Tag: statistics

Int J Nurs Stud. 2025 Sep 30;173:105238. doi: 10.1016/j.ijnurstu.2025.105238. Online ahead of print.

ABSTRACT

BACKGROUND: Family involvement in advance care planning is important to achieve patients’ wishes and reduce the surrogate burden, particularly in family-centric cultures. Informal caregivers play an important role in helping patients with cancer plan their current and future care, and they serve as surrogate decision makers when patients are unable to make decisions themselves.

OBJECTIVES: To assess surrogate engagement levels in advance care planning and to identify the challenges for surrogate engagement in advance care planning.

DESIGN: A mixed-method design was adopted in which quantitative data collection was followed by qualitative interviews.

SETTING/PARTICIPANTS: Cancer caregivers nominated as potential surrogate decision makers were recruited via convenience sampling from a single cancer centre in Guangzhou, China. In total, 170 participants completed the survey, 25 of whom were interviewed individually.

METHODS: Surrogate-reported engagement levels were assessed quantitatively using in-person surveys. A subset of the participants underwent semi-structured in-depth interviews to share their healthcare experiences and perspectives on advance care planning. Quantitative data were analysed using descriptive statistics and univariate analyses, whereas qualitative data were thematically analysed and interpreted in the context of the quantitative findings.

RESULTS: During their prior experience, 95.3 % of the participants were involved in cancer patients’ medical care discussions, whereas 27.6 % actively engaged in advance care planning. Concerningly, most of them had insufficient knowledge and lacked self-efficacy, contemplation, and readiness regarding the surrogate role and end-of-life issues. Three key challenges influencing surrogate engagement in advance care planning were identified: (1) limited awareness of advance care planning, (2) ambivalent motivation arising from surrogate experiences and responsibilities, and (3) lack of support for surrogates’ needs.

CONCLUSION: This study revealed that cancer caregivers serving as potential surrogates reported limited engagement in advance care planning, with three key challenges: lack of awareness, motivation, and support. To overcome these challenges, early engagement strategies should focus on clarifying the concepts and potential benefits of advance care planning, resolving surrogate ambivalence, and facilitating access to support.

PMID:41092510 | DOI:10.1016/j.ijnurstu.2025.105238

MCN Am J Matern Child Nurs. 2025 Nov-Dec 01;50(6):357-361. doi: 10.1097/NMC.0000000000001146. Epub 2025 Oct 15.

ABSTRACT

BACKGROUND: Maternal mortality rates in the United States are alarmingly high, especially in rural areas with limited access to care. Clinicians in rural hospitals are challenged to maintain their obstetric knowledge and skills due to low patient volumes and limited educational opportunities. The purpose of this project was to improve maternity care in rural Texas by providing tailored obstetric education and simulations to enhance emergency response and team collaboration.

INTERVENTIONS: A team of five nurses provided simulation-based perinatal education to clinicians in 10 rural facilities and maternity deserts, including county emergency services. Tailored simulations conducted in situ addressed various obstetric emergencies and were designed to match each facility’s staffing ratios. Post-simulation surveys were sent to evaluate participants’ understanding, recognition, communication, and collaboration.

RESULTS: Surveys from 48 participants, including nurses, technicians, and other health care professionals, indicated significant improvements in understanding, recognition, communication, and preparedness for obstetrical emergencies after simulation training. Qualitative feedback underscored the project’s success, highlighting the increased confidence, knowledge, and multidisciplinary collaboration among the participants. The simulation education effectively addressed facility-specific needs, enhancing overall effectiveness and engagement, despite challenges with participant attendance and group sizes.

DISCUSSION: Perinatal outreach has improved rural health care teams’ confidence, preparedness, and competence in managing obstetric emergencies through specialized education and hands-on simulations. To ensure continued success, it is crucial to continually reassess and adapt educational programs to meet the evolving needs of rural health care facilities, thereby enhancing patient care and outcomes.

PMID:41092467 | DOI:10.1097/NMC.0000000000001146

Int J Surg. 2025 Oct 16. doi: 10.1097/JS9.0000000000003696. Online ahead of print.

ABSTRACT

BACKGROUND: Stress Urinary Incontinence (SUI) is one of the top five chronic diseases globally. The traditional theory of SUI does not adequately explain certain subgroups of patients. This study aims to investigate the risk factors and potential mechanisms underlying female SUI.

MATERIALS AND METHODS: A dual-tertiary center, cross-sectional study was conducted. A finite element model (FEM) was developed using data from a female volunteer. A total of 42 rats were utilized as animal models. Female participants presenting with lower urinary tract symptoms were recruited and categorized into four groups based on their SUI and Levator ani avulsion (LAA) status: SUI +/LAA +, SUI +/LAA-, SUI-/LAA +, and SUI-/LAA-. Data were collected from the FEM, animal models, and human participants.

RESULTS: The FEM demonstrated that in simulations of unilateral LAA, the ipsilateral urethra exhibited deviation and displacement toward the site of avulsion, accompanied by distortion. Rats with LAA showed a significantly higher incidence of SUI (P = 0.031), particularly those with unilateral LAA (P = 0.011). A total of 1629 women were ultimately included in the study. Statistical significance was observed specifically in patients with unilateral LAA (OR = 1.87 (95% CI,1.389-2.481), P < 0.001). Measurements of the levator-urethral gap (LUG) indicated that the closer the avulsion site was to the urethral opening, the higher the likelihood of SUI occurrence, which aligns with the urethral deviation patterns observed in the FEM analysis.

CONCLUSION: Unilateral LAA is a significant risk factor for SUI. The urethral deviation induced by unilateral LAA may represent an additional etiological mechanism of SUI, beyond the traditional fascial hammock theory.

PMID:41092446 | DOI:10.1097/JS9.0000000000003696

J Econ Entomol. 2025 Oct 15:toaf271. doi: 10.1093/jee/toaf271. Online ahead of print.

ABSTRACT

Drosophila suzukii (Diptera: Drosophilidae) is a major pest of soft-skinned fruits, inflicting economic losses through pre-harvest infestation. Among reduced-risk strategies, Attract-and-Kill (A&K) presents an alternative to full-cover insecticide sprays by concentrating exposure to insecticide-laced lures. However, compatibility of insecticides and attractants, as well as application volume, requires optimization to improve efficacy. We evaluated A&K formulations that combined organic Entrust SC (spinosad), Pyganic (pyrethrin), and conventional Gowan Malathion-8 Flowable (malathion), Mustang Maxx (zeta-cypermethrin) insecticides with 2 attractants, Combi-Protec (4:1, plant extract: sugar) and Decoy (citric acid), under laboratory conditions using blueberries. Each attractant-insecticide tank mix was applied at 5 droplet levels (0, 2, 6, 10, and 14). Compared to the 0 droplet, spinosad reduced fruit damage with Decoy, while malathion reduced fruit damage with Combi-Protec and Decoy, demonstrating strong synergism. Spinosad, malathion, and zeta-cypermethrin induced adult mortality depending on the attractant used. A&K achieved a rapid mortality rate within 5 h, at 85.4%, when applied as droplets in Munger cells, significantly faster than simulated full-cover sprays (33.9%) applied across glass plates, thereby limiting the window for oviposition and resistance development. A dose-response trend was observed, where 6 or more droplets consistently resulted in higher mortality and reduced egg-laying, although not always statistically significant. These findings highlight the potential of A&K systems, particularly those incorporating malathion or spinosad with Decoy, to achieve rapid and effective control of D. suzukii. Optimized A&K formulations can enhance integrated pest management (IPM) by minimizing environmental exposure, reducing reliance on full-cover applications, and slowing resistance evolution.

PMID:41092437 | DOI:10.1093/jee/toaf271

JMIR Cancer. 2025 Oct 15;11:e68411. doi: 10.2196/68411.

ABSTRACT

BACKGROUND: Mobile health (mHealth) apps are playing an increasingly important role in health care, including in radiotherapy. However, adherence remains low. One way to increase adherence is to tailor app features to the patients’ preferences.

OBJECTIVE: This study aimed to explore the importance of patient preferences regarding the features of a therapy-supporting app in radiotherapy. In addition, we examined factors associated with the perceived importance of these features.

METHODS: A cross-sectional questionnaire study was conducted with patients undergoing radiotherapy between summer 2021 and winter 2022. The subjective importance of 18 features of a treatment-accompanying app was explored using a 5-point Likert scale from 1=not so important to 5=extremely important. Descriptive analyses were used to show the rated importance of app functions. Associations with possible predictors were examined using multiple hierarchical regressions, with age (interval-scaled), gender (dichotomous), previous experience with mHealth apps (dichotomous), education (3-level nominal), and supportive care needs (interval-scaled) as predictors.

RESULTS: A total of 84 radiotherapy patients participated. The average age was 62 (SD 12.5) years. The feature with the highest importance was security against hacking (46/77, 60% extremely important). Explained variances in the regression analyses ranged between R2=0.25 (The app should give me tips on suitable sporting activities that are possible with my illness) and R2=-.07 (The app should provide me with information about suitable self-help offers). Previous mHealth usage predicted the importance of 6 features, such as managing appointments (β=.275; P<.05). Decreasing age was related to 6 features, for example, showing test results and laboratory values (β=-.358; P<.05). Other predictors were an increasing age and greater supportive care needs.

CONCLUSIONS: Patients undergoing radiotherapy rated app features as having varying levels of importance. The findings may help to tailor mHealth apps in radiotherapy, potentially improving adherence to app usage.

PMID:41092423 | DOI:10.2196/68411

JMIR Med Educ. 2025 Oct 15;11:e68697. doi: 10.2196/68697.

ABSTRACT

BACKGROUND: Improving the quality of education in clinical settings requires an understanding of learners’ experiences and learning processes. However, this is a significant burden on learners and educators. If learners’ learning records could be automatically analyzed and their experiences could be visualized, this would enable real-time tracking of their progress. Large language models (LLMs) may be useful for this purpose, although their accuracy has not been sufficiently studied.

OBJECTIVE: This study aimed to explore the accuracy of predicting the actual clinical experiences of medical students from their learning log data during clinical clerkship using LLMs.

METHODS: This study was conducted at the Nagoya University School of Medicine. Learning log data from medical students participating in a clinical clerkship from April 22, 2024, to May 24, 2024, were used. The Model Core Curriculum for Medical Education was used as a template to extract experiences. OpenAI’s ChatGPT was selected for this task after a comparison with other LLMs. Prompts were created using the learning log data and provided to ChatGPT to extract experiences, which were then listed. A web application using GPT-4-turbo was developed to automate this process. The accuracy of the extracted experiences was evaluated by comparing them with the corrected lists provided by the students.

RESULTS: A total of 20 sixth-year medical students participated in this study, resulting in 40 datasets. The overall Jaccard index was 0.59 (95% CI 0.46-0.71), and the Cohen κ was 0.65 (95% CI 0.53-0.76). Overall sensitivity was 62.39% (95% CI 49.96%-74.81%), and specificity was 99.34% (95% CI 98.77%-99.92%). Category-specific performance varied: symptoms showed a sensitivity of 45.43% (95% CI 25.12%-65.75%) and specificity of 98.75% (95% CI 97.31%-100%), examinations showed a sensitivity of 46.76% (95% CI 25.67%-67.86%) and specificity of 98.84% (95% CI 97.81%-99.87%), and procedures achieved a sensitivity of 56.36% (95% CI 37.64%-75.08%) and specificity of 98.92% (95% CI 96.67%-100%). The results suggest that GPT-4-turbo accurately identified many of the actual experiences but missed some because of insufficient detail or a lack of student records.

CONCLUSIONS: This study demonstrated that LLMs such as GPT-4-turbo can predict clinical experiences from learning logs with high specificity but moderate sensitivity. Future improvements in AI models, providing feedback to medical students’ learning logs and combining them with other data sources such as electronic medical records, may enhance the accuracy. Using artificial intelligence to analyze learning logs for assessment could reduce the burden on learners and educators while improving the quality of educational assessments in medical education.

PMID:41092407 | DOI:10.2196/68697

JMIR Pediatr Parent. 2025 Oct 15;8:e74964. doi: 10.2196/74964.

ABSTRACT

BACKGROUND: Health care systems face challenges of inconsistent quality, inefficiency, and rising costs. Fragmented applications of clinical decision support systems (CDSSs), clinical pathways (CPs), and diagnosis-related group (DRG) payment systems have limited their synergistic potential.

OBJECTIVE: This study proposed a CDSS-CP-DRG closed-loop model enabled by digital health technologies; specifically, the CDSS optimized CP execution through real-time data, the CP standardized workflows to support DRG cost control, and DRG payment pressures drove iterative improvements in both technology and processes. This research aimed to validate the model’s effectiveness in clinical efficacy, cost control, and standardized diagnosis and treatment of bronchopneumonia in children and provide evidence for value-based health care transformation.

METHODS: A total of 4543 children with bronchopneumonia were selected and divided into the experimental or control group based on whether the intelligent diagnosis and cost control system was used in the diagnostic process. Chi-square test, 1-way analysis of variance, paired t test, multiple regression analysis, and other mathematical statistical methods were used to verify the difference between the outcomes of the two groups of patients.

RESULTS: This study demonstrated comparably high cure rates in both groups (P>.05). However, the experimental group exhibited a 0.4-day reduction in average length of stay, 12.3% lower total hospitalization costs, RMB 135.3 (US $19) higher medical insurance reimbursement surplus, and a reduction of 0.16 defined daily doses of antibiotic use intensity versus the control group (P<.05 for all significant differences).

CONCLUSIONS: The novel intelligent diagnosis and cost control system demonstrated significant improvement in clinical effect, cost control, and standardized treatment for pediatric bronchopneumonia, but the CP for pediatric pneumonia requiring intensive care still needs further attention and adjustment.

PMID:41092402 | DOI:10.2196/74964

JNCI Cancer Spectr. 2025 Oct 15:pkaf098. doi: 10.1093/jncics/pkaf098. Online ahead of print.

ABSTRACT

BACKGROUND: Diagnosis, treatment, and outcomes of colon cancer in the U.S. differs between patients younger than age 50 (early-onset colon cancer, EOCC) and those age 50 or older (average-onset, AOCC) and may be impacted by access to care. Less is known about surgical quality and post-operative outcomes between patients with EOCC and AOCC. This study aimed to compare patients with EOCC and AOCC in surgical aspects and 30-day postoperative complications and readmissions in the Military Health System.

METHODS: The cohort included patients diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 who received surgery. Poisson regression with robust standard errors estimated the adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) in association with age at diagnosis for the outcomes.

RESULTS: Among 333 patients with EOCC and 1369 patients with AOCC, there were no statistically significant differences in surgical delay, positive margins, or inadequate lymphadenectomy. Patients with EOCC had statistically higher adjusted 30-day risk of any complication (ARR = 1.31, 95% CI = 1.05, 1.63), inclusive of general surgical (ARR = 1.64, 95% CI = 1.14, 2.38) and gastrointestinal (ARR = 1.29, 95% CI = 1.00, 1.65) complications, relative to patients with AOCC. There was no statistically significant difference in 30-dayreadmission for patients with EOCC (ARR = 1.30, 95% CI = 0.84, 202) compared to patients with AOCC.

CONCLUSION: In the Military Health System, patients with EOCC had higher adjusted 30-day risk of complications following surgery compared to patients with AOCC. This finding may have implications for care delivery and postoperative management of patients with EOCC to reduce complication burden and achieve optimal outcomes.

PMID:41092401 | DOI:10.1093/jncics/pkaf098

JMIR Res Protoc. 2025 Oct 15;14:e69213. doi: 10.2196/69213.

ABSTRACT

BACKGROUND: Body image distress (BID) is a significant psychological issue for patients with head and neck cancer (HNC) and arises from the visible disfigurements and functional impairments often associated with the disease and its treatment. Understanding the factors contributing to BID in this population is crucial for developing effective interventions and support mechanisms.

OBJECTIVE: This systematic review outlines methods for identifying, evaluating, and synthesizing the available evidence on factors associated with BID among patients with HNC. This review intends to explore both clinical and psychosocial variables that may influence body image perceptions and the resulting psychological impact.

METHODS: This review will follow the Joanna Briggs Institute (JBI) Reviewer’s Manual for Systematic Reviews Concerning Etiology and Risk Factors. PsycINFO, MEDLINE, EBSCOhost CINAHL, Web of Science, Cochrane Library, and Embase were searched for relevant studies from inception to December 2024. All in-depth quantitative analyses, descriptive observational studies, experimental studies, and quasi-experiments published in English or Chinese were analyzed and described. Studies examining factors associated with BID in patients with HNC were included. The population, exposure, comparison, and outcome (PECO) format was used to develop the search strategy. For different databases, search terms will be combined using Boolean operators. The JBI Risk of Bias Tool was used to evaluate bias risk in the included studies. The extracted data will include basic study information, research design, sample characteristics, BID measurement tools, primary outcomes, statistical analysis methods, and quality assessment results. Subgroup and meta-regression analyses will be performed on different therapies, treatment stages, genders, ages, cultural backgrounds, etc. I2 statistics will be used to evaluate heterogeneity, and funnel plots will address publication bias. If we detect significant heterogeneity, the findings will be reported as a systematic review without a meta-analysis.

RESULTS: The database search will be conducted in October 2025. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of March 2026.

CONCLUSIONS: This study will summarize the factors that can help identify and evaluate the factors associated with BID in patients with HNC, providing up-to-date evidence to inform the management of body image in this patient population.

PMID:41092400 | DOI:10.2196/69213

Mol Biol Evol. 2025 Oct 1;42(10):msaf211. doi: 10.1093/molbev/msaf211.

ABSTRACT

Orphan genes, which encode species-specific proteins, are common but are rarely investigated. The SARS-CoV-2 orphan gene, ORF10, has been understudied; in vitro work suggests it may modulate innate immunity. Whether ORF10 influences COVID-19 outcomes in humans remained unknown. Here, analyzing millions of SARS-CoV-2 genomes, we find ORF10 sequences are identical to ancestral Wuhan-Hu-1 haplotype. In all variants of concern, <5% of genomes carry any ORF10 mutation. Despite limited statistical power due to the sparsity of mutated sequences, four ORF10 mutations were associated with less severe clinical outcomes in COVID-19 patients: three affect protein structure, one alters RNA structural dynamics. No mutations were linked to increased severity. ORF10 transcript levels in humans and human models are conditionally discordant from other SARS-CoV-2 genes. ORF10 expression in A549 and 293T cells significantly perturbs oxidative phosphorylation gene expression, disrupts immune gene networks, and shifts expression of 14 novel human transcripts. ORF10 is present in multiple Betacoronavirus pandemicum strains, but absent from SARS-CoV-1-like strains. We propose that this strain-restricted orphan gene contributes to severe COVID-19 in humans, with implications for future therapeutic strategies. These findings underscore the importance of studying recently evolved, potentially overlooked, viral orphan genes as a standard approach in pandemic preparedness.

PMID:41092398 | DOI:10.1093/molbev/msaf211