Tag: statistics

BMC Nurs. 2026 May 23. doi: 10.1186/s12912-026-04634-8. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Cancer is one of the leading causes of death globally. Against the backdrop of inadequate life education and a deep-rooted death-avoidant culture in China, oncology nurses faced with multiple challenges in hospice care. The attitude of oncology nurses towards care of the dying is a crucial factor in improving the quality of palliative care. However, few studies have explored the attitude toward care of the dying of oncology nurses and their influencing mechanisms. This study aimed to explore the mediating effect of meaning in life on the fear of death and attitude toward care of the dying among oncology nurses in China.

METHODS: Data were collected from July to August 2024 using Chinese versions of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-C), the Collett-Lester Fear of Death Scale (CLS), and Purpose in Life Test (CPLT-C). SPSS version 26.0 and AMOS version 24.0 were used for statistical analysis.

FINDINGS: The mean total attitude score towards care of the dying was 95.52 ± 18.18. The fear of death was positively correlated with the meaning in life (r = 0.442, P < 0.01), and positively correlated with the attitude toward care of the dying (r = 0.340, P < 0.01). Meaning in life was positively correlated with attitude towards care of the dying (r = 0.474, P < 0.01). Meaning in life partially mediated the relationship between fear of death and attitudes toward care of the dying. The mediating effect (0.297) accounted for 63.19% of the total impact (0.479).

CONCLUSION: Nurses’ fear of death is positively correlated with their attitude towards care of dying, and the meaning of life plays a partial mediating role in it. This discovery challenges the common view that “fear of death is necessarily detrimental to humanistic care”, highlighting the significant role of existentialist resources in shaping nurses’ professional attitudes. Based on this, intervention measures should focus on strengthening the intermediary resource of life meaning. Medical administrators, educators and policymakers can combine traditional training methods with emerging technologies to help nurses master palliative care knowledge and skills while cultivating and consolidating a sense of life meaning.

PMID:42177484 | DOI:10.1186/s12912-026-04634-8

BMC Cancer. 2026 May 23. doi: 10.1186/s12885-026-16146-4. Online ahead of print.

ABSTRACT

OBJECTIVE: Androgen receptor pathway inhibitors (ARPIs) are cornerstone treatments for advanced prostate cancer; however, their potential to increase fall risk remains a significant clinical concern. This meta-analysis aims to provide a rigorous, drug-specific evaluation of the association between novel ARPIs and the risk of falls.

METHODS: We systematically searched PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov for Phase 2 or 3 randomized controlled trials (RCTs) comparing ARPIs (enzalutamide, apalutamide, and darolutamide) with control groups (placebo or non-steroidal antiandrogens [NSAA]). The primary outcomes were risk ratios (RRs) for all-grade and grade ≥ 3 falls. To account for multiplicity across correlated outcomes and the limited number of studies, pooled RRs were estimated using random-effects models with the restricted maximum-likelihood (REML) method. All analyses were performed on a logarithmically transformed scale, with 97.5% confidence intervals (CIs). Prediction intervals (PIs) were calculated to assess the dispersion of effects. Subgroup analyses were stratified by specific ARPI agents, control types, and clinical stages.

RESULTS: Eleven RCTs involving 12,239 patients were included. Overall, ARPIs were significantly associated with the increased risk of all-grade falls (RR 2.00, 97.5% CI 1.46-2.73, P < 0.0001, I² = 77.6%; PI 0.67-5.99) and grade ≥ 3 falls (RR 2.15, 97.5% CI 1.32-3.52, P = 0.0008, I² = 0%; PI 1.15-4.02). However, risk profiles varied substantially across individual agents. Enzalutamide was associated with the highest risk increase (RR 2.55 vs. placebo, 97.5% CI 1.62-4.01, I² = 79.2%; RR 2.47 vs. NSAA, 97.5% CI 1.14-5.37, I² = 71.8%), followed by apalutamide (RR 1.65, 97.5% CI 0.77-3.52, I² = 87.2%). In contrast, darolutamide demonstrated a favorable safety profile with no statistically significant increase in the risk of all-grade falls (RR 1.25, 97.5% CI 0.87-1.79, I² = 0%) or severe falls (RR 1.31, 97.5% CI 0.34-5.00).

CONCLUSIONS: Current evidence indicates that the increased risk of falls associated with ARPI therapy varies significantly among individual agents, rather than being a uniform class effect. While enzalutamide and apalutamide are statistically associated with elevated fall risk, darolutamide appears to maintain a more favorable safety profile. However, these drug-specific comparisons remain exploratory due to subgroup imbalances. Clinicians should consider proactive fall-risk assessments and individualized treatment selection, particularly for elderly or frail populations.

PMID:42177476 | DOI:10.1186/s12885-026-16146-4

Cost Eff Resour Alloc. 2026 May 23;24(1):66. doi: 10.1186/s12962-026-00770-9.

ABSTRACT

BACKGROUND: Clinical pathways (CPs) are guidelines to standardize processes, improve quality of care and maximize resources through the implementation of evidence-based care for a medical procedure, thus reducing variation and risk. Our aim was to evaluate the cost of care for robotic colorectal surgery using a CP compared to surgery without a CP.

METHODS: This was a non-interventional micro-costing study with a hospital-level perspective. It was carried out using the three standard steps. First, all resources involved in the implementation of the CP were identified. Second, resource consumption was measured. Third, the resources identified were valued and measured to estimate the average cost per group. This included the costs related to perioperative care and treatment of complications. Finally, a sensitivity analysis was conducted based on the hypothetical capacity utilization of the robotic equipment, costs of CP development and a discount rate of 3% over a period of five years.

RESULTS: The study population comprised 63 patients: 21 in the CP group (robotic colorectal surgery with CP) and 42 in the no-CP group (robotic colorectal surgery without CP). The mean cost per patient in the CP group was €12,663 (range: €8,093 to €26,475), whereas in the no-CP group it was €11,128 (range: €8,357 to €17,268). The main cost drivers in the CP group were materials and disposables (33% of total costs) and staff (20% of total costs). In the no-CP group, they accounted for 38% and 20% of total costs, respectively. The CP group was used for the sensitivity analysis. In year 1, at 100% utilization the mean cost per patient was €12,364, increasing to €17,883 at 20% utilization. In year 5, at 100% utilization the mean cost per patient was €13,986, rising to €20,519 at 20% utilization.

CONCLUSION: The evidence from our study indicates that using a CP for perioperative care of patients undergoing robotic colorectal surgery was not associated with a statistically significant reduction in cost of care.

PMID:42177472 | DOI:10.1186/s12962-026-00770-9

BMC Psychiatry. 2026 May 23. doi: 10.1186/s12888-026-08212-9. Online ahead of print.

ABSTRACT

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity beyond developmental expectations. Problematic technology engagement, including increased smartphone use, is frequently observed among adolescents with ADHD. Phubbing, a term combining ‘phone’ and ‘snubbing,’ refers to ignoring others in a social setting by focusing on one’s smartphone rather than engaging in face-to-face interaction and has been linked to impaired interpersonal communication. Cognitive Disengagement Syndrome (CDS), formerly referred to as sluggish cognitive tempo (SCT), is characterized by excessive daydreaming, mental confusion, low initiative, and slowed responding and is associated with social withdrawal. However, no prior studies have investigated ADHD-phubbing or CDS-phubbing relationships in adolescents. This study examined group differences in phubbing and explored associations among phubbing, ADHD symptoms, and CDS severity.

METHODS: In this case-control study, 48 adolescents diagnosed with ADHD and 38 healthy controls aged 12-17 completed; Sociodemographic Data Form, General Phubbing Scale, and Conners-Wells Adolescent Self-Report Scale Short Form. Parents completed Child and Adolescent Behavior Inventory SCT Scale. ADHD was diagnosed via DSM-5 based clinical interviews. Group comparisons and correlation analyses were conducted using appropriate statistical tests.

RESULTS: Phubbing scores were significantly higher in the ADHD group than in controls. Phubbing scores demonstrated significant positive correlations with self-reported ADHD symptom domains, including conduct problems, inattention, hyperactivity, and the ADHD Index. CDS severity did not reach significance within the ADHD group but was significantly associated with phubbing scores in the full sample. Adolescents whose CDS symptoms impaired social functioning reported higher phubbing scores. Daily smartphone use exceeding 3 hours and social media use were also associated with elevated phubbing scores.

CONCLUSION: These findings indicate that phubbing scores is elevated among adolescents with ADHD and is positively associated with ADHD symptom severity. CDS-particularly when accompanied by social impairment-is also associated with higher phubbing scores. The results highlight the potential utility of assessing smartphone and other electronic technology use when evaluating adolescents with ADHD and CDS. However, given the cross-sectional nature of this study, causal or directional inferences cannot be drawn. Future research with larger and untreated samples is warranted.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42177470 | DOI:10.1186/s12888-026-08212-9

BMC Palliat Care. 2026 May 23;25(1):154. doi: 10.1186/s12904-026-02149-2.

ABSTRACT

BACKGROUND AND OBJECTIVES: Clinical ethics support services (CES) may support palliative care teams in ethical conflicts. However, it is not known to what extent these services are available, used and how their relevance is perceived by the teams. The study focuses on the accessibility and evaluation of ethics consultations in specialized outpatient palliative care teams and inpatient hospices.

METHODS: This study conducted a cross-sectional 21-item anonymous survey among teams of registered specialized outpatient palliative care services (n = 304) and inpatient hospices (n = 260) in Germany concerning availability, utilization and evaluation of clinical ethics support services.

RESULTS: A total of 175 (58%) specialized outpatient palliative care teams and 102 (39%) inpatient hospice teams responded to the questionnaire; of these two-thirds have access to CES. A number of ethical challenges were reported in these settings, many of which are perceived as burdensome. However, satisfaction with existing services is rather moderate and teams report fewer than five consultations per year. Nevertheless, ethics consultation is regarded as being highly useful, with positive effects reported, including enhanced confidence in decision-making processes and reduced burden for team members. Interestingly, team members with formal training in clinical ethics had a significant positive impact on the perception of CES and the frequency of consultations.

CONCLUSION: Although specialized outpatient palliative care and inpatient hospice teams reported facing a number of burdensome ethical challenges, ethics consultations fall short of accessibility to CES. This discrepancy can be resolved by structured training of team members in clinical ethics to increase the level of awareness and utilization of CES in specialized outpatient palliative care and inpatient hospices.

PMID:42177468 | DOI:10.1186/s12904-026-02149-2

Int J Gynaecol Obstet. 2026 May 23. doi: 10.1002/ijgo.71076. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the present study was to assess changes in cesarean section (CS) rates over 3 years at a public tertiary care hospital using the Robson Ten Group Classification System (RTGCS). The specific objectives were to compare population distribution across Robson groups, evaluate overall, group-specific, absolute and relative CS rates and assess data quality and completeness.

METHODS: This analytical cross-sectional study was conducted at a public tertiary care hospital in Rawalpindi, Pakistan and spanned over two phases. Phase 1: June 2019 to November 2019 and phase 2: August 2022 to January 2023. For analysis, RTGCS was applied. Robson’s report tables (RRTs) of two phases were generated to calculate and compare CS rates. Statistical analysis included the calculation of P values (considering <0.05 as significant) by chi-square and Fisher exact tests, odds ratios (ORs), relative risks (RRs) and 95% confidence intervals (CIs), using established online tools.

RESULTS: The total number of women included in study during phase 1 were 5437, and in phase 2 were 3762. Overall CS rate increased from 31.06% (phase 1) to 40.09% (phase 2) (P < 0.001). In both phases, Robson group 3 was the largest (33% and 25.2% in phases 1 and 2, respectively) and group 9 was the smallest (<1%). The highest absolute contribution towards CS rate was made by group 5, followed by groups 10 and 2 in both phases. Combined contribution of groups 5, 10, and 2 was 70.5% in phase 1 and 64.9% in phase 2. Group 9 had the highest group-specific CS rate in both phases (93.7% and 100%). In phase 1, it was followed by groups 5 (80.4%), 6 (78.2%) and 7 (72%), while in phase 2 by groups 6 (89.6%), 5 (85.2%), and 8 (72.2%). In CS rate, a statistically significant increase was noted in Robson groups 1, 3, 5, 6, 8, and 10, while a decline was observed in group 4 only.

CONCLUSION: The overall CS rate significantly increased over time. This rise was mainly due to a shift in the obstetric population in high-risk groups; 6, 8, 9, 10, and group 5. Conversely, the reduced CS rates in groups 2 and 4 suggest improved induction practices. The data quality was satisfactory.

PMID:42175756 | DOI:10.1002/ijgo.71076

Risk Anal. 2026 Jun;46(6):e70267. doi: 10.1111/risa.70267.

ABSTRACT

High temperatures are increasingly associated with adverse mental health outcomes, yet the influence of structural modeling assumptions on these estimates remains underexplored. This study examined the short-term association between high temperatures and mental health-related-hospitalizations in 21 major Italian cities from 2005 to 2023, using national hospital discharge data. Exposure-lag-response relationships were modeled through a Distributed Lag Nonlinear Model (DLNM) framework estimated within a Generalized Additive Model (GAM). Analyses focused on June-September and included hospitalizations with a primary diagnosis of mental disorders, considering the code 295-316 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). A Global Sensitivity Analysis (GSA) assessed how structural decisions, such as the specification of temperature and lag splines, and the inclusion of September, affect risk estimates. A total of 210,310 hospitalizations were recorded. The cumulative exposure-response curve showed a marked nonlinear increase in risk, reaching relative risk values close to two at temperatures exceeding 40 ${}^{\circ }C$ . The GSA revealed that the number and placement of knots in the temperature dimension were the dominant contributors to output variability, with total-order sensitivity indices approaching one across most of the temperature range. Variations in the lag structure contributed minimally, while including or excluding September influenced model fit but only modestly affected risk estimates. Uncertainty quantified through GSA was substantially larger than that quantified by standard confidence intervals, indicating that structural assumptions meaningfully shape inference. Within the DLNM-GAM framework, high summer temperatures were consistently associated with increased psychiatric hospitalizations. Incorporating GSA clarified which modeling choices influence estimates, improving transparency and robustness in evaluating heat-related mental health impacts.

PMID:42175751 | DOI:10.1111/risa.70267

Eur J Prev Cardiol. 2026 May 23:zwag267. doi: 10.1093/eurjpc/zwag267. Online ahead of print.

ABSTRACT

Randomized controlled trials (RCTs) remain the gold standard for causal inference in cardiovascular prevention but are often limited by cost, feasibility, and restricted generalizability. The rapid expansion of real-world data (RWD) offers new opportunities to address clinically relevant questions beyond the scope of RCTs, yet observational analyses remain highly susceptible to bias, particularly when study design is not aligned with the underlying causal question. Target trial emulation (TTE) is an increasingly adopted framework that improves the validity and interpretability of observational studies by explicitly specifying the protocol of the hypothetical randomized trial that would ideally answer the clinical question. This review provides a practical guide to TTE in cardiovascular prevention. We describe its conceptual foundations within the counterfactual framework, emphasizing the shift from a model-driven to a design-first approach, and outline the seven key components of the target trial protocol: eligibility criteria, treatment strategies, assignment procedures, time zero definition, outcomes, estimand, and statistical analysis plan. We clarify the role of analytical methods within TTE, including propensity score approaches, g-computation, and g-estimation, and provide guidance on selecting the appropriate method based on the estimand and treatment strategy. A step-by-step implementation framework is proposed, covering common pitfalls such as immortal time bias and prevalent user bias, the use of negative control analyses as diagnostic tools, and the handling of missing data. Illustrative examples from cardiovascular prevention demonstrate how TTE enhances causal interpretation across a range of clinical questions. TTE strengthens the credibility of real-world evidence by improving transparency, reducing avoidable design biases, and aligning analyses with clinically meaningful decisions. It does not eliminate residual confounding and should be viewed as complementary to, rather than a substitute for, randomized evidence.

PMID:42175748 | DOI:10.1093/eurjpc/zwag267

Chronobiol Int. 2026 May 23:1-9. doi: 10.1080/07420528.2026.2678271. Online ahead of print.

ABSTRACT

Excessive use of smartphones and tablets has become increasingly common among children, contributing to adverse physical and mental health outcomes. Evening chronotype and inadequate sleep habits have been identified as potential risk factors. However, despite growing concerns, there is limited evidence on the relationship between chronotype, sleep patterns, and digital device addiction in children. In this cross-sectional study, 213 Iranian schoolchildren aged 4-11 years were assessed using validated Persian versions of three standardized instruments: the Children’s Chronotype Questionnaire (CCTQ), the Children’s Sleep Habits Questionnaire (CSHQ), and the Smartphone and Tablet Addiction Questionnaire. This is the first study in Iran to employ the CCTQ to examine the association between chronotype and smartphone addiction in children. Data analysis included descriptive statistics, Spearman’s correlation, stepwise regression, and Kruskal-Wallis tests. Sleep problems and smartphone/tablet addiction were significantly more prevalent in children with an evening chronotype, followed by those with a neutral chronotype, and were lowest in those with a morning chronotype. In addition, the M/E and CSHQ scores were positively associated with smartphone/tablet addiction scores, whereas later sleep onset time on scheduled days showed a negative association. Specifically, each one-unit increase in the M/E score was linked to a 0.75-point increase in the average addiction score (β = 0.75, SE = 0.17, p < 0.01), and each one-unit increase in the CSHQ score corresponded to a 0.35-point increase (β = 0.35, SE = 0.13, p < 0.05). Conversely, each one-unit delay in sleep onset time on scheduled days was associated with a 0.15-point decrease in the average addiction score (β = -0.15, SE = 0.09, p < 0.05). Children with an evening chronotype appear more susceptible to both poor sleep habits and smartphone/tablet addiction. These findings, in line with previous research on adolescents and adults, support the notion that circadian misalignment plays a pivotal role in technology-related behavioral risks. Early identification of chronotype and the implementation of strategies to promote healthier sleep schedules may be beneficial for fostering healthier sleep patterns and more balanced device use among children.

PMID:42175734 | DOI:10.1080/07420528.2026.2678271

Am Surg. 2026 May 23:31348261455090. doi: 10.1177/00031348261455090. Online ahead of print.

ABSTRACT

BackgroundPostoperative respiratory depression (PRD) is potentially preventable yet remains difficult to preemptively detect. We evaluated whether three post anesthesia care unit (PACU) events-oversedation, caffeine administration for impaired arousal, and naloxone administration-can serve as early markers of delayed PRD requiring naloxone administration on wards.MethodsWe retrospectively identified patients who underwent general anesthesia between 2018 and 2023 at a quaternary care academic medical center. From electronic medical records, we retrieved PACU naloxone and caffeine treatments, scores of sedation assessments using the Richmond Agitation-Sedation Scale (RASS), and ward naloxone administrations within 24 hours after PACU discharge.ResultsAmong 95 870 patients, 186 (0.19%, 95% CI 0.17-0.22) required naloxone for respiratory depression after PACU discharge. Ward naloxone administration was independently associated with naloxone (OR 9.11, 95% CI 4.69-17.71, P < 0.001) and caffeine (OR 2.00, 95% CI 1.21-3.32, P = 0.007) administrations, and with PACU RASS scores ≤ -3 (OR 2.16, 95% CI 1.56-2.99, P < 0.001).ConclusionsNaloxone administration in PACU was the strongest predictor of delayed PRD, followed by oversedation and PACU caffeine administration, indicating that information routinely collected during PACU recovery may offer insight into delayed respiratory risk before transition to hospital wards. In light of the overall low incidence of ward naloxone use, these findings support selective, risk-based vigilance for patients exhibiting these PACU events rather than broad adjustments to existing monitoring practices.

PMID:42175723 | DOI:10.1177/00031348261455090