Category: Statistics

Prehosp Emerg Care. 2025 Jul 24:1-16. doi: 10.1080/10903127.2025.2538741. Online ahead of print.

ABSTRACT

OBJECTIVES: Whether clinical outcomes differ for hemorrhaging patients receiving prehospital whole blood versus blood component transfusion is unclear. Furthermore, most prehospital transfusion studies are limited to injured patients and commingle interfacility transfers with 9-1-1 scene responses. This study assessed outcomes exclusively among 9-1-1 scene response patients receiving prehospital transfusion with either whole blood or blood components for traumatic and non-traumatic hemorrhage.

METHODS: Using the ESO Data Collaborative for 2019- 2023, patients 8 to 100 years old who received whole blood or blood components were identified. Interfacility transports, patients receiving blood products prior to EMS arrival, and those with pre-arrival cardiac arrest were excluded. The primary prehospital outcome was change in shock index, along with changes in individual vital signs (Glasgow coma score (GCS), heart rate, systolic blood pressure). The primary hospital outcome was mortality at emergency department (ED) or hospital disposition. We also analyzed adverse events.

RESULTS: Of 1,990 eligible patients, 1,515 received whole blood and 475 received blood components. There were significant baseline differences between the two groups, with whole blood more frequently used by ground ambulance services, in urban areas and for penetrating trauma. Patients receiving blood components had statistically greater decreases in shock index (median change, -0.3 vs. -0.2, p = 0.040) and heart rate (median change, -7 bpm vs. – 4 bpm, p = 0.007), but there was no significant difference in mortality for patients receiving whole blood vs. blood components after multivariable analysis adjusting for baseline differences (adjusted odds ratio: 1.7, CI: 0.6-4.9). No patients in either group received prehospital epinephrine, and there were no ED diagnoses of transfusion reaction. Three whole blood patients had diagnoses related to thromboembolic events, but these were unlikely to be related to the transfusion.

CONCLUSIONS: In this retrospective observational study of 9-1-1 scene response patients with traumatic or non-traumatic hemorrhage, differences between shock index and heart rate for patients receiving whole blood or blood components were of questionable clinical significance, and adjusted mortality did not significantly differ for the two groups. There were no instances of prehospital anaphylaxis or ED transfusion reactions. Both transfusion strategies appear equally effective and safe.

PMID:40705958 | DOI:10.1080/10903127.2025.2538741

J Eval Clin Pract. 2025 Aug;31(5):e70203. doi: 10.1111/jep.70203.

ABSTRACT

BACKGROUND: Nursing education encompasses both theoretical knowledge and clinical practice. Nursing students can find the opportunity to increase their competences by applying the knowledge they have learnt in theoretical education in clinical practice. A multitude of factors influence the efficacy of clinical practice. It is expected that students will develop professional competencies before graduation and cultivate a positive attitude towards the nursing profession and clinical practice.

OBJECTIVE: The objective of this study is to examine the influence of nursing students’ competencies and their attitudes toward the profession on their attitudes toward clinical practice.

METHODS: The study employed a correlational design. This study was conducted in a hospital between February 27 and August 25, 2023, and included 585 nursing students who agreed to participate in the study. The study used the Nursing Students’ Attitudes towards Clinical Practices Scale, the Attitude Scale for Nursing Profession, and the Competency Inventory of Nursing Students as data collection tools together with the Descriptive Information Form. Structural equation modelling was used to analyse the research data.

RESULTS: The study revealed that nursing students’ competencies and attitudes toward the profession influence their attitudes toward clinical practices.

CONCLUSION: Nursing students’ attitudes and competencies towards the profession should be taken into consideration throughout their education to enhance the efficacy and quality of clinical practice.

PMID:40705950 | DOI:10.1111/jep.70203

J Eval Clin Pract. 2025 Aug;31(5):e70215. doi: 10.1111/jep.70215.

ABSTRACT

AIM: To conduct the cross-cultural and psychometric validation of the ‘Ageism in the Organizational Context Scale’ with Peruvian nursing students.

METHODS: This is a methodological quantitative study conducted with 882 nursing students between February and August 2023. For the adaptation process, the forward-backward method of the original version from Portuguese to Spanish was used. The content analysis was performed with the participation of specialist judges, while for the internal structure of the construct, confirmatory factor analysis and measurement invariance with multigroup confirmatory factor analysis were used.

RESULTS: Content validity was 0.93. The best internal structure of the construct is represented by the bi-factor model for the 14-item scale (CFI and TLI > 0.97, RMSEA = 0.057 and SRMR = 0.028). The measurement invariance by sex for the four levels (configural, metric, strong and strict) is also satisfactorily fulfilled. The internal consistency of the bifactor model according to the hierarchical omega (> 0.85) and the H coefficient for the latent construct (> 0.90) presented high reliability. In addition, the ordinal alpha coefficient and McDonald omega presented high precision (≥ 0.85).

CONCLUSION: The Ageism in the Organizational Context Scale adapted to the Peruvian version with 14 items showed excellent validity evidence based on the internal structure of the construct for a bifactor model and high reliability for the general score and for the two dimensions in nursing students. Identifying ageism towards the older population among nursing students is important in the training of future nurses, eliminating prejudice and improving the quality of care in this population.

PMID:40705949 | DOI:10.1111/jep.70215

J Eval Clin Pract. 2025 Aug;31(5):e70146. doi: 10.1111/jep.70146.

ABSTRACT

RATIONALE: Many service users with neurological conditions do not meet the recommended physical activity requirements. Cultivating early and ongoing access to physical activity and exercise opportunities is vital to improve or maintain function and general health in this vulnerable group.

AIM: To evaluate the impact of a pathway that aimed to facilitate access and adherence to physical activity and exercise for service users with neurological conditions.

METHODS: A London-based NHS healthcare team providing community neurorehabilitation developed a pathway in co-production with public health, local authority, third sector parties and service users to facilitate physical activity and exercise opportunities. First, NHS neurophysiotherapists offered a bespoke programme on exercise, physical activity and education to service users for up to 12 weeks. The pathway continued in local gyms, supported by a fitness instructor, for at least a further 12 weeks. Using a pre-post design, outcomes relating to function, strength and physical activity were recorded at baseline, 6-12 weeks (health care) and 6 weeks later (telephone survey after transition to local gyms). Data analysis was descriptive.

RESULTS: Thirty-five service users (20 men), mean (SD) age 60 (15), with a range of neurological conditions, were eligible and included. Ten participants dropped out: eight (23%) for medical reasons, two (6%) for other reasons. Due to the COVID-19 pandemic, four (11%) service users could not transition when facilities closed in March 2020. Analysis showed potential beneficial effects on function, strength and physical activity for service users as well as reduced waiting times to access the NHS and local gyms.

CONCLUSION: Outcomes suggested the pathway enabled service users to access and adhere to physical activity and exercise following neurorehabilitation. This evaluation included small numbers but could inform service development and future studies.

PMID:40705945 | DOI:10.1111/jep.70146

Braz J Cardiovasc Surg. 2025 Jul 24;40(4):e20240216. doi: 10.21470/1678-9741-2024-0216.

ABSTRACT

INTRODUCTION: Delirium is one of the most serious and common neuropsychological complications in the immediate postoperative period of cardiac surgery, always resulting in negative consequences, prolonged hospitalization, and increased early and late morbidity and mortality.

METHODS: An active search for acute cognitive dysfunction was performed in the electronic medical records written by the multidisciplinary team about the immediate postoperative period of 262 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass operated on in 2019 at the Instituto do Coração of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. To maintain randomness, data were collected from 25 patients per month for a total of 10 months.

RESULTS: Seventy-three patients (27.9%) presented symptoms of delirium or perioperative neurocognitive disorder in the postoperative period, with a median time of four days. The most frequent symptoms were changes in cognition (25.6%), attention (25.2%), and agitation (24.8%). Patients with delirium had a longer intensive care unit stay (median seven days vs. three days, P < 0.001), longer mechanical ventilation (median 977 vs. 535, P < 0.001), longer hospital stay (median 20 days vs. 13 days, P < 0.001), and higher incidence of hospital death (22.2% vs. 3.2%, P < 0.001).

CONCLUSION: The incidence of delirium immediately after cardiac surgery was high, around 27.9%, which is consistent with values found in the literature. The occurrence of delirium was highly associated with worse outcomes, such as longer hospital stays and mortality.

PMID:40705941 | DOI:10.21470/1678-9741-2024-0216

J Eval Clin Pract. 2025 Aug;31(5):e70213. doi: 10.1111/jep.70213.

ABSTRACT

RATIONALE: In Portugal, living wills-legal documents allowing individuals to express healthcare preferences in case of future incapacity-have been recognized since 2012. Despite this, public engagement remains limited, and previous studies have highlighted both public unawareness and knowledge gaps among healthcare professionals.

AIMS AND OBJECTIVES: This study aimed to assess the perspectives, knowledge, and clinical use of living will among Portuguese General Practitioners (GPs), given their pivotal role in promoting health literacy and patient autonomy.

METHODS: A cross-sectional, quantitative survey was conducted among Portuguese GPs, using a 30-item online questionnaire that covered demographics, knowledge, attitudes, and clinical practices. Non-parametric statistical analyses, including Spearman correlation and the Mann-Whitney test, were used to assess associations.

RESULTS: A total of 392 GPs answered the questionnaire, with a median age of 35 years. In their clinical practice, almost half of healthcare professionals have had conversations with their patients about Advance Directives (ADs), although 22.3% were unable to locate a living will in the Portuguese Public Healthcare Service Electronic System. The median number of correct answers to the 14 questions that require knowledge about the Portuguese law of ADs was 10, with a minimum of 5 and a maximum of 14. Most doctors reported that fewer than 1% of their patients have inquired about ADs.

CONCLUSIONS: Despite recognizing the importance of living wills, GPs seldom address them in consultations, often due to limited knowledge and practical barriers. Findings underscore the need for targeted training and public awareness initiatives to promote advanced care planning in primary care settings.

PMID:40705937 | DOI:10.1111/jep.70213

JMIR Med Inform. 2025 Jul 24;13:e69286. doi: 10.2196/69286.

ABSTRACT

BACKGROUND: Several clinical cases and experiments have demonstrated the effectiveness of traditional Chinese medicine (TCM) formulas in treating and preventing diseases. These formulas contain critical information about their ingredients, efficacy, and indications. Classifying TCM formulas based on this information can effectively standardize TCM formulas management, support clinical and research applications, and promote the modernization and scientific use of TCM. To further advance this task, TCM formulas can be classified using various approaches, including manual classification, machine learning, and deep learning. Additionally, large language models (LLMs) are gaining prominence in the biomedical field. Integrating LLMs into TCM research could significantly enhance and accelerate the discovery of TCM knowledge by leveraging their advanced linguistic understanding and contextual reasoning capabilities.

OBJECTIVE: The objective of this study is to evaluate the performance of different LLMs in the TCM formula classification task. Additionally, by employing ensemble learning with multiple fine-tuned LLMs, this study aims to enhance classification accuracy.

METHODS: The data for the TCM formula were manually refined and cleaned. We selected 10 LLMs that support Chinese for fine-tuning. We then employed an ensemble learning approach that combined the predictions of multiple models using both hard and weighted voting, with weights determined by the average accuracy of each model. Finally, we selected the top 5 most effective models from each series of LLMs for weighted voting (top 5) and the top 3 most accurate models of 10 for weighted voting (top 3).

RESULTS: A total of 2441 TCM formulas were curated manually from multiple sources, including the Coding Rules for Chinese Medicinal Formulas and Their Codes, the Chinese National Medical Insurance Catalog for proprietary Chinese medicines, textbooks of TCM formulas, and TCM literature. The dataset was divided into a training set of 1999 TCM formulas and test set of 442 TCM formulas. The testing results showed that Qwen-14B achieved the highest accuracy of 75.32% among the single models. The accuracy rates for hard voting, weighted voting, weighted voting (top 5), and weighted voting (top 3) were 75.79%, 76.47%, 75.57%, and 77.15%, respectively.

CONCLUSIONS: This study aims to explore the effectiveness of LLMs in the TCM formula classification task. To this end, we propose an ensemble learning method that integrates multiple fine-tuned LLMs through a voting mechanism. This method not only improves classification accuracy but also enhances the existing classification system for classifying the efficacy of TCM formula.

PMID:40705933 | DOI:10.2196/69286

J Eval Clin Pract. 2025 Aug;31(5):e70226. doi: 10.1111/jep.70226.

ABSTRACT

BACKGROUND: Clinical pharmacy services have gained high recognition worldwide, but are still unevenly developed and inequitable. This study aims to explore the setting and implementation of clinical pharmacy services in county hospitals in China and to identify the associated factors, as well as the perceptions and demands of healthcare professionals.

METHODS: A national cross-sectional survey of clinical pharmacy services in county hospitals in China from April to October 2023. Data were obtained from questionnaire surveys of stakeholders including leaders of pharmacy departments, pharmacists, doctors, and nurses in county hospitals in China. Data was analyzed using descriptive statistics, chi-square test, t-test and Wilcoxon rank sum test.

RESULTS: A total of 1510 questionnaires were collected from 362 county hospitals in 15 provinces in China. The median number of clinical pharmacists in county hospitals was 3 (2-5), far less than the requirement. More than 80% of the hospitals have established working mode and procedures of clinical pharmacy services, but only around 30% of them have incentive policy and charge for services. At present, over 60% of county hospitals consistently provide prescription review. Clinical pharmacy services significantly contributed to the rational use of medication and were highly valued by both doctors and nurses.

CONCLUSION: The findings indicated that clinical pharmacy services were embedded into daily work of clinical pharmacists, which was highly recognized by healthcare professionals. However, the implementation and sustainability of these services in county hospitals are still restricted by inadequate resources, incomplete systems, and insufficient competence.

PMID:40705930 | DOI:10.1111/jep.70226

J Eval Clin Pract. 2025 Aug;31(5):e70214. doi: 10.1111/jep.70214.

ABSTRACT

AIMS AND OBJECTIVES: Understanding the perspectives of health professionals about Electronic Health Records (EHRs) is pivotal for better management of health information systems (HIS). The purpose of this study is to examine explanatory factors of usage of EHRs according to the physician and hospital manager’s evaluations.

METHODS: A survey was administered in three hospitals in the İzmir metropolitan area, and 202 physicians and hospital administrators participated in this study. The internal consistency of the questionnaire was assessed using Cronbach’s Alpha (0.74), and the suitability of the factor analytical model was assessed using KMO (0.79) and Bartlett’s test (X² = 1720.97, p < 0.001). Exploratory factor analysis was performed with Varimax rotation to determine the factors underlying the model. Then, confirmatory factor analysis (CFA) was performed to reveal the latent structure of the model.

RESULTS: The performance of CFA model is statistically significant (p < 0.0001), acceptable at moderate level (X²/df = 3,81) the goodness-of-fit indices are good (CFI = 0,87; GFI = 0,76; NFI = 0,83; AGFI = 0,70). Three factors explain the latent structure of this model and evaluations of physician and hospital managers towards the usage of EHRs named as: benefits of usage of EHRs; concerns about the usage of EHRs and the effect of EHRs on the quality of work, efficiency, access to the information and safety.

CONCLUSION: Study results highlight the necessity of comprehending the EHR from the perspectives of health professionals and managers by focusing on the advantages of EHRs, concerns towards the deployment of EHR systems, and the improvement effects of EHR in work quality, efficiency, and HIS.

PMID:40705929 | DOI:10.1111/jep.70214

Nucleic Acids Res. 2025 Jul 19;53(14):gkaf714. doi: 10.1093/nar/gkaf714.

ABSTRACT

Spatial transcriptomics (ST) has emerged as an efficient technology for mapping gene expression within tissue sections, offering informative spatial context for gene activities. However, most current ST techniques suffer from low spatial resolution, where each spatial location often contains cells of various types. Deconvolution methods are used to resolve the cell mixture within the spots, but conventional approaches rely on spot-by-spot analyses, which are limited by low gene expression levels and disregard spatial relationships between spots, ultimately reducing performance. Here, we introduce DECLUST, a cluster-based deconvolution method to accurately estimate the cell-type composition in ST data. The method identifies spatial clusters of spots using both gene expression and spatial coordinates, hence preserving the spatial structure of the tissue. Deconvolution is subsequently performed on the aggregated gene expression of individual clusters, mitigating the challenges associated with low expression levels in individual spots. We evaluate DECLUST on simulated ST datasets from a human breast cancer tissue and two real ST datasets from human ovarian cancer and mouse brain. We compare DECLUST to current methods including CARD, GraphST, Cell2location, and Tangram. The results indicate that DECLUST not only maintains the spatial integrity of tissues but also outperforms existing methods in terms of robustness and accuracy. In conclusion, DECLUST provides an effective and reliable approach for identifying cell-type compositions in ST data.

PMID:40705925 | DOI:10.1093/nar/gkaf714