Category: Statistics

Cureus. 2025 Dec 19;17(12):e99594. doi: 10.7759/cureus.99594. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: Acute hand infections are a frequent cause of emergency surgical admission and can lead to significant morbidity. C‑reactive protein (CRP) and white blood cell (WBC) count are commonly used biomarkers, yet their comparative value for monitoring treatment response remains unclear.

METHODS: We conducted a retrospective cohort study of 69 consecutive patients with culture‑positive acute hand infections admitted between January and May 2024 at a single tertiary centre. Demographics, comorbidities, infection type, microbiology, management strategy, and outcomes were collected. CRP and WBC were recorded at admission and serially throughout treatment. Trends were analysed in relation to infection type and clinical response.

RESULTS: The cohort was predominantly male, with 51 patients (73.9%), and diabetes mellitus was the most common comorbidity, being present in 22 patients (31.9%). Staphylococcus aureus was the leading pathogen. Elevated CRP (>10 mg/L) was present in 62 patients (89.86%) on admission, while leukocytosis was observed in 16 patients (23.2%). Mean CRP declined significantly from 72.4 mg/L at admission to 18.6 mg/L by discharge (p<0.001), whereas WBC changes were not statistically significant (p=0.184). Deep infections demonstrated significantly higher admission CRP levels than superficial infections (112.3 mg/L vs. 38.7 mg/L; p=0.002).

CONCLUSIONS: Serial CRP measurement is a more sensitive marker of treatment response in acute hand infections than WBC. Higher admission CRP correlates with deeper infections and longer hospital stay. Incorporating serial CRP monitoring into routine care may support antibiotic stewardship, discharge planning, and resource utilisation.

PMID:41556000 | PMC:PMC12812222 | DOI:10.7759/cureus.99594

Cureus. 2025 Dec 18;17(12):e99532. doi: 10.7759/cureus.99532. eCollection 2025 Dec.

ABSTRACT

Background Globally, stroke continues to rank among the foremost contributors to mortality and long-term disability, with a growing burden in India. Beyond traditional vascular risk factors, metabolic markers, such as serum sodium, uric acid, and homocysteine, have been implicated in stroke outcomes, but their prognostic role in Indian patients is unclear. Objective This study’s objectives are to determine the prognostic significance of serum sodium, uric acid, and homocysteine levels in patients with ischemic and hemorrhagic stroke in relation to in-hospital mortality and to evaluate the modifying influence of common comorbidities and seasonal variation on these outcomes. Methods At a New Delhi tertiary care hospital, 236 consecutive stroke patients (182 ischemic, 54 hemorrhagic) were recruited for a hospital-based study between November 2022 and November 2023. CT/MRI confirmed diagnosis. Demographics, comorbidities, and laboratory values (sodium, uric acid, and homocysteine) were gathered, and logistic regression and the chi-square test were used to look at their relationships with in-hospital mortality. Results Hyponatremia was observed in 90 patients (38.1%) and demonstrated a substantial correlation (p < 0.001) with a higher rate of in-hospital death. Out of the total 236 patients, 28 (11.9%) died during hospitalization. Among these, 21 patients (75%) had documented hyponatremia, while seven patients (25%) maintained normal sodium levels. Conversely, 69 patients with hyponatremia (76.7%) recovered and were discharged without mortality. The chi-square test revealed a strong association between hyponatremia and in-hospital mortality (χ² = 23.84, p < 0.001), confirming that reduced serum sodium significantly increased the risk of death. In contrast, hyperuricemia (22 patients, 9.3%) and hyperhomocysteinemia (144 patients, 61%) showed no significant associations with mortality (χ² = 1.37, p = 0.24 and χ² = 0.98, p = 0.32, respectively). Diabetes (120 patients, 50.8%) and hypertension (53 patients, 22.4%) were the most common comorbidities, but did not independently predict outcomes. Seasonal analysis revealed that ischemic strokes were slightly more frequent in winter (107 cases, 45.3%) compared to summer (93 cases, 39.4%), while hemorrhagic strokes were evenly distributed across seasons (30 in winter, 24 in summer). Mortality was marginally higher in winter (13 deaths, 5.5%) than in summer (10 deaths, 4.2%), but this difference was not statistically significant (χ² = 0.63, p = 0.459). These results suggest that mild climatic variation in the Delhi region did not exert a notable influence on short-term stroke outcomes, possibly due to consistent hospital care and limited temperature extremes across the study period. Conclusion Hyponatremia was independently linked to in-hospital mortality, whereas uric acid and homocysteine were not, in this Indian stroke cohort. By simultaneously evaluating multiple metabolic markers together with comorbidities and seasonal influences, this study offers a broader and region-specific perspective on stroke prognosis. The findings highlight hyponatremia as a simple, inexpensive marker for risk stratification and emphasize the need for multicenter longitudinal research to determine whether its correction improves survival.

PMID:41555980 | PMC:PMC12812411 | DOI:10.7759/cureus.99532

BMC Med Educ. 2026 Jan 20. doi: 10.1186/s12909-026-08606-z. Online ahead of print.

ABSTRACT

BACKGROUND: Proper basic life support (BLS) skills are crucial for laypeople and health care professionals to increase the survival of cardiac arrest patients. A practical examination at the end of a BLS course may be beneficial for prolonging skill retention. We aimed to investigate the efficacy of our BLS training and the effect of BLS practical examinations on skill retention among fifth-year medical students compared with the effect of additional practice and continuous assessment.

METHODS: In this randomized, assessor-blinded, parallel group study, fifth-year medical students took a practical BLS examination (“practical examination” group) or participated in an additional 30-minute practice with continuous assessment (“additional practice” group) two weeks after a 90-minute intrahospital COVID-19 BLS training. BLS skill retention was assessed two weeks, two months and one year later, and the results of the two groups were compared. Fourteen elements of BLS were evaluated during the skill retention assessments. Descriptive statistics and Mann‒Whitney and Fisher’s exact tests were used for statistical analysis.

RESULTS: Thirty-two voluntary students were included (practical examination: n = 17, additional practice: n = 15), with no significant differences in basic characteristics (age: p = 0.891; gender: p = 0.999; previous BLS education: p = 0.469; previous participation in BLS: p = 0.678; planning to work in emergency medicine or critical care: p = 0.471). BLS skills were satisfactory during all skill retention assessments, except for the application of protective equipment and depth of chest compressions. More students placed surgical masks on patients’ faces in the additional practice group during the first skill retention assessment (p = 0.005). However, this difference disappeared over time, and both groups performed poorly in the application of protective equipment. The activation of the chain of survival and high-quality chest compressions were acceptable during all the skill retention assessments. There was no significant difference in overall BLS skill retention between the two groups (total score after two weeks: p = 0.764; after two months: p = 0.542; after one year: p = 0.791).

CONCLUSIONS: The BLS course provided by our department was effective; however, the BLS practical examination did not offer a significant advantage in terms of skill retention compared to additional practice and continuous assessment in our student population.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41555322 | DOI:10.1186/s12909-026-08606-z

BMC Urol. 2026 Jan 19. doi: 10.1186/s12894-026-02054-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the performance of ChatGPT-4o in estimating International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) based on patients’ natural language descriptions and full outpatient records, compared to actual questionnaire scores.

MATERIALS AND METHODS: This study included 91 patients, of whom 52 completed IPSS and 77 completed OABSS. ChatGPT-4o was prompted with verbatim symptom statements and full medical records written by a urologist. Predicted scores were compared to actual scores using paired t-tests, weighted Cohen’s kappa for item-level agreement, Spearman’s correlation for total scores, and Bland-Altman plots for bias. Diagnostic classifications (lower urinary tract symptoms [LUTS]: IPSS ≥8; overactive bladder [OAB]: OABSS ≥3 with urgency ≥2) were assessed using McNemar’s test and receiver operating characteristic curve analysis.

RESULTS: Mean IPSS scores estimated by ChatGPT-4o were statistically significantly lower than patient-reported scores (11.2 vs. 13.6, p = 0.006), whereas OABSS scores did not differ significantly between the two methods (6.99 vs. 6.86, p = 0.686). Diagnostic agreement was high: LUTS in 42 (actual) vs. 38 (GPT) patients, and OAB in 51 vs. 50 patients. Area under curve was 0.81 for IPSS and 0.91 for OABSS. Kappa values ranged from 0.23-0.81 (IPSS) and 0.44-0.71 (OABSS), with highest concordance in quality of life (QoL) and urgency incontinence. Spearman’s correlation coefficient was 0.60 (IPSS) and 0.70 (OABSS). Accuracy was lower in first-visit patients.

CONCLUSIONS: GPT-4o estimated IPSS and OABSS with moderate but clinically acceptable accuracy. Its performance was comparable regarding diagnostic classification, particularly for QoL and OABSS. ChatGPT-4o may complement traditional questionnaires, particularly with missing or incomplete patient-reported data.

PMID:41555309 | DOI:10.1186/s12894-026-02054-z

BMC Cancer. 2026 Jan 19. doi: 10.1186/s12885-026-15598-y. Online ahead of print.

ABSTRACT

BACKGROUND: Testicular germ cell tumors (TGCTs) are the most common solid malignancies among young men. Although overall survival exceeds 95%, a subset of patients still present with advanced disease or relapse. Identifying clinicopathological and modifiable lifestyle factors associated with advanced-stage presentation may improve risk stratification and guide management.

METHODS: This retrospective study included 96 patients with TGCTs treated at a single tertiary center. Data on smoking status, body mass index (BMI), lymphovascular invasion (LVI), and tumor size were analyzed. Associations between these parameters and stage at diagnosis were assessed using chi-square tests and multivariable logistic regression. Recurrence-free survival (RFS) was evaluated by the Kaplan-Meier method.

RESULTS: Among 96 patients (median age, 31 years), 59.4% had early-stage and 40.6% had advanced-stage disease. Smoking (OR = 8.17; p = 0.014), LVI (OR = 70.23; p < 0.001), and tumor size ≥ 4 cm (OR = 12.00; p = 0.009) were independently associated with advanced-stage presentation, whereas BMI showed no significant association. Recurrence occurred in 13.5% of patients, more frequently among smokers and LVI-positive cases, though not statistically significant.

CONCLUSION: Smoking, lymphovascular invasion, and tumor size ≥ 4 cm were independently associated with advanced-stage presentation in TGCTs, whereas obesity showed no significant association. The combined evaluation of pathological and lifestyle factors may enhance individualized risk stratification and inform future risk-adapted management strategies.

PMID:41555284 | DOI:10.1186/s12885-026-15598-y

J Matern Fetal Neonatal Med. 2026 Dec;39(1):2614840. doi: 10.1080/14767058.2026.2614840. Epub 2026 Jan 19.

ABSTRACT

INTRODUCTION: The importance of prenatal determination of chorionicity for the management of twin pregnancies is well recognized. However, research on the contribution of prenatal evaluation of zygosity to the management of twins is limited. We assessed the utility of adding SNP-based cell-free DNA (cfDNA) zygosity testing to ultrasound chorionicity assessment for the clinical management of twin pregnancies.

METHODS: Prospective observational study involving 13 United States practices with proficiency in prenatal ultrasound. Patients diagnosed by ultrasound with twins in the first trimester were assessed with cfDNA screening for zygosity. Ultrasound assessment of chorionicity was performed prior to cfDNA results. Placental pathology was used as the gold standard for chorionicity assessment. Gestational age at delivery and standardized birthweights were compared, based on chorionicity and zygosity.

RESULTS: 110 twin pregnancies were included. Among 79 dichorionic (DC) cases confirmed by placental pathology, one (1.3%) was misclassified as monochorionic (MC) by ultrasound, but was dizygous (DZ) by cfDNA, consistent with DC. Of 31 monozygotic (MZ) twins by cfDNA, confirmed as MC by pathology, ultrasound misclassified one (3.6%) as DC. Median gestational age at delivery was earlier for MZ twin pregnancies (35.0 weeks) compared to DZ (36.9 weeks, p = 0.02). After adjusting for fetal sex and gestational age at birth, MZDC twins had significantly lower birthweights (p = 0.006) and birthweight percentiles (p = 0.004) than DZDC twins.

CONCLUSIONS: Based on postpartum placental pathology as the reference standard for determining MC versus DC, cfDNA zygosity testing appears to aid in the prenatal assignment of chorionicity. Larger studies are needed to confirm the value of zygosity testing in the management of twin pregnancies.

PMID:41555214 | DOI:10.1080/14767058.2026.2614840

Pediatr Dent. 2025 Nov 15;47(6):408-448.

ABSTRACT

Purpose: Evaluate and compare the accuracy and completeness of responses provided by ScholarGPT and ChatGPT-4 Omni (ChatGPT-4o) to clinical questions in pediatric dentistry. Methods: Thirty clinical questions across six clinical topics were developed. Responses were collected from ScholarGPT and ChatGPT-4o and independently evaluated by six experienced pediatric dentists. The evaluators used a five-point Likert scale for accuracy and three-point scale for completeness. Accuracy was rated for factual correctness, relevance, and coherence, while completeness reflected how fully the response addressed the question. Statistical analysis was performed using non-parametric tests, including the Wilcoxon signed-rank and Kruskal-Wallis tests. Results: ScholarGPT received significantly higher median accuracy scores (five, interquartile range [IQR] equals zero) compared to ChatGPT-4o (four, IQR equals one) across all topics (P<0.001). In completeness scores, ScholarGPT (three, IQR equals one) also out-performed ChatGPT-4o (two, IQR equals zero; P<0.001). ScholarGPT showed the highest accuracy in the “fissure sealants” (five, IQR equals zero), while the lowest was observed in “development of dentition and occlusion” (five, IQR equals one). ChatGPT-4o yielded the lowest accuracy in “development of dentition and occlusion” (four, IQR equals two) and the highest in “fluoride” (four, IQR equals one). Accuracy scores varied significantly across topics for both ChatGPT-4o (P=0.012) and ScholarGPT (P=0.001). However, differences in completeness across topics were observed only for ScholarGPT (P=0.008). Conclusions: ScholarGPT provided more accurate and complete responses to pediatric dentistry questions than ChatGPT-4o, suggesting that domain-specific artificial intelligence tools can aid dental education and clinical support, though further refinement is needed.

PMID:41555199

Nurs Health Sci. 2026 Mar;28(1):e70291. doi: 10.1111/nhs.70291.

ABSTRACT

Nurses play a key role in medication review. This study explores nursing students’ awareness and understanding of concepts (pharmacology, medication review, polypharmacy, and deprescribing) and gives insight into their preparedness to engage with these in clinical settings. This cross-sectional survey was conducted at a London higher education institution. The sample comprised 127 third-year undergraduate adult and paediatric nursing students. Data were collected using a structured questionnaire, which included free-text items to capture qualitative insights. Quantitative data were analyzed using descriptive statistics, while thematic analysis explored qualitative responses. Respondents were familiar with the terms medication review (94%, 118/125) and polypharmacy (76%, 96/126), but not deprescribing (37%, 46/125). Although respondents could identify triggers for initiating a medication review, their understanding of the collaborative nature of the process for healthcare professionals and patients was inconsistent. Respondents were able to identify medications that may warrant review and potential deprescribing. Core concepts related to medication review were generally understood by respondents. However, understanding of deprescribing, as well as the nurse’s role in advocating for patients during medication review, was less consistent.

PMID:41555163 | DOI:10.1111/nhs.70291

Dermatol Ther (Heidelb). 2026 Jan 19. doi: 10.1007/s13555-025-01646-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Switching biologics within or across classes can improve outcomes for patients with psoriasis who failed to meet their treatment goals on their original therapy. The objective of this study was to identify real-world baseline features which are associated with switching psoriasis therapies following sustained use of a biologic therapy.

METHODS: The study was a retrospective analysis of the prospective, multicenter, non-interventional PPD™ CorEvitas™ Psoriasis Registry cohort. Patient sociodemographics, comorbidities, treatment history, disease activity, and patient-reported outcome measures were assessed at baseline visits, along with changes in disease activity and treatment at follow-up visits. Patients were classified at each follow-up visit as either switchers from one biologic therapy to another or non-switchers. Three analytic strategies-logistic regression, random forest, and decision trees-were used to identify features associated with switching.

RESULTS: Patients contributed 14,729 follow-up visits, of which 995 episodes (6.8%) reflected a switch in biologic therapy. In logistic regression models, statistically significant associations with switching were seen for features including body surface area (BSA) involvement at baseline, change in BSA involvement from baseline to follow-up, and addition of at least one non-biologic systemic medication to treatment between baseline and follow-up. In random forest estimations, these three variables along with patient-reported fatigue and quality of life were determined to be most important. Finally, in the decision tree analysis, four subgroups of patients with moderate/severe BSA involvement at baseline in combination with other specific variables were identified as having a > 50% likelihood of switching.

CONCLUSION: Identification and recognition of these features and combinations thereof can facilitate shared decision-making between clinicians and patients to improve both outcomes of and patient satisfaction with biologic therapy.

PMID:41555153 | DOI:10.1007/s13555-025-01646-1

J Autism Dev Disord. 2026 Jan 20. doi: 10.1007/s10803-025-07211-1. Online ahead of print.

ABSTRACT

PURPOSE: Social skill interventions are frequently used to support the development of social competence in children with autism spectrum disorder (ASD). The Superheroes Social Skills program (SSS), a multicomponent social skills curriculum, has shown promise in supporting social skill acquisition and use in autistic children. The present exploratory pilot study evaluated the effectiveness of a brief version of SSS on social skill accuracy and quality of skill use of five young children with ASD.

METHOD: Single-case design (multiple probe design across skills, replicated across participants) was used to evaluate the effect of a brief SSS intervention implemented in a series of weekly 20-minute sessions. Five young autistic children participated in the study. Social skill accuracy and quality of skill use were measured to assess the impact of the intervention.

RESULTS: Results of the study indicated that participants increased in social skill accuracy and quality of skill use following participation in the intervention, with statistical analysis of data also supporting the effectiveness of the brief intervention.

CONCLUSION: Although preliminary, findings of this pilot study suggest that a brief variation of SSS may have utility as a strategy to address social skill needs in young children with ASD. Given the small sample included in the study, further replication is necessary to address limitations to external validity.

PMID:41555143 | DOI:10.1007/s10803-025-07211-1