Category: Statistics

J Eval Clin Pract. 2025 Aug;31(5):e70211. doi: 10.1111/jep.70211.

ABSTRACT

AIM: This study aimed to investigate how COVID-19 lockdowns in Türkiye influenced parents’ actions when their child was ill or injured and how they perceived the impact of the lockdown on the severity of their child’s illness and the treatment received.

METHODS: This descriptive, and cross-sectional mixed method was conducted with 104 parents whose children experienced illness or injury during the pandemic lockdowns between July and September 2022. Data was collected through online survey using snowball sampling method. Descriptive statistics and pearson’s chi-square test were used for statistical analysis, while free-text data was subjected to thematic analysis.

RESULTS: Of the parents who sought medical help, 51.7% reported their child being admitted to hospital, and 29.8% noted their child had a chronic health illness. These parents were more likely to report that changes in health services affected their child’s treatment compared to those with children without a long-term health issue (45.1% vs. 12.3%, p < 0.001). The experiences of parents seeking help for their sick or injured child during the lockdown were categorized into three main themes: the lockdown’s impact on the child, health service accessibility during the lockdown, and parental help-seeking behavior during lockdown.

CONCLUSION: It is concluded in this study that during COVID-19 lockdowns, pediatric nurses should guide parents regarding when and where to seek medical assistance to mitigate potential complications resulting from reduced parental help-seeking behavior.

PRACTICE IMPLICATIONS: To ensure the uninterrupted monitoring and treatment of children with chronic health issues during lockdowns, it is advisable to expand telemedicine practices.

PMID:40705916 | DOI:10.1111/jep.70211

Eur Endod J. 2025 Jul;10(4):285-295. doi: 10.14744/eej.2025.75547.

ABSTRACT

Objectives The trial was conducted to assess the impact of passive ultrasonic irrigation, XP endo finisher, AF max file, and manual dynamic agitation on postoperative pain and analgesic consumption at 6 h., 12 h., 24 h., 48 h., 72 h., and a week later on single-rooted lower premolar teeth with acute irreversible pulpitis and apical periodontitis. Methods. Seventy patients were contributed in the trial. A total of 64 eligible patients were randomized into four equal groups (n=16 per group). Considering the irrigation activation approach, participants were separated into four groups as follows: Group 1: passive ultrasonic irrigation. Group 2: XP-endo Finisher. Group 3: Fanta AF max file Group 4: Manual dynamic agitation. Following the root canal procedure, the intensity of postoperative discomfort was measured by a verbal rating scale. The frequency and quantity of analgesics used were recorded. Results. Using an analysis of variance (ANOVA), there was a statistically significant difference between the percentage of preoperative and postoperative pain at most of the follow-up period (p<0.001**) in each group. Additionally, a significant difference (p<0.05) in the postoperative pain level and analgesic consumption was found among groups and most of the time intervals. Shapiro-Wilk and Kolmogorov-Smirnov tests, the Chi-square test, Fisher’s exact test, and the McNemar test were used. The excessive percentage of postoperative pain and analgesic intake was found in the MDA group, followed by the Max file and the XPF, while the lowest postoperative pain and analgesic intake were related to the PUI group. There was a significant difference (p<0.05) between the PUI and MDA groups in the degree of pain severity and increase in analgesic intake at 72 h. Regarding the percentage of swelling, there was a statistically notable difference (p<0.05) between groups after 24 h time intervals. Conclusions Minimal postoperative pain and minimal analgesic intake were significantly accompanied by passive ultrasonic irrigation, while PUI and analgesic intake were increased in MDA. (EEJ-2025-03-041).

PMID:40705453 | DOI:10.14744/eej.2025.75547

Eur Endod J. 2025 Jul;10(4):296-306. doi: 10.14744/eej.2025.27132.

ABSTRACT

AIM: This study aimed to evaluate the effectiveness of the Er,Cr: YSGG 2780 nm laser pulse duration during root canal retreatment using the laser-activated irrigation method (PIPS).

METHODS: The study investigated the cleanliness of root canal walls in single-rooted premolars using PIPS. Teeth were initially instrumented, filled with bioceramic (BC) sealer and gutta-percha, and then retreated using nickel-titanium (NiTi) retreatment rotary files. The teeth were randomly assigned to four equal groups: control (manual irrigation), ultrasonic irrigation (UI), laser-activated irrigation with a 60 µs pulse duration, and laser-activated irrigation with a 700 µs pulse duration. Irrigation solutions consisted of 17% EDTA and 2.5% sodium hypochlorite. Statistical analysis was performed using SPSS version 21.0. Normality was checked using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Group comparisons were conducted using Dunnett’s t-test and the LSD test, with a significance level set at p ≤ 0.05.

RESULTS: Statistical analysis of scanning electron microscopy (SEM) images revealed superior cleaning efficiency in both laser groups, with a significant improvement in cleanliness rates compared to the other groups. Group 4 (700 µs) achieved the highest percentage of open dentinal tubules (>75%) in the coronal and middle thirds, while Group 3 (60 µs) showed 50- 75% tubule openness. Groups 1 and 2 showed significantly lower cleaning effectiveness, particularly in the apical third.

CONCLUSION: The pulse duration plays a crucial role in the activation of laser irrigants during root canal retreatment. The 700 µs PIPS activation resulted in better cleaning outcomes compared to the 60 µs laser activation. (EEJ-2025-02-025).

PMID:40705451 | DOI:10.14744/eej.2025.27132

Eur Endod J. 2025 Jul;10(4):312-318. doi: 10.14744/eej.2025.69926.

ABSTRACT

OBJECTIVE: This study investigated the intratubular decontamination promoted by high-power sonic and ultrasonic devices using either a stepwise intraoperative activation (SIA) technique or a final conventional activation (CA) approach during root canal chemomechanical preparation.

METHODS: Fifty human lower premolars were contaminated with Enterococcus faecalis and assigned into five groups (n=8): conventional syringe irrigation (CSI); final ultrasonic activation (FUA) using the ultrasonic insert 25/25 IRRI S; final sonic agitation (FSA) using the high-power sonic insert 20/28 Eddy system (both CA techniques); stepwise ultrasonic activation (SUA); and stepwise sonic agitation (SSA) using the same devices during and after canal preparation (SIA techniques). Remaining specimens served as controls. Root canal preparation was performed with the Reciproc system and 5.25% NaOCl, followed by final irrigation with 17% EDTA. Bacterial viability was assessed via confocal microscopy with Live/Dead technique. Statistical analysis was employed using non-parametric tests (α=0.05).

RESULTS: SUA showed the lowest bacterial viability, followed by FSA, both statistically similar. SSA and FUA were similar but less effective than SUA and FSA (p<0.05). The CSI group had significantly higher bacterial viability compared to all other groups (p<0.05).

CONCLUSION: High-power sonic agitation and ultrasonic activation enhanced intratubular decontamination against E. faecalis. The SIA technique, using IRRI S or Eddy systems, effectively reduced bacterial viability and represents a promising approach for root canal disinfection. (EEJ-2024-11-185).

PMID:40705447 | DOI:10.14744/eej.2025.69926

Eur Endod J. 2025 Jul;10(4):326-332. doi: 10.14744/eej.2025.85866.

ABSTRACT

OBJECTIVE: The objective of this investigation was to assess and compare the fracture resistance of roots filled with AH Plus, Total Fill and AH Plus bioceramic sealers using single cone, warm vertical compaction (WVC), and soft-core techniques.

METHODS: This study utilized the palatal root canals of eighty extracted human maxillary first molars. All roots were sectioned to maintain a uniform root length of 11 mm. The samples were mechanically prepared using EdgeFile X7 rotary files to size 40/0.04. Eight teeth were left unfilled as a control group, while the remaining teeth were classified into three primary categories according to the sealer utilized for obturation; AH plus, TotallFill and AH Plus Bioceramic (BC). Each group was divided into three subgroups (n = 8) based on the obturation technique; single-cone, WVC and soft-core. Every tooth was set into blocks of acrylic resin, and a universal testing equipment (Instron Corp) with a metal-like spreader tip was used to measure the fracture force at a speed of 0.5 mm/min. The collected data were examined utilizing ANOVA, succeeded by Tukey’s test.

RESULTS: The control group’s fracture resistance values were significantly less than the obturated groups in study. Overall, the fracture resistance of AH Plus and AH Plus BC were significantly higher than that of Total Fill BC sealers. The WVC and soft-core were significantly higher than single cone techniques. The obturation technique did not significantly influence the fracture resistance of AH Plus and Total Fill. While the fracture resistance of AH Plus BC was significantly impacted., WVC was significantly higher than single cone group. When roots were obturated with WVC technique, AH Plus BC exhibited statistically significant higher values of fracture resistance than AH plus and Total Fill. There was no significant difference between the three sealers when single cone and soft-core were used.

CONCLUSION: According to this in vitro investigation, Obturation with AH Plus and AH Plus BC sealers enhanced the fracture resistance of the roots more significantly than TotalFill BC sealer, while obturation with WVC and soft-core yielded greater fracture resistance compared to the single cone approach. (EEJ-2024-11-170).

PMID:40705445 | DOI:10.14744/eej.2025.85866

Eur Endod J. 2025 Jul;10(4):278-284. doi: 10.14744/eej.2024.71473.

ABSTRACT

This double-blinded randomised clinical trial aimed to compare the efficacy of lignocaine, diclofenac sodium and ketorolac tromethamine as supplemental intraligamentary injections for intra-appointment pain in normotensive and hypertensive patients with moderate to severe symptomatic irreversible pulpitis.

METHODOLOGY: Ethical clearance was obtained, and the trial was registered on the Clinical Trial Registry India (CTRI/2020/09/027635; Registered on 07/09/2020). A total of 198 patients were divided into two groups-hypertensive group (Group 1; n=99) and normotensive (healthy) group (Group 2; n=99). After computerised randomisation and double blinding, participants were subdivided into three subgroups-1A/2A: lignocaine (n=33), 1B/2B: diclofenac sodium (n=33) and 1C/2C: ketorolac tromethamine (n=33). The preoperative visual analogue scale (VAS) scores was recorded. For the hypertensive group, blood pressure was recorded, and inferior alveolar nerve block (IANB) comprising 1.8ml of 2% lignocaine without adrenaline was administered. For the normotensive group, IANB with 1.8ml of 2% lignocaine with adrenaline was administered. A supplemental intraligamentary injection comprising one of the experimental drugs was injected to both the groups. Endodontic access was gained, and the intraoperative VAS score was recorded. As part of the statistical analysis, paired t-tests, Tukey’s post hoc test and ANOVA were performed using SPSS software version 20.

RESULTS: Supplemental intraligamentary injections of diclofenac sodium and ketorolac tromethamine showed a statistically significant difference (p<0.05) compared to lignocaine in the reduction of intraoperative pain with no side effects in hypertensive and healthy individuals.

CONCLUSION: Supplemental injections of both NSAIDs performed better than lignocaine in reducing intraoperative pain among healthy and hypertensive individuals. (EEJ-2023-06-076).

PMID:40705444 | DOI:10.14744/eej.2024.71473

JMIR Med Inform. 2025 Jul 24;13:e66476. doi: 10.2196/66476.

ABSTRACT

BACKGROUND: The American Medical Association recommends that electronic health record (EHR) notes, often dense and written in nuanced language, be made readable for patients and laypeople, a practice we refer to as the simplification of discharge notes. Our approach to achieving the simplification of discharge notes involves a process of incremental simplification steps to achieve the ideal note. In this paper, we present the first step of this process. Large language models (LLMs) have demonstrated considerable success in text summarization. Such LLM summaries represent the content of EHR notes in an easier-to-read language. However, LLM summaries can also introduce inaccuracies.

OBJECTIVE: This study aims to test the hypothesis that summaries generated by LLMs from highlighted discharge notes will achieve increased accuracy compared to those generated from the original notes. For this purpose, we aim to prove a hypothesis that summaries generated by LLMs of discharge notes in which detailed information is highlighted are likely to be more accurate than summaries of the original notes.

METHODS: To test our hypothesis, we randomly sampled 15 discharge notes from the MIMIC III database and highlighted their detailed information using an interface terminology we previously developed with machine learning. This interface terminology was curated to encompass detailed information from the discharge notes. The highlighted discharge notes distinguished detailed information, specifically the concepts present in the aforementioned interface terminology, by applying a blue background. To calibrate the LLMs’ summaries for our simplification goal, we chose GPT-4o and used prompt engineering to ensure high-quality prompts and address issues of output inconsistency and prompt sensitivity. We provided both highlighted and unhighlighted versions of each EHR note along with their corresponding prompts to GPT-4o. Each generated summary was manually evaluated to assess its quality using the following evaluation metrics: completeness, correctness, and structural integrity.

RESULTS: We used the study sample of 15 discharge notes. On average, summaries from highlighted notes (H-summaries) achieved 96% completeness, 8% higher than the summaries from unhighlighted notes (U-summaries). H-summaries had higher completeness in 13 notes, and U-summaries had higher or equal completeness in 2 notes, resulting in P=.01, which implied statistical significance. Moreover, H-summaries demonstrated better correctness than U-summaries, with fewer instances of erroneous information (2 vs 3 errors, respectively). The number of improper headers was smaller for H-summaries for 11 notes and U-summaries for 4 notes (P=.03; implying statistical significance). Moreover, we identified 8 instances of misplaced information in the U-summaries and only 2 in the H-summaries. We showed that our findings supported the hypothesis that summarizing highlighted discharge notes improves the accuracy of the summaries.

CONCLUSIONS: Feeding LLMs with highlighted discharge notes, combined with prompt engineering, results in higher-quality summaries in terms of correctness, completeness, and structural integrity compared to unhighlighted discharge notes.

PMID:40705416 | DOI:10.2196/66476

JMIR Form Res. 2025 Jul 24;9:e73453. doi: 10.2196/73453.

ABSTRACT

BACKGROUND: Urinary issues pose a significant burden on health care systems, necessitating innovative solutions to enhance patient care and alleviate the provider burden.

OBJECTIVE: The objective of this study was to explore health care professionals’ perceptions of urinary issues and assess their acceptance and readiness to adopt wearable and remote technologies for managing these conditions. The study aimed to identify the attributes and barriers influencing technology integration in clinical practice, using established theoretical frameworks, such as the Health Belief Model (HBM) and the Technology Acceptance Model (TAM).

METHODS: A cross-sectional survey-based study was conducted. A structured survey questionnaire was administered online to a sample of 256 health care professionals recruited through social media and personal networks. The survey included both closed- and open-ended questions to gather data. Quantitative data were analyzed using descriptive statistics, Pearson correlation, and multiple regression.

RESULTS: Quantitative analysis revealed strong correlations between belief agreement and factors such as health literacy (r=0.591, P<.001), the perceived burden (r=0.628, P<.001), device attributes (r=0.650, P<.001), and support services (r=0.622, P<.001). Multiple regression analysis identified that the perceived burden (β=.284, P=.01), device attributes (β=.371, P<.001), and integrating technology (β=.312, P<.001) are positively associated. The survey demonstrated strong internal consistency, with Cronbach α=.85, indicating high reliability in measuring health care professionals’ perceptions of technology adoption.

CONCLUSIONS: Health care professionals’ acceptance of technology in managing urinary issues is influenced by factors such as the perceived burden, device attributes, and the ease of integrating technology into existing workflows. Addressing barriers to technology adoption, providing comprehensive training and support, and prioritizing user-centered design are crucial for successful technology integration. Future research should focus on longitudinal studies and explore the perspectives of patients and other stakeholders to gain a more holistic understanding of technology integration in urological care.

PMID:40705415 | DOI:10.2196/73453

J Med Internet Res. 2025 Jul 24;27:e73687. doi: 10.2196/73687.

ABSTRACT

BACKGROUND: In recent years, digital technologies have shown possibilities for improving cognitive function after stroke, but their effectiveness and treatment options vary, the optimal treatment remains unclear, and the current evidence is somewhat contradictory.

OBJECTIVE: This study aimed to evaluate the efficacy of various digital interventions in improving poststroke cognitive function and provide evidence-based support for clinical decision-making.

METHODS: A systematic search was conducted across PubMed, Web of Science, Cochrane Library, Scopus, Embase, and CNKI databases from their inception to January 2025, with no restrictions on language or publication year. Randomized controlled trials evaluating digital interventions (eg, virtual reality [VR], computer-assisted cognitive therapy [CACT], and robot-assisted therapy [RAT]) for poststroke cognitive impairment in adults (aged≥18 y) were included. Eligible studies reported outcomes measured by the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE), with cognitive improvement quantified through pre- to postintervention scores. Multiple researchers independently extracted data. Network meta-analysis was performed using R software, incorporating consistency or inconsistency models (based on Deviance Information Criterion differences), random-effects models, and I² statistics to assess heterogeneity. Sources of heterogeneity were analyzed through sensitivity analyses, subgroup analyses, and meta-regression. Intervention efficacy was ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values. Robustness and consistency were validated via Egger test, sensitivity analyses, and node-splitting methods. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS: A total of 2128 articles were retrieved, with 27 meeting the inclusion criteria. Compared to conventional rehabilitation or care (C), CACT demonstrated significant superiority in MoCA scores (mean difference [MD]=3.03, 95% CI 1.69 to 4.38; SUCRA=91.53%); while cognitive training (CCT) demonstrated no statistical difference (MD=0.70, 95% CI -0.88 to 2.28). The ordering is CACT>VR>RAT>CCT. For MMSE scores, RAT ranked highest in efficacy (MD=5.99, 95% CI 3.20 to 8.79; SUCRA=99.44%); whereas both VR (MD=1.34, 95% CI -0.94 to 3.62) and CCT (MD=1.12, 95% CI -1.46 to 3.69) showed no significant improvement. The ordering is RAT>CACT>CCT>VR.

CONCLUSIONS: Digital therapies are effective in improving cognitive functioning in patients post stroke. CACT showed superior efficacy on the MoCA (emphasizing executive functioning), while RAT had the highest efficacy in the MMSE (focusing on basic cognition), suggesting different domain-specific effects. However, caution is warranted due to the heterogeneity of the included studies, risk of bias, and limited sample sizes in some studies. Future research should focus on optimizing intervention protocols, integrating neuromodulation or traditional rehabilitation techniques, and exploring cost-effective clinical implementation strategies.

PMID:40705404 | DOI:10.2196/73687

JMIR Form Res. 2025 Jul 24;9:e69556. doi: 10.2196/69556.

ABSTRACT

BACKGROUND: Just-in-time adaptive interventions (JITAIs) are a promising approach in mental health care given the potential scalability (ie, interventions are offered automatically and remotely) and preciseness (ie, the right interventions are offered at the right moments). Typically, a smartphone app is programmed to assess users’ psychological states in daily life; when a particular state is detected, the app prompts users to engage in specific behaviors. Conceptually, JITAIs hold significant potential for precision health, although there is currently limited evidence in the literature.

OBJECTIVE: We implemented this scheme as a smartphone intervention for daily stress management, based on cognitive behavioral therapy (CBT), and evaluated its feasibility and efficacy using a single-case experimental design.

METHODS: A total of 8 Japanese adults (community sample: 4 women; mean 37.6, SD 13.1 y) were recruited. An AB phase design with multiple random baselines was used, where “A” represents the baseline phase and “B” represents the intervention phase. Throughout the study period (28 d), participants were prompted to indicate their momentary levels of stress (range 0-100) using a smartphone thrice a day. The baseline phase duration was randomly varied among participants, lasting between 7 and 14 days. The remaining period was used as the intervention phase (14-21 d), where 6 CBT-based exercises (ie, breath control, mindfulness, relaxation, self-talk, cognitive defusion, and cognitive restructuring) were offered depending on the reported levels of stress.

RESULTS: Approximately 70% (6/8) of the participants perceived the intervention to be useful and helpful. A randomization test detected a statistically significant decrease in reported stress levels after the intervention began (P=.005), though this effect was less pronounced when analyzed individually for each participant. Multilevel model analysis detected a significant acute reduction in the momentary level of stress right after completing a CBT-based exercise (pre-exercise: mean 47.98, SD 21.65; post exercise: mean 42.13, SD 19.88; P=.03; Cohen dz=0.58). Also, a significant reduction in depressive rumination was observed in the postintervention assessment (preintervention: mean 13.00, SD 3.21; post intervention: mean 9.25, SD 2.60; P=.01, Cohen dz=1.17).

CONCLUSIONS: The intervention was feasible and effective in reducing subjective stress (and rumination) in the study sample. The small sample size and the nonclinical nature of the sample may limit the generalizability and implications of the study findings for clinical practice. More evidence should be collected to draw solid conclusions for technical and technological as well as clinical aspects of mobile interventions. Accumulating exemplars with different implementations will clarify how a JITAI can be designed and developed on a mobile platform and how the program can be delivered in the prevention and treatment of mental ill health.

PMID:40705402 | DOI:10.2196/69556