Category: Statistics

BMC Nurs. 2026 May 15. doi: 10.1186/s12912-026-04751-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Contemporary nursing education increasingly relies on evidence-informed teaching strategies that improve learning outcomes while supporting students’ psychological well-being. High-fidelity simulation (HFS) is a well-established educational method; however, less is known about the role of individual learner characteristics, such as creativity, in shaping its effectiveness.

AIM OF THE STUDY: This study aimed to examine creativity in the cognitive and characterological domains and to analyze its relationship with satisfaction, self-confidence, perceived learning outcomes, and stress experienced during high-fidelity simulation classes among nursing students.

MATERIALS AND METHODS: A cross-sectional study was conducted among 286 first-year undergraduate nursing students participating in HFS classes during the 2022/2023 and 2023/2024 academic years. Data were collected using an author-designed questionnaire, the Student Satisfaction and Self-Confidence in Learning Scale (SSCL), and the Creative Behavior Questionnaire (KAHN III). Statistical analysis included Spearman’s rank correlation coefficient and the Mann-Whitney U test, with the level of significance set at p < 0.05.

RESULTS: Higher levels of creativity in both the cognitive and characterological domains were positively associated with students’ satisfaction, self-confidence, and selected perceived learning outcomes. Characterological creativity was positively associated with perceived development of knowledge, practical skills, and social competencies, whereas cognitive creativity was associated with perceived development of knowledge and social competencies. Higher creativity was also associated with lower levels of stress related to independent task performance, patient communication, and procedural execution during simulation scenarios.

CONCLUSIONS: The findings suggest that creativity may be an important learner-related factor associated with more favorable educational experiences in high-fidelity simulation. Higher creative dispositions were linked to greater satisfaction and self-confidence, as well as lower stress during simulation activities. These results support the inclusion of creativity-supportive elements in the design of nursing simulation curricula.

TRIAL REGISTRATION: Not applicable.

PMID:42141458 | DOI:10.1186/s12912-026-04751-4

BMC Med Educ. 2026 May 16. doi: 10.1186/s12909-026-09251-2. Online ahead of print.

ABSTRACT

BACKGROUND: The Script Concordance Test (SCT) is an effective tool for clinical reasoning assessment. However, many faculty members are still unfamiliar with this modality, and there are challenges in recruiting panelists who are mandatory for the assessment of SCT. The aim of this study was to assess the benefits of providing training in the quality of SCTs produced by junior faculties members.

METHODS: This was a randomized, single-blind, two-centre trial. The intervention consisted of 2 h of interactive training. The primary outcome was a comparison of the percentage of post-intervention valid SCT between the trained and the control group. The secondary outcome was to determine the factors associated with the quality of SCT.

RESULTS: In two medical schools in the Paris area, 115 participants were recruited in February 2024; they produced 460 SCT. Nine panels of experts were assembled. The percentage of post-intervention valid SCTs was significantly higher in the trained group (41% versus 16%, p < 0.001). This was confirmed in a sensitivity analysis performed on all the SCTs, adjusted for unbalanced variables between the two randomization arms (“risk” of producing a valid SCT when the participants were in the trained arm: aOR 2.53 [1.57; 4.13], p < 0.001).

CONCLUSION: Our prospective randomized study suggested the significant benefits for inexperienced physicians of an initial training in SCT writing quality.

PMID:42141456 | DOI:10.1186/s12909-026-09251-2

Mol Med. 2026 May 15. doi: 10.1186/s10020-026-01497-2. Online ahead of print.

ABSTRACT

BACKGROUND: T1 non-muscle-invasive bladder cancer (NMIBC) represents a biologically aggressive subgroup with substantial heterogeneity in recurrence and progression risk. Current clinicopathological risk stratification tools lack sufficient precision to identify patients at the highest risk of progression to muscle-invasive bladder cancer (MIBC).

OBJECTIVE: To characterize transcriptomic differences between T1 and < T1 (Ta/Tis) NMIBC and to explore the association of fibroblast activation protein-α (FAP) gene expression with disease progression.

METHODS: Transcriptomic profiling was performed on formalin-fixed paraffin-embedded (FFPE) tumor tissue from 66 patients with primary, treatment-naïve NMIBC and 5 patients with T2 disease (included for exploratory comparisons). Analyses included differential gene expression, gene set enrichment analysis (GSEA), molecular subtyping, immune cell deconvolution, and evaluation of FAP expression in relation to recurrence and progression. External validation of FAP was conducted in three independent NMIBC cohorts.

RESULTS: T1 tumors demonstrated a distinct transcriptomic profile compared with < T1 tumors, characterized by enrichment of cell cycle-related and metabolic pathways and a higher prevalence of aggressive molecular subtypes. Despite these molecular differences, no statistically significant differences in recurrence-free, progression-free, cancer-specific, and overall survival were observed, likely reflecting limited event numbers. Among recurrent tumors, early recurrences (≤ 24 months) were associated with epithelial-mesenchymal transition signatures. FAP expression increased with tumor stage (p = 0.0005) and was associated with progression (p = 0.002) and mortality (p = 0.01). Patients with tumors in the highest quartile of FAP expression had worse progression-free survival. This association was consistently observed in three external NMIBC cohorts.

CONCLUSIONS: T1 NMIBC exhibits distinct transcriptomic features suggestive of increased biological aggressiveness. Elevated FAP expression is reproducibly associated with progression risk across multiple cohorts, supporting its potential role as a biomarker of aggressive disease. Given the limited number of progression events, these findings should be considered hypothesis-generating and warrant prospective validation before clinical implementation.

PMID:42141426 | DOI:10.1186/s10020-026-01497-2

BMC Urol. 2026 May 16. doi: 10.1186/s12894-026-02169-3. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter displacement during urodynamic studies remains a common challenge, potentially introducing artifacts, compromising test accuracy, and decreasing patient comfort. Despite the clinical significance of stable catheter fixation, evidence-based recommendations for optimal fixation techniques are lacking. This study seeks to address this gap by comparing the effectiveness and patient comfort associated with three commonly used catheter fixation methods during urodynamic study.

METHODS: We retrospectively collected data from non-randomized patients who underwent urodynamic studies (UDS) at West China Hospital of Sichuan University between April and June 2023. Patients were selected based on predefined inclusion and exclusion criteria and assigned to one of three catheter fixation methods. The effectiveness of the following fixation techniques was evaluated: waterproof tape fixation (Group 1: catheter secured to the skin with adhesive tape), (2) patient-manual fixation (Group 2: patient holds the catheter manually throughout the procedure), and (3) silk thread fixation (Group 3: catheter secured with silk suture tied and fixed externally).

RESULTS: A total of 168 patients were enrolled in the study, with 56 patients in each group. The median ages for Groups 1, 2, and 3 were 66 (47.25, 76), 67 (61,71), and 66 (48, 76.75) years, respectively. There were no statistically significant differences among the three groups in terms of maximum cystometric capacity (MCC), bladder compliance (BC), maximum flow rate (Qmax), detrusor pressure at Qmax (Pdet.Qmax), bladder contractility index (BCI), or bladder outlet obstruction index (BOOI) (P > 0.05). The overall incidence of catheter displacement was 35.71% in Group 1, 0% in Group 2, and 14.29% in Group 3. Statistically significant differences in Comfort-B scale scores were observed between Group 1 and Group 2, and between Group 2 and Group 3 (P < 0.000). Similarly, visual analogue scale (VAS) scores also showed significant differences between Group 1 and Group 2, and between Group 2 and Group 3 (P < 0.000).

CONCLUSIONS: Our preliminary assessment indicated that the three catheter fixation methods did not significantly influence urodynamic parameters. Notably, patient-manual fixation achieved the lowest catheter displacement rate (0%) but was associated with the highest pain and discomfort scores. In contrast, waterproof tape and silk thread fixation offered better patient comfort but with higher displacement rates. These findings highlight a trade-off between catheter stability and patient comfort, suggesting that fixation method selection should be individualized based on patient characteristics and procedural requireme.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42141422 | DOI:10.1186/s12894-026-02169-3

BMC Infect Dis. 2026 May 15. doi: 10.1186/s12879-026-13417-0. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the clinical characteristics and prognosis of immunocompromised and non-immunocompromised patients with sepsis and to develop a novel mortality prediction model for these patients.

METHODS: This prospective cohort study was conducted between February and October 2023 in the emergency department (ED) of Peking Union Medical College Hospital and included 145 sepsis patients (67 with immunocompromised state and 78 without). The primary outcome was 90-day all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression were employed to assess the relationship between immune status and mortality risk, identify independent risk factors, and develop a predictive nomogram.

RESULTS: The 90-day mortality rate in immunocompromised patients was significantly higher than that in the control group (55.2% vs. 34.6%, p = 0.013). Multivariate Cox proportional hazards regression analysis identified immunocompromised state as an independent risk factor for mortality (HR = 2.980, 95% CI: 1.679-5.288; p < 0.001). In the subgroup analysis, autoimmune diseases (HR = 3.926, 95% CI: 1.763-8.744), poorly controlled diabetes (HR = 4.432, 95% CI: 1.638-11.992), and malignant neoplasms (HR = 3.195, 95% CI: 1.203-8.486) were significantly associated with an increased mortality risk. After statistical adjustment, seven factors were significantly associated with sepsis mortality (p < 0.05), including respiratory tract infection, urinary tract infection, intensive care unit (ICU) admission, the Sequential Organ Failure Assessment (SOFA) score, immunocompromised state, septic shock, and urgent surgery. The nomogram model based on these factors demonstrated strong predictive ability and accuracy, with a C-index of 0.808 (p < 0.001).

CONCLUSION: Immunocompromised state is an independent risk factor for mortality in sepsis patients, and different types of immunosuppression exert varying impacts on prognosis. The nomogram model developed on the basis of these findings offers valuable guidance for individualized risk assessment in clinical practice.

PMID:42141420 | DOI:10.1186/s12879-026-13417-0

BMC Neurol. 2026 May 15. doi: 10.1186/s12883-026-04961-y. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple Sclerosis (MS) is a chronic neurological disorder affecting 2.8 million individuals worldwide, characterized by motor dysfunction and cognitive impairment that remain poorly addressed by pharmacological interventions alone. Transcranial Direct Current Stimulation (tDCS) has emerged as a promising non-invasive neuromodulation technique for symptom management in MS patients.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the efficacy of tDCS in improving motor and cognitive functions in patients with MS, and to assess its safety profile.

METHODS: A comprehensive literature search was conducted across PubMed, Scopus, EMBASE, Wiley Online Library, and Google Scholar databases. Studies were selected based on PICOS criteria, including randomized controlled trials and quasi-experimental studies involving adults (≥ 18 years) with all types of MS receiving tDCS interventions. Methodological quality was assessed using RoB 2.0 and ROBINS-I. Meta-analyses were performed using RevMan 5.4.1 with random-effects models for outcomes with substantial heterogeneity and fixed-effects models where I² = 0%. Additionally, the protocol was prospectively registered with the Open Science Framework.

RESULTS: Twenty-two studies published between 2015 and 2025 were included in this review. Meta-analysis revealed that tDCS significantly improved information processing speed (SDMT: MD = 7.71, 95% CI: 1.60-13.82, p = 0.01) and functional mobility (TUG: MD = -1.03 s, 95% CI: -2.08-0.02, p = 0.05). While individual studies showed improvements in gait speed and balance, pooled analyses for these outcomes did not reach statistical significance (gait speed: MD = 0.16 m/s, 95% CI: -0.07-0.38, p = 0.18; Berg Balance Scale: MD = 1.18, 95% CI: -2.03-4.39, p = 0.47). Qualitative analysis revealed consistent improvements in manual dexterity, working memory, executive function, and complex attention. Additionally, no serious adverse events were reported across studies; mild and transient side effects (e.g., tingling, itching) were noted, and completion rates were high (98% in studies that reported them).

CONCLUSION: This systematic review provides preliminary evidence supporting tDCS as a potentially beneficial adjunctive intervention for MS patients, particularly for cognitive processing speed enhancement based on two small studies. While individual studies reported motor improvements, pooled meta-analyses for gait speed and balance failed to demonstrate statistical significance, indicating insufficient evidence for definitive motor benefits despite positive signals in individual trials. The substantial limitation of small study numbers per meta-analysis (2-6 studies), combined with limited MS subtype-specific data in most studies, significantly constrains confidence in these findings and limits assessment of external validity across different MS populations. Larger, standardized, multi-center randomized controlled trials with adequate subgroup representation and extended follow-up periods are essential to establish clinical significance and treatment durability.

PMID:42141416 | DOI:10.1186/s12883-026-04961-y

BMC Oral Health. 2026 May 15. doi: 10.1186/s12903-026-08518-w. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to assess the impact of silver and titanium dioxide nano-coatings on stainless steel and nickel titanium arch wires concerning friction, surface roughness and the release of nickel, silver, and titanium ions.

METHODS: A total of 168 arch wires measuring 17.8 cm in length were divided into two groups based on the type of the orthodontic arch wire material: 84 stainless steel (SS) wires and 84 nickel titanium (NiTi) wires. Each group of these wire materials was evenly divided into three subgroups according to the nano coating material: non-coated group (control), titanium dioxide nanoparticles (TiO₂NPs) and silver nanoparticles (Ag-NPs). Static friction on a specially designed acrylic plate was measured using a universal testing machine. Surface roughness data was then gathered using a profilometer machine, and inductively coupled plasma-optical emission spectroscopy (ICP-OES) was used to determine the ion release of Ni, Ag and Ti ions. The collected data were compared using a two-way ANOVA and the Bonferroni test for repeated pairwise comparisons. In the ion release test all samples had been incubated in 10 milliliters of artificial saliva and the data was collected at intervals of after 48 h, one week and two weeks, respectively. Then compared using a three-way mixed ANOVA.

RESULTS: The nano-coating effect on arch wires static frictional resistance was statistically significantly higher in the nanocoated wires especially in nanocoated SS arch wires (p < .001). The surface roughness of both arch wires is significantly impacted by the nanocoating as it became lower in nanocoated arch wires especially Ag-NPs coated SS arch wires (p < .001). Ni ion release significantly decreased in SS arch wires coated with TiO₂NPs in comparison to SS wires coated with Ag-NPs and to NiTi arch wires coated with Ag-NPs and TiO₂NPs (p < .001).

CONCLUSIONS: Ag-NPs and TiO₂NPs coatings are suitable for decreasing static friction in arch wires and improving surface roughness. Nano coating can improve surface roughness, static friction resistance especially for SS arch wires. Ion release of Ag and Ti ions in NiTi and SS coated arch wires is in safety concerns associated with nanoparticle dimensions. Ni ion release decreased in nano-coatings so, nano-coatings slightly improved the corrosion resistance especially in SS arch wires coated with TiO₂NPs.

PMID:42141410 | DOI:10.1186/s12903-026-08518-w

BMC Pregnancy Childbirth. 2026 May 15. doi: 10.1186/s12884-026-09214-x. Online ahead of print.

ABSTRACT

BACKGROUND: Placenta accreta spectrum (PAS) is a severe obstetric condition associated with substantial maternal and neonatal morbidity. This study aimed to evaluate a five-year experience of PAS management in a tertiary referral center and compare outcomes with those from a preceding five-year period.

METHOD: this retrospective cohort study was conducted at hospitals affiliated with Shiraz University of Medical Sciences, a tertiary referral center in southern Iran. Pregnant women diagnosed with PAS between January 2020 and December 2024, compared with a historical cohort from January 2015 to December 2019. Clinical and operative data of PAS cases were reviewed. Maternal morbidity and mortality were defined as primary outcomes, while operative characteristics, intraoperative complications, and neonatal outcomes were secondary outcomes. Statistical analyses were performed using SPSS software, with Mann-Whitney and Chi-square tests applied for inter-period comparisons. Maternal morbidity and mortality, operative blood loss, intraoperative complications, gestational age at diagnosis and delivery, and neonatal outcomes were assessed.

RESULTS: Of 325 PAS cases, 300 women underwent hysterectomy and were included in the analysis. The mean gestational age at operation was 31.16 ± 6.16 weeks, and 97% had a prior cesarean section. PAS was diagnosed before 14 weeks in 5%, between 14 and 28 weeks in 41%, and after 28 weeks in 54% of cases. Emergency surgery was required in 18.3%. Mean intraoperative blood loss was 2119.76 ± 1612.93 mL and was significantly higher in placenta percreta (p < 0.001). Bladder injury occurred in 23%, and 79% required packed cell transfusion. Neonatal survival was 83.7%, with 74.7% admitted to the NICU. Compared with the earlier cohort, gestational age at diagnosis was significantly earlier, hospital stay was shorter, and fifth-minute Apgar scores were higher (all p < 0.001).

CONCLUSIONS: Enhanced prenatal diagnosis and multidisciplinary management have improved maternal and neonatal outcomes in PAS over recent years.

PMID:42141408 | DOI:10.1186/s12884-026-09214-x

BMC Cardiovasc Disord. 2026 May 16. doi: 10.1186/s12872-026-05931-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have become an important therapeutic option for patients with dyslipidemia. Evolocumab and alirocumab are monoclonal antibodies targeting circulating PCSK9, whereas inclisiran is a small interfering RNA (siRNA) agent that suppresses hepatic PCSK9 synthesis and requires only twice-yearly dosing. Although these agents are proven effective in clinical trials, direct real-world comparative evidence on lipid-lowering efficacy, apolipoprotein B (apoB) reduction, safety, and adherence remains limited.

METHODS: This was a real-world, retrospective study conducted at a single center. A total of 198 patients were consecutively enrolled and assigned to three groups (n = 66 per group): inclisiran, evolocumab, or alirocumab. Baseline characteristics, including age, sex, and familial hypercholesterolemia (FH) status (assessed by DLCN criteria), were well-balanced across cohorts. All lipid parameters were analyzed using standardized automated biochemical analyzers at a centralized laboratory to ensure measurement consistency.

RESULTS: At 180 days, all three agents achieved robust and significant reductions in LDL-C from baseline (p < 0.001), with no significant differences observed between the groups. Notably, inclisiran demonstrated a numerical advantage in the reduction of apolipoprotein B (apoB) compared with evolocumab and alirocumab at 180 days (0.650 g/Lvs.0.774 g/L and 0.752 g/L, respectively), although these between-group differences did not reach formal statistical significance (p > 0.05). Treatment persistence was highest in the inclisiran group (69.7%), followed by evolocumab (56.1%) and alirocumab (50.0%). All therapies were well-tolerated with no new safety signals.

CONCLUSIONS: In this real-world study, Inclisiran, evolocumab, and alirocumab are all highly effective in lowering LDL-C in a real-world setting. Inclisiran may offer additional clinical value through superior treatment persistence and a favorable numerical trend toward enhanced apoB suppression.

PMID:42141407 | DOI:10.1186/s12872-026-05931-5

BMC Cardiovasc Disord. 2026 May 15. doi: 10.1186/s12872-026-05968-6. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular diseases (CVD) continue to be the leading cause of global mortality. Despite the alarming statistics, effective prevention of CVD remains a significant challenge in practice. The available risk stratification tools have critical limitations in the early detection of CVD. To address these gaps, it is crucial to integrate additional risk detection methods for more accurate identification of at-risk patients.

OBJECTIVES: This article addresses the limitations of conventional CVD risk factors and emphasizes the need for individualized risk evaluation. Additionally, it evaluates the role of imaging techniques in the early detection of CVD and the personalized use of aspirin therapy when subclinical atherosclerosis becomes advanced.

METHODS: This article is based on an expert literature review and reflects the outcomes of a medical advisory board meeting that was held in the Middle East (ME) region. A multidisciplinary group of experts discussed the “cardiac risk continuum” concept and the importance of advanced subclinical atherosclerosis detection beyond traditional binary CVD classification. Experts evaluated the clinical feasibility of utilizing carotid ultrasound and coronary artery calcium (CAC) scoring, and assessed the role of aspirin in primary prevention for at-risk patients.

RESULTS: The need for tailored risk assessment strategies and individualized preventive measures was highlighted. The experts agreed on the practical use of CAC scoring and/or carotid ultrasound to identify at-risk patients and quantify subclinical atherosclerosis. Data suggest that aspirin estimated benefit increases proportionally with atherosclerosis burden and becomes a net-positive at CAC > 100 or carotid plaque score above 2.

CONCLUSIONS: The experts emphasized the importance of individualized screening strategies tailored to the Middle Eastern population, considering the challenges and resource limitations in the region. They recommended selective use of CAC and carotid ultrasound to improve risk stratification and to guide a more personalized approach to managing CVD. The experts stressed the need for standardized protocols, healthcare providers’ education, and infrastructure development to ensure the effective implementation of these approaches.

PMID:42141396 | DOI:10.1186/s12872-026-05968-6