The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies

Relationship of the revised anticholinergic drug scale with cultured cell-based serum anticholinergic activity and cognitive measures in older adults with mild cognitive impairment or remitted depression

OBJECTIVE

The Anticholinergic Drug Scale (ADS) is a commonly used measure of anticholinergic exposure. This study describes an expanded and revised version of the ADS (rADS) and its relationship with cultured cell-based serum anticholinergic activity (cSAA) and cognitive measures.

STUDY PARTICIPANTS

Adults aged 60 years and older with mild cognitive impairment (MCI), remitted major depressive disorder (rMDD), or both, participate in the Prevention of Alzheimer's Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation (PACt-MD) study.

STUDY DESIGN

Cross-sectional investigation of data from the PACt-MD study.

MEASURES

The rADS includes ratings for 1047 distinct products, about twice as many as the originally published scale; previously published ratings were revised for 40 drugs. Total rADS scores were calculated as sums of ratings of all drugs taken by participants; cSAA was measured in the participants' sera; cognitive performance included measures of executive function, language, processing speed, verbal memory, visuospatial memory, working memory, and an overall composite score.

STATISTICAL ANALYSIS

The relationship between rADS total scores and cSAA was examined using a Spearman rank correlation coefficient. Relationships between rADS total scores and cognitive performance measures were explored in multivariable linear regression models.

RESULTS

The sample included 310 participants (mean [standard deviation] age: 72 (6) years; 61.6% were women, and 81.6% had MCI [with or without rMDD]). Total rADS scores were positively correlated with cSAA (Spearman's correlation coefficient: 0.178, p = 0.0016). Total rADS scores were not significantly associated with cognitive performance.

CONCLUSIONS

The revised scale is recommended as a replacement for the original ADS since it includes ratings for more drugs and was significantly, albeit weakly, associated with cSAA, similar to previous findings using the original ADS.

Online osteoarthritis training programme for community-based clinicians: Mixed methods cohort study

Background

Core osteoarthritis interventions are ideally delivered in community-based settings. However, many community-based clinicians lack confidence and/or competence to effectively deliver high-quality, culturally-safe, evidence-based osteoarthritis care.

Objective

Assess changes in community-based dietitians', pharmacists', and physiotherapists' knowledge and confidence to treat people with knee osteoarthritis after completing online KneeCAPS training, and explore perceptions of usefulness, what clinicians learned, and how this influenced their ability to provide osteoarthritis care.

Design

Mixed methods cohort study with quantitative measures and qualitative free-text and focus group interviews.

Results

158 clinicians completed baseline measures, of which 121 completed all required training modules and 68 provided 3-month follow-up; 17 participated in focus groups. Osteoarthritis Knowledge Scale scores (mean change 6.7; 95 % CI 5.1, 8.3) and Confidence in Osteoarthritis Skills scores (mean change 11.8; 95 % CI 9.4, 14.3) increased across the cohort. Clinicians considered the training was thorough, helpful, and clinically applicable. Clinicians reported increased confidence to manage osteoarthritis, and gaining knowledge and skills to help patients. Three themes reflected areas of learning or professional growth: the importance of culturally-safe relationship-building to engage all patients in care; helpful ways to think about osteoarthritis based on best evidence; and the focus and structure of consultations to support sustainable health behaviours. An integrative theme reflected new awareness of the impact of language and communication on patient relationships and outcomes.

Conclusion

KneeCAPS osteoarthritis training improved knowledge about and confidence in skills to manage knee osteoarthritis, particularly regarding culturally-safe relationships, paradigms for making sense of OA, supporting behaviour change, and communication to support participation.

Trends in cardiac arrest care and mortality in United States emergency departments over eight years

INTRODUCTION

Cardiac arrest in the emergency department (ED) is a rare event. Prior studies have used dedicated cardiac arrest registries, but few have leveraged "big data" from electronic healthcare vendors to analyze trends in the care of patients excluded from registries.

METHODS

This was a retrospective cohort study of adult patients in the ED with cardiac arrest from Epic Cosmos, a database with 277 million patients. Patients with ICD-10 codes corresponding to cardiac arrest in the ED were included. Outcomes included the incidence of cardiac arrest, mortality, code length, and extracorporeal membrane oxygenation (ECMO). Data were compared using odds ratio with 95 % confidence intervals (CI).

RESULTS

Among 196,834,283 ED visits from 1/1/2016 to 12/31/2023, there were 429,917 (0.22 %) cardiac arrests and 197,233 (45.88 %) patients who died in the ED. The incidence of cardiac arrest (0.26 %) and death in the ED (55.70 %) peaked in 2020. Cardiac arrest was more common in male and older patients, between 00:00-05:59, on weekends, and in the South (p < 0.001). The median code length was 10-20 min. Only 0.29 % of cardiac arrest patients received ECMO. Compared to 2016, the odds of a code length > 90 min and ECMO in 2023 were 1.43 (95 % CI 1.32-1.54) and 3.58 (95 % CI 2.41-5.31) times greater, respectively.

CONCLUSION

Although cardiac arrest in the ED is a rare event, almost half of patients die in the ED. The use of ECMO after cardiac arrest is increasing but remains low. Further research is needed to mitigate these differences in care.

Intravenous Thrombolysis in Patients Taking Direct Oral Anticoagulation Treatment Before Stroke Onset: Results from the Safe Implementations of Treatments in Stroke International Stroke Registry

OBJECTIVES

Intravenous thrombolysis (IVT) is contraindicated for acute ischemic stroke (AIS) patients taking direct oral anticoagulants (DOACs) within 48 hours before index stroke. Limited data exist on off-label use of IVT for these patients. We compared the safety and outcomes of IVT in AIS patients with DOAC treatment and patients with no OAC before index stroke.

METHODS

We analyzed data from the Safe Implementations of Treatments in Stroke (SITS) International Stroke Thrombolysis Registry during 2013-2024. Outcomes were symptomatic intracerebral hemorrhage (SICH) by the SITS Monitoring Study and European Cooperative Acute Stroke Study II definitions, functional independency (modified Rankin Scale score 0-2), and death by 3 months. Propensity score matching with a nearest neighbor matching algorithm with a ratio of 1:2 was used for relevant clinical variables. We also analyzed the time from last DOAC dose to IVT treatment.

RESULTS

A total of 1,311 DOAC and 129,384 no OAC patients were included. We matched 894 patients with DOAC to 1,788 with no OAC. The mean age was 75 years versus 76 years, and the median National Institutes of Health Stroke Scale score 11 versus 12, respectively. Patients with DOAC had a similar proportion of outcomes compared with patients with no OAC: SICH per SITS Monitoring Study (1.1 vs 1.5%, p = 0.50), SICH per European Cooperative Acute Stroke Study II (4.0 vs 4.3%, p = 0.82), any parenchymal hematoma (6.3 vs 7.8, p = 0.22), and functional independency (47.9 vs 46.4%, p = 0.59) and death (25.1 vs 24.0%, p = 0.65) at 3-month follow-up. The time from last DOAC dose to IVT did not affect outcomes.

INTERPRETATION

In this observational study, we did not find any difference in outcomes after IVT therapy in AIS patients with DOAC compared with no OAC treatment before index stroke. ANN NEUROL 2025;97:1205-1214.

Aspirin Plus Clopidogrel Reduces Infection Risk Compared With Aspirin or Clopidogrel Alone in Acute Ischemic Stroke

PURPOSE

Activated platelets modulate immune responses. Platelet activation coincides with poststroke immunosuppression, so we hypothesized that platelet inhibition would mitigate immunosuppression and decrease the risk of infectious complications after stroke. In this study, we aimed to evaluate the contribution of platelet inhibition by antiplatelet agents to poststroke infection.

METHODS

We performed a prospective cohort study of 975 patients with acute ischemic stroke to compare the differences in the risk of infection within 7 days after admission between aspirin alone, clopidogrel alone and aspirin plus clopidogrel. Multivariable Cox proportional hazards regression model was used to assess the association between antiplatelet therapy and poststroke infection.

FINDINGS

Among 975 included patients, 578 received aspirin, 98 received clopidogrel, and 299 received both. A total of 113 patients experienced poststroke infection within 7 days after admission. The combination of aspirin and clopidogrel decreased the risk of poststroke infection compared with aspirin alone (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.22-0.77; P = 0.006), as compared with clopidogrel alone (HR, 0.46; 95% CI, 0.22-1.00; P = 0.050). We found no difference in infection risk between clopidogrel and aspirin. When assessing site-specific infections, a significant difference was observed only in the risk of pneumonia between dual antiplatelet therapy and aspirin alone.

IMPLICATIONS

Dual antiplatelet therapy with aspirin and clopidogrel is associated with decreased infection after stroke compared with aspirin or clopidogrel monotherapy. The findings support the net protective effect of aspirin and clopidogrel against poststroke infection.

Knowledge of vitamin D and practices of vitamin D supplementation in a Scottish adult population: A cross-sectional study

Background: Vitamin D supplementation practices (dose and frequency) are relatively unknown in the Scottish population, with no recent up-to-date data available. Reassessing current knowledge, practices, and awareness of vitamin D supplementation following a national health campaign in 2020 by Food Standards Scotland on vitamin D is warranted. Aim: This article aims to present the knowledge and awareness of vitamin D, and current vitamin D supplementation practices in adults living in Scotland. Methods: A cross-sectional study was performed between June and July 2022 using an online survey adapted from previous work on assessing knowledge of vitamin D in adults. Participants aged 18+, living in Scotland for ≥6 months were eligible to participate. Scores for knowledge were calculated as a percentage. Univariate associations between demographic and supplement use were established by χ2-test and logistic regression performed to predict factors associated with daily vitamin D intake. Results: Four hundred and three participants (72.7% female), mean age 36.4 (±14.2 years), completed the study. Awareness of vitamin D was very high (99.5%) but the mean overall knowledge score was poor (31.4 ± 15.3%), with those with a university degree more likely to have knowledge scores at/above the mean compared with those with lower levels of education, χ2(1, N = 393) 10.7, p = 0.001, odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.7-2.7). Finally, 64.3% took vitamin D supplements, of which 37.5% took them daily during winter months, with only 7.4% taking the recommended daily dose. Conclusion: The current study highlights the need to improve both knowledge of vitamin D and practices of vitamin D supplementation during the autumn and winter months in Scotland.

Exploring differences in reported mental health outcomes and quality of life between physically restrained and non-physically restrained ICU patients; a prospective cohort study

BACKGROUND

Physical restraints are frequently used in ICU patients, while their effects are unclear.

OBJECTIVE

To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status.

RESEARCH METHODOLOGY/DESIGN

Prospective cohort study. Patients were included when 16 years or older, admitted for at least 12 h and provided informed consent. Differences between groups were analysed using linear mixed model analyses.

SETTING

Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands.

MAIN OUTCOME MEASURES

Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores.

RESULTS

2,764 patients were included, of which 486 (17.6 %) were physically restrained for median 2 [IQR 1-6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95 %CI 0.37 to 1.41, p < 0.001; PCS -2.82, 95 %CI -4.47 to -1,17p < 0.001; MCS -2.67, 95 %CI -4.39 to -0.96, p < 0.01). At 12-months, only the PCS scores remained significantly lower (-1.71, 95 %CI -3.42 to -0.004, p < 0.05).

CONCLUSION

Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months.

IMPLICATIONS FOR CLINICAL PRACTICE

Use of physical restraints is associated with statistical significant worse mental and physical outcomes.

High Hospitalization Rates and Risk Factors Among Frail Patients With Cirrhosis: A 10-year Population-based Cohort Study

BACKGROUND & AIMS

Cirrhosis-related inpatient hospitalizations have increased dramatically over the past decade. We used a longitudinal dataset capturing a large metropolitan area in the United States from 2011 to 2021 to evaluate contemporary hospitalization rates and risk factors among frail patients with cirrhosis.

METHODS

We conducted a retrospective, longitudinal cohort study using the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) database, an electronic health record repository that aggregates de-duplicated data across 7 health care systems in the Chicago metropolitan area, from 2011 to 2021. The primary outcome of our study was the rate of hospitalization encounters. Frailty was defined by the Hospital Frailty Risk Score. Hospitalization rates were reported per 100 patients per year, and a multivariable logistic regression analysis identified predictors of annual hospitalization probability.

RESULTS

During the study period, of 36,971 patients, 16,265 patients (44%) were hospitalized (compensated, 18.4%; decompensated, 81.6%). Hospitalization rates were highest in patients with decompensated cirrhosis, reaching nearly 77.3 hospitalizations/100 patients per year. Hospitalization rates among patients with compensated cirrhosis were also high (14.2 vs 77.3 hospitalization/100 patients per year), with odds of annual hospitalization 3 times (odds ratio, 3.1; 95% confidence interval, 2.9-3.4) as high among compensated patients with intermediate frailty and 5 times (odds ratio, 5.2; 95% confidence interval, 4.5-6.0) as high among those with severe frailty (compared with compensated patients with low frailty).

CONCLUSION

Compensated and decompensated cirrhosis patients with intermediate to severe frailty face a substantially increased odds of annual hospitalizations compared with those with low frailty. Future work should focus on targeted interventions to incorporate routine frailty screenings into cirrhosis care and to ultimately minimize high hospitalization rates.

Vagal modulation after training at different levels of the Pilates method

INTRODUCTION

cardiovascular and autonomic adjustments occur during and after physical exercise, and exercise intensity can directly influence the magnitude of these adjustments. Therefore, it is important to analyze post-exercise recovery to provide better guidance for prescription strategies.

OBJECTIVE

to analyze autonomic behavior during post-exercise recovery after the Pilates method at different intensity levels.

METHODS

in total, 24 healthy young men were included in this study. The participants underwent 12 weeks of Pilates training. The exercises were progressive between beginners, intermediate, and advanced levels. Post-exercise autonomic behavior was analyzed using vagal indices of heart rate variability. Descriptive statistics were adopted with Repeated Measures Analysis of Variance and the Bonferroni correction.

RESULTS

for intermediate and advanced levels, a decrease in vagal modulation was observed (p < 0.05) in the first 5 min after exercise compared to rest, represented by the rMSSD and SD1 indices.

CONCLUSION

intermediate and advanced exercise reduced parasympathetic modulation in the initial minutes of post-exercise recovery. The beginner level did not promote changes in autonomic behavior immediately after the exercise session.

Association between polyvictimization and multiple suicide attempts among sexual minority youth: Findings from the 2015-2021 National Youth Risk Behavior Survey

BACKGROUND

Few studies have examined the association between polyvictimization and multiple suicide attempts among sexual minority youth (SMY) using nationally representative samples.

OBJECTIVES

The objectives of this study were to examine the prevalence of polyvictimization among SMY and the cross-sectional association between polyvictimization and multiple suicide attempts among SMY.

PARTICIPANTS AND SETTINGS

Data for this study came from the 2015-2021 Youth Risk Behavior Survey. The sample consisted of 10,092 youth (aged 14-18 years) who self-identified as lesbian, gay, questioning.

METHODS

Multinomial logistic regression was conducted to examine the association between polyvictimization and multiple suicide attempts among SMY.

RESULTS

Of the 10,092 SMY, 13.9 % attempted suicide multiple times during the past year, and 15.6 % experienced three or more forms of victimization. Controlling for other factors, the risk of multiple suicide attempts was 10.72 times higher for SMY who experienced three or more forms of victimization (RRR = 10.72, 95 % CI = 7.52-15.27) and 3.90 times higher for those who experienced two forms of victimization (RRR = 3.90, 95 % CI = 2.70-5.62), when compared to their non-victimized SMY counterparts.

CONCLUSIONS

Interventions that seek to reduce violence and victimization targeted at SMY may be effective in preventing multiple suicide attempts among SMY.

Clinical Predictors in Acute Optic Neuritis: Analysis Based on Clinical Trial Data

PURPOSE

To identify baseline clinical predictors of visual outcomes 6 months after acute optic neuritis using data from our completed clinical neuroprotection trial: Treatment of Optic Neuritis with Erythropoietin (TONE).

DESIGN

Secondary analysis of data from the TONE study cohort (NCT01962571).

PARTICIPANTS

A total of 103 patients presenting within 10 days of a first episode of acute unilateral optic neuritis as a clinically isolated syndrome with baseline high-contrast visual acuity (HCVA) ≤20/40 Snellen (logarithm of the minimum angle of resolution 0.3). Patients were recruited from 12 German university hospitals between November 25, 2014, and October 9, 2017.

METHODS

We selected potential predictors based on literature research and experience, and then computed initial linear regression models that each included 1 predictor together with the baseline value of the outcome of interest. We used a forward-selection approach to build a multiple regression model for each outcome. Because the trial medication of the TONE study (erythropoietin) had no effect on the visual system, we used pooled (treatment-agnostic) data for all analyses.

MAIN OUTCOME MEASURES

Independent predictors of HCVA, low-contrast letter acuity, visual-evoked potential (VEP) P100 peak times, macular ganglion cell and inner plexiform layer thickness, and peripapillary retinal nerve fiber layer thickness at 6 months.

RESULTS

On multiple regression, the most consistent predictors were higher baseline HCVA, which was associated with better outcomes across all measures except VEP conduction time; male sex, which predicted worse outcomes for all measures except HCVA; and older age, which was linked to poorer functional outcomes.

CONCLUSIONS

Patients who are older, are male, and present with worse initial visual function may be at risk for worse clinical outcomes in acute optic neuritis. This knowledge may inform individual patient counseling, facilitate patient selection for time-sensitive and invasive immunomodulatory treatments, and can be used to ensure balanced risk characteristics in clinical neuroprotection trials.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

UK Medical Cannabis Registry: An Analysis of Clinical Outcomes of Medicinal Cannabis Therapy for Cancer Pain

Cancer pain (CP) is a prevalent condition with limited pharmacotherapeutic options. Cannabis-based medicinal products (CBMPs) have shown analgesic effects, but their efficacy in CP remains contentious. This study aims to evaluate the change in patient-reported outcome measures (PROMs) and adverse events (AEs) in CP patients treated with CBMPs. A case series was conducted using prospectively collected clinical data from the UK Medical Cannabis Registry. Primary outcomes were the changes in the Brief Pain Inventory (BPI), pain visual analogue scale (Pain-VAS), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7), Patient Global Impression of Change (PGIC) and Single-Item Sleep Quality Scale (SQS) questionnaires from baseline to 1, 3, and 6 months. AEs were recorded and graded. p < 0.050 was considered statistically significant. One hundred and sixty-eight participants were included. CBMPs were associated with improvements in all pain-specific PROMs at all follow-up periods (p < 0.050). Improvements in GAD-7, SQS, and EQ-5D-5L index scores were also observed (p < 0.050). Twenty-nine AEs (17.26%) were reported by five patients (2.98%), mostly mild-to-moderate (72.41%). Although the observational design means causality cannot be established, the findings support the development of future randomized controlled trials into CP management with CBMPs.

Evaluating general practitioners' focused lung ultrasound competence and findings in patients with suspected community-acquired pneumonia in general practice

OBJECTIVES

To evaluate general practitioners' (GPs') ability to perform focused lung ultrasound (FLUS) following a training program and assess FLUS feasibility in general practice. Also, to describe FLUS findings and evaluate GPs' ability to interpret these in adults with acute lower respiratory tract infection (LRTI) when pneumonia is suspected and assess GPs' perception of FLUS impact.

METHODS

Nine GPs, using point-of-care ultrasound, completed a FLUS training program. Adults (≥ 18 years) with acute cough (< 28 days) and at least one other symptom of acute LRTI, where the GP suspected pneumonia, were subsequently included. All patients received FLUS. The GPs reported FLUS findings, feasibility, and perception of FLUS impact. Recorded FLUS videos from all patients were reviewed by two specialists (Specialist Reference). The specialists assessed FLUS image quality. Agreements between the GPs and the Specialist Reference on FLUS findings were used to evaluate GPs' ability to interpret FLUS.

RESULTS

Of 91 patients included, FLUS image quality was acceptable or higher in 84 patients (92.4%). FLUS proved feasible with only two scans not completed. The GPs reported FLUS pathological findings in 51.7% of patients in 78% agreement with the Specialist Reference and Cohen's kappa 0.56. Focal B-lines represented the most frequent pathological findings. The GPs perceived that FLUS impacted change in tentative diagnosis and/or plans for treatment and/or visitation in 29 (32.0%) of patients.

CONCLUSION

After the training, the GPs performed FLUS well. Interpretation of FLUS pathology presence was of moderate agreement. The GPs perceived that FLUS had impact on patient management.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT04711031.

Impact of Direct Transfer to Angiography Suite on Treatment Time Metrics in Patients With Acute Intracerebral Hemorrhage

BACKGROUND

Shorter times to initiate antihypertensive and anticoagulation reversal treatments enhance their benefits in acute intracerebral hemorrhage (ICH). Improving workflows to optimize time performance metrics is strongly advocated. We aimed to evaluate the impact of direct transfer to angiography suite (DTAS) on time metrics for antihypertensive and anticoagulation reversal treatments in patients with stroke with suspected large vessel occlusion whose final diagnosis was ICH.

METHODS

We conducted a single-center, retrospective, observational cohort study using prospectively collected data from patients with ICH <6 hours directly arriving at a Comprehensive Stroke Center in Barcelona, Spain, from March 1, 2016, to August 31, 2023. Patients suspected of acute stroke from large vessel occlusion (prehospital Rapid Arterial Occlusion Evaluation scale score >4 and in-hospital National Institutes of Health Stroke Scale score >10) followed either direct transfer to computed tomography (DTCT) or DTAS protocol based on angiosuite availability. We compared door-to-needle times for initiating antihypertensive (primary outcome) and anticoagulation reversal treatments between both workflows.

RESULTS

Among 220 patients with ICH (mean age, 73.0±13.6 years; 131 [59.5%] male), 199 (90.5%) followed the DTCT protocol and 21 (9.5%) followed the DTAS protocol. Door-to-imaging time was shorter in the DTCT group than in the DTAS group (11 [7-17] versus 15 [12-20] minutes; P=0.013). Antihypertensive treatment was initiated in 168 (76.4%) patients, with the DTCT group having shorter door-to-needle times (20 [15-26] versus 30 [18-40] minutes; P=0.002). The anticoagulation reversal was administered to 34 (87.2%) of 39 anticoagulated patients, with the DTCT group achieving shorter door-to-needle times (28 [22-38] versus 58 [39-78] minutes; P=0.047). Time-to-event analysis showed that the DTCT group had a higher probability of initiating antihypertensive (P=0.001) and anticoagulation reversal (P=0.014) treatments sooner compared with the DTSA group.

CONCLUSIONS

Patients with ICH following the DTAS workflow, without tailored actions, present longer door-to-needle times to initiate antihypertensive and anticoagulation reversal treatments compared with those following the DTCT workflow protocol.

Iodine-Based Dual-Energy Computed Tomography After Mechanical Thrombectomy Predicts Secondary Neurologic Decline from Cerebral Edema After Severe Stroke

BACKGROUND

Patients with severe stroke are at high risk of secondary neurologic decline (ND) from the development of malignant cerebral edema (MCE). However, early infarcts are hard to diagnose on conventional head computed tomography (CT). We hypothesize that high-energy (190 keV) virtual monochromatic imaging (VMI) from dual-energy CT (DECT) imaging enables earlier detection of ND from MCE.

METHODS

Consecutive patients with severe stroke with National Institute of Health Stroke Scale (NIHSS) scores > 15 and DECT within 10 h of mechanical thrombectomy from May 2020 to March 2022 were included. We excluded patients with parenchymal hematoma type 2 transformation. Retrospective analysis of clinical and novel variables included the VMI Alberta Stroke Program Early CT Score (ASPECTS), total iodine content, and VMI infarct volume. The primary outcome was secondary ND, defined using a composite outcome variable of clinical worsening (increase in NIHSS score ≥ 4 or decrease in Glasgow Coma Scale score > 2) or malignant radiographical edema (midline shift ≥ 5 mm at the level of the septum pellucidum). Fisher's exact test and Wilcoxon's test were used for univariate analysis. Logistic regression was used to develop prediction models for categorical outcomes.

RESULTS

Eighty-four patients with severe stroke with a median age of 67.5 (interquartile range [IQR] 57-78) years and an NIHSS score of 22 (IQR 18-25) were included. Twenty-nine patients had ND. The VMI ASPECTS, total iodine content, and VMI infarct volume were associated with ND. The VMI ASPECTS, VMI infarct volume, and total iodine content were predictors of ND after adjusting for age, sex, initial NIHSS score, and tissue plasminogen activator administration, with areas under the receiver operating characteristic curve (AUROC) of 0.691 (95% confidence interval [CI] 0.572-0.810), 0.877 (95% CI 0.800-0.954), and 0.845 (95% CI 0.750-0.940). By including all three predictors, the model achieved an AUROC of 0.903 (95% CI 0.84-0.97) and was cross-validated by the leave one out method, with an AUROC of 0.827.

CONCLUSIONS

The VMI ASPECTS and VMI infarct volume from DECT are superior to the conventional CT ASPECTS and are novel predictors for secondary ND due to MCE after severe stroke. Clinical trial registration ClinicalTrials.gov identifier: NCT04189471.

Physical Activity, Quality of Life, and Pelvic Floor Disorders Before and After Hysterectomy for Gynecological Cancer: A Prospective Cohort Study

INTRODUCTION AND HYPOTHESIS

This study investigated physical activity (PA) levels and health-related quality-of-life (HRQoL) before and after, and associations between pelvic floor disorders (PFD) and PA/HRQoL after, hysterectomy for gynecological cancer.

METHODS

Secondary analysis of a longitudinal cohort study, with assessments before, 6 weeks, and 3 months after hysterectomy for gynecological cancer. The International Physical Activity Questionnaire-short form was used to assess PA and European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (QLQ-C30) to assess HRQoL. Changes over time were analyzed using generalized estimating equations or linear mixed models. Associations between PFD with PA and HRQoL were analyzed using logistic regressions and analyses of variance.

RESULTS

Of 126 participants, median age 63 years, most had endometrial (69%) and/or stage 1 cancer (72%) and underwent total hysterectomy (65%). Pre-surgery, 39% met PA guidelines, increasing to 53% 3 months post-surgery (+14%, 95% CI 2-25). Mean global health status/QoL domain scores from the QLQ-C30 did not change significantly (+4.4/100 points, 95% CI -0.8 to 9.6). Three months post-surgery, whether participants met PA guidelines was not associated with PFD. Participants with anal incontinence or double incontinence had lower global health status/QoL scores than participants without these symptoms (mean (SD) AI 61.4 (17.8) vs no AI 72.5 (18.7), p = 0.006; DI 61.5 (17.9) vs no DI 71.7 (18.8), p = 0.019).

CONCLUSION

PA levels were low pre- and post-surgery but worse preoperatively. This presents an opportunity for prehabilitation interventions to optimize physical function. There was no association between meeting PA guidelines and PFD. Global health status/QoL was slightly below population norms pre- and post-surgery. Lower HRQoL was associated with some symptoms of PFD.

Stroke Sensitivity Calculation in Medical Emergency Calls and Factors Associated With Stroke Suspicion: A Retrospective Registry-Based Study

STUDY OBJECTIVE

Sensitivity for stroke detection in emergency medical communication centers (EMCCs) varies widely. Few studies offer detailed insights into the out-of-hospital pathways of patients with stroke. This study explored the ability of EMCCs to detect strokes in medical emergency calls using an alternative method for estimating stroke sensitivity in EMCCs, thereby laying the foundation for developing artificial intelligence decision-support tools. It also identified factors associated with stroke recognition in medical emergency calls.

METHODS

Overall, 1,164 patients with stroke in the catchment area of Bergen EMCC in 2018 and 2019 were included, and a data set from the EMCC was established manually and linked with data from the Norwegian Stroke Registry for analysis. Descriptive analysis and multivariable logistic regression were performed on data obtained from patients primarily assessed by the EMCC (n=838).

RESULTS

Stroke detection sensitivity was 76.8% in our study using the alternative method compared with 63.4% with traditional methods. Logistic regression analysis showed a positive association between stroke suspicion and ischemic strokes (odds ratio [OR]=0.317 [0.209 to 0.481]) and wake-up strokes (OR=1.716 [1.110 to 2.653]). Among Norwegian Stroke Registry symptoms, only aphasia/dysarthria was positively associated with stroke suspicion (OR=1.600 [1.087 to 2.353]), whereas leg paresis (OR=0.609 [0.390 to 0.953]) and vertigo (OR=0.376 [0.204 to 0.694]) were negatively associated.

CONCLUSION

We employed an alternative method for estimating EMCC stroke sensitivity and identified factors of particular interest for future EMCC research, relevant when developing and testing decision-support tools, such as artificial intelligence.

In Vivo Intramuscular pH in Tibia Fractures Is Acidic Prior to Stabilization and Equilibrates Toward Systemic pH 48 h Post Stabilization

Early and reliable diagnosis of acute compartment syndrome (ACS) remains challenging for providers. Transcutaneous intramuscular pressure (TIMP) measurements, historically proposed for ACS diagnosis, are unreliable and prone to errors. Little is known about In Vivo limb pH balance in lower extremity injuries. The aim of this observational study was to quantify acid-base chemistry through invasive measurement of intramuscular pH (IpH) adjacent to tibia fractures. Patients with tibial shaft or plateau fractures undergoing intramedullary nail or external fixator application were included. We compared anterior compartment IpH to venous pH (VpH) measurements at presurgery and 12, 24, 36, and 48 h postoperatively, as well as TIMP measurements at the beginning and end of surgery. A total of 39 patients with tibia fractures (11 plateau, 27 shaft) provided consent. Initial IpH was universally acidic (mean [SD] 6.57 [0.506]) compared to VpH (7.35 [0.0600]). Final IpH at 48 h converged to VpH (IpH 7.41 [0.408], VpH 7.40 [0.0305]). IpH and VpH demonstrated a significant positive correlation over all 48 h (rrm = 0.476, df = 115, analytic 95% CI [0.322, 0.605], p < 0.0001). There was no correlation between TIMP and IpH (rrm = 0.041, df = 33, analytic 95% CI [-0.296, 0.369], p = 0.816). In tibia fractures requiring operative stabilization, adjacent musculature demonstrated nearly 1 order of magnitude more acidic than systemic circulating physiology prior to skeletal stabilization. Limb IpH converged to systemic VpH within 48 h after surgery. No correlation exists between heritage TIMP measurements and direct measures of intramuscular physiology in the form of In Vivo IpH; improvements in diagnostic modalities for muscular diagnoses, such as compartment syndrome, remain valuable. Level of Evidence: Level 2 prospective observational cohort. Clinical Significance: This study provides a critical foundation for understanding the In Vivo acid-base balance of muscle tissue adjacent to fractures, allowing for future research into the consequence of tissue acidity on inflammation, immune response, and fracture healing.

Disparities in Survival Across Multiple Cancer Sites at Low-Income-Serving Hospitals

BACKGROUND

Social determinants of health play a significant role in the incidence, diagnosis, and treatment of cancers, contributing to healthcare disparities. However, the impact of facility-level factors on patient outcomes are often obscured. We aimed to determine whether hospitals serving the lowest-income patients have poorer overall survival outcomes.

PATIENTS AND METHODS

 We identified patients diagnosed with nonmetastatic colorectal, breast, gastric, and pancreatic cancers (2010-2019) using the National Cancer Database. Patient median income, estimated by residential zip code, was converted into linear mean scores (LMS), with aggregated scores compiled for each hospital. Hospitals were ranked according to average patient LMS and grouped by quartile, with the lowest quartile representing lowest-income-serving hospitals (LIH) and the top quartile denoting highest-income-serving hospitals (HIH).

RESULTS

A total of 833,874 patients were included for analysis, consisting of patients with colorectal (n = 379,423), breast (n = 389,852), pancreatic (n = 45,543) and gastric (n = 19,056) cancer. The 5-year overall survival (OS) was lower for patients receiving treatment for colorectal (67.6 versus 73.6%, p < 0.001), breast (81.9 versus 89.5%, p < 001), gastric (41.9 versus 56.0%, p < 0.001), and pancreatic (31.5 versus 42.1%, p < 0.001) cancer at LIH versus HIH, and this effect had a dose-dependent relationship with hospital income quartile. Within each hospital quartile, patients with higher income had decreased risk of death compared with those with lower income (p < 0.001).

DISCUSSION

Patients treated for colorectal, breast, gastric, and pancreatic cancer at LIH have worse survival than those at HIH. Income inequality contributes to differences in healthcare outcomes, and these differences are further compounded by the institution at which a patient receives care.

Readmission Rates in Reduced Ejection Fraction Heart Failure Patients on Triple Guideline-Directed Medical Therapy at Hospital Discharge

BACKGROUND

Heart failure (HF) places a significant burden on the health care system, driven primarily by HF hospitalizations. While HF guidelines recommend initiation of quadruple guideline-directed medical therapy (GDMT) in patients with HF with reduced ejection fraction (HFrEF), in-hospital initiation of quadruple therapy remains a clinical challenge, particularly in patients with additional high-risk comorbidities.

OBJECTIVE

The purpose of this study was to compare the efficacy and safety of triple GDMT with a sodium-glucose cotransporter inhibitor (SGLTi) vs mineralocorticoid receptor antagonist (MRA) added to beta blocker and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNi).

METHODS

This retrospective cohort study was conducted in hospitalized patients with acute HFrEF. Patients who received triple GDMT therapy with a SGLTi or MRA added to beta blocker and ACEi/ARB/ARNi therapy at discharge were compared. The primary outcome was 90-day readmission for HF with secondary outcomes of 30-day readmission for HF and 90-day readmission for GDMT-associated adverse events.

RESULTS

A total of 210 patients were included (SGLTi group, n = 105; MRA group, n = 105). Rates of 90-day readmission for HF between SGLTi and MRA groups were 23 (21.90%) vs 15 (14.29%); P = 0.1516. After adjusting for co-variables associated with 90-day readmission, 90-day readmission for HF was not significantly different in patients in the SGLTi vs MRA group (adjusted hazard ratio = 1.742, 95% confidence interval [CI] = 0.833 to 3.434; P = 0.1092). Rates of 90-day readmission for GDMT-associated adverse events were similar between groups.

CONCLUSION AND RELEVANCE

In this cohort of patients receiving triple GDMT at discharge after hospitalization for acute HFrEF, triple therapy with an SGLTi vs MRA resulted in similar rates of 90-day HF hospitalization.

Painful symptoms and spine-specific activity limitations associated with dural ectasia in individuals with Marfan syndrome: a cross-sectional comparative study (MARFANLOMB)

PURPOSE

To compare frequencies and characteristics of painful symptoms, spine-specific activity limitations and health-related quality of life, between individuals with Marfan syndrome with dural ectasia, and those without.

METHODS

We conducted a cross-sectional comparative study. All individuals with Marfan syndrome followed in a single center were screened. The presence of dural ectasia was assessed using CT-scan or magnetic resonance imaging. Endpoints were the frequencies and characteristics of painful symptoms, spine-specific activity limitations and health-related quality of life.

RESULTS

Overall, 90 individuals were included: 86 (96%) had FBN1 mutations, 55 (61%) had dural ectasia and 35 (39%) had not. Mean age was 39.3 (9.4) years, 45 (50%) were women and 80 (89%) had back pain. The frequencies of headache with upright posture and of pain in the lower back when coughing, laughing and/or sneezing were numerically higher in participants with dural ectasia (49% vs. 26% and 13% vs. 0%, respectively). We found no difference between the 2 groups for health-related quality of life.

CONCLUSION

Individuals with Marfan syndrome and dural ectasia, as compared to individuals with Marfan syndrome without dural ectasia, could display a specific pattern of painful symptoms, including lower back pain and headache with upright posture. However, none of the comparisons performed reached statistically significant difference.

The effectiveness of e-learning in focused cardiac ultrasound training: a prospective controlled study

INTRODUCTION

Focused Cardiac Ultrasound (FOCUS) is an essential tool for rapid cardiac assessment across various clinical subspecialties. Consequently, teaching foundational FOCUS skills is of critical importance. This study investigates the effectiveness of e-learning in imparting FOCUS skills.

MATERIALS AND METHODS

This prospective, controlled study assessed competency development among medical students attending a FOCUS workshop (study group) at two time points: T1 (pre-training) and T2 (post-training, after completing e-learning). The competence gain of the group was compared to a reference group (control group) of physicians who had also used the e-learning in preparation for a certified FOCUS workshop. Objective competencies were measured at both time points using short-answer and multiple-choice theory tests. Subjective self-assessments of competencies and opinions of the e-learning were investigated through evaluation forms at T2 using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). Demographic information was collected at T1, and user behaviour during e-learning was assessed at T2. Primary endpoints were the increase in theoretical competencies (study group) and the comparison of subjective and objective competency levels (study vs. reference).

RESULTS

A total of 104 participants (study group = 48; reference group = 56) were included. The study group exhibited a significant (p < 0.001) increase in theoretical competencies. However, at T2 the reference group achieved significantly higher theoretical test scores (p < 0.001). One influencing factor was previous practical experience (p = 0.02), which was significantly higher in the reference group (p < 0.001). Both groups estimated their competency at the end of preparation to be at similar levels (4.3 ± 0.9 scalepoints [SP] versus 4.3 ± 1.0 SP; p = 0.94). Evaluation results of the e-learning were positive in both groups (5.8 ± 0.9 SP versus 6.2 ± 0.7 SP; p = 0.04), with results in the reference group being significantly higher.

CONCLUSION

Both the improvement in competencies and the positive reception of digital learning media should encourage the increased implementation of e-learning formats. This study shows that such formats in ultrasound training can effectively complement face-to-face workshops and should be included in certified training curricula.

Sex differences in the association between Life's Essential 8 and serum anti-aging Klotho protein levels: a cross-sectional analysis in middle-aged to older adults

Background

This study explores the association between cardiovascular health metrics (Life's Essential 8, LE8) and serum anti-aging Klotho protein levels among American adults aged 40-79, with a focus on sex-specific differences.

Methods

Utilizing data from the 2007-2016 National Health and Nutrition Examination Survey (NHANES), we applied weighted multivariable regression analyses, restricted cubic spline (RCS) modeling, and subgroup analyses to investigate the association between Life's Essential 8 (LE8) scores-including Health Behaviors and Health Factors scores-and serum Klotho concentrations, with a focus on gender differences.

Results

Our study encompassed 9,534 participants, including 4,946 females and 4,588 males. Weighted multivariable regression analyses revealed that only females exhibited a positive association between Life's Essential 8 (LE8) scores and serum Klotho protein levels. Specifically, a 10-point increase in LE8 scores resulted in an elevation of Klotho levels by 17.61 pg/mL (95% CI: 9.53-25.69). Similarly, a 10-point increase in Health Behaviors scores increased Klotho levels by 5.7 pg/mL (95% CI: 0.14-11.26), and a 10-point increase in Health Factors scores was associated with a rise in Klotho levels by 14.6 pg/mL (95% CI: 7.70-21.51). Sensitivity analyses showed a significant positive trend in Klotho levels correlating with improvements in cardiovascular health (CVH) levels among females (β = 72.9, 95% CI: 35.91-109.88; p for trend <0.001), consistent across both Health Behaviors and Health Factors scores. No similar trends were noted in males. In females, the dose-response relationship between LE8 scores and Health Factors scores displayed nonlinear patterns, whereas Health Behaviors scores showed linear patterns. Optimal threshold was identified at 65 for LE8 score. These results were consistent across various demographic and health statuses, emphasizing the sex-specific influence of LE8 scores on serum Klotho levels. This study underscores the importance of considering gender differences in cardiovascular health and its impact on anti-aging protein levels.

Conclusion

In the present study, LE8 scores and its sub-scales were positively related to serum Klotho level in middle-aged and elderly women. This study provides new evidence of sex differences in the association between LE8 scores and serum anti-aging Klotho protein levels.

Phthalate Metabolites and Their Relationship with Abdominal and General Obesity: Evidence from the Aragon Workers' Health Study (AWHS)

BACKGROUND/OBJECTIVES

Phthalates are endocrine-disrupting chemicals that are commonly used in plastic consumer products and food packaging, with growing evidence suggesting that they have a potential role in obesity. This study aimed to investigate the association between urinary concentrations of phthalate metabolites and both general and abdominal obesity among adult males in Spain.

METHODS

We analysed data from 1124 male participants of the Aragon Workers' Health Study (AWHS) collected between 2011 and 2014 in Zaragoza, Spain. Eleven urinary phthalate metabolites were measured and adjusted for creatinine levels. Multivariate logistic regression models were used to evaluate associations between phthalate exposure and general and abdominal obesity, controlling for dietary and lifestyle factors. Dose-response relationships were explored using restricted cubic spline models.

RESULTS

Higher urinary concentrations of di(2-ethylhexyl) phthalate (∑DEHP) and two of its metabolites-mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP)-were significantly associated with general obesity. The adjusted odds ratios were: ∑DEHP [OR = 1.26; 95% CI: 1.01, 1.58], MEOHP [OR = 1.24; 95% CI: 1.00, 1.53], and MEHHP [OR = 1.26; 95% CI: 1.03, 1.55]. In contrast, mono-isobutyl phthalate (MiBP) was inversely associated with abdominal obesity [OR = 0.73; 95% CI: 0.57, 0.93].

CONCLUSIONS

These findings suggest a positive association between exposure to DEHP and its metabolites and general obesity. This highlights the potential importance of environmental exposures as modifiable factors in obesity prevention and supports the need for further investigation in nutritional and public health contexts.

Impact of waist-to-hip and waist-to-height ratios on physical performance: insights from the Longevity Check-up 8+ project

BACKGROUND

Physical performance is crucial for healthy aging. Body composition has gained particular attention. Anthropometric measurements, specifically the waist-to-hip ratio (WHR) and the waist-to-height ratio (WHtR), have emerged as valuable indicators. This study aims to investigate the correlation between abnormal WHR and waist-to-height ratios with physical performance.

METHODS

Data from the Longevity Check-up 8+ project were analyzed. Anthropometric measurements were used to calculate WHR and WHtR. Physical performance was evaluated through the chair stand test. ANCOVA assessed the impact of WHR and WHtR on physical performance, while Cox proportional-hazards models were used to assess the relation between WHR, WHtR and physical performance. ROC curves analyzed their predictive capability.

RESULTS

Among 10690 participants (mean age 57.0 ± 14.8 y; 54% females), men exhibited higher WHR and WHtR and a higher prevalence of abnormal values (61% and 71%). Women took longer to complete the chair stand test (7.9 ± 2.7 vs. 7.6 ± 2.4 seconds, p < 0.01). Abnormal WHR and WHtR were associated with poorer physical performance after adjusting for confounders (HR: 1.28; 95% CI: 1.08-1.53; HR: 1.32; 95% CI: 1.04-1.66). ROC curve analysis showed that WHtR had superior predictive capability to identify lower physical performance across age and gender groups.

CONCLUSIONS

Individuals with higher WHR and WHtR values demonstrated poorer physical performance, underscoring the importance of monitoring abdominal fat distribution as a predictor of functional health and aging-related outcomes.

Using Blood Group Genotyping to Predict Hemolysis in Patients With β-Thalassemia Major With Frequent Transfusions: Protocol for a Cross-Sectional Study

BACKGROUND

Hemolytic transfusion reactions are a major complication in patients with β-thalassemia major receiving regular transfusions. These reactions can be influenced by blood group incompatibilities, particularly in settings with limited genotyping practices. In Indonesia, the role of blood group genotyping in predicting hemolysis has not been thoroughly studied.

OBJECTIVE

This study aims to analyze the association between blood group genotyping and the incidence of hemolysis in people with thalassemia undergoing repeated transfusions.

METHODS

This is a cross-sectional study involving people with β-thalassemia major younger than 18 years old who received regular transfusion with intervals of 2-4 weeks and have received more than 20 units of transfusion. Participants with leukemia, lymphoproliferative diseases, diabetes, solid tumors, and immunosuppression disorders were excluded from the study. Genotyping examination was conducted using Allele-Specific polymerase chain reaction (PCR ASP) while phenotyping was examined using immunoserology. Follow-up gene sequencing was conducted to observe the blood group variants. Hemolysis was assessed using several markers such as haptoglobin, free hemoglobin, lactate dehydrogenase, bilirubin, and hemoglobinuria, measured by Cobas C113, the enzyme-linked immunosorbent assay, and urinalysis.

RESULTS

Clinical and laboratory data collection is completed. A total of 90 samples were collected, data analyses were undertaken, and the initial results were reported in September 2024.

CONCLUSIONS

The results of this study will provide information on the blood groups' systems that can predict hemolysis occurrence in patients with β-thalassemia undergoing repeated transfusion. These data will contribute to the best possible patient care management and blood transfusion therapy, thereby reducing the risk of hemolysis and improving the quality of life for patients with thalassemia in Indonesia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/64379.

Increased prevalence and risk of atherosclerotic cardiovascular disease in individuals with Type 1 diabetes and metabolic dysfunction-associated steatotic liver disease

OBJECTIVE

This study aimed to investigate the correlation between metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerotic cardiovascular disease (ASCVD) in individuals with type 1 diabetes (T1D).

METHODS

Adults with T1D (n = 659) were consecutively screened for liver steatosis via abdominal ultrasound. The presence of macrovascular disease (including coronary artery disease [CAD], peripheral artery disease [PAD], or ischaemic stroke [CVA, cerebrovascular accident]) was identified via electronic medical records. The 5- and 10-year risks of fatal/nonfatal ASCVD were assessed via the Steno Type 1 Risk Engine. Insulin resistance was assessed via the estimated glucose disposal rate (eGDR).

RESULTS

The MASLD prevalence was 16.8%. The prevalence of composite ASCVD (18.9 vs. 6.8%, p < 0.001), CAD (9.9 vs. 4.7%, p = 0.031), PAD (9.0 vs. 2.2%, p < 0.001) and CVA (6.3 vs. 1.1%, p = 0.002) was greater in people with MASLD. The 5-year (7.8 [2.1-14.4] vs. 4.8 [1.6-12.0]%, p = 0.034) and 10-year (15.0 [4.1-26.8] vs. 9.4 [3.1-22.5]%, p = 0.035) risks of ASCVD were greater in those with MASLD. MASLD was associated with prevalent ASCVD (adjusted OR 4.26, 95% CI 1.79-10.11, p < 0.001), independent of age, sex, diabetes duration, smoking, statin use, LDL-cholesterol, the glomerular filtration rate, albuminuria, and metabolic syndrome.

CONCLUSION

MASLD is associated with both an increased prevalence of ASCVD and an increased calculated risk of fatal/nonfatal ASCVD in people with T1D.

Application of machine learning algorithms in osteoporosis analysis based on cardiovascular health assessed by life's essential 8: a cross-sectional study

BACKGROUND

Life's Essential 8 (LE8) for assessing cardiovascular health (CVH) has been demonstrated to be inversely associated with osteoporosis (OP). This study aims to create a machine learning (ML) model to assess the clinical association value of lifestyle and behavioral factors, assessed by LE8, on OP risk in the United States.

METHODS

This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES), encompassing participants aged ≧ 50 with comprehensive LE8 and OP information. Initially, the study compared the characteristics of participants with OP against those with normal bone health. Linear and nonlinear associations of LE8 and OP were analyzed by multifactor logistic regression and restricted cubic spline (RCS). Subsequently, LE8 features were integrated into six distinct ML models for OP analysis. Evaluate model performance using relevant metrics and curves. The best-performing model was further analyzed using SHapley Additive exPlanations (SHAP) to rank and clarify the positives and negatives of the contribution of individual LE8 components.

RESULTS

Among 3,902 participants, 364 (9.33%) were identified as having OP. Conventional regression showed that health behaviors (HB) and health factors (HF) in LE8 were negatively and positively correlated with OP, respectively, and that total LE8 was nonlinearly associated with OP. Through comparison of the Area Under the Curve (AUC), Accuracy, F1-Score, Precision, Recall, Specificity, Receiver Operating Characteristic (ROC), Decision Curve Analysis (DCA), and Calibration Curve Analysis (CCA), the optimal performance achieved by the Light Gradient Boosting Machine (LightGBM) model incorporating the 20 features. SHAP analysis revealed that the contributions of LE8 components were ranked as follows: Body Mass Index (BMI) > sleep health > blood glucose > nicotine exposure > blood lipids > blood pressure > Healthy Eating Index-2015 (HEI-2015) > physical activity. Where sleep health, blood lipids, and HEI-2015 were the main negative contributors to OP, BMI was the main positive contributor.

CONCLUSIONS

The integration of LE8 with a LightGBM model offers a promising strategy for analysing OP in the American population, underscoring the potential of ML approaches in enhancing clinical assessments.

A Real-world Evaluation of Longitudinal Healthcare Expenses in a Health System Registry of Type-2 Diabetes Mellitus and Cardiovascular Disease Enabled by the 21st Century Cures Act

Introduction

Type 2 diabetes (T2D) is associated with substantial healthcare spending, but quantifying these expenses has been limited to cohorts of self-selected patients or assessments of insurance claims for major healthcare events. Leveraging the 21 st Century Cures Act, which mandated reporting hospital-level service, we pursued a comprehensive evaluation of healthcare spending in a diverse cohort of individuals with T2D.

Methods

We designed a pragmatic, observational cohort study of patients with T2D seeking regular care (≥ 1 visit/2 years) across 5 hospitals and an outpatient network (2013-2023) in the Yale New Haven Health System. We used the chargemaster file to extract Medicare and insurance-negotiated cash prices for all healthcare events. We used residential zip codes to define median household income based on US Census data. We also examined the prevalence of financial hardship, defined by health expenses >20% of income, and identified its predictors using multivariable logistic regression. All values were assessed as 2023 US$. Key cohorts were defined across strata with and without atherosclerotic cardiovascular disease (ASCVD) and/or heart failure (HF) before or up to 1 year after the T2D diagnosis.

Results

Overall, 106,881 patients with T2D followed for a median of 5.4 years (IQR: 3.1-7.5) had 2,258,376 healthcare visits, representing $3.56 billion in expected healthcare expenses. Annualized expected expenses among those without ASCVD/HF were $444 (147-4,471), compared with $2,930 (209-13,240) among those with ASCVD/HF. Across cohorts, 9-29% of patients with T2D had healthcare expenses above the threshold for financial hardship. Compared with White patients, Black and Hispanic patients were more likely, and Asians were less likely to have financial hardship (aOR: Black, 1.81 [1.73-1.91]; Hispanic, 1.39 [1.31-1.48]; Asian, 0.46 [0.37-0.57]).

Conclusion

A digital, individualized, expense-linked T2D registry showed that patients with (vs without) cardiovascular comorbidities had substantially higher medical expenses, with 1 in 5 facing financial hardship.

GRAPHICAL ABSTRACT

Estimating the longitudinal causal effect of insufficient sleep on depressive symptoms: Evidence from the CHARLS study

BACKGROUND

The relationship between sleep and depression has been extensively explored; however, research on the long-term causal effects of chronic sleep insufficiency on depressive symptoms remains limited. This study employs advanced causal inference techniques to assess the longitudinal impact of sleep insufficiency on depressive symptoms, accounting for both time-invariant and time-varying confounders.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Sleep insufficiency was defined as <6 h of sleep per day. Longitudinal targeted maximum likelihood estimation (LTMLE) was used to examine the impact of persistent sleep insufficiency over 2 to 9 years on depressive symptoms, measured by the CESD-10 scale. Subgroup analyses by gender and age, as well as the effects of napping duration, were also conducted.

RESULTS

The study included 4362 participants, with a mean age of 55.90 years (SD = 7.71). At baseline, 924 participants reported insufficient sleep. The average treatment effect (ATE) for depressive symptoms increased initially, peaking at 3.75 points at 7 years, then slightly declining to 3.66 points at 9 years. The ATE was higher in females (4.57) than in males (2.80). Napping for over 30 min was associated with reduced depressive symptoms. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

This study provides evidence of the longitudinal causal effect of insufficient sleep on depressive symptoms. Over 9 years, ATE initially increased, plateauing after 7 years. Napping for over 30 min was linked to lower depressive symptoms, especially in those with insufficient nighttime sleep. Subgroup analyses showed stronger effects in females.

Impact of specialist palliative care on utilization of healthcare and social services at the end-of-life: a nationwide register-based cohort study

Non-malignant diseases cause 60% of non-communicable diseases requiring palliative care, yet specialist palliative care services primarily focus on cancer. We investigated end-of-life healthcare and social services utilization among cancer and non-malignant patients, and, secondarily, access to specialist palliative care and its effect on services utilization. This retrospective, nationwide register-based study included all adults (n = 38 540) who died from non-communicable life-limiting diseases in Finland in 2019, categorized into neurodegenerative (31%), other non-malignant (36%), and cancer (33%) groups. Hospital was the most common place of death (61%). Healthcare utilization substantially increased during the final weeks of life in all groups but remained highest in cancer patients. Social services utilization was highest in neurodegenerative diseases. Specialist palliative care contact was significantly (P < .001) higher in cancer (30.1%) compared to neurodegenerative (10.9%) and other non-malignant (7%) diseases. Early (>30 days before death) compared to late/no specialist palliative care contact significantly reduced emergency care contacts (47.8% vs. 52.2%) and hospitalizations in secondary hospitals (24.7% vs. 33.7%), and increased specialist palliative care ward (15.5% vs. 1.5%) and hospital-at-home (36.8% vs. 3.4%) utilization during the final month (P < .001). Healthcare utilization was high in all disease groups, highest among cancer patients. Hospital was the most common place of death. Specialist palliative care contact was rare in non-malignant diseases. Early contact with specialist palliative care associated with lower emergency care utilization and secondary hospital inpatient care during the last month of life. These results highlight the necessity for timely equitable specialist palliative care services for all.

Nonlinear association between estimated plasma volume status and acute kidney injury in acute pancreatitis patients

BACKGROUND

Acute pancreatitis (AP), a severe pancreatic inflammatory condition, with a mortality rate reaching up to 40%. Recently, AP shows a steadily elevating prevalence, which causes the greater number of hospital admissions, imposing the substantial economic burden. Acute kidney injury (AKI) complicates take up approximately 15% of AP cases, with an associated mortality rate of 74.7%-81%.

AIM

To evaluate the efficacy of estimated plasma volume status (ePVS) in forecasting AKI in patients with AP.

METHODS

In this retrospective cohort study, AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023. Electronic medical records were adopted for data extraction, including demographic data and clinical characteristics. The association between ePVS and AKI was analyzed using multivariate logistic regression models, with potential confounders being adjusted. Nonlinear relationship was examined with smooth curve fitting, and infection points were calculated. Further analyses were performed on stratified subgroups and interaction tests were conducted.

RESULTS

Among the 1508 AP patients, 251 (16.6%) developed AKI. ePVS was calculated using Duarte (D-ePVS) and Kaplan-Hakim (KH-ePVS) formulas. After adjusting for covariates, the AKI risk exhibited 46% [odds ratio (OR) = 1.46, 95% confidence interval (CI): 0.96-2.24] and 11% (OR = 1.11, 95%CI: 0.72-1.72) increases in the low tertile (T1) of D-ePVS and KH-ePVS, respectively, and 101% (OR = 2.01, 95%CI: 1.31-3.05) and 51% (OR = 1.51, 95%CI: 1.00-2.29) increases in the high tertile (T3) relative to the reference tertile (T2). Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS, with inflection points at 4.3 dL/g and -2.8%, respectively. Significant interactions were not observed in age, gender, hypertension, diabetes mellitus, sequential organ failure assessment score, or AP severity (all P for interaction > 0.05).

CONCLUSION

Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients. A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula, and a J-shaped curve at -2.8% for the Kaplan-Hakim formula.

Serum alpha-klotho levels associate with bone mineral density in chronic kidney disease patients from NHANES 2011 to 2016

This study investigated the relationship between serum Alpha-Klotho (α-Klotho) levels and bone mineral density (BMD) in patients with chronic kidney disease (CKD) using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. A population of 781 CKD patients aged ≥ 40 years was analyzed using multiple linear regression models to examine the association between serum α-Klotho levels and BMD at different skeletal sites, with adjustments for demographic, lifestyle, and clinical factors. Results showed that serum α-Klotho levels were significantly correlated with BMD at thoracic spine (β = 0.004 g/cm2, p = 0.00264), total BMD (β = 0.003 g/cm2, p = 0.02591), and trunk BMD (β = 0.002 g/cm2, p = 0.03708), while no significant associations were observed at the left leg, lumbar spine, or pelvis. Stratified analyses showed that the association was more pronounced in men, non-Hispanic whites, those with a body mass index greater than 29.9 kg/m2, and those without hypertension and diabetes. The inconsistent associations observed across different skeletal sites suggest that it remains unclear whether serum α-Klotho levels are consistently associated with BMD in CKD patients. Additionally, the cross-sectional design precludes any determination of causality in the observed site-specific associations.

Segmental Lordosis After Open Transforaminal Lumbar Interbody Fusion Using Expandable Oblique Versus Static Anterior Banana Cages

BACKGROUND AND OBJECTIVES

Expandable oblique interbody cages have gained popularity because of their suitability in minimally invasive surgical approaches and their ease of operative insertion. We aimed to determine whether static anteriorly placed banana cages or expandable obliquely placed cages provide greater lordosis when performing open transforaminal lumbar interbody fusion with concomitant posterior column osteotomy (PCO).

METHODS

We performed a single-surgeon retrospective consecutive cohort study which compared patients who underwent transforaminal lumbar interbody fusion using a static anteriorly placed banana cage vs an expandable obliquely placed cage. All TLIFs were performed open with PCO and included patients with focal degenerative pathology as well as global spinal deformity. Patient data were collected preoperatively, at 6-month follow-up, and at the last available follow-up. The primary outcome was defined as the change in segmental lordosis (ΔSL) measured using 6-month postoperative upright lumbar spine x-rays.

RESULTS

In total, 210 patients met inclusion criteria, including a total of 227 static cages and 100 expandable cages. The median ΔSL for the expandable cohort was significantly higher than the static cohort (6.1° [2.4, 8.4] vs 4.1° [1.3, 6.9], P = .016). This difference persisted after multivariate regression analyses and propensity score matching. Preoperative SL was found to have the greatest impact on ΔSL with a 3.23° increase for segments with preoperative SL < 15° compared with segments with preoperative SL ≥ 25° (P < .001). The overall median (T12-S1) delta lumbar lordosis (ΔLL) for all patients was 3.5° [-0.5, 10.2]. Although ΔLL was larger for static cages (median difference of 2.2°, P = .031), after propensity score matching, the expandable cage cohort experienced 3.24° greater ΔLL compared with the static cohort (P = .004).

CONCLUSION

Open TLIFs performed in conjunction with a PCO yielded 2.0° greater median ΔSL when using expandable obliquely placed cages compared with using static anteriorly placed banana cages. This represents a 50% increase between static and expandable cages. Cage type did not provide a clear advantage for overall ΔLL.

The Effect of Vasopressin on 90-Day Mortality in Patients With Cardiogenic Shock: A Retrospective Cohort Study Using Propensity Score-Weighted Analysis

Background: Cardiogenic shock (CS) may lead to a refractory vasoplegic state that requires vasopressin on top of norepinephrine. Vasopressin has been available in France since January 2022. However, data assessing the clinical impact of vasopressin in CS are very scarce. Objective: In this study, we aimed to assess the association between vasopressin and 90-day mortality in a cohort of CS. Method: We conducted a retrospective, single-center study at Amiens University Hospital comparing two cohorts of patients experiencing at least Stage C of CS: one historical cohort from 2018 to 2019 without vasopressin and a contemporary cohort from 2022 to 2023 treated with vasopressin. The primary outcome was 90-day mortality. The secondary outcome was the occurrence of serious adverse events (SAEs) during ICU stay. Inverse probability of treatment weighting (IPTW) derived from propensity score was used to reduce imbalances in baseline characteristics. Results: We included 201 patients in the study: 59 in the vasopressin group and 142 in the no vasopressin group. The SOFA score and norepinephrine equivalent were higher in the vasopressin group (13 [10-16] vs. 12 [9-15]; p = 0.02 and 0.72 [0.21-1.51] vs. 0.13 [0.07-0.34]; p < 0.001, respectively). There was no significant difference between the two groups for the 90-day mortality (n = 31/59 vs. 75/142; p = 0.97). Before adjustment, vasopressin was not associated with 90-day mortality (OR = 0.98 [95% CI 0.50-1.78]; p = 0.87). After weighting, vasopressin remained not associated with 90-day mortality (OR = 1.10 [95% CI 0.56-2.17]; p = 0.77). There was no significant difference for SAEs between the two groups (n = 57/142 [40%] vs. n = 23/59 [39%]; p = 0.88). Conclusion: Vasopressin was not associated with 30-day mortality and SAEs in patients with CS.

A pre - post quasi-experimental study of team-based learning effectiveness for Vietnamese nursing students

BACKGROUND

Team-Based Learning (TBL) is a student-centered teaching strategy designed to improve problem-solving skills, knowledge, and practical abilities. Despite its increasing use in nursing education globally, limited research has explored its effectiveness in Vietnam. This study evaluates the impact of TBL on learning outcomes, accountability, preferences, satisfaction, engagement, perceptions, and attitudes of Vietnamese nursing students during the Nursing Care for Adults with Internal Medicine course.

METHODS

A quasi-experimental pre-post study was conducted with 186 fourth-year nursing students at a nursing faculty in Vietnam during the 2023-2024 academic year. TBL was implemented in the course, and data were collected using validated instruments, including the Individual Readiness Assurance Test (i-RAT), Team Readiness Assurance Test (t-RAT), Classroom Engagement Survey (CES), and Perceived Collective Efficacy (PCE) scale. Data were collected from January to April 2024 and analyzed using SPSS version 20.0.

RESULTS

The mean t-RAT scores significantly exceeded i-RAT scores, increasing from 8.17 to 9.68 (t = -19.507, p < 0.001), indicating improved group performance. Students' attitudes toward teamwork showed significant improvements across all dimensions, with higher post-TBL mean scores. CES and PCE scores also increased significantly post-TBL (31.37 ± 2.002 vs. 29.54 ± 2.186; t = -8.981, p < 0.001; 4.03 ± 0.488 vs. 3.64 ± 0.461, t = -8.667, p < 0.001). Additionally, students reported positive experiences with TBL, with average scores for accountability, preference, and satisfaction at 31.19 ± 2.975, 57.10 ± 5.279, and 36.54 ± 3.815, respectively.

CONCLUSIONS

TBL effectively enhances academic performance, teamwork attitudes, and group responsibility awareness among Vietnamese nursing students. This approach holds promise for improving nursing education in Vietnam, and educators are encouraged to expand its application to other universities and disciplines.

Prevalence of insomnia, fatigue and symptoms of mental health problems among emergency medical service nurses: a cross-sectional study

BACKGROUND

Emergency medical service nurses worldwide face continuous high-stress situations caused by critical incidents that can overwhelm them emotionally and affect their daily functioning and sustainable employability. Repeated exposure to these incidents negatively impacts their mental health. The COVID-19 pandemic has further exacerbated these issues, with high prevalence rates of insomnia and fatigue among emergency medical service nurses serving as key predictors of mental health problems. Until now little is known about the mental consequences of the COVID-19 pandemic on EMS nurses. This study, the first of its kind in the Netherlands, aims to assess the prevalence of insomnia, fatigue, and symptoms of mental health problems and identify associated risk factors.

METHODS

A national cross-sectional study was conducted in the Netherlands in spring 2022. Data were collected through an online survey among emergency medical service nurses covering personal characteristics as well as validated scales on insomnia, fatigue, anxiety, depression, and Post Traumatic Stress Disorder.

RESULTS

Prevalence rates were 39.2% for insomnia, 32.5% for fatigue, 18.4% for anxiety, 16.2% for depression and 10% for Post Traumatic Stress Disorder. Not recovering from COVID-19 was linked to higher odds of fatigue, while living alone was associated with insomnia. Working as an emergency medical dispatcher and more work experience were linked to increased fatigue. Regional differences in emergency medical services organizations and full recovery of COVID-19 showed to result in lower odds of insomnia in ambulance professionals.

CONCLUSIONS

Insomnia and fatigue are prevalent among emergency medical service nurses. These conditions heighten the risk of severe mental health problems and potential sickness leave. Further research is needed to explore factors contributing to these issues and to develop targeted interventions supporting professionals sustainability.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of prognostic nutritional index on oncological outcomes and mortality among advanced gastric cancer patients: European GASTRODATA registry analysis

While Prognostic Nutritional Index (PNI) is an established predictor of outcomes in Asian gastric cancer (GC) patients, data among Western populations are limited. This study assessed the predictive value of PNI in European GC patients undergoing multimodal treatment. Data from GASTRODATA, the largest European repository of GC patients undergoing gastrectomy, were collected between 2017 and 2022. The primary outcome was textbook outcome (TO) achievement, and the secondary was 90-day mortality. PNI was calculated one day before surgery, with a cut-off of 45.5 based on ROC analysis. Among 721 patients included 60.7% were men. Most patients had advanced tumors (cT3-4 = 75.2%) and metastatic lymph nodes (57.7%). Neoadjuvant chemotherapy (NAC) was administered to 46.7% of patients, and 32.9% received adjuvant chemotherapy. Median PNI was 49.5 (IQR 45.0-56.4). Low PNI was present among 30% of patients and was associated with decreased odds of TO achievement (OR = 0.57, 95% CI 0.37-0.89), higher 90-day mortality (OR = 4.99, 95% CI 2.32-10.73). NAC administration was associated with lower morbidity risk (OR = 0.56, p = 0.0408), and low PNI was a predictor of receiving AC (p = 0.0005). PNI was a valuable predictor for oncological outcomes and morbidity among European GC patients undergoing multimodal. While low PNI was associated with decreased odds of TO achievement and increased risk of 90-day mortality, further prospective and nutritional intervention studies are warranted to standardize the PNI threshold and improve its clinical applicability.

Triathlon: Ergo Nutrition for Training, Competing, and Recovering

Triathlon is a multi-sport event that combines swimming, cycling and running. The distances vary and the physiological demands are high. Objectives: This review compiles information on nutritional strategies and ergogenic supplements for triathlon training, competition and recovery. It aims to provide an understanding of the specific challenges and needs of the sport to help triathletes and coaches optimise performance through effective training and nutrition plans. Methods: English-language publications were searched using the keywords triathlon, nutrition, recovery and ergogenic aids, alone or in combination, in databases. Results: Maintaining good glycogen levels, consuming enough carbohydrates and staying properly hydrated are key to athletic performance, especially for triathletes. Education regarding nutrition, the role of probiotics and supplements, and diet modification for the enhancement of performance and recovery are pivotal considerations. Conclusions: Triathletes are at risk of RED-S due to negative energy balance and high fibre/plant protein diets, especially women. Optimising muscle glycogen through tailored diet and training, especially pre- and in-race nutrition, including carbohydrate loading and hydration strategies, is critical. Education is needed to improve post-exercise nutrition, while probiotics and certain supplements may aid performance and recovery. Dietary support is important for resistance training to optimise performance and recovery.

Heat Loss During Procedural Sedation for Endoscopy: A Descriptive Study

PURPOSE

Little is known about heat loss during procedural sedation. Our descriptive study aimed to examine the pattern and characteristics of heat loss in this population.

DESIGN

Continuous temperature monitoring via a zero-heat-flux device examined heat loss among patients receiving procedural sedation for upper and lower endoscopy procedures.

METHODS

Adults receiving procedural sedation for lower and complex upper endoscopic procedures at the study hospital on an outpatient basis were included. Temperature was collected prospectively from the zero-heat-flux device. Demographic and clinical data including shivering and thermal comfort were collected from health records or directly from patients. The Gastrointestinal Endoscopy Satisfaction Questionnaire was completed the next day. Change in body temperature was analyzed using linear mixed-model analysis from induction to the end of procedure.

FINDINGS

Among the 165 participants, mean body temperature declined to below 36 °C at 45 minutes from induction. A linear trend model from induction estimated that for every 15 minutes of procedural sedation, body temperature decreased on average by 0.19 °C [95% confidence interval -0.18, -0.21]. Almost one-third (30%, 45/164) were hypothermic on arrival to first-stage recovery, increasing to 42% (68/163) on arrival to second-stage recovery.

CONCLUSIONS

Patients receiving procedural sedation for endoscopic procedures may experience heat loss comparable to the initial phase of general or neuraxial anesthesia. Active warming and continuous temperature monitoring are yet to be implemented in this population.

Development and preliminary validation of the GebStart-tool for advising nulliparous women in early labour

OBJECTIVES

Nulliparous women in early labour are unsure when to go to hospital. The aim of this study was to develop and preliminary validate a tool for advising for or against hospital admission.

METHODS

We developed the preliminary long version of the GebStart-tool with 32 items based on focus group discussions and a scoping review. It was applied in a multicentre study with n = 394 women during their contact with the hospital. Because of the formative and complex character of the GebStart-tool, factor analysis was not appropriate. Instead, items were subdivided deductively into the domains 'Physical symptoms', 'Emotional state', Self-management' and 'Resources'. Distribution of response options, adjusted Cox regressions with time intervals describing care needs as outcomes and adjusted multinomial regression with the outcome 'Care decision' were used to reduce items and for preliminary validation.

RESULTS

The reduced GebStart-tool contained 15 items and cutoff points at 22 and 33 points. The total score of the instrument was significantly associated with all time intervals describing care needs (duration between completion of the tool and hospital admission (HR = 1.08, 95% CI [1.05-1.10], p < 0.001), onset of active labour (HR = 1.06, 95% CI [1.04-1.08], p < 0.001), first use of medical pain management (HR = 1.08, 95% CI [1.06-1.11], p < 0.001), first use of alternative pain management (HR = 1.08, 95% CI [1.05-1.10], p < 0.001)). However, a higher total score of the reduced GebStart-tool was not significantly associated with a reduced risk for the decision 'Stay at home' (RR = 0.98, 95% CI [0.94-1.02], p = 0.421), but with a significantly higher risk for the decision 'Hospital admission' (RR = 1.13, 95% CI [1.05-1.22], p = 0.001) compared to 'Keep in contact'.

CONCLUSION

We developed a practical instrument with 15 items based on scientific evidence. Further research of the GebStart-tool in larger samples is necessary. Moreover, the use in clinical practice accompanied by implementation research and translation into other languages should be envisaged.

Exploring online learning: Virtual teaching quality, student satisfaction, and academic performance among nursing students in Peru - a cross-sectional study

Background

Virtual teaching has become an essential component of nursing education today, but its impact on practical courses remains unexplored. There is a need to understand how the quality of virtual teaching influences both academic performance and student satisfaction.

Objective

This study aims to explore how nursing students' satisfaction and academic performance in practical courses relate to the quality of virtual teaching in a Peruvian university in 2023.

Methods

A descriptive cross-sectional correlational study was conducted by surveying 125 nursing students in northern Peru from March to May 2023. The data were collected using the Online Education Scale and Academic Satisfaction Scale. Academic performance was assessed through documentary analysis of the students' general averages, and Kendall's tau-b test was used to assess the relationship. Additionally, Pearson's Chi-square test and both bivariate and multivariate logistic regression analyses were conducted to obtain more precise relationships.

Results

The study found that 54.4% of nursing students rated virtual teaching quality as low, with the same percentage reporting low satisfaction and 59.2% having low academic performance. Virtual teaching quality was positively correlated with satisfaction (τb = 0.415, p <0.01) and negatively with academic performance (τb = -0.176, p = 0.043). Pearson's Chi-square and logistic regression showed significant relationships in several virtual teaching dimensions. Virtual collaborative teaching and development of virtual capabilities were rated low by 72.8% and 60.8% of students, respectively. Both had significant odds ratios (COR: 4.1, AOR: 3.8, p = 0.012 and COR: 3.8, AOR: 3.5, p = 0.010). Virtual resources and accompaniment showed moderate ratings, with significant results for virtual resources (COR: 1.5, AOR: 1.3, p <0.001) and virtual accompaniment (COR: 1.2, AOR: 1.0, p = 0.040).

Conclusion

This study revealed that poor-quality virtual teaching negatively impacted nursing students in Peru, leading to reduced satisfaction and academic performance. The positive correlation between teaching quality and satisfaction suggests that improving virtual teaching could enhance student satisfaction. However, the negative correlation with academic performance highlights challenges in adapting practical nursing education to virtual formats. Improving virtual methodologies and exploring innovative strategies, such as hybrid learning models, are essential for improving outcomes in nursing education.

Intravaginal prasterone for urinary urgency in postmenopausal women without urodynamic detrusor overactivity

OBJECTIVES

Symptoms of an overactive bladder are frequently reported in women with genitourinary syndrome of menopause. Despite a frequent association with detrusor overactivity, urodynamic assessment does not always reveal this condition, which suggests a leading role for increased bladder mucosal sensitivity due to hormone deprivation in producing urinary symptoms. The present study assessed the effects of intravaginal prasterone on urgency symptoms in those patients receiving treatment for concurrent vulvovaginal atrophy.

STUDY DESIGN

This was an observational cohort study on 21 women with genitourinary syndrome of menopause, including urgency symptoms, without detrusor overactivity on urodynamic assessment. Patients received intravaginal prasterone 6.5 mg daily and were reassessed at 12 weeks.

MAIN OUTCOME MEASURES

Urinary symptoms and their impact on the quality of life were evaluated through the Urogenital Distress Inventory (UDI-6) and Overactive Bladder short-form (OAB-Q SF) questionnaires; secondary outcomes included urinary frequency and prevalence of urgency or incontinence as recorded in a voiding diary, and scores on a visual analogue scale (VAS) for vaginal discomfort.

RESULTS

A significant improvement in urinary symptoms was observed in the scores on both the UDI-6 (57.1 +/- 20.7 vs 30.2 +/- 22.7, p < 0.001) and the OAB-Q SF (61.3 +/- 19.7 vs 35.7 +/- 22, p < 0.001); a significant improvement was also reported in terms of better quality of life, diminished VAS scores, and a reduction in incontinence and daily and nocturnal frequency.

CONCLUSIONS

Women complaining of urgency related to genitourinary syndrome of menopause with no urodynamic evidence of detrusor overactivity may benefit from treatment with intravaginal prasterone.

Enhancing patient rehabilitation outcomes: artificial intelligence-driven predictive modeling for home discharge in neurological and orthopedic conditions

In recent years, the fusion of the medical and computer science domains has gained significant traction in the scientific research landscape. Progress in both fields has enabled the generation of a vast amount of data used for making predictions and identifying interesting clusters and pathways. The Machine Learning (ML) model's application in the medical domain is one of the most compelling and challenging topics to explore, bridging the gap between Artificial Intelligence (AI) and healthcare. The combination of AI and medical information offers the possibility to create tools that can benefit both healthcare providers and physicians. This enables the enhancement of rehabilitation therapy and patient care. In the rehabilitation context, this work provides an alternative perspective: prediction of patients' home discharge upon completing the rehabilitation protocol. Demographic and clinical data were collected on 7282 inpatients from electronic Medical Record, each record was categorized into Neurological Patients (NP, N = 3222) or Orthopedic Patients (OP, N = 4060). To identify the most suitable machine learning model, an extensive data preprocessing phase was conducted. This process involved variables recoding, scaling, and the evaluation of different dataset balancing methods to optimize model performance. Following a thorough review and comparison of algorithms commonly employed in the clinical-rehabilitative field, the Random Over Sampling (ROS) technique, in combination with the Random Forest (RF) machine learning model, was selected. Subsequently, a comprehensive hyperparameter tuning phase was performed using a grid search approach. The optimized model achieved an average accuracy of 98% for OP and 96% for NP, based on 10-fold cross-validation applied to the balanced training set (unrealistic scenario). When tested on the unbalanced dataset (real-world condition), the RF model maintained strong generalization performance, achieving 90% accuracy for OP and 83% for NP. This work points out the increasing importance of AI in medicine, especially in the realm of personalized rehabilitation. The use of such approaches could signify a transformative shift in healthcare. The integration of machine learning not only enhances the precision of treatment but also opens new possibilities for patient-centered care, improving outcomes and quality of care for individuals undergoing rehabilitation.

Practice of ventilation in critically ill pediatric patients: protocol for an international, long-term, observational study, and results of the pilot feasibility study

OBJECTIVE

This manuscript describes the protocol of an investigator-initiated, international, multicenter, long-term, prospective observational study named PRactice of VENTilation in PEDiatric Patients (PRoVENT-PED), designed to investigate the epidemiology, respiratory support practices and outcomes of critically ill pediatric patients.

DESIGN

Data will be collected biannually over 10 years during predefined 4-week intervals, with an additional optional period to accommodate data collection during an epidemic or pandemic. The specific focus of PRoVENT-PED will evolve as the study progresses, initially emphasizing collecting detailed ventilator data from invasively ventilated patients. In later phases, the focus will shift to noninvasive respiratory support and typical aspects of respiratory support, like patient-ventilator asynchronies, weaning practices, and rescue therapies, as extracorporeal support. PRoVENT-PED includes patients under 18 years of age, admitted to a participating intensive care unit, and receiving respiratory support. The endpoints vary with the focus in each phase but will always include a set of key settings and ventilation parameters and related outcomes. If applicable, potentially modifiable factors and associations with outcomes will be studied. The pilot feasibility study demonstrated that the electronic capturing system effectively collects all necessary data within a reasonable time limit, with little missing data.

CONCLUSION

PRoVENT-PED is a 10-year, international, multicenter study focused on collecting data on respiratory support practices in critically ill pediatric patients. Its scope evolves from invasive to noninvasive ventilatory support, ultimately encompassing patient-ventilator asynchronies, weaning practices, and rescue therapies.

Metformin administration improves adverse outcomes in older adult burn patients: a single-centre cohort study

This study assesses the safety and efficacy of metformin administration in older adult burn patients, a rapidly growing demographic with substantially poorer outcomes. This is a single-centre cohort study of older adults (≥60 years) admitted to a provincial burn center over 15 years. Clinical outcomes, laboratory measures, inflammatory markers, and adipose tissue single-nuclei RNA sequencing (SnRNA-seq) were compared among metformin-treated and non-treated controls. A total of 50 metformin-treated and 262 control older burn patients met the eligibility criteria. Despite pre-admission comorbidities, metformin-treated patients showed improved survival, no significant differences in the number of hypoglycemic episodes, a lower incidence of lactic acidosis, and reduced circulating levels of organ damage markers. SnRNA-Seq further revealed that metformin may exert its beneficial effects by local restoration of immune and inflammatory responses. In older burn patients, metformin was linked with improved outcomes and no adverse effects, underscoring its safety and efficacy in this population.

The relationship between suicidal ideation and eating disorders in the context of violence experiences

BACKGROUND

Suicidal ideation and eating disorders (EDs) are significant mental health concerns that can have devastating consequences and both cases were independently associated with violence experiences. The purpose was to investigate the relationship between suicidal ideation and eating disorders within the context of violence experiences.

METHODS

This cross-sectional study was conducted with 935 participants aged 18-40. Sociodemographic questionnaire, the Suicide Probability Scale (SPS), the Eating Disorder Evaluation Scale short form (EDE-Q-13) and the Violence Experiences Questionnaire-Revised (VEQ-R) were the data collection instruments.

RESULTS

50.6% of the participants were male, 56.5% were single and the mean age was 29.46 ± 5.96 years. As the educational and economic status of the participants increased, SPS median scores also increased significantly. Higher SPS median scores were found in single, smoking, and substance-using participants. Females, overweight, and obese participants scored significantly higher on the EDE-Q-13. Lower economic status, smoking, and substance use were associated with higher VEQ-R median scores. EDs, suicidal ideation, and experiences of violence showed a significant, albeit weak, positive relationship. In multiple regression analysis, both violence experiences and EDs influenced suicide probability. The median EDE-Q-13 score was higher in participants with divorced parents or a family history of chronic disease. The median VEQ-R score was higher in individuals with divorced parents, a family history of chronic disease, or deceased parents or fathers.

CONCLUSIONS

Our results suggest that various forms of childhood violence are linked to both EDs and suicidal thoughts. Furthermore, the correlation between EDs and suicidal ideation may exist independently of childhood violence.

Association between occupational and environmental dust exposure and autoimmune diseases: A systematic review and meta-analysis

BACKGROUND

Occupational and environmental dust exposure is often overlooked, presenting significant public health concerns. Recent studies suggest it may increase the risk of autoimmune diseases. However, previous research has primarily focused on specific diseases or dust types, leaving the broader relationship unclear. A comprehensive meta-analysis are needed to clarify this connection.

METHODS

We systematically searched PubMed and Google Scholar up to October 2023, following PRISMA guidelines. Study quality was assessed using standard tools, and a random-effects model was used to estimate pooled odds ratio (OR) and 95 % confidence interval (CI), with subgroup analyses by dust type and disease category.

RESULTS

From 90 initial records, 19 studies were included. Dust exposure was significantly associated with increased autoimmune disease risk (OR 1.36, 95 % CI 1.13-1.59). Both occupational (OR 1.18, 95 % CI 1.11-1.26) and environmental dust exposure (OR 1.12, 95 % CI 1.04-1.20) were linked to higher risk. Subgroup analysis showed a strong association between silica exposure and connective tissue diseases, particularly granulomatosis with polyangiitis (OR 5.75, 95 % CI 2.79-8.71). Sensitivity analysis confirmed the findings, though publication bias was noted.

CONCLUSION

Our findings highlight a significant association between dust exposure and autoimmune disease risk, underscoring the need for stricter occupational safety measures and environmental regulations. Targeted interventions, such as improved ventilation systems and personal protective equipment (PPE), should be prioritized. Future research should focus on elucidating underlying mechanisms to inform prevention and treatment strategies.

Pharmacist support in the entry of blood drug concentration test order avoids vancomycin-induced kidney injury

Background

Task shifting and sharing have been proposed as strategies to address healthcare staffing shortages and improve patient outcomes. In emergency and intensive care medicine, pharmacist interventions have shown potential to reduce medication errors and improve care quality. However, the precise benefits of pharmacist support in therapeutic drug monitoring (TDM) for emergency center inpatients require further verification.

Objective

To determine the contribution of pharmacist support in entering blood drug concentration test orders to patient safety during anti-methicillin-resistant Staphylococcus aureus (MRSA) drug administration in the emergency and critical care center, and investigate the association between this support and the frequency of vancomycin-induced kidney injury.

Design

Single-center retrospective cohort study comparing outcomes 2 years before and 2 years after implementing pharmacist support for blood concentration test order entry.

Methods

Patients receiving intravenous vancomycin with blood concentrations measured at the emergency center were included. Propensity score matching was used to minimize confounding. The primary outcome was the change in frequency of vancomycin-induced kidney injury before and after pharmacist support implementation.

Results

Pharmacist support significantly reduced the frequency of vancomycin-induced kidney injury (from 6.5% to 0.0%, p = 0.043) and shortened time to first TDM implementation (p = 0.019) in the overall cohort. Similar significant reductions were observed in the propensity score matched cohort (from 11.9% to 0.0%, p = 0.013).

Conclusion

Pharmacist support in entering blood drug concentration test orders significantly reduced vancomycin-induced kidney injury frequency and shortened time to first TDM, enhancing patient safety during anti-MRSA medication administration in the emergency and critical care center. This task-shifting approach demonstrates clear benefits for patient care and physician workload.

Assessing the magnitude and lifestyle determinants of food addiction in young adults

PURPOSE

Food addiction involves excessive consumption of highly processed foods rich in salt, sugar, and fats driven by hedonic eating behaviors. Increased food addiction, especially among young adults, could potentially lead to eating disorders. Hence, the current study aimed to assess the magnitude and lifestyle determinants of food addiction in young adults from Mumbai, India METHODS: Healthy young adults (n = 354) aged 18-25 years were recruited using convenience sampling. Utilizing web-based platforms, the Yale Food Addiction Scale 2.0 was administered. Statistical analysis was performed with significance at a p value of ≤ 0.05.

RESULTS

The mean age of participants was (20.99 ± 1.94) years, and the magnitude of food addiction was 11.3%. Sociodemographic determinants such as age (p = 0.000), socio-economic status (p = 0.000), and education (p = 0.000), and lifestyle determinants such as BMI (p = 0.012), dietary habits (p = 0.000), sleep (p = 0.001), physical activity (p = 0.001), anxiety (p = 0.001), and depression (p = 0.000) were significantly associated with food addiction. However, after adjusting for sociodemographic factors, the relationship between lifestyle factors and food addiction became evident. The frequent consumption of specific unhealthy foods increased the risk (OR ≥ 1.0, p value ≤ 0.05), while the consumption of healthy foods reduced the risk (OR<1.0, p value ≤ 0.05) of food addiction.

CONCLUSION

The present study revealed a rising magnitude of food addiction and its determinants among Indian youth, highlighting the urgency of sensitization and designing targeted nutrition interventions to combat food-related addiction and hence reducing the risk of eating disorders.

LEVEL OF EVIDENCE

Level V, Descriptive Study.