Tag: statistics

Med Glas (Zenica). 2025 Aug 25;22(2):179-184. doi: 10.17392/2014-22-02.

ABSTRACT

A caesarean section (CS) is an obstetric surgical intervention and mode of delivery which aims to finish the pregnancy surgically. CS are one of the most important surgical interventions in modern obstetrics and have lead to a significant reduction of fetal and maternal mortality. However, it is important to take into consideration that CS can have risks and lead to unwanted short-term and long-term consequences. One of the main questions of modern obstetric is the ideal CS rate, including ways to reduce an undesirably high CS rate. The ideal CS rate ranging between 10 to 20% according to various research, but some countries have reached rates exceeding 50%, while in other, less developed countries, the issue of accessibility for CS still exists and consequently leads to a high mortality rate. Significant inequality exists in CS accessibility between developed and less developed areas of countries, and countries themselves. In some cases it is even desirable to increase CS rates in order to reduce negative patient outcome.

PMID:41082735 | DOI:10.17392/2014-22-02

Health Lit Res Pract. 2025 Oct;9(4):e105-e116. doi: 10.3928/24748307-20250612-03. Epub 2025 Oct 15.

ABSTRACT

BACKGROUND: Despite the significance of health literacy, studies show the inadequacy of health literacy in the health system of Iran. Inadequate health literacy is considered a warning for service providers. It needs to be integrated into educational programs that are administered within health and medical centers.

OBJECTIVE: Therefore, the present study was conducted to explore the barriers to health literacy in Iran’s health system.

METHODS: The present qualitative study was conducted in 2023 using a conventional content analysis. To this aim, 18 participants were selected among urban health center staff, 21 from rural health centers, 10 health volunteers, and 8 trainees (people participating in training classes) for interviews and group discussions. After the first interview, continuous data analysis began and continued to saturation level. The data were collected through semi-structured interviews and focus group discussions and were simultaneously analysed using a conventional qualitative analysis.

KEY RESULTS: Two main categories of internal and external barriers were detected. The data analysis led to the extraction of four main subcategories: (1) personal barriers (trainee’s inadequate competence, lack of physical or mental health, low motivation and commitment of health staff, beliefs, contextual barriers); (2) interpersonal barriers (health care providers’ misunderstanding of correct training, malcommunication or miscommunication in training sessions, the trainer’s limited skill, underestimated role of education in behavior change); (3) organizational barriers (high workload of health care staff, inadequate human resources, poor management and distrust in the health system, low organizational motivation); and (4) social barriers (uninterest in learning about health issues, issues related to the internet and cyberspace, lack of interpectoral cooperation).

CONCLUSION: Considering the multidimensional nature of barriers to health literacy, it is recommended to make and implement a comprehensive plan to integrate efforts by health authorities and institutions, mass media, experts, decision-makers, policymakers, and service providers to remove barriers.

PMID:41082729 | DOI:10.3928/24748307-20250612-03

J Glob Health. 2025 Oct 14;15:04312. doi: 10.7189/jogh.15.04312.

ABSTRACT

BACKGROUND: Current recommendations for neonatal bed requirements are largely assumption-based rather than data-driven. We aimed to estimate the number of beds per 1000 live births needed for the care of small and sick newborns.

METHODS: We first extracted data from studies published between 2018 and May 2023. Then, due to considerable heterogeneity in the data, we performed a meta-analysis using a random effects model to estimate the number of neonatal admissions and the length of stay. We divided the total patient days (admission rate multiplied by the length of stay) by 365 to estimate the annual number of beds per 1000 live births.

RESULTS: We include 54 included studies, of which 46 provided data on the incidence of neonatal admissions and 20 on length of stay. The pooled analysis indicated that the number of neonates requiring admission ranged from 126 to 143 per 1000 live births. Admission rates were higher in the African region (160.5; 95% confidence interval (CI) = 122.2-198.7), in low-income countries (175.3; 95% CI = 102.8 to 247.8), in tertiary care settings (147.5; 95% CI = 115.9-179.1), and in settings with a high neonatal mortality rate (149.4; 95% CI = 90.5-218.2). The pooled length of stay was estimated to be 6.4 days (95% CI = 5.7-7.1). The overall estimated number of beds needed for the care of small and sick newborns was 2.4 (95% CI = 2.0-2.8) per 1000 live births, with regional variations.

CONCLUSIONS: This method estimates the required neonatal care beds using admission rates and hospital stay data, aiding healthcare planning. Refinements and local adaptations are needed for effective policy decisions.

REGISTRATION: PROSPERO: CRD42023417847.

PMID:41082719 | DOI:10.7189/jogh.15.04312

J Clin Oncol. 2025 Oct 13:JCO2500036. doi: 10.1200/JCO-25-00036. Online ahead of print.

ABSTRACT

PURPOSE: Immunotherapy targeting PD-L1 improves outcomes in patients with unresectable stage III non-small cell lung cancer (NSCLC) and no progression after definitive, concurrent chemoradiotherapy (cCRT). Earlier administration of immunotherapy, simultaneously with cCRT, may improve outcomes further.

METHODS: Eligible patients were randomly assigned (2:1) to receive either durvalumab or placebo administered from the start of cCRT. Patients without progression after completing cCRT received consolidation durvalumab or placebo (per initial random assignment) until progression. The primary end point was progression-free survival (PFS) by blinded independent central review. Key secondary end points included objective response rate (ORR), overall survival (OS), the proportion of patients alive at 24 months (OS24), and safety.

RESULTS: In total, 328 patients were randomly assigned to receive durvalumab (n = 219) or placebo (n = 109). There was no statistically significant difference with durvalumab versus placebo in PFS (hazard ratio [HR], 0.85 [95% CI, 0.65 to 1.12]; P = .247) or OS (HR, 1.03 [95% CI, 0.78 to 1.39]; P = .823); OS24 was 58.4% versus 59.5%, respectively. Confirmed ORR was 60.7% with durvalumab versus 60.6% with placebo (difference, 0.2% [95% CI, -15.2 to 16.3%]; P = .976). With durvalumab versus placebo, respectively, maximum grade 3 or 4 adverse events (AEs) occurred in 53.4% versus 59.3% of patients, pneumonitis or radiation pneumonitis (group term) in 28.8% (grade ≥3: 4.6%) versus 28.7% (grade ≥3: 5.6%), AEs leading to discontinuation of durvalumab or placebo in 25.6% versus 12.0%, and fatal AEs in 13.7% versus 10.2%.

CONCLUSION: Among patients with unresectable stage III NSCLC, durvalumab administered from the start of cCRT failed to demonstrate additional benefit compared with cCRT plus placebo. Consolidation durvalumab following definitive cCRT remains the standard of care in this setting.

PMID:41082707 | DOI:10.1200/JCO-25-00036

Neurology. 2025 Nov 11;105(9):e214309. doi: 10.1212/WNL.0000000000214309. Epub 2025 Oct 13.

NO ABSTRACT

PMID:41082698 | DOI:10.1212/WNL.0000000000214309

Neurology. 2025 Nov 11;105(9):e214250. doi: 10.1212/WNL.0000000000214250. Epub 2025 Oct 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Preclinical-to-clinical translational failure is common in neurologic research. Reasons for translational failure are complex and multifaceted, but it is increasingly recognized that translational decision making may be influenced by preclinical work that is overly optimistic, due to a lack of scientific rigor. Previous research has demonstrated that statistical errors are common in preclinical research, yet results of preclinical null hypothesis significance testing contribute to the body of evidence used to evaluate whether a new intervention is a candidate for translation. However, no empirical investigations exist yet that compare positive and negative clinical trials on the statistical soundness of contributing studies. The aim of this study was to explore, for 3 neurologic indications (multiple sclerosis, Parkinson disease, epilepsy), whether negative clinical trials show a higher prevalence of statistical misapplication in preceding animal experiments, compared with positive human trials.

METHODS: A modified meta-research, case-control design with multistep systematic search was used. Phase 2 clinical trials (completed January 1, 2010-October 31, 2020) were identified on ClinicalTrials.gov. Best practice methods were used to systematically search MEDLINE and Embase for animal experiments preceding the start of each human trial, for each intervention and disease. Statistical reporting and decision-making data were gathered from animal articles by collectors blinded to human trial outcome. Rates of statistical mistakes were compared between animal articles preceding positive vs negative human trials using weighted percentages and CIs.

RESULTS: The final sample included 24 trials (8 negative) and 70 associated rodent studies. Animal studies preceding negative human trials had higher rates of misapplication of solely cross-sectional statistical tests to longitudinal data (93% [95% CI 83-100] vs 66% [95% CI 47-82]) and of the use of plots that concealed continuous data distributions (98% [95% CI 95-100] vs 71% [95% CI 51-91]), indicating possible mishandling of continuous data.

DISCUSSION: Statistical practice in animal studies was generally poor or not well reported, with rates of some statistical mistakes occurring more frequently before negative trials than positive trials. This was an exploratory study with a highly selected sample, yet it suggests that translational decision making should include evaluation of the quality of preclinical statistical practice.

PMID:41082697 | DOI:10.1212/WNL.0000000000214250

Ecol Lett. 2025 Oct;28(10):e70219. doi: 10.1111/ele.70219.

ABSTRACT

The phenotypes of individuals within a population create a dynamic social environment that influences phenotypic selection and population growth. Fluctuations in the frequencies of these phenotypes can influence population mean fitness and the relative fitness of phenotypes, and thus impact both population dynamics and phenotypic evolution. Various theoretical frameworks have been used to study the impact of frequency dependence on ecological and evolutionary dynamics. However, their diversity and mathematical complexity have obscured the relationship between theoretical models and empirical work. To bridge this gap, we discuss the effects of frequency dependence on phenotypic selection and population growth from a statistical perspective. We classify frequency-dependent effects on fitness according to their additive, relative or multiplicative effects, and explore how their interaction with population density can affect the eco-evolutionary dynamics of continuous traits. We show how these different effects can be mapped onto the parameters of simple linear regression models and derive how their magnitude is expected to affect the population carrying capacity and equilibrium mean phenotype. We then use individual-based simulations to complement our analytical results and demonstrate that quantifying frequency-dependent effects on fitness is key for understanding how populations will respond to environmental change.

PMID:41082684 | DOI:10.1111/ele.70219

J Physician Assist Educ. 2025 Oct 14. doi: 10.1097/JPA.0000000000000716. Online ahead of print.

ABSTRACT

INTRODUCTION: Physician associates/assistants (PAs) require extensive clinical training through supervised clinical practice experiences (SCPEs) to meet accreditation standards. While PA programs must document student performance during rotations, there is considerable variability in assessment methods. Many programs use a 2-pronged approach: end-of-rotation (EOR) exams and preceptor evaluations. This study aims to evaluate whether SCPE preceptor evaluations are associated with student performance on EOR exams or Physician Assistant National Certifying Examination (PANCE).

METHODS: This retrospective study analyzed data from 782 students across 3 PA programs over 5 years (2020-2024). The study focused on Family Medicine, Emergency Medicine, and Internal Medicine rotations, comparing preceptor evaluations with EOR and PANCE scores.

RESULTS: Mean PANCE score was 468.2 ± 73.9, with mean EOR scores of 410.6 ± 23.2 for internal medicine, 409.3 ± 22.7 for family medicine, and 410.2 ± 22.1 for emergency medicine. Preceptor evaluations averaged 4.36 ± 0.7 on a 5-point Likert scale. While some statistically significant correlations were identified between preceptor evaluations and standardized exam performance, correlation coefficients were weak (-0.11 to 0.17).

DISCUSSION: Despite some statistically significant correlations, the practical utility of preceptor evaluations in predicting standardized exam performance is negligible. This suggests that preceptor evaluations, although essential to evaluate for clinical competencies beyond standardized evaluations, may not be predictive of academic student success. Preceptor evaluations reveal a weak correlation, when present, with standardized examinations. These findings prompt reflection upon the traditional reliance on preceptor evaluations and suggest that future research is needed at both the programmatic and national levels to capture a comprehensive understanding of student competence as a future clinician.

PMID:41082682 | DOI:10.1097/JPA.0000000000000716

Microsurgery. 2025 Oct;45(7):e70120. doi: 10.1002/micr.70120.

ABSTRACT

BACKGROUND AND OBJECTIVES: The tongue is the most common site of oral malignancy, and surgical treatment may result in impaired feeding, swallowing, and speech. Free tissue transfer is the preferred method for reconstructing complex defects. Evidence remains unclear on whether sensory reinnervation improves function. The objective of this review is to evaluate the outcome of patients undergoing innervated versus noninnervated free flap reconstruction following tongue cancer surgery.

METHODS: A systematic review was performed to determine the role of sensory neurotization in lingual reconstruction. Only studies with comparative designs were eligible for inclusion. Primary outcome measures included static two-point discrimination (S2PD), pinprick sensation, swallowing, and speech. A meta-analysis was performed using key data analysis to calculate weighted effect sizes for reconstruction with or without neurotization using random-effects models. The statistical heterogeneity was determined using the Higgins’ method.

RESULTS: Nine studies were included which produced 107 reinnervated flaps and 117 non-innervated flaps for pooled analysis. Objective measures of sensation were significant, favoring the reinnervation group for pinprick sensation and S2PD (p < 0.05), with the pooled difference in proportions being 0.25 and -13.88 (0.06-0.45, 95% CI, -26.66 mm to -1.11, 95% CI), respectively. Functional outcome measures revealed significantly improved speech in the reinnervated group (p < 0.05, non-weighted means 74.8 vs. 62.5%).

CONCLUSIONS: This study found a strong association favoring the sensory neurotization for tongue reconstruction. Higher quality studies are required to further define the role of reinnervation for the restoration of swallow, relative differences between type of free flap selected, and measure changes in patients’ quality of life.

PMID:41082276 | DOI:10.1002/micr.70120