BMC Medicine最新文献

{"title":"Risk-adapted intervals for colorectal cancer screening using fecal immunochemical tests: a modelling study based on the BLITZ cohort.","authors":"Thomas Heisser, Teresa Seum, Michael Hoffmeister, Hermann Brenner","doi":"10.1186/s12916-026-05138-7","DOIUrl":"10.1186/s12916-026-05138-7","url":null,"abstract":"<p><strong>Background: </strong>Established screening programs for colorectal cancer (CRC) based on fecal immunochemical tests (FITs) employ fixed screening intervals of either one year or two years for all participants. We aimed to assess the potential design of risk-adapted FIT screening intervals based on quantitative values of the fecal hemoglobin concentration among FIT negative participants.</p><p><strong>Methods: </strong>Using COSIMO, a previously validated simulation tool, we compared CRC risks in subgroups with initially negative FIT. Subgroups were stratified by stool hemoglobin levels at screening (< 8 (low), 8-<10 (medium), 10-<17 µg (high) Hb/g stool), a routinely available measure in FIT-based screening programs. Colorectal neoplasia prevalences at model start were informed by 6,661 screening colonoscopy participants in Germany at average CRC risk with negative FIT and available colonoscopy results (BLITZ study). Simulations were run for hypothetical cohorts of 100,000 individuals.</p><p><strong>Results: </strong>Of 6,661 FIT-negative participants, 6,016 (90%), 273 (4%), and 372 (6%) were in the low, medium, and high-negative subgroups, respectively. In those low-negative, expected cancer detection rates were 0.17%, 0.30%, 0.42%, 0.53%, and 0.62%, after screening intervals of 1, 2, 3, 4, and 5 years, respectively. Cancer detection rates among the small groups of medium- and high-negative patients were up to six times higher and exceeded the expected 2-year detection rates of the low-negative group already after 1 year of follow-up.</p><p><strong>Conclusions: </strong>Fecal hemoglobin concentrations among FIT negative participants may be a readily available, highly informative tool for defining risk-adapted annual or biennial FIT screening intervals.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain imaging-derived phenotypes influence risk of bipolar disorder: comprehensive exposome-wide association and wide-angled genetic analyses.","authors":"Wenzhuo Yang, Lin Pan, Haoqun Xie, Jialin Deng, Yifan Li, Yu Hu, Yihe Zhang, Kaijun Sun, Hongyu Chen, Laiyu Yang, Zijian Chen, Bincheng Yu, Leyan Chen, Zibing Zhao, Yonggao Mou, Yinsheng Chen, Sheng Zhong","doi":"10.1186/s12916-026-05152-9","DOIUrl":"10.1186/s12916-026-05152-9","url":null,"abstract":"<p><strong>Background: </strong>Despite many reported imaging markers for bipolar disorder (BD), systematic assessment across diverse brain imaging-derived phenotypes (IDPs) is lacking. We used epidemiological and genetic analyses to progress from association to causality and identify candidate biomarkers and potential pathways of BD.</p><p><strong>Methods: </strong>We conducted an Exposome-Wide Association Study (ExWAS) in 35,680 UK Biobank participants to assess associations of 686 brain IDPs with BD. Genetic correlations were estimated via linkage disequilibrium score regression (LDSC). Bidirectional two-sample Mendelian randomization (MR) and meta-analysis were performed using large-scale GWAS data to infer causality. Additional analyses, including Functional Mapping and Annotation (FUMA), protein-protein interaction (PPI) network analysis, and spatiotemporal gene expression profiling during human brain development, were performed to investigate potential biological mechanisms of BD and IDPs.</p><p><strong>Results: </strong>In our ExWAS analyses, we identified 10 significant exposome-level IDPs, and LDSC further revealed 67 IDPs with significant genetic correlations with BD. The MR analyses provided robust causal evidence for 12 IDPs, 6 of which were further validated by meta-analysis. Integrative analyses identified two associations supported by both epidemiological and genetic evidence (IDP.1510: fractional anisotropy in the forceps major, and IDP.0387: volume of the right lateral orbital frontal cortex). Additionally, we identified pleiotropic genes between IDPs and BD. Gene enrichment analyses implicated shared biological pathways, such as nucleosome assembly and neutrophil extracellular trap formation . PPI network analysis suggested that histone family members occupied central hubs in the interaction network. Spatiotemporal expression profiling identified region-specific developmental trajectories of pleiotropic genes in brain regions, including the cerebellum and thalamus, with the late fetal to early postnatal period potentially representing a sensitive developmental period for neurodevelopmental effects of BD susceptibility genes.</p><p><strong>Conclusions: </strong>This study establishes an atlas of brain IDPs associated with BD, by integrating epidemiological and genetic evidence. The findings highlight candidate IDPs, including right lateral orbital frontal cortex volume and fractional anisotropy in the forceps major, that were consistently associated with BD across complementary analyses. Our results provide genetically supported targets for early intervention and precision psychiatry.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent intelligence and imaging-detected atherosclerosis in middle age: a population study of Swedish men.","authors":"Hampus Eriksson, Ángel Herraiz-Adillo, Patrik Wennberg, Bledar Daka, Irene Esteban-Cornejo, Cecilia Lenander, Daniel Berglind, Ulrika Müssener, Fang Fang, Carl Johan Östgren, Karin Rådholm, Pontus Henriksson, Viktor H Ahlqvist","doi":"10.1186/s12916-026-05140-z","DOIUrl":"10.1186/s12916-026-05140-z","url":null,"abstract":"<p><strong>Background: </strong>Childhood or adolescent intelligence has been linked to major somatic diseases and premature mortality, but the underlying pathways remain unclear. The aim of this study was therefore to determine whether adolescent intelligence is associated with atherosclerosis in middle age and whether this association is mediated by the American Heart Association's Life's Essential 8 (LE8) metric of cardiovascular health markers.</p><p><strong>Methods: </strong>This population-based prospective cohort study linked data from men who underwent mandatory military conscription in adolescence with data from the Swedish CArdioPulmonary bioImage Study (SCAPIS). A standardized intelligence test was administered at conscription (mean age, 18.3 years; standard deviation [SD], 0.5), assessing logical reasoning, spatial ability, technical skills, and verbal comprehension. Scores were standardized to a mean of 100 (SD, 15). Atherosclerosis in middle age (mean age, 56.6 years; SD, 3.9) was assessed using coronary computed tomography angiography (CCTA) for coronary stenosis (0%, 1-49%, and ≥ 50%), coronary artery calcium (CAC) scores (0, 1-99, and ≥ 100 Agatston units), and carotid ultrasound for unilateral or bilateral carotid plaque/s. LE8 components assessed in SCAPIS were analyzed as potential mediators. Associations were modeled using multinomial logistic regression, and mediation was estimated using counterfactual mediation analysis.</p><p><strong>Results: </strong>A total of 8,117 men were included in the analysis of coronary stenosis, 7,958 for CAC, and 9,092 for carotid plaque. Higher adolescent intelligence was generally inversely associated with atherosclerosis in middle age. In analyses with adjustments (Model 2) for coronary stenosis, each 15-point (1 SD) increase in adolescent intelligence was associated with 17% lower odds of having ≥ 50% coronary stenosis (OR: 0.83; 95% CI: 0.75-0.90; P-value: <0.001). An intelligence difference between 70 and 130 corresponded to a prevalence difference of 4.1 percentage points (10.3% vs. 6.2%) of coronary stenosis ≥ 50%. Similar associations were observed for CAC scores and bilateral carotid plaques. Mediation via LE8 accounted for 41% to 68% of the association across outcomes.</p><p><strong>Conclusions: </strong>Higher adolescent intelligence was associated with a lower burden of atherosclerosis in middle age, an association that may be partly mediated by modifiable cardiovascular health factors.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological domain shift and statistical nesting concerns in generative AI-based spatial tumor growth prediction for pediatric diffuse midline glioma.","authors":"Wang Li, Xiaohu Sun, Sining Pei","doi":"10.1186/s12916-026-05141-y","DOIUrl":"10.1186/s12916-026-05141-y","url":null,"abstract":"<p><strong>Background: </strong>Laslo et al. recently reported a guided denoising diffusion implicit model for spatial tumor growth prediction on magnetic resonance imaging (MRI) in pediatric diffuse midline glioma. Their proof-of-principle study demonstrates the feasibility of generative artificial intelligence (AI) for producing patient-specific tumor growth maps as an early step toward informing personalized radiotherapy planning in data-limited pediatric neuro-oncology settings. However, the external validation cohort comprised only 13 patients, and growth-region prediction performance, measured using the continuous Dice coefficient (cDICE; median ≈ 0.22; range 0.071-0.376), was considerably weaker than full-tumor performance (cDICE median ≈ 0.81; range 0.439-0.877). In this Matters Arising, we provide a focused methodological commentary on several issues that should be considered when interpreting the translational implications of this work.</p><p><strong>Main body: </strong>First, training both the diffusion model and the tumor-size regressor on pooled adult glioblastoma and pediatric high-grade glioma data may introduce biological domain shift, given differences in molecular drivers, anatomical distribution, growth kinetics, and treatment response. Second, although patient-level data splitting was appropriately performed, slice-level performance estimates may overstate precision because multiple correlated two-dimensional slices are nested within a small number of patients. Third, clinical utility should be evaluated against radiotherapy-relevant benchmarks, including target-volume delineation, isotropic expansion margins, geographic miss, normal-tissue exposure, and growth-region-specific performance.</p><p><strong>Conclusions: </strong>Addressing these points would strengthen the evidentiary basis for future clinical translation of generative tumor growth modeling.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining variations in adherence to guideline-recommended post-acute kidney injury care in primary care in England: a population-based cohort study.","authors":"Pearl L H Mok, Simon Sawhney, Tom Blakeman, Matthew J Carr, Rachel A Elliott, Robbie Foy, Simon Ds Fraser, Evangelos Kontopantelis, Andrew J P Lewington, Alireza Mahboub-Ahari, Paul Roderick, Nicholas M Selby, Darren M Ashcroft","doi":"10.1186/s12916-026-05042-0","DOIUrl":"10.1186/s12916-026-05042-0","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a clinical syndrome characterised by a sudden deterioration of kidney function. It is common and usually occurs as a complication of severe illness or major surgery. Despite the high risk of complications and a decade of improvement initiatives in the UK, little is known about the quality of post-discharge AKI care. Our population-based cohort study investigated adherence to guideline-recommended post-AKI care in general practices in England.</p><p><strong>Methods: </strong>Using English hospital admission data (2017-2021), we created a cohort of discharged patients (≥ 18 years) with a hospital diagnostic code of AKI. Using linked Clinical Practice Research Datalink Aurum primary care data, we examined percentages of AKI episodes meeting the criteria of 14 guideline-recommended post-AKI care indicators, covering: AKI coding in primary care, post-discharge primary care contacts, kidney health and blood pressure monitoring, and guideline-indicated prescribing. Variations of indicator adherence according to patient characteristics were quantified using binomial mixed regression.</p><p><strong>Results: </strong>209,222 patients (48.0% females; mean age 74.1 years) were included, representing 279,187 AKI inpatient episodes. Only 19.5% (95% CI 18.5-20.5) of episodes had AKI coded in primary care within 30 days of discharge, while 72.6% (95% CI 71.8-73.4) had a documented contact with general practice. At 90 ± 30 days after discharge, serum creatinine was measured in 34.2% (95% CI 33.7-34.8) of episodes, blood pressure in 34.6% (95% CI 34.0-35.1), and albumin-creatinine ratio in 4.2% (95% CI 4.0-4.4). Testing was less common amongst younger patients and those without comorbid conditions. Renin-angiotensin system inhibitor prescribing rates were low in patients likely to benefit.</p><p><strong>Conclusions: </strong>There are multiple missed opportunities for improving post-AKI care. Rates of measuring albuminuria were particularly low, despite its strong association with subsequent kidney and cardiovascular events. The limited post-AKI clinical activity amongst younger patients and those without comorbidities undermines the prevention and early intervention of chronic kidney diseases. Clearer discharge arrangements, including case-specific guidance on discharge summaries, and the development and evaluation of concerted implementation strategies spanning secondary and primary care are needed.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The gender pain gap in prehospital analgesia: the role of patient and provider gender - an analysis of 106,888 helicopter emergency medical service (HEMS) missions.","authors":"Andrea Schmidt, Hans-Jörg Busch, Lilith Huebsch, Florian Reifferscheid, Jörg Braun, Sebastian Heinrich, Julian Ganter","doi":"10.1186/s12916-026-05131-0","DOIUrl":"10.1186/s12916-026-05131-0","url":null,"abstract":"<p><strong>Background: </strong>Pain management is a core ethical principle in emergency medicine, yet gender-related differences in analgesic treatment have been reported. This study examines whether patient and emergency physician gender influence prehospital pain management.</p><p><strong>Methods: </strong>This retrospective observational cohort study included all primary helicopter emergency medical service missions conducted by DRF Stiftung Luftrettung in Germany between January 2012 and June 2025. Adult patients (≥ 18 years) with a Glasgow Coma Scale score ≥ 11 and without airway management were analyzed. Pain severity was assessed using the Numeric Rating Scale (NRS). Patient characteristics, analgesic treatment, and emergency physician gender were analyzed using descriptive statistical methods. The study was approved by the Ethics Committee Freiburg (25-1272-S1, August 19th 2025).</p><p><strong>Results: </strong>A total of 106,888 cases was included, of which 38.5% were female and 61.5% male. Initial pain severity was comparable between genders, with a similar distribution across NRS categories. Despite this, women received analgesic treatment less frequently than men (62.0% vs. 66.9%; p < 0.001), whereas a greater effect is seen when particularly examining the use of opioid analgesics (50.0% vs. 57.1%; p < 0.001). This finding is consistent across all pain severity subgroups. Pain scores at patient handover were similar for women and men, indicating comparable pain levels at the end of prehospital care.</p><p><strong>Conclusions: </strong>Despite comparable pain intensity, women received analgesic and opioid treatment less frequently than men in prehospital care, indicating potential gender-based inequalities in pain management. These findings underscore the need for strategies to ensure equitable analgesic treatment.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148696971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The tumour microenvironment influences long-term tamoxifen benefit in postmenopausal ER+/HER2- breast cancer patients: a secondary analysis of the randomised Stockholm Tamoxifen (STO-3) trial.","authors":"Paula Camargo-Romera, Miguel Castresana-Aguirre, Oscar Danielsson, Huma Dar, Arne Östman, Kamila Czene, Linda S Lindström, Nicholas P Tobin","doi":"10.1186/s12916-026-05091-5","DOIUrl":"10.1186/s12916-026-05091-5","url":null,"abstract":"<p><strong>Background: </strong>The tumour microenvironment (TME) influences breast cancer progression and treatment response. We investigated whether TME composition predicts tamoxifen benefit in postmenopausal women with oestrogen receptor-positive, HER2-negative (ER+HER2-) breast cancer.</p><p><strong>Methods: </strong>This study included 513 patients from the Stockholm Tamoxifen (STO-3) trial, which randomised postmenopausal, lymph node-negative women to tamoxifen or no endocrine therapy. Bulk tumour transcriptomes were deconvoluted with the ConsensusTME algorithm to estimate the relative abundance of 18 immune and stromal cell types. A summary score of combined immune cells was created on a per patient basis and evaluated alongside fibroblast and endothelial stromal compartments. Patients were categorised into immune and stromal tertiles on the basis of these scores. Associations between TME composition and tumour characteristics were evaluated using Spearman correlations and Fisher's exact test. Tamoxifen benefit was analysed by univariable Kaplan-Meier (log-rank) and multivariable Cox proportional hazards adjusting for age, tumour size, grade, progesterone receptor, Ki-67, and radiotherapy. Differential expression was assessed with limma and pathway enrichment with fgsea using Hallmark gene sets from MSigDB.</p><p><strong>Results: </strong>Low immune abundance was significantly associated with higher ER expression (Kruskal-Wallis test p < 0.001). Among tamoxifen-treated patients, those with low immune scores showed improved distant recurrence-free interval (DRFI) relative to untreated patients (log-rank p < 0.001). Similarly, intermediate endothelial (p < 0.001) and low/intermediate fibroblast abundances (p = 0.042, p = 0.009) were associated with favourable DRFI. In multivariable models, low immune (adjusted HR = 0.17, 95% CI 0.08-0.40), intermediate endothelial (aHR = 0.21, 95% CI 0.09-0.51), and low/intermediate fibroblast tertiles (aHR = 0.50, 95% CI 0.27-0.93; aHR = 0.36, 95% CI 0.17-0.77) retained significance. Transcriptomic analysis revealed enrichment of oestrogen-response, MYC-target, and oxidative-phosphorylation pathways in low-immune and low-fibroblast tumours, while interferon-γ response and allograft rejection pathways were downregulated.</p><p><strong>Conclusions: </strong>TME composition modulates tamoxifen benefit in postmenopausal ER+HER2- breast cancer. Low immune, intermediate endothelial, and low/intermediate fibroblast abundances are associated with improved benefit from tamoxifen, suggesting that both immune and stromal compartments influence endocrine treatment efficacy.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence empowers full-stack histopathological diagnosis and prognosis of renal cell tumor: a multi-center study with external validation.","authors":"Ying Xiong, Wei Xi, Gelei Zhang, Xiaoyuan Luo, Li Xiao, Jianbo Gao, Run Wang, Kang Wang, Yun Zhao, Qi Sun, Zilong Wang, Jianming Guo, Le Qu, Yingyong Hou, Di Zhao, Shuo Wang","doi":"10.1186/s12916-026-05110-5","DOIUrl":"10.1186/s12916-026-05110-5","url":null,"abstract":"<p><strong>Background: </strong>The rapid advancement of digital pathology has opened unprecedented opportunities for intelligent diagnosis in renal cell tumor. However, there remains a significant gap in the availability of reliable deep learning models capable of comprehensive kidney cancer detection, classification, grading, and survival prediction.</p><p><strong>Method: </strong>This study retrospectively analyzed 11,135 whole-slide images (WSIs) from 7033 patients with renal tumor, sourced from four medical centers and two public cohorts. Histopathological representations were extracted using the foundation model Prov-GigaPath. A full-stack renal tumor diagnosis and prognosis framework was developed by combining fully supervised learning and weakly supervised multi-instance learning to enable both regional characterization and patient-level inference.</p><p><strong>Results: </strong>The deep learning model demonstrated high accuracy in identifying normal tissue (AUC = 0.990), tumor tissue (AUC = 0.982), necrosis tissue (AUC = 0.994), sarcomatoid differentiation (AUC = 0.967), and pseudocapsule tissue (AUC = 0.990) across various pathological types of renal cell tumor. For nine major subtypes of renal cell tumor, classification AUC reached 0.956-0.998 across multi-center validation cohorts. WHO/ISUP nuclear grade prediction for clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) achieved an AUC of 0.867. A whole-slide-derived pan-renal cell tumor pathological risk score independently predicted overall survival and significantly outperformed WHO/ISUP grading in prognostic stratification (p < 0.001).</p><p><strong>Conclusions: </strong>We developed and validated a comprehensive AI framework integrating tissue-region detection, renal tumor subtype classification, nuclear grading, and survival prediction. These findings support its potential as a decision-support tool for renal tumor pathology, while prospective workflow-based studies are warranted to determine its clinical utility and impact on pathologist performance.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic inequality in recommended childhood vaccinations in Germany: evidence from insurance claims and concentration index decomposition.","authors":"Christopher Nussbaum, Leonie Sundmacher, Wiebke Schuettig","doi":"10.1186/s12916-026-05113-2","DOIUrl":"10.1186/s12916-026-05113-2","url":null,"abstract":"<p><strong>Background: </strong>Despite well-established childhood immunization programs in many high-income countries, vaccination series are often delayed or not completed. Gaps in vaccination coverage are more common among children from socioeconomically disadvantaged households, among whom they are associated with higher rates of related hospitalizations. We aimed to assess the extent of these gaps in Germany, as well as the presence of socioeconomic inequality and the factors accounting for it.</p><p><strong>Methods: </strong>Using health insurance claims data from Techniker Krankenkasse for 2016-2019, we examined vaccination coverage for a comprehensive set of STIKO-recommended childhood vaccinations in six birth-year cohorts (2011-2018; approximately 430,000 children; 2.5 million recommended vaccinations). Coverage was defined as completion of the recommended series with all doses administered within the recommended age window. Socioeconomic inequality was quantified using the Erreygers-corrected concentration index and decomposed into contributions from factors such as parental education and travel time to the treating physician.</p><p><strong>Results: </strong>Approximately 80% of vaccination series in the sample were complete and administered within the recommended age window. Vaccination coverage showed a small but statistically significant socioeconomic gradient (concentration index = 0.024, 95% confidence interval: 0.023 to 0.025) favoring children from higher socioeconomic households. In the decomposition analysis, provider type accounted for the largest share of this gradient, with lower completion rates and timeliness among children whose outpatient care was mainly delivered by general practitioners compared with pediatricians. Parental education contributed to a lesser extent, and travel time contributed little to the observed inequality.</p><p><strong>Conclusions: </strong>Childhood vaccination coverage in Germany remains below national targets and shows a small socioeconomic gradient. The gradient appears to be less strongly related to logistical access barriers than to differences in how vaccinations are delivered in outpatient care outside pediatric settings. These provider-type differences in vaccination delivery may therefore be more relevant for narrowing the observed gradient than further reductions in travel time.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital patient safety interventions in primary care: a systematic review and meta-analysis.","authors":"Jung Yin Tsang, Claire Planner, Chloe-Nicole Low, Stuart Stewart, Charlotte Morris, Brandon Wong, Spyridon Marios Delitheos, George Kulangara, Lap Kan Derek Yu, Ashwanth Bosswell Suresh Babu, Alyaa Ajabnoor, Darren M Ashcroft, Maria Panagioti","doi":"10.1186/s12916-026-05048-8","DOIUrl":"10.1186/s12916-026-05048-8","url":null,"abstract":"<p><strong>Background: </strong>Patient safety events are among the top ten causes of death and disability worldwide, with most considered preventable, particularly in primary care. Digital interventions are increasingly used in primary care to improve patient safety, targeting errors and preventing adverse events. Evaluating their effectiveness and implementation is essential to inform clinical practice and policy. The study aims included a systematic review and meta-analysis of the effectiveness of digital patient safety interventions in primary care, comparing single and multicomponent interventions, identifying effective components, and exploring factors influencing their success.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and CENTRAL were searched from January 2001 to June 2025, restricted to English-language publications. This review followed PRISMA guidelines. Randomized controlled trials assessing digital interventions aimed at improving patient safety outcomes in primary care were included. Safety outcomes were grouped into medication safety and non-medication process measures, and adverse events. Two reviewers independently extracted and verified data and assessed risk of bias, resolving discrepancies by consensus. Random-effects meta-analysis was performed for predefined safety outcomes, and a narrative synthesis described implementation factors.</p><p><strong>Results: </strong>Seventy-four randomized controlled trials (RCTs) were included. Meta-analysis demonstrated benefits for medication safety process measures (k = 54; Odds Ratio (OR) 1.46, 95% confidence interval (CI): 1.30-1.64), non-medication process measures (k = 40; OR 1.77, 95% CI: 1.56-2.01), and adverse events (k = 12; OR 1.17, 95% CI: 1.06-1.30). Overall, multicomponent interventions consistently showed greater improvements than single-component interventions. Interventions combining components of clinical decision support and audit and feedback were most effective for medication safety, while patient-facing components had greater impact on non-medication process measures. Results remained consistent in sensitivity analyses restricted to higher-quality RCTs. Effectiveness was likely influenced by implementation factors, including workflow integration and relational support.</p><p><strong>Conclusions: </strong>Digital interventions in primary care are associated with moderate improvements across multiple patient safety process measures. Multicomponent approaches appear most promising, with effectiveness potentially shaped by implementation, patient engagement and contextual factors. These findings support the broader adoption of well-designed, contextually adapted digital strategies to enhance patient safety and underscore the need for ongoing evaluation of the sociotechnical factors supporting delivery of these interventions.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}