Category: Statistics

Trials. 2026 Feb 6. doi: 10.1186/s13063-025-09412-6. Online ahead of print.

ABSTRACT

BACKGROUND: Exploring barriers and enablers to participant recruitment into trials is a common discussion point in trial methodology. Participant information leaflets (PIL) can be long, have complexity above the average UK reading age, and may discourage engagement with research. This Study Within a Trial (SWAT) explored whether changing the design of a PIL influences recruitment rate and its value in patient decision-making. It was conducted within a host trial taking place in an emergency setting, where time is at a premium, and decisions on trial participation are needed more quickly than in most non-emergency settings.

METHODS: We have conducted a randomised SWAT, comparing the standard format PIL with one that has been adapted to be visually appealing, with improved readability and reduced word count. Patients considered eligible for the host trial were provided with a randomly allocated PIL type; consent rates were compared. Those consenting to take part in the host trial were asked to complete a questionnaire to explore the value of the PIL in their decision-making to take part in the trial; responses were compared across the two information sheets. The sample size was dictated by host trial recruitment.

RESULTS: Between September 2019 and September 2022, with a brief pause during the COVID19 pandemic, 271 participants were randomised to receive either the optimised PIL (n = 138) or the conventional PIL (n = 133). The recruitment rates were 47.1% (65/138) in the optimised PIL group and 48.9% (65/133) in the conventional PIL group; this difference was not statistically significant (p = 0.771). There were no significant differences in responses from participants recruited to the host trial who completed the Decision-Making Questionnaire.

CONCLUSION: Improving the readability and visual presentation of the participant information sheet provided to participants had no effect on recruitment rate, and did not appear to impact decision-making of recruited participants.

PMID:41645217 | DOI:10.1186/s13063-025-09412-6

J Orthop Surg Res. 2026 Feb 5. doi: 10.1186/s13018-026-06721-7. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to comprehensively examine the distal femoral valgus cut angle (VCA) utilized during total knee arthroplasty (TKA) in the Turkish population and identify the radiological and demographic factors influencing this critical surgical parameter.

METHODS: A retrospective analysis was performed on 193 lower extremity orthoradiographs from 120 patients diagnosed with end-stage knee osteoarthritis between January 2020 and December 2023. Key radiological variables assessed included VCA, mechanical femorotibial angle (MTFA), neck-shaft angle (NSA), medial offset (MO), and lateral distal femoral angle (LDFA).

RESULTS: The mean VCA was 6.48 ± 0.83 degrees, with no statistically significant differences observed between genders (p = 0.755). A moderate negative correlation was identified between VCA and NSA (r = – 0.423, p < 0.001), while weak to moderate positive correlations were observed between VCA and both MO (r = 0.337, p < 0.001) and LDFA (r = 0.307, p = 0.002). No significant associations were found between VCA and the other evaluated parameters.

CONCLUSIONS: The results highlight the necessity of personalized assessment of VCA during TKA to optimize radiological outcomes, as opposed to a standardized approach. In the Turkish population, VCA is primarily influenced by NSA, MO, and LDFA, with coronal plane deformities showing no significant effect. This study emphasizes the importance of considering patient-specific anatomical variations during preoperative planning.

PMID:41645210 | DOI:10.1186/s13018-026-06721-7

Harm Reduct J. 2026 Feb 5. doi: 10.1186/s12954-026-01408-y. Online ahead of print.

ABSTRACT

BACKGROUND: The rate of hepatitis C virus (HCV) treatment initiation and cure is suboptimal among people experiencing homelessness. A recent randomized controlled trial conducted by our study team compared peer-assisted telemedicine for HCV (TeleHCV) to peer-assisted referral to local providers (enhanced usual care [EUC]) in a rural population in Oregon. We hypothesized that the TeleHCV treatment model is more effective than EUC among those with unstable housing.

METHODS: In this secondary analysis of the Oregon TeleHCV randomized controlled trial in adults with HCV and injection drug use (n = 203), we explored the role of unstable housing as an effect modifier of the TeleHCV intervention using a Poisson regression analysis. Randomized arm, frequency of peer contacts, and medication lockers were exposures of interest. HCV cure, defined as undetectable HCV RNA 12 weeks after treatment initiation, is the primary outcome.

RESULTS: Overall, attaining HCV cure was less likely for those with unstable housing (RR = 0.68, 0.49-0.96, p = 0.026). However, unstably housed participants assigned to the TeleHCV arm were more than 6 times more likely to achieve HCV cure compared to unstably housed EUC participants (RR = 6.47, 3.12-13.43, p < 0.001) with a statistically significant interaction between treatment assignment and housing status (p = 0.022). The impact of TeleHCV on HCV cure was also identified among stably housed participants, but with a smaller effect size (RR = 2.15, 1.19-3.89, p = 0.012). Among participants with unstable housing, greater peer engagement was associated with an increased likelihood of both treatment initiation (RR = 1.24, p < 0.001) and HCV cure (RR 1.26; p < 0.001).

CONCLUSIONS: The peer-assisted TeleHCV intervention was substantially more effective for achieving HCV cure among participants with unstable housing at baseline compared to those unstably housed who received EUC. The treatment model should be broadly disseminated to target populations with HCV and high rates of homelessness to achieve HCV elimination goals.

CLINICAL TRIALS REGISTRATION: NCT04798521.

PMID:41645194 | DOI:10.1186/s12954-026-01408-y

BMC Public Health. 2026 Feb 6. doi: 10.1186/s12889-026-26535-w. Online ahead of print.

NO ABSTRACT

PMID:41645167 | DOI:10.1186/s12889-026-26535-w

BMC Psychiatry. 2026 Feb 5. doi: 10.1186/s12888-026-07878-5. Online ahead of print.

ABSTRACT

BACKGROUND: The period immediately following psychiatric inpatient care is recognized as a time of elevated risk of suicide, yet little is known about factors that influence how soon suicide occurs after discharge.

AIM: To examine the timing of suicide among persons after psychiatric discharge and identify sociodemographic and clinical factors associated with a shorter time to death by suicide.

METHODS: We included all adults in Sweden who died by suicide in 2015 and who had been discharged from psychiatric inpatient care during the last three months of life (n = 140). Sociodemographic and clinical variables were extracted from electronic medical records, including contextual factors from the last hospitalization (involuntary care, documented suicide risk, unplanned discharge). Time to suicide was modelled using stratified Cox proportional hazards regression.

RESULTS: The median time from discharge to death was 32 days. Older age was the only background factor independently associated with a shorter time to suicide; each additional 10 years of age was associated with shorter time to suicide, as indicated by an increased unadjusted hazard ratio (uHR) of 1.26 (95% CI: 1.12-14.2, p < .001). A diagnosed neurotic, stress-related and somatoform disorder (ICD-10 code F40-F49) was associated with a longer time to suicide (uHR = 0.68 (0.47-0.98), p = .036), although this association was not statistically significant when adjusting for age (aHR 0.82, 0.56-1.20, p = .310). Previous suicide attempts, sex, substance use disorder and depressive disorders were not associated with time to suicide. Neither involuntary care nor the presence or absence of a formal suicide risk assessment during inpatient stay predicted earlier suicide. Unplanned discharges were likewise unrelated to the time to suicide.

CONCLUSIONS: Among people who died by suicide within three months of psychiatric discharge, only older age independently predicted a shorter time to suicide. The absence of clear signals-particularly from routinely collected risk assessments-suggests that timely, universal follow-up may be more appropriate than attempts to target aftercare on the basis of standard risk markers.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41645161 | DOI:10.1186/s12888-026-07878-5

BMC Health Serv Res. 2026 Feb 5. doi: 10.1186/s12913-026-14093-1. Online ahead of print.

ABSTRACT

BACKGROUND: This study explores the “wave-off” mechanism in healthcare, in which physicians implicitly discourage patient revisits to manage high workloads. Understanding this mechanism is critical for balancing workload management and patient-centered care, as it highlights how physician discretion shapes patient behavior and operational efficiency.

METHODS: We analyze 200,426 outpatient records from a cardiology department to investigate the relationship between physician workload and the likelihood of patient revisits. We introduce a novel metric, Sample Entropy, to quantify patient “stickiness,” or the propensity to revisit. We examine physician behaviors-such as referrals for diagnostic examinations and medication prescribing-to identify strategies used to modulate patient flow. Statistical analyses assess the impact of workload on revisit patterns and the mechanisms driving the wave-off effect.

RESULTS: Higher physician workloads are significantly associated with reduced short-term patient revisits. Physicians manage workload by prescribing more medications and referring fewer diagnostic examinations, laboratory tests, particularly for patients with higher stickiness as measured by Sample Entropy. These behaviors alleviate short-term workload pressure but risk long-term inefficiencies, potentially reflecting bounded rationality in clinical decision-making.

CONCLUSIONS: The wave-off mechanism illustrates a trade-off between immediate workload relief and long-term operational performance. While it helps physicians address short-term capacity constraints, it may undermine optimal long-term patient care and system efficiency. This study highlights the operational and behavioral implications of physician-driven demand modulation, including the subtle yet consequential phenomenon of physician-reduced demand, in which patients are implicitly discouraged from revisiting due to workload-driven adjustments in care delivery.

PMID:41645147 | DOI:10.1186/s12913-026-14093-1

BMC Oral Health. 2026 Feb 5. doi: 10.1186/s12903-026-07846-1. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to evaluate the flexural strength and surface hardness of denture base resins that have been milled using computer-aided design and computer-aided manufacturing milling (CAD/CAM) and conventional heat-polymerized denture base resins (HP).

METHODS: Eighty samples were made using CAD/CAM resin material (Polident CAD/CAM and Interdent CC discs) and conventional heat-polymerised acrylic resin (HP) (IvoBase CAD and PMMA). Based on the denture base material, the samples were categorised into eight groups: each group (n = 10), flexural strength (n = 40), surface hardness (n = 40). Both the surface hardness and flexural strength were evaluated using the Vickers hardness test and the three-point flexure test, respectively. A statistical analysis with a significance level of α = 0.05 was used to analyze the data.

RESULTS: Compared with HP resins, milled CAD/CAM resins demonstrated significantly higher flexural strength and surface hardness (p < 0.001). The flexural strength of MHC 72.72 ± 5.95 is significantly lower than that of IHC 78.96 ± 3.36, PCC 108.59 ± 6.51, and VCC 99.88 ± 6.05 MPa. Surface hardness is significantly lower in MHC (18.40 ± 2.28 VHN) than in the other groups: IHC (21.30 ± 2.40 VHN), PCC (31.07 ± 2.07 VHN), and VCC (27.09 ± 1.55 VHN).

CONCLUSION: Compared with heat-polymerized acrylic resin, milled CAD/CAM resins performed exceptionally well in terms of flexural and surface mechanical properties.

PMID:41645141 | DOI:10.1186/s12903-026-07846-1

BMC Nurs. 2026 Feb 5. doi: 10.1186/s12912-026-04371-y. Online ahead of print.

NO ABSTRACT

PMID:41645139 | DOI:10.1186/s12912-026-04371-y

BMC Surg. 2026 Feb 5. doi: 10.1186/s12893-026-03562-3. Online ahead of print.

ABSTRACT

BACKGROUND: Wrist ganglion cysts (GCs) are the most common soft-tissue masses of the hand and wrist. Although surgical excision is considered the most effective treatment, recurrence remains a clinical concern. Anatomical and demographic predictors of postoperative recurrence are not well established.

METHODS: We included 347 patients who underwent surgical excision of wrist GCs between 2015 and 2023, with a minimum follow-up of 24 months. Clinical data (age, sex, side, hand dominance) and magnetic resonance imaging (MRI)-based topographic features (volume, surface area, wall thickness, location, longest and shortest diameters, aspect ratio, and distance to the adjacent joint) were recorded retrospectively. The primary outcome was cyst recurrence at a minimum follow-up of 24 months, defined as clinically or radiologically confirmed return of the cyst. Statistical analyses included chi-square tests, t-tests or Mann-Whitney U tests, and univariable and multivariable logistic regression analyses. All analyses were performed in the Python (Google Colab) environment using the pandas, NumPy, SciPy, and statsmodels libraries.

RESULTS: The overall recurrence rate at a minimum follow-up of 24 months was 8.6% (30 of 347). Dominant-hand involvement was significantly associated with recurrence (χ² p = 0.006). In age-adjusted logistic regression, dominant-hand involvement increased the risk (OR = 6.51; 95% CI, 1.87-22.63; p = 0.003). Cyst distance to the adjacent joint was significantly shorter in recurrent cases (mean 7.6 mm vs. 8.1 mm; t-test p = 0.001, Mann-Whitney U p = 0.021). Based on age-adjusted logistic regression, each additional millimeter of cyst-to-joint distance conferred a 41% relative reduction in recurrence risk (OR = 0.59; 95% CI, 0.39-0.90; p = 0.013).

CONCLUSIONS: MRI-based evaluation of cyst-to-joint distance and consideration of dominant-hand involvement may help identify patients at increased risk of recurrence after surgical excision of wrist GCs. Incorporating these factors into preoperative planning may optimize surgical strategy, guide follow-up, and improve patient counseling.

PMID:41645133 | DOI:10.1186/s12893-026-03562-3

BMC Infect Dis. 2026 Feb 5. doi: 10.1186/s12879-026-12784-y. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infections remain an important public health challenge among people living with HIV (PLHIV), with their heaviest toll borne in sub-Saharan Africa. These infections accelerate liver disease progression, complicate antiretroviral therapy (ART) management, and contribute to morbidity and mortality. This study assessed the seroprevalence of HBV and HCV and liver injury among PLHIV on ART in the Upper East Region of Ghana.

METHODS: In a cross-sectional survey, a total of 294 PLHIV receiving ART at three treatment sites were recruited between June and August, 2024. Sociodemographic and clinical data were obtained using a structured questionnaire after informed consent. Participants were screened for HBV serological markers and anti-HCV using a lateral flow rapid immunochromatographic test, and liver injury was evaluated biochemically by measuring serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Descriptive statistics were used to summarise participant characteristics and logistics regression to assess factors associated with HBV and HCV coinfections and liver injury.

RESULTS: The overall seroprevalence of viral hepatitis was 13.3% (95% CI: 9.6-17.7), with HBV (9.2%; 95% CI: 6.1-13.1) more common than HCV (4.1%; 95% CI: 2.1-7.0). HBV infection was significantly higher in males than females (17.5% vs. 7.4%; p = 0.025) and more common among participants with tertiary education (21.4%; 95% CI: 4.7-50.8) relative to those without formal education (4.5%; 95% CI: 1.7-9.6; p = 0.022). Urban residents showed higher but not statistically significant HBV seroprevalence than rural participants (14.9% vs. 7.3%; p = 0.050). HCV seroprevalence showed no significant sociodemographic associations. The seroprevalence of liver injury was 17.7% (95% CI: 13.5-22.5). Being a male was independently associated with liver injury (adjusted odds ratio [aOR]: 4.35; 95% CI: 1.81-10.47; p = 0.001). Older age was also a predictor: compared to participants aged 20-30 years, those aged 31-40 (aOR: 13.31; 95% CI: 1.37-129.76; p = 0.026), 41-50 (aOR: 20.01; 95% CI: 1.90-210.33; p = 0.013), and > 50 years (aOR: 15.62; 95% CI: 1.41-172.51; p = 0.025) had markedly increased odds. Longer ART duration was protective: individuals on ART for > 10 years had reduced odds of liver injury compared to those on ART for 1-5 years (aOR: 0.39; 95% CI: 0.16-0.97; p = 0.042).

CONCLUSION: The findings show that HBV and HCV are prevalent among PLHIV on ART in the Upper East Region of Ghana. Liver injury affects nearly one in five PLHIV in this setting. These findings highlight the need for targeted viral hepatitis B and C and liver enzymes monitoring and integration of hepatitis management into HIV care, particularly among older men and patients in the early years of ART in this population.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41645131 | DOI:10.1186/s12879-026-12784-y