Category: Statistics

Isr J Health Policy Res. 2025 Dec 31;14(1):81. doi: 10.1186/s13584-025-00744-x.

ABSTRACT

BACKGROUND: Appropriate procurement of blood cultures (BC) is essential for diagnosis of bacteremia and susceptibility testing. This includes (1) adequate preparation of the venipuncture site to minimize contamination; (2) obtaining ≥ two sets with a time interval before starting antibiotics. Although these recommendations are standard since the 1960s, adherence is far less than expected – which may adversely impact on the management of bacteremic patients.

AIMS OF STUDY: This single-center study conducted in Shaare Zedek Medical Center aimed to decrease the proportion of contaminated BCs and to increase the percentage of obtaining two sets of BC/ blood-culture-taking episode.

METHODS: Determination of both markers at baseline, then monthly for one year, then subsequently on a quarterly basis; showing data from all departments in real-time to all department directors; and providing short educative lectures during departmental staff meetings, at baseline and after 1-2 years. These markers were adopted as one of the hospital-wide quality measures.

RESULTS: In the 20-year period 2000-2019 more than 1 million BCs were obtained, of which 70% were from patients ≤ 72 h in hospital. During the 5-year study (2020-2024), the percent of blood-culture-taking episodes from which two culture sets were obtained increased annually by ± 16% from a baseline of 27% (9010/33306) in 2020, to 46% (18462/40191) in 2024 (Incidence Rate Ratios, IRR 1.16 [95%CI 1.13-1.18], p < 0.001). This improvement was observed in almost all departments and was especially profound in the emergency department (ED), starting at a baseline of 19% (1979/10326) and increasing to 53% (5304/9915)(IRR 1.33 [95%CI 1.27-1.39], p < 0.001). During the same period, the annual proportion of false-positive BCs, from which only contaminants were isolated, decreased annually by 18% from 2.4% (1592/65230) in 2020 to 1.3% (895/68991) in 2024 (IRR 0.82 [95%CI 0.77-0.88], p < 0.001). This improvement was observed in all departments: in the emergency department, this rate decreased from 3.3% (676/20529) to 1.56% (272/17459) (IRR 0.79 [95%CI 0.75-0.83], p < 0.001).

CONCLUSION: A simple educational intervention, combined with meticulous data mining and presentation of each department’s results, with comparison of all other departments, led to significant and sustained improvement in measurable markers.

PMID:41469732 | DOI:10.1186/s13584-025-00744-x

Cancer Med. 2026 Jan;15(1):e71490. doi: 10.1002/cam4.71490.

ABSTRACT

BACKGROUND: Patient-derived organoid (PDO) models have emerged as critical tools in pancreatic ductal adenocarcinoma (PDAC) research and are used as surrogates for studying the individual’s tumor biology. Still, PDO-based concepts for direct clinical application remain challenging. In this prospective observational trial (OrgaPanCCC-01), we aim to address clinical feasibility, identify predictive factors for PDO establishment, and assess the prognostic potential of PDO establishment for patient’s survival.

METHODS: Samples for PDO generation were prospectively collected via endoscopy, surgery, and transcutaneous punch biopsy, or from ascites. Patients were followed up for a median time of 14.6 months. We evaluated the clinical feasibility by determining the PDO establishment rate and the time required for establishment. Uni- and multivariate analyses were performed to examine the effect of clinical and sample characteristics on PDO establishment. For the predictive and prognostic potential, PDO establishment was correlated to the patients’ disease-free (DFS), progression-free (PFS) and overall survival (OS).

RESULTS: Between 2021 and 2023, 75 patients were enrolled with radiologically suspected PDAC at the Charité Universitätsmedizin Berlin and at the Waldfriede Krankenhaus Berlin. PDAC was confirmed in 62 patients (83%). PDO establishment was achieved in 58% (n = 36/62) of patients within a median of 28 days, supporting the feasibility of clinical implementation. In the uni- and multivariate analysis, samples from metastatic sites (p = 0.04) and higher CA19-9 levels (p = 0.03) were found to be positively correlated with PDO growth. Patients without PDO growth tended to have longer PFS (p = 0.32), whereas no statistically significant correlation was observed between PDO growth and OS.

CONCLUSION: In this prospective observational trial, we show that PDO generation is feasible at a success rate of 58% within a clinically reasonable time frame of 6 weeks. The efficacy of PDO establishment depended on sample site, with metastatic samples showing higher establishment rates. Higher CA 19-9 levels were positively correlated with PDO growth. Successful PDO establishment did not have a prognostic value for OS. Overall, our findings underline the great potential of PDO-based precision medicine approaches, which should further be evaluated in prospective interventional translational trials.

PMID:41469727 | DOI:10.1002/cam4.71490

Obstet Gynecol Surv. 2025 Dec 1;80(12):757-759. doi: 10.1097/OGX.0000000000001475.

ABSTRACT

(Abstracted from Lancet Oncol 2025;26(10):1370-1381) Fifteen percent to 20% of endometrial cancer patients have a high-risk form of the disease; this classification indicates a higher risk of cancer recurrence and cancer-related death. The standard therapy for high-risk endometrial cancer is pelvic radiotherapy.

PMID:41468091 | DOI:10.1097/OGX.0000000000001475

Obstet Gynecol Surv. 2025 Dec 1;80(12):737-738. doi: 10.1097/01.ogx.0001176336.07664.a1.

ABSTRACT

(Abstracted from JAMA 2025;333(21):1925-1928) Restrictive abortion policies in many states may raise ethical and clinical considerations among neonatologists, who feel obligated to attempt life support to infants, regardless of the prognosis. Studies that have evaluated trends in initiating active treatment and the survival rate of infants born between 22 and 25 weeks of gestation are scarce.

PMID:41468084 | DOI:10.1097/01.ogx.0001176336.07664.a1

Breastfeed Med. 2025 Dec 22. doi: 10.1177/15568253251406258. Online ahead of print.

ABSTRACT

Background: Diaper dermatitis (DD) is a very common problem in infants between 1 and 6 months. While it rarely causes long-lasting problems, it can cause serious short-term problems for both infants and parents. Accordingly, this study compared the effect of breast milk and diaper rash cream containing Hamamelis virginiana (12 mg/100 g) on the healing process in 0-6 month-old infants with DD. Methods: This randomized, single-blinded trial was conducted with 60 infants aged 0-6 months diagnosed with DD. Participants were assigned to either the breast milk group (BG) or the comparison group (CG) receiving Hamamelis virginiana cream. Demographic characteristics and DD severity were assessed using a structured demographic questionnaire and the validated Assessment of the Severity of Uncomplicated DD in Infants Scale. Statistical analyses included Shapiro-Wilk, Mann-Whitney U, Wilcoxon signed rank, Chi-square, and Fisher’s exact tests. Significance was set at p < 0.05. Results: Before the intervention, the mean scale score was 5.17 ± 0.46 in the BG, 2.83 ± 1.37 in the CG, which was a statistically significant difference. After the intervention, there was a significant decrease in the mean scale score in the BG to 0.03 ± 0.18, whereas the mean decrease was smaller in the CG (1.53 ± 1.11). The difference in the mean scale scores between the groups was statistically significant (p < 0.001). Furthermore, the postintervention mean scale score of the BG was significantly lower than that of the CG. However, baseline severity differences limit direct comparison of treatment efficacy. Conclusions: Topically applied breast milk appears to be a safe, accessible, and cost-effective option for treating uncomplicated DD, with greater improvement than cream containing Hamamelis virginiana. However, baseline severity differences limit direct comparison. Further studies using block randomization are recommended.

PMID:41468068 | DOI:10.1177/15568253251406258

Surg Infect (Larchmt). 2025 Dec 19. doi: 10.1177/10962964251409563. Online ahead of print.

ABSTRACT

Introduction: Surgical site infections continue to pose a major challenge in healthcare, contributing to prolonged hospitalizations and increased morbidity and mortality. Despite advancements in antimicrobial agent treatments, bacterial resistance remains an important obstacle. Among various antimicrobial agents, silver compounds have been re-evaluated for their broad-spectrum efficacy. Previous studies, have demonstrated the potential of silver carboxylate embedded in a titanium dioxide/polydimethylsiloxane (TiO₂/PDMS) matrix as a material of biomedical relevance. This study aims to expand upon these findings by examining the cytotoxicity profile of silver carboxylate in four human cell lines that play a crucial role in wound healing. Hypothesis: Controlled silver elution from the TiO₂/PDMS matrix produces a cytotoxicity profile comparable with commonly used antibiotic agents at clinically relevant exposures. Methods: In this study, silver carboxylate beads were prepared using a modified method, whereby silver neodecanoate was incorporated into a TiO₂/PDMS matrix. The modification involved adjusting the concentration ratios to optimize the release profile for controlled silver elution. Primary human osteoblasts (OBs), keratinocytes (KTs), skeletal muscle cells (SkMs), and endothelial cells (ETs) were cultured under standard conditions and, after 24 h, were exposed to specific silver carboxylate concentrations (1×, 10×, and 100%) without additional washing steps before exposure. In addition, we included a comparative analysis with newly developed silver formulations (silver nanoparticles at 10 and 30 nM, and colloidal silver at 100 and 300 nM) and a panel of conventional antibiotic agents, including vancomycin (5 and 50 µg/mL), tobramycin (5 and 50 µg/mL), linezolid (2 and 20 µg/mL), and polymyxin E (2 µg/mL). Cell viability following exposure was measured using the MTT assay, and the results were analyzed statistically using analysis of variance followed by post hoc Tukey tests. Results: OBs exhibited marked cytotoxicity at higher silver carboxylate concentrations, particularly at the 10× condition, with viability comparable with that observed with higher dose antibiotic agents such as vancomycin 50 µg/mL and tobramycin 50 µg/mL. SkMs and ETs demonstrated limited sensitivity at 1× exposure but showed substantial loss of viability at 10×, consistent with dose-dependent toxicity. KTs were the most sensitive cell type, displaying decreased viability even at 1× exposure. The modified TiO₂/PDMS matrix demonstrated an enhanced controlled release mechanism, resulting in lower cytotoxicity compared with both early silver formulations and conventional antibiotic agents. Conclusion: This study builds upon previous investigations on silver carboxylate and provides new insights into its cytotoxic effects across additional human cell lines, including ETs and SkMs. The enhanced controlled release from the modified TiO₂/PDMS matrix reduces cytotoxicity compared with previous formulations and commonly used antibiotic agents. These results highlight the importance of concentration-dependent toxicity and support further evaluation of this material in future in vivo and translational studies. The cytotoxicity profile of silver carboxylate embedded in a modified TiO₂/PDMS matrix shows variability across different human cell types, but may be relevant for future evaluation in models that require a detailed assessment of biocompatibility. This study expands on previous research by introducing additional cell lines and optimizing the release mechanism of silver carboxylate to enhance its cytotoxicity profile and safety. Addressing current limitations, including lactate dehydrogenase (LDH) interference, will be essential for a comprehensive evaluation and for establishing safe concentration thresholds for future in vivo applications. Future research should focus on validating these findings in animal models and evaluating the systemic effects of prolonged silver exposure.

PMID:41468057 | DOI:10.1177/10962964251409563

Water Sci Technol. 2025 Dec;92(12):1687-1708. doi: 10.2166/wst.2025.172. Epub 2025 Dec 3.

ABSTRACT

A dam is constructed across a river, which stores and supplies water for various purposes. Though the dams have many benefits, there is always a threat of a break. The research is aimed at developing a dam break simulation model for the Tiga dam and producing an inundation map of affected areas. The study conducted a dam break analysis for the Tiga dam in Kano State, Nigeria, using HEC-RAS and HEC-HMS. The analysis simulated dam failure scenarios to predict breach parameters and flood hydrograph downstream. The results showed that 213 communities would be affected, with 122 in Jigawa State and 91 in Kano, covering an area of 4,397.06 km². Breach peak flow was estimated as 117,000 m³/s, arriving in 31.3 min. Validation of the hydrodynamic breach model performance was done using the observed annual outflow and simulated results, employing the Nash -Sutcliffe efficiency (NSE) statistical analysis. The NSE score of 0.71 indicates a decent fit of the HEC-RAS model to the data. The study recommends that the Hadejia Jama’are River Basin Development Authority implement the findings to develop emergency response plans and flood mitigation strategies to safeguard lives and property downstream. Future studies should conduct socio-economic impacts on affected areas.

PMID:41468046 | DOI:10.2166/wst.2025.172

JAMA Netw Open. 2025 Dec 1;8(12):e2549679. doi: 10.1001/jamanetworkopen.2025.49679.

ABSTRACT

IMPORTANCE: Residence in a disadvantaged neighborhood is a key driver of racial and ethnic disparities in the diagnosis and management of chronic diseases; however, its impact on disparities in access to waitlisting and kidney transplantation (KT) is unclear.

OBJECTIVE: To examine the association between neighborhood disadvantage and access to waitlisting and KT.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study (January 1, 2015, to December 31, 2021) used a US national registry to assess adults (aged ≥18 years) with end-stage kidney disease (ESKD) and adult KT candidates. Statistical analysis was performed in March 2025.

EXPOSURE: Residential neighborhood disadvantage score (built environment disadvantage, criminal injustice, education disadvantage, unemployment, housing instability, poverty, social fragmentation, transportation barrier, and wealth inequality) ascertained by American Community Survey and other public data sources.

MAIN OUTCOMES AND MEASURES: The adjusted hazard ratios (AHRs) of waitlisting and KT (any KT, live-donor KT [LDKT], and preemptive KT) were assessed across tertiles of the neighborhood disadvantage score using cause-specific hazard models. Interaction terms were used to quantify these aforementioned associations by race and ethnicity.

RESULTS: The study included 501 444 adults with ESKD initiating dialysis (mean [SD] age, 63.9 [14.6] years; 293 937 [58.6%] male; 25 790 [5.1%] Asian [Asian American, Native Hawaiian, and Pacific Islander], 133 923 [26.7%] Black, 66 323 [13.2%] Hispanic, and 275 408 [54.9%] White) and 95 068 KT candidates on the waitlist (mean [SD] age, 53.7 [13.0] years; 60 328 [63.5%] male; 6956 [7.3%] Asian, 25 215 [26.5%] Black, 15 685 [16.5%] Hispanic, and 47 212 [49.7%] White). A total of 173 880 adults with ESKD (34.7%) and 26 718 KT candidates (28.1%) resided in high-disadvantage neighborhoods. After adjustment, adults residing in high-disadvantage neighborhoods were less likely to be waitlisted (AHR, 0.71; 95% CI, 0.69-0.72) compared with those in low-disadvantage neighborhoods. Specifically, Asian (AHR, 0.87; 95% CI, 0.80-0.95), Black (AHR, 0.68; 95% CI, 0.66-0.70), Hispanic (AHR, 0.89; 95% CI, 0.86-0.92), and White (AHR, 0.68; 95% CI, 0.66-0.71) adults in high-disadvantage neighborhoods were less likely to be waitlisted compared with White adults in low-disadvantage neighborhoods. Overall, candidates residing in high-disadvantage neighborhoods were less likely to receive any KT (AHR, 0.89; 95% CI, 0.87-0.92), LDKT (AHR, 0.65; 95% CI, 0.62-0.69), and preemptive KT (AHR, 0.62; 95% CI, 0.58-0.67). Notably, Black candidates residing in high-disadvantage neighborhoods were less likely to receive KT (AHR, 0.60; 95% CI, 0.58-0.62), LDKT (AHR, 0.23; 95% CI, 0.21-0.25), and preemptive KT (AHR, 0.22; 95% CI, 0.20-0.25) compared with White candidates in low-disadvantage neighborhoods.

CONCLUSIONS AND RELEVANCE: In this cohort study of adults with ESKD and KT candidates, residence in high-disadvantage neighborhoods was associated with reduced access to waitlisting and KT; it also was associated with persistent racial and ethnic disparities in LDKT and preemptive KT. These results suggest that to support equitable access, clinicians and transplant programs should work with social workers and community advocates to implement initiatives (eg, outreach and financial support) that address structural barriers and direct resources to affected neighborhoods.

PMID:41468017 | DOI:10.1001/jamanetworkopen.2025.49679

JAMA Netw Open. 2025 Dec 1;8(12):e2551677. doi: 10.1001/jamanetworkopen.2025.51677.

ABSTRACT

IMPORTANCE: Approximately 2000 children die each year of child abuse and/or neglect. Foster care is designed as a targeted intervention to reduce harm to children, but its association with child maltreatment mortality is not well understood.

OBJECTIVE: To examine whether foster care entry rates are negatively associated with rates of child mortality due to child abuse and/or neglect.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed associations between child maltreatment mortality rates and foster care entry rates at the state level using administrative data from all US states from January 1, 2010, to December 31, 2023 (N = 700 state-years). Administrative records on all children in state-supervised foster care and all children whose death was attributed by child welfare agencies to child maltreatment were assessed.

EXPOSURES: Number of children entering foster care per 1000 child population.

MAIN OUTCOMES AND MEASURES: Number of child fatalities due to child abuse and/or neglect per 100 000 child population.

RESULTS: The study analyzed 3.4 million records of children in state-supervised foster care from 2010 to 2023 and 24 108 child fatalities that states attributed to child abuse and/or neglect. In 2023, states reported a mean (SD) of 2.62 (1.85) deaths per 100 000 child population and reported a mean (SD) of 3.21 (1.75) entries into foster care per 1000 child population. No evidence was found of a negative association between state-year level foster care entry rates and state-year-level child maltreatment mortality rates (β = 0.17; 95% CI, 0.01-0.34).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, child maltreatment mortality rates did not appear to decrease with higher foster care entry rates or increase with decreasing foster care entry rates. This evidence suggests that there is not a negative association between child maltreatment mortality rates and foster care entry rates.

PMID:41468015 | DOI:10.1001/jamanetworkopen.2025.51677

JAMA Netw Open. 2025 Dec 1;8(12):e2551683. doi: 10.1001/jamanetworkopen.2025.51683.

ABSTRACT

IMPORTANCE: Best-practice guidelines recommend oral medications for treating agitation in the emergency department (ED). However, there is limited study of their use in the ED, especially in the setting of drug and alcohol intoxication.

OBJECTIVE: To evaluate the implementation of oral medications to treat agitation in an ED in which intramuscular medications were standard and to increase the use of oral medications to treat agitation.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study analyzed 2 populations. First, all ED patients in an urban level 1 adult and pediatric trauma center from January 1, 2018, to May 31, 2024, were studied to compare the preintervention and postintervention periods. Second, during the 12-month implementation period from September 16, 2020, to August 31, 2021, patients were prospectively observed in an area of the ED dedicated to caring for patients with drug and alcohol intoxication.

EXPOSURE: Oral medications to treat agitation, including olanzapine and lorazepam, were encouraged via education and real-time feedback for ED staff.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients receiving their first sedating medication via the oral route. Secondary outcomes included data on time to adequate sedation and adverse drug events.

RESULTS: Of 460 600 ED encounters (median patient age, 38 years [IQR, 27-55 years]; 57.8% men; 184 050 [40.0%] before the intervention, 276 550 [60.0%] after), the proportion of patients receiving any sedating medication was similar between time periods (11.8% before intervention vs 11.5% after). The proportion of patients receiving their first sedating medication via the oral route increased after the intervention (7.2% vs 31.4%; difference, 24.2 percentage points [pp] [95% CI, 23.6-24.8 pp]). Among 1178 patients receiving sedating medications during implementation (860 [73.0%] with alcohol intoxication; median breath or blood concentration, 0.22% [IQR, 0.16%-0.28%]), 630 (53.5%) were offered oral medication, of whom 446 (70.8%) accepted it. Time to adequate sedation was 15 minutes (IQR, 7-33 minutes) for oral and 15 minutes (IQR, 9-26 minutes) for intramuscular medications (median difference, 1 minute [95% CI, -0.6 to 2.6 minutes]). There were no significant differences between routes in rates of additional rescue medications (oral, 31.8%; intramuscular, 28.4%; difference, 3.4 pp [95% CI, -2.0 to 8.8 pp]) or adverse drug reactions (oral, 2.7%; intramuscular, 1.1%; difference, 1.6 pp [95% CI, -0.1 to 3.3 pp]).

CONCLUSIONS AND RELEVANCE: In this quality improvement study, emergency physicians successfully adopted oral medications for treating agitation, primarily from intoxication. No difference was found in time to adequate sedation when oral or intramuscular medications were used as primary therapy. These data support best-practice guidelines that suggest oral medications should be first-line treatment for agitation in the ED.

PMID:41468014 | DOI:10.1001/jamanetworkopen.2025.51683