between socio-demographic characteristics and vaccination uptake were examined using chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05.

RESULTS: The mean age of respondents was predominantly 36-40 years (32.5%), with males constituting 72.3%. Most respondents had tertiary education (91.8%) and were civil servants (83.4%). Overall awareness of HBV was high (95.5%), with a mean knowledge score of 12.37 ± 1.42. Good knowledge was observed in 74.2% of respondents, while 57.2% demonstrated good attitudes toward HBV prevention. Vaccination uptake was high, with 93.5% reporting receipt of at least one vaccine dose. However, only 22.3% had completed the recommended three-dose schedule, while 48.2% and 23.1% had received one and two doses, respectively. Willingness to complete vaccination was reported by 81.6% of respondents. Perceived barriers included high vaccine cost (72.4%), inadequate access to health facilities (96.9%), fear of side effects (71.9%), and insufficient information (73.5%). No significant associations were found between socio-demographic variables and vaccination uptake (p > 0.05 for all).

CONCLUSION: Despite high HBV vaccination initiation and knowledge levels, substantial gaps in vaccine completion persist. Addressing financial, informational, and access-related barriers is essential to improve full vaccination coverage among Nigerian adults.

PMID:42522034 | DOI:10.1186/s40794-026-00311-5

Isr J Health Policy Res. 2026 Jul 29;15(1):30. doi: 10.1186/s13584-026-00773-0.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death among young people worldwide and remains a significant cause of mortality across all age groups, especially in older adults. The underlying causes of suicide span various disciplines and are deeply influenced by societal attitudes, which fluctuate between glorification and severe condemnation of suicide. This study aims to evaluate the role of court rulings on suicidal behavior, with particular attention to implications for healthcare policy in Israel.

METHODS: We searched the national court rulings databases for alleged psychiatry malpractice in suicide-related cases and of pre-trial settlements from 1985 to 2023. For court decisions, we collected patients’ socio-demographic and clinical characteristics, lawsuit characteristics, and the quality of medical documentation and decision-making processes. For pre-trial settlements, we collected data about lawsuit characteristics. Two researchers reviewed the qualitative data, while the quantitative data was analyzed with descriptive statistics.

RESULTS: Over the 38-year period, there were 20 psychiatry malpractice court lawsuits related to patient suicides, including 17 deaths and 3 life threatening attempts. Of these, 12 (60%) of cases were won by the plaintiff, and eight (40%) by the defendant. In 14 cases, the suicides occurred in inpatient units and in six cases in community settings. The number of lawsuits notably increased over time for suicide events, with 17 pre-court settlements between 1985 and 1997, and 56 cases in each of the subsequent periods (1998-2010 and 2011-2023).

CONCLUSIONS: The number of malpractice lawsuits related to suicide in Israel is increasing over time. Our findings, which show a rise in both litigation and pre-trial settlements, may put pressure on psychiatrists to avoid certain kinds of work, especially in the public sector. Such a shift could have broader effects on the quality of suicide prevention efforts and overall mental health care. The study highlights the structural tension between retrospective legal accountability and prospective clinical and public-health approaches to suicide prevention. Addressing this challenge requires balanced policy responses, including strengthening patient-safety and risk-management systems, improving clinical documentation and decision transparency, fostering constructive collaboration between legal and mental health systems, and considering alternative compensation mechanisms that reduce adversarial pressures while supporting affected families.

PMID:42522033 | DOI:10.1186/s13584-026-00773-0

Cardiovasc Diabetol. 2026 Jul 28;25(1):212. doi: 10.1186/s12933-026-03312-y.

ABSTRACT

BACKGROUND: Copeptin, a surrogate marker for vasopressin secretion, is associated with cardiovascular disease, insulin resistance and dysglycaemia. The cardioprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) may involve vasopressin modulation through fluid redistribution, but whether this effect persists long-term in high-cardiovascular-risk patients with newly detected dysglycaemia remains unknown.

METHODS: In this post-hoc analysis of the SOCOGAMI double-blind, placebo-controlled trial, 42 patients (mean age 67.5 years, 19% females) with impaired glucose tolerance or newly detected type 2 diabetes following an ACS and no heart failure were randomized to empagliflozin 25 mg/day (n = 20) or placebo (n = 22) for 7 months. Copeptin was measured during oral glucose tolerance tests (OGTT) at baseline, after 7 months on-treatment, and 3 months after treatment withdrawal. Treatment effects were assessed by repeated-measures ANOVA with treatment × time interaction and linear mixed-effects models.

RESULTS: Haematocrit, but not copeptin, showed a significant between-group difference at 7 months (p = 0.03 and p = 0.63, respectively). Both markers returned toward baseline after treatment withdrawal, but the overall treatment × time interaction was not significant for either (p = 0.72 and p = 0.64 respectively). Results were unchanged after accounting for a baseline imbalance in diuretic use (35% vs. 14%). Copeptin was not associated with the glucose-lowering effect of empagliflozin and no differential copeptin response during the OGTT across groups or visits was observed. In exploratory analyses, copeptin correlated with arterial pulse wave velocity at baseline (rs = 0.40, unadjusted p = 0.03).

CONCLUSIONS: In this post-hoc analysis, empagliflozin treatment was not associated with statistically significant sustained vasopressin secretion in post-ACS patients with newly detected dysglycaemia and preserved cardiac function. Due to the limited power and the absence of early on-treatment sampling these findings cannot exclude AVP modulation and warrant confirmation in adequately powered studies.

TRIAL REGISTRATION: EudraCT number 2015-004571-73.

PMID:42522027 | DOI:10.1186/s12933-026-03312-y

Infect Dis Poverty. 2026 Jul 28;15(1):84. doi: 10.1186/s40249-026-01484-z.

ABSTRACT

BACKGROUND: The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) scheme, supported by the World Bank, is establishing four zonal National Institutes of Virology (NIVs) in India. It is essential to identify the zonal disease and research priorities so as to focus research at zonal levels. This study reports a zonal viral disease prioritisation exercise to support outbreak response and collaborative research. It describes zonal-prioritised viral diseases, assesses concordance and differences in zonal priority lists and, and identifies cross‑cutting research themes and preparedness gaps using an multicriteria decision analysis (MCDA)‑based consensus process.

METHODS: We conducted a cross-sectional, multi-stakeholder consultative study across four geographical zones of India in March 2024. The zonal-level consultative workshops employed a systematic consensus-building approach using the modified One Health Zoonotic Disease Prioritisation (OHZDP) tool, adapted for emerging viral diseases and applied via MCDA. We identified zonal-level stakeholders, listed 40 viral diseases and categorised them into three groups: common occurrence (Group A), limited occurrence (Group B), and rare occurrences with a chance of emergence, evolution or importation (Group C). The stakeholders from state health departments, medical colleges, research institutes and the Virus Research and Diagnostic Laboratory (VRDL) network ranked the viral diseases and research themes in each zone. Spearman rank correlation was used to assess concordance of priority rankings between zones.

RESULTS: A total of 186 participants (42-48 per zone) contributed to the four zonal workshops including collaborators from VRDL laboratories (26%), public health stakeholders from Integrated Disease Surveillance programme(IDSP) (28%), invited experts (21%), organisers (19%) and Indian Council of Medical Research (ICMR) representatives (6%). The key outcomes included the zone-specific lists of priority viral diseases in Groups A, B and C. There were zonal variations in viral disease prioritisation, reflecting local epidemiological patterns. Spearman rank correlation analysis showed moderate positive correlation between the Central and East zones (rho = 0.697, P = 0.031), whereas other pairwise comparisons were not statistically significant, which indicated both shared and distinct priority patterns within the zones. The top five priority viral diseases across zones included dengue, influenza, measles, Japanese encephalitis and hepatitis A. The research themes and subthemes were then decided for collaborative research.

CONCLUSIONS: These multistakeholder consultations provided a novel, replicable template for prioritising viral diseases to develop strategies for mitigating the impact of future outbreaks through collaborative research. These zonal priorities may guide similar exercises at national, regional and global levels in future.

PMID:42522023 | DOI:10.1186/s40249-026-01484-z

BMC Pediatr. 2026 Jul 25;26(1):691. doi: 10.1186/s12887-026-07370-9.

ABSTRACT

BACKGROUND: Most severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children are mild, yet neurological complications can occur. Host immune variability is partly determined by human leukocyte antigen (HLA) polymorphisms and may influence susceptibility. This study investigates whether specific HLA-B alleles are associated with neurological involvement in pediatric coronavirus disease 2019 (COVID-19).

METHODS: This retrospective study spanned over one year, including children with confirmed SARS-CoV-2 infection. Patients were classified into two groups: patients with COVID-19 with neurological disease (neuro-COVID-19), and those with COVID-19 without neurological disease (non-neuro COVID-19). A control group of 120 healthy children was included to represent baseline allele distribution. HLA-B class I allele typing was performed using polymerase chain reaction with sequence-specific oligonucleotide probes (PCR-SSOP).

RESULTS: HLA-B49 represented the most common allele among children suffering from neurological COVID-19 (10.4%). None of the alleles reached statistical significance when compared in patients with and without neurological disease. A possible, but not statistically significant, lower frequency of the HLA-B52 allele was observed in cases with neurological manifestations (p = 0.088). However, in exploratory unadjusted analyses, HLA-B53 showed higher odds of neurological involvement when compared with children without neurological disease and healthy controls (OR = 6.29; 95% CI: 1.23-32.13; nominal p = 0.027), while HLA-B45 demonstrated a positive trend (OR = 3.75; 95% CI: 0.87-16.22; nominal p = 0.077). These allele-level findings were not corrected for multiple comparisons and should therefore be interpreted as exploratory and hypothesis-generating.

CONCLUSIONS: This study suggests a possible immunogenetic contribution to neurological complications in pediatric COVID-19, with a nominal unadjusted signal for HLA-B53. Given the small sample size, multiple-allele testing, and the absence of adjusted modelling, this finding should be considered exploratory and hypothesis-generating. Validation in larger multicenter cohorts with correction for multiple comparisons and adjustment for relevant confounders is required.

PMID:42522012 | DOI:10.1186/s12887-026-07370-9

BMC Gastroenterol. 2026 Jul 25;26(1):477. doi: 10.1186/s12876-026-05164-y.

ABSTRACT

BACKGROUND AND AIM: Autoimmune pancreatitis (AIP) is a rare chronic form of pancreatitis mediated by autoimmune mechanisms. Evidence regarding the diagnostic performance of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in AIP remains limited. This study aimed to estimate the pooled diagnostic accuracy of EUS-FNB in patients with AIP.

METHODS: PubMed, Embase, Cochrane Library, CNKI, and Wanfang Database were systematically searched to identify fully published studies evaluating EUS-FNB for tissue sampling in AIP. Pooled estimates were generated using a random-effects model. The assessed outcomes included diagnostic accuracy, sample adequacy, contribution to AIP diagnosis, and adverse events.

RESULTS: Sixteen studies, including one randomized controlled trial and four prospective studies, comprising 732 patients, were included. The overall diagnostic accuracy was 79% (73%-83%). Diagnostic accuracy was higher for the Franseen needle (83%, 75%-90%) and Fork-tip needle (90%, 80%-99%) compared with the reverse/forward‑bevel (51%, 31%-71%), with a statistically significant difference (P < 0.001). The 22G needle also demonstrated superior diagnostic accuracy (85%, 79%-91%) compared with 19G/20G needles (70%, 42%-98%) (P < 0.001). The pooled sample adequacy rate was 97% (95%-98%). EUS-FNB contributed to the diagnosis in 69% (50%-88%) of cases where diagnosis could not be established using imaging, serology, or involvement of other organs. The overall adverse event rate was 4% (1%-8%).

CONCLUSIONS: EUS-FNB demonstrates excellent histological tissue acquisition and moderate diagnostic accuracy in AIP, with a low rate of adverse events. The 22G Franseen or Fork-tip needles may be a reasonable option, though direct comparative evidence is lacking.

PMID:42522011 | DOI:10.1186/s12876-026-05164-y

BMC Ophthalmol. 2026 Jul 25;26(1):443. doi: 10.1186/s12886-026-05159-z.

ABSTRACT

PURPOSE: To assess the association between retinal fluorescence lifetimes (τm) and choriocapillaris (CC) flow deficits (FD) in intermediate age-related macular degeneration (AMD).

METHODS: Twenty-six pseudophakic eyes with intermediate, non-exudative AMD (mean age 83 ± 5 years) underwent fluorescence lifetime imaging ophthalmoscopy (FLIO) and optical coherence tomography angiography (OCTA). Fluorescence lifetimes were recorded in short- and long-wavelength channels and analyzed across ETDRS subfields. CC flow deficits were quantified using local thresholding. Associations between τm and FD were evaluated using Spearman’s rank correlation.

RESULTS: Mean τm values were consistently higher in the long-wavelength channel compared to the short-wavelength channel across all subfields. Mean CC FD increased from the outer ring (0.50 ± 0.07) to the central subfield (0.65 ± 0.11). Correlation coefficients between τm and FD ranged from – 0.07 to 0.37, with no statistically significant associations (all p > 0.05).

CONCLUSIONS: No statistically significant association was observed between fluorescence lifetimes and choriocapillaris flow deficits in this exploratory cohort. Although both biomarkers are known to be altered in AMD, the absence of evidence for a statistically significant spatial association suggests that FLIO and OCTA may reflect complementary aspects of disease pathology. Larger studies incorporating structural retinal biomarkers and longitudinal follow-up are warranted.

CLINICAL TRIAL REGISTRATION: Not applicable.

PMID:42522009 | DOI:10.1186/s12886-026-05159-z