Tag: statistics

Eur J Med Res. 2025 Apr 19;30(1):310. doi: 10.1186/s40001-025-02583-7.

ABSTRACT

BACKGROUND: Identifying the risk of stroke in patients with atrial fibrillation (AF) presents a challenge, as existing tools such as the CHA2DS2-VASc score primarily emphasize medical history, affording relatively less attention to the electrocardiogram (ECG). Exploring HRV (heart rate-related variability) parameters could help refine risk prediction for thromboembolic ischemic stroke and enhance personalized management. This paper investigates how HRV parameters may inform the risk of acute ischemic stroke in atrial fibrillation patients.

METHODS: Data were retrospectively collected from Zhongnan Hospital’s electronic registry for patients with atrial fibrillation admitted in 2022. The sample was sorted into cases and controls based on specific inclusion and criteria. The outcome was the onset of acute ischemic stroke (AIS) in recurrent paroxysmal non-valvular atrial fibrillation. Cases and control data were analyzed using different statistical methods based on distribution, and the association between HRV parameters and the risk of stroke in paroxysmal atrial fibrillation was assessed. Binary logistic regression was utilized to assess a predictive model for stroke risk based on heart rate variability (HRV) parameters.

RESULTS: A total of 3218 medical records with atrial fibrillation were retrieved. Out of 3218 medical records with atrial fibrillation, 192 were selected after screening, including 93 cases and 99 controls. The cohort comprised 93 females (50 cases) and 99 males (43 cases). Mean ages were 68.67 ± 1.95 for cases and 68.35 ± 1.19 for controls, with no significant difference (P > 0.05). Hypertension history was significantly more common in cases (P = 0.006), indicating a dependency between hypertension and acute ischemic stroke in non-valvular paroxysmal AF. SDNN mean rank was significantly lower in cases (P = 0.024), and LF was significantly reduced (P = 0.044). Other HRV parameters showed lower values in cases, but differences were not statistically significant. We found that AVTD (abnormal variation in the time domain) alone was significantly associated with acute ischemic stroke in non-valvular paroxysmal AF. While AVFD (abnormal variation in frequency domain) and AVA (abnormal variation in arrhythmogenicity) were not individually significant, a combined variable (CDV) from AVTD, AVFD, and AVA was also statistically significant (P = 0.029). In this model, SDNN, AVTD, history of hypertension, as well as the CHA2DS2-VASc score and the use of novel anticoagulant medicines (NOACS), were significant predictors in both univariate and multivariate analyses. At the same time, CDV was significant only in univariate analysis. These findings may suggest that HRV parameters may provide clues to the risk of acute ischemic stroke in non-valvular paroxysmal AF.

CONCLUSION: This study found that abnormal variation in HRV parameters was more observed in patients with acute ischemic stroke. Then, unlike previous research, this study uniquely integrated multiple HRV parameters to develop novel indices such as AVTD, AVFD, AVA, and CDV, which somehow demonstrated a significant association with the risk of AIS. These new metrics, combined with conventional risk factors and CHA2DS2-VASc score, brought great improvement to the model prediction for AIS risk.

PMID:40251653 | DOI:10.1186/s40001-025-02583-7

BMC Rheumatol. 2025 Apr 18;9(1):44. doi: 10.1186/s41927-025-00498-8.

ABSTRACT

OBJECTIVES: Fatigue is a prominent symptom in patients with psoriatic arthritis (PsA). There was a wide variety of statistics previously reported on fatigue prevalence in patients. This systematic review examined the current literature to derive the overall prevalence of fatigue and risk factors in PsA patients.

METHODS: A systematic review of the literature with subsequent meta-analyses was conducted. Publications assessing fatigue severity and prevalence in patients with PsA using validated measurement scores were identified from seven online databases (Cochrane, CINAHL, EMBASE, Google Scholar, MEDLINE, PubMed, and Web of Science), from inception until January 2024. Employing a random effects model, we calculated the pooled fatigue prevalence. Quality assessment of included studies was performed utilising the Joanna Briggs Critical Appraisal Tool.

RESULTS: The final analysis included 15 studies with 6482 PsA patients. Pooled fatigue prevalence was 0.51 (95% CI: 0.41, 0.61; I2 = 97.4%). There was substantial heterogenicity across the studies, with biologics use and geographical location in terms of Western versus Eastern countries being possible sources of heterogeneity. Age, disease duration, gender, tender joint count, swollen joint and enthesitis count are among the most commonly reported risk factors for fatigue in multivariate logistic regressions.

CONCLUSIONS: Approximately half of the patients with PsA experienced fatigue. Biologics use and geographical location of the study were possible sources of heterogeneity in the subgroup analysis.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40251651 | DOI:10.1186/s41927-025-00498-8

J Cardiothorac Surg. 2025 Apr 18;20(1):209. doi: 10.1186/s13019-025-03421-x.

ABSTRACT

BACKGROUND: Acetaminophen (APAP) is widely used in the treatment of patients after surgery, but the prognosis of patients with coronary artery bypass grafting (CABG)-related acute respiratory distress syndrome (CABG-ARDS) is still unclear. This study aims to explore the role of APAP in the management of CABG related ARDS.

METHODS: We collected clinical data on patients with CABG-ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The primary outcome was early mortality after ARDS, and the secondary outcomes were length of hospital stay and duration of mechanical ventilation (MV). Multivariate logistic regression and Cox regression models were used for statistical analysis, and inverse probability processing weighting (IPTW), overlap weighting (OW) and propensity score matching (PSM) were used to explore the robustness of the outcomes.

RESULTS: A total of 5459 patients were enrolled in the analysis. Multivariate logistic regression analysis revealed that the 14-day mortality in APAP group was significantly lower than that in non-APAP group (0.5% vs. 2.7%, OR = 0.301; 95% CI, 0.170-0.531; P < 0.001). The APAP group also showed a significant advantage in Cox regression analysis (0.5% vs. 2.7%, HR = 0.329; 95% CI, 0.187-0.577; P < 0.001). IPTW, OW, and PSM analyses were conducted between the two groups, and the differences remained significant. These results were consistent in 30-, 60-, and 90-day mortality analyses. Meanwhile, exposure to APAP was associated with a shorter length of hospital stay and a reduced duration of MV (P < 0.001).

CONCLUSION: The administration of APAP was associated with reduced early mortality in patients with CABG-ARDS, as well as shorter length of hospital stay and duration of MV.

PMID:40251639 | DOI:10.1186/s13019-025-03421-x

BMC Psychol. 2025 Apr 18;13(1):401. doi: 10.1186/s40359-025-02676-2.

ABSTRACT

From a holistic perspective of positive psychology, there is a dearth of knowledge regarding how its three underlying factors (i.e., positive subjective experience, positive individual traits, and positive collective institutions) co-shape learners’ willingness to communicate (WTC), a critical facilitator of foreign language learning achievement. This research gap is particularly evident for learners in multi-ethnic regions who have been underrepresented in foreign language education in China. This issue may constrain our understanding of the contributions of positive psychology to the field of applied linguistics, since the role of positive psychological factors in influencing WTC may be distinct across diverse ethnic populations. Besides, the relative importance of these three factors in predicting WTC has yet to be investigated in latent models. Given that different pedagogical approaches may engender disparate perceptions and attitudes among learners, it is of the utmost importance to ascertain which factor should be prioritized in classroom psychological interventions, as well as in teacher training programs. To address these gaps, this study addressed the joint effect of positive subjective experience (foreign language peace of mind, FLPOM), positive individual trait (language-specific grit), and positive collective institution (classroom environment) on WTC using structural modeling analysis. Furthermore, the study employed latent dominance analysis to ascertain the relative importance of these three factors in promoting WTC. The sample consisted of 643 multi-ethnic foreign language students from five provinces in Western China. The findings suggested that FLPOM, grit, and classroom environment collectively stimulate learners’ WTC. Notably, FLPOM, a factor that has not previously been examined in relation to in-class or face-to-face WTC, emerged as the most statistically significant predictor of WTC. Therefore, it is imperative that foreign language practitioners and learners recognize the significance of FLPOM in language learning and teaching in Chinese multi-ethnic regions.

PMID:40251638 | DOI:10.1186/s40359-025-02676-2

BMC Med. 2025 Apr 18;23(1):228. doi: 10.1186/s12916-025-04060-8.

ABSTRACT

BACKGROUND: Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between county-level access to exercise opportunities and cardiovascular disease (CVD) mortality across US counties.

METHODS: We conducted an ecological analysis using aggregated data from two primary sources: the County Health Rankings and Roadmaps data and CDC WONDER mortality data. We compared county-level age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization variables. The rate ratio (RR) for CVD mortality was also calculated using generalized linear models.

RESULTS: We observed significant variations in CVD mortality across different levels of exercise opportunities access and physical inactivity, which was consistent across all demographic subgroups (P < 0.001). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR = 0.93 [0.91-0.95]), and the association was most pronounced for acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76-0.85]). The county-level physical inactivity was significantly associated with an increased risk of CVD mortality (RR, 1.16 [1.14-1.17]), especially for ischemic heart disease (IHD) (RR, 1.35 [1.31-1.38]) and AMI (RR, 1.32 [1.25-1.38]). All demographic subgroups demonstrated similar benefits in reducing the risk of CVD by improving the county-level indicators of physical activity.

CONCLUSIONS: Counties have the potential to make significant environmental strides in improving the cardiovascular health of their populations by enhancing access to exercise opportunities in the context of urbanization.

PMID:40251637 | DOI:10.1186/s12916-025-04060-8

BMC Med Educ. 2025 Apr 18;25(1):572. doi: 10.1186/s12909-025-07176-w.

ABSTRACT

BACKGROUND: Artificial Intelligence (AI) Chatbots (e.g., ChatGPT, Microsoft Bing, and Google Bard) can emulate human interaction and may support physiotherapy education. Despite growing interest, physiotherapy students’ perspectives remain unexplored. This study investigated Italian physiotherapy students’ knowledge, use, and perception of the benefits and limitations of AI Chatbots.

METHODS: A cross-sectional study was conducted through Survey Monkey from February to June 2024. One thousand five hundred and thirty-one physiotherapy students from 10 universities were involved. The survey consisted of 23 questions investigating: (a) respondent characteristics, (b) AI Chatbot knowledge and use, (c) perceived benefits, and (d) limitations. Multiple-choice and Likert-scale-based questions were adopted. Factors associated with knowledge, use, and perceptions of AI were explored using logistic regression models.

RESULTS: Of 589 students (38%) that completed the survey, most were male (n = 317; 53.8%) with a mean age of 22 years (SD = 3.88). Nearly all (n = 561; 95.3%) had heard of AI Chatbots, but 53.7% (n = 316) never used these tools for academic purposes. Among users, learning support was the most common purpose (n = 187; 31.8%), while only 9.9% (n = 58) declared Chatbot use during internships. Students agreed that Chatbots have limitations in performing complex tasks and may generate inaccurate results (median = 3 out of 4). However, they neither agreed nor disagreed about Chatbots’ impact on academic performance, emotional intelligence, bias, and fairness (median = 2 out of 4). The students agreed to identify the risk of misinformation as a primary barrier (median = 3 out of 4). In contrast, they neither agreed nor disagreed on content validity, plagiarism, privacy, and impacts on critical thinking and creativity (median = 2 out of 4). Young students had 11% more odds of being familiar with Chatbots than older students (OR = 0.89; 95%CI 0.84-0.95; p = < 0.01), whereas female students had 39% lesser odds than males to have used Chatbots for academic purposes (OR = 0.61; 95%CI 0.44-0.85; p = < 0.01).

CONCLUSIONS: While most students recognize the potential of AI Chatbots, they express caution about their use in academia. Targeted training for students and faculty, supported by institutional and national guidelines, could guarantee a responsible integration of these technologies into physiotherapy education.

TRIAL REGISTRATION: Not applicable.

PMID:40251635 | DOI:10.1186/s12909-025-07176-w

BMC Med Inform Decis Mak. 2025 Apr 18;25(1):169. doi: 10.1186/s12911-025-02998-6.

ABSTRACT

The automated processing of Electronic Health Records (EHRs) poses a significant challenge due to their unstructured nature, rich in valuable, yet disorganized information. Natural Language Processing (NLP), particularly Named Entity Recognition (NER), has been instrumental in extracting structured information from EHR data. However, existing literature primarly focuses on extracting handcrafted clinical features through NLP and NER methods without delving into their learned representations. In this work, we explore the untapped potential of these representations by considering their contextual richness and entity-specific information. Our proposed methodology extracts representations generated by a transformer-based NER model on EHRs data, combines them using a hierarchical attention mechanism, and employs the obtained enriched representation as input for a clinical prediction model. Specifically, this study addresses Overall Survival (OS) in Non-Small Cell Lung Cancer (NSCLC) using unstructured EHRs data collected from an Italian clinical centre encompassing 838 records from 231 lung cancer patients. Whilst our study is applied on EHRs written in Italian, it serves as use case to prove the effectiveness of extracting and employing high level textual representations that capture relevant information as named entities. Our methodology is interpretable because the hierarchical attention mechanism highlights the information in EHRs that the model considers the most crucial during the decision-making process. We validated this interpretability by measuring the agreement of domain experts on the importance assigned by the hierarchical attention mechanism to EHRs information through a questionnaire. Results demonstrate the effectiveness of our method, showcasing statistically significant improvements over traditional manually extracted clinical features.

PMID:40251623 | DOI:10.1186/s12911-025-02998-6

BMC Med Educ. 2025 Apr 18;25(1):573. doi: 10.1186/s12909-025-07156-0.

ABSTRACT

BACKGROUND: Traditional lecture-based learning has been the cornerstone of dental education; however, active learning strategies such as flipped classrooms are gaining popularity for their potential to enhance student engagement and performance. This study evaluated the effectiveness of three teaching methods-traditional live lectures, flipped video classrooms, and interactive flipped classrooms-on improving academic performance and student perceptions among fourth-year dental students.

METHODS: This study employed a stratified randomization design involving 156 fourth-year dental students using a single lecture in an undergraduate orthodontics course. The students were first grouped into four categories based on their Grade Point Average (GPA): Excellent, Very Good, Good, and Satisfactory. From these groups, students were randomly drawn and placed into one of three intervention groups: live lecture, flipped classroom with video lectures, and flipped classroom with interactive video lectures. Pre- and post-intervention assessments evaluated knowledge improvement, while objective structured assessments measured academic performance. Student perceptions were gauged using validated Likert-scale questionnaires. Paired t-tests assessed within-group differences, and ANOVA compared effectiveness across teaching methods. Pearson’s correlation analysis examined the relationship between academic performance and GPA of the students.

RESULTS: All three teaching methods showed significant improvements in post-intervention scores (p < 0.001). The Live Lecture Group had the greatest mean improvement (27.69), followed by the Flipped Video Lecture Group (27.30) and the Flipped Interactive Lecture Group (27.11). However, ANOVA revealed no statistically significant differences between the groups (F (2, 153) = 0.007, p = 0.993). Female students performed better in the live lecture setting (32.60 ± 25.08) compared to males (23.79 ± 21.44). Students with lower GPAs benefited most from the interactive flipped classroom, Pearson’s correlation indicated a strong positive association between GPA and post-intervention scores (r = 0.708, p < 0.001). Student satisfaction was highest in the interactive flipped classroom, with 97.7% rating the experience as “Excellent” or “Very Good.”

CONCLUSIONS: All three teaching methods led to significant improvement in post-test scores. While students reported higher engagement and satisfaction in flipped and interactive flipped lectures, the live lecture method was also effective for knowledge retention. These findings highlight the importance of tailoring educational strategies to diverse student needs in dental education. Educators should consider a blended model that integrates flipped and traditional strategies selectively, balancing feasibility with student needs, as developing multiple formats can be time-intensive with only modest differences in outcomes.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40251621 | DOI:10.1186/s12909-025-07156-0

J Cardiothorac Surg. 2025 Apr 18;20(1):210. doi: 10.1186/s13019-024-03230-8.

ABSTRACT

OBJECTIVE: To observe, compare and explore the effect of enhanced extracorporeal counterpulsation (EECP) treatment on cardiac rehabilitation in patients with acute myocardial infarction (AMI) after undergoing percutaneous coronary intervention (PCI) using a drug-coated balloon (DCB).

METHODS: This study was a prospective randomised controlled trial of 60 patients with AMI after undergoing PCI using a DCB. Using a random number table method, the patients were randomly divided into control and rehabilitation groups, with 30 patients in each. The follow-up period was 6 months. Patients in the control group received conventional drug and exercise rehabilitation after undergoing DCB-based PCI; those in the rehabilitation group were also given an EECP-based rehabilitation regimen after 7 days of medication and exercise rehabilitation. The effects of EECP on the rehabilitation of patients with AMI after undergoing DCB-based PCI were evaluated by observing changes in cardiac function before and after treatment in the two groups of patients, including cardiac output (CO), stroke volume (SV), brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and 6-minute walking distance (6MWD).

RESULTS: After 6 months of treatment, the control versus the rehabilitation groups’ cardiac function results were as follows: CO (5.00 ± 0.67 vs. 4.64 ± 0.58, P = 0.023), SV (70.53 ± 3.33 vs. 65.57 ± 6.10, P < 0.001), BNP (157.63 ± 15.37 vs. 219.40 ± 16.73, P < 0.001), LVEF (65.57 ± 4.33 vs. 60.10 ± 2.92, P < 0.001) and 6MWD (455.43 ± 39.75 vs. 400.73 ± 36.81, P < 0.001). The patients in the rehabilitation group showed improved cardiac function compared with the control group, with statistically significant differences. Furthermore, the improvement in the New York Heart Association cardiac function grading (P < 0.001) and Canadian Cardiovascular Association angina grading (P < 0.001) in the rehabilitation group were significantly improved compared with the gradings of the control group.

CONCLUSION: Using EECP treatment significantly improved the cardiac function of patients with AMI after undergoing DCB-based PCI and was beneficial for their cardiac rehabilitation.

PMID:40251618 | DOI:10.1186/s13019-024-03230-8

J Health Popul Nutr. 2025 Apr 18;44(1):122. doi: 10.1186/s41043-025-00817-2.

ABSTRACT

BACKGROUND: There is mounting evidence suggesting a direct connection between inflammatory responses and the pathophysiology of overactive bladder (OAB). However, conventional inflammatory markers do not directly indicate a correlation with OAB. Therefore, our goal was to investigate the relationship between OAB and a novel inflammatory marker, the neutrophil percentage-to-plasma-albumin ratio (NPAR).

METHODS: This study included 28,906 participants from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multivariate regression models and multiple regression equations were applied to evaluate the correlation between NPAR and OAB. Additionally, to evaluate the possibility of a linear relationship between NPAR and OAB, smoothed curve fitting was used. Sensitivity and stratified analyses were conducted to assess the robustness of the results.

RESULTS: The final sample size consisted of 28,906 individuals, with an overall OAB prevalence of 24.6%. Using a weighted multivariate logistic model and adjusting for multiple covariates, we identified a strong association between NPAR and OAB (OR 1.074, 95% CI 1.06-1.08). Individuals in the highest NPAR quartile had a 32% greater prevalence of OAB compared to those in the lowest quartile. Smoothed curve fitting showed a nonlinear connection between NPAR and OAB, and the effect sizes remained consistent across specific subgroups (P for interaction < 0.05).

CONCLUSION: The incidence of OAB was shown to positively correlate with higher NPAR levels in this investigation. NPAR might be a useful and affordable biomarker for determining who is at risk for OAB, facilitating timely intervention.

PMID:40251617 | DOI:10.1186/s41043-025-00817-2